Consumption of a specific carbohydrate diet (SCD) and Mediterranean diet offer similar benefits for managing symptoms of Crohn disease (CD), a study in Gastroenterology suggests.

Patients with CD sometimes opt for a therapeutic dietary intervention as an alternative to chronic immunosuppressive treatments, but high-quality data on these diets are currently lacking. Furthermore, many major medical associations lack evidence-based recommendations or guidelines on the use of therapeutic diets for managing CD.

Some studies, however, have linked a Mediterranean-like diet to a lower risk of CD. Additionally, other research has found the consumption of a Mediterranean diet is associated with reduced symptoms and improvements in quality of life among patients newly diagnosed with CD.


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In this study, a United States research team randomly assigned 194 patients with mild to moderate CD symptoms to follow either a Mediterranean diet (n=92) or a SCD (n=99) for 12 weeks. In total, 191 patients were included in the final analysis.

The SCD allowed for the consumption of most fresh fruits and vegetables except for starchy vegetables, such as corn and potatoes. Some legumes are preferred over others, while grains are not allowed in the SCD. In contrast, the Mediterranean diet tends to be more liberal, allowing whole grains, fresh fruits, vegetables, nuts, fish, and olive oil.

Participants received prepared meals and snacks based on their assigned diet for the first 6 weeks. After 6 weeks, participants followed the diet independently. Researchers assessed symptomatic remission at week 6.

At the 6-week time point, there was no significant difference between the SCD and Mediterranean diet groups in the proportion of participants who achieved symptomatic remission (46.5% vs 43.5%, respectively; P =.77).

Significant fecal calprotectin (FC) response, defined as FC <250 μg/g and a reduction by >50% in patients with a baseline FC of >250 μg/g, was also similar between the SCD and Mediterranean diet groups (34.8% vs 30.8%, respectively; P =.83). Additionally, a C-reactive protein (CRP) response, defined as a high-sensitivity CRP (hsCRP) <5 mg/L and a >50% reduction in CRP from baseline in patients with hsCRP of >5mg/L, was also similar between the SCD and Mediterranean diet arms (5.4% vs 3.6%, respectively; P =.68).

A limitation of this study was the lack of assessment of endoscopic healing. Additionally, the investigators noted the generalizability of the results to populations across different regions remains unknown.

The researchers concluded that the Mediterranean diet “may be preferred to SCD due to its well documented general health benefits and relative ease of implementation as compared to SCD” in patients with mild to moderate CD symptoms.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Lewis JD, Sandler R, Brotherton C, et al. A randomized trial comparing the specific carbohydrate diet to a Mediterranean diet in adults with Crohn’s disease. Published online May 27, 2021. Gastroenterol. doi:10.1053/j.gastro.2021.05.047