Foods to Avoid with Crohn’s Disease: Your Comprehensive Guide - Dr. Michael Ruscio, DC

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Foods to Avoid with Crohn’s Disease: Your Comprehensive Guide

Using Diet, Probiotics, and Lifestyle to Improve Your Symptoms 

Key Takeaways:

  • Certain foods like whole grain breads, cabbage, onions, and dairy may worsen or trigger Crohn’s flares.
  • Healing your gut with targeted diet and lifestyle therapies is more effective for managing Crohn’s disease than avoiding specific foods indefinitely.
  • An elimination diet– which can follow different frameworks– can help to manage Crohn’s disease. 
  • Listening to your body throughout the elimination diet process will help you determine which specific foods you may need to avoid (and which ones you don’t). 
  • Elemental diets can also significantly improve symptoms of Crohn’s disease. 
  • Probiotics can work in conjunction with diet to improve Crohn’s disease symptoms.
  • Lifestyle strategies like sun exposure and meditation may improve Crohn’s disease. symptoms.

Certain foods and dietary patterns (like lots of fried foods and a Western-type diet) may contribute to the development of Crohn’s disease. If you’ve already been diagnosed, it’s important to focus on a balanced diet that’s anti-inflammatory (like the Paleo diet), but there may also be some specific foods that could worsen your symptoms. So, how can you figure out which foods to avoid?

Whole grain breads, alcohol, cabbage, chili sauce, and cow’s milk are some examples of foods that are frequently reported to worsen Crohn’s symptoms [1]. Of course, everyone is different, so it’s important to listen to your own body. You can identify your trigger foods (and which ones you’re fine with) by following an elimination diet.

In this article, we’ll discuss the foods to avoid with Crohn’s disease and explain why healing your gut with a combination of diet, lifestyle, and probiotics will ultimately allow you to have more food freedom and a better quality of life. We’ll also share the healing journey of our patient Kyle who struggled with unmanaged Crohn’s disease for years before implementing a comprehensive gut-healing protocol.

Foods to Avoid With Crohn’s Disease

The ultimate goal is to have the least restrictive diet possible, but there are certain foods and dietary patterns you may want to avoid when trying to prevent and/or heal a Crohn’s disease flare.

The following foods may not affect your symptoms, so you don’t necessarily need to avoid everything on this list if you don’t personally find that they trigger you.

It’s also important to remember that healing your gut will allow you to tolerate a variety of foods that you otherwise may react to in the context of an unhealthy gut.

Observational research has found the following foods to trigger and/or worsen Crohn’s disease symptoms for some people (based on a patient questionnaire) [1, 2]:

  • Deep fried foods
  • Whole grain bread; wheat 
  • Alcohol
  • Cabbage
  • Chili sauce
  • Whole cow’s milk
  • Leafy and non-leafy vegetables
  • Spicy foods
  • Nuts
  • Milk & dairy products
  • Red meat
  • Soda
  • Popcorn
  • High-fiber foods
  • Corn
  • High-fat foods
  • Seeds
  • Coffee
  • Beans
  • Sugar 
  • High FODMAP foods (including apples, onions, cow’s milk, cauliflower) 
  • Processed foods

This is a quite extensive list, so you may be wondering what you can eat. Rather than focusing on specific foods, I recommend improving the landscape of your gut with certain dietary patterns, nutritional supplements, and lifestyle strategies. Before we get into the specifics, let’s review what Crohn’s disease is.

What Is Crohn’s Disease?

Crohn’s disease is a type of inflammatory bowel disease (IBD) that can affect every part of the gastrointestinal (GI) tract (ulcerative colitis is another form of IBD that only affects the colon). Crohn’s disease most often occurs in the terminal ileum of the small intestine and the right colon of the large intestine [3].

While an exact cause is unknown, Crohn’s disease probably results from a combination of [3]:

  • Genetics
  • Diet
  • Altered immune function
  • Environmental factors (drugs, toxins, infections, intestinal microbes)

Not surprisingly, a Western diet that’s low in fruits and vegetables and high in processed meats, refined grains, and added sugar has been associated with significantly increased risk of developing the disease [4]. On the other hand, an anti-inflammatory diet like the Mediterranean or Paleo may help prevent Crohn’s disease [5] and a low FODMAP diet plan can improve Crohn’s disease symptoms [6, 7].

Crohn’s disease is a relapsing and remitting condition, meaning flares come and go. During the onset of a flare, inflammation starts in the intestinal crypts (pouches in the intestinal lining) until ulcers form in the intestinal wall, leading to lesions in the mucosa (specialized tissue that lines the intestine). Once the flare settles, scar tissue can form [3].

Uncontrolled Crohn’s disease can lead to severe inflammation causing fistulas and/or strictures. Your healthcare provider may recommend a combination of medications like immunosuppressant and biologic drugs, diet, nutritional supplements, lifestyle changes, and/or even surgery (in more severe cases) [3].

The good news here is diet, probiotic supplements, and lifestyle measures can be very effective for healing the gut and managing Crohn’s disease [8].

What Are the Symptoms of Crohn’s Disease?

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Patients with Crohn’s disease can experience a variety of digestive and non-digestive symptoms based on the severity of the disease.

Crohn’s flare-ups can cause [3]:

  • Pain in the right lower abdomen (colon pain)
  • Gas and bloating
  • Diarrhea that may include mucus and blood
  • Fever
  • Weight loss
  • Anemia
  • Cramping

When the small intestine is involved, patients can experience these additional symptoms [3]:

  • Malabsorption of nutrients
  • Upper abdominal pain
  • Loss of appetite

 Non-digestive symptoms can include [3]:

  • Inflammation of the eyes, mouth, and lips 
  • Canker sores
  • Fatty liver
  • Gallstones
  • Inflammation and scarring of the bile ducts (primary sclerosing cholangitis)
  • Kidney stones and/or swelling
  • Urinary tract infections
  • Painful nodules under the skin and painful ulcers on the skin
  • Arthritis (spine, sacrum, knees, ankles, hips, wrists, elbows)
  • Blood clots
  • Brain fog [9]
  • Fatigue
  • Hemorrhoids [10]

Patients with Crohn’s disease are often at greater risk of malnutrition as it’s difficult to meet their nutritional needs due to multiple food sensitivities, poor appetite, and malabsorption. One systematic review and meta-analysis of patients with IBD (including Crohn’s disease) found when compared to healthy controls, the IBD patients had a significantly lower intake of protein and iron and inadequate intake of certain other nutrients and healthy foods [11].

Fortunately, Crohn’s disease can be effectively managed with a variety of natural therapies.

Gut Healing for Crohn’s Disease

Implementing a natural approach will likely lead to more complete healing and improved quality of life. Let’s start by discussing diet therapy options that have been shown to be helpful for Crohn’s disease.

Diet Therapy for Crohn’s Disease

The ultimate goal is to have the most varied and balanced diet possible. There may indeed be some foods you don’t tolerate well, and you can learn which foods to avoid by implementing an elimination diet. 

An elimination diet helps to both identify and remove the foods that may be driving inflammation and an altered immune response. And when you eliminate trigger foods, it gives your gut the chance to heal so you can expand your diet in the future. 

There are three phases: elimination, reintroduction, and maintenance. And the research on diet therapy and Crohn’s disease suggests several possible elimination diet options.

Diet Option One

We typically recommend the Paleo diet as a first option. This meal plan removes common food allergens and inflammatory foods and focuses on whole foods that are pretty easy to tolerate for most people…

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During the elimination phase, you’ll remove grains, beans, legumes, lentils, processed foods, additives, inflammatory fats (vegetable oils and margarine), and dairy products then observe your symptoms. You might notice a dramatic improvement in just a few weeks.

Once you’re feeling better, you’ll begin to reintroduce the eliminated foods one at a time and observe for any change in symptoms. If you tolerate the eliminated foods, then you can add them back to your meal plan. If you have a recurrence of symptoms, then you’ll want to keep the tested food out of your diet for a little longer.

Going through this process allows you to easily adjust your meal plan until you settle on a maintenance plan that works for you. The goal is to have a diet that’s as varied and balanced as possible, without triggering your symptoms.

Research has given some additional dietary considerations specific to Crohn’s disease for you to consider when implementing the Paleo diet:

  • Consume leafy green vegetables daily (if tolerated) since they’ve  been associated with lower fecal calprotectin levels (a marker of inflammation in the gut), which is associated with Crohn’s disease remission [12].
  • Consume adequate dietary fiber (unless an intestinal obstruction is present) due to the overall anti-inflammatory benefit [13]. While some patients report fiber worsens their symptoms [1, 2, 14], low-quality studies haven’t found any benefit with low-fiber diets or low residue diets for Crohn’s disease [15].

If you’ve worked through the Paleo elimination diet process and still have some lingering symptoms, you may want to move to the second option, the low FODMAP diet.

Diet Option Two

The low FODMAP diet has been found to reduce GI symptoms and to be an effective treatment for IBD [6, 7, 16, 17]. This is another elimination diet that removes highly fermentable starches and sugars, which may aggravate Crohn’s symptoms. Here’s a chart of foods to choose from and foods to avoid on the low FODMAP diet:

Food TypeLow FODMAP FoodsHigh FODMAP Foods
VegetablesZucchini, green beans, bok choy, red bell pepper, eggplant, carrot, lettuce, potato, tomatoCauliflower, artichokes, asparagus, cabbage, broccoli, green bell pepper
FruitsBlueberries, kiwi, banana, grape, lemon, lime, orange, cantaloupeBlackberry, apricot, mango, apple, avocado, pear, peach, nectarines, watermelon
LegumesXLentils, beans, chickpeas, peas
Nuts & SeedsMacadamia nuts, almonds (less than 10 each), peanuts, pecans, walnuts (less than 10 each)Cashews, pistachios, almonds (greater than 10 each)
Dairy Products & Dairy SubstitutesFeta cheese, lactose-free milk or cheese, almond milkBrie cheese, ice cream, yogurt
GrainsWhite rice, quinoa, milletWheat and rye
SweetenersGlucoseFructose, high fructose corn syrup, mannitol, xylitol, sorbitol, maltitol, agave
Prebiotics & AdditivesXGalactooligosaccharides (GOS), isomalt, inulin, fructooligosaccharides (FOS)

To implement the low FODMAP diet, follow the same process listed above with elimination, reintroduction, and maintenance. 

The third diet option is quite a bit more restrictive than Paleo or low FODMAP, but there are some smaller research trials that have found it to be beneficial.

Diet Option Three

If you’ve tried the Paleo diet and a low FODMAP diet for several weeks or even months but still have some Crohn’s disease symptoms, you may try the autoimmune protocol diet (AIP). A few small trials have found the AIP diet to improve quality of life and IBD symptoms [18, 19, 20]. The AIP diet is essentially a stricter version of Paleo eating that eliminates a wider variety of foods linked with triggering inflammation for people with autoimmune diseases like Crohn’s disease. 

Here’s a quick snapshot of foods to include and foods to avoid on this type of diet:

Foods to IncludeFoods to Avoid
Grass-fed or wild-caught animal lean proteins (meat, fish, poultry, organ meats, bone broth)All grains, eggs, and legumes such as green beans, black beans, white beans, kidney beans, and garbanzo beans
Healthy fats and oils (coconut oil and coconut milk, olive oil, avocados and avocado oil)All nuts and seeds, such as almonds, walnuts, and chia seeds, including their derivatives like seed and vegetable oils and flours (like almond flour)
Wide variety of fresh fruits and vegetables (sweet potatoes, greens, lettuce, cucumbers, zucchini, berries, apples, and melon)Nightshade vegetables (tomatoes, potatoes, peppers, eggplant, tomatillos) and spices derived from nightshades (paprika and cayenne pepper)
Non-dairy fermented foods (sauerkraut, kombucha, kimchi)All dairy products, including ghee, kefir, milk, cheese, and cream
Herbs and spices not derived from seeds (cinnamon, turmeric, thyme, oregano, basil, rosemary)Spices derived from seeds, including fennel, cumin, dill, anise, mustard, coriander, and nutmeg
Stevia and maple syrupMost added or artificial sweeteners and food additives, plus coffee and alcohol

The AIP diet is pretty restrictive, so it shouldn’t be considered a first option. 

In addition to diet therapy, you may consider a short gut reset with an elemental diet.

Elemental Diets for Crohn’s Disease

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The elemental diet is a liquid meal replacement that’s very easily absorbed in the digestive tract and supplies all macronutrients and essential vitamins. The formula (hypoallergenic, anti-bacterial, and anti-inflammatory) is sold as a powder that you simply mix, blend, or shake up with water and sip on throughout the day. 

Semi-elemental diets differ in that instead of the proteins being fully broken down into amino acids, they’re partly broken down.

Multiple studies have shown elemental diets to be as effective as anti-inflammatory drugs like prednisone in promoting the remission of Crohn’s disease. And they’ve also been shown to decrease inflammation, reduce autoimmunity, and prevent Crohn’s relapses [21, 22, 23, 24, 25, 26, 27, 28, 29, 30].

Semi-elemental diets can be just as effective as fully elemental diets, and they’re usually more palatable and easier to implement. One prospective observational study of Crohn’s disease patients given only a semi-elemental diet for nutrition for 12 weeks found reduced disease activity along with higher rates of remission (from 5.6% to 71.8%), and a significant decrease in [31]:

  • The average number of daily stools (from 4.6 to 1.7)
  • Malnutrition (91.5% to 23.9%) 

Elemental diets can be used for two to four days for a gut reset but are also safe to be used for longer periods of time. Here at the Ruscio Institute for Functional Medicine, we’ve taken the hassle out of starting an elemental diet and have designed several great-tasting formulas that are scientifically backed to improve your gut health. 

If diet therapy and/or a gut reset with an elemental diet has been helpful but you still have room for improvement, you should consider adding probiotics. 

Probiotics for Crohn’s Disease

As I explain in Healthy Gut, Healthy You, probiotics have been shown to be very helpful for IBD, especially when it comes to maintaining remission. While the research seems to be inconclusive surrounding the benefit of probiotics for putting active Crohn’s disease into remission [32, 33], one clinical trial found Saccharomyces boulardii improved gut microbial composition and led to faster resolution of intestinal symptoms in IBD patients [34]. And probiotics, in general, work synergistically with diet therapy to reduce inflammation and improve gut health for people with IBD [35, 36].

In the clinic, we recommend triple therapy probiotics, which include:

  • Lactobacillus/bifidobacterium probiotic blend
  • Saccharomyces boulardii probiotic
  • Soil-based probiotic

Probiotics have been extensively studied and are effective for and well-tolerated by most people, so they’re definitely worth a try.

Lifestyle Therapy for Crohn’s Disease

In addition to diet and probiotics, certain lifestyle strategies may be helpful:

  • Safe sun exposure: Inadequate vitamin D levels are associated with greater gut permeability (leaky gut) and worse outcomes for IBD patients [37, 38, 39]. The best way to boost vitamin D is with safe sun exposure. In addition, sun exposure has been shown to protect against IBD [40].
  • Mind-body techniques: IBD patients who practiced a mind-body intervention experienced symptom improvement and improvements in inflammation [41]. In addition, IBD patients who completed a breath-body-mind workshop had significant improvements in both mental and physical symptoms, quality of life, and inflammation [42].

It often takes a combination of strategies to experience more complete healing. Let’s take a look at Kyle’s healing journey.

How Kyle Managed His Crohn’s Disease and Optimized His Gut Health

Kyle tried for years to manage his Crohn’s disease. He used biologic drugs and even surgery but still felt unwell overall. He contacted us at the Ruscio Institute for Functional Medicine hoping to find relief from the stomach pain he had with everything he ate. Kyle also reported frequent constipation, low energy, bloating, and headaches.  

We started Kyle on the Gupta program (a brain retraining program that focuses on mindfulness) and our triple therapy probiotics and he reported almost immediate symptom relief. He said his digestion, constipation, and abdominal pain were all significantly improved. 

In addition to mindfulness and probiotic therapy, he implemented a low FODMAP diet and noticed even more symptom improvement. Where previously all foods triggered stomach pain, Kyle was able to gradually expand his diet to include more variety and he discovered more about the specific foods he needs to avoid. Kyle also added abdominal massage, which he found very helpful for constipation.

Kyle’s journey has taken consistent effort and the willingness to try different natural therapies. Rather than simply focusing on avoiding specific foods, he opted for a step-by-step gut healing protocol and has experienced wonderful results.

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Manage Crohn’s Disease With Diet, Probiotics, and Lifestyle

There’s a spectrum of severity when it comes to Crohn’s disease. Some patients with mild cases may make simple dietary changes and feel great. Other patients with severe cases may require special and specific diets, probiotics, herbs, and even medications or surgery. While there’s no cure for Crohn’s disease, natural therapies  can be very effective for healing and preventing flares.

Certain foods like whole grain breads, cabbage, dairy foods, and onions may need to be avoided initially. But rather than focusing on specific foods to avoid with Crohn’s disease, opt for complete gut healing. A Paleo or low FODMAP diet, probiotics, and other lifestyle measures will allow you to ultimately expand your diet and improve your quality of life.

If you’re not feeling well after implementing these foundational principles, check out the Great-in-8 step-by-step action plan in Healthy Gut, Healthy You, which provides very detailed instructions on how to heal your gut. If you need more specialized or personalized support, feel free to contact us at the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

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