A Whole-Food Smoothie Diet Induces Clinical and Biochemical Remission in Children with Mild-Moderate Crohn’s Disease

A Whole-Food Smoothie Diet for Children with Crohn’s Disease?

Exclusive enteral nutrition (EEN) or consuming a fully liquid nutrition as a therapy to induce remission in Crohn’s disease (CD) has been the mainstay of nutrition intervention for over 50 years. While it is still unknown how EEN works to induce remission, it is thought to work through shifting the gut microbiome. The power of EEN comes from its ability to induce mucosal healing especially when compared to corticosteroids, and its superior safety profile. In children, it is especially valued as an intervention given its ability to replenish nutritional deficits and improve growth.¹

To date, commercial formulas containing numerous ingredients with known negative impact on the gut health and the intestinal microbiome have been the mainstay of treatment with EEN. 

Now researchers from Seattle Children’s hospital are discovering that a whole-food smoothie formula could be used for induction of remission in children newly diagnosed with mild-to-moderate CD. It may also lead to an increase of gut microbiome richness, considered a generally good indicator of a “healthy gut.”  

The latest findings come from a pilot study recently published in the Journal of Pediatric Gastroenterology and Nutrition² that was carried out by researchers at Seattle Children’s Hospital and University of Washington. For the study, researchers recruited 10 children with newly diagnosed active CD that had not yet been treated with drugs or nutritional therapies. 

All children received an initial 7-10 day period of a gradual increase in the amount of smoothie diet consumed, then received all their nutrition via the home-made smoothie. “Key to the researchers goal was to ensure the smoothie was nutritionally complete when taken with a multivitamin and that the ingredients were easy to find, including bananas, egg whites, water, avocado oil, strawberries, plain Greek yogurt, almond butter, honey, and table salt. All other food staples and drinks outside water were excluded,” said David Suskind, an author of the new study and a professor of pediatrics at Seattle Children’s Hospital and the University of Washington School of Medicine. This composition is reminiscent of the specific carbohydrate diet. The home-made smoothie tasted less sweet as compared to commercial formulas and was overall well tolerated by participants and by an initial healthy adult test group. 

The participants followed the diet for 4 weeks while the researchers tracked dietary intake, weight, symptoms, blood tests including markers of gut inflammation (C-reactive protein and fecal calprotectin) and looked at changes in their gut microbiomes at the beginning, middle and end of study. 

By the end of the study, the smoothie-only diet induced clinical remission in 8 out of 10 children-evaluated by a Pediatric Crohn Disease Activity Index below 10 that reflects inactive disease by physician global assessment-. Also, the diet reduced fecal calprotectin in over half (below 250 mcg/mg) in 6 out of 10 participants and below 100 mcg/g in 4 out of 10 children. Similarly, C-reactive protein normalized in 7 out of 10 children. The efficacy achieved by the whole-food smoothie was similar to commercial formulas and obtained in a shorter time (4 weeks vs 8-12 weeks).

“This research has the potential to expand treatment options given its reliance on standard food items from the grocery and also has the potential of better understanding the mechanism by which nutritional interventions like EEN work,” said Dr. Suskind.

The smoothie intake was also associated with an increase in gut microbiome richness and the abundance of Streptococcus and Bifidobacterium while a decreased abundance of Blautia.³ These positive changes in the fecal microbiome are different from those observed when using commercial formulas (decrease in Bifidobacterium abundance and overall gut microbiome diversity)⁴ and may account for the observed diet benefits of the smoothie-only diet in remission of CD. 

“Much more research is required in this area to understand the impact of these changes in the microbiome and their effect on the pathophysiology of Crohn’s disease itself. The research team continues to explore the effects of the intervention in CD examining its effect on the metabolome, bile acids and proteome in an ongoing study,” said Dr. Suskind.

To sum up, this is the first study that shows the efficacy and safety of a home-made smoothie with whole foods for improving symptoms and inflammation in children with mild-moderate CD. 

While these findings make it easier for parents and caregivers to prepare the smoothie at home, additional long-term studies that replicate these findings are needed. Please before trying the home-made smoothie on your own, you should ask the supervision from a doctor/registered dietitian in order to avoid nutritional deficiencies and monitor the evolution of disease.

References:

<sup>1. Gkikas K, Svolos V, White B, Gerasimidis K. An update on dietary therapies in paediatric Crohn’s disease. Curr Opin Clin Nutr Metab Care. 2024; 27(3):304-312. doi: 10.1097/MCO.0000000000001024. 
2. Lee D, Braly K, Nuding M, Braly I, Hopp C, Twible H, et al. Reverse-engineered exclusive enteral nutrition in pediatric Crohn’s disease: A pilot trial. J Pediatr Gastroenterol Nutr. 2024; 78(5):1135-1142. doi: 10.1002/jpn3.12196.
3..Holmberg SM, Feeney RH, Prasoodanan PK V, et al. The gut commensal Blautia maintains colonic mucus function under low-fiber consumption through secretion of short-chain fatty acids. Nat Commun. 2024; 15(1):3502. doi: 10.1038/s41467-024-47594-w.
4. Leach ST, Mitchell HM, Eng WR, et al. Sustained modulation of intestinal bacteria by exclusive enteral nutrition used to treat children with Crohn’s disease. Aliment Pharmacol Ther. 2008; 28(6):724-733. doi: 10.1111/j.1365-2036.2008.03796.x.</sup>

‍Dr. Andreu Prados is a science and medical writer specializing in making reliable evidence of non-prescription therapeutics for gastrointestinal conditions understandable, engaging and ready for use for healthcare professionals and patients.

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