Lillemor Berntson
Published: 10 June 2021
Abstract:
“To explore possible anti-inflammatory effects of the specific carbohydrate diet in children with juvenile idiopathic arthritis. This diet has shown anti-inflammatory effect in children with inflammatory bowel disease.”
Methods:
“Twenty-two patients with juvenile idiopathic arthritis (age 6.3–17.3 years), with ≤2 inflamed joints and an erythrocyte sedimentation rate < 30 mm/h, were included in this explorative study. Fifteen children completing four weeks on the diet were evaluated. A dietician introduced parents and children to the diet, and two follow-ups were performed during the intervention. Conventional laboratory tests and multiplex analyses of 92 inflammatory proteins were used. Short-chain fatty acids in faecal samples were examined.”
Results:
“The diet significantly decreased morning stiffness (p = 0.003) and pain (p = 0.048). Physical function, assessed through the child health assessment questionnaire, improved (p = 0.022). Arthritis improved in five of the seven children with arthritis; in those seven, multiplex analyses showed a significant decrease in nine inflammatory proteins, including TNF-alpha (p = 0.028), after four weeks. Faecal butyrate, analysed in all 15 participants, increased significantly (p = 0.020).”
Conclusion:
“The specific carbohydrate diet may have significant positive effects on arthritis in children with juvenile idiopathic arthritis, but further studies are needed.”
Here are some more detailed excerpts from this study:
Introduction:
“… Increased gut permeability has been shown in several other inflammatory diseases and in one study on JIA, suggesting that a dysfunctional gut barrier could increase the possibility for bacteria and other substances to interplay with the immune system, leading to a breakage of T cell tolerance.
These factors may alter the likelihood of JIA by influencing the development of the immune system, the integrity of the intestinal mucosal barrier, and the differentiation of immune stimulatory and regulatory cells.
As in many other autoimmune diseases, like rheumatoid arthritis (RA), the composition of the bacterial flora seems to be altered in children with JIA, though results are not consistent [12,13,14,15]. In addition to studies on environmental factors and microbiota in JIA, indicating an aberrant microbial setting, there are several studies supporting an important role for gut microbiota in relation to the immune system.
The microbiome affects development of the intestinal mucosal barrier and is essential for the normal generation and maturation of gut-associated lymphoid tissue [16]. The microbiome also has an impact on production of TH17 cells…
One possible way to affect the intestinal canal is through the diet. The specific carbohydrate diet (SCD) has been shown to have beneficial effects in inflammatory bowel disease. SCD is a nutritionally balanced diet focused on removing many complex carbohydrates such as grains, dairy products except yoghurt fermented for over 24 h, vegetables rich in starch, and sugars, except monosaccharides like those found in honey.
The digestion of complex carbohydrates relies on enzymes produced by the microbiota and large amounts of carbohydrates are believed to alter the microbiota. Monosaccharides, on the other hand, can be absorbed by enzymes in enterocytes and are therefore considered to have a lesser impact on the gut microbiota.
Thus, the diet includes for example meat, poultry, fish, eggs, nuts, fruits, beans, peas, honey, fully fermented yogurt and hard cheese, while grains, rice, corn, potatoes, dairy products high in lactose, refined sugar and candy are excluded. Furthermore, most processed food is not allowed in SCD, as it contains emulsifiers and additives, proven to have a negative impact on the mucus layer in mouse intestines [20]. The diet has been shown to induce clinical and biochemical remission in paediatric Crohn’s disease (CD) and ulcerative colitis, but not complete healing…”
Discussion:
“This study on SCD comprised only fifteen patients and the arthritis was not verified by ultrasound, which are its major weaknesses. Also, children with different categories of the disease, on different medical treatments, were included, which may have confounded interpretation of results.
It was a challenge to coordinate inclusion of a patient with a period of three months of a stable, low to median inflammatory state. Also, it would have been preferable to have a control group, which was difficult to organize in practice.
The author can only speculate that elimination of processed food, additives, and emulsifiers, and restriction of carbohydrates and dairy products play an immunological role in JIA. Processed food often contains high amounts of exogenous advanced glycation end products (AGEs), which are common in food products that have been heated. Exogenously added AGEs have been shown in animal studies to affect immune and epithelial cells by activating the receptors for AGEs in various types of cells, such as immune cells, endothelial cells, myocytes, and neurons, but studies in humans have not come that far.
High-fructose corn syrup (HFCS) is a popular sweetener in the food industry, for example in soda. High consumers of sodas have been shown to have an increased risk of arthritis in adults compared with low consumers. HFCS is decreased in SCD compared with in a conventional diet; there is currently a lack of knowledge about the occurrence of AGEs.
The results from this study indicate that a diet like SCD may be of benefit in children with JIA and that studies on the immunological influence from diet in such children may potentially open up a new field of research.”
Conclusion:
“Making the home-cooked meals required in SCD was a challenge for many of the families, but the fairly rapid improvement in the majority of the children motivated both parents and children. A strength of the study was that the SCD is well-described and studied in children with inflammatory conditions in the digestive tract, as one of two diets studied in paediatric IBD.
The results from this study suggest that specific carbohydrate diet may provide a promising complementary treatment modality for children with JIA. Further studies are needed to understand which children with JIA may benefit from SCD, how the diet affects the immune system, and how long-lasting any effects are.”
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