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Crohn's Disease Forum » Books, Multimedia, Research & News » Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet


01-13-2014, 10:32 PM   #1
hugh
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Lifestyle-related disease in Crohn’s disease: Relapse prevention by a semi-vegetarian diet

SVD diet for crohn's, science or just sciency?

There have been a few references to this study on the forum so I thought i'd share my view.
For those that haven't seen it it was a small prospective study where 22 people in remission with crohn's were observed while on a 'semi-vegetarian diet' for two years.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877178/

On closer inspection I'd say the whole study is just a piece of propaganda

Most people just read the abstract so i'll summarise it (please let me know if you think I left out something important and remember, it's a summery, i'm trying to encapsulate the information that people will walk away with)
An abstract of the abstract if you will
The aim....
“To investigate whether semi-vegetarian diet (SVD) has a preventive effect against relapse of Crohn’s disease (CD) in patients who have achieved remission, who are a high-risk group for relapse.”

The Method......
"[they] consumed an SVD during hospitalisation [and] were advised to continue with an SVD and avoid known high-risk foods for inflammatory bowel disease"

The Results.......
"SVD showed significant prevention in the time to relapse compared to that in the omnivorous group"
"There was no untoward effect of SVD."


CONCLUSION: SVD was highly effective in preventing relapse in CD.

My opinion?
What a piece of shit.

Two main reasons for this conclusion:
1/ So many dietary factors were changed yet all the credit was given to the reduction in consumption of meat.
2/ Patients were classed as 'omnivores' if they failed to meet the any of the dietary restrictions.
“Dietary pattern was classified into two groups: SVD and omnivorous diet. When the following two conditions were fulfilled, it was regarded as SVD in this study. One is that a patient follows the principle of SVD: daily intake of rice, vegetables, and fruits, and occasional intake of fish, meat, and other animal-based foods. The other one is that a patient refrains from foods reported as risk factors for IBD in or outside Japan as stated above[20-30]. A diet that did not fulfill these two conditions was regarded as an omnivorous diet.”

So, just to clarify this.........

The study has been framed to deliberately mislead.
For the purpose of this study the 'semi-vegetarians' (from the links in the original study [20-30]) refrained from sugar[20,23,24], carbohydrates[21], fast foods[24], cola,chewing gum and chocolate[25], western foods (bread for breakfast, butter, margarine, cheese, meats, and ham and sausage)[27], and were encouraged to eat more fruit and vegetables.
'Omnivores' were those who did not stick to the diet, either by eating more meat or by eating anything else on the restricted list (sugar, bread, chewing gum?).

If they had any interest in being honest then the groups would have been called 'Real food' and 'crap food'

The study did show that a real 'food diet' is superior to a 'crap food' diet for maintaining remission, and this is of interest to anyone struggling with Paleo/SCD, as it also indicates that rice might be a safe carb. (but i'd go with white over brown)

Aside from the obvious deception of the title (SVD bearing little relevance to the diet, and 'omnivore' bearing little relevance to those who fail to adhere to the diet), the whole study is an exercise in bad science.
It starts with an aim and sets out to support that aim by avoiding any attempt to question it and using lots of bogus references to make itself look sciency.
I'm just going to pick through it if anyone hasn't tuned out yet.....

The introduction.......

Starts off quite well,- unknown origin, multi-factoral, genes, environment, gut bacteria and disbiosis
-Hey, i'm on board so far...
There is enough evidence to indicate that IBD is a diet-related disease
- ok, i'm still there,
wealthy nations where dietary westernization inevitably occurs
- yup, gotcha ,
Dietary westernization is characterized by increased consumption of animal protein, animal fat, and sugar,”
- meat and sugar?
“with decreased consumption of grains.”
-huh? Unreferenced, Not in my supermarket. It's ALL wheat ,corn, soy and sugar......
A dietary study during dietary transition in Japan incriminated an increased intake of animal fat and animal protein in the increase in CD
- yes, a study showed that both meat and CD have increased over time, but if TV viewing had been a variable there would have been a similar correlation (they both went up, causation can be inferred but not concluded)
“Pre-illness case-control studies, including those in Japan, have reported increased intake of sugar, fast foods, chocolate, and cola drinks in IBD, and a decrease in total fruit and vegetable fiber in CD
-back on track, must be talking about the non-vegetarian sugar, fast foods, chocolate, and cola drinks
“Case-control studies in Japan are consistent; western foods including bread are a risk factor, whereas traditional Japanese foods are a preventive factor”
- yup, loving it. non-vegetarian bread?
“a positive association with a western diet (meats, fatty foods, and desserts)”
-There it is again meat, fat, and desserts (definitely not the paleo crowd). This is from a study into crohn's in children [1]. The study used “food frequency questionnaires” to assess pre-disease diet, and the results....
Well, they identified four dietary patterns, of which they only mention two.
Pattern 1 consisted of “meats, fatty foods, and desserts”, and in girls ONLY was associated with CD. Lets get this straight, girls who ate the most dessert, fatty foods (not animal fat, most likely grains deep fried in vegetable oils) and meat were more likely to get CD.
“Pattern 2, common to both boys and girls, was characterized by vegetables, fruits, olive oil, fish, grains, and nuts and was inversely associated with CD in both genders “, what, no dessert?
I'm interested in the other two groups.
Maybe group 3 was meat and vegetables with low risk and maybe group 4 was grains, fatty foods and desserts with high risk?
Whatever it was, this study shows the same real food/crap food divide.

“Diets rich in animal protein and animal fat cause a decrease in beneficial bacteria in the intestine[31,32]”
-Bullshit!
31 - “The data indicate that animal protein consumption has little effect on the fecal bacterial profile in humans” http://www.ncbi.nlm.nih.gov/pubmed/832279
32 - “These findings suggest that significant reductions in anaerobic gram-positive bacilli and increased numbers of bacteroides and clostridia in the feces were induced by the intake of a western diet.” http://www.ncbi.nlm.nih.gov/pubmed/3747865 -western diet – processed meat, corn, wheat, soy, sugar, vegetable oil

“Consequently, if a suitable diet is identified and patients stick to the diet, we believe that the majority of IBD patients could be free from relapse without medication.”

- hallelujah

Shall I go on?
Anyone still there?

“Therefore, we regard IBD as a lifestyle-related disease that is mediated by mainly a westernized diet
- and i'm back with you, western diet y'say?
“Consequently, if a suitable diet is identified and patients stick to the diet, we believe that the majority of IBD patients could be free from relapse without medication.”
- I like what you are saying.....
“most prebiotics are extracts of plants. Therefore, we thought that a vegetarian diet would be suitable for IBD.”
- a bit of a leap, don'cha think? Maybe 100% fibre (prebiotics) is the next logical step?
“Foods that have been shown to be a risk factor for IBD in or outside Japan, including sweets, bread, cheese, margarine, fast foods, carbonated beverages, and juices, were discouraged. Healthy habits were encouraged: no smoking, regular physical activity, moderate or no use of alcohol, regularity of meals, and not eating between meals.
- that's a lot to say, lets just call it semi-vegetarian, they will know what we mean......

Skipping down to the results......
The relapsers....
Case 2 relapsed after giving up the diet (what part of the diet? did he eat the omniverous bread?)
Case 3 relapsed -“consumed vegetables and fruits only once a week and ate sweets frequently.”
Case 6 relapsed -”cooked and added meat to the SVD that was prepared by his mother.”
Case 22 relapsed -”consumed vegetables and fruits only once a week and ate sweets frequently.”

The others
Case 9 was 'omniverous' from the start but stayed in remission
Case 15 stayed in remission but “consumed animal foods more often than the standard for an SVD”

The Discussion........
“it is reasonable to conclude that the SVD protected patients from relapse but an omnivorous diet did not.”
-Yes, but only if you say the “SVD” protected patients from relapse but an “omnivorous” diet did not, and i'd be doing those little finger wave air speech marks just to make sure.

In fact i'd write it like this...

“it is reasonable to conclude that the SVD real traditional food diet protected patients from relapse but an omnivorous any old shit diet did not.”

[1] Dietary patterns and risk for Crohn's disease in children
http://www.ncbi.nlm.nih.gov/pubmed/18092347
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Last edited by hugh; 01-13-2014 at 11:57 PM.
01-13-2014, 11:02 PM   #2
PsychoJane
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I don't feel as though this studies is completely wrong. I think it is a good start for a deeper analysis in fact. The amount of participant is not high enough in my opinion but it is not rare to see small scale studies like these. Maybe there is a certain excess in the terminology used but I don't feel offended by it even though i'll agree the term omnivorous might be a little large in this case.

I think it just suggest that western diet is to be questioned regarding IBD and that it seems food do play a role. It also rings me a bell that maybe we over medicate this condition and that people are likely to, either through diet or naturally, remain in remission for longer than they believe without medication.
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01-13-2014, 11:23 PM   #3
hugh
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I don't feel as though this studies is completely wrong. I think it is a good start for a deeper analysis in fact.
Totally agree, that's what i'm trying to do, dig deeper.....

Maybe there is a certain excess in the terminology used but I don't feel offended by it even though i'll agree the term omnivorous might be a little large in this case.
that's what offended me the most, anybody who reads it quickly will walk away with the opinion that eating less meat will be beneficial, but then they will probably replace it with some grains or processed shit from the supermarket.
The study doesn't even come close to making a case against meat, but it does make a great case against processed western foods.
Unfortunately (and probably deliberately) it gives the impression that 'vegetarian' is the way to go while burying the reality (only tubers and rice for carbs, no sugar or wheat or processed foods)

I think it just suggest that western diet is to be questioned regarding IBD and that it seems food do play a role. It also rings me a bell that maybe we over medicate this condition and that people are likely to, either through diet or naturally, remain in remission for longer than they believe without medication.
And if they had called it the TJD (traditional japanese diet) or the 'RFD' (real food diet) vs SAD (standard american diet) or SWD (standard western diet) then i'd be singing it's praise but it is manufacturing a link that doesn't exist and trying to obscure a link that does.
01-13-2014, 11:32 PM   #4
kiny
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There are large studies that don't find any association between fat intake and crohn's disease.

01-13-2014, 11:35 PM   #5
kiny
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There is enough evidence to indicate that IBD is a diet-related disease.

Consequently, if a suitable diet is identified and patients stick to the diet, we believe that the majority of IBD patients could be free from relapse without medication.
lol

Last edited by kiny; 01-13-2014 at 11:51 PM.
01-14-2014, 12:01 AM   #6
hugh
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Hmmm, i liked that bit .... "if" and "could be"
01-14-2014, 01:43 PM   #7
sid
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okay so tis comes up again. There has been this discussion many time on this fourm wether vegetarian diet is good in IBd or not. But yes a detailed study is definitely needed.

I personally believe a vegetarian diet is definitely better than a non-veg diet. I take veg 90% of time remaining 10% consists of fish and chicken (just no red meat)...and I feel it is really easy on my tummy.
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