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There is a growing body of evidence that our gut microbiome--the bacteria that live in our intestines—is important in influencing the state of our health.
When disease strikes, alteration in the composition of the bacteria that live in our gut, may also offer the first clue that that there is an imbalance in our bodies.
For many chronic diseases including diabetes, coronary artery disease, and rheumatoid arthritis, it is becoming clear that a diet rich in fruits, vegetables, legumes and whole grains may be vital in treatment as well as prevention.
When it comes to Crohn’s disease (CD), the same may also be true, based on ongoing and continued research which indicates that a whole food, plant-based diet may be instrumental in inducing remission of the disease.
A recent case report published in the journal, Nutrients demonstrates that eating a plant-based diet may be an effective treatment to help induce remission in CD .
The case study describes a young man in his late 20's who had been diagnosed with CD after experiencing episodic severe abdominal pain, bloating, nausea, and ulcers for many years. After 1 year of treatment with intravenous medications, he achieved remission.
The following year, the patient eliminated all animal products and processed foods from his diet during a 40-day religious observation and now has no further symptoms of CD. He elected to continue the whole food, plant-based diet, including fruits, vegetables, whole grains, and legumes--and experienced a complete remission of CD. When an upper endoscopy revealed complete healing of the lining of the small bowel, he was able to stop taking medications; in fact, he has not had any relapses since he changed his diet.
"This case study offers hope for hundreds of thousands of people suffering from the painful symptoms associated with Crohn's disease," said study co-author Hana Kahleova, M.D., PhD, Director of Clinical Research at the Physicians Committee for Responsible Medicine in a press release.
Important Data Regarding Crohn’s Disease
Only about 10% of traditionally managed Crohn's disease patients achieve long-term remission using standard medications to treat Crohn’s disease, and up to half of patients will need surgery (small bowel resection, ileostomy, subtotal colectomy) within 10 years of diagnosis.
CD is an inflammatory bowel disease (IBD) that causes chronic inflammation of the intestinal tract. CD typically affects the end of the small intestine known as the ileum , as well as the first part of the large bowel known as the colon. However, the disease may occur in any part of the gastrointestinal (GI) tract, including the mouth, esophagus. stomach, rectum or anus. Meanwhile, ulcerative colitis (UC) only involves the large bowel or colon.
The exact cause of CD is not known, but a combination of factors including genetics, an environmental influence, and an upregulated immune system are believed to be causative.
The important thing to understand is that plant-based diets are high in fiber which promotes overall gut health . Fiber also feeds the healthy bacteria in the gut, which may offer a protective effect against Crohn's disease and other digestive ailments.
While more research is needed, previous studies have supported the conclusion that diets rich in plant proteins and whole foods may benefit Crohn's disease patients. (Whole foods are plant foods that are not refined or processed, or refined or processed as minimally as possible before being eaten. A whole foods plant-based diet does not include animal products.)
" This case study supports the idea that food really is medicine ," added Kahleova. "Not only does it show that eating a high-fiber, plant-based diet could help lead to Crohn's disease remission, but all the 'side effects' are good ones, including a reduced risk for heart disease, type 2 diabetes, and certain types of cancer."
Standard Approach To Treating Crohn’s Disease
The goal of medical treatment in patients with newly diagnosed CD centers on inducing and then maintaining remission. For low-risk patients, tapering doses of oral budesonide or prednisolone (both steroid medications) are typically prescribed for 6–8 weeks. Those who need additional courses of steroids are typically treated with thiopurine medications (azathioprine or 6-mercaptopurine). If additional treatment is necessary, a “biologic” drug such as infliximab or adalimumab is often begun.
In those who are higher risk, a “top-down approach” is generally initiated with early initiation of biologics to induce and maintain remission. Maintenance therapy in high-risk patients requires ongoing therapy with thiopurines and/or biologic drugs for at least 12 months.
The patient in this case report was noted to be high-risk as a result of having moderately severe inflammation, severe symptoms, diagnosis under the age of 30, and disease involving the anus.
A number of studies have noted that a decrease in animal products and dairy with a corresponding increase in whole plant foods have led to clinical improvement in IBD patients, especially CD. In one study, 15 of 16 patients achieved remission at 2 years using a semi-vegetarian diet. Comparatively, a combination of infliximab and azathioprine, without any specific dietary intervention, led to a 6-month clinical remission in only 57% of cases in one study.
The use of a plant-based whole food diet has also been employed with success along with standard medications in patients with CD. The use of a Crohn’s Disease Elimination Diet (CDED) led to 6 week remission rates of 71% in newly diagnosed patients and 62% in patients with established disease in recent case series reports. The CDED approach is quite similar to a whole food, plant-based diet. The CDED advocates removal or minimal exposure to flavor enhancers, food emulsifiers, sources of omega-6 fatty acids and dairy products, while also recommending sources of plant polysaccharides and dietary fiber.
Research also suggests that a whole food plant-based diet may be ideal for gut health by encouraging the development of more diverse microbial systems. It turns out that higher plant-based fiber intake encourages the growth of bacteria that ferment fiber into metabolites as short-chain fatty acids (SCFAs), including acetate, propionate, and butyrate. There are many beneficial health effects of SCFAs such as enhanced immunity against pathogenic bacteria, and a stronger blood–brain barrier.
Diet and Crohn’s Disease
While data indicate that about 700,000 people in the U.S. have CD, it is also clear that CD has become more widespread throughout the world, with increased incidence in countries newly becoming industrialized.
A significant number of epidemiological studies have demonstrated associations between diet and inflammatory bowel disease (IBD) which includes Crohn’s disease as well as ulcerative colitis. Research further demonstrates that diets that which are higher in animal protein, total fat, animal protein and dairy fat have been associated with IBD prevalence.
While IBD is more common in populations with higher intakes of ultra-processed foods, it clear that a greater intakes of fruits, vegetables, whole grains, and legumes may also have a protective effect, reducing disease flare ups, along with the potential to induce remission.
Research further supports the concept that the gut microbiome may be a crucial aspect between diet and CD progression. Common food emulsifiers and artificial flavor enhancers have been shown to promote the growth of a certain subtype of pathogenic adherent-invasive E. coli (AIEC), a dangerous bacteria found in the gut microbiome of patients with CD. At the same time, consuming soluble plant polysaccharides have been shown to reduce adherence of AIEC bacteria. The bottom line is that a diet with excessive animal products and low in fiber can lead to significant changes in the gut microbiome and result in overgrowth of specific types of bacteria that have been associated with development of IBD.
Prospective case series have also demonstrated that a diet that eliminates or restricts animal protein, animal fat, dairy, emulsifiers, and other artificial food additives can lead to remission of CD. What’s also clear is that such a dietary change is effective in patients with newly diagnosed active CD and in patients with established CD who have failed to respond to standard medical therapy, with reported clinical remission rates of 78% and 90%, respectively. Whole food dietary intervention is also well tolerated by patients with CD with excellent compliance.
A diet that focuses on whole foods and plant-based sources of protein has also been reported to be beneficial in the maintenance of CD remission. A case series of 22 patients revealed a remission rate of 92% in CD patients who remained on a whole food semi-vegetarian diet for two years, compared to 25% in patients who continued with a standard omnivorous diet.
Translation of Data Into Practice
“There has been a growing body of evidence supporting benefits of a plant-based diet and improvements in gut microbiota,” emphasized Sharon Zarabi, RD, CDN, CPT, Bariatric Program Director, Lenox Hill Hospital, Northwell Health.
“Many don’t realize that added ingredients in processed foods have been wreaking havoc in our insides--the slice of bread you are eating today has a vast difference in ingredients than the innocent flour water and yeast once defined as bread in our former days,” offered Zarabi. “The preservatives, additives, and flavor enhancers all act as foreign bodies: our organs don’t have a voice, so they react with inflammatory markers, and in the long term develop into disease.”
Zarabi emphasizes that “we should start adopting the philosophy that food is medicine and has the ability to treat and cause disease.”
“You are what you eat,” she explained, “and although there is no dietary cause to Crohn’s disease (an inflammatory bowel disorder) there are ways to minimize inflammation within the body with whole foods that come from the earth.”
But a "return to nature" and eating clean may actually be the most sound advice. “Avoiding foods that are highly processed and sticking to the foods our ancestors ate from nature can be part of the solution,” Zarabi added.
“Plant-based diets have recently become popular and I hope it’s not a trend, but here to stay--we should be eating plants that are in their whole food form and contain synergistic effects that promote healing and maintenance of health,” she concluded.
The Take-Away
While a diet rich in whole grains, fruits, and vegetables and legumes is critical in the prevention and treatment of heart disease, diabetes, hypertension, obesity, gallbladder disease, rheumatoid arthritis, and multiple cancers, this case report along with prior research studies offers encouraging evidence that Crohn’s disease may also be one of the ailments that benefit from adoption of such a diet. Ongoing research will hopefully provide a more definitive answer.
