- Tamar Feldman, RDN CDE
The Mediterranean Diet: A New Arsenal in the Fight Against Crohn’s Disease?
Updated: Aug 29, 2022
The Mediterranean Diet, arguably one of the healthiest diet protocols that exist, now has another benefit to add to its already impressive list: A reduction of symptoms of Crohn’s Disease. While a Mediterranean-style diet is known for its overall health benefits and has been linked to lower all-cause mortality and diseases such as cancer or heart disease, it had never been studied in relation to IBD prior to the recent study completed in 2021.
DINE -CD (1) (The Diet to Induce Remission in Crohn’s Disease) was the first-ever national study of diet interventions to manage Crohn’s disease symptoms. It was a randomized clinical trial that compared the Specific Carbohydrate Diet™ (SCD) to a Mediterranean diet in individuals with mild to moderate Crohn’s symptoms, and measured quality of life improvements as well as lab markers to assess improvement.
After six weeks, roughly 43% of patients following a Mediterranean-style diet and 46% of patients following the Specific Carbohydrate Diet achieved symptomatic remission. At week 12, differences between the two diets remained statistically insignificant. While lab markers measuring inflammation were statistically not changed from either diet, the fact that participants achieved symptomatic remission is still significant and indicates that the diet can be implemented as part of broader medical interventions to manage Crohn’s Disease.
The study authors concluded that due to the greater ease of following the Mediterranean Diet and other health benefits associated with it, it may be preferred over the Specific Carbohydrate Diet for Crohn’s patients with mild to moderate symptoms.
I had suspected what was proven by the study for a while – in fact, due to the limited evidence that already existed pointing in that direction as well as its known anti-inflammatory benefits, (Crohn’s is an inflammatory condition after all!) I had been utilizing the Mediterranean Diet (with a disclaimer to clients that evidence is still limited) as one type of anti-inflammatory diet for Crohn’s in my practice with excellent results prior to the official study. It’s always great to prove what we suspect though with hard data, as clinical practice needs to be guided by evidence rather than limited data or anecdotal accounts.
How to Plan a Mediterranean Diet
The foundation of the Mediterranean diet should include minimally processed whole grains, legumes (beans/split peas/lentils, etc.), nuts and seeds (ground initially for Crohn’s Disease), a large variety of fruits and vegetables, and herbs and spices. Olive oil (cold pressed virgin) is used liberally in food preparation and maybe a strong contributing factor to the anti-inflammatory properties of the diet.
Fish accounts for the second tier of the pyramid and is eaten often (daily or at minimum 2-3x per week) and eggs and poultry are on the third tier, with recommended consumption limited. In practice, I advise only 4 eggs per week and poultry (white meat only) at most 3x per week in 4-6 ounce portions. Dairy is additionally limited – I advise no cheese at all or at most 2-3 ounces of reduced fat cheeses per week, and yogurt (low-fat/plain only) at most 6 ounces daily.
While the diet may take some time to get used to coming from the Standard American Diet heavy on animal protein and dairy, I find that most individuals adapt quickly, and learn to enjoy their lighter food and how it makes them feel. The key is to start slow – perhaps initially modifying one or two dinners per week to a Mediterranean-style, and slowly increasing as you adapt.
Super-Easy Mediterranean Style Bean Chili
Serve on top of brown rice, quinoa, or grain of your choice.
3 Tbsp extra virgin olive oil
1 red pepper, diced
1 green pepper, diced
2 celery stalks, diced
1 small onion, diced
2 cans kidney or black beans, rinsed and drained
Chili powder, to taste
1 15-ounce can of tomato sauce
¼ cup water
Heat oil on a low flame in a skillet or small pot. Add diced veggies and cook for 5 minutes, stirring. Add in beans, tomato sauce, water, and chili powder. Heat on low-medium flame for 10 minutes. Enjoy!
Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn's Disease. Gastroenterology. 2021 Sep;161(3):837-852.e9. DOI: 10.1053/j.gastro.2021.05.047. Epub 2021 May 27. PMID: 34052278; PMCID: PMC8396394.