Can dietary modifications help prevent Crohn's (Crohn's disease) flares?

From the Guidelines

Changing diet can help prevent Crohn's disease flares, with the Crohn's Disease Exclusion Diet (CDED) being a potential adjunct or monotherapy for reducing inflammation in active CD, as shown in a recent pilot RCT with a 62% remission rate at Week 6 1.

Key Dietary Recommendations

• The CDED has accumulating supportive data for its use in adult patients with CD, with 50% of patients maintaining remission up to Week 24 and 35% achieving endoscopic remission 1.
• The Mediterranean diet is also recommended, given its ease of adherence and approximately 40% symptomatic remission rates, similar to the Specific Carbohydrate Diet (SCD) 1.
• Identifying and avoiding personal trigger foods while maintaining good nutrition is crucial, with common triggers including high-fiber foods, dairy products, fatty or fried foods, spicy foods, alcohol, and caffeine.

Benefits of Dietary Changes

• Dietary modifications can reduce mechanical irritation to the inflamed intestinal lining, decrease the workload on the digestive system, and potentially modify the gut microbiome.
• Staying well-hydrated and eating smaller, more frequent meals can ease digestive stress.
• Food journaling is recommended to identify personal triggers.

Importance of Personalized Nutrition Plans

• Dietary management should complement, not replace, prescribed medications.
• Patients should work with healthcare providers to develop personalized nutrition plans that prevent nutritional deficiencies.
• The guidance for consumption of healthy eating patterns, such as the Mediterranean diet, is essential for patients with IBD 1.

From the Research

Dietary Interventions for Crohn's Disease

• The Mediterranean diet may play a role in managing Crohn's disease due to its anti-inflammatory effects and long-term sustainability 2
• Exclusive enteral nutrition, the Crohn's disease exclusion diet, or the specific carbohydrate diet may be used as a short-term adjunct to medical therapy to improve mucosal healing in active Crohn's disease 2, 3, 4
• The low-FODMAP diet can assist in reducing symptoms for patients without evidence of active bowel inflammation 2, 3

Role of Diet in Preventing Crohn's Disease Flares

• Higher intake of dietary fiber (fruit fiber) has been associated with a reduced risk for Crohn's disease 4
• Avoidance of processed foods, packaged with preservatives and emulsifiers, may be important in decreasing intestinal inflammation 3
• There is a paucity of clear dietary recommendations for the reduction in risk of Crohn's disease clinical relapse 4

Dietary Recommendations for Crohn's Disease Management

• Exclusive enteral nutrition remains the most validated nutritional recommendation for inducing remission in Crohn's disease 3, 4, 5
• The specific carbohydrate diet has demonstrated reductions in Crohn's disease severity scores in conjunction with medical therapies 3, 4
• Dietary studies are still in a rudimentary stage, and large prospective randomized control studies are needed to evaluate the efficacy of different diets 3, 5