Thursday, 31 August 2017

Diarrhea vs. Constipation: How to Adjust Your Diet for Crohn’s Disease

Getting enough nutrients can be daunting when you have an inflammatory bowel disease like Crohn’s. It’s even harder when you’re experiencing symptoms like diarrhea or constipation. You may not feel like eating healthy meals when you have these symptoms, but experts at the Crohn’s & Colitis Foundation of America (CCFA) assert that nutrition is vital when your symptoms flare.

Crohn’s disease can prevent vitamins and minerals from being absorbed properly by the body, and being malnourished can make it harder for the body to heal. Factor in other symptoms, like abdominal pain, nausea, and a resulting poor appetite, and eating healthfully becomes even more difficult.

Although most Americans with Crohn's disease don’t become seriously malnourished unless their disease is severe, it's possible to develop deficiencies in iron, vitamin B12, and vitamin D, says James D. Lewis, MD, professor of medicine and epidemiology and associate director of the Inflammatory Bowel Disease Program in the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. Dr. Lewis recommends getting tested periodically for nutritional deficiencies and warns not to shun food when you’re having symptoms. Instead, make every bite count during a Crohn’s disease flare.

What to Eat When You Have Diarrhea

The best foods for Crohn’s disease vary from person to person, says Lisa Cimperman, RD, a clinical dietitian at University Hospitals Case Medical Center in Cleveland and a spokesperson for the Academy of Nutrition and Dietetics. She recommends keeping a food and symptom diary and choosing foods that you know your body tolerates. Here are some additional tips:

  • Go bland. Some people with Crohn’s disease have told Lewis and his colleagues that eating bananas, rice, and yogurt help. Cimperman suggests trying oatmeal, Cream of Wheat, unsweetened applesauce, tender lean poultry or fish, peeled white and sweet potatoes, rice and corn cereals, soft cooked vegetables, such as carrots or squash, and smooth peanut, almond, or cashew butter.
  • Drink up. Diarrhea can lead to dehydration, and if you don’t drink enough fluids it could affect your kidneys and increase your chance of developing kidney stones. The CCFA recommends sipping (not gulping) a half ounce of water for every pound you weigh on a daily basis — that's almost nine 8-ounce glasses of water a day for a 140-pound person.
  • Replace electrolytes. When diarrhea is severe, you may need to replace electrolytes, such as sodium, potassium, and phosphorus, with enhanced sports drinks or coconut water, Cimperman says.
  • Skip dairy, except yogurt. Milk and other dairy products may make diarrhea and gas worse, Cimperman says. “But I would encourage trying to include yogurt,” she adds. “It’s a source of probiotics — good bacteria that may help keep your gut and immune system functioning properly.” Look for plain Greek yogurt and mix in unsweetened applesauce.
  • Peel fruit and vegetables. It’s better to avoid fiber-rich skins during periods of diarrhea.
  • Skip citrus and raw leafy greens. Citrus fruits and pineapple have a fibrous texture that you may want to avoid. The same goes for uncooked leafy greens like kale, but you could try cooking them or adding them to a smoothie, Cimperman says.
  • Consider an all-liquid diet. Although it’s an extreme restriction diet, one option is an all-liquid diet consisting of a nutritional formula, Lewis says. In the United States, people get the formula, which can be taken as a drink or through a feeding tube, from their doctors. The science behind it is incomplete, but Lewis and others are doing research on using such a formula as the sole source of nutrients. The problem is that we all like to eat, Lewis says, so it’s a tough diet to follow.

What to Eat When you Have Constipation

Constipation is less common among people with Crohn’s disease, but it can happen when the disease is under control. Should this occur, approach constipation as you would if you didn’t have Crohn’s disease, Lewis says. But he cautions that constipation could be a sign of a serious problem, such as a blockage in the intestine or inflammation so severe it narrows the intestine. If constipation comes on suddenly, he says, see your doctor. Otherwise, you can try the following tips for relief:

Choose higher-fiber foods. You don’t want to increase fiber intake too quickly because this could cause gas, but gradually adding in beans, vegetables, and high-fiber cereals, such as bran and shredded wheat, can help ease constipation, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Keep drinking liquids. Drinking water and fruit and vegetable juices, along with eating clear soups, helps fiber do its job of making you regular.
Pass on low-fiber foods. Avoid ice cream, cheese, meat, processed foods, fast food, frozen meals, and processed snack foods.

As you deal with symptoms of Crohn’s disease, remember that general guidelines don’t rule over what works best for you individually.

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