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Important to our understanding and prevention of the global increase of inﬂammatory bowel disease, we know that dietary ﬁber appears to reduce risk, whereas dietary fat, animal protein, and sugar may increase risk. “Despite the recognition of the Westernization of lifestyle as a major driver of the growing incidence of inflammatory bowel disease, no countermeasures against such lifestyle changes have been recommended, except that patients with Crohn’s disease should not smoke.” Look, we know consuming whole, plant-based foods is synonymous with an anti-inflammatory diet. Here’s a list of foods with inflammatory effects; here’s a list of foods with anti-inflammatory effects. So, how about putting a plant-based diet to the test?
Just cutting down on red and processed meat didn’t work, but what about cutting down on all meat? A 25-year-old guy diagnosed with Crohn’s disease, but failed to enter clinical remission despite standard medical therapy. But after switching to a diet based exclusively on grains, legumes (like beans, split peas, chickpeas, and lentils), vegetables, and fruits, he entered clinical remission, without the need for medication and showed no signs of Crohn’s disease on follow-up colonoscopy.
It’s worth delving into some of the details. The conventional treatment they started him on is inﬂiximab, sold as REMICADE®, which can cause a stroke, and may increase your chances of getting lymphoma or other cancers—but it’s a bargain for only $35,000 a year. And it may not even work in 35 to 40 percent of patients. And that seemed to be the case here. So, they upped the dose, after 37 weeks and still suffering after two years on the drug—until he tried completely eliminating animal products and processed foods from his diet, finally experiencing a complete resolution of his symptoms.
Prior to this, his diet had been a typical American diet. But having experienced complete clinical remission for the first time since his diagnosis, he decided to switch to a whole-food, plant-based diet permanently, severely reducing his intake of processed food and limiting animal products to one serving, or less, per week. And whenever his diet started to slip, symptoms started coming back. But he could always wipe them out by eating healthier. After six months of implementing these changes in diet and lifestyle, including stress relief and exercise, a follow-up demonstrated complete mucosal healing of the gut lining with no visible evidence of Crohn’s disease.
We know “[a] diet consisting of whole grains, legumes, fruits, and vegetables has been shown to be helpful in the prevention and treatment of heart disease, obesity, diabetes, hypertension, gallbladder disease, rheumatoid arthritis, and many cancers. Although further research is required …, this case report suggests that Crohn’s disease might be added to this list of conditions.” But that further research has already been done! About 20 patients with Crohn’s disease were placed on a semi-vegetarian diet, meaning no more than a half-serving of fish once a week and a half-serving of meat once every two weeks, and achieved 100 percent remission rate at one year and 90 percent at two years.
Some strayed from the diet though. Let’s see what happened to them. After a year, half had relapsed, and at year two, only 20 percent remained in remission. But those that stuck with it had remarkable success. It was a small study with no formal control group, but represents the best reported result in Crohn’s relapse prevention published in the medical literature to date.
Nowadays, Crohn’s patients are often treated with so-called biologic drugs, expensive injected antibodies that suppress your immune system and have effectively induced and maintained remission in Crohn’s disease, but not in everybody. The current remission rate in Crohn’s with early use of REMICADE® is 64 percent. So, 30 to 40 percent of patients are likely to experience a disabling disease course even after treatment. What about adding a plant-based diet? Remission rates jumped up to 100 percent for those who didn’t have to drop out due to drug side effects. Even if you exclude the milder cases, 100 percent of those with serious—even severe—fulminant disease achieved remission.
But if you look at gold standard systematic reviews, they conclude that the effects of dietary interventions on inflammatory bowel diseases, Crohn’s disease and ulcerative colitis, are uncertain. This is because only randomized controlled trials were considered. Totally understandable, as that’s the most rigorous study design. “Nevertheless, people with inflammatory bowel disease deserve advice based on the ‘best available evidence’ rather than no advice at all . .” And switching to a plant-based diet has been shown to achieve far better outcomes than those reported on conventional treatments in both active and quiescent stages in both Crohn’s and ulcerative colitis. For example, here are one-year remission rates in Crohn’s disease: 100 percent compared to budesonide, an immunosuppressant corticosteroid drug; a half elemental diet, meaning like at-home tube feedings; the $35,000 a year drug REMICADE®; or the $75,000 a year drug Humira. Safer, cheaper, and more effective? Maybe we should recommend plant-based diets for inflammatory bowel disease.
It would seem clear that treatment based on treating the cause of the disease is optimal. Spreading the word about healthier diets could help halt the scourge of inflammatory bowel, but how are people going to hear about this amazing research without some kind of public education campaign? That’s what NutritionFacts.org is all about.
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