Diet to control crohn's
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kiny
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Elemental nutrition has proven to be effective to control Crohn's disease inflammation in multiple studies, in both adults and children. They are especially effective in patients with ileal involvement and especially with stricturing disease. The limiting factor of Elemental diets is simply patient adherence and compliance. Elemental diets taste bland and boring, especially polymeric versions of EN can taste a bit bitter, and not everyone can tolerate them. I tolerate them all because I got used to them, but they can taste a bit boring at first.
Low FODMAP diets appear to be somewhat effective due to their specific exclusion of fructans, exclusion of other FODMAPS don't seem to have any beneficial effect. It would be easier to just avoid fructans than to try to follow a low FODMAP diet. Over 60% of crohn's disease patients are fructose intolerant. Of course, EN don't contain fructans to begin with (they are based on low DI maltodextrins / dextrose / glucose).
Diets like SCD, or other diets in general, lack any credible evidence that they are effective, there really isn't enough data out there. SCD also simply lack the calories to be sustainable long-term. SCD don't have the necessary carbs or bioavailable fats to simply get your calories. People don't lose weight on EN because it contains ample carbs and fats in the form of maltodextrins and medium chain triglycerides. SCD doesn't have either, it avoids all complex carbs and uses fats that are not very bioavailable, so people quickly lose weight on SCD. The sugars SCD recommends from things like honey aren't even properly digested due to the fructose intolerance of CD patients (fructose absorption is not helped with the addition of glucose, whatever internet dieticians claim, study after study show fructose has low bioavailability regardless of the form it comes in).
Low FODMAP diets appear to be somewhat effective due to their specific exclusion of fructans, exclusion of other FODMAPS don't seem to have any beneficial effect. It would be easier to just avoid fructans than to try to follow a low FODMAP diet. Over 60% of crohn's disease patients are fructose intolerant. Of course, EN don't contain fructans to begin with (they are based on low DI maltodextrins / dextrose / glucose).
Diets like SCD, or other diets in general, lack any credible evidence that they are effective, there really isn't enough data out there. SCD also simply lack the calories to be sustainable long-term. SCD don't have the necessary carbs or bioavailable fats to simply get your calories. People don't lose weight on EN because it contains ample carbs and fats in the form of maltodextrins and medium chain triglycerides. SCD doesn't have either, it avoids all complex carbs and uses fats that are not very bioavailable, so people quickly lose weight on SCD. The sugars SCD recommends from things like honey aren't even properly digested due to the fructose intolerance of CD patients (fructose absorption is not helped with the addition of glucose, whatever internet dieticians claim, study after study show fructose has low bioavailability regardless of the form it comes in).
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kiny
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I believe 'exclusion diets' don't work simply because they don't make any sense.
It takes around 3 to 5 days before the adaptive immune system mounts an inflammatory cascade in response to signaling from lamina propria macrophages.
Macrophages react within hours, but the damage and therefore pain to the intestine is caused by the adaptive response, that response is more specific but much much slower, especially when it involves intestinal tissue that is simply not easy to reach. (intestinal macrophages likely replicate within intestinal tissue instead of evolving from blood monocytes for that reason).
You can not possibly relate inflammation or pain to food you ate just a few hours ago, the immune response that would actually evoke pain due to deep tissue inflammation would come several days later.
(This is also shown by Rutgeerts his study, inflammation due to the introduction of a fecal stream high in bacterial load happens several DAYS later, not hours. Whatever bacteria, food antigen, or microparticle is causing the immune response, it causes this response DAYS later, making it completely infeasible to do exclusion test. The inflammation in crohn's disease is a chain reaction of inflammatory steps that would have started several days ago, you can't even pinpoint which day, it could be 3 to 5 days, it depends on the patient.)
It takes around 3 to 5 days before the adaptive immune system mounts an inflammatory cascade in response to signaling from lamina propria macrophages.
Macrophages react within hours, but the damage and therefore pain to the intestine is caused by the adaptive response, that response is more specific but much much slower, especially when it involves intestinal tissue that is simply not easy to reach. (intestinal macrophages likely replicate within intestinal tissue instead of evolving from blood monocytes for that reason).
You can not possibly relate inflammation or pain to food you ate just a few hours ago, the immune response that would actually evoke pain due to deep tissue inflammation would come several days later.
(This is also shown by Rutgeerts his study, inflammation due to the introduction of a fecal stream high in bacterial load happens several DAYS later, not hours. Whatever bacteria, food antigen, or microparticle is causing the immune response, it causes this response DAYS later, making it completely infeasible to do exclusion test. The inflammation in crohn's disease is a chain reaction of inflammatory steps that would have started several days ago, you can't even pinpoint which day, it could be 3 to 5 days, it depends on the patient.)
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I have crohn's since 2008, and used pentasa, infliximab, (I had surgery before humera) humera, and currently failing vedolizumab. I'm really worried of running out of medications to control my disease and i do not want to go through another surgery
, i will definitely have chat about the elemental diet with my doctor, did you tried the elemental diet your self @kiny ? you write so many informative replies in this website, i hope you're enjoying long lasting remission. we are trying to increase vedolizumab dose hopping it will induce remission again but I'm not optimistic because i had 70% of crohn's symptoms within 10 days of my dose. my doctor is planning to start ustekinumab if we find out vedo is not working any more.
is there any reliable website of listing all approved medication for crohn's? i want to see how many do i have left. and what happens after i fail them all? I know i ask a lot of question and i don't know a lot about my disease, please excuse my ignorance and my bad english
, i will definitely have chat about the elemental diet with my doctor, did you tried the elemental diet your self @kiny ? you write so many informative replies in this website, i hope you're enjoying long lasting remission. we are trying to increase vedolizumab dose hopping it will induce remission again but I'm not optimistic because i had 70% of crohn's symptoms within 10 days of my dose. my doctor is planning to start ustekinumab if we find out vedo is not working any more.is there any reliable website of listing all approved medication for crohn's? i want to see how many do i have left. and what happens after i fail them all? I know i ask a lot of question and i don't know a lot about my disease, please excuse my ignorance and my bad english
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There is a lot of information out there on diet for Crohn’s and a lot is very contradictory and anecdotal. EEN (special milkshakes), SCD (specific carbohydrate diet), CDED (Crohn’s disease exclusion diet) all have small studies suggesting works for some. There seems to be general agreement that vitamin D is helpful. Some folk seem to get along with just dietary changes, others need biologics + careful diet and still struggle.
I asked my consultant about AMAT (antibiotic therapy) because the side effects profile looked a lot safer than biologic drugs, he said worth trying if exhaust biologic options but not before. A recent study concluded, like everything, seems to help some and do nothing for others (Redhill study, see Human Para website).
There is some excitement about faecal transplants but seems quite risky.
Qu biologics are testing a new method based on stimulating rather than suppressing immune system. Again, initial trials suggests helps some not others.
A retired British professor is trying to develop a vaccine but seems to be going at snails pace.
So be reassured there is stuff in the pipeline, we’re all in the boat of trying to string out current meds until something better comes along. I am personally failing entyvio and trying to buy time with 4 weekly infusions and diet modification (no gluten, limited sugar, limited refined carbs, organic everything, green smoothies, vit d and c and k, bone broth, live yoghurt, vsl3, fish oil). Whether it has helped I will update in a month or so when they do my next tests.
Good luck.
I asked my consultant about AMAT (antibiotic therapy) because the side effects profile looked a lot safer than biologic drugs, he said worth trying if exhaust biologic options but not before. A recent study concluded, like everything, seems to help some and do nothing for others (Redhill study, see Human Para website).
There is some excitement about faecal transplants but seems quite risky.
Qu biologics are testing a new method based on stimulating rather than suppressing immune system. Again, initial trials suggests helps some not others.
A retired British professor is trying to develop a vaccine but seems to be going at snails pace.
So be reassured there is stuff in the pipeline, we’re all in the boat of trying to string out current meds until something better comes along. I am personally failing entyvio and trying to buy time with 4 weekly infusions and diet modification (no gluten, limited sugar, limited refined carbs, organic everything, green smoothies, vit d and c and k, bone broth, live yoghurt, vsl3, fish oil). Whether it has helped I will update in a month or so when they do my next tests.
Good luck.
@Delta_hippo we're in same position, please update me when you have your results, i hope you control it again with vedo. my doctor requested anti bodies and vedo level test to see if i have developed anti bodies or not. I don't take any supplements i will ask my doctor if i need any thank you very much for your reply.
@lukesjr I researched CDTreat it's very smart approach i hope they prove its efficacy soon. I'm picky eater i hope this diet is not tasteless and has many options
@lukesjr I researched CDTreat it's very smart approach i hope they prove its efficacy soon. I'm picky eater i hope this diet is not tasteless and has many options
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