Care and Feeding on a Crohn's Diet

by Samantha Gray

Editor's Note: The following article offers dietary recommendations based on the experience of one individual with Crohn's Disease and should not be taken as medical advice. You should check with your doctor or registered nutritionist before choosing a diet that is right for you.

"I can’t eat anything anymore. I’m a freak." That’s what my husband said when he was first diagnosed with Crohn’s disease over five years ago. Specifically, he has Crohn’s disease with stenosis of the IC valve, and his diet must include very little or no fiber. Upon diagnosis, his doctor rattled off a long list of what my husband could never eat again. Put in the negative like that, it sounded like a lot of forbidden foods. Despite his original concern, my husband and I have found a long list of foods he can eat. If you are on a similar diet, it will take time to adjust and learn what you can and can’t eat. As a help, I would like to share what we have learned about shopping, cooking and eating out.

Shopping

Stock your kitchen with plenty of food that fits your diet. The last thing you want is to look for a snack and find only inedible foods. If fiber-loving family or friends use the same kitchen, make an effort keep high-fiber food in a separate place.

When shopping, read product labels to learn the fiber content of anything you consider buying. Fiber in some people with Crohn's can irritate the intestinal lining. If less than one gram of fiber per serving is an acceptable threshold for you, I would recommend the following grocery list as a start:

• Hard cheese without bits of vegetables in it, ricotta cheese, cottage cheese, ice cream and skim milk
• Rice based cereals like Rice Krispies and Rice Chex
• White bread, rolls, biscuits in a tube, instant mashed potato flakes, white flour and pasta
• Processed meats such as ground chuck, hot dogs, lunch meat, frozen or fresh fish and chicken; avoid meats with a stringy texture or a tendency to be tough such as steak and pork chops
• Tomato paste and tomato sauce - plain, not canned brands with seasonings
• Soups without vegetable chunks such as tomato, cheese, cream of potato, cream of mushroom, cheap chicken noodle soup, broth and bouillon granules without parsley or other seasonings in the mix
• Granulated or powdered seasonings to replace the flavor of vegetables without adding significant fiber including onion, celery and garlic; avoid even the tiniest leaf-like seasonings
• Bananas
• “Boost” nutritional supplement drink. Important note: any other supplement drink we have seen is high fiber, including “Boost Plus”

Whip up a Meal

With a stocked kitchen, the next challenge is updating your recipes to fit your diet. It took us awhile to convert our recipe book, but with time we found ways to season and substitute so that we could still cook many of our favorite dishes. To get you started, I’ll share two of our favorite meals created from the grocery list above.

Lasagna

For a dinner to feed at least six people, you’ll need an 8oz package of lasagna noodles, 16oz of ground chuck, a 24oz can of tomato sauce, ½ teaspoon onion powder, ¼ teaspoon garlic powder, ¼ teaspoon salt, a 15oz carton of ricotta cheese, 16oz of mozzarella cheese (sliced or shredded), 1 cup of grated parmesan cheese, white rolls and butter or margarine.

Preheat your oven to 375 degrees.

Prepare the noodles as directed on the package, rinse in cold water and set aside until the meat sauce is done. For the sauce, brown the ground chuck over medium heat in a frying pan and drain the grease. Add tomato sauce and seasonings to the meat and simmer over low heat while stirring occasionally for fifteen minutes. With all ingredients prepared and on hand, you’re ready to layer the lasagna. Scoop 1/3 of the meat sauce into a 9 by 13-inch baking pan and spread evenly over the bottom. Add a layer of noodles. Cover the noodles with half the ricotta cheese and 1/3 of the mozzarella cheese. Add a second, identical layer of meat sauce, noodles, ricotta and mozzarella cheese. Lay down a third layer of noodles, the remaining meat sauce and mozzarella cheese, and top with the Parmesan cheese. Bake the lasagna for 40 minutes, or until it is hot and bubbling and all the cheese is melted. After removing the lasagna from the oven, let it stand 15 minutes before serving with white rolls and butter or margarine.

Fried chicken fingers, stuffing, biscuits and mashed potatoes with gravy>

Stuffing

The most difficult piece of this meal is the stuffing because it must be started two hours before the meal and requires prep work the day before. To make stuffing for two people, you’ll need a half a bag of white bread torn into bite-sized pieces and air-dried for 24 hours, two 15oz cans of chicken broth, ¼ teaspoon salt, ½ teaspoon granulated sage, ½ teaspoon onion powder, ¼ teaspoon granulated celery or celery salt and ¼ teaspoon granulated pepper. First, preheat the oven to 450 degrees. Next, boil the broth and seasonings for 5 minutes, stirring constantly to keep the seasonings from settling out, then pour the broth over the bread in a baking dish, making sure to distribute the liquid over all the bread. Do not stir. Bake the stuffing for 30 minutes, remove it and stir just a bit with a large spoon to move the top layer of bread into the middle or bottom of the pan, then bake for another 30 to 60 minutes or until the stuffing is no longer soupy. Allow to stand 10 to 15 minutes before serving.

Chicken strips

For enough chicken to feed two people, you’ll need ½ pound of boneless and skinless chicken breasts, ½ cup of flour, 1½ cups milk, ¼ teaspoon salt, ½ teaspoon granulated sage, ½ teaspoon onion powder, ¼ teaspoon paprika, ¼ teaspoon granulated pepper, frying oil and a zip-lock plastic bag. When the stuffing is taken out of the oven, wash and dry chicken then cut into 1-inch-wide strips. Mix the seasonings with the flour in the plastic bag, dip the chicken strips into a bowl with the milk, then drop the milk-coated chicken into the bag. Close the bag and shake to thoroughly coat chicken with seasoning then fry in hot oil for 4 to 5 minutes on each side. When chicken strips are done, place them on a plate covered in 2-3 paper towels to absorb the oil. As a lower-fat alternative to frying, you may bake the chicken for 20 minutes at 450 degrees.

Biscuits

I recommend using the refrigerated biscuit dough in tubes from the store. Heat according to directions after the stuffing is removed from the oven, typically 8-10 minutes at 450 degrees.

Mashed potatoes with gravy

For the mashed potatoes, you’ll need 2/3 cup of water, ¼ teaspoon salt, 1 tablespoon of butter or margarine, 1/3 cup of milk and 2/3 cup of instant mashed potato flakes. When the chicken strips are done, combine everything except the flakes in a microwave safe serving bowl and microwave on high for 3 minutes. If you don’t have a microwave, boil the water and add it to everything except the flakes in a serving bowl. Then add the flakes and stir with a fork until they are the desired consistency. To make gravy, you’ll need 2 tablespoons of the chicken drippings, 2 tablespoons of flour, 1 teaspoon chicken bouillon granules and ½ cup of milk. Combine all of this in a sauce pan and stir constantly over low heat. When the gravy thickens and begins to bubble, remove it immediately and serve. If it becomes too thick, add a little milk.

Go Out to Eat

When you decide you want to go out for the evening, remember two words: special order. Be specific and thorough in listing everything you want left off the plate and don’t be shy about substitutions. I strongly recommend sending the waiter to check details with the chef before you finalize your order. And don’t forget garnishes. Chefs often sprinkle parsley flakes or other garnish across the entire plate for visual appeal, creating a meal that is inedible for you.

When it comes to fulfilling special orders, my husband and I have found three classes of restaurants. First, there are the high dollar, fine dining establishments. The waiters here are used to demanding, finicky tastes and the chefs make food to order. If you are specific about what you want, you can usually get it without a problem. Then there are the mid-level, sit-down-service restaurants. We’ve had poor luck in this type of restaurant because the food is often prepared before the meal is even ordered and therefore can’t be tailored. That brings us to the third type of restaurant, the fast food joint. Take advantage of the special order privileges they all allow. Just get to know the menus and find out what to omit.

Live and Eat Well

My husband and I have found that despite his medical restrictions, there is a lot of food that fits a low-to-no-fiber diet. I hope that our tips help you make the changes you need to live a healthy, happy life with Crohn’s disease. Just remember to stock your kitchen with your diet in mind, fine tune your recipes and special order. Bon apetit!

© 2000 Samantha Gray

Samantha Gray is a freelance writer whose husband has Crohn's Disease.