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Those with Crohn’s disease know just how much of a pain it can be. From abdominal pain to rectal bleeding, and other symptoms Crohn’s can be really painful and frustrating. The good news is traditional, nourishing diets, like paleo, can offer sweet relief from annoying (and sometimes outright discouraging) symptoms.
What Is Crohn’s Disease?
Crohn’s disease (along with ulcerative colitis) is an Inflammatory Bowel Disease (IBD). It’s different from irritable bowel syndrome (IBS), which is a set of digestive symptoms and not a disease process. Both Crohn’s and colitis are autoimmune conditions. Aka the immune system attacks the body’s tissues.
All autoimmune diseases are characterized by chronic inflammation. That’s because the immune system is overactive and triggers inflammation to promote healing. The challenge of any autoimmune disease, including Crohn’s disease, is finding what’s causing the immune system to over-respond.
In Crohn’s disease, the immune system attacks the gastrointestinal tract. While ulcerative colitis affects the mucosa lining the gut, Crohn’s disease extends through the gut wall into the serosa lining. About a third of Crohn’s sufferers only have disease in the small intestine. Half have both the large and small intestines affected, and about 20% have disease in the large intestine alone.
Those with Crohn’s disease can have long periods of remission and then have a flare when symptoms return or get much worse.
Symptoms of Crohn’s Disease
Here are some common symptoms of Crohn’s disease. Those with several of these symptoms may need to see a health practitioner, naturopath, functional medicine dietitian, or holistic doctor:
- Chronic diarrhea (sometimes alternating with constipation)
- Abdominal pain and cramping
- Fever due to infection
- Rectal bleeding from ulcers
- Weight loss or weight gain
- Abscesses (a localized infection)
- Fistulas (abnormal tubes connecting 2 hollow organs, for instance, the vagina and colon)
- Intestinal obstructions (strictures)
- Nutrient deficiencies due to malnutrition
These are IBD symptoms in general, so may also be due to ulcerative colitis or infectious colitis. If someone suspects Crohn’s, a medical doctor will likely have them take a blood test to confirm this disease. They may also refer the patient to a gastroenterologist, who may order further testing, like a colonoscopy.
The symptoms above may come and go with flares and periods of remission.
Why Is Food So Important?
Since Crohn’s is a disease of the digestive tract, it makes sense that the types of food eaten would affect symptoms. Crohn’s disease is also a disease of chronic inflammation. Certain foods cause inflammation for everyone. Healthy people just have a higher tolerance to inflammatory foods. They also seem to have faster inflammation-lowering responses.
With Crohn’s, these foods can set off an inflammatory response that lingers. Removing typically inflammatory foods from the diet can help calm the immune response, allowing the gut to heal. Including plenty of supporting nutrients is also important for healing the gut.
My family healed our guts using the GAPs diet. Some may find success following GAPS as well, but not if they have histamine issues. GAPS staples, like bone broth and fermented foods, are really high in histamines. In that case, the paleo diet might be a better option.
The paleo diet increases protein, fiber, healthy fats, potassium, and vitamin intake. It decreases carbohydrates, sugars, and preservatives. These changes can help someone with Crohn’s diminish their symptoms and live a more vibrant life free of pain and digestive distress.
Which Foods to Avoid with Crohn’s
Everyone is different, but the following foods tend to be problematic for those with Crohn’s disease. Some of these (like margarine), are foods that I don’t recommend anyone consuming!
- Processed foods
- Sugar alcohols, like sorbitol
- Whole grains, (especially with gluten)
- Dairy products (many with Crohn’s are lactose intolerant)
- Raw fruits and vegetables
- Vegetable oils or margarine
- FODMAP foods (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols)
- High fiber foods
- Legumes like beans, lentils, peas, and soy.
- Peanut butter (Also a legume)
- Spicy foods
What Not to Eat During a Flare
These are some general food categories that can cause problems due to their effects on inflammation or gut dysbiosis. However, during a Crohn’s disease flare, a temporary low-fat or low-fiber diet may be needed until the inflammation calms down.
According to the Crohn’s & Colitis Foundation, these foods may trigger pain or diarrhea during a flare:
- Insoluble fiber foods
- Sugar alcohols
- Sugary foods
- High-fat foods
- Spicy foods.
When in remission, higher fiber foods, nuts, beans, fruits, and vegetables are better tolerated.
Different foods can cause symptoms in different people. That’s where a customized paleo diet can be helpful. Keeping a food diary is a great way to really pinpoint what your trigger foods are.
Which Foods Are Left? (Try Paleo)
The paleo diet focuses on everyday, modern foods that mimic the food groups of our hunter-gatherer ancestors. It’s higher in protein, lower in carbohydrates, and avoids foods introduced in the agricultural era. These are foods like grains, legumes, and dairy.
- Higher protein intake – Protein makes up 15% of calories in the average western diet. That’s much lower than the 19-35% found in hunter-gatherer diets. Red meat, seafood, and other animal products are staple foods in modern-day paleo diets.
- Lower carbohydrate intake – Non-starchy fresh fruits and vegetables represent the main carbohydrate source. These provide for 35-45% of daily calories. Almost all of these foods are low glycemic so they’re slowly digested and absorbed, and won’t spike blood sugar levels.
Foods that are usually well-tolerated by those with Crohn’s include:
- Fish (especially types rich in omega-3 fatty acids)
- Seafood (ideally, wild-caught/harvested)
- Red meats/Lean protein (ideally, grass-fed or pastured-raised)
- Eggs (duck eggs may be better tolerated for some)
- Cooked, steamed, or roasted veggies
- Fruits (cooked during a flare)
- Nuts and seeds without added oil (not during a flare)
- Healthy oils and fats (like tallow, lard, avocados, olive oil, and coconut oil).
In general, these are well tolerated by those with Crohn’s disease, but it’s also possible to have allergies to these foods. It’s not uncommon to have allergies to certain fish like cod, shellfish allergies, tree nut allergies, or allergies to chicken eggs –the whites, the yolks, or both. Personally, I don’t tolerate eggs well so it’s something I avoid.
It may be worth it to do a blood test to make sure these healthy foods aren’t creating more inflammation. I use and recommend this genetic testing to help figure out which foods are helpful or harmful for someone.
Paleo Cookbooks for Crohn’s Disease Diet
I’ve bought and tried recipes from several Paleo cookbooks over the years. Many I’ve even received as gifts! Here are a few I recommend:
- The 30-Day Guide to Paleo Cooking by Hayley Mason and Bill Staley
- Nom Nom Paleo by Michelle Tam + Henry Fong
- Everyday Paleo Italian Cuisine by Sarah Fragoso
- Paleo Indulgences by Tammy Credicott
- Practical Paleo by Diane Sanfilippo
- Paleo Slow Cooking by Chrissy Gower
- Everyday Paleo Family Cookbook by Sarah Fragoso
There are a few more Paleo cookbook recommendations in this post. Because Crohn’s is an autoimmune condition, a specific autoimmune protocol, as outlined by The Paleo Approach, may be a good place to start. You can also find numerous paleo-compliant recipes on the Wellness Mama website.
Nutritional Supplements for Crohn’s
Food is ultimately the best source of nutrients, but Crohn’s usually causes deficiencies. Supplements can complement a balanced diet to help resolve these nutritional deficiencies. A few common ones associated with Crohn’s disease are:
- Vitamin B12
- Fat-soluble vitamins A, D, E, and K.
Your nutritionist or health care professional may recommend supplementing these. They may also suggest the following:
These supplements also help support overall health as they support gut health and lower inflammation.
Crohn’s Disease Diet: The Bottom Line
Crohn’s is a disease of chronic inflammation. To get Crohn’s disease under control, it’s critical to get the inflammation under control. While we can’t control everything we’re exposed to, we can definitely control diet. Focusing on a low-inflammation diet with plenty of clean, healing protein may help. The right diet can go a long way toward lessening flare-ups and improving quality of life!
Have you struggled with Crohn’s disease? Have you overcome it? What diet has worked for you? Please share with us below!
- Ranasinghe IR, Hsu R. Crohn Disease. [Updated 2022 May 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
- Crohn’s & Colitis Foundation. (2022). What Should I Eat?. Crohn’s & Colitis Foundation website.
- Centers for Disease Control and Prevention. (2022). FastStats: Diet/Nutrition. CDC.gov website.
- Cordain, L., Eaton, S., Miller, J. et al. The paradoxical nature of hunter-gatherer diets: meat-based, yet non-atherogenic. Eur J Clin Nutr 56 (Suppl 1), S42–S52 (2002).