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Specific Diet for Crohn's Disease

blog Dec 19, 2019

Over the years, I have seen many people who have been able to heal their digestive tract by augmenting their diet; different conditions and individual variability tend to necessitate individualized dietary plans but overall many GI conditions improve just by changing what people eat. 

Although in the US the usual treatment of Crohn's disease includes biologic or immune suppressing drugs, many studies have shown that using an Elemental diet (ED) can have comparable success.  Elemental diets are generally a powdered mix of carbohydrate, fat, and hydrolyzed protein, plus vitamins and minerals that are mixed with water and replace traditional meals. While this is effective, it is very expensive and difficult to tolerate, as generally at least half of the people taking an ED need to be tube fed.

However, a new Israeli study compared children with Crohn's disease who were treated with ED alone to those who received half their calories from ED and half from a Crohn's-disease specific exclusion diet.  In the first six weeks the treatments were equally successful. As the ED only group returned to normal foods, however, those who remained on the exclusion diet were more successful at staying in remission.

The Exclusion diet is interesting because it keeps out some very specific categories of foods that have recently been found to dramatically increase inflammation and disrupt the microbial balance of the digestive tract. It removes elements that increase inflammation and microbial permeability, and includes foods that improve microbial diversity and decrease inflammation. The specific components of the diet plan include:

Fiber and pectins from fruits and veggies which helps to produce butyrate and other short chain fatty acids which reduce inflammation in the gut. A low fiber diet also promotes the invasion of pathogenic bacteria into the lining of the gut: “depriving colonic microbes from fibre in rodent models will favour taxa that can use alternative carbon sources found within the colonic mucus; this then leads to depletion of the mucus layer, disruption of the barrier, immune activation and tissue damage”

Extremely limited animal fats and moderate intake of fats from vegetable sources. A diet high in animal fat is associated with a higher incidence of IBD, whereas a diet high in Omega 3 fats decreased risk. High fat diets also encourage the accumulation of secondary bile acids, which inhibit the growth of healthy bacteria. 

Exclusion of Gluten containing grains. The specific carbohydrate diet, which excludes all grains, has been a popular option for Crohn’s patients who are seeking dietary treatment, and has shown some clinical success. Gluten and wheat specifically are described by the authors of this study as alpha amylase/trypsin inhibitors that encourage inflammation in the gut and promote intestinal permeability.

Exclusion of processed foods There are a number of food additives that have been shown to impact intestinal permeability and the integrity of GI mucosa.  This includes two common emulsifiers, carboxymethylcellulose and polysorbate-80, and thickeners such as maltodextrin and carageenan. Martino JV et al write “Animal studies consistently report that carrageenan and CMC induce histopathological features that are typical of IBD while altering the microbiome, disrupting the intestinal epithelial barrier, inhibiting proteins that provide protection against microorganisms, and stimulating the elaboration of pro-inflammatory cytokines.“ 

Feel free to contact me if you want more specific information on the Crohn's Specific diet used in this study!

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