Coping With Crohn's Disease

Practical Tips for Living Well and Avoiding Flares

The emotional impact of Crohn's disease can often be as profound as the physical symptoms. Frequent bowel movements, abdominal cramps, and gas can make life difficult if you're out in public or trying to carry on with your work life or social obligations. Fortunately, there are steps you can take to reduce the risk of flares and live a fuller, more productive life. It starts with identifying your individual triggers, adjusting your diet to normalize bowel function, and finding the emotional support to overcome challenges that may pop up along the way.

Physical

In addition to following the medication course set out by your doctor, easing symptoms and preventing flares largely comes down to living a healthy lifestyle that encourages healthy bowel function and doesn't instigate your condition.

Eat a Balanced Diet

Information regarding the dietary treatment of Crohn's disease can be confusing. While some people insist that you that you need to avoid entire food groups, that's actually a bad idea. 

Rather, what you need to do is ensure a healthy diet with a balanced intake of protein, fats, carbohydrates, and nutrients.

Your doctor may also recommend vitamin and nutritional supplements if blood tests reveal that you are low in potassium, magnesium, or other essential nutrients.

Don't Shy Away From Fiber

In the past, doctors used to advise people with Crohn’s disease to avoid fiber, as this was believed to promote diarrhea. Today, we understand that a healthy intake of fiber—25 grams per day for women and 38 grams per day for men—helps maintain regularity and decrease the risk of symptom flares.

But, it’s not just any fiber you need to consume. Soluble fiber (found in fruits, vegetables, nuts, and legumes) is the type that dissolves in water and helps soften stools while slowing the emptying of the intestines. By contrast, insoluble fiber pulls water from the intestines and may increase the risk of bloating, gas, diarrhea, and pain.

Avoid Triggers

Ultimately, the only foods you need to avoid are those that cause you problems.

In the same way that the symptoms of Crohn's disease can vary from person to person, so, too, can the foods that trigger a flare. Finding the list of problematic foods can be a process of trial and error, requiring you to methodically eliminate and reintroduce foods until you know which ones to avoid.

When starting the process, there are a number of common culprits you should consider, including:

  • Alcohol
  • Butter and margarine
  • Caffeinated coffee and teas
  • Carbonated drinks
  • Corn kernels
  • Cured and processed meats
  • Fried and high-fat foods
  • Gas-producing foods 
  • Mayonnaise
  • Nuts and seeds
  • Raw fruits
  • Raw vegetables
  • Red meat
  • Spicy foods
  • Whole grains and bran

Get Help From a Nutritionist

To find the maintenance diet that's right for you, ask your doctor for a referral to a nutritionist experienced with inflammatory bowel disease (IBD). In some cases, the nutritionist will be able to identify an undiagnosed food intolerance and switch you to, say, a gluten-free or lactose-free diet to gain better control of your symptoms. Others may suggest a FODMAP diet, which excludes certain carbohydrates and sugars believed to be associated with disease flares.

Hydrate

You also need to ensure proper hydration to normalize your bowel function. This demands no less than eight tall glasses of water per day. (People who are older or overweight may need to adjust their daily consumption.) Alcohol, coffee, and caffeinated drinks are not advised, as they are diuretic and more likely to promote dehydration rather than alleviate it.

Exercise

Consider routine exercise as part of your management plan. People with Crohn's disease often avoid physical activity for fear that it may set off an attack—and that's a mistake.

In fact, if performed appropriately, a daily, 30-minute workout will not only aid in the normalization of your bowel function but improve your mood and reduce fatigue.

Quit Smoking

The simple truth is that smokers with Crohn's disease have a far greater risk of flares and are more likely to require aggressive immune suppressant therapy compared to non-smokers with the disease. In the end, you may likely never fully achieve sustained remission unless you make an effort to stop smoking.

If you need help, your doctor can advise you on the various drug and cessation options available to you, many of which will be covered by Medicare, Medicaid, and private insurance plans.

Emotional

Stress does not cause Crohn's disease, but it may trigger a  flare or worsen existing symptoms. As living with a chronic disease can be emotionally challenging, you need to find strategies to manage stress on a daily basis and "dial down" your response should symptoms strike.

Many people with Crohn's disease turn to mind-body therapies, which honor the role that emotions play in your general health and well-being. These therapies can be used both to prevent flares and treat acute ones.

Options include:

  • Mindful meditation, in which you aim to recognize, but avoid responding to any unpleasant sensation
  • Deep-breathing exercises, in which you focus on rhythmic breathing to achieve a calming, meditative state
  • Guided imagery, in which you conjure pleasant mental images to relax and unwind
  • Tai chi, which uses controlled, slow movements to increase mindfulness and calm
  • Gentle yoga; mindfulness is an inherent part of the physical practice
  • Progressive muscle relaxation (PMR), in which you methodically tense and release your muscles to gradually release stress
  • Biofeedback, which uses a machine to detect stressful responses so that you can learn to better control them

Getting regular exercise and sleep can also help you regulate your mood and deal with stress.

Social

Crohn's disease can leave some feeling isolated and reluctant to share their feelings with others, perhaps out of embarrassment or fear of how they might react.

If this is you, start by reaching out to others also affected by the disease, who know firsthand what you are going through. You might consider contacting your ​local chapter of the Crohn's and Colitis Foundation for referrals to peer-lead support groups in the area or seeking out a support community on social media.

With that being said, try not discount the importance of friends and family in building a cohesive support network. Many people simply don't understand what Crohn's disease is and will be better equipped to support and advocate for you if you help educate them both about the disease and how it is affecting you personally.

On the other hand, if you are experiencing anxiety and depression that you can't seem to shake, ask your doctor for a referral to a psychologist or psychiatrist who may offer you counseling and, if needed, medications to help you better cope.

Practical

Sometimes, all it takes is a few easy "fixes" to better manage your Crohn's disease on a daily basis. Whether you are struggling to control symptoms or simply to want to do everything you can to sustain remission, there a few practical tips that can help:

  • Keep a diary. By keeping a daily record of what you have eaten, how you are feeling, and what you have experienced during the day, you may be able to spot triggers that you've previously missed.
  • Read food labels. Processed and packaged foods often contain chemicals and substances (like MSG, nitrates, saturated fats, gluten, and caffeine) that can trigger Crohn's symptoms. The more you are aware of what is in your food, the easier it will be to avoid products that can hurt you.
  • Never skip meals. If you do, you will be more likely to overeat and overburden your gastrointestinal tract. To keep your hunger at bay (and keep the digestive system moving), eat three regular meals along with two to three healthy snacks per day. In the end, it is far better to eat five to six times per day than to overindulge once or twice.
  • Drink beverages slowly.  Gulping down a drink or sipping it through a straw introduces air into the stomach, leading to increased belching, pain, and gas.
  • Avoiding overheating. Staying out in the sun for too long or exercising strenuously can raise your body temperature excessively and trigger diarrhea.
  • Plan ahead. When planning an outing, make every effort to locate where the nearest bathrooms will be so that you are never caught out. Similarly, if visiting a restaurant, check online or call in advance to see what you can eat. In this way, you won't be hurried by the server and order the wrong food.
  • Don't go out feeling hungry. If you do, you may end up grabbing something that sets off symptoms.
  • Bring your own food. If going to a party, bring an item you know you can eat and share with others in the group. Most hosts will be completely understanding if you advise them in advance about your dietary limitations.
  • Be consistent. Whether you are out with friends or traveling, try not to tax your body with extreme changes in diet. Your digestive tract is happiest when things are stable and constant. Challenging the system with something exotic or excessive may end up disrupting the equilibrium you've been working so hard to maintain. 

By staying positive and focused, you can master your disease rather than let it control you.

Sources:

Bernstein, C.; Singh, S.; Graff, L. et al. A Prospective Population-Based Study of Triggers of Symptomatic Flares in IBD. Amer J Gastroenterology. 2010; 105:1994-2002. DOI: 10.1038/ajg.2010.140.

Crohn's and Colitis Foundation of America. (2017) Living with Crohn's Disease. New York, New York: Crohn's and Colitis Foundation of America. 

Danuta, O.; Rodacki, T.; Domagala-Rodacki, R. et al. Diet and nutritional factors in inflammatory bowel diseases. World J Gastroenterol. 2016; 22(3):895-905. DOI: 10.3748/wjg.v22.i3.895.