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A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn’s Disease

      Background & Aims

      This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean diet (MD) as treatment for Crohn’s disease (CD) with mild to moderate symptoms.

      Methods

      Adult patients with CD and with mild-to-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6 weeks, participants received prepared meals and snacks according to their assigned diet. After 6 weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at week 6 included fecal calprotectin (FC) response (FC <250 μg/g and reduction by >50% among those with baseline FC >250 μg/g) and C-reactive protein (CRP) response (high-sensitivity CRP <5 mg/L and >50% reduction from baseline among those with high-sensitivity CRP >5 mg/L).

      Results

      The study randomized 194 patients, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with the SCD (SCD, 46.5%; MD, 43.5%; P = .77). FC response was achieved in 8 of 23 participants (34.8%) with the SCD and in 4 of 13 participants (30.8%) with the MD (P = .83). CRP response was achieved in 2 of 37 participants (5.4%) with the SCD and in 1 of 28 participants (3.6%) with the MD (P = .68).

      Conclusions

      The SCD was not superior to the MD to achieve symptomatic remission, FC response, and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD and other health benefits associated with the MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms. ClinicalTrials.gov Identifier: NCT03058679

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      AMeD (Alternate Mediterranean Diet Score), BASFI (Bath Ankylosing Spondylitis Functional Index), CD (Crohn’s disease), CDAI (Crohn’s Disease Activity Index), CDED (Crohn’s Disease Exclusion Diet), CRP (C-reactive protein), DINE-CD (Diet to INducE Remission in Crohn’s Disease), FC (fecal calprotectin), FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), HEI-2015 (Healthy Eating Index 2015), hsCRP (high-sensitivity C-reactive protein), IBD (inflammatory bowel disease), IQR (interquartile range), MD (Mediterranean Diet), PC (principal coordinate), PERMANOVA (permutational multivariate analysis of variance), PRO-2 (2-item patient-reported outcome), PROMIS (Patient-Reported Outcomes Measurement Information System), SCD (Specific Carbohydrate Diet), sCDAI (short Crohn’s Disease Activity Index), sIBDQ (Short Inflammatory Bowel Disease Questionnaire), TNF (tumor necrosis factor-α)
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