What diet is indicated for Crohn's disease?

Mediterranean Diet is the First-Line Dietary Approach for Crohn's Disease

For patients with Crohn's disease, a Mediterranean diet rich in fresh fruits, vegetables, monounsaturated fats, complex carbohydrates, and lean proteins while limiting ultraprocessed foods, added sugar, and salt is the recommended dietary approach for overall health and well-being. 1

Dietary Recommendations Based on Disease State

For Patients in Remission

• Follow a Mediterranean diet that includes:
  • Variety of fresh fruits and vegetables
  • Monounsaturated fats (olive oil, avocados)
  • Complex carbohydrates (whole grains if tolerated)
  • Lean proteins
  • Low intake of ultraprocessed foods, added sugar, and salt 1

For Patients with Strictures

• Modify the Mediterranean diet by:
  • Emphasizing careful chewing
  • Cooking and processing fruits and vegetables to a soft consistency
  • Peeling fruits and vegetables to reduce fibrous content
  • Avoiding roughage like raw lettuce, unpeeled apples, and raw broccoli 1, 2
  • Consider blending or mashing vegetables to improve tolerance 2

For Active Disease

• Exclusive Enteral Nutrition (EEN):

  • Liquid nutrition formulations are effective for inducing clinical remission and endoscopic response
  • Stronger evidence exists in children than adults
  • Can be used as a steroid-sparing bridge therapy 1, 3
  • Typically administered for 6-8 weeks 3

• Crohn's Disease Exclusion Diet (CDED):

  • A type of partial enteral nutrition therapy
  • Effective for induction of clinical remission in mild to moderate Crohn's disease of relatively short duration 1, 4
  • Allows some whole foods while excluding others that may trigger inflammation
  • Clinical trials show 57-68% remission rates at 6 weeks 4

For Preoperative Nutrition

• EEN is recommended for malnourished patients before elective surgery to:
  • Optimize nutritional status
  • Reduce postoperative complications 1

For Complicated Disease States

• Parenteral nutrition is indicated for:
  • High-output gastrointestinal fistula
  • Prolonged ileus
  • Short bowel syndrome
  • Severe malnutrition when oral/enteral nutrition has failed
  • Intra-abdominal abscess/phlegmonous inflammation 1

Nutritional Monitoring

• Regular screening for malnutrition through assessment of:

  • Unintended weight loss
  • Edema and fluid retention
  • Fat and muscle mass loss 1

• Monitor for specific deficiencies:

  • Vitamin D and iron in all patients
  • Vitamin B12 in patients with extensive ileal disease or prior ileal surgery 1, 2

Special Considerations

Partial Enteral Nutrition (PEN)

• May be better tolerated than EEN
• When combined with a highly restrictive diet (like CDED), appears to be as effective as EEN in inducing remission 5
• Shows high adherence rates (97.5%) in clinical studies 2, 4

Food Reintroduction

• After completing EEN, foods should be gradually reintroduced
• Consider using a low fat, low fiber exclusion diet for 2-4 weeks, followed by gradual food reintroduction 2

Common Pitfalls to Avoid

1. Unnecessarily restrictive diets: Avoiding healthy foods during remission can lead to nutritional deficiencies
2. Ignoring individual food intolerances: Personalized dietary triggers should be identified and avoided
3. Poor monitoring: Regular nutritional assessment is essential to prevent malnutrition
4. Attempting EEN without proper support: Consultation with a registered dietitian is crucial for success 1, 2
5. Relying on parenteral nutrition when not indicated: Parenteral nutrition should not be used as primary treatment for inflammatory luminal Crohn's disease 1

Multidisciplinary Approach

• Consultation with a registered dietitian is essential, especially for:
  • Newly diagnosed patients
  • Patients with complicated disease
  • Implementation of specialized diets like EEN or CDED 1, 2

The Mediterranean diet approach represents the most current evidence-based dietary recommendation for Crohn's disease, with modifications based on disease state and individual patient factors 1. For active disease, enteral nutrition therapies (EEN or CDED) have shown effectiveness in inducing remission, while parenteral nutrition should be reserved for specific indications when enteral routes are not feasible 1.