RS Boneh et al. Clin Gastroenterol Hepato 2021; 19: 752-759. Dietary Therapies Induce Rapid Response and Remission in Pediatric Patients With Active Crohn’s Disease
The authors collected data from a multicenter randomized trial of the CD exclusion diet (CDED) in children (mean age, 14.2 ± 2.7 y) with Crohn’s disease who were randomly assigned to groups given either exclusive enteral nutrition (EEN, n = 34) or the CDED with 50% (partial) enteral nutrition (PEN) (n = 39).
The CDED has been discussed previously on this blog; it aims to avoid animal and saturated fat, milk fat, gluten, specific emulsifiers, taurine, red (reduced heme) and processed meat, and certain fibers from some fruits and vegetables. In addition to excluding patients who received competing therapies (eg. steroids, immunomodulators, and biologics), the authors excluded patients with isolated large bowel disease (L2).
- At week 3 of the diet, 82% of patients in the CDED group and 85% of patients in the EEN group had a dietary response or remission. Median serum levels of C-reactive protein had decreased from 24 mg/L at baseline to 5.0 mg/L at week 3 (P < .001)
- Among the 49 patients in remission at week 6, 46 patients (94%) had had a diet response or remission by week 3 and 81% were in clinical remission by week 3
The authors note that the rapid response to dietary therapy suggests a role for a ‘trial by diet’. As such, dietary therapy could be used as monotherapy, for patients failing other therapies, or as a bridge to biological therapy. The authors note that the exact reasons for response to dietary therapy are unsettled and could be “due to both foods excluded and foods enriched in the diet.” In addition, they note that diet appears to be a trigger for inflammation and that reintroduction of foods leads to rebound in inflammation (eg. higher calprotectin) and dysbiosis.
My take: This study shows that dietary therapy works quickly. In this small study, the effectiveness of combined CDED with 50% PEN was similar to EEN.
Related blog posts:
- Dietary Therapy for Inflammatory Bowel Disease This is good lecture review on dietary therapy
- Can IBD Be Treated with Diet Alone?
- Good Food and Bad Food for Crohn’s Disease -No Agreement | gutsandgrowth
- Pushing the Boundaries on Dietary Therapy for Crohn’s Disease: CD-TREAT
- Position Paper: Nutrition in Pediatric IBD
- CDED Diet for IBD/IBD Updates
- Specific Carbohydrate Diet | gutsandgrowth
- Disappointing Results from SCD Diet (small study)
- Crohn’s Disease with Isolated Colonic Involvement Less Responsive to EEN
- Practical Advice on Enteral Nutrition | gutsandgrowth
- Head-to-Head: Enteral Nutrition vs. anti-TNF
- Gut Microbiome, Crohn’s Disease and Effect of Diet …
- The Search for a Dietary Culprit in IBD | gutsandgrowth
- Top Lecture: Enteral Nutrition for Crohn’s Disease …
- There is No Healthy Microbiome
- Why Does Enteral Nutrition Work for Crohn’s Disease? Is it due to the Microbiome?