- Tamar Feldman, RDN CDE
Case Study: Crohn’s Disease and A Nutritional Intervention
Profile: Aviva* 21 years old
Aviva was a self-assured young woman who had been diagnosed with Crohn’s disease 6 months prior. At our initial consult, she was on a relatively benign anti-inflammatory medication used occasionally for mild Crohn’s cases. Her symptoms were still not fully controlled, and her main complaints were occasional abdominal discomfort and loose stools.
Aviva’s main concern was to reduce her current symptoms and prevent a flare-up of her condition, which would necessitate the usage of stronger medications. When she voiced the commonly verbalized desire to “get off all the medications,” I explained as I typically do at an initial visit that this goal may not be attainable for all individuals. We set an initial achievable goal of improved quality of life and reduced symptoms on her current regimen.
Lifestyle: High achiever, studying for a health profession
Mom verified that while Aviva overall managed her stress well, she definitely placed a lot of internal pressure on herself in the process of achieving her goals.
Stress can exacerbate most health conditions, including Crohn’s disease. In fact, I find that the majority of my GI clients are of either “type A” personality, prone to anxiety, or experiencing or have experienced severe or chronic stress due to extraneous circumstances. I discussed with Aviva the importance of learning and adopting healthy stress management and relaxation techniques.
Known Food Intolerances: Raw fruits and vegetables, dairy foods, greasy foods, spicy foods
Most individuals suffering from Crohn’s disease cannot tolerate the above foods well. Other commonly problematic foods for many individuals are nuts/seeds, alcohol, coffee, and high-fiber whole grains
Overall Rating of GI symptoms: 6 (on a scale of 1-10, 1 = perfect, 10 = awful)
Breakfast - Skipped or a bag of dry cereal
Snacks - White pretzels, crackers, applesauce
Lunch - Sushi, rice cakes with tuna or egg, salad with avocado (problematic in large quantities but seemed to be ok in a smaller portion)
Dinner - Chicken, turkey, fish with rice or potatoes; veggie soup or cooked veggie
Aviva appeared to be limiting her diet due to a fear of many foods and the desire to lead a functional life without exacerbating her Crohn’s.
Aviva, her mom, and I discussed what dietary restrictions she would be agreeable to trying. Aviva was quite nervous about any intense intervention such as SCD or the Crohn’s Disease Exclusion Diet and wanted to start on a milder dietary regimen with supplements and see if she could still achieve success. Because she had already identified dairy as a trigger, and there is limited data to support a dairy-free diet in IBD, we agreed upon a Mediterranean diet that excluded dairy.
The Mediterranean and dairy-free diet: I provided Aviva with a customized meal plan and some helpful recipes
Temporarily eliminate raw fruits and vegetables, choosing cooked forms such as soups, fruit soup, and applesauce; Blended smoothies are permitted
Citrucel Fiber, if prone to loose stools
Nutritional foods to incorporate into the diet
Sauerkraut 1-2 Tbsp /day
Bone broth 1 cup daily
Anti-inflammatory greens powder
1 month later
Aviva had been following the diet religiously for one month. She had already seen an improvement in her symptoms, giving herself a 4 on the self-assessment scale. Labs showed low Vitamin D levels.
Vitamin D 5000 IU/day – with follow-up monitoring, and decrease to 2000 IU/day once at baseline
Methylated B complex
Aviva reported progressive significant improvement, with session 3 spent mainly thinking up new food ideas. By session 4, she scaled her Crohn's symptoms at a 2, and she had cut her medication dosage in half with her physician’s supervision. She requested my approval to reintroduce salad and raw fruits, which I allowed in small quantities, increasing as tolerated. I requested that she re-test blood inflammatory markets and Vitamin D.
Session 5: 6 months later
Aviva was including most raw fruits and vegetables, maintaining a 2 on her Crohn’s self-assessment scale, and was happy with her diet. We were thrilled that her inflammatory markers were in the normal range! Vitamin D supplementation to maintain her sufficient levels was advised indefinitely.
Working with Aviva was a wonderful experience demonstrating to me the effectiveness of nutritional therapy combined with a positive attitude and a strong will. While not all Crohn’s cases are fortunate to see complete improvement, most can see some degree of positive change from an evidence-based dietary approach.
Note: Names have been changed to protect privacy*
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Tamar Feldman, RDN CDE is a Registered Dietitian/Nutritionist and a Certified Diabetes Educator, specializing in nutritional therapy for gut health, autoimmune disease, and hormone balance. She serves as the lead dietitian for GI Trak virtual gut health center and is a wellspring magazine contributor.