People who have Crohn's disease often seek to ease their symptoms by changing what they eat, and new research suggests the Mediterranean diet may be their best bet. Although Blacks may have a lower risk of developing an inflammatory bowel disease (IBD), they still have a significant risk, according to John Hopkins Medicine.
The study evaluated one of the commonly used diets for Crohn's disease, known as the specific carbohydrate diet (SCD), comparing it with the Mediterranean diet, which is sometimes recommended by doctors for its heart health benefits, but not for inflammatory bowel diseases like Crohn's.
The scientists found that both diets reduced symptoms almost equally, but the study concludes that the greater ease of following the Mediterranean diet might make it one that patients prefer to follow.
"Physicians are seeing patients who are on increasingly restrictive diets," study co-author Dr. Arun Swaminath says.
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The downside of these tightly controlled eating regimens is that patients may not be getting enough calories or nutritional variety, he says. An easier-to-follow diet may help with that.
"It's the idea of helping my patients avoid a pathway of increasingly restrictive foods for them to feel like they're being healthy enough to control the underlying problem. If I can keep them away from that dark pathway, I feel like I've done something good," Swaminath says.
Crohn's disease involves the immune system and is characterized by abdominal symptoms, such as pain and diarrhea, and chronic inflammation, according to the U.S. Centers for Disease Control and Prevention. Together with ulcerative colitis (another inflammatory bowel disease), it affects about 3 million people in the United States.
The study was conducted in 33 sites across the United States between September 2017 and October 2019. The study included 191 patients who were randomly
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assigned to one of the two diets, following it for 12 weeks. The participants received prepared food for the first six weeks.
The diets affected their symptoms, and at 12 weeks about 42.4 percent had symptomatic remission with SCD and 40.2 percent with the Mediterranean diet, according to the report.
The SCD includes unprocessed meats, fresh fruits and non-starchy vegetables. It restricts certain legumes, all grains, certain sweeteners, canned fruits and vegetables, and certain dairy products. The Mediterranean diet is low in red and processed meats and features fresh fruits and vegetables, nuts, fish, lean meats, whole grains, small amounts of dairy and uses olive oil as its primary source of fat.
Diet isn't the only line of defense against Crohn's disease. For more than 20 years, since the first biologic medication was approved, there has been a blossoming of different medical therapies, Swaminath adds. Prior to that, existing medications including steroids and immune modulators were repurposed to treat the disease.
"While admittedly, we haven't cured everybody or gotten everyone into a medicine-induced remission, we can help most people get to essentially a normal quality of life," Swaminath says.
Still, some people want an alternative to immunosuppressive therapy, according to the study, and high-quality data on diets for Crohn's disease is lacking.
Swaminath shares that the people who were included in the study had mild to moderate disease. If someone is really sick and already malnourished, most physicians would not put them into a diet strategy, he adds.
"What that means is, despite being on therapy, clearly they're on the therapy because it's working and they were better than they were before, but they still have symptoms that weren't cured," Swaminath says. "And if we can get half of those patients better by changing their diet or adopting one of these strategies, that really, I think, is valuable."
Diet isn't a substitute for medication, but more of
an adjunct, Dr. Elie Abemayor, chief of the division of gastroenterology at Northern Westchester Hospital in Mount Kisco, N.Y. says.
The two diets both try to reduce inflammation, but the Mediterranean diet is more palatable, he adds.
When a patient is having more significant active inflammation, there's some belief that following a less inflammatory diet over the short term helps people and possibly lowers the likelihood of the patient progressing to a more significant inflammatory condition and disease, Abemayor says.
"I think that, in the short term, it is beneficial. I think longer-term, whether keeping people on Mediterranean diets or putting them on the SCD diet, I don't think that the jury's in on that yet, but I think probably in terms of general health it's probably a better diet for everybody to be on a Mediterranean-type diet," Abemayor suggests.
Some research is investigating whether the gut microbiome may play a role, Abemayor says, and whether people are more likely to respond to different kinds of treatment depending on their microbiome.
"I think that's where a lot of these treatments for gastrointestinal conditions are going to be headed, to stratify people based on genetics, based on maybe their microbiome, based on other kinds of things which separate one group from another," Abemayor says.
What foods should you eat?
If you are interested in starting the Mediterranean diet, check with your doctor to make sure it is safe for your condition. If this diet is deemed safe, you can try this plan, which can be adjusted to meet your specific needs and preferences.
Do:
- Eat: Vegetables, fruits, nuts, seeds, legumes, potatoes, whole grains, breads, herbs, spices, fish, seafood and extra virgin olive oil.
- Eat in moderation: Poultry, eggs, cheese and yogurt.
- Eat only rarely: Red meat.
Don't
You should avoid these foods:
- Added sugar: Soda, candies, ice cream, table sugar and many others.
- Refined grains: White bread, pasta made with refined wheat, etc.
- Trans fats: Found in margarine and various processed foods.
- Refined oils: Soybean oil, canola oil, cottonseed oil and others.
- Processed meat: Processed sausages, hot dogs, etc.
- Highly processed foods: Anything labeled “low-fat” or “diet” or which looks like it was made in a factory.
Make sure to read labels carefully to avoid any foods that may include ingredients not listed in this diet.
It is recommended that you eat fish and seafood at least twice a week. You should use water as your go-to beverage. You may also drink coffee and tea and one glass of wine a day. You should avoid fruit juices that are high in sugar.
