Early in my career, I met a patient with Crohn’s disease whose medical record showed moderate-to-severe inflammation.
Had I reviewed the wrong chart? 🤔
Because sitting in front of me was someone who felt completely fine.
No pain, no urgency, normal BMs.
She told me she’d only been diagnosed with Crohn’s after presenting with chronically low vitamin B12 and the occasional mouth ulcer.
She came to see me to learn what to eat (and what to avoid) to get better — and to find out whether she could eat her favorite salads, which everyone kept telling her to avoid.
Without GI symptoms to guide us (and with limited research back in 2012), we took a common-sense approach: mostly whole foods, minimal added sugar, and meals she genuinely enjoyed.
For her, that meant keeping small amounts of her beloved salads.
(A low-roughage diet is typically used to manage GI symptoms — and she didn’t have any, nor was she at risk for obstruction.)
Instead of tracking GI symptoms, we focused on her energy, mood, and overall quality of life — all of which improved (even though she hadn’t realized they were low until she felt better).
Since then, I’ve met many patients like her — people with active IBD but few or no GI symptoms.
Just last week, one of my patients with Crohn’s shared that she’s in mucosal remission after following the dietary plan we developed — one aimed at helping her heal rather than feel better, since she’d been asymptomatic all along.
All this to say: even when patients feel fine, they could still be flaring — and what they eat still matters.
For those who don’t work with people with IBD regularly, that’s something to keep in mind.
And for those who adjust diet based mainly on symptoms, it’s worth remembering that nutrition in IBD goes far beyond symptom management.
Want a quick refresher on all the ways diet can support IBD beyond symptom relief?
I shared some key talking points in this post — you can read them here.
