Patients with inflammatory bowel disease (IBD) may benefit from switching to a specific carbohydrate diet, according to a case study.
The report, “Diet To The Rescue: Cessation Of Pharmacotherapy After Initiation Of Exclusive Enteral Nutrition (EEN) Followed By Strict And Liberalized Specific Carbohydrate Diet (SCD) In Crohn’s Disease, was published in the journal Digestive Diseases and Sciences.
To normalize inflammation, patients with IBD are sometimes put on a completely liquid diet known as exclusive enteral nutrition (EEN). Although EEN appears to be effective for both children and adults with Crohn’s disease, several trials have shown that adults with ulcerative colitis may not benefit as much.
A possible option for them, and for IBD patients who do not respond to a liquid diet, is a specific carbohydrate diet (SCD). It restricts foods made of complex carbohydrates that may promote intestine inflammation, such as grains, dairy products, most starches and several types of sugar.
Stanford University School of Medicine researchers reviewed the case of a 15-year-old boy who had had diarrhea for four months, mild pain in the abdominal region and occasional rectal bleeding.
As his symptoms worsened, doctors did several analyses to try to find what was causing them. They found increased inflammatory markers in his blood, and endoscopy and colonoscopy revealed signs of damage in his intestine. A diagnosis of Crohn’s disease was confirmed by intestine biopsies.
Oral prednisone (1 mg/kg/day) and methotrexate (15 mg weekly) improved his condition. In the months after he finished his medication, he was better, but inflammation remained mildly increased.
He was then put on a liquid diet for a month and a half. Inflammatory markers were still increased, so doctors extended the diet two weeks.
The boy was then sent to another medical center for a second opinion. Doctors there put him on a specific carbohydrate diet for two months.
His inflammation improved, and he was even able to stop his methotrexate treatment. Six months after the diet, inflammation remained stable and he was allowed to include a non-SCD meal per week.
“Leveraging the anti-inflammatory benefits of certain foods is an attractive option to patients motivated to avoid medication side effects, especially for children with IBD who face a lifetime of medications,” doctors wrote. “Furthermore, patients with IBD who do not receive specific nutrition support often have inadequate nutritional intake.”
“[N]utrition is an important therapeutic option in IBD,” they added. “Both EEN and SCD have shown some efficacy in the induction and maintenance of remission in pediatric patients with IBD. This case demonstrates that, when strictly followed, the SCD may be a therapeutic pathway to achieve remission and permit medication withdrawal in some patients, while it can maintain disease control with mild diet liberalization.”