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This is Digestive Health and Nutrition magazine from the American Gastroenterology Association.

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Macaroons for Crohn's?

By Karen McNally Bensing

Recent Internet and newspaper articles reported that eating a couple of coconut macaroons (small coconut cookies) every day brought relief to some sufferers of Crohn's disease. Supposedly, the therapeutic ingredient was coconut oil, and whether you ate store-bought macaroons or your mother's home made recipe didn't seem to matter. Any food containing coconut oil was reported to be equally effective.

So far, no clinical trials have established the beneficial effects of either macaroons or coconut oil in managing the symptoms of inflammatory bowel disease (IBD). But because Crohn's disease and ulcerative colitis are both digestive disorders, it seems reasonable to think that some foods may sooth an inflamed intestine while others irritate it.

AGA member David Sachar, MD, Clinical Professor of Medicine and Director Emeritus of the Division of Gastroenterology at Mount Sinai School of Medicine in New York, remembers the Archway macaroon story very well. Although the cookies' therapeutic benefits never panned out, the story is useful as a parable, he says. "It shows that people are so desperate for relief from the ravages of Crohn's disease that they'll grasp at any straw (or in this case, cookie)." He also notes that no claim of effective treatments for a chronically relapsing and remitting disease can be believed without an adequately controlled clinical trial.

It's not food itself that's the culprit in IBD, but an overactive intestinal immune system that sounds the alarm when it encounters perfectly harmless foods, explains Dr. Sacher. "You can't eliminate all stimuli," he says. "So today's principal mode of treatment is to damp down the intestine's abnormal response through drug therapy." Such drugs include corticosteroids, immunosuppressants like Imuran� (azathioprine), Purinethol� (6-mer- captopurine) and methotrexate, and newer biologicals like Remicade� (infliximab).

Despite the positive effects of medications, most people with IBD experience an increase in pain, diarrhea and bloating related to food. During flares, it's hard to know what to eat. Foods that caused no problems during the disease's quiet times become intolerable to an angry digestive tract.

My Experiences

I've had Crohn's for more than 30 years. It's been well controlled with medication, and, thankfully, I've been spared surgery. Most of the time I can eat pretty much what I want � salads, raw fruits (if they're peeled), pizza, even peanuts. Popcorn is always a no-no. When my Crohn's acts up, every meal sends me to the bathroom. I feel bloated and can't bear to wear anything that constricts my roiling intestines. Even the blandest of diets is disagreeable. I'm limited to small amounts of boiled rice and flat ginger ale until things settle down. Gradually, I return to more normal meals.

Dr. Sachar offers three principles of dietary advice to his IBD patients. "The best nutrition is found in food," he says. "I encourage patients with IBD to eat as close to a normal diet as possible."

Basic healthy eating patterns apply to people with Crohn's and ulcerative colitis. Eat a variety of foods with lots of fruits, vegetables and complex carbohydrates such as breads, cereals and pasta. Limit fat and sweets. Substitute fish and poultry for red meats, and use low-fat dairy products.

Dr. Sachar's second principle addresses "plumbing considerations." Roughage found in raw vegetables, fruit peels, nuts and popcorn can damage the fragile intestines of those with ulcerative colitis. Fibrous foods may cause blockages in people with Crohn's whose intestines are narrowed by inflammation � much like a backed-up pipe. Minimize roughage by peeling and cooking fruits and vegetables. Avoid tough cuts of meat and foods containing nuts, including chunky peanut butter.

Third, Dr. Sachar says that when it comes to food, "let your own experience be your guide. If a food is troublesome, don't eat it." If milk makes you queasy and bloated, try lactose-free dairy products instead. Spicy, rich, fatty foods don't always agree with me. Although I enjoy them, I limit how much and how often I eat cheesecake, chips or French fries.

If you're underweight or deficient in vitamins and minerals, consider seeing a registered dietitian. Dietitians are experts in assessing individual nutritional needs and will work with you to develop meal plans to add pounds and improve your overall nutritional status. Most health insurance plans will cover such consultations with a referral from your primary care physician.

Many people with IBD experiment with alternative nutritional approaches, such as the Gottshall Diet, which recommends eating only certain easily digested carbohydrates that are well absorbed by the intestine. "Many alternative strategies offer real relief," Dr. Sachar says. You may want to try such diets, adapting them to suit your own symptoms and food preferences.

I myself haven't been tempted by the purported benefits of macaroons � mainly because I don't care for coconut. If only chocolate chip cookies had the same healing properties!

https://www.gastro.org/cgi-bin/dhn-free-art.pl?URL=Macaroons-for-Crohn's?12002

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My website on IBS is www.ibshealth.com

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