Treating Crohn’s Disease with a
Plant-Based Diet – a Case Report
Stewart D Rose* and Amanda J Strombom
Plant-Based Diets in Medicine, USA
Submission:January 01, 2019;Published: February 13 , 2019
*Corresponding author: Stewart Rose, Plant-Based Diets in Medicine, 12819 SE 38th St, #427, Bellevue, WA 98006, USA
How to cite this article: Rose S D, Strombom A J. Treating Crohn’s Disease with a Plant-Based Diet – a Case Report. Adv Res Gastroentero Hepatol.
002 2019; 12(3): 555837. DOI 10.19080/ARGH.2019.12.555837.
Crohn’s disease is notoriously difficult to treat and this patient was no exception. Patients are typically treated with a wide range of drugs, most of which have significant side effects, and surgery. This is a case study of a 63-yr old male, who was first diagnosed with Crohn’s disease in 1988. Over the past thirty years, he experienced persistent pain, chronic diarrhea and chronic fatigue. Extraintestinal manifestations included aphthous stomatitis, arthralgia especially in the knees and hips, eczema and uveitis. His comorbidities included shingles, exacerbated by immunosuppression, severe post herpetic neuralgia, and noise-induced hearing loss of both ears. The patient also has benign prostatic hypertrophy and diverticulosis.
Despite the full range of treatment, the patient remained with very significant symptoms, medication side effects and poor quality of life. In May 2017, the patient chose to go on a plant-based diet. Within two months, significant improvements in symptoms resulted. After three months, the patient was able to discontinue all immunosuppressant drugs. After one year, the patient reports no symptoms requiring medications other than ranitidine 150mg 2x/day and loperamide 10mg/day needed for post op management of resections. Fatigue, pain, diarrhea and all extraintestinal manifestations have virtually been eliminated. The patient reports a very large improvement in quality of life.
The current standard treatment for Crohn’s disease involves medication to manage symptoms and induce remission, and when necessary, bowel resection. An epidemiological study found that the risk of Crohn’s disease was reduced by 70% in females and 80% in males following a vegetarian diet. This suggested treating Crohn’s disease with a plant-based diet [1,2]. A well-designed interventional study published in 2010, using a semi-vegetarian diet, achieved a 100% remission rate at 1 year and 92% at 2 years [1,3].
A more advanced study published in 2017 examined whether a substantial improvement of the relapse-free rate in Crohn’s disease could be obtained by incorporating three recently developed concepts in medicine: biologics, a plant-based diet and window of opportunity. This was followed by maintenance of remission with a plant-based diet, rather than further use of biologics with or without immunosuppressants . All patients in this study who completed the protocol achieved remission at week 6. Remission rates by intention-to-treat and per protocol analysis were 96% and 100%, respectively. Improvements were seen in biomarkers such as C-reactive protein (CRP) and Crohn Disease Activity Index (CDAI) and in mucosal healing. This study has shown that a plant-based diet can improve the efficacy of biologics such as infliximab .
While research shows the efficacy of a plant-based diet in the treatment of Crohn’s disease, few physicians currently employ it as a therapeutic modality. This treatment, if used appropriately, can save the patient medication side effects, surgery, extraintestinal manifestations and quite a bit of money. Here, we report on a case of a patient with longstanding Crohn’s disease, successfully treated with a vegetarian diet.
A 63-year old male patient was first diagnosed with Crohn’s disease in 1988 at the age of 33 years old. Once diagnosed, he realized that symptoms had been present since his late teens. Symptoms included persistent pain, chronic diarrhea and chronic fatigue. Crohn’s disease may be complicated by extraintestinal
manifestations in up to 40% of patients . In this patient,
extraintestinal manifestations included apthous stomatitis,
arthralgia especially in the knees and hips, eczema and uveitis.
The patient’s medical history was otherwise unremarkable. He
was normotensive and had a BMI within the acceptable range.
Total cholesterol and ratio of HDL and LDL were within normal
limits. Renal function was normal.
His comorbidities included shingles, exacerbated by immunosuppression,
and severe post herpetic neuralgia (treated
with block transforaminal steroid epidural and block lumbar
epidural steroid), and noise-induced hearing loss of both ears.
The patient had benign prostatic hypertrophy and diverticulosis.
The patient was initially treated with sulfasalazine and
prednisone. This treatment was not fully effective. The
patient complained that medication side effects were extreme
irritability, greatly increased appetite with weight gain and
trouble sleeping. His symptoms of Crohn’s disease stabilized
at a not very comfortable level with continued pain, occasional
severe diarrhea and chronic, moderate fatigue.
Later treatments included were azathioprine, mesalamine,
metronidazole, infliximab (discontinued due to allergic reaction),
pregabalin, certolizumab pegol, famotidine, and Budesonide.
More recently, albuterol, fluticasone, ranitidine and loperamide
were added. However, significant symptoms persisted, although
attenuated, and the patient continued to have a poor quality
of life. Results of CT scan, MRI, flouriscopic and endoscopic
examinations were consistent with Crohn’s disease. Biopsy
confirmed the diagnosis.
During the course of illness, surgeries were required to:
a) Relieve obstruction in the proximal duodenum and the
b) Remove the cecum and appendix with reanastomosis
c) Resection of four severe obstructions along the jejunum
d) Resection of two of the obstructed sections along with
the ileocecal valve
e) A cholecystectomy – extensive scarring was noted.
In May 2017, the patient chose to go on a plant-based diet.
Within two months, significant improvements in symptoms resulted. By August 2017, the patient was able to discontinue all
immunosuppressant drugs. After one year, the patient reports
no symptoms requiring medications other than ranitidine
150mg 2x/day and loperamide 10mg/day needed for post
op management of resections. Fatigue, pain, diarrhea and all
extrainstestinal manifestations have virtually been eliminated.
The patent reports a very large improvement in quality of life.
He reports currently eating primarily whole grains, beans,
fruits, vegetables, tofu, and using plant-based milks. Over the
past few months he has begun to eat fish, mostly white fleshed
with some salmon, usually around 3-4 times per month, eggs
once or twice per week, and has some dairy products, always
cultured, never milk, and ice cream once a week or so. The fish
does not cause any symptoms but the eggs and dairy cause some
very mild discomfort on occasion
The results for this patient are in line with interventional
studies. The safety and efficacy of a plant-based diet to treat
Crohn’s disease would seem quite advantageous. It has no
contraindications and no adverse reactions. Therefore, it may
be safely used as monotherapy, or combined with standard
treatments. Treatment with a plant-based diet also reduces the
risk of common diseases that the Crohn’s patient will face in
common with all patients, such as coronary artery disease and
type II diabetes mellitus.
Given the substantial advantages, more study is warranted.
However, given its safety, the physician can institute therapy
with a plant-based diet immediately