When you start to experience symptoms again, it can be really difficult to know what to eat and how to get yourself back to feeling well again. Below are 15 diet, lifestyle, self-advocacy tips to keep in your back pocket the next time you’re in a Crohn's or colitis flare.
Remember, symptoms are poorly correlated with disease activity, so just because you’re in a symptomatic flare, it doesn't necessarily mean you have active inflammation. All of the tips included in this article can be used during a flare with or without active disease.
Advocate for yourself
- Reach out to your doctor when you notice new symptoms. Your gastroenterologist can only help you if they know which symptoms you’re having. Know that they’ll never think you’re a burden for letting them know. If you don’t want to call, you can always send them a message through your patient portal.
- Request inflammatory lab tests. Ask your doctor if they can order labs to check for inflammation such as your C-reactive protein, sedimentation rate, and fecal calprotectin. If you haven’t had a scope or imaging study done recently, your doctor may bring you in for a colonoscopy, endoscopy, MRI, CT scan, or ultrasound to check on your disease activity.
Keep your diet expansive
- Swap out inflammatory foods for tasty alternatives. Just because you’re in an IBD flare doesn’t mean you have to eat a restrictive diet.
- Prioritize hydration. Is your urine a pale yellow? If not, you probably need to get in more hydrating fluids. Try adding in an electrolyte-containing beverage to encourage more fluid consumption and hold onto your electrolytes.
- Honor your hunger cues by having safe meals/snacks readily available. It's a normal response to skip or delay meals due to fear of symptoms, but that's not going to make you feel good. So, when possible, try having safe snacks around so that you can honor your hunger cues as they come up.
- Find satisfying alternatives for trigger foods. Trigger foods are any food that causes a symptom response for you. They can be inflammatory or anti-inflammatory and are unique to you. If you know chili powder triggers symptoms, you can either (1) have it and accept that you may have symptoms, (2) decrease the amount to decrease your symptom severity, or (3) swap it out for other herbs/seasonings.
- Eat mostly whole foods. Try to cook most of your meals at home. Cooking at home will help you to keep the ingredients in your meals simple as you’ll be able to control any trigger or inflammatory foods that you add in. If you’re too exhausted to cook, ask your friend, family member, or significant other to help while you rest. Keep a running list of safe meal ideas handy that you can rely on when you're feeling symptomatic.
- If you have active disease, eat plenty of protein-rich foods. During a flare with active disease, our protein requirements increase, so try to make sure that every time you eat, it contains some protein.
- Honor your food cravings. If you love pizza, but it triggers symptoms, adjust the recipe so that you can tolerate it and so that it's still satisfying. If you don’t want to modify your favorite dish, you can always eat it as is. Sometimes the symptoms are worth it! Remember, it’s important to nurture your relationship with food, even during a flare.
- Include plenty of tolerated fruits and vegetables in your diet during a flare. Research actually suggests that Crohn’s disease patients who consume high fiber foods (like fruits and veggies) were 40% less likely to flare than those who followed a low fiber diet1. You may need to adjust the texture and type of fiber to improve tolerability. If you’re not used to consuming a lot of fiber right now, you should slowly increase the amount of fiber in your diet over time to improve tolerance. If you have stricturing Crohn’s disease, you should work with a dietitian to help you safely increase fiber in your diet.
- Consume cooked and cooled starches daily. Cooked & cooled starches, such as potatoes, rice, and oatmeal, are very anti-inflammatory because they are used as fuel for probiotics and the cells throughout your colon. They tend to be well tolerated, too.
Optimize your lifestyle for rest and recovery
- Prioritize sleep. During a flare, your body is working overtime and it’s important to maximize the energy you get during your sleeping hours. To grab a few extra minutes each night, try heading to bed earlier or setting your alarm a few minutes later in the morning to maximize your sleep time. If you're having nocturnal bowel movements, try meditating when you get back into bed to help get back to sleep faster.
- Focus on stress management. Stress can make our symptoms worse so it’s important to have a stress management routine in place to reduce stress during flares. A walk around the block to clear your mind or a body scan meditation before bed are both great options to try.
- Eat foods that feel nourishing mentally and physically. When we’re experiencing symptoms, it’s easy for fear of food and restriction to creep into our life. If you’re in a symptomatic flare or have active disease, remind yourself that you need nutrients now more than ever. Choose foods and meals that feel nourishing and satisfying to eat so you can maintain a healthy relationship with food.
- Focus on getting plenty of rest. During a flare, many of us try to push through our fatigue and then feel bad that we’re not able to keep up with all of our responsibilities. It’s important to take the time you need to rest and lean on others for help when we’re not feeling our best. If you’re in a flare, can you take a day off of work? Can you add in a relaxing bedtime activity to unwind from the day and prepare your body for a good night sleep?
Work with an IBD dietitian nutritionist
- A dietitian with expertise in Crohn's disease and ulcerative colitis can help you implement these recommendations in a way that is sustainable and works with your lifestyle and preferences.
- Brotherton CS, Martin CA, Long MD, Kappelman MD, Sandler RS. Avoidance of Fiber Is Associated With Greater Risk of Crohn's Disease Flare in a 6-Month Period. Clin Gastroenterol Hepatol. 2016 Aug;14(8):1130-6. doi: 10.1016/j.cgh.2015.12.029. Epub 2015 Dec 31. PMID: 26748217; PMCID: PMC4930425.