When Medications Fall Short: Exploring Diet in Mild Crohn’s Disease, With Sidhartha Sinha, MD

For patients with mild Crohn’s disease (CD), treatment decisions are often complicated by a lack of appropriate therapeutic options. While corticosteroids, the onlyUS Food and Drug Administration (FDA)-approved therapy for this population, can rapidly improve symptoms, their long-term toxicity often outweighs their benefits. As a result, there has been a growing interest in nonpharmacologic strategies for disease management.

“We often think about [steroids] as being some of the best drugs and some of the worst drugs at the same time. They can make patients feel better, and sometimes we need to do that and do that quickly, but they come with a whole slew of side effects,” Sidhartha Sinha, MD, an assistant professor of gastroenterology and hepatology at Stanford, told HCPLive. “We're always looking at ways to improve the treatment of patients, and fortunately, now we have many advanced therapies that offer some benefit, but patients who have mild and sometimes very moderate Crohn's disease fit into this area where there may not be therapies that are appropriate for them. In these cases, we think that lifestyle can really make an impact.”

With this therapeutic gap in mind, he and a team of investigators conducted an open-label, randomized, controlled, clinical trial assessing the effectiveness of a fasting-mimicking diet (FMD) for reducing clinical disease activity in patients with mild-to-moderate CD. In the study, patients consumed a FMD for 5 consecutive days per month for 3 consecutive months. For the remaining days in each month, patients consumed their regular baseline diet. Patients in the control group continued their baseline diet.

Study results showed that short, structured periods of significant caloric restriction were associated with improvements in clinical disease activity and biochemical markers of inflammation. In some cases, patients achieved complete clinical remission.

However, Sinha emphasized that FMD should not be viewed as a replacement for standard medical therapy. Instead, he says the results suggest that diet may serve as a complementary strategy, especially for patients who fall into the gray zone between minimal symptoms and disease severe enough to justify immunosuppressive or biologic treatment.

One of the notable strengths of the study was its real-world design. Participants reflected everyday clinical practice, including patients already receiving pharmacologic therapy as well as those who had chosen not to initiate medication. Across both groups, the dietary intervention was associated with reductions in disease burden, reinforcing the idea that nutritional strategies may exert benefits independent of medication status.

Sinha went on to emphasize the importance of considering safety, noting that an intervention should never cause harm. Accordingly, his study only enrolled patients with mild to moderate disease and excluded those who were pregnant, underweight, or otherwise at risk.

He noted that despite the low caloric intake during the fasting periods, no significant differences in weight were observed between the intervention and control groups, likely due to post-intervention caloric rebound. Adverse effects such as fatigue and headache were mild, transient, and resolved quickly once normal eating resumed, something Sinha says can likely be expected after long periods of not eating much food or skipping meals.

Taken together, he says the findings suggest that carefully designed dietary interventions like FMD may offer a promising, low-risk adjunct for patients with mild Crohn’s disease while also opening the door to more mechanistically informed lifestyle research in IBD.

Editors’ note: Sinha reports no relevant disclosures.

References

1. Brooks A. Fasting-Mimicking Diet Elicits Clinical, Biochemical Response in Mild Crohn’s Disease. HCPLive. January 13, 2026. Accessed January 16, 2026. https://www.hcplive.com/view/fasting-mimicking-diet-elicits-clinical-biochemical-response-in-mild-crohn-s-disease

2. Ha C. Management of Patients With Mild Crohn's Disease. Gastroenterol Hepatol (N Y). 2024;20(6):345-347.https://pmc.ncbi.nlm.nih.gov/articles/PMC11346010/