Can You Eat Pizza with Ulcerative Colitis Or Crohn’s Disease?

Researchers have come to a general consensus that the typical “Western Diet” could be increasing the prevalence of IBD. The western diet has a heavy emphasis on meat, omega-6 polyunsaturated fatty acids, and simple sugars—the fast foods so prevalent in our society. This eating style promotes inflammation.

Pizza, unfortunately, is a food that can be categorized into the Western Diet. However, pizza can feel like a slice of normalcy. So while it’s a food that may not be recommended to consume 6 times a day every day, there may be a case to be made for enjoying pizza occasionally, if you tolerate it.

Specific IBD Food Triggers That Can Affect Pizza Tolerance

Pizza contains a few of the more common food triggers reported by IBD warriors, including:

• Lactose
• High dietary fat
• Red meat (if pepperoni or sausage is used as a topping)

Some IBD warriors may be sensitive to other ingredients used in the pizza, such as:

• tomato used in pizza sauce
• gluten in the crust

Notably, there can be a dose-dependent effect when consuming these foods. For example: consuming 6 slices of pizza will contain more dietary fat than 3 slices of pizza.

However, please note: while there are some food triggers that are more common for people with IBD, different guts tolerate different foods differently with this condition!!

Does Cheese Aggravate Ulcerative Colitis or Crohn’s disease?

Cheese can aggravate UC or Crohn’s disease if an IBD warrior is lactose intolerant.

Lactose is the sugar found in milk and dairy foods. The lactose sugar, which is a type of carbohydrate, is complex in structure. To digest lactose properly, people need to have a specific enzyme in the small intestine. This enzyme is called lactase.

If you have trouble digesting lactose (lactose intolerance), you may have diarrhea, bloating, stomach pain, and gas symptoms 30-90 minutes after consuming dairy products. 

If you’re lactose intolerant, your healthcare team may have recommended following a lactose-free diet to prevent additional symptoms and discomfort on top of the flare. 

But food intolerances are unique for IBD warriors, and many people with IBD are just fine with dairy, which would make this recommendation unnecessary!

Lactose Amounts in Dairy Foods

Of note, different dairy products contain different amounts of lactose. For example, one cup of nonfat milk contains 12.47 grams of lactose, whereas 1 oz of cheddar cheese contains 0.05 grams of lactose. Additionally, a dose-dependent effect cheese may be experienced – the cheese on 4 slices of pizza will contain twice as much lactose as 2 slices of pizza!

Can Lactase Enzyme Tablets Help?

If you have lactose intolerance, certain products are now widely available that can allow you to enjoy dairy-containing foods. One example that has worked for my husband with Crohn’s (who is totally lactose-intolerant) when he wants to partake in eating pizza is over-the-counter lactase enzyme tablets (also known as “dairy pills”). 

The enzymes found in these supplement tablets are natural lactase enzymes like those found in our guts that break down the milk sugar (lactose) to help reduce discomfort.

While my husband with Crohn’s disease appreciates that these lactase enzyme tablets aren’t a perfect fix, they can help his symptoms greatly when he’s in a pinch and chooses to eat pizza.

Pizza Ingredients to Be Aware Of

When asking if you can still eat pizza with ulcerative colitis or Crohn’s disease, another concern is the ingredients, known when buying a frozen pizza.

When buying a frozen pizza when you have IBD, the first place to start is the Ingredients on the food label. If the product is formulated with an ingredient that doesn’t fit your needs (say it contains an ingredient that’s a food trigger for you, or is not a part of your eating style or medically recommended diet you’re on) there’s really no point in spending time or energy looking further at that particular product.

A good rule of thumb for Ingredients when you have IBD is to try to stick with ingredients you can pronounce. For example, researchers are exploring whether food additives such as emulsifiers (with names like maltodextrin, carrageenan, xanthan gum, and more) may pose risks with respect to promoting inflammation and triggering disease activity in people with IBD. 

Because these food additive ingredients are generally the mark of highly processed food, there is a case to be made for seeking out some simple swaps to reduce the number of these ingredients in your eating plan in favor of whole or more minimally processed alternatives.

Minimally Processed Frozen Pizza Options

Something I help my clients do is find IBD-friendly items at their preferred grocery store based on their specific food triggers. Here are a few traditional frozen cheese pizza brands that are more minimally processed in comparison to other options out there (please note that I am not paid or sponsored to mention these products:

• Home Run Inn Classic Cheese Pizza
• Kirkland Signature Cheese Pizza
• Rao’s Homemade Brick Oven Pizza

Please note that the above examples contain gluten, dairy, and other potential triggers for IBD warriors. Please double check the ingredients to ensure they are products that can work for you.

Pizza Ingredient Substitutions for people with UC and Crohn’s

Cheese

Did you know that “naturally lactose-free” is becoming a more common site on cheeses found in the grocery store? These cheeses are usually aged for a long time, because as a general rule, the longer a cheese is aged, the more time the bacteria have to break down the remaining milk sugars (lactose), resulting in lower overall lactose content.

Here are some examples of naturally lactose-free cheese (please note that I am not paid or sponsored to mention any of these products):

• Boar’s Head Canadian Cheddar Cheese – aged 1000 days
• Boar’s Head Gold Label Imported Swiss Cheese – aged over 120 days
• Cabot’s Extra Sharp Cheddar Cheese – naturally aged

Gluten-Containing Crust

In a lot of online gluten-free pizza crust recipes, you’ll find xanthan gum added as an ingredient to help bind the gluten-free crust together. However, I don’t recommend using this ingredient when you have Crohn’s disease or ulcerative colitis.

It’s worth doing a bit of experimentation to find which flours you enjoy the taste and texture of – I enjoy rice and/or buckwheat flour gluten-free crusts.

Tomato Sauce

If you don’t tolerate tomatoes, it can be fun to experiment with alternative pizza sauces. For example:

• No-mato roasted veggies sauce (blend of carrots + other veggies)
• Homemade pesto
• Hummus
• Olive oil

So Can you Eat Pizza with IBD? 

Short answer: yes, if tolerated!

Pizza is a food that can be categorized into the Western Diet, which research has linked to the increased prevalence of IBD. But pizza can feel like a slice of normalcy. There’s a case to be made for enjoying pizza occasionally, if you tolerate it!

Work with your IBD dietitian to find a pizza that can work with your individualized food triggers and preferences. Then come up with customized goals as to how often pizza can be incorporated into your eating pattern!