The Real, Honest Diet for Crohns Patients
By
A Nutritionist Gastroenterologist
Frank W Jackson MD
Every Crohns patient wants to know what to eat, how much, and how often.
The bookstore and the web are filled with diets for the Crohns patient. A certain Carbo diet is in vogue right now and some patients swear by it. None of these diets is based on good medical research. Most of them rely only good nutritional intuition or the profit motive. In my previous gastroenterology practice I gave the best advice possible. Get enough calories. Eat lots of protein, meaning animal foods. You should take a multivitamin pill. And yes, we were seeing better and better drug therapies for Crohns. Diet, however, remained in the back round simply because we did not have good research information to get very specific. The Crohns and Colitis Foundation and the Mayo Clinic educational web sites, too, could not and, indeed, even today do not give much information beyond what I say above. But now there is some solid research material and some very provocative advise on what Crohns persons should be putting in their mouth. Read on or be sure to send this to a friend who has or knows someone who has Crohns Disease.
Earlier this year an academic group of physicians did what is called a meta-analysis, meaning they surveyed the entire medical literature on what Crohns people were eating just before they got the disease diagnosed. They looked at over 1000 published articles and found 19 with enough good research and documentation for the following conclusions:
- Reduce animal protein, especially, meat in the diet. A portion the size of a deck of cards once a day is about right.
- Fats and vegetable oil. These should be reduced as well. The unexpected and the big news was that people who got Crohns were ingesting lots of vegetable fats. So, reduce the olive and other vegetable oils.
- Significantly increase the amount of plant food, meaning vegetables, grains and fruit. Fruit, in particular, seemed to be protective.
These above recommendations are based on the best science we have. This research comes from the medical article below (link1).
Food Additives
The other part of nutrition is that of food additives. The increase in the incidence of Crohns disease has paralleled the increase in food additives to prepared, packaged, and bottled foods. The most important of these additives may be the emulsifiers.
Before understanding emulsifiers you need to know some secrets about what is happening within the lower bowel and colon of everyone including Crohns patients. We all have a very large number of bacteria in our colon. They are part of our health make up and should be providing many health benefits. With a solid plant food based diet the bacterial mix swings toward the good side. In Crohns people the bacterial mix is abnormal, meaning there are far more bad types of bacteria than the good ones. The change in diet above helps to swing the bacteria mix back to the good ones that provide so many known health benefits. In so doing the inflammation may be reduced.
The Mucous Layer
The second big secret is that we all have a very tough layer of thick, tenacious mucous covering the inside lining of the bowel. This is called the mucous layer. It protects us from bacteria invading the bowel wall as happens in a Crohns person.
In research two different emulsifiers have been shown to dissolve this mucous layer in Crohns prone animals and lead to invasion of bacteria with inflammation and infection.
Emulsifiers
An emulsifier is a food additive, frequently chemically made, that does something in the food to which it is added. It may make an emulsion and allow the mixing of oil and water as in salad dressings. It can and often is used to give good mouth feel in ice cream. They have no calories and so they are often used in low calorie foods as a substitute for fat and oil. They may prolong shelf life.
Now back to the mucous layer. In Crohns patients, bad bacteria invade through this mucous lining. An emulsifier from a packaged food may help to emulsify this mucous barrier and in so doing allow bacteria to move through.Research has shown this to occur with the very commonly used emulsifiers carboxy methyl cellulose (link 2) and polysorbate (link 3). There are well over 100 different emulsifiers that can be added to factory prepared foods. You need to read the labels carefully and not buy or eat factory prepared food where there are items on the label that you do not recognize. Assume that they could be emulsifiers. The names of some others are xanthum gum, glycerides, and celluloses. If you want to learn the names of these additives, go to Wikipedia and search for E numbers. Under the 400 series you will find the names of these many emulsifiers.
Fresh Foods
The way to avoid all food additives is to shop fresh. Buy fresh foods, especially the fresh vegetables and fruits. Frozen vegetables and fruits are fine, but, again read the labels. Avoid the center isles in food stores where these factory made foods are present. Read labels and look up words you do not recognize. Assume they could be emulsifiers. The FDA says that all food additives are safe. However, these decisions were made long before we knew much about the mucous layer of the intestine and how important it is, especially for the Crohns patient.
Prebiotics
A prebiotic is not a probiotic which is a bacteria in yogurt, other dairy products or pills. A prebiotic, on the other hand, is soluble plant fiber that is used by the best bacteria in the gut to promote their growth. When they grow, the bad bacteria do not. They are in a wide variety of plants. Please go my educational web site jacksongi.com to learn more about prebiotics and to search for the Crohns Diet under the Diet section. The Crohns Therapeutic Diet is presented in detail. Our Prebiotin products are a great supplement to your diet.
References
- Dietary risk of developing inflammatory bowel disease.
http://www.ncbi.nlm.nih.gov/pubmed/21468064 - Inflammation of the small intestine after carboxy methyl cellulose ingestion
http://www.ncbi.nlm.nih.gov/pubmed/18844217 - Movement of Crohns bacteria across the mucous layer. Effect of the emulsifier polysorbate
http://www.ncbi.nlm.nih.gov/pubmed/20813719
