This study compared the effectiveness of the Specific Carbohydrate Diet (SCD) to the Mediterranean Diet (MD) as treatment for Crohn’s disease (CD) with mild to moderate symptoms.
Adult patients with CD and with mild-moderate symptoms were randomly assigned 1:1 to consume the MD or SCD for 12 weeks. For the first 6-weeks, participants received prepared meals and snacks according to their assigned diet. After 6-weeks, participants were instructed to follow the diet independently. The primary outcome was symptomatic remission at week 6. Key secondary outcomes at week 6 included: fecal calprotectin (FC) response (FC <250 μg/g and reduction by >50% among those with baseline FC >250 μg/g) and C-Reactive Protein (CRP) response (high-sensitivity CRP (hsCRP) <5 mg/L and >50% reduction from baseline among those with hsCRP >5mg/L).
194 patients were randomized, and 191 were included in the efficacy analyses. The percentage of participants who achieved symptomatic remission at week 6 was not superior with SCD (SCD 46.5%, MD 43.5%; P = .77). FC response was achieved in 8/23 participants (34.8%) with SCD and 4/13 participants (30.8%) with MD (P = .83). CRP response was achieved in 2/37 participants (5.4%) with SCD and 1/28 participant (3.6%) with MD (P = .68).
SCD was not superior to MD to achieve symptomatic remission, FC response and CRP response. CRP response was uncommon. Given these results, the greater ease of following the MD, and other health benefits associated with MD, the MD may be preferred to the SCD for most patients with CD with mild to moderate symptoms.
A recent article in Lancet (“Health effects of dietary risks in 195 countries, 1990–2017:
a systematic analysis for the Global Burden of Disease Study 2017″ -open access) estimated that bad diets lead to 11 million deaths per year. Thanks to Ana Ramirez for sending me this article. “High intake of sodium, low intake of whole grains, and low intake of fruits were the leading dietary risk factors for deaths and DALYs globally and in many countries.”
About 11 million deaths a year are linked to poor diet around the globe…
As part of a new study published in The Lancet, researchers analyzed the diets of people in 195 countries using survey data, as well as sales data and household expenditure data. Then they estimated the impact of poor diets on the risk of death from diseases including heart disease, certain cancers and diabetes. (They also calculated the number of deaths related to other risk factors, such as smoking and drug use, at the global level.)…
“Generally, the countries that have a diet close to the Mediterranean diet, which has higher intake of fruits, vegetables, nuts and healthy oils [including olive oil and omega-3 fatty acids from fish] are the countries where we see the lowest number of [diet-related] deaths,” …
What would happen if everyone around the globe began to eat a healthy diet, filling three-fourths of their plates with fruits, vegetables and whole grains? We’d run out…
Improving diets won’t be easy: A range of initiatives may be needed, including nutrition education and increased access to healthy foods, as well as rethinking agricultural production.
A recent randomized controlled trial (C Properzi et al. Hepatology 2018; 68: 1741-54) compare the Mediterranean diet (MD) and a low-fat (LF) diet for non-alcoholic fatty liver disease.
A total of 48 patients completed the 12-week study and were analyzed; subjects had a mean BMI of 31. Both groups consumed a 2400-2600 kcal diet.
Despite minimal weight loss, both groups had significant reduction in hepatic steatosis as determined by magnetic resonance spectroscopy (MRS): 25.0% in LF and 32.4% in MD. Both had wide confidence intervals due to the small number of subjects.
Liver enzyme improved in both groups.
Weight loss was minimal, 1.6 kg and 2.1 kg in LF and MD respectively
Framingham Risk Score (FRS), cholesterol, triglycerides, and hemoglobin A1c were improved with MD but not with LF (all P<0.05)
The associated editorial (pg 1668-71) notes the following:
“Considering the current evidence, recommending the MD for patients with NAFLD might be an appropriate therapeutic option, not least because …[of the} increased risk of CVD.”
Longer-term RCTs are needed
“It has to be stressed that, in most cases, any form of healthy diet (eg. LF or MD), which leads to caloric reduction…should be encourage for patients with NAFLD…The importance of weight loss has been highlighted in patients with biopsy-proven NASH.”
My take: If you have to make a dietary recommendation, this study indicates that MD is probably a better diet than LF in patients with NAFLD.
A recent study (J Ma et al. Gastroenterol 2018; 155: 107-17) shows that a “better diet” was associated with less liver fat.
Among the 1521 participants form a Framingham Heart Study cohort (Mean age 51 years at start of study), the authors assessed diet with a 125-item Harvard food frequency questionnaire and liver fat using liver-phantom ratio (LPR) on CT images between 2002-2005 and then again 2008-2011. They specifically looked at 2 diet scores:
Mediterranean-style diet score (MDS)
Alternative Healthy Eating Index (AHEI)
For each 1 standard deviation increase in MDS, the LPR increased (less liver fat) by 0.57 and the odds for incident fatty liver decreased by 26% (P=.002)
Similarly, for each 1 standard deviation increase in AHEI, LPR increased by 0.56 and the odds for incident fatty liver decreased by 21% (P=.02)
My take: This study shows that Improved diet quality over 6 years was associated with reduced liver fat accumulation
Thus far, “the benefits of medications to treat obesity remain limited because of side effects and inadequate efficacy, especially in the long term.” This is part of an editorial (Siraj ES, Williams J. NEJM 2015; 373: 82-3) that explains a recent study (Pi-Sunyer X, et al. NEJM 2015; 373: 11-22). However, there is a huge need for a cost-effective medication because bariatric surgery is not feasible for 400 million obese persons worldwide.
Liraglutide (marketed as Victoza) has been approved by the FDA for weight loss in adults based on this published study and two other trials. Liraglutide is a glucagon-like peptide-1 (GLP-1) mimetic. The authors conducted a 56-week, double-blind trial with 3731 non-diabetic patients. In a 2:1 design, most patients received a once-daily subcutaneous 3.0 mg injection of liraglutide; some received placebo. Both groups received lifestyle counseling.
At week 56, the treatment group had lost a mean of 8.4 kg compared with the placebo group which lost 2.8 kg.
There were similar rates of adverse events (mildly increased in treatment group); the rate of new diagnoses of diabetes was less than one-eighth that in the placebo group. A 2-year extension trial is being analyzed to further pursue this finding. Also, the authors note that 4 cases of breast cancer (0.2%) were detected in the treatment group compared with 1 (0.1%) in the placebo group. This finding could have been due to easier exam following weight loss. It is noted that the labeling for liraglutide has a black box warning regarding thyroid c-cell tumor risk which have occurred in rodents at clinically relevant doses.
Despite the weight loss, the editorial has a cautious tone.
“There were statistically significant, although sometimes quantitatively modest, improvements in secondary end points, which included glycemic control, fasting insulin concentrations, cardiometabolic markers, and quality-of-life measures.”
“Most obese participants stayed obese, reversal of the metabolic syndrome was not quantified, and liraglutide may be required indefinitely, like statins, but with delivery by injection and at a nontrivial cost.” According to http://www.goodrx.com, the approximate retail price is $596.01 for 18 mg. For type 2 diabetes, the dosage varies from 1.2 to 1.8 mg per day, after the first week which is dosed at 0.6 mg.
Take-home point: This new medication may help with modest weight loss but at a very significant cost. In addition, long-term data are lacking. Thus, right now, this medication does not provide the cost-effective option to bariatric surgery.
They singled out 447 volunteers considered at high risk of heart disease. Heart disease and dementia are already linked — people with a higher risk of one usually have a higher risk of the other, also.
Two groups were assigned to follow the Mediterranean diet and told to add either five 5 tablespoons of extra virgin olive oil a day or a handful of mixed nuts. The third group got the low-fat advice….
The volunteers, who had an average age of 67, were tested from time to time on memory skills. The group who ate the extra nuts did better in terms of memory and the group given extra virgin olive oil performed better on tests that required quick thinking…
Just over 13 percent of those who got extra olive oil were diagnosed with mild cognitive impairment, which may or may not lead to Alzheimer’s disease. Just 7 percent of those who got nuts were diagnosed with mild cognitive impairment, while around 13 percent of those who got neither developed memory loss.
But many of the patients actually saw their memories get better over the four years. On average, those in the low-fat-only group lost some memory and thinking skills, but those who got extra nuts had their memory skills improve on average, while those who got olive oil had improvements in problem-solving and planning skills…
According to a recent BMJ study, the Mediterranean diet may protect your chromosomes. From the NY Times link –here’s an excerpt:
They found that the diet is associated with longer telomeres, the protective structures at the end of chromosomes. Shorter telomeres are associated with age-related chronic diseases and reduced life expectancy.
Researchers used data on 4,676 healthy women, part of a larger health study, whose diets were ranked on a scale of one to nine for similarity to the ideal Mediterranean diet. Researchers measured their telomere lengths with blood tests and followed them for more than 20 years with periodic examinations.
The study, published in the journal BMJ, controlled for body mass index, smoking, physical activity, reproductive history and other factors, and found that the higher the score for adherence to the diet, the longer the telomeres. The difference in telomere length for each point on the adherence scale, the researchers estimate, was equivalent to an average 1.5 years of life.
From AJC (see link below): “The study lasted five years and involved about 7,500 people in Spain. Those who ate Mediterranean-style with lots of olive oil or nuts had a 30 percent lower risk of major cardiovascular problems compared to those who were told to follow a low-fat diet but who in reality, didn’t cut fat very much. Mediterranean meant lots of fruit, fish, chicken, beans, tomato sauce, salads, and wine and little baked goods and pastries.” Methods (at NEJM.org) “In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years.”
This month a followup letter provides long-term data on the outcomes of individuals assigned to either a low-carb, low-fat, or Mediterranean diet (NEJM 2012; 1373-74).
An initial study posted two-year results. Now after an additional four years, the following results were noted:
Among the 259 participants (80% of original groups and 95% who completed the initial two years), 67% had continued their original assigned diet.
For the entire 6-year period, the total weight loss was 3.1 kg in the Mediterranean group, 1.7 kg in the low-carb group and 0.6 kg in the low-fat group.
At 6 years the change in the ratio of LDL to HDL were similar in all three groups though the low-carb group had the most favorable results with a reduction of 0.16.
At 6 years, the reduction in triglyceride levels from baseline were significant for the Mediterranean group (21.4 mg/dL) and the low-carb group (11.3 mg/dL).
All of the groups had regained some of their weight loss from the initial 2-year period. The most favorable outcomes were noted in the Mediterranean diet and then the low-carb diet in this workplace intervention trial.