Inflammatory bowel disease can be hell. New evidence suggests a diet can fix it

Diet alone can cure the two main types of inflammatory bowel disease in children, according to research published in the Journal of Clinical Gastroenterology.

During the study, carried out at Seattle Children’s Hospital, paediatric patients with either Crohn’s disease or ulcerative colitis were put on a diet called the specific carbohydrate diet for 12 weeks as the sole medical intervention. The diet removes grains, processed foods and sugars (except for honey), and much dairy. It promotes vegetables, fruits, meats and nuts.

After 12 weeks, the diet alone was shown to bring paediatric patients with active Crohn’s and ulcerative colitis into clinical remission in eight out of the 10 patients who finished the study.

Common symptoms of Crohn’s, which is a type of irritable bowel disease, include cramping, diarrhoea, anaemia, weight loss, and severe abdominal pain. It was previously believed that anti-inflammatory and immunosuppressant drugs were the only way to treat it. In some cases surgery is required.

Dr David Suskind, a gastroenterologist at Seattle Children’s Hospital who led the study, said: ‘This changes the paradigm for how we may choose to treat children with inflammatory bowel disease.

‘For decades or longer, medicine has said diet doesn’t matter, that it doesn’t impact disease. Now we know that diet does have an impact, a strong impact. It works, and now there’s evidence.’

The specific carbohydrate diet has long been hyped as a way to treat inflammatory bowel diseases but without much evidence to support it.

Instant analysis
This is a prospective cohort study, usually more useful for delineating the natural history of a condition as opposed to determining treatment options, but often extremely helpful in initial research in an area where little has been done previously.

Recent research appeared to implicate changes in gut bacteria in the pathology of inflammatory bowel disease and it stands to reason that changes in gut bacteria as a result of a change in diet could affect the clinical impact of the disease or at least demonstrate improvements in blood markers for infection.

The diet used was the specific carbohydrate diet — essentially what is also known as a ketogenic diet.

Proteins found in grains including gluten have been shown to have an inflammatory effect on the bowel in susceptible, non-coeliac patients as well as coeliac patients and this is part of the rationale for excluding them.

Dietary compliance was excellent, with only two patients dropping out of the study.

At two weeks, five out of 12 patients were in clinical remission and, by the eight-week mark, eight of 10 patients were in remission.

Significant improvements were seen in two markers of inflammation, C-reactive protein and ESR (erythrocyte sedimentation rate), with normalisation seen in most patients after 12 weeks.

Changes were documented to occur in the gut bacteria as a result of the diet, which may or may not be the reason for the observed improvement.

The study doesn’t address whether the children ever entered what is known as ketosis (where the body burns fat rather than carbohydrates), which by itself might explain why the inflammatory markers improved so markedly.

This study is extremely promising. However, further research is needed before medics are able to encourage dietary changes based on high-quality evidence.
TSA
Research score: 3/5