A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn’s Disease

Abstract

Crohn's disease symptomaƟc remission Fecal calprotecƟn response CRP response Week 6 Outcomes Specific Carbohydrate Diet Mediterranean Diet Participants achieving outcome (%) See Covering the Cover synopsis on page 739; See editorial on page 798. BACKGROUND & AIMS: This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean diet (MD) as treatment for Crohn's disease (CD) with mild to moderate symptoms. METHODS: Adult patients with CD and with mild-to-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6 weeks, participants received prepared meals and snacks according to their assigned diet. After 6 weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at Gastroenterology 2021;161:837-852 CLINICAL ATweek 6 included fecal calprotectin (FC) response (FC <250 mg/g and reduction by >50% among those with baseline FC >250 mg/g) and C-reactive protein (CRP) response (highsensitivity CRP <5 mg/L and >50% reduction from baseline among those with high-sensitivity CRP >5 mg/L). RESULTS:The study randomized 194 patients, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with the SCD (SCD, 46.5%; MD, 43.5%; P ¼ .77). FC response was achieved in 8 of 23 participants (34.8%) with the SCD and in 4 of 13 participants (30.8%) with the MD (P ¼ .83). CRP response was achieved in 2 of 37 participants (5.4%) with the SCD and in 1 of 28 participants (3.6%) with the MD (P ¼ .68). CONCLUSIONS: The SCD was not superior to the MD to achieve symptomatic remission, FC response, and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD and other health benefits associated with the MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms. ClinicalTrials.gov Identifier: NCT03058679

Dietary manipulation of the gut microbiome in inflammatory bowel disease patients: Pilot study

“…In adults with CD, a recent randomized trial that included interventions with either the SCD or the Mediterranean diet has also demonstrated a remarkable effect of diet in inducing remission. 23 Specifically, after only 6 weeks on either diet half of the patients in the trial achieved symptomatic remission with ≥30% showing reduction of fecal calprotectin levels. 23 For ulcerative colitis (UC), a catered nutritious low-fat/high-fiber diet has been shown to improve the overall quality of life, lower inflammatory markers, decreased dysbiosis, and specifically favor Faecalibacterium prausnitzi .…”

Nutritional Therapies and Their Influence on the Intestinal Microbiome in Pediatric Inflammatory Bowel Disease

“…EEN is recommended as first-line therapy to induce remission in paediatric CD [ 42 ]. While these recommendations differ in adult CD management [ 2 , 60 ], a prospective, open-label trial from 2018 in Japan assessing the role of combination infliximab dose escalation with elemental diet versus infliximab dose escalation alone had to be stopped early due to clear benefits in the combination therapy over monotherapy treatment group in the midterm analysis [ 61 ].…”

Clinical and Histologic Remission in an Adult Crohn’s Disease Patient Following the Specific Carbohydrate Diet and Its Impact on Healthcare Costs

“…Preliminary studies of SCD intervention in pediatric and adult IBD patients have demonstrated promising results in low-number patient cohorts, including achieving clinical and mucosal remission and normalization of blood and stool laboratory markers [8][9][10][11][12][13][14]. A recent randomized trial in adult Crohn's disease patients demonstrated symptomatic remission and fecal calprotectin (FCP) response in 46.5% and 34.6% of patients, respectively, after a six-week regimented SCD intervention, matching the response seen in the Mediterranean diet intervention arm [15].…”