Beneficial effects of a fasting-mimicking diet in patients with Crohn’s disease
Kulkarni C et al, Nat Med. 2026;32(3):1023-1033
A fasting-mimicking diet on 5 consecutive days per month for 3 months was superior to a baseline diet for inducing clinical response and remission as well as improvements in inflammation markers in patients with mild-to-moderate Crohn’s disease in a randomized trial.
In healthy individuals, short cycles of a fasting-mimicking diet (FMD) decrease systemic inflammatory markers and improve metabolic health. Potential benefits of FMD have not been investigated in Crohn's disease (CD). We conducted an open-label, randomized, controlled trial to assess the effects of FMD in adults with mild-to-moderate CD. Patients in the FMD group followed an FMD for five consecutive days per month for three consecutive months, returning to their regular baseline diet on non-FMD days. Control participants continued their baseline diet. The primary outcome of clinical response was a reduction in CD Activity Index (CDAI) of at least 70 points or CDAI of ≤ 150 after the third 5-day diet cycle. Forty-five patients in the FMD group (69.2%) and 14 patients in the control group (43.8%) met the primary outcome of clinical response (p = 0.03). Forty-two patients in the FMD group (64.6%) and 12 patients in the control group (37.5%) achieved the secondary outcome of clinical remission (p = 0.02). There was also a decline from baseline in fecal calprotectin (an inflammatory marker) in the FMD group compared with the control group (-22.0% vs. 8.0%, p = 0.03). Exploratory analyses of plasma metabolites and peripheral blood mononuclear cell gene expression revealed post-FMD decreases in key inflammatory lipid mediators and immune-effector transcripts, concordant with reduced CD activity. Together, these findings demonstrate that FMD is superior to a baseline diet for inducing clinical response, clinical remission and biochemical improvement in mild-to-moderate CD, and support further investigation of FMD as an adjunctive therapy for chronic inflammatory diseases.
