title: Development of a low phenolic acid diet for the management of orofacial granulomatosis.
abstract: BACKGROUND
  Orofacial granulomatosis (OFG) is a rare disease of unknown cause. A cinnamon- and benzoate-free diet is successful in up to 72% of patients. Phenolic acids are among the chemical constituents restricted in this diet, which avoids some but not all of these structurally similar compounds. The present study aimed to: (i) develop a novel diet low in phenolic acids; (ii) implement this in a small clinical trial; and (iii) assess its nutritional adequacy.
  
  
  METHODS
  A literature review identified 10 papers quantifying phenolic acids from which 91 10-mg phenolic acid exchanges were devised. A phenolic acid exclusion diet with precautionary micronutrient supplementation was designed and implemented in 10 patients. Phenolic acids were excluded for 6 weeks and were reintroduced at a rate of one exchange every second day for 6 weeks. Wilcoxon matched pairs tests analysed disease outcomes measured by an oral disease severity scoring tool at weeks 0, 6 and 12. Nutritional adequacy was assessed, excluding micronutrient supplementation, at weeks 0 and 6, and compared intakes with dietary reference values.
  
  
  RESULTS
  The diet was nutritionally inadequate for a range of micronutrients. Seven of 10 patients responded. Mean [standard deviation (SD)] severity scores improved from week 0-6 [20.8 (9.39) and 10.1 (5.72); P = 0.009] and were maintained in five patients who completed the reintroduction [6.6 (3.13) and 7.2 (5.54); P = 0.713].
  
  
  CONCLUSIONS
  A low phenolic acid diet with micronutrient supplementation holds promise of a novel dietary treatment for OFG. Further work is required in larger studies to determine long-term outcomes.
authors.affiliation: Diabetes and Nutritional Sciences Division, King's College London (KCL), London, UK; Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust (GSTFT), London, UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Campbell
authors.forename: M P
authors.initials: MP
authors.lastname: Escudier
authors.forename: P
authors.initials: P
authors.lastname: Milligan
authors.forename: S J
authors.initials: SJ
authors.lastname: Challacombe
authors.forename: J D
authors.initials: JD
authors.lastname: Sanderson
authors.forename: M C E
authors.initials: MC
authors.lastname: Lomer
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004032:Diet; D019587:Dietary Supplements; D005247:Feeding Behavior; D005260:Female; D051261:Granulomatosis, Orofacial / Q000178:diet therapy*; D006801:Humans; D062385:Hydroxybenzoates / Q000008:administration & dosage* / Q000032:analysis; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D062385:Hydroxybenzoates; D018977:Micronutrients; C017616:phenolic acid
keywords: Crohn's disease; orofacial granulomatosis; phenolic acids