“Make Your Own Do Not Eat List”
The diets of patients with Crohns are as varied and unusual as the attendees of amusement parks on a summer day (great people watching I love it)….. Some people eat or drink everything while others stick to narrow diets supplemented by vitamins and snake oils (which cost an arm and a leg). However talk to any patient and invariably they will have some list (of varying length) of foods or drinks that they have noticed hurt them or cause abdominal discomfort. This is a really important list as it means you likely will never or only rarely touch these foods as they risk triggering a flare. Therefore I think the criteria for determining what gets put on the list is worthy of careful consideration.
Some people may think I am weird but I will only put something on my “do not ever eat or drink” list until I have put it through an elimination and subsequent challenge. For me, simply closely keeping track of which foods I eat throughout the day because didn’t cut it because I generally eat or drink a lot of stuff throughout the day and it can be difficult to determine which food exactly is causing trouble. I would rather really know which suspect food is causing trouble rather than guessing from a laundry list of what I ate during the week. Nevertheless, you need to get some sort of rudimentary list going. Some people use excel spreadsheets, I think there are phone apps now, and others (like me) just write down suspect foods in a little book that I carry with me.
Once I make a list charting foods I have eaten with bowel habits I generally examine it closely looking for trends that are temporally associated with increased bowel movement (BM) frequency, pain or blood. These are my measures of what constitutes a ‘bad food’ (use whatever criteria you want). Then I will completely clean up my diet for about 1-2 weeks. During this time I will eat only the blandest foods, NO RESTAURANTS (as you do not know ingredients), no alcohol at all and just ensure that digestion is going good. Once everything has settled down to an adequate degree (as I said this generally takes about 1-2 weeks for me) I will reintroduce only one suspected food. . . For me the results have usually been quite striking. Blueberries, pinnapple, oatmeal, avocado and beer caused night and day changes in bowel habits with the reintroduction of as little as 1 beer or a little bowl of fruit. Generally later in the day I will have all the uncomfortable symptoms back again but to me it is worth it because I have some sort of evidence that a specific food is causing a specific problem. I generally do repeat challenges every once in a while just to confirm.
This may sound like an extreme or weird method for some folks but to me I like to be sure that the one food I suspect is ACTUALLY THE ONE CAUSING THE PROBLEM. We eat a lot of foods with a lot of different ingredients so I know it can be really hard to get the right food on the list. Additionally this method can let me get really specific within food groups rather than swear off whole groups like citrus fruits or wheat. Instead I can test each food individually against the other members of the same group to see what I can tolerate. I have determined several foods that were ok to eat through this method which is also a benefit over a system of outright elimination based on suspicion alone.
You need to figure out which foods bother you asap because I would bet we all are continuing to eat some foods which are causing some low level discomfort. Whatever your method for identifying foods it will require you to be a careful historian so think about yourself and figure out what kind of list will work for you. Are you a smart phone addict? Get an app for your phone. A computer whiz? Use excel spreadsheets. Old school person like me? Use paper and pencil. Once you have a list and identified suspects it’s up to you to determine what level of evidence you need to put a food on the “do not eat list”. Once you do though expect some relief because diet control is super important in Crohn’s.