Updated on February 8, 2023
- Because of the complex relationship between Crohn’s disease and food, many patients are confused about what constitutes an appropriate diet to control symptoms.
- Research suggests a high-fiber diet and the Autoimmune Protocol Diet has significant benefits for patients with Crohn’s disease.
- Butyric acid supplements and probiotics could replicate or augment the benefits of specialized diets for more robust symptom relief and diminished reliance on highly restrictive eating.
When many patients think about a Crohn’s disease diet, they think of the foods they can’t eat, because so many foods are viewed as triggers that can initiate or exacerbate painful and debilitating gastrointestinal symptoms. Although some elimination diets are supported by strong empirical evidence, it is important to recognize there are also studies indicating that certain foods are particularly beneficial for Crohn’s disease patients. When it comes to the management of Crohn’s disease, focusing on positive action—that is, emphasizing foods that patients can eat rather than limitations on the foods they should avoid—can be a more empowering approach for patients who struggle with seemingly intractable gastrointestinal symptoms for years. The latest research suggests that some of the best foods for Crohn’s disease include those high in fiber and those that combine probiotics with prebiotic fiber. In addition, there are nutritional supplements that can augment the nutritional benefits of these foods, making an even bigger beneficial impact on distressing symptomatology.
High-Fiber Foods for Crohn’s Disease? Taking a Second Look
For Crohn’s disease patients, advice to eat more fiber might come as a surprise because physicians have been recommending low-fiber diets for decades based on the assumption that fiber potentially triggers and intensifies Crohn’s symptoms. However, the body of research suggesting the potential benefits of high-fiber diets has a long history and, relative to Crohn’s, is gaining traction within the scientific and clinical communities.
As early as the mid-1970’s, clinical evidence indicates that fiber does not harm patients. For example, in a 1985 randomized, controlled study of 70 Italian patients with Crohn’s disease, researchers found that switching patients from a low-fiber diet to a standard Italian diet had no negative effect on gastrointestinal symptoms and did not lead to intestinal obstruction, as some clinicians at the time would have predicted. Rather, it allowed the patients to enjoy more appetizing meals, and it also enhanced the overall nutritional content of patients’ diets. Still, only recently have researchers begun to take more seriously the notion of the benefits of a high-fiber diet for Crohn’s. The impetus for the research comes partly from observations that the incidence and severity of Crohn’s disease are on the rise in Western nations where processed foods are replacing high-fiber whole grains.
To explore the connection between dietary fiber and Crohn’s disease, researchers at the University of Virginia in 2014 conducted a randomized, controlled, single-blind clinical trial in which different groups of adult patients with Crohn’s disease received different instructions for dietary fiber intake. The control group was instructed to follow the traditional advice given to Crohn’s disease patients: stay hydrated and avoid whole grains, dairy products, and high-fiber foods on days when symptoms are particularly prominent. In contrast, patients in the intervention group were instructed to eat one packet of whole wheat bran cereal (which was provided by the study coordinator) and drink at least 48 ounces of unsweetened fluids daily. At the end of the four-week trial, the results were remarkable: not only did the patients in the wheat bran-inclusive diet experience no worse symptoms, they also reported better gastrointestinal function. Moreover, there were no significant rises in biomarkers for inflammation, indicating that fiber intake does not promote the physiological processes that underpin Crohn’s disease.
One hypothesis that possibly explains the benefits of a high-fiber diet for Crohn’s disease patients is that indigestible fiber is metabolized to butyric acid by gut bacteria. This should come as no surprise because butyric acid is involved in a wide range of inflammation-related processes that might affect the pathophysiology of Crohn’s disease. Indeed, some studies show that some populations of gut bacteria that produce butyrate, such as Faecalibacterium prausnitzii, are lower in Crohn’s disease patients. In a study in Japan in 2015, researchers conducted a small-scale, case-controlled trial in which a plant-based, semi-ovo-lacto vegetarian diet was initiated for patients with Crohn’s disease, with the goal of providing the limited population of butyric acid-producing bacteria with more dietary fiber to ferment. When patients started eating an average of 32.4 g of dietary fiber daily (within a 2,000 calorie diet) alongside a biologic drug, they achieved a short-term decline in gastrointestinal symptoms, as well as a 92-percent remission rate after two years. These results suggest that high-fiber fruits and vegetables could be some of the best foods for Crohn’s disease patients. The results also suggest that directly introducing butyric acid as a nutritional supplement might offer relief for Crohn’s disease patients by simulating a rise in butyric acid by key gut bacteria.
The Benefits of Fermented Foods and Prebiotic Fiber for Patients with Crohn’s Disease
Although rigorous clinical evidence on the benefits of probiotics is lacking, there is still strong support for the notion that a diet that supports the health of the microbiome can address symptoms in Crohn’s disease patients. Some studies with supplementary probiotics indicate that introducing certain types of bacteria can ameliorate symptoms. There are also studies that show that fecal transplantation, which introduces new microbiota into a patient’s GI tract, can have significant positive results. Therefore, researchers have yet to fully abandon the idea that probiotic-rich fermented foods—like yogurt, kombucha, bean paste, and miso—are among the best foods for Crohn’s disease.
Intriguingly, one of the principles of the Autoimmune Protocol Diet—an increasingly popular dietary guideline for Crohn’s disease patients—is to combine foods high in prebiotic fiber with probiotics, an approach that has been shown to be more effective than supplementation with probiotics alone. In one study on the Autoimmune Protocol Diet, patients were encouraged to eat leeks and onions (two foods high in prebiotic fiber) alongside fermented foods, and after four weeks, all eight patients in the study reported positive results. Although this study was extremely small—with only eight Crohn’s disease patients taking part—the combination of prebiotic fiber and probiotics might be a promising strategy for patients who have not had success with probiotic-only therapy in the past.
Additionally, the results support an earlier 2007 study that suggested a therapeutic combination of a probiotic containing lactic acid bacteria and psyllium (a prebiotic fiber) induced remission in patients with active Crohn’s disease. Indeed, of the probiotic-containing foods and supplements supported by rigorous research, some of the most promising are those that contain lactic acid bacteria. Notably, lactic acid bacteria are known to produce butyric acid, the above-described multifunctional compound that supports the body’s natural inflammatory response. This association suggests that the benefits of these foods, like those of the high-fiber foods, might be mediated through the production of butyric acid by gut bacteria.
Making Smart Dietary Changes: Options for Crohn’s Disease Patients
Although there are no definitive results on the best foods for Crohn’s disease patients, the evidence indicates that the most promising dietary options are to choose foods and supplements that support the health of the gut microbiome. By increasing the intake of cereal-, fruit- and vegetable-based dietary fiber, and by combining prebiotic fiber with probiotic foods, patients might experience short-term relief and maintain long-term remission. In addition, supplements that directly introduce butyric acid, which is otherwise produced when gut bacteria metabolize dietary fiber, might also have similar beneficial effects, so patients and practitioners might want to consider including this emerging supplement in their therapies.
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