Two amateur cooks explore the world of cooking for a Crohn's and Colitis diet

The IBD Guide to Eating Out

While Marnina and I really enjoy cooking, we never turn down the opportunity to occasionally have someone else cook for us.  We do not eat out very often, maybe once a week, often on Saturday nights.  We relish these occasions because it represents one meal we do not have to plan, and we also enjoy trying new restaurants and cuisines.  We have our pick of any cuisine (the Washington, D.C. area offers every cuisine you can imagine), and believe me, we do our research before we head out.  There have been nights where we have debated for nearly an hour about which cuisine to eat, and then when we do finally choose a cuisine, we spend an additional 20-30 minutes looking online for restaurants that are well-reviewed, within our price range, within our driving range, and of course, that offer IBD-friendly food.  Over time (after visiting hundreds of restaurants together over the course of 5+ years), certain cuisines have stood out as more IBD-friendly than others.

We have assembled this IBD restaurant guide partly because we have yet to find one online.  The average American eats out several times a week, and those with IBD often have a more difficult time choosing IBD-safe foods at restaurants or even finding a restaurant that meets their dietary needs.  In creating the guide, we wanted to provide the “average” IBDer with some practical knowledge of each cuisine, and to give tips on how to navigate a menu and order food when dining and exploring various cuisines.  We hope the guide will become a tool for those with IBD to allow them to make smarter choices.  We also hope to expand it to include additional information (by no means is this guide an exhaustive review of each cuisine!), and in the future we hope to add lesser-known cuisines, such as Korean, Afghan, and El Salvadorian.  Feel free to add your own thoughts about the guide, which cuisine you prefer, IBD-friendly restaurants that you recommend, or even certain dishes that you always order because they are “safe” for you.

The guide includes a range of grades ranging from A+ to an F for each of the cuisines.  We based our grading system on the following 5 factors:

1) The food itself
2) The variety of food offered that is generally IBD-friendly
3) The willingness of the chefs to modify dishes to meet certain needs
4) The knowledge of the serving staff
5) The nutritional benefits of the cuisine

We did not use a sophisticated scoring system with percentages, standard deviations, or anything remotely resembling a math equation.  We just used our plain-old noggins to reflect on how each of the five factors contributes to an IBDer’s overall experience at each particular cuisine.

***As we always emphasize, IBD is very individualized; what works for some does not work for others. You might want to try to keep a food journal and see if certain foods affect your symptoms to better judge which restaurants and cuisines work for you.***

***Disclaimer:  Many of these cuisines have been Americanized, and the description I provide for each cuisine is the Americanized version.  Also, the tips contained in this blogpost are for someone who follows a diet similar to Marnina’s – they cannot be generalized to the entire IBD population.***

Indian

Eating out at our favorite Indian restaurant in Cambridge, MA

Grade: B

Indian cuisine can be tricky for IBDers because everyone reacts differently to different amounts of spicy food and different fats/oils.  Indian food includes lots of spices; some of the frequently used spices are chili peppers, cumin, turmeric, fenugreek, ginger, coriander, garlic, and black mustard seed.[1]  One popular spice mix is garam masala, a powder that typically includes five or more dried spices. Before ordering a dish, ask the server what spices the dish contains to be sure that you aren’t setting yourself up for disaster.  Don’t be afraid to ask the server questions – they are supposed to know the menu front and back and are there to make sure that you have a positive dining experience.

Most of the Indian food served in the U.S. is North Indian cuisine, which is generally less spicy than South Indian cuisine.  North Indian cuisine uses a lot of yogurt, cream, and is often non-vegetarian.  Tandoori chicken and naan are typical of North Indian cuisine.[1]  Many of the Indian dishes served in the U.S. are creamy/saucy, which can means lots of oil or butter.  Most Indian curries are cooked in vegetable oils, but peanut oil, coconut oil, sesame oil and butter-based ghee are used frequently.[1]

Only a few Indian dishes are dairy, which is helpful because many IBD sufferers are lactose intolerant or have a dairy sensitivity.   The most commonly found dairy food is paneer, a fresh curd cheese made by curdling heated milk with lemon juice or other food acid.[2]

Rice biryanis are usually safe optioms because they are rice-based, and include spices and sometimes even meat, eggs and vegetables.  If the biryani comes with peas or lots of spices, you can ask the server to modify the dish to your liking.

Luckily, there are lots of vegetarian options if you do not eat meat.  Palak Paneer (farmer’s cheese in a  thick curry sauce based on pureed spinach) is a popular vegetarian dish, as well as Aloo Ghobi (potatoes and cauliflower).

Marnina really enjoys Indian food because she likes the spice, and she often says that the food is so well-cooked that it is almost the consistency of baby-food, and therefore easier to digest. She does make sure that her dishes never come with peas and that she doesn’t order the whole wheat naan.

Also, be careful with the appetizers when eating Indian food. At many restaurants the server may bring a cracker-like bread while you are waiting for your meal with many different kinds of dips.  This flat unleavened bread is known as roti, and it sometimes has whole cumin seeds. If you are sensitive to seeds, avoid the “bread” in its entirety.  Your food will be worth the wait.

Tips:

  • Order the lowest level of spice if spiciness bothers you
  • Be sure to ask the serve to make sure there is no cream and little oil in what you order/order dishes that have little to no cream and/or oil
  • Do not order dishes with chili peppers, or red and green peppers if these peppers bother you
  • Avoid spicy hot curries
  • Order dishes with turmeric!  Turmeric has been shown to have many anti-inflammatory properties
  • Order a dish that does not come with globs of cream/sauce, such as a tandoori chicken (chicken that is marinated in yogurt, seasoned with a tandoori masala spice, other spices, and cooked in a clay oven)[1]
  • Do not order deeply fried dishes (eg. samosas)
  • Avoid the dishes with legumes (chickpeas and lentils are commonly found in Indian dishes)
  • Avoid naan if you have gluten/wheat intolerance.  Naan is usually made using wheat flour
  • Be careful of whole seeds in your dish, such as cumin seeds
  • Considering ordering baked bread with chutneys, tandoori seafood or vegetarian dishes
  • Ask questions!

Japanese

The one time (to be repeated in the future) that we didn’t go out for sushi. Instead, we made it ourselves!

Grade: A-

Most IBDers can tolerate sushi and sashimi, as long as the sushi does not have raw vegetables or seeds.  When Marnina and I eat sushi and/or sashimi, we stick with the seafood dishes that are paired with something non-fibrous, such as shitake mushrooms.  There are many omega-3 fatty acids that can be found in sushi, such as salmon, tuna, mackerel, and avocado.  The seaweed is not too fibrous either.  Seaweed was one of the first foods that Marnina checked when she was told to avoid fibrous foods upon returning from the hospital – luckily, the seaweed used to make sushi (nori) are very thin and do not contain a lot of fiber.

Many Japanese dishes are fried, but some are just tempura-fried (lightly fried).  In general, the Japanese tend to pan-fry, stir-fry, steam, grill, or boil their dishes, so as long as you avoid the lightly fried dishes you should be okay.  Generous amounts of spices are used, so if you are sensitive to lots of seasonings, be careful what you order.  If MSG bothers you, avoid the soy sauce, and ask the server what seasonings/flavorings have MSG.

The heavy emphasis on rice and noodles means this cuisine is often IBD friendly.  Noodles are featured in many soup dishes too, and the noodles are often rice, buckwheat, or wheat based.  The Japanese also use a lot of IBD friendly veggies that are well-cooked, such as mushrooms and carrots.

Tips:

  • Start off with some gyoza! These potsticker dumplings typically consist of a ground meat and/or veggie filling wrapped into a thinly rolled piece of dough.  Gyoza are steamed so nothing raw.
  • Avoid edamame if fiber bothers you. Yes, edamame is incredibly healthy for a normal person, but the beans are very high in fiber and can be a dangerous food for someone with IBD
  • If ordering sushi, remember to ask the server for no seeds! (regular sushi is almost always rolled in sesame seeds)
  • Avoid the deep-fried and pan-fried dishes
  • Avoid wasabi if spicy foods bother you
  • Consider ordering broiled fish, broiled tofu, udon soup or soba noodles
  • Ask questions!

Thai

Picture courtesy of TheCulinaryLife.com

Grade: B+

Thai cuisine is IBD friendly because of the availability of rice and noodle dishes, and because of the abundance of dishes with cooked veggies.  Their flavorings tend to come from chili sauces, fresh herbs, and other seasonings.  Most non-Thai curries consist of powdered or ground dried spices, whereas the major ingredients of Thai curry are fresh herbs.  A simple Thai curry paste consists of dried chilies, shallots and shrimp paste.[3]  More complex curries include garlic, galangal, coriander roots, lemon grass, kaffir lime peel and peppercorns.[3]  Thai food can be highly seasoned, and sometimes spicy.  Therefore, always ask the server about the spiciness of a dish before ordering it.

Thai cooks often stir-fry the food in coconut oil (high in saturated fat) so try not to eat an entire noodle or rice dish in one sitting.

Many of the soups are low fiber, such as miso soup.  Thai chefs tend to use broth and simmered veggies and/or tofu in their soups, as well as flavorful herbs such as lemongrass.

Tips:

  • Order some steamed dumplings as an appetizer!
  • Thai restaurants usually indicate a dish’s spiciness by the number of hot peppers next to the name of the dish, so pick a mild dish or ask the server if a spicy dish can be made mild
  • The fat content can be relatively high in a Thai dish, so ask the server to package ½ the dish before it is brought to your table (you will also go home with leftovers for the next day!)
  • Consider ordering Pad Thai noodles, noodle dishes, or steamed seafood
  • Ask questions!

Chinese

Eating Chinese food on Christmas Day — a Jewish tradition!

Grade: B+

Chinese cuisine is not as bad as many people make it out to be.  It is entirely possible for someone with IBD to walk out of a Chinese restaurant with their GI system intact.  To start, the soup options are low-fiber (egg-drop or wonton soup).  The entrees are usually served with a side of white rice, a food that is easy for most IBDers to digest, and the entrees do not contain dairy products.  In addition, Chinese food rarely uses much tomato, which is listed as one of the foods most likely to cause a Crohn’s flare.   However, that is where the good news ends.  One of the main appetizers are fried spring rolls (avoid these at all costs!). The entrees are often very fatty because of the generous amount of oil used in the meat, noodle, rice, vegetable dishes.  Also, if spice bothers you, avoid the dishes that are marked in some way as spicy.  In addition, MSG is found in many Chinese foods, which can exacerbate symptoms associated with IBD.

If not feeling well, you should not feel safe ordering a dish that has lots of vegetables because Chinese cooks usually only slightly steam their vegetables, which are much more nutritious than well-cooked vegetables, but this can cause problems because the fibers are not as easy to digest.

Tips:

  • Ask the server to package half of your dish even before it arrives so that you are not tempted to consume your entire meal
  • Ask that very little oil be used in your dish
  • Many Chinese restaurants have a special menu section with “healthy choices” that are steamed and have no oil added – these options should be an automatic draw from people with IBD
  • If ordering appetizers, order a steamed option
  • Stick with white rice rather than brown rice or fried rice (unless you can tolerate brown rice)
  • Ask the server if the veggies can be cooked longer to insure that they are soft, ask for less oil
  • Rather than ordering fried-food dishes, look for tempura fried (lightly fried)
  • Ask for less spice if that bothers you
  • Avoid cruciferous veggie dishes, such as beef and broccoli,
  • Moo shi, a popular Chinese dish, is probably not tolerated by many IBDers (it is usually made with some combination of cooked cabbage, bok choy, snow peas, and celery, all of which have a lot of roughage).
  • Ask if your dish is prepared using MSG
  • Consider ordering Dim Sum, steamed vegetable or seafood dumplings, or stir-fried seafood
  • Ask questions!

American

Chocolate birthday fondue for Marnina’s 21st birthday

Grade: C+

American cooking is the fusion of multiple ethnic or regional approaches into completely new cooking styles. When you think of traditional American dishes, the first things that probably come to mind include chicken wings, mac ‘n’ cheese, French fries, barbecue, grilled cheese, burgers, and hotdogs.  For the purposes of this restaurant guide, I will refer to a traditional American restaurant that serves everything from burgers to a wedge salad to crab cakes.

Much of American food is high in fat due to the plentiful use of meats, cheeses, oils, and sauces.  A regular old burger will often contain 6-8 oz. of ground beef with cheddar cheese, and some kind of sauce, not to mention a side of onion rings, French fries, or coleslaw.  One of the biggest culprits is the size of the serving, such as a 16 oz. ribeye steak, an inordinate amount of beef for such a fatty cut of meat.  American restaurants often like to make their chicken or seafood “crusted,” otherwise known as fried in breadcrumbs or fried in some other crumb mixture.  Even the salads often contain bacon, some kind of cheese, croutons (bread crumbs drenched in oil), and a fatty dressing (avoid Caesar dressing at all costs!).

Tips:

  • Start off with a non-creamy soup, such as chicken noodle or minestrone
  • Look for steamed or stir-fried dishes, or sandwiches that have a lean protein and some cooked vegetables
  • If you can tolerate salad, order a salad that is paired with a protein
  • If your dish comes with french-fries ask the waiter if you can substitute them for a baked potato or a cooked vegetable – believe me, your guts will thank you later!
  • Be careful with the desserts – cheesecake, ice cream sundaes, apple pie and the other traditional “American” desserts tend to be incredibly fatty. If ordering dessert is unavoidable, share with someone else so you don’t end up consuming the entire dish

Mexican/Tex-Mex

We love enchiladas!

Grade: C-

Mexican and Tex-Mex cuisines are characterized by their heavy use of melted cheese, corn, meat (particularly beef), tomatoes, beans, and spices, in addition to tortillas.  Chili con carne and fajitas are actually Tex-Mex inventions.  A common feature of Tex-Mex is the combination plate, with several of the above on one large platter. Serving tortilla chips and a hot sauce or salsa as an appetizer is common in Tex-Mex restaurants. There are lots of spices used, and chili peppers and jalapenos are used sometimes for additional spice.

In terms of IBD-friendliness, Mexican/Tex-mex is not the friendliest cuisine.  The fat content from the cheese and beef, the generous amounts of spice, the beans, the corn, the salsa, and the corn tortillas are a disaster for someone with IBD.  To compound the problem, the portions are massive, especially in a combination platter.  To top it off, the vegetables that are used (red and green peppers, onions, and corn) are vegetables that are often difficult to digest for some (corn especially), and sometimes the peppers and onions that come with fajitas are not well-cooked enough.  Corn is technically a grain, but is used in cooking as a vegetable or starch.  The Mexican rice (or white rice in some instances) is one of the few IBD-friendly ingredients.

The combination of hard-shelled tacos (a fried tortilla), diced tomatoes, onions, hot sauce and cheese can make for a disastrous meal for someone with IBD.

Tips:

  • If corn bothers you, as tempting as it may be, don’t eat the tortilla chips
  • If tomatoes bother you, pass on the salsa
  • Avoid corn tortillas and hard shell tacos – ask for flour tortillas
  • Avoid the combination platters
  • Ask your server to make your dish mild if the spices bother you
  • Ask the server to package half of your dish even before it arrives so that you are not tempted to consume your entire meal
  • Avoid dishes that have lots of meat and cheese (some burritos, some fajitas, etc)
  • Avoid corn chips to begin with because they might be fried
  • Ask questions!

Italian

Picture courtesy of NJ.com

Grade: B

Italian cuisine has been heavily Americanized, and has become known for its mass amounts of topping and quantity.  The staples include dry pasta, tomato sauce, and olive oil.  Many individuals with IBD cannot tolerate tomato sauce because of the acidity.

Common dishes include lasagna, spaghetti with meatballs, eggplant parmesan, chicken or veal parmesan, pizza, calzones, and sausage and peppers.  In general, Italian food is not overly offensive to someone with IBD (unless they avoid tomato sauce), and Italian offers a huge amount of choices.  The vegetables in the main dishes are usually well-cooked too.  However, the proportions are often over-sized, and some of the sauces, such as Alfredo sauce (cream, butter, and Parmigiano-Reggiano cheese) are very fatty, which can cause irritation.  The large amount of pasta, pizza, or dough from calzones/strombolis can also lead to over-eating.  Italians are often heavy-handed with cheese too, meaning the fat content in the dishes can be very high.

Tips:

  • Ask the server to package half of your dish even before it arrives so that you are not tempted to consume your entire meal.  This is especially important for dishes that involve pasta or pizza.
  • If you order pizza, you can remove some of the extra grease/fat by dabbing the pizza with napkins
  • If you can tolerate tomato sauce, choose marinara (tomato sauce without the meat) or Bolognese sauce (tomato based sauce mixed with ground meat).
  • Order fish or chicken – Lots of Italian places go beyond the basic pasta and pizza. If they offer salmon with vegetables or a tuna fish sandwich, order what is going to aggravate your intestines the least
  • If you order pizza, try wiping off some of the extra grease/fat that is on top of the pizza using a napkin
  • Some pasta dishes are drenched in oil (usually olive oil), so just be careful about the amount that you consume
  • If you order a dish with vegetables (eg. Pasta Primavera), make sure that the vegetables are cooked enough
  • Ask questions!

Greek

Graduation dinner with our families at a Greek restaurant in Boston…lots of yummy fish!

Grade: A-

Greek cuisine makes wide use of olive oil, vegetables and herbs, grains and bread, wine, fish, and various meats, including lamb, poultry, and pork. In addition, the Greeks use a lot of olives, cheese, eggplant, and yogurt, as well as phyllo pastry.  Right off the bat, it is obvious that this cuisine is going to be relatively friendly for someone with IBD because of the (often moderate) use of olive oil and certain fish, both of which have omega-3’s, which have been shown to be anti-inflammatory.

There are lots of low fiber options at Greek restaurants.  While it is very traditional to start with a Greek salad (lettuce, raw red onion, feta cheese, and olives and therefore not so IBD-friendly), many of the appetizers aka meze are IBD-friendly.  Some examples include spanakopita (usually spinach, feta cheese, onions, egg and seasoning wrapped in phyllo pastry in the form of a pie), souvlaki (small pieces of meat and sometimes vegetables grilled on a skewer), and grape leaves (grapevine leaves stuffed with rice and vegetables and/or meat).[4]  The appetizers are often phyllo dough stuffed with feta cheese, herbs, and some type of vegetable, such as cooked spinach or mushrooms.

The Greeks tend to roast, bake, sauté, or cook their foods on a spit, and so their cooking techniques do not impart lots of unhealthy fats.[4]  They do not use very fibrous vegetables either– they focus on potatoes, eggplant, zucchini, spinach, mushrooms, and a few other vegetables.  Their entrees often feature some type of protein (shrimp, leg of lamb, chicken) cooked in olive oil, and include feta cheese, herbs, and/or some auxiliary ingredient, such as pine nuts.[4]  Their national dish, Moussaka (Greek Moussaka) is layers of sliced potato, eggplant, zucchini, and ground beef topped with a béchamel sauce.

Gyro pitas are popular, which include roasted meat that has been cooked on a vertical spit.  The sandwich usually comes with some tzatziki sauce stuffed inside, which is made of yogurt mixed with cucumbersgarlic, olive oil, lemon juice, and parsley.[5]  The cucumbers are usually small enough to cause little problems for IBD sufferers. 

Tips:

  • Avoid high-fat dishes that include meat and cheese
  • Pick a fish dish with a side of cooked veggies
  • Desserts often have crushed nuts (eg. Baklava) – avoid these desserts if you cannot tolerate nuts
  • Enjoy some good wine if you can tolerate alcohol!
  • Ask questions!

General Restaurant Guidelines for Living with IBD and Eating Out:

  • Watch out for hidden fat.  Look for simply steamed or broiled seafood, or grilled chicken
  • Ask for all sauces on the side
  • Divide the food on your plate in half and eat slowly.  Make it a rule to always leave the other half of your food to take home to avoid overeating, which can trigger a flare-up
  • Ask the server if you’re not sure about an item.
  • Do not be afraid to make special requests.  Don’t be afraid to tell the server that you have food allergies (when asking for a modification to a dish).  For example, when placing an order for sushi without sesame seeds, Marnina always tells her waiter that she is allergic to the seeds.  By doing so, she avoids further questioning and the waiter will understand the importance of making sure that her dish comes without seeds. You don’t want to get into the details of why you really can and cannot eat certain foods when ordering at a restaurant. Saying you have a food allergy is enough!
  • Make sure to advocate for yourself and make your needs known to the waiter
  • Check menu descriptions carefully! Check menus online before you get to a restaurant to determine whether or not there will be options for you. You don’t want to get to a restaurant, sit down, and then realize that there is nothing for you to eat.

_____________________________________________________________________________

Sources:

[1] http://en.wikipedia.org/wiki/Indian_cuisine

[2]http://en.wikipedia.org/wiki/Paneer

[3] http://en.wikipedia.org/wiki/Thai_cuisine

[4] http://en.wikipedia.org/wiki/Greek_cuisine

[5] http://en.wikipedia.org/wiki/Tzatziki

[6] www.theculinarylife.com

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Comments on: "The IBD Guide to Eating Out" (3)

  1. I’m very glad you liked my photo. In exchange for you using it, I’d like a link from your site, please.

  2. Hi Stephanie,

    We added your site as a source on that blog. Thank you very much for allowing us to use your photo.

  3. This was really helpful. I became romantically interested in a very nice girl that also happens to suffer from Crohns/IBD, while I have absolutely no diet problems. Oh well! Anyways, I’m terrified that something bad might happen on our first (or subsequent) dinner date(s). You might have just saved my little heart hehe. Thanks!

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