Can reduction of sugar intake reduce the risk of complications of Crohn,s disease?
Since the mid 1970,s it has been known that patients with Crohn,s disease consume more sugar than patients with ulcerative colitis or normal subjects. In this discussion, it is to be understood that sugar means the disaccharide sucrose, which is also commonly known as table sugar. Initially, two studies from Germany showed that patients with Crohn,s eat more sucrose than healthy controls (23,28). A number of studies since then have confirmed this finding (37).
The usual teaching is that this is due to patients changing dietary habits to accomidate their inability to tolerate many foods. However, patients with ulcerative colitis who often have similar digestive complaints do not have increased sucrose intake (11,24,34,38). Also, patients who have Crohn,s report that when they get sick their sucrose intake actually drops rather than increases. Other studies show that symptoms are not changed when sucrose is restricted (1) and one study suggested that sucrose worsens symptoms (1).
Studies have been done to look at whether restriction of sucrose intake is of benefit in patients with Crohn,s. In a study of 64 patients with Crohn,s (7), 32 patients were put on a diet which minimized sucrose and white flour, and substituted whole wheat and fruits. While the experimental and control groups were in different clinics, the treated group had 80% less days in the hospital and only 1 patient required surgery compared to 5 in the control group. (Interestingly, this experiment was done before the first epidemiological studies reported increased sucrose intake in Crohn,s patients).
In a larger study, results were not as beneficial (35). 190 patients treated with sugar restrictin compared to 162 treated with usual diet showed that 3.7% of treated patients needed surgery compared to 8.6% of controls and hospital admission rates were 9.5% in treated patients and 13% in controls. These numbers did not reach statistical significance.
K. W. Heaton, one author of the 64 patient study described
above (7), noted that in the
larger study of 352, patients were British and were asked to consume fruits and vegetables, a decidedly unBritish activity. Also, the control group showed a drop in sucrose consumption, which makes it possible that the control group was really a partially treated group. Unfortunately, a subgroup analysis was not reported with controls who did not reduce their sucrose intake.
I regularly recommend that my patients reduce or eliminate sucrose in the diet. I allow commercial bread, which does have some sugar added, but I advise that patients do not consume anything with obvious sugar in it or sprinkled on it and do not add sugar to drinks or when cooking. (I suspect that fermentation will have consumed the sucrose in regular bread, but not sweet bread). I recommend that a safe substitute is honey, which is fructose.
Stephen Holland, M.D.
University of Illinois College of Medicine at Urbana-Champaign.
©1997, Stephen Holland.
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This material was abstracted from the chapter "Dietary Factors in the Etiology of Crohn,s Disease written by K. W. Heaton, in Inflammatory Bowel disease edited by Gunnar Järnerot, Raven press 1987.
1. Brandes, J.W. and Lorenz-Meyer, H. Zuckerfreie Diät: eine neuer Perspektive zur Behanndlung des Morbus Crohn? Eine randomsierte, kontrollierte Studi. Z. Gastroenterol., 19:1-12, 1981.
7. KW Heaton, JR Thornton, PM Emmett. Treatment of Crohn,s disease with an unrefined-carbohydrate, fiber-rich diet. Br. Med. J. 2:764-766, 1979
11. G Järnerot, I Järnmark, K Nilsson. Consumption of refined sugar by patients with Crohn,s disease, ulcerative colitis, or irritable bowel syndrome. Scand. J. Gastroenterol. 18:999-1002, 1983.
23. GA Martine, JW Brandes. Increased consumption of refined carbohydrates in patients with Crohn,s disease. Klin. Wochenschr. 54:367-371, 1976.
24. GA Martin, A Stenner, WJ Brandes. Diet and ulcerative colitis. Br. Med J. 2:1401, 1978.
28. B. Miller, F Fervers, R Rohbeck, G. Strohmeyer. Zuckerkonsum bei Patiententen mit Morbus CrohnVerh. Dtsch. Ges Inn Med. 82:922-924, 1976.
34. GB Porro, E Pnaza. Smoking, sugar, and inflammatory bowel disease. Br. Med. J. 291:971, 1985.
37. JR Thornton, PM Emmett, KW Heaton. Diet and Crohn,s disease: characteristics of the pre-illness diet. Br. Med. J. 2:762-764, 1979.
38. JR Thornton, PM Emmett, KW Heaton. Diet and ulcerative
colitis. Br. Med. J. 1:293-294, 1980.
©1997, Stephen Holland.
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