Crohn’s Disease (CD) is a type of inflammatory bowel disease that causes inflammation of the intestinal tract, most commonly the small and/or large intestines though it can affect any part of your digestive tract from mouth to anus. Symptoms include diarrhea and abdominal pain.
According to a 2010 report, in Malta there are about 1600 patients receiving treatment for inflammatory bowel disease (CD and Ulcerative Colitis combined). Data collected between 1993 and 2005 reported that the incidence of CD in Malta was 0.96 per 100,000 per year for males and 1.62 per 100,000 per year for females. This is lower than the overall incidence of CD in other European countries.
Diet and Crohn’s Disease
The link between diet and Crohn’s Disease is increasingly being recognized, and in fact it is now know that heredity explains only up to 26% of why some children develop CD. The Crohn’s Disease Exclusion Diet (CDED) is a special type of diet that is able to induce remission in early mild-to-moderate CD in adults, with 69% achieving remission in the first 6 weeks of CDED.
The Modulife diet is based on the CDED + Partial Enteral Nutrition, and is the most scientifically studied diet therapy for people with Crohn’s Disease. Modulife is preferred over liquid-only diets (exclusive enteral nutrition) as it is easier to adhere to. It is also suitable for both adults and children.
What Does the Crohn’s Disease Exclusion Diet (CDED) / Modulife Involve?
The Modulife Diet involves eating liquid formula together with foods from the allowed list. Foods that are thought to cause inflammation or damage the gut are avoided. Modulife diet is implemented into three phases:
In phase 1 (weeks 1 to 6), 50% of your nutritional needs will be met by a liquid formula (Modulen), and the rest will be from whole foods. There are a number of ‘mandatory’ foods that should be included every day; these are – 150-200g chicken breast, 2 eggs, 2 bananas, 1 peeled apple, and 2 potatoes (cooked and cooled to increase their content of resistant starch). In addition, there are number of allowed foods that can be used, such as rice and rice flour, avocado, strawberries, peeled cucumbers, tomatoes, carrot, olive and canola oil, spices, herbs, honey and table sugar (up to specified amounts).
In phase 2 (weeks 7 to 12), Modulen will make up 25% of your calorie needs while the rest will be from food. The ‘mandatory’ foods of phase 1 still apply in phase 2, but there is a larger number of allowed foods, including more vegetables, fruits, a slice of bread a day, quinoa, lean beef once a week, and nuts.
Phase 3 (weeks 13 and beyond) is referred to as the ‘maintenance phase’, and more foods are gradually re-introduced into the diet. Liquid formula (Modulen) will make up 25% of daily nutritional requirements (or, on the advice of a health professional, it may not be used in phase 3). In terms of foods, there are no ‘mandatory’ foods and the list of allowed foods is expanded further, including yogurt, oats, 2 slices bread, and almost all fruit and vegetables. In addition, you are allowed 2 ‘free days’ per week, where you can consume foods that are not on the allowed list (including restaurant foods). Generally, these 2 ‘free days’ are Saturdays and Sundays, where a person can enjoy the added flexibility.
Manuel Attard is a registered dietitian and nutritionist trained in IBD and is currently the only Maltese recognized as a ModuLife expert on their international directory.