scholarly journals The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3749
Author(s):  
David L. Suskind ◽  
Dale Lee ◽  
Young-Mo Kim ◽  
Ghassan Wahbeh ◽  
Namita Singh ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Therapeutic Potential ◽  
Controlled Trial ◽  
Intestinal Microbiome ◽  
Patient Specific ◽  
Carbohydrate Diet ◽  
Microbiome Composition ◽  
The Impact ◽  
Specific Carbohydrate Diet

Background: Crohn’s disease (CD) is a chronic inflammatory intestinal disorder associated with intestinal dysbiosis. Diet modulates the intestinal microbiome and therefore has a therapeutic potential. The aim of this study is to determine the potential efficacy of three versions of the specific carbohydrate diet (SCD) in active Crohn’s Disease. Methods: 18 patients with mild/moderate CD (PCDAI 15–45) aged 7 to 18 years were enrolled. Patients were randomized to either SCD, modified SCD(MSCD) or whole foods (WF) diet. Patients were evaluated at baseline, 2, 4, 8 and 12 weeks. PCDAI, inflammatory labs and multi-omics evaluations were assessed. Results: Mean age was 14.3 ± 2.9 years. At week 12, all participants (n = 10) who completed the study achieved clinical remission. The C-reactive protein decreased from 1.3 ± 0.7 at enrollment to 0.9 ± 0.5 at 12 weeks in the SCD group. In the MSCD group, the CRP decreased from 1.6 ± 1.1 at enrollment to 0.7 ± 0.1 at 12 weeks. In the WF group, the CRP decreased from 3.9 ± 4.3 at enrollment to 1.6 ± 1.3 at 12 weeks. In addition, the microbiome composition shifted in all patients across the study period. While the nature of the changes was largely patient specific, the predicted metabolic mode of the organisms increasing and decreasing in activity was consistent across patients. Conclusions: This study emphasizes the impact of diet in CD. Each diet had a positive effect on symptoms and inflammatory burden; the more exclusionary diets were associated with a better resolution of inflammation.

Sa1992 Mucosal Healing With the Specific Carbohydrate Diet in Pediatric Crohn's Disease: Preliminary Results of a Prospective Pilot Study

2012 ◽  
Vol 142 (5) ◽  
pp. S-376 ◽  
Author(s):  
Stanley A. Cohen ◽  
Angela N. Stallworth ◽  
Bailey M. Koch ◽  
David H. Mason ◽  
Jeffrey Blumenthal ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Pilot Study ◽  
Crohn's Disease ◽  
Mucosal Healing ◽  
Carbohydrate Diet ◽  
Preliminary Results ◽  
Prospective Pilot Study ◽  
Specific Carbohydrate Diet

scholarly journals Changes in the Intestinal Microbiota Are Seen Following Treatment with Infliximab in Children with Crohn’s Disease

2020 ◽  
Vol 9 (3) ◽  
pp. 687 ◽  
Author(s):  
Kinga Kowalska-Duplaga ◽  
Przemysław Kapusta ◽  
Tomasz Gosiewski ◽  
Agnieszka Sroka-Oleksiak ◽  
Agnieszka H. Ludwig-Słomczyńska ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biological Treatment ◽  
Intestinal Microbiome ◽  
Sequencing Analysis ◽  
Healthy Children ◽  
Core Microbiome ◽  
Tnf Α ◽  
Before And After ◽  
The Impact

The aim of the study was to determine the impact of biological treatment with tumor necrosis factor α antibodies (anti-TNF-α) on the intestinal microbiome of children with severe Crohn’s disease (CD) and to evaluate the differences in the intestinal microbiome between patients treated with biological therapy and healthy children. Microbiota composition was analyzed by 16S next-generation sequencing (NGS) and microbial profiles were compared between studied groups. Fifty-four samples (from 18 patients before and after anti-TNF-α induction therapy and 18 healthy children) were used in the sequencing analysis. Shannon’s diversity index (p = 0.003, adj. p = 0.010) and observed operational taxonomic units (OTUs) (p = 0.007, adj. p = 0.015) were different between controls and patients with prior therapy for CD. Statistically significant dissimilarities between beta diversity metrics, indicating distinct community composition across groups, were observed in patients with CD before and after therapy. We did not observe any differences between controls and patients with CD after therapy. Core microbiome analysis at species level showed that 32 species were present only in patients with CD but not in controls. The results show that biological treatment is associated with changes in the intestinal microbiome of patients with CD: these changes result in an intestinal microbiome pattern similar to that seen in healthy children. Long-term observation is necessary to determine whether treatment can lead to full restoration of a healthy-like microbiome.

P167 ADULT CROHN’S DISEASE TREATED WITH THE SPECIFIC CARBOHYDRATE DIET (SCD): A CASE REPORT USING OBJECTIVE MARKERS OF RESPONSE

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S39-S39
Author(s):  
Ali Arjomand
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Hospital Admissions ◽  
International Travel ◽  
Severe Malnutrition ◽  
Successful Implementation ◽  
Carbohydrate Diet ◽  
Patient Reported ◽  
Specific Carbohydrate Diet

Abstract The specific carbohydrate diet (SCD) has been shown to resolve symptoms in pediatric IBD patients, inducing clinical remission and normalizing or significantly reducing inflammatory markers. Demonstration of similar effects, including changes to objective disease markers, are lacking in the adult IBD patient. Presented here are clinical, biomarker, microbiome, imaging and histologic observations after successful implementation of the SCD in an adult with moderate-to-severe Crohn’s disease. HISTORY: A 50-year-old male patient, diagnosed with Crohn’s disease in 2001, implemented the SCD in 2017 according to the published protocol. Prior to diet intervention, medical management consisted of mesalamine (1 g orally 4x/day for 6 mo.); infliximab (300 mg IV/8 wks for 5 yrs), natalizumab (300 mg IV/4 wks for 6 mo.), adalimumab (40 mg sc/14 d for 7 yrs; every 7 d for 1 yr) and vedolizumab (300 mg IV/8 wks for 1 yr). Corticosteroids were administered with adalimumab and vedolizumab over a continuous span of 8 yrs (prednisone 15–20 mg/d or budesonide 9 mg/d). Two resections of the terminal ileum were performed in 2003 and 2015. History included annual ER or hospital admissions and severe malnutrition (albumin 1 g/dL). TPN was provided in 2008 and 2015. DIETARY INTERVENTION: The patient was advised to switch to ustekinumab after LOR to vedolizumab and return of active inflammation. The patient refused further biologic treatment and proceeded with the SCD intervention. Prednisone (40 mg/d) was initiated during diet transition. The patient adhered to a strict SCD protocol, eliminating sugar, grains, starch and all forms of processed foods while adding home-fermented yogurt. Results: By day 10, the patient reported loss of abdominal and lower back pain along with a 5 lb weight drop. Cooked, non-starchy vegetables, nut flours and other foods were then introduced according to the SCD protocol and as tolerated. At month 3, the patient reported 1–2 formed BM/d, increased energy and mobility, loss of joint pain and a stable weight. The patient initiated yoga 3x/wk. Advanced SCD foods continued to be introduced one at a time. Stool was well-formed and of large mass. Prednisone was tapered to 20 mg/d at month 3 and 0 mg/d by month 8. At month 12, MRE and colonoscopy showed resolution of inflammation and normal mucus in the terminal ileum assessed by biopsy. At month 24, FCP and CRP remained in the normal range. Microbiome analysis of fecal samples showed poor diversity at all times with minor phyla-level changes at month 12. International travel resulted in genus-level increase in diversity. The patient has completed 3 years with the SCD and plans to maintain the diet as part of a lifestyle change. Prospective studies are needed in adult IBD patients, including moderate-to-severe cases, to assess the long-term efficacy of the SCD using objective markers of response.

Sign in / Sign up

Export Citation Format

Share Document