Q&A: Patients with Crohn’s disease may prefer Mediterranean diet

In a recent randomized controlled trial, researchers found that both the specific carbohydrate diet and the Mediterranean diet were associated with improvements in mild to moderate Crohn’s disease symptoms.

For the trial, Arun Swaminath, MD, an associate professor at the Feinstein Institutes for Medical Research and chief of the division of gastroenterology at Lenox Hill Hospital, and colleagues randomly assigned 194 adults with Crohn’s disease and mild to moderate symptoms in a 1:1 ratio to the Mediterranean diet or specific carbohydrate diet (SCD) for 12 weeks.

The researchers reported that the rate of symptom remission at week 6 was not superior in the SCD group compared with the Mediterranean diet group — 46.5% vs. 43.5%.

However, given the “greater ease” of following the Mediterranean diet, as well as other health benefits associated with it, patients with inflammatory bowel disease (IBD) may prefer the Mediterranean diet over SCD, according to the researchers.

Healio Primary Care spoke with Swaminath to learn more about the findings and the next steps for this research.

Healio Primary Care: What prompted you to conduct this study?

Swaminath: For all gastroenterologists, one of toughest pieces of advice to give is what is the “best diet” for our patients, although our patients ask the question all the time. If you Google search diet and IBD, there will be more than 1 million links to various opinions but not much data. This study fills a huge gap in our knowledge with practical information.

Healio Primary Care: What does previous research suggest about each diet in people with IBD?

Swaminath: Before this, data from food surveys suggested generalities, like avoiding meats, carbonated sodas and emulsifiers, would lead to improvements in disease activity or keep patients in remission longer. We also know that liquid diets (exclusive enteral nutrition) had the strongest data (in kids), with a potent effect in getting symptomatic patients into remission, and we’ve been trying to identify the critical parts of these diets to make them more palatable to the general population. These strict diets work in between 60% and 80% of pediatric patients, so there is room for improvement, even from what was seen in this study.

Healio Primary Care: Were you surprised by your findings? Why or why not?

Swaminath: I don’t think I was surprised by the findings. I remained fairly agnostic about specific dietary changes my patients were making, mainly because something different seemed to influence improvements seen in different patients. Nothing felt universal. At the end of the study, although there was not one diet that showed major improvement over the other, both the SCD and the Mediterranean diet showed symptom remission by the end of the 12 weeks; needed relief for these patients.

Healio Primary Care: What are your next steps for this research?

Swaminath: Although this research looked at a fairly large cohort (close to 200 people), it would be interesting to expand the trial to a larger cohort. I would also find it beneficial to look at some of the pros and cons of other diets that are common among patients seeking relief from their IBD symptoms, like comparing the keto diet with the Mediterranean diet.

Healio Primary Care: What is the take-home message for primary care physicians?

Swaminath: For general physicians, I would advocate supporting your patients’ goals without compromising their nutrition health because it can be a slippery slope of increasingly restrictive diets that can end up doing the opposite of what the patient intended. There should also be goal setting in that patients who are motivated to try a diet can be supported, but that hard endpoints of improvement in inflammatory biomarkers or healing of the gastrointestinal mucosa is the ultimate goal and not just symptom improvement.