During a flare, should you eat more or less fiber?
Crohn’s disease is a chronic autoimmune disease, which means you can’t “cure” it, but you can take steps to manage your symptoms and improve your quality of life. In fact, many patients can successfully achieve remission—a state of no or mild symptoms—for years at a time thanks to treatment.
When Crohn’s disease symptoms get worse, this is known as a flare, which is caused by worsened inflammation in the body, according to David P. Hudesman, MD, associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
“It’s important to communicate [your symptoms] with the provider, so they can better help figure out what’s driving those symptoms,” says Dr. Hudesman. “Is it Crohn’s, or is it something else?”
Here are the lifestyle tips doctor’s recommend to manage a Crohn’s disease flare:
1. Quit smoking
“Smoking cigarettes is the worst thing you can do for Crohn’s disease,” says Dr. Hudesman. “There’s many studies showing that it worsens the course of Crohn’s disease—so how complicated that Crohn’s disease is. If you have surgery for Crohn’s, and you smoke cigarettes, you’re more likely to have another surgery.”
Additionally, cigarettes may reduce the effectiveness of Crohn’s disease treatments, such as biologics.
2. Live a healthy lifestyle
This includes things like getting enough exercise, sticking to a healthy sleep schedule, and eating a balanced, anti-inflammatory diet. While your lifestyle can’t cure the disease, it has been shown to minimize symptoms and improve quality of life.
A healthy lifestyle also minimizes your risk of complications associated with Crohn’s disease, such as osteoporosis and colorectal cancer, or common chronic diseases like heart disease or type 2 diabetes.
Regarding a healthy diet, be cautious about attempting fad diets that claim to cure or reverse your disease. “There’s no perfect diet for Crohn’s or ulcerative colitis,” says Dr. Hudesman. “How you feel is different than what’s happening inside. So going on a certain diet or restricting what you’re eating may make you feel better, but inside, things could be the same, or actually getting worse.”
Consider visiting with a registered dietitian if you’re having trouble finding the balanced diet that works with your body and aids in your disease management. (Find out what to expect at your first appointment with a nutritionist here.)
3. Reduce stress
Stress plays a critical and reciprocal role in Crohn’s disease. Those experiencing disruptive symptoms can often have elevated levels of stress, and stressful situations can also make symptoms worse or lead to flares, according to the Crohn’s and Colitis Foundation of America.
4. Limit high-fiber foods during a flare
Generally, fiber is essential for a healthy diet, but during a flare, it can worsen symptoms. During those periods, it might be beneficial to choose plain white bread instead of whole-wheat bread, for example. These are easier to digestion, and thus easier for your Crohn’s disease.
5. Try over-the-counter medicines
There are some do’s and don’ts for OTC meds to manage Crohn’s disease. During a flare, do try these OTC options:
Antidiarrheals can safely help to reduce diarrhea
Fiber supplements can reduce cramping and bulk up stool
Mild antispasmodics can reduce pain caused by bowel spasms
But while you’re in the pharmacy for a flare, don’t grab NSAIDs, or nonsteroidal anti-inflammatory drugs, like ibuprofen, naproxen, or aspirin. These OTC pain relievers can irritate the digestive system and make a flare worse.
Ideally, if you stick to your treatment plan and a healthy lifestyle, you may be able to prevent a flare altogether and remain in remission. This is why it’s important to continue taking your prescribed medications and playing an active role in your treatment, even when you’re feeling well.
Dr. Hudesman is an associate professor in the Department of Medicine and medical director of the IBD Center at NYU Langone Health.
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So to minimize the risk of flaring,
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the most important things patients could do is take their medications,
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come to follow-up visits, even if they're feeling well,
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and get the required blood work and stool tests.
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So when symptoms worsen, it could be a Crohn's flare,
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so more inflammation on the inside.
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It's important to communicate with the provider,
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so then they can better help figure out what's driving those symptoms.
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Is it Crohn's, or is it something else?
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I wouldn't recommend rushing to taking something over-the-counter,
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or adjusting or increasing medications without getting a better sense
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of what's causing the symptoms.
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Smoking cigarettes is the worst thing you could do for Crohn's disease.
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There's many studies showing that it worsens the course of Crohn's disease,
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so how complicated that Crohn's disease is.
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If you have surgery for Crohn's, and you smoke cigarettes,
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you're more likely to have another surgery and the disease to come back.
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And if you're on medications for your Crohn's disease,
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such as your biologics, there is some evidence
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showing that people do not respond as well to biologics
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if they smoke cigarettes.
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Many studies have shown that exercise,
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being on a well-balanced diet,
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people feel better with their Crohn's disease.
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It improves quality of their life and it minimizes the symptoms.
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Also, stress reduction.
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Sometimes, going to yoga, or going to the gym,
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you get your exercise, and that can also reduce stress as well.
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There's no perfect diet for Crohn's or ulcerative colitis.
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How you feel is different than what's happening inside.
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So going on a certain diet, or restricting what you're eating,
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may make you feel better, but inside,
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things could be the same or actually getting worse.
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When you're in an active flare, when you have active symptoms,
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that's where foods high in fiber may worsen the symptoms.
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Symptoms that could be controlled by over-the-counter medications,
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so, frequent bowel movements or diarrhea could be controlled
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with over-the-counter antidiarrheals.
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Fiber supplements, I think, are underutilized,
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and can help bulk up stool,
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possibly cause less cramping and less looser bowel movements.
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For pain or spasms, that's when I like to prescribe a mild antispasmodic.
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What you do want to avoid over-the-counter is NSAIDs or nonsteroidal anti-inflammatories,
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such as ibuprofen, naproxen, and aspirin.
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So what patients could do to really manage their Crohn's
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is to be an active member of their care,
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discussing their concerns with their physicians.
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Patient education: Crohn’s disease (beyond the basics). Waltham, MA: UpToDate, 2019. (Accessed on December 5, 2019 at https://www.uptodate.com/contents/crohn-disease-beyond-the-basics.)
The facts about inflammatory bowel diseases. New York, NY: Crohn’s & Colitis Foundation of America 2014. (Accessed on December 5, 2019 at https://www.crohnscolitisfoundation.org/sites/default/files/2019-02/Updated%20IBD%20Factbook.pdf.)