Authors: Nieves R, Jackson RT.
Institution: David Grant Medical Center, Department of Pediatrics, 101 Bodin Circle, Travis Air Force Base, CA 94535, USA.
Author: GALLAND L.
Study Puspose: To determine whether dietary modification and nutritional supplementation for adult patients with Crohn's disease can relieve symptoms, induce clinical remission, and decrease the use of anti-inflammatory and immune suppressive drugs.Methods: …The dietary treatment was administered in a tiered fashion. The initial diet was a grain free, low disaccharide diet (the specific carbohydrate diet, SCD); this was followed for 30 days. If a symptom reduction of 50 percent or more occurred the diet was maintained and nutritional supplementation was begun with fish oil capsules supplying 875 mg of EPA per day and a multi-vitamin/multi-mineral preparation supplying 400 mg of vitamin E, 20 mg of zinc, 200 mcg of selenium, 800 mcg of folic acid. If there was less than a 50 percent reduction in symptoms, additional dietary changes were made on an individual basis…
Results: All 20 patients demonstrated a decrease in symptoms and reduction in medication use. Six patients have entered complete clinical remission, discontinued all medication, and maintained remission for five to 80 months. The most rapid response in this category belongs to a 28 year old male who presented with daily fevers of 40 degrees C, bloody diarrhea six times per day, a serum albumen of 2.6 g/dl, ESR of 90 and oxalic acid excretion of 164mg per day, despite the use of azathioprine 100 mg per day and prednisone 40mg per day. This patient achieved complete clinical and laboratory remission during the first 60 days and has maintained remission for three years. For the remaining 14 patients, reduction in symptoms scores were from 90 percent to 40percent (mean reduction of 65 percent)…
Discussion AND Conclusions: …Individualized dietary modification and nutritional supplementation was associated with a reduction in symptoms, induction of clinical remission, and decreased use of medication. All patients in this study were already receiving conventional therapy. Further studies are warranted to determine whether individualized nutritional therapy should be considered first line treatment of adult Crohn's disease.
Authors: Brandes JW, Korst HA, Littman KP.
Summary: 20 patients with Crohn's disease were entered into a prospective study, after they had been submitted to standard treatment of the acute phase. In this study long term treatment or treatment between the acute relapses of the disease consisted in daily doses of 8 mg methylprednisolone and 3 mg salazosulfapyridine; in addition the diet was sugar-free and rich in fibers. When remission continued (activity index below 150 point) the drugs were stopped and only dietary treatment was continued.The course of the disease was followed by frequent endoscopic examinations and by determinations of the activity index according to Best. 16 patients were in remission after an average treatment period of 19.6+/-6.6 months without drugs only using the dietary regimen described. 4 cases relapsed after 7.5+/-4.3 months (activity index greater tha 150 points, intestinal ulcerations); they had to be treated again according to the acute phase standard treatment schedule. These results encourage further trials, where after 6 months of drug treatment the drugs are stopped, and only dietary treatment is continued during the remission phase.
Authors: Riemann JF, Kolb S.
Summary: Nutrition apparently plays an important role in the etiology of Crohn's disease. Possible influences by commercially produced foodstuffs and their additives together with changes in composition of the diet are discussed. Several examiners could show, that patients with Crohn's disease even prior to the beginning of their illness have a significantly increased consumption of refined carbohydrates if compared to a control group.Therapeutic regimes with reduction of synthetic carbohydrates as well as increase in crude fiber content of the diet have demonstrated a positive influence on the disease. Besides the conventional drug therapy a simultaneous diet as described appears to have a favorable influence on both acute attacks of the disease as well as extending the state of remission.
Authors: Heaton KW, Thornton JR, Emmett PM.
Comment: Thirty-two patients with Crohn's disease were treated with a fibre-rich, unrefined-carbohydrate diet in addition to conventional management and followed for a mean of four years and four months. Their clinical course was compared retrospectively with that of 32 matched patients who had received no dietary instruction.Hospital admissions were significantly fewer and shorter in the diet-treated patients, who spent a total of 111 days in hospital compared with 533 days in the non-diet-treated control group. Whereas five of the controls required intestinal operation, only one diet-treated patient needed surgery. This is in strong contrast to general experience with this disease.
Treatment with a fibre-rich, unrefined-carbohydrate diet appears to have a favourable effect on the course of Crohn's disease and does not lead to intestinal obstruction.
Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=519185&dopt=Abstract
Authors: Brandes JW, Lorenz-Meyer H.
This study demonstrated the efficacy of a low carbohydrate diet for Crohn’s sufferers.
Comment: Since several studies have shown that patients with Crohn's disease have an increased consumption of refined carbohydrates, the influence of a diet excluding refined sugar on the course of the disease was examined.In a randomised control trial, 20 patients (10 patients in each group) with Crohn's disease were treated for an average of 18 months with two different diets. The patients used in the study had a low or middle activity of the disease. Drug treatment was omitted 14 days before commencement of the study. The first group was treated with a low carbohydrate diet (refined sugar excluded), the second group received a high carbohydrate diet (refined sugar-rich).
In patients with higher activities of the disease (activity index 100-200 points), the diet which restricted refined sugar was superior to the sugar-rich diet; in 4 out of 5 patients the disease activity decreased and remained so throughout the study-period. In contrast to this 4 patients treated with the sugar-rich diet had to be taken off the treatment because of increasing activities of the disease.
In patients with quiescent disease (activity index less than 100 points), neither of the diets showed detrimental effects. The statistical analysis of clinical and laboratory dates noted during the study period resulted in no significant differences between the two groups.
Study link: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7013307&dopt=Abstract
