Elemental diet nourishing the digestive system and protecting from Crohn's flare-ups.

Beating Crohn's Flare-Ups: Can a Special Diet Help Adalimumab Work Better?

Theo Raines in Health & Wellness December 2025 • 5 min read.

"New research explores how combining an elemental diet with adalimumab could reduce loss of response in Crohn's patients, especially when other treatments have failed."

Crohn's disease, a chronic inflammatory condition of the digestive tract, often requires ongoing management to control symptoms and prevent flare-ups. Biologic therapies, such as adalimumab, have revolutionized treatment, offering many patients significant relief. However, one of the significant challenges in Crohn's disease management is the eventual loss of response to these medications, leaving individuals searching for alternative strategies.

Adalimumab, a TNF-alpha inhibitor, works by targeting and blocking a specific protein that causes inflammation. Over time, some individuals may experience a reduced effectiveness of adalimumab, leading to a return of symptoms. This loss of response can occur for various reasons, including the development of antibodies against the drug.

A recent study has explored an adjunctive approach to combat this issue: combining adalimumab therapy with an elemental diet. This article will delve into the findings of this research, examining how this combined approach may help reduce the loss of response to adalimumab, particularly in individuals with intractable Crohn's disease, offering a beacon of hope for those seeking to maintain long-term remission.

Elemental Diet: Aiding Adalimumab in Crohn's Management

Elemental diet nourishing the digestive system and protecting from Crohn's flare-ups.

The research, spearheaded by Kenji Watanabe and colleagues, investigated the efficacy of using a concomitant elemental diet to reduce the loss of response to adalimumab (ADA-LOR) in Crohn's disease patients. The study enrolled 117 patients, dividing them into two groups: one receiving an elemental diet (ED) of at least 900 kcal/day, and another with a non-ED group consuming less than 900 kcal/day. The results shed light on the potential benefits of this combined approach, especially for those who have not responded well to other treatments.

The study revealed several key findings:

Reduced Loss of Response: Concomitant ED therapy reduced ADA-LOR in individuals who were intolerant or refractory to infliximab (IFX), another common biologic medication, in a dose-related manner.
TNF-alpha Levels: Reductions in tumor necrosis factor-alpha (TNFα) levels, achieved through concomitant ED intake, may contribute to reducing ADA-LOR in Crohn's disease patients. Serum TNFα levels were significantly lower in the ED group at weeks 28 and 52 of the study.
No Impact on ADA Levels: Serum adalimumab levels did not differ significantly between the groups, suggesting the elemental diet's benefits aren't due to increased drug absorption but rather its impact on the inflammatory process.

These results suggest that incorporating an elemental diet into the treatment plan can be a beneficial strategy, particularly for individuals who have previously struggled with other therapies. By reducing inflammation, the elemental diet appears to create a more favorable environment for adalimumab to work effectively, thereby prolonging its efficacy and reducing the likelihood of disease flare-ups.

Implications for Crohn's Disease Management

This study offers a promising avenue for improving the long-term management of Crohn's disease. For individuals experiencing a decline in the effectiveness of adalimumab, incorporating an elemental diet may help to regain control over their symptoms and maintain remission.

The finding that elemental diets can reduce TNFα levels is particularly significant. TNFα is a key driver of inflammation in Crohn's disease, and lowering its levels can have a cascade of beneficial effects, potentially reducing the need for higher doses of medication or more aggressive treatments.

While these results are encouraging, it's important to note that further research is needed to fully understand the optimal duration and composition of elemental diets for Crohn's disease management. However, for those seeking to enhance the effectiveness of their adalimumab therapy and improve their overall quality of life, discussing the potential benefits of an elemental diet with their healthcare provider is a worthwhile step.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/jgh.13969, Alternate LINK

Title: Efficacy Of A Concomitant Elemental Diet To Reduce The Loss Of Response To Adalimumab In Patients With Intractable Crohn'S Disease

Subject: Gastroenterology

Journal: Journal of Gastroenterology and Hepatology

Publisher: Wiley

Authors: Naoko Sugita, Kenji Watanabe, Noriko Kamata, Tomomi Yukawa, Koji Otani, Shuhei Hosomi, Yasuaki Nagami, Fumio Tanaka, Koichi Taira, Hirokazu Yamagami, Tetsuya Tanigawa, Masatsugu Shiba, Toshio Watanabe, Kazunari Tominaga, Daijiro Kabata, Ayumi Shintani, Tetsuo Arakawa, Yasuhiro Fujiwara

Published: 2018-02-22

Everything You Need To Know

What is Crohn's disease, and why is adalimumab used to treat it?

Crohn's disease is a chronic inflammatory condition affecting the digestive tract. It requires ongoing management to control symptoms and prevent flare-ups. Adalimumab is a biologic therapy, a TNF-alpha inhibitor, used to treat Crohn's. However, some individuals experience a loss of response to adalimumab over time, leading to a return of symptoms. This is a significant challenge, as it means the medication becomes less effective in controlling the disease.

How does adalimumab work, and why might it become less effective?

Adalimumab, a TNF-alpha inhibitor, works by targeting and blocking a specific protein, TNF-alpha, that causes inflammation in Crohn's disease. Its significance lies in its ability to provide significant relief to many patients by reducing inflammation and controlling symptoms. Unfortunately, the body can develop antibodies against adalimumab, leading to a reduced effectiveness and a return of symptoms over time. This is known as a loss of response, making the medication less effective.

What is an elemental diet, and how does it relate to adalimumab?

An elemental diet involves consuming a formula of easily absorbed nutrients. In the context of this research, the elemental diet was combined with adalimumab therapy. The significance lies in its potential to reduce the loss of response to adalimumab. The study by Kenji Watanabe and colleagues showed that incorporating an elemental diet could lead to reduced ADA-LOR, particularly in individuals who have not responded well to other treatments, such as infliximab. It works by reducing inflammation, thereby creating a more favorable environment for adalimumab to work effectively.

How can combining an elemental diet with adalimumab help in managing Crohn's disease?

The combination of an elemental diet and adalimumab therapy offers a potential solution for individuals experiencing a decline in the effectiveness of adalimumab. The study found that the elemental diet, when used concomitantly, reduced ADA-LOR. The results suggest that this approach can improve the long-term management of Crohn's disease by prolonging the efficacy of adalimumab and reducing the likelihood of disease flare-ups. The elemental diet may also reduce TNF-alpha levels, which may contribute to reducing ADA-LOR.

What were the main findings of the study regarding the elemental diet and adalimumab?

The study found several key results. Firstly, the elemental diet reduced the loss of response to adalimumab in individuals who were intolerant or refractory to infliximab. Secondly, reductions in TNF-alpha levels, achieved through the elemental diet, may contribute to reducing ADA-LOR. Finally, serum adalimumab levels did not differ significantly between the groups, indicating that the elemental diet's benefits are not due to increased drug absorption, but rather its impact on the inflammatory process. This suggests that adding an elemental diet to the treatment plan can be a beneficial strategy, especially for those who have previously struggled with other therapies.