In the Journals

Specific carbohydrate diet shows promise in pediatric IBD

Children with Crohn’s disease and ulcerative colitis achieved clinical remission after specific carbohydrate diet therapy, according to the results of a small prospective study.

The specific carbohydrate diet focuses on consuming natural, nutrient-rich foods like fruits, vegetables, meats and nuts, and avoidance of all grains, processed foods, dairy except for certain fermented yogurts and hard cheeses, and sugars except for honey.

David L. Suskind, MD

David L. Suskind

“For decades or longer, medicine has said diet doesn’t matter, that it doesn’t impact disease. Now we know that diet does have an impact, a strong impact. It works, and now there’s evidence that it can move patients into remission,” David L. Suskind, MD, of the department of pediatrics, division of gastroenterology, Seattle Children’s Hospital and University of Washington, said in a press release. “This changes the paradigm for how we may choose to treat children with inflammatory bowel disease.”

To evaluate the effects of the specific carbohydrate diet on clinical disease activity, inflammatory markers and fecal microbial composition in pediatric patients with active IBD, Suskind and colleagues performed a multicenter open-label study involving 12 patients (mean age, 12.8 ± 2.2 years) with mild-to-moderate disease activity who adhered to the diet for 12 weeks. Nine of the patients were enrolled at Seattle Children’s, and three were enrolled from Children’s Center for Digestive Health Care in Atlanta; nine had Crohn’s disease, three had ulcerative colitis; six were boys; and the average disease duration was 1.3 ± 1.6 years.

The researchers required that patient medication regimens remained stable throughout the study, and patients received counseling from a dietician throughout the study, and received clinical follow-up visits at weeks 2, 4, 8 and 12. The researchers also performed stool microbial analysis before and after the dietary intervention.

At 12 weeks, eight of the 10 patients who completed the diet intervention achieved clinical remission. Mean Pediatric Crohn’s Disease Activity Index decreased from 28.1 ± 8.8 to 4.6 ± 10.3, and mean Pediatric Ulcerative Colitis Activity Index decreased from 28.3 ± 23.1 to 6.7 ± 11.6.

The dietary intervention was not effective for two patients, and two others were unable to adhere to the diet throughout the study period, though no adverse events occurred.

In addition, all but one patient had improvement in C-reactive protein levels by week 2, and of the seven patients who completed the dietary intervention and had elevated CRP at baseline, only two continued to have elevated CRP at 12 weeks. Mean CRP levels dropped from 24.1 ± 22.3 to 7.1 ± 0.4 mg/L in the patients from Seattle (normal CRP < 8 mg/L) and from 20.7 ± 10.9 to 4.8 ± 4.5 mg/L in the patients from Atlanta (normal CRP < 4.9 mg/L).

Finally, stool microbiome analysis showed most patients had distinct microbial dysbiosis before the dietary intervention, and subsequent significant changes in microbial composition after the dietary intervention.

The researchers acknowledged that study limitations include possible participant bias due to the open-label study design, difficulty in ascertaining diet compliance, and the small sample size. Additional prospective studies are needed to confirm the safety and efficacy of dietary therapy in patients with IBD, they wrote.

“Each person’s disease is unique, just as each person is unique,” Suskind said in the press release. The specific carbohydrate diet “is another tool in our tool box to help treat these patients. It may not be the best treatment option for everyone, but it is an effective treatment for those who wish to try a dietary therapy.” – by Adam Leitenberger

Disclosures: Suskind reports he has written a patient handbook on nutrition in IBD.

Children with Crohn’s disease and ulcerative colitis achieved clinical remission after specific carbohydrate diet therapy, according to the results of a small prospective study.

The specific carbohydrate diet focuses on consuming natural, nutrient-rich foods like fruits, vegetables, meats and nuts, and avoidance of all grains, processed foods, dairy except for certain fermented yogurts and hard cheeses, and sugars except for honey.

David L. Suskind, MD

David L. Suskind

“For decades or longer, medicine has said diet doesn’t matter, that it doesn’t impact disease. Now we know that diet does have an impact, a strong impact. It works, and now there’s evidence that it can move patients into remission,” David L. Suskind, MD, of the department of pediatrics, division of gastroenterology, Seattle Children’s Hospital and University of Washington, said in a press release. “This changes the paradigm for how we may choose to treat children with inflammatory bowel disease.”

To evaluate the effects of the specific carbohydrate diet on clinical disease activity, inflammatory markers and fecal microbial composition in pediatric patients with active IBD, Suskind and colleagues performed a multicenter open-label study involving 12 patients (mean age, 12.8 ± 2.2 years) with mild-to-moderate disease activity who adhered to the diet for 12 weeks. Nine of the patients were enrolled at Seattle Children’s, and three were enrolled from Children’s Center for Digestive Health Care in Atlanta; nine had Crohn’s disease, three had ulcerative colitis; six were boys; and the average disease duration was 1.3 ± 1.6 years.

The researchers required that patient medication regimens remained stable throughout the study, and patients received counseling from a dietician throughout the study, and received clinical follow-up visits at weeks 2, 4, 8 and 12. The researchers also performed stool microbial analysis before and after the dietary intervention.

At 12 weeks, eight of the 10 patients who completed the diet intervention achieved clinical remission. Mean Pediatric Crohn’s Disease Activity Index decreased from 28.1 ± 8.8 to 4.6 ± 10.3, and mean Pediatric Ulcerative Colitis Activity Index decreased from 28.3 ± 23.1 to 6.7 ± 11.6.

The dietary intervention was not effective for two patients, and two others were unable to adhere to the diet throughout the study period, though no adverse events occurred.

In addition, all but one patient had improvement in C-reactive protein levels by week 2, and of the seven patients who completed the dietary intervention and had elevated CRP at baseline, only two continued to have elevated CRP at 12 weeks. Mean CRP levels dropped from 24.1 ± 22.3 to 7.1 ± 0.4 mg/L in the patients from Seattle (normal CRP < 8 mg/L) and from 20.7 ± 10.9 to 4.8 ± 4.5 mg/L in the patients from Atlanta (normal CRP < 4.9 mg/L).

Finally, stool microbiome analysis showed most patients had distinct microbial dysbiosis before the dietary intervention, and subsequent significant changes in microbial composition after the dietary intervention.

The researchers acknowledged that study limitations include possible participant bias due to the open-label study design, difficulty in ascertaining diet compliance, and the small sample size. Additional prospective studies are needed to confirm the safety and efficacy of dietary therapy in patients with IBD, they wrote.

“Each person’s disease is unique, just as each person is unique,” Suskind said in the press release. The specific carbohydrate diet “is another tool in our tool box to help treat these patients. It may not be the best treatment option for everyone, but it is an effective treatment for those who wish to try a dietary therapy.” – by Adam Leitenberger

Disclosures: Suskind reports he has written a patient handbook on nutrition in IBD.

    See more from Ulcerative Colitis Resource Center