Patients With IBD Cite Symptom Relief With Online Intervention Tool

Patients with inflammatory bowel disease (IBD) who used a personalized online dietary intervention tool experienced improvements in a host of symptoms, a researcher reported.

In the real-world study, 87 adults on the Specific Carbohydrate Diet (SCD), who used the My SCD Protocol, reported improvement with the intervention, at a median 21 days, from baseline, in:

• Belching: 39% intervention vs 7% baseline (+218% change)
• Vomiting: 22% vs 7% (+466%)
• Bloating or pressure: 38% vs 15% (+151%)
• Flatulence: 37% vs 18% (+105%)

However, there was no reported improvement in mucus appearance and urgency, stated Ali Arjomand, PhD, of Modulla Health in Bellevue, Washington, in a presentation at the virtual Crohn's & Colitis Congress.

Still, many of those who reported "no symptoms" reported symptom improvement after the intervention versus baseline for back pain (55% vs 31%), gastrointestinal bleeding (58% vs 43%), nausea (76% vs 57%), joint pain (46% vs 34%), and more, he stated.

"When patients do see improvement or disappearance of symptoms, they become really committed and adhere to the diet and stay for a longer haul," Arjomand said. "The goal here is to show some immediate response, change the quality of life, and show improvements."

While Arjomand, who is the founder and director of Modulla Health, told MedPage Today that "Patients are more than ready to take charge and implement changes to their diet and lifestyle," he cautioned that the My SCD Protocol does not translate as well to elderly populations, who may not be as comfortable using digital tools.

The study results are promising, but "other places have not been able to get these results because it's [the SCD diet] very strict on the carbs dietary intake," commented Mark Corkins, MD, of the University of Tennessee Health Science Center in Memphis, who was not involved in this study. "Somehow, close follow-up and compliance makes everything better too."

The SCD Diet was popularized in the 1980s with the book Breaking the Vicious Cycle by Elaine Gottschall. The diet calls for the inclusion of fruits, vegetables, fresh meat, beans, and healthy oils, and the exclusion of grains (wheat, rice, corn), sugar, dairy, and more. SCD "has demonstrated reductions in CD [Crohn's disease] severity scores in conjunction with medical therapies, and larger trials on its efficacy are ongoing," researchers wrote in a 2020 report. The 2021 DINE-CD study looked at the SCD diet versus the Mediterranean diet (MD) as treatment for mild-to-moderate CD, and reported "SCD was not superior to the MD to achieve symptomatic remission," mostly because the latter was easier to follow.

Arjomand and co-author Rachelle Caviness, RD, CD, also of Modulla Health, wrote that there "is currently no comprehensive IBD dietary intervention presented in a customizable, easy-to-follow protocol format." Arjomand added that "Many patients self-initiate dietary changes without guidance or supervision," putting them at risk of malnutrition, under-nutrition, or other risk factors.

The comprehensive HIPPA-compliant My SCD Protocol, based on ingredient tolerance and patient preferences, is "totally scalable, giving patients full power," he stated.

With the protocol, four sequential stages expand a patients' tolerable ingredients: elimination (for 5 days), followed by reintroduction, maintenance, and expansion, each lasting about 6 months. Step-by-step instructions, education resources, and assessments are provided. A customized variety of stage-specific curated recipes support diet implementation by a "trial -and-error approach" or with dietitian supervision. Patients choose from a "legal list" of 164 recipes and 304 SCD ingredients.

Supervising healthcare professionals access real-time, self-reported app data on patient meals, symptoms, physical activity, bowel activity, lifestyle journal, and progress, according to the researchers.

Study participants were referred to the IBD nutrition clinic or directly sought support. The majority were women (56%), and 54% had CD with an average disease duration of 12.6 years, while 46% had ulcerative colitis with an 8.6 year disease duration. Most (78%) were on IBD medication.

Less than half (43%) had been on a "special diet" previously, while 11 were on the SCD diet at enrollment. Many (61%) reported recent weight loss within a year, while 60% reported a willingness to change their diet, and half said they were willing to change their lifestyle.

Corkins cautioned that the findings "are based on clinical results reports, but not lab data," citing the possibility of the "halo effect," so "patients may think they are doing better then do better."

Arjomand said the next research steps would be "to report additional outcomes, such as fecal calprotectin and other objective markers, in an 'eat-to target' approach, using diet to reach certain targets."

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