In this issue we include a publication detailing how the Crohn’s Disease Exclusion Diet + Partial Enteral Nutrition (CDED+PEN) and Exclusive Enteral Nutrition (EEN) change the microbiome as well as a study on how the CDED+PEN effects fecal calprotectin levels. In addition, we include two articles examining patient experiences with the specific carbohydrate diet (SCD), one using semi-structured interviews and another through a needs assessment survey.
Successful Dietary Therapy in Paediatric Crohn's disease is Associated with Shifts in Bacterial Dysbiosis and Inflammatory Metabotype Towards Healthy Controls
Citation: Verburgt CM, Dunn KA, Ghiboub M, et al. Successful Dietary Therapy in Paediatric Crohn’s Disease is Associated with Shifts in Bacterial Dysbiosis and Inflammatory Metabotype Towards Healthy Controls. J Crohns Colitis. Published online September 15, 2022. doi: https://doi.org/10.1093/ecco-jcc/jjac105
Both the Crohn’s Disease Exclusion Diet + Partial Enteral Nutrition (CDED+PEN) as well as Exclusive Enteral Nutrition (EEN) have been shown to induce remission for mild to moderate Crohn’s disease. For this study researchers spanning six countries attempted to understand whether these nutritional therapies worked by shifting the microbiome. By examining stool samples of 54 pediatric patients at weeks 0, 6, and 12 of treatment, the researchers found that dietary therapy “brings the microbiome to a state more similar to healthy controls, but this time frame appears insufficient to achieve complete re-biosis.” The full study discusses the microbiome shifts, including writing: “results suggest that the drop in Proteobacteria is likely to play an important role in achieving clinical remission with dietary therapy, particularly with CDED+PEN.”
Read the full study: https://doi.org/10.1093/ecco-jcc/jjac105
Effect of the Crohn's Disease Exclusion Diet (CDED) on Fecal Calprotectin Level in Children with Active Crohn's Disease
Citation: Matuszczyk M, Meglicka M, Wiernicka A, et al. Effect of the Crohn’s Disease Exclusion Diet (CDED) on the Fecal Calprotectin Level in Children with Active Crohn’s Disease.
J Clin Med. 2022;11(14):4146. doi:
https://doi.org/10.3390/jcm11144146
At the Children’s Memorial Health Institute in Warsaw, Poland, 48 children with Crohn’s disease and elevated fecal calprotectin (FCP) levels (≥ 250.00 µg/g), were treated with the 12-week CDED + PEN (partial enteral nutrition) protocol. Some of the results were:
- 17 (35.42%) patients - FCP level normalized
- 26 (54.17%) patients - FCP level decreased at least 50%
- 16 of 29 the patients not in remission at week 0 achieved clinical remission by week 12
- 10 (20.83%) patients failed to complete the full 12-week protocol due to lack of efficacy/intolerance of the treatment
In their conclusion, the authors wrote: “In the group under analysis, this nutritional intervention resulted in a significant decrease in FCP level and contributed to normalization of this parameter in one-third of patients, which is a similar or better result compared to pharmacological treatment.”
Read the full study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9317017/
Assessing Barriers to use of Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease: A Qualitative Study
Citation: Schwartz NRM, McNichol SR, Devine B, Phipps AI, Roth JA, Suskind DL. Assessing Barriers to use of the Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease: A Qualitative Study.
JPGN Reports. 2022;3(3): e239. doi:
https://doi.org/10.1097/PG9.0000000000000239
Researchers conducted in-depth interviews with the parents of 10 children with IBD who receive treatment at Seattle Children’s Hospital which offers the specific carbohydrate diet (SCD). The children were currently on the SCD (n=4), previously on the SCD (n=4), or chose not to try the diet (n=2). Potential barriers to using the SCD included food cost (unprocessed foods), time commitment for food preparation, and psychosocial impacts.
Parents noted that “while the SCD initially seemed overwhelming, it gets easier over time”, and there were spillover effects with parents of 6 children reporting improving “their own health and understanding of nutrition.” All the parents, even those whose children had success, desired more research on the diet.
Perspectives on Specific Carbohydrate Diet Education from Inflammatory Bowel Disease Patients and Caregivers: A Needs Assessment
Citation: Rivera N, Nguyen K, Kalami V, Blankenburg R, Ming Yeh A. Perspectives on Specific Carbohydrate Diet Education from Inflammatory Bowel Disease Patients and Caregivers: A Needs Assessment.
JPGN Reports. 2022;3(3): e222. doi:
https://doi.org/10.1097/PG9.0000000000000222
In June 2020, researchers surveyed 208 people who either cared for a child with IBD (57%), had IBD themselves (40%), or a partner/spouse with IBD (3%). The survey sought to learn peoples’ motivations for starting the SCD, how they learned about the SCD, and barriers to starting the diet which included:
- An initial steep learning curve
- Lack of support and education from healthcare professionals
- Time commitment involved with meal preparations
- Need for guidance on how to introduce foods
The authors write that the survey results "will be used to guide creation of an educational SCD curriculum for the public."
