MD, PhD, FMedSci, FSB, FRCP, FRCPEd

The WDDTY is not my favourite journal – far from it. The reason for my dislike is simple: far too many of its articles are utterly misleading and a danger to public health. Take this recent one entitled ‘Paleo-type diet reversing Crohn’s and ulcerative colitis’, for instance:

START OF QUOTE
Crohn’s disease and ulcerative colitis are being reversed solely by diet—essentially a Paleo diet. The non-drug approach has been successful in 80 per cent of children who’ve been put on the special diet.

The diet—called the specific carbohydrate diet (SCD)—has been pioneered by Dr David Suskind, a gastroenterologist at Seattle Children’s Hospital. The diet excludes grains, dairy, processed foods and sugars, other than honey, and promotes natural, nutrient-rich foods, including vegetables, fruits, meats and nuts.

Children are going into complete remission after just 12 weeks on the diet, a new study has discovered. Ten children with inflammatory bowel disease (IBD)—an umbrella term for Crohn’s and ulcerative colitis—were put on the diet, and eight were completely symptom-free by the end of the study. Suskind started exploring a dietary approach to IBD because he became convinced that the standard medical treatment of steroids or other medication was inadequate. “For decades, 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,” he said.

END OF QUOTE

“For decades, medicine has said diet doesn’t matter, that it doesn’t impact disease”.

Really?

In this case, I must have studied an entirely different subject all these years ago at university – I had been told it was medicine but perhaps…???…!!!

It took me some time to find the original paper – they cited a wrong reference (2017 instead of 2016). But eventually I located it. Here is its abstract:

GOAL:

To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND:

IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY:

Pediatric patients with mild to moderate IBD defined by pediatric Crohn’s disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS:

Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS:

SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

What does this mean?

The WDDTY report bears very little resemblance to the journal article (let alone with the title of their article or any other published research by David Suskind).

How come?

I cannot be sure, but I would not be surprised to hear that the latter was ‘egged up’ to make the former appear more interesting.

If that is so, WDDTY are (once again) guilty of misleading the public to the point of endangering lives of vulnerable patients.

SHAME ON EVERY OUTLET THAT SELLS WDDTY, I’d say.

8 Responses to Paleo-type diet reversing Crohn’s and ulcerative colitis

  • My son has Crohn’s. His specialists are well versed in the current literature, and I also have coeliac, so the issue of potential autoimmune issues related to cereals has been discussed. The view of the specialists is that there is no evidence-based dietary approach to management right now.

    The risk of course is that people will self-medicate with this diet and take themselves off immunosuppressants. That could lead to permanent damage and potentially leave them facing colostomy.

  • Given the latest rather sad news about Paul Gascoigne, does anyone have any ideas about whether rehab works? Genuinely not trying to be funny or sarcastic, but if it does, then why does he keep going back in? Is it genuine, or just a kind of fashion accessory for rich celebrities? The way that some people claimed a few years ago that having a criminal record was?
    Are there better ways to deal with it?

  • I also found this brand-new review: https://www.ncbi.nlm.nih.gov/pubmed/27793606

    The most common question asked by patients with inflammatory bowel disease (IBD) is, “Doctor, what should I eat?” Findings from epidemiology studies have indicated that diets high in animal fat and low in fruits and vegetables are the most common pattern associated with an increased risk of IBD. Low levels of vitamin D also appear to be a risk factor for IBD. In murine models, diets high in fat, especially saturated animal fats, also increase inflammation, whereas supplementation with omega 3 long-chain fatty acids protect against intestinal inflammation. Unfortunately, omega 3 supplements have not been shown to decrease the risk of relapse in patients with Crohn’s disease. Dietary intervention studies have shown that enteral therapy, with defined formula diets, helps children with Crohn’s disease and reduces inflammation and dysbiosis. Although fiber supplements have not been shown definitively to benefit patients with IBD, soluble fiber is the best way to generate short-chain fatty acids such as butyrate, which has anti-inflammatory effects. Addition of vitamin D and curcumin has been shown to increase the efficacy of IBD therapy. There is compelling evidence from animal models that emulsifiers in processed foods increase risk for IBD. We discuss current knowledge about popular diets, including the specific carbohydrate diet and diet low in fermentable oligo-, di-, and monosaccharides and polyols. We present findings from clinical and basic science studies to help gastroenterologists navigate diet as it relates to the management of IBD.

  • One of my staff suffers severe Crohns, currently managed well with a (very expensive) monoclonal antibody – go Big Pharma. She eats carefully but most fibrous fruit and veg trigger rapid and painful relapses. The diet above would probably hospitalise her. Well done Lynne and Bryan. As ever.

    And, Edzard, please don’t grace WDDTY with the the title “journal”. It is a magazine. A tawdry, lying, paranoiac, stupid and blinkered one.

  • It’s easy to criticise the magazine or newspaper that carries a science story that misrepresents the findings from a trial. However, often the journalist has only regurgitated the contents of the press release and it’s the Press Office that has created the ‘alternate facts’ in the first place.

    Here is the press release for the research paper (from Seattle’s Children Hospital):
    http://www.newswise.com/articles/novel-diet-therapy-helps-children-with-crohn-s-disease-and-ulcerative-colitis-reach-remission

    WDDTY’s article is a re-hash of this (although admittedly with a misleading heading courtesy of a sub-editor).

    • press-releases are written by journalists; the published articles are authored by journalists; both types of journalists have a responsibility to do their jobs well. all too often thy fail.

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