James Lewis, MD, on Diet and Nutrition in Crohn's Disease

Dr James Lewis recaps his presentation on using diet —including the Crohn's Disease Exclusion Diet, the Low FODmap Diet, and the Mediterranean diet—as an adjunct to medical therapy for Crohn's disease, and the potential for diet to perhaps prevent disease among people at high risk in the future.

James Lewis, MD, is chief of Gastroenterology and Hepatology and professor of medicine at the University of Pennsylvania Presbyterian Medical Center in Philadelphia, Pennsylvania.

Hi, I'm Jim Lewis. I'm a gastroenterologist at the University of Pennsylvania, and I'm here at the AIBD meeting 2024. Today, I had the pleasure of speaking to the congress about the role of diet and nutrition in the management of Crohn's disease. There's been quite a bit of progress in this field over the course of the last decade, but not equal to that which has happened with medications. And so an important goal at this point is to figure out what is the niche for diet and nutrition in the management of Crohn's disease.

I think there are several important places where we can use diet effectively, but for most people it's to improve their general health, and for those, I think it's safe to recommend a more Mediterranean-style or plant-emphasizing diet to try and reduce their risk of cardiovascular and other complications that may be outside of Crohn's disease.

For other patients, we can think about using diet to try and improve their symptoms when the inflammation is already well controlled from medications, but they continue to have symptoms. So using a diet such as the low FODMAP diet can be a wonderful strategy. I also, in my practice, will use nutrition to try and avoid the use of steroids. I often will do this by recommending a short course of exclusive enteral nutrition using a meal replacement formula for essentially 100% of people's calories over the course of anywhere from 2 to 8 weeks. An important advancement in this part of nutrition care is the better-tasting formulas that are available today so that people no longer need to use a nasogastric tube to administer these therapies.

Another place where I like to think about using exclusive nutrition is in our patients who are getting ready for surgery. Some recent summary of existing studies has shown that patients who have preoperative exclusive enteral nutrition have about a 50% lower likelihood of wound infections and deep or soft tissue infections.

In the end, one of the things that I like to think about for the future, although I don't know that we're there yet, is the idea of whether we could use nutrition to try and prevent disease in people who we know are at high risk. So for example, children or siblings of somebody who already has Crohn's disease could, using a diet sourced essentially from fresh ingredients and avoiding ultra-processed foods, potentially prevent these people from ever developing Crohn's disease. Obviously, prevention is better than any treatment that we have, so time will tell whether we get there, but stay tuned for breakthroughs that hopefully will happen in the next several years.