Eating Vegan with Crohn's Disease

Balancing a Vegan Diet for Crohn’s

Don’t believe the hype: It’s actually very easy to get complete nutrition with a vegan diet, especially one that is based on whole foods. A few easy guidelines will help you figure out a plant based whole foods diet that will agree with your Crohn’s disease.

The building blocks of a vegan diet for Crohn’s disease are the same building blocks for any healthy diet: fruits, vegetables, whole grains, beans, legumes, and nuts. Think back to the food pyramid. The majority of your calories will come from whole grains, beans and legumes.

Note: When adding significant amounts of fiber to your diet, it is very important to drink water. 6-8 cups a day is typically recommended.

Long Grain Brown Rice. 1 serving of 1/4 cup has 160 calories.
Whole Wheat Cous Cous. 1 serving of 1/3 cup has 220 calories.
Quinoa. 1 serving of 1/4 cup has 160 calories.
Buckwheat Soba Noodles. 1 serving of 2 oz has 190 calories.
Whole Wheat Bread. 1 serving of 1 slice has 100 calories.
Oatmeal. 1 serving of 1/2 cup has 150 calories.
Grits. 1 serving of 1/4 cup has 130 calories.

Red Split Lentils. 1 serving of 1/4 cup has 180 calories.
Chana Dal, Split Desi Chickpeas. 1 serving of 1/4 cup has 160 calories.
Great Northern Beans. 1 serving of 1/2 cup has 100 calories.
Black Beans. 1 serving of 1/2 cup has 120 calories.
Dark Red Kidney Beans. 1 serving of 1/2 cup has 120 calories.
Garbanzo Beans. 1 serving of 1/2 cup has 110 calories.

This information is coming from the packages of food in my pantry. This is what I had on hand today, and you can see there is a large variety to choose from. I typically shop at Kroger, a basic big box grocery chain, and occasionally go to Trader Joe’s or Patak Brothers (Indian grocery) to get different varieties of lentils or grains. These foods should be relatively accessible in your local grocery store.

Pairing a legume or bean with a whole grain will start any meal off around 2-300 calories. If you are eating several small meals a day to ease digestion, adding in one fruit and one vegetable will top off your caloric and nutritional needs. Round out your day with 1 or 2 servings of nuts or nut butter for additional calories and nutrients.

Once you build up your pantry with dried or canned whole grains, legumes, and beans, you will find it very simple to prepare any meal. I also keep several containers of vegetable stock on hand for cooking grains, as it gives any grain a more complex and savory flavor.

In addition to basic nutrition and caloric needs, the body with Crohn’s needs a little additional pampering. Including foods with resistant starch and prebiotic qualities will help maintain a healthy gut microbiome that allows you to more easily digest the plant based whole foods your body needs.

Common foods with resistant starch:
Plantains
Green Bananas
Beans
Peas
Lentils
Rice that has been cooked and cooled (ie: leftovers)
Potatoes that have been cooked and cooled
Whole grain pasta that has been cooked and cooled
Uncooked oats, added to smoothies, or soaked in the fridge overnight

Resistant starch does not raise your glucose levels, and is not digested in your small intestine. When it reaches your large intestine, it ferments slowly, releasing a small amount of gas, and feeding the healthy bacteria in your guts. Foods that feed healthy gut bacteria are called prebiotic. Resistant starch decreases cholesterol, helps control constipation, reduces the risk of colon cancer (a side-effect of biologic medications), and helps you feel more full after eating.

Other prebiotic foods:
Garlic
Onions
Leeks
Asparagus
Bananas
Oats
Apples
Cocoa (thank you jesus)
Flax seed
Wheat bran (found in whole wheat flour)
Seaweed

Based on this information, you can see why eating applesauce and vegetable soup during active disease would promote mucosal healing. You may already eat a lot of foods on the list. Eating them more regularly, or even daily, will improve your gut health. Additionally, a healthy gut regulates immune function and mood.

Finally, before you freak out about B12, take a deep breath and buy some Nutritional Yeast. Its like vegan shakey cheese. Nutritional yeast is heated and dried, rendering the yeast inactive. People with yeast allergies should still avoid this food, however. Alternatively called “nudge” or “crust dust,” nutritional yeast contains: protein, fiber, B1, B2, B3, B6, B12, potassium, iron, and calcium. Nudge reduces inflammation and supports immune function. Plus, it tastes really damn good.

Easing into Vegan

The bulk of scientific research on diets for weight loss is conclusive: diets don’t work. One reason for this is because our bodies are designed to maintain their weight during times of hardship and famine. This has been an asset to our species evolutionarily, and no amount of calorie counting will change this fact. The other reason why diets don’t work is, well, because it’s incredibly difficult to change your eating habits, and most people who try fail.

Trying a new diet for Crohn’s, however, doesn’t have the limitations of dieting for weight loss. Many people with Crohn’s struggle to put on weight, so we’re trying to eat more, not less, calories. Finally, when you get immediate feedback from your body as it rejects a food, it’s easier to give it up.

Our bodies are programmed to change our perception of foods that make us sick so that we find them unappetizing and avoid them in the future. This becomes an issue when EVERYTHING makes you sick due to your ulcerated digestive system. For people with Crohn’s, the struggle with diet is to find foods that we are excited to eat, and to rebuild a positive relationship between our minds, bodies, and our food.

The first step in building this relationship is getting into remission. This will require help from a gastroenterologist, probably some kind of medication, and eating whatever you can stomach.

A fool proof short term diet for remission is food replacement shakes, also called enteral nutrition. Some hospitals use enteral nutrition as a first step to Crohn’s treatment, but it isn’t a popular choice because liquid diets are super boring and patients have a hard time sticking to them. If you are willing to take the dive, however, food replacement shakes help reset your gut microbiota and speed up mucosal healing.

Once your gut has started healing, you will find it much easier to eat. Foods will be appetizing again, and you will be able to add new and different foods to your diet. This is the time to keep a food diary and pay close attention to what foods correlate with increased or decreased symptoms. This technique helped me realize that soy made me incredibly bloated, I was lactose intolerant, and processed food triggered Crohn’s symptoms for me.

When your health is stable and you have the time and energy to devote to trying a whole foods plant based diet, the first thing to work on is your mindset. You are rebuilding your relationship to food, and this diet is about eating more. It is about eating more servings of fruits and vegetables every day. It is about working more whole grains into your diet. It is about trying new and different fruits, vegetables, nuts, grains, beans and legumes, seeing what you like, and learning how to make them the most delicious to your tastes.

Before I plunged into a vegan diet, I tried to increase my intake of fruits and vegetables to 6-7 servings a day. I pack my breakfast and lunch to eat at work, so this was as simple as including 6-7 servings of fruit and vegetables in my lunchbox. If I found I wasn’t eating something, I’d swap it out for a different fruit or vegetable I knew I liked. By the time I was meeting my goal of 7 servings of fruit and veggies a day, I had already replaced a large amount of my diet with plant based whole foods.

Adding more to your diet is way easier than eating less of things you think you can’t live without. Adding more allows you to experiment and see what you like, learn what your body can tolerate, and discover new foods you’ve never tried before. Adding more allows you to give yourself permission, to be gentle with yourself during your healing process, and learn from your experiences.

This approach to veganism worked really well for me. I had been vegan and vegetarian before, a few years ago, and I was raised eating a large variety of fruits and vegetables. These experiences helped me know what to eat and how to eat it. If you haven’t had these experiences, however, I recommend experimenting at the grocery store. Each time you shop for food, put a new fruit or vegetable in your cart. It’s low risk, low cost, and you don’t have to like it; but if you do, you’ve made it one step closer to easing into vegan.

Diet for Active Disease and Remission

Note: this is purely anecdotal and not meant to constitute medical advice. Please work with your doctor to find the best treatment for your Crohn’s disease. It is a serious disease that can be life threatening.

Most people with Crohn’s react differently to different foods. During my round of steroids, when my disease was still active, I had a very difficult relationship to food. I was frequently painfully bloated, nauseated, and vomited more times than I care to remember. When you have developed the most efficient way of containing and disposing of your own vomit, that is a sign you are vomiting too frequently.

(Pro tip: puke into two plastic grocery bags, tie it off and put it outside in the dumpster.)

It took me a lot of trial and error and months of detailed food and symptom tracking to figure out what to eat. My go-to active disease diet is homemade applesauce with cinnamon, plain broth, and chicken soup with carrots and onions (I wasn’t vegan at the time).

For the applesauce, I would roughly core and chop about 6 apples and put them in a crock pot on low for 12-16 hours. I would add a generous amount of cinnamon, and sometimes honey or maple syrup. For people who cannot digest fruit and vegetable peels, I suggest peeling the apples before hand. Crumble raw pecans into the applesauce for better texture if you can tolerate them.

You could buy applesauce without additives, however hot fresh homemade applesauce comes with the added benefit of feeling like you’re doing quality self-care.

For a hearty healing stew, throw a frozen chicken breast in a pot with onions, carrots, garlic, celery, and some herbs, salt and pepper to taste. Top off with water or broth and simmer for 2 hours.

Now that I am avoiding animal products, my healing stew consists of: potatoes of various colors, carrots, onion, celery, garlic, fennel root, herbs, salt and pepper to taste. Cover the vegetables with vegetable broth and simmer for 1-2 hours. Peel the vegetables if you have difficulty digesting the skins. You can also puree this in a blender to make it even easier to digest.

And… that’s all I was able to tolerate when I was sick! It sure made shopping easy, except for the crippling fatigue.

As my health and appetite improved, I was able to add in other foods, such as: nuts, bananas, whole wheat toast, oatmeal, rice, fruit juice. Eventually I was able to eat a wider variety of raw fruits, such as strawberries and blueberries, pineapple, apples, mango, etc. I had some trouble with cherries, but I think I may have eaten way too many. Jury’s still out on that one.

Cooked vegetables and greens with whole grains (quinoa or rice) has become the backbone of my remission diet. Basic recipe looks like this: onion cut into moons, bell pepper thinly sliced, finely chopped celery and maybe carrots, salt, add 2-3 servings of quinoa or rice, top off with vegetable broth, cook for the amount of time indicated for the grain.

Feeling wild? Throw in some coarsely chopped kale, spinach, collard greens, or chard. Red split lentils are a savory addition to this one pot meal, and this can become many different meals by switching up the spices.

Roasted potatoes are another staple that pairs well with the above meal. Roll taters in olive oil, sprinkle with salt, roast at 375 for 35 mins. I like new potatoes of all colors because they cook fast and have a high ratio of crispy skin to insides.

For me, the key to success on a whole foods diet is to focus on the wide variety of things I can have, and try to add in new and different fruits and vegetables depending on what is in season. Eating mostly produce has me at the grocery store about 2 times a week. I cook a pot of food every couple days, which provides dinner and 2 lunches, and sometimes left overs for the next night. This cuts down on the amount of time I spend cooking.

Check out cookbooks from the library for inspiration! Many global cuisines are whole foods and plant based, as processed food is a luxury of the “developed” world. Some of my favorites: Indian, Persian, middle eastern, Mexican, Columbian, Thai, Italian, Peruvian, and vegetable based/not fried Chinese foods.

Lastly, I want to stress the importance that cooking for myself at home has had. Restaurants are notorious for giving us gigantic portions. I do better eating 5-6 small meals a day. Restaurants also often put more oil or butter in their dishes than one would when cooking at home. Finally, for people who are lactose or gluten intolerant, it is nearly impossible to know what will be in your food at restaurants. Beware that saag paneer on the Indian buffet: it tastes so dank because of the heavy cream! Bring lactase enzymes or pay the price at 3am: you have been warned!

Getting Off Meds & Going Whole Foods Plant Based

No one wants to be told they will be living the rest of their life on medication. For many in the US with substandard health insurance, being told you will live the rest of your life on expensive medications is a paradox.

How can I live well if I can’t afford to live? How can the best option for a decent quality of life be monthly intravenous infusions of a drug that costs $30,000 a shot? How can I manage to survive if I’m too sick to work, but too poor to afford the medication that can heal me?

These are the decisions I was trying to make in 2017 when I was diagnosed with Crohn’s disease. I was bed ridden for 3 months with constant diarrhea, too weak to work, too fatigued to do household chores most days. I was living off of an internet tutoring job that was sometimes interrupted by bouts of vomiting. I had some financial help from my parents, but I also racked up thousands of dollars of credit card debt, plus maxing out three medical deductibles in one year. I lost my job and insurance in January, started a second deductible in February, and a third in August when I got my next full time job.

Needless to say, Crohn’s ruined me financially, and physically. At the advice of my gastroenterologist, I went on an intense course of steroids for 3 months, and started on an incredibly expensive biologic drug, Remicade.

My story is very similar to others who are diagnosed with this debilitating and life changing disease. I was lucky to be diagnosed early in the game; some people suffer for years before even getting a Crohn’s diagnosis and flounder without appropriate medical care for their disease. The longer it takes you to get treatment, the more severely your gastrointestinal tract is damaged, sometimes resulting in the need for emergency surgery and removal of sections of diseased intestine.

After a year on Remicade, I was in clinical remission, although I was still suffering from a host of extra-intestinal complications of Crohn’s. These included intense fatigue and pain flares, which were difficult to manage working full-time as a high school teacher. I didn’t do much outside of work other than sleep, and occasionally grade stacks of assignments.

In November of 2018, I took a rediculously expensive test to see if the Remicade was working in my body. My inflammation markers (CRP) had started ticking up over the summer. The test showed that my body was producing antibodies to the Remicade, and my immune system was attacking the drug.

Each infusion was accompanied by an anaphlactoid immune response, where I would flush and have difficult breathing. I was given intravenous Benadryl and steroids before each infusion, but still was having reactions. In April of 2019, I cancelled my Remicade appointment and decided I was going to stop taking this incomprehensibly expensive and dangerous drug.

After reading dozens of medical publications, and getting very little advice from my gastroenterologist, I decided I could safely stop Remicade and try to manage my disease using diet. Most research suggested a Whole Foods Plant Based Diet. Current studies are looking at the relationship between the Crohn’s Disease Elimination Diet and remission. CDED is a whole foods plant based diet that avoids processed foods and emulsifiers, which are believed to permiate the mucosal layer of the intestine and induce an inflammation response.

In the past 8 months I have greatly increased the amount of fruits and vegetables I eat, along with whole grains. I haven’t been hard core about the total elimination of dairy, and through this I discovered that I am now lactose intolerant. A few late nights of stomach cramps and intense diarrhea cleared that one up pretty fast for me. I wasn’t a big meat eater before, and I had been vegan and vegetarian in the past, so I already had a wealth of resources and cooking skills to maintain a balanced diet and nutrition. The biggest shift for me has been eliminating processed foods.

Processed foods are literally everywhere, all of the time, enticing you with their shelf stability and convenience. But the industrial additives that allow these foods to persist in your pantry are the same additives that may be wreaking havock on our intestines. This is anecdotal of course, but I have found when I indulge in processed foods, I get negative feedback (diarrhea) from my body within 24 hours. Returning to a whole foods diet usually corrects this within 1-2 days. As many Crohn’s sufferers will attest, your best friend in this disease is paying close attention to how your body responds to certain foods. I can definitely confirm that my body responds negatively to processed foods, and responds in a positive and self healing way to whole foods.

When I started my Whole Foods Plant Based diet and went off meds, I had been in remission for a year and a half. My initial remission was most likely induced by steroids, and sustained in the short term by the Remicade. As my immune system developed antibodies to the Remicade and my CRP levels crept upward, I chose to try regulating my disease with diet. So far, my CRP levels have gone back down below 4, and I am meeting both my nutritional and intestinal needs with diet. I have had fewer pain flares this year. I still suffer from fatigue, but I hope this will improve as my remission deepens.

This blog will track my progress in attempting to control Crohn’s Disease with diet. I hope that other people with Crohn’s who have had similar experiences with medication will try to change their diets to support better health, either in conjunction with medication or without. I had to quit Remicade because of its prohibitive cost, as well as the terrible side effects I was having with my monthly infusions. Please know that there are many options for treatment of Crohn’s, and that finding the best treatment for you may mean getting second and third opinions, switching doctors, or doing your own medical research and bringing that to your doctor.

Rebecca Riley