Two New Studies on the Efficacy of Diet in Treating IBD

More good news for you all.  Two studies were released at once providing yet further support for the use of the Specific Carbohydrate Diet (SCD) in inflammatory bowel disease.  As you know, my personal experience in curing my son of inflammatory bowel disease has biased me considerably in favor of what I regard as a miracle diet.  After a year on SCD, Alex’s colonoscopy showed absolutely zero pathology.  (Several posts on The Biome Buzz talk are about my experiences.  Here’s another one.) Considering the importance of diet to health, it’s remarkable how few studies are actually done on diet but then again, sadly, who is going to pay for them?

The first for today was a randomized controlled study performed at the University of Pennsylvania and presented at the (virtual) Crohn’s and Colitis Congress.[i]  Unfortunately, the study was only 12 weeks long, which is unfortunately very short but still, the results were quite significant.  194 patients with mild-to-moderate Crohn’s disease (with a disease index score of 176-399) took part.  Two diets were tested:  the Specific Carbohydrate diet and a Mediterranean diet. In the first half of the study, the patients were given prepared meals but then they prepared their own in weeks 7 through 12.  While the patients were not required to have ongoing inflammation, it was established that about half of them did.

The results were very encouraging:  after 6 weeks, 44% of the patients on the Mediterranean diet and 47% of those on SCD achieved symptomatic remission.  Clinical remission, based upon the disease index noted above, showed similar numbers:  48% for the Mediterranean diet and 49% for SCD.  Quality of life measures, including fatigue, pain, sleep and social isolation, also improved significantly in both groups (no differences between the 2), and some measures of inflammation (fecal calprotectin) also improved, with SCD again edging out the Mediterranean diet by a little.  These numbers remained similar at the end of the 12 week study.

The lead researcher, in his presentation, states that, “Both diets were well tolerated despite the increased consumption of fruit and vegetables, which is something that historically we often have told patients with active disease to avoid…”  He then goes on to say, “Based on these findings, if you had to choose between these two diets, for most Crohn’s disease patients you might consider the Mediterranean diet, given its other health benefits, although I will say the Specific Carbohydrate diet has never been tested for those other health benefits…”[ii]

Let me point out, as an extremely experienced SCDer:  most people who undertake the SCD find regular periods of “regression” that are very temporary and are often followed by periods of marked improvement.  Elaine Gottschall actually mentions the first one of these in her groundbreaking book, Breaking the Vicious Cycle:  “Most cases begin to improve within three weeks after the dietary regimen has been started and improvement usually continues.  At about the second or third month, there is sometimes a relapse even when the diet has been carefully followed…Do not allow this to discourage you!  Once the individual gets over this, improvement is usually steady with minor setbacks occurring occasionally during the first year.”[iii]  It is especially unfortunate, therefore, that results were measured at the 12- week mark of SCD, when almost everyone experiences a brief relapse.

The second study, also presented at the same virtual conference, was again conducted by Dr. David Suskind at Seattle Children’s Hospital. [iv] I say again because this is not the first time Dr. Suskind has run a study that shows the efficacy of SCD in the pediatric population.  (I talk about his work on The Biome Buzz.  Look here  and here.) In this case, he ran what is called an n-of-1 trial:  a single subject serves as their own control and treatment is tested over time.  He used a series of n-of-1 trials to determine the efficacy of SCD in reducing the symptoms of IBD as well as inflammation, by comparing the individual to themselves when on their typical diets.  The patients in this study ranged in age from 7 to 18.  They were kept on their baseline diets for 4 weeks and then moved to either SCD or a modified SCD (which permitted oats and rice) for 8 weeks.  The patients then rotated every 8 weeks to the alternative diet in the study for a total of 32 weeks.  Throughout those 32 weeks, the patients were studied for stool frequency and consistency (ie. constipation and/or diarrhea), gastrointestinal symptoms, disease activity and that same inflammatory marker, fecal calprotectin.  54 patients in total were initially enrolled, but only 21 completed the full 32 weeks with 2 crossovers to the two diets.  Suskind’s results showed that both diets improved gastrointestinal symptoms and pain about equally, and both reduced markers of inflammation from baseline.

In the concluding paragraph of this paper, the researchers point out that their data substantiate changes in carbohydrate and protein metabolism throughout the diet and that “…these shifts in metabolic function are consistent with the reduction in simple and processed carbohydrates, causing the microbiome community to derive more of its energy from more complex nutrients.” They also point out that in such a study there is always a danger of noncompliance – there is simply no way to know if people are cheating or not.  Fortunately, they have enough objective data to prove their point:  they have blood and fecal measures before and after dietary intervention.  Thus, despite these limitations, “…this study highlights the link between diet and IBD via the intestinal microbiota.”

A side note for anyone considering SCD:  this is my personal experience, having worked with many individuals over the years.  SCD must be adhered to strictly, with no grains including rice and oats, to have optimal effect.  This is not science and Dr. Suskind’s study shows differently.  However, again, based upon nothing more than my experience and observations, I can’t help but wonder if these families were truly strictly adhering to the diet in the periods in which it was pure SCD.  After all, it would be hard to take away rice and oats from a child when you allowed them previously.  I question compliance in this study:  it would even up the two groups’ responses, after all, if people were cheating.

That aside, yet again, diet proves to be a key factor in health and disease which comes as a surprise to exactly no one.

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[i] https://crohnscolitiscongress.org/

[ii] https://www.medpagetoday.com/meetingcoverage/ccc/90861

[iii] Gottschall, E. Breaking the Vicious Cycle. 2000: Kirkton Press, Ltd: Baltimore, Ontario.

[iv] Suskind DL, Lee D, Kim YM, et al. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. Nutrients. 2020;12(12):3749. Published 2020 Dec 6. doi:10.3390/nu12123749