What are the best foods to avoid during a Crohn's disease flare-up?
People with Crohn's are subject to "flare-ups," which are periods of inflammation where a person has diarrhea, nausea, and stomach cramping when they eat. As a result, doctors may often recommend a person take different dietary approaches when they have a flare-up and when they do not.
The following article describes some dietary approaches for those with Crohn's when they are going through a flare-up and for their typical daily diet.
Foods to avoid
People should avoid wild rice during a Crohn's disease flare-up.
During a flare-up, most doctors and dietitians will recommend avoiding high-fiber foods and foods that are known to stimulate the gut, such as spicy foods.
Beverages to avoid during a Crohn's flare-up include:
- alcoholic drinks
- caffeinated drinks
- highly sweetened drinks, such as with sugar or corn syrup
Very sugary drinks can worsen diarrhea that a person commonly experiences during a flare-up.
Breads and starches
While many diet plans recommend whole grains, a flare-up diet usually involves a low-fiber approach. This means a person should avoid the following foods:
- brown rice
- cereals containing nuts, dried fruit, or seeds
- whole-grain breads, crackers, or pastas
- whole-wheat breads, crackers, or pastas
- wild rice
A person should avoid dairy products that may contain added sources of fiber. Examples can include:
- cheeses that contain nuts or seeds
- yogurts that contain fruit skins, such as whole blueberries, cherries, or strawberries
Eating other dairy foods in moderation can be helpful during a flare-up, by providing calcium and live active cultures.
Some fat sources may contain fiber or are naturally high in fiber. Examples of fats to avoid include:
- salad dressings with poppy seeds
Raw fruits and fruit juices with pulp are foods to avoid during a Crohn's flare-up. Other examples include:
- dried fruits, such as raisins
- prune juice
While people should avoid raw fruits when they have a flare-up, they can eat bananas, melon, and apples with the skins removed.
It is best to avoid fried eggs when having a Crohn's flare-up.
High-fat protein sources can cause gas and irritate the intestinal lining. As a result, some of the foods to avoid on a flare-up include:
- fried eggs
- fried meat
- high-fat lunch meats, such as salami
- nut butters with seeds
- tough or chewy cuts of meat
Sweets and desserts
Examples of sweets to avoid while on a flare-up diet include:
- foods containing bran, such as muffins
- cookies or other sweets made with whole-grain flour
- dried fruit
A person should also avoid foods that are made with sugar alcohols, as these can cause gas in some people. Examples include mannitol, sorbitol, and xylitol.
Vegetables that a person should avoid on a flare-up diet include:
- Brussel sprouts
- lima beans
- potato skins
- winter squash
Some of these foods are not necessarily high in fiber, such as onions, but are known to irritate the stomach of a person with Crohn's disease.
Foods to eat during a flare-up
Excess inflammation in the gut leads to symptoms of a Crohn's flare-up. Most doctors will recommend eating a diet called a low-residue diet, which focuses on foods that limit the amount of solid waste in a person's stool.
Following a low-residue diet is the equivalent of helping the bowel to rest and recover because the intestinal tract does not have to work as hard to digest foods.
This diet is recommended only during periods of inflammation. It is a low-fiber approach that does not usually benefit a person with Crohn's when they are not experiencing a flare-up.
Beverages that a person can enjoy when experiencing a Crohn's flare-up include:
- decaffeinated drinks, such as decaffeinated tea or coffee
- low-sugar rehydration drinks
Caffeine can be stimulating to the bowels and worsen diarrhea. If a person typically consumes caffeine in a day, they may wish to try switching some of their usual caffeinated products to decaffeinated ones. This may help them to reduce their caffeine consumption with a lower risk of experiencing withdrawal symptoms.
Breads and starches
Low-fiber bread and cereal options will stimulate the bowels the least. Examples of these foods include:
- breads made with white, refined, or all-purpose flour
- refined cereals (cooked or dry), such as grits or puffed rice
- white rice
As a general rule, if a food has more than 2 grams of fiber per serving, it is not a good option on a flare-up diet.
If dairy products do not make symptoms worse, people can have up to 2 servings a day during a flare-up.
The number of dairy servings per day may depend upon the individual dietary needs of a person with Crohn's.
Some people with the condition find dairy products worsen their symptoms. If this is not the case, a person can eat 2 servings or less of the following options:
- cottage cheese
- yogurt with live active cultures
Fats that are okay to include in a flare-up diet, within moderation, include:
- salad dressing
Peeling fruits can help to remove some of the added fiber that stimulates the bowels during a Crohn's flare-up.
Other fruits that people can eat during a flare-up include:
- canned fruits, except for cherries or berries
- peeled apples or applesauce
- pulp-free fruit juices
- ripe bananas
- ripe melons
Many protein sources are okay to eat during a flare-up, as long as a person cooks them so that they are tender and easy to cut with a fork.
Examples of these foods include:
- eggs, cooked where the yolk is solid
- nut butters that do not contain seeds
- soy products
Sweets and desserts
People should enjoy sweets and desserts in moderation, although sugary foods can trigger an upset stomach for some people with Crohn's.
Examples of sweets to enjoy include:
- fruit-flavored popsicles without fruit pieces in them
- hard candies
- ice creams that do not contain nuts
Examples of vegetables to eat on a low-residue diet include:
- canned vegetables that do not have seeds
- cooked vegetables, such as seed-free squash and green beans
- potatoes without the skin
- pulp-free vegetable juice
A person can also remove skins from vegetables to cut down their fiber content.
Some of the foods a person eats on a flare-up diet may not have the same nutrition profile as their typical diet does. As a result, a doctor may recommend taking vitamins, such as folate, vitamin B-6, and vitamin B-12.
Some people with Crohn's may also take the medication methotrexate, which can result in folic acid deficiencies. So, a person should take a folic acid supplement on a day they are not taking their methotrexate.
Diet tips and preventing flare-ups
When a person is not going through a flare-up, switching to a high-fiber diet can help with their Crohn's disease. This diet promotes digestive regularity and good health.
There is no single food or food group that doctors link with every instance of Crohn's disease. Different people may have different foods that might irritate the gut and contribute to inflammation.
Doctors will often recommend that people with Crohn's disease keep a food journal of everything they eat and in what amounts. A person will be encouraged to list the symptoms — if any — they experience after eating certain foods.
Common foods that may worsen symptoms include spicy foods, dairy products, alcohol, and high-fiber grains. However, these are not triggers for all people with Crohn's disease.
Additional considerations and diet tips for a person with Crohn's include:
- Eating several small meals each day instead of large ones to reduce reflux and gas.
- Drinking plenty of water throughout the day to help digestion.
- Adding fiber sources slowly and drinking plenty of water to help the body adjust.
A person should also ask their doctor if there are any specific recommendations they should follow, regarding their diet.
Crohn's flare-ups can make a person need to change their diet to include low-fiber options. But this is only a temporary approach to take until the flare-up has passed.
A person can identify individual dietary triggers that may worsen Crohn's symptoms and work with their doctor or nutritionist to develop a healthful eating plan.