Managing Crohn’s disease (CD) extends beyond medication, with lifestyle and behavior playing a crucial role in patient outcomes. Addressing factors such as smoking, poor sleep hygiene, inadequate exercise and diet, and stress can improve quality of life and treatment success, but personalized, patient-centered approaches are key to making meaningful changes.

Lifestyle and behavior play a huge role in managing CD. When I sit down with a patient with CD, I always start by asking, “What’s most important to you?” If the patient wants to talk about nonmedical interventions for their CD, we discuss lifestyle and behavior changes as part of their treatment plan, and this becomes a treatment discussion that they take seriously.

I put smoking cessation at the top of my list. Smoking is not just bad for a person’s general health—it is also one of the worst things for CD. Patients with CD who smoke have worse outcomes, need more medications, and are at a higher risk for disease progression. I always emphasize that quitting smoking can reduce the need for medication and lower the risk of cancer, but I also acknowledge that it is challenging, and I offer to provide resources to help.

Additionally, I ask patients with CD about their sleep hygiene. Poor sleep is a huge issue, especially in a world where people fall asleep next to their phones, with notifications frequently lighting up the room. If you have CD, sleep becomes even more important. Patients with active disease may wake up multiple times each night due to symptoms, and this can lead to chronic fatigue and irritability.

Physical activity is another powerful tool. It releases endorphins, improves mood, and helps with inflammation. Studies show that physical activity positively impacts patient-reported outcomes, potentially leading to reduced symptoms and improved well-being. Even simple walking improves quality of life. For patients who say that they cannot exercise due to joint pain, I reassure them that they can. There are programs designed for those with arthritis and other limitations, and, if needed, I refer them to physical therapy to create a suitable plan. I have even suggested to patients that they adopt a dog. Having a dog is a built-in reason to go for a walk, and small lifestyle changes like this can have a lasting impact.

Patients with CD often ask about what diet they should follow. While there is no universally recommended diet, reducing processed foods has proven to be beneficial. In 2021, there was a multicenter, head-to-head study looking at the Mediterranean diet and the specific carbohydrate diet in adults with CD. No differences were found between the 2 diets in terms of patient outcomes at the end of 12 weeks. However, patients may prefer the Mediterranean diet because it is more flexible. So, rather than pushing a strict diet, I focus on avoiding processed foods, minimizing red meat, and reducing sugar and alcohol intake.

Research suggests that the highest-rated apps for patients with inflammatory bowel disease include those that include behavior change techniques that improve patient adherence to treatment and support long-term management. Some inflammatory bowel disease apps even incorporate stress management features, which can be even more helpful.