is an inflammatory bowel disease that can affect any part of the gastrointestinal tract from mouth to anus, and can involve the full thickness of the bowel wall, characterised by periods of flares and remissions
The cause of Crohn’s Disease is still unknown; however the environment, genes and the gut bacteria are thought to be involved.
Diagnosis for CD may include colonoscopy, endoscopy, imaging studies such as barium x-rays and abdominal CT, stool cultures and sigmoidoscopy.
Dietary management of CD
Diet plays a key role in the management of CD. Some interventions that may be considered in the management can include:
Change in dietary intake to meet nutrient requirements (energy, protein)
Prevention and management of mineral and vitamin deficiency & supplementation
Modified fibre diet (active or in remission)
Specialised diets: Exclusive Enteral Nutrition (EEN) and Crohn's Disease Exclusion Diet (CDED) in management of flares to reduce inflammation
Elimination Diet (Low FODMAP diet) in managing functional symptoms (in remission)
- Modified diet to optimise gut health
EEN is a treatment option for patients with Crohn’s Disease. EEN aims to get your disease into remission or to reduce the inflammation in your gut before surgery. EEN is safe and for some people it may be a good alternative to medications such as steroids.
EEN may work by changing the mix of bacteria that live in the gut, by directly reducing inflammation, by removing specific components of food and/or by giving the gut a chance to heal while providing balanced nutrition.
It involves replacing all food with specialised nutrition drinks. These drinks provide all the energy, protein, vitamins and minerals you need and are available in a number of different flavours. You will usually be asked to follow this program for 6-8 weeks.
The CDED is a dietary therapy that has been demonstrated to decrease inflammation and induce remission in Crohn's disease. The diet is thought to help by removing foods that may change the bacteria in your gut and promote inflammation, while increasing other foods that provide fibre and resistant starch which help to reduce inflammation. It is a structured diet that allows specific foods along with a liquid nutritional formula (Partial Enteral Nutrition).
The Low FODMAP Diet
The low FODMAP diet is an evidence based dietary strategy to successfully manage of functional symptoms when your CD is in remission. FODMAP is an acronym for Fermentable Oligo-, Di, Mono-saccharides And Polyols. It is considered to be a second-line dietary strategy after assessment and management of dietary and lifestyle factors that may contribute to symptoms.
The low FODMAP diet involves collective restriction of a group of short-chain carbohydrates that have been shown to increase small intestinal water volume and be rapidly fermented in the large intestine, leading to increased gas (e.g. hydrogen) production and gastrointestinal symptoms (i.e. pain, bloating, distension, flatulence, nausea and altered bowel motility).
The low FODMAPs diet is a dietitian-taught program to ensure nutritional intake adequacy despite food restrictions. The long-term restriction of FODMAPs is not recommended. Structured reintroduction of FODMAPs is recommended after two to six weeks to identify which FODMAPs you are sensitive to, your level of tolerance to each individual high FODMAP foods, and optimise food variety and self-management long term.
Gastrointestinal System - Inflammatory Bowel Disease Background. 2018. PEN
Diet in Inflammatory Bowel Disease (IBD). 2021. GESA
Crohn’s Disease Exclusion Diet. 2020. DECCAN group
Exclusive Enteral Nutrition. AuSPEN Clinical Practice Toolkit.
National Institute for Health and Clinical Excellence. Irritable bowel syndrome in adults. Diagnosis and management of irritable bowel syndrome in primary care. London (UK): National Institute for Health and Clinical Excellence. Clinical guideline 61 Update 2015. Available from: http://www.nice.org.uk/Guidance/CG61
© 2021 Dietetic Gut Clinic