A 31-year-old man with a severe form of Crohn’s disease that caused painful fistulas (abnormal tunnels in the body) tried a special diet called the Crohn’s Disease Exclusion Diet along with a liquid nutrition supplement. After 12 weeks, his inflammation markers dropped to their lowest levels in three years, his fistula drainage nearly disappeared, and he was able to reduce his medication. Two years later, he remained healthy without needing hospitalization or additional drugs. This case suggests that this specific diet approach might help people with this difficult type of Crohn’s disease, though more research is needed to confirm these results.

The Quick Take

  • What they studied: Whether a special exclusion diet combined with liquid nutrition could help a patient with Crohn’s disease who had painful fistulas (abnormal tunnels) that weren’t improving with standard medication alone.
  • Who participated: One 31-year-old man who had been diagnosed with Crohn’s disease 11 years earlier and had undergone surgery. He had been on high-dose medication for three years but kept having flare-ups and fistula problems.
  • Key finding: After 12 weeks on the Crohn’s Disease Exclusion Diet plus liquid nutrition, the patient’s inflammation markers dropped to their lowest point in three years, his fistula drainage almost completely stopped, and he was able to reduce his medication doses. He stayed healthy for two years without needing hospitalization.
  • What it means for you: This case suggests that a specialized diet might help some people with difficult-to-treat Crohn’s disease, but this is just one person’s experience. More research with many more patients is needed before doctors can recommend this approach widely. If you have Crohn’s disease, talk to your doctor before making major diet changes.

The Research Details

This is a case report, which means doctors documented the detailed medical story of one patient over time. The patient followed the Crohn’s Disease Exclusion Diet (CDED), which removes certain foods thought to trigger inflammation, while also receiving a partial liquid nutrition supplement to ensure adequate nutrition. Doctors tracked his symptoms, blood work showing inflammation levels, and quality of life over 12 weeks and then for two years afterward.

The CDED is a multi-phase diet that starts very restrictive and gradually reintroduces foods. In this case, the patient combined it with partial enteral nutrition (PEN), meaning he got some of his calories from a medical liquid formula rather than food alone. This combination approach had not been previously documented in detail for patients with perianal Crohn’s disease (the type affecting the area around the anus).

Doctors measured success by looking at blood tests for inflammation, physical examination findings, endoscopy results (camera examination of the intestines), and the patient’s own report of how he felt and his quality of life.

Case reports are important because they document unusual or new approaches that might help patients. While a single case cannot prove something works for everyone, it can point researchers toward promising new directions. This case is particularly valuable because perianal Crohn’s disease is especially difficult to treat, and many patients don’t respond well to standard medications alone. If diet could help these patients, it would be a major breakthrough.

This is a single case report, which is the lowest level of scientific evidence. The main strength is that it’s thoroughly documented with objective measurements (blood tests, endoscopy) over a long period (two years). The main limitation is that we cannot know if the diet caused the improvement or if other factors played a role. We also don’t know if this would work for other patients with similar conditions. The patient was already on medication, so we can’t tell how much the diet alone contributed versus the combination of diet and medicine.

What the Results Show

After 12 weeks on the CDED plus liquid nutrition, the patient showed remarkable improvement. His blood markers of inflammation dropped to the lowest levels he had experienced in the three years he had been on high-dose medication. Most notably, the fistula drainage (fluid leaking from the abnormal tunnels) almost completely disappeared.

Based on these improvements, doctors were able to reduce his medication doses. They stretched out the time between his medication injections from every 4 weeks to every 6 weeks, and eventually to every 8 weeks. They also removed the seton (a medical device used to help drain fistulas).

Two years after starting the diet, the patient remained in excellent health. He had not experienced any flare-ups serious enough to require hospitalization, had not needed any additional medications, and continued to follow the maintenance phase of the CDED diet. His condition remained stable throughout this period.

The patient reported improvements in his quality of life, though specific details weren’t provided. His anthropometric measurements (body size and composition) were tracked, suggesting doctors were monitoring his nutritional status carefully while on the restricted diet. The fact that he was able to maintain good nutrition while on the CDED plus liquid nutrition combination suggests this approach can be nutritionally adequate when done properly.

This is the first detailed case report of the CDED being used specifically for perianal Crohn’s disease. Previous research has shown that the CDED can help some Crohn’s disease patients, but mostly those with inflammation in other parts of the intestines. The CDED has also been studied with partial enteral nutrition in other patient groups. This case is novel because it combines these approaches in a patient with the particularly difficult perianal form of the disease.

This is a single case report, so we cannot know if these results would happen for other patients. We don’t know if the diet alone caused the improvement or if it was the combination of diet and the medication the patient was already taking. The patient had already been on medication for years, so we can’t compare the diet to no treatment. We also don’t know if this would work for patients who haven’t had surgery or who are on different medications. Finally, we don’t have information about whether the patient made other lifestyle changes (like stress reduction or exercise) that might have contributed to his improvement.

The Bottom Line

Based on this single case, the CDED combined with liquid nutrition may be worth discussing with your doctor if you have perianal Crohn’s disease that isn’t responding well to standard treatment alone. However, confidence in this recommendation is low because it’s based on just one patient. Do not start this diet on your own without medical supervision, as restrictive diets can lead to nutritional deficiencies. If you’re interested, ask your gastroenterologist (digestive system doctor) about whether this approach might be appropriate for your specific situation.

This case is most relevant to people with Crohn’s disease, particularly those with perianal involvement (fistulas or abscesses around the anus) who are not improving adequately with standard medications. It may also interest gastroenterologists and nutritionists who treat Crohn’s disease patients. People with other types of inflammatory bowel disease should not assume these results apply to them without consulting their doctor. This case should not be used to guide treatment decisions without professional medical input.

In this case, significant improvements appeared within 12 weeks, with the most dramatic change being the reduction in fistula drainage. However, the medication dose reduction happened gradually over months, and the patient remained stable for two years. If you were to try this approach, you should expect that any benefits would likely take weeks to months to appear, and you would need regular monitoring with blood tests and doctor visits to assess progress.

Want to Apply This Research?

  • Track daily symptoms including bowel movement frequency, fistula drainage (if applicable), abdominal pain level (1-10 scale), and energy level. Also note which foods you ate each day to identify patterns. This data can be shared with your healthcare team to assess whether dietary changes are helping.
  • If working with your doctor on a CDED approach, use the app to log which foods you’re eating and avoiding according to the diet phases. Set reminders for meal times and liquid nutrition supplements. Track your adherence to the diet plan to help identify which foods might trigger symptoms.
  • Set up weekly check-ins to review your symptom patterns and dietary adherence. Create alerts to remind you of upcoming doctor appointments where you can discuss your progress. Use the app to track any changes in medication doses or medical procedures (like seton placement/removal) alongside your dietary changes to help your doctor understand the full picture of your treatment.

This case report describes the experience of one patient and should not be used as medical advice. The Crohn’s Disease Exclusion Diet is a restrictive diet that requires medical supervision to ensure adequate nutrition. Do not start this diet without consulting your gastroenterologist or healthcare provider. Results in one patient do not guarantee results in others. This information is for educational purposes only and does not replace professional medical diagnosis, treatment, or advice. Always work with your healthcare team before making significant changes to your diet or medication regimen.