IBD patients using specific carbohydrate diet report symptom improvement
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Patients with inflammatory bowel disease reported improvement in symptoms using a personalized specific carbohydrate diet, according to a presenter at the Crohn’s and Colitis Congress.
Ali Arjomand, PhD, director of Modulla Health in Washington, and colleagues developed My SCD Protocol, a customizable plan for patients with IBD, based on the specific carbohydrate diet (SCD). The digital protocol provides educational resources, self-assessment tools and instructions for patients interested in using the SCD.
“The real key is not to go too fast with the introduction of ingredients and also not to go too slow,” Arjomand said during the presentation. “So, I base that on patient-reported self-monitoring on how they're doing and how they're responding to the ingredients. Essentially that's where they progress until they reach their individual goals. This is very customized. That's why it's called My SCD Protocol. Every patient does it their way, according to their needs. “
Arjomand and colleagues evaluated 87 IBD patients who implemented the My SCD Protocol, which includes 304 SCD ingredients and 164 stage-specific recipes. Ingredients were presented in four stages — elimination, reintroduction, maintenance and expansion — to help patients expand tolerable ingredients. pPatients used a HIPAA-compliant mobile app to self-report symptoms, meals and progress, which could be assessed by the patient’s care team.
Investigators observed clinical and biochemical responses in both adult and pediatric IBD patients on the SCD and noted improvements in patients’ self-reported symptoms.. From baseline to 21 days of intervention, the greatest improvements were reported in vomiting (7% vs. 22%), belching (7% vs. 39%), bloating/pressure (15% vs. 38%) and flatulence (18% vs. 37%).
“It's a very brief intervention but [patients are] seeing marked response in some of their observable interventions and symptoms,” Arjomand said. “This is critical, because when patients do see improvement, or disappearance of symptoms, they become really committed and adhere to the diet and stay for longer haul. So, the goal here is to show some immediate response change the quality of life and show improvements.”
The next steps, Arjomand explained, include fecal calprotectin measurements, objective markers, eat-to-target, connect with electronic health records and to bring My SCD Protocol to other existing IBD centers.
Perspective
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Stacy Asimes, MS, RD, CNSC
The specific carbohydrate diet (SCD) can be incredibly confusing and difficult to follow for patients. This individualized approach would make it much easier for patients to follow the SCD and may become an excellent resource for patients who wish to take on this diet.
While the symptomatic improvement is a positive, I would be interested to see the impact of the SCD on the disease itself, with the next step of looking into inflammatory markers such as fecal calprotectin. Results from the 2021 CD-Dine study showed equal rates of symptomatic remission at 6 and 12 weeks for patients on the SCD and the Mediterranean diet, which is less restrictive and easier to follow. I would be interested to see if using this specific SCD protocol provided any benefits over following a Mediterranean diet.
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Arjomand A, et al. My SCD protocol: An online, comprehensive, remotely-supervised protocol for IBD patients to implement an effective dietary intervention. Presented at: Crohn’s and Colitis Congress; Jan. 20-22, 2022 (virtual meeting).
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