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Randomized Controlled Trial
. 2021 Sep;161(3):837-852.e9.
doi: 10.1053/j.gastro.2021.05.047. Epub 2021 May 27.

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

James D Lewis  1 , Robert S Sandler  2 , Carol Brotherton  3 , Colleen Brensinger  4 , Hongzhe Li  5 , Michael D Kappelman  6 , Scott G Daniel  7 , Kyle Bittinger  7 , Lindsey Albenberg  7 , John F Valentine  8 , John S Hanson  9 , David L Suskind  10 , Andrea Meyer  11 , Charlene W Compher  12 , Meenakshi Bewtra  13 , Akriti Saxena  14 , Angela Dobes  15 , Benjamin L Cohen  16 , Ann D Flynn  8 , Monika Fischer  17 , Sumona Saha  18 , Arun Swaminath  19 , Bruce Yacyshyn  20 , Ellen Scherl  21 , Sara Horst  22 , Jeffrey R Curtis  23 , Kimberly Braly  4 , Lisa Nessel  4 , Maureen McCauley  4 , Liam McKeever  4 , Hans Herfarth  2 ; DINE-CD Study Group
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Randomized Controlled Trial

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

James D Lewis et al. Gastroenterology. 2021 Sep.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Gastroenterology. 2022 Nov;163(5):1473. doi: 10.1053/j.gastro.2022.07.058. Epub 2022 Aug 26. Gastroenterology. 2022. PMID: 36038368 No abstract available.

Abstract

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.

Keywords: Clinical Trial; Comparative Effectiveness; Mediterranean Diet; Nutrition; Randomization.

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Figures

Figure 1.
Figure 1.
Study enrollment, allocation of diets and follow-up
Figure 2.
Figure 2.
Primary and key secondary outcomes after 6 weeks of diet therapy.
Figure 3.
Figure 3.
Primary and key secondary outcomes after 12 weeks of diet therapy
Figure 4.
Figure 4.. Stratified analyses to assess for treatment effect heterogeneity.
Point estimates and 95% confidence intervals are risk differences from unadjusted models. Test for treatment effect heterogeneity using conditional logistic regression accounting for the stratified randomization all produced P values greater than 0.05.
See this image and copyright information in PMC

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