Nutrition with Crohn's and Colitis: Frequently Asked Questions

On the Crohn's and colitis forum on YNET.

During my guest appearance, I am asked many questions and try to answer all of them in real time. Here is a summary of our conversation.

You are welcome to ask any additional question below, and I will answer to the best of my knowledge and experience.

P.S. Nobody knows everything. If you ask a question and I am unsure of the answer, I will say so, research the subject, and return with the most authoritative answer I can find! Also, nothing here replaces individual consultation, personal tailoring, or your own experience. Advice that suits one person may not suit another. It is all individual.

Nutrition and Crohn's: frequently asked questions (FAQ)

Q: Dietary fiber is good for healthy people and bad for people with Crohn's. True or false?

A: It depends on the fiber and the stage of the disease (with or without diarrhea).

Q: The reason foods such as brown rice or whole-wheat pasta are not good for people with Crohn's is that they contain dietary fiber. True or false? Is there another reason they are not good?

A: White rice is excellent during diarrhea. Brown rice contains insoluble dietary fiber and is not good during diarrhea, but is good when bowel movements are normal. Pasta is made from wheat. Check wheat's effect on your digestive system individually. Regular pasta may be tolerated with a sensitive gut; whole-wheat pasta only when bowel movements are normal.

Q: People tend to think of white flour as something "bad." Why?

A: White wheat flour contains nothing but starch and a little protein, mainly gluten. It is almost devoid of the vitamins and minerals found in whole-wheat flour, and the same applies to dietary fiber. Whole wheat also contains the germ, which is very rich in wheat germ oil and many vitamins and minerals, such as vitamin E and B vitamins. During remission, I would recommend whole-wheat flour (at least 70%, which is more suitable for baking than 100% whole-wheat), or spelt flour. Again, though, take individual sensitivity into account.

Q: What is the problem with fried food? Why is it hard to digest? What disadvantages are there beyond difficult digestion? During good periods without digestive problems, is there a reason to avoid it?

A: Fried food is a whole chapter in nutritional science. Let us distinguish: Light frying at home, in fresh oil (canola or other cold-pressed oils are recommended), for a short time, may be tolerated by the bowel and also in terms of heart disease, vascular disease, cancer, and so on. Deep-frying, especially industrial frying (such as falafel or shawarma kept hot all day), is serious trouble. Here is why: heating oil creates substances that promote inflammation and increase the risk of clogged arteries and cancerous processes. These are free radicals (not politicians). The longer oil is heated and the higher the temperature, the more free radicals it contains. People who feel unwell after fried food (heartburn, abdominal pain, and so on) are blessed with a mechanism signaling that this food is not good for them. Others do not feel it until much more significant illnesses develop. This also applies to nuts and seeds: fresh ones are healthy, roasted ones harmful.

Q: The same question about different fruit and vegetables?

A: Fruit and vegetables generally contain plenty of soluble and insoluble fiber; it depends on the state of the digestive system. As a rule, cooked ones are always easier to digest during diarrhea. Fresh ones should each be tested individually in different digestive states. In principle, fruit and vegetables are very healthy, again subject to tolerance. They are known for anticancer and immune-strengthening effects.

Q: Often the same dishes in different restaurants affect me differently: one is tolerated, while another comes out after half an hour. Seasoning is usually the reason. True or false?

A: In my opinion, it depends more on the cooking method, then on seasoning. Seasoning includes soup powders, which are generally not healthy because of their salt, saturated fats, and so on. In general, be careful with restaurant food. Read the articles I wrote about this on ONLIFE.

Q: Do spices offer anything beyond flavor? (Over the years, I have found that unseasoned food is easier to digest.)

A: Some fresh spices contribute minerals, while others have a mild medicinal-herb effect. Cumin, for example, reduces gas after legumes; cinnamon "warms the center" according to Chinese medicine and is therefore good for colds or infectious diarrhea. But if you feel better without them, that is what suits you!

Q: I suffer from nausea. What would you suggest?

A: First, make sure this is not an acute condition indicating a bowel obstruction. If not, and it is a chronic problem, several measures can be tried, all through trial and error: fresh or dried ginger, sucked or steeped in hot water and drunk after cooling. A lemon wedge, orange wedge, or another citrus fruit can be sucked or added to tea. Eat dry foods such as toast or crackers, with or without low-fat cheese. Avoid fried and fatty foods. Eat small, frequent meals, and try not to eat late at night. Quite a few medications are available today, of course in consultation with your doctor.

Q: Tivall: good or bad?

A: All industrially produced food is very problematic. Occasionally, on the go, it is not an issue; regular consumption is best avoided.

Q: Dairy products are problematic for people with Crohn's but important generally. I largely avoid them and consume very little. What are the consequences (apart from calcium deficiency, which I know about), and what are the alternatives? How can I get what dairy provides?

A: First, relax. The entire Far East lives without dairy, and everything is fine. The main issue is a lack of calcium and protein. It is therefore important to replace them with soy products (tofu, soy milk, and so on), vegetables where possible, small legumes (lentils, peas, red lentils), sardines with their bones, peeled raw almonds and nuts, raisins, and similar foods. A calcium supplement with vitamin D is essential, one that is absorbed!

Trans fat, saturated fat, and unsaturated fat

Q: Trans fat is bad for everyone, both healthy people and people with Crohn's. The main reason is clogged arteries. True or false? What other disadvantages are there?

A: Very true. It is also carcinogenic and increases inflammation risk; see the section on frying. Other sources include margarines, snacks, "hydrogenated fat," and store-bought cakes and cookies: read the labels. The same usually applies to bourekas and frozen pizzas.

Q: What is the difference between saturated and unsaturated fat, apart from one being animal-based and the other plant-based, in their effects on the body? Healthy people usually avoid excess fat to prevent weight gain and higher cholesterol. For people with Crohn's, who usually do not need to worry about obesity or cholesterol, is there a reason to avoid increased fat consumption?

A: It depends on the fat. Recommended fats are plant-based and cold-pressed: tahini, avocado, olive oil, raw almonds and nuts, for example. Butter is also possible if dairy is not a problem. Read more here about better and less suitable oils.

This is general news information and is not a substitute for personal advice from a doctor or dietitian.