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Alanna Cabrero, MS, RDN, CDN

Clinical Dietitian, Private Practice at Alanna Cabrero Nutrition, PC, New York

Q: Will almond milk or peanut butter cause inflammation or will it aggravate Colitis ? I know eating nuts and seeds in their solid natural form is hard to digest but what if the food is in a liquid and or butter form, i.e. almond milk or peanut butter?

A: Please note - nuts and seeds do not increase inflammation or worsen colitis. They are great foods that have fiber, healthy fats, protein, and antioxidants. That said, during a flare the whole food forms may be harder to digest or feel a little irritating to the GI. So the modified texture such as smooth nut/seed butter (almond butter, sunflower butter, cashew butter, etc) or milks (coconut milk, hemp milk, etc) can definitely be more conducive during periods of inflammation. Make sure to reduce added sugars, processed oils, and additives such as carrageenan when choosing nut/seed butters or milks. hide answer

Q: I'm 16 and was diagnosed with Crohn's last year. However, I experience severe constipation and have been hospitalized before because of it. Information I read says to eat vegetables when constipated but a lot of the veggies I can't eat because of narrowing. What foods will help with constipation? What other lifestyle and diet changes should be to help with this issue?

A: My recommendations for patients who have both constipation and narrowing of the GI are the following: 1) Slow down and chew your food well. 2) Drink enough liquids (ideally water) while eating. 3) Modify textures, especially when it comes to fiber. Therefore, cooking, liquefying (smoothies, soups, etc), grinding, pureeing, or finely chopping can help boost fibrous foods without making matters worse. 4) Spread out your fiber throughout the day. 5) Move after meals to aid digestion. Ideally, walk 5-10 minutes after bigger meals. 6) Make sure you are squatting on the toilet to aid proper evacuation of bowels and reduce straining. You can use something like the Squatty Potty, but it can also be a simple step stool. 7) Consult a dietitian. There may be supplements or other specific suggestions that can help you. Constipation varies patient to patient, so I may use magnesium, fiber supplements, abdominal massage, or coffee to stimulate bowels, to mention a few, but it may not be favorable to everyone. hide answer

Q: I was diagnosed with Crohn's over a month ago and have drastically adjusted my diet along with the medication. My biggest heartbreak is coffee. Do people find it problematic to drink it (only one cup a day) while in remission without it contributing to a new flare up or is it best to be remove it from my diet forever?

A: There is no clear research on coffee/caffeine and IBD. I am usually okay with most of my patients having a cup of coffee (or two) a day. That said, there are usually a few things that I clarify about coffee/caffeine beforehand: 1) Caffeine stimulates the bowels, so if you have urgency and/or diarrhea, which usually accompany a flare, I would avoid. It’s just basically fueling the fire and not helping the symptoms. 2) Coffee is not all created equal. A lot of the negative health associations with coffee are more related to what you put into the coffee – sugars, artificial sweeteners, fat, etc. So, a little bit of milk, lactose free milk, or milk alternative is the better choice. And remember, 1 cup equals 8 ounces (portion control). 3) Coffee/caffeine can exacerbate stress, anxiety, and alter sleep. So, if you are experiencing any of these issues, I would decrease or avoid. hide answer

Q: I’m wondering what oils my daughter can have. She has been diagnosed with ulcerative colitis. I know olive oil is good but vegetable oil is not. What about cotton seed oil, soy bean oil? Palm oil, sunflower oil and hydrogenated vegetable oil? Any help would be greatly appreciated.

A: • Flaxseed oil is a great option for drizzling and salads. It’s high in plant-based omega-3 fatty acids, but you can’t cook with it, because it oxidizes quickly. • Extra virgin olive oil is my favorite and a great choice for low-smoking points, so usually okay for drizzling, salads, and light sautéing. It has high amounts of anti-inflammatory monounsaturated fats that are also easier to digest/break down. • Avocado oil is packed in heart-healthy monounsaturated fats, but unlike olive oil can be used at a higher smoking point (about 375 to 400F). It has a neutral flavor, and has been less chemically processed than canola or other vegetable oils. • Cold-pressed safflower or sunflower oil is low in saturated fats and high in omega-9 fatty acids. They both have higher smoking points (about 475 to 510F), so can be used frying (in moderation) and sautéing. • As far as soy bean oil, it’s a great source of polyunsaturated fatty acids as well as vitamin E, but much like other vegetable-based oils, I would choose cold-pressed or expeller-pressed oil. Ideally choosing organic and/or non-GMO varieties and always avoid the words hydrogenated or partially hydrogenated, which usually imply presence of trans fats, which we want to avoid. It also has a higher smoking point at 450F. hide answer

Q: I was recently diagnosed with a mild case of Crohn's ileitis. I was wondering what diet and lifestyle changes I should make to accommodate to my disease?

A: 1) Eat a cleaner diet. Try to choose whole foods and whole ingredients. Reduce/avoid processed, packaged, artificial, dyed, and fast food. This naturally forces you to cook a little more and have a better general awareness of food. I usually do suggest to try and choose local/organic options, especially when it comes to animal products and use the Dirty Dozen/ Clean 15 for all produce, which will help reduce pesticide exposure. 2) Avoid foods that exacerbate symptoms. It can help to keep a food/symptom diary. Some common triggers are: a. Alcohol and/ or caffeine (stimulants) b. Dairy products, usually high in lactose such as milk, ice-cream, creamy sauces c. Fried or high-fat foods, such as fried foods, red meats, processed meats, pastries d. Large quantities of roughage, such as salads, beans, whole nuts/seeds. Too much fiber, especially during a flare, usually exacerbates symptoms. e. Refined sugars and flours. Some patients are sensitive to high amounts of gluten, such as bagels, pastas, cookies, etc f. Additives and preservatives such as MSG, antibiotics, emulsifiers, artificial sweeteners, and coloring agents 3) Instead of altogether avoiding foods, try to change the quality and/or texture of the food. For instance, patients during a flare may not be able to have a salad, but you may be able to include a little spinach in a smoothie, add yam and squash to a chicken soup, or have soft/skinless fruit such as bananas, cantaloupe, or papaya as a snack. Cooked, blended, stewed, ground, and pureed food are can be easier to digest. 4) Focus on how you eat as much as what you eat. Chewing your food, slowing down, eating mindfully, and avoiding overeating are as important. This aids the digestive process and essentially creates a better relationship with food. 5) Find something that helps you relax and find your happy place, it can be meeting with a friend, finding a support group, meditation or Yoga. Stress mgt is a key part of your overall healing. hide answer