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Crohn's Disease Forum » Books, Multimedia, Research & News » Carbs not a risk factor in IBD


09-30-2014, 11:15 AM   #1
VeganOstomy
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Carbs not a risk factor in IBD

Anyone see this new study?

http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract

Carbohydrate Intake in the Etiology of Crohn's Disease and Ulcerative Colitis.

Abstract

BACKGROUND::
Diet may have a role in the etiology of inflammatory bowel disease. In previous studies, the associations between increased intakes of carbohydrates, sugar, starch, and inflammatory bowel disease are inconsistent. However, few prospective studies have investigated the associations between these macronutrients and incident Crohn's disease (CD) or ulcerative colitis (UC).

METHODS::
A total of 401,326 men and women were recruited between 1991 and 1998. At recruitment, dietary intakes of carbohydrate, sugar, and starch were measured using validated food frequency questionnaires. The cohort was monitored identifying participants who developed incident CD or UC. Cases were matched with 4 controls, and odds ratios were calculated for quintiles of total carbohydrate, sugar, and starch intakes adjusted for total energy intake, body mass index, and smoking.

RESULTS::
One hundred ten participants developed CD, and 244 participants developed UC during follow-up. The adjusted odds ratio for the highest versus the lowest quintiles of total carbohydrate intake for CD was 0.87, 95% CI = 0.24 to 3.12 and for UC 1.46, 95% CI = 0.62 to 3.46, with no significant trends across quintiles for either (CD, Ptrend = 0.70; UC, Ptrend = 0.41). Similarly, no associations were observed with intakes of total sugar (CD, Ptrend = 0.50; UC, Ptrend = 0.71) or starch (CD, Ptrend = 0.69; UC, Ptrend = 0.17).

CONCLUSIONS::
The lack of associations with these nutrients is in agreement with many case-control studies that have not identified associations with CD or UC. As there is biological plausibility for how specific carbohydrates could have an etiological role in inflammatory bowel disease, future epidemiological work should assess individual carbohydrates, although there does not seem to be a macronutrient effect.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.
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09-30-2014, 01:33 PM   #2
alex_chris
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Thanks, haven't seen this.

Just on your heading, what this study says is that carbs do not seem to be a risk factor in DEVELOPING Crohn's, but carbs may well be a contributor to activr inflammation for patients with crohn's.
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09-30-2014, 01:39 PM   #3
nogutsnoglory
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Thanks for this, it's obviously much more complicated than diet alone.
09-30-2014, 01:51 PM   #4
VeganOstomy
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but carbs may well be a contributor to activr inflammation for patients with crohn's.
I don't believe we've seen evidence of that, but more specifically, depending on the source of your carbs (veg, fruits, whole grains, legumes, etc.), you may reduce inflammation through various pathways. There is evidence to suggest that certain carbs , including fiber, help to feed the good bacteria in our system, which lowers inflammation. The same foods reduce inflammation across the board, lowering CRP, IGF-1, NeuGc, etc. It also happens to be the reason why people with Rheumatoid Arthritis find a lot of relief from eating high-carb, whole -food diets (there's quite a few studies for RA and diet).

It'll be interesting to see where things go.
09-30-2014, 03:37 PM   #5
wildbill_52280
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haha, in the presence or absence of fiber and vitamin d? perhaps under those conditions refined carbohydrates may show an association, but ill bet the fiber intake and vitamin d levels would be more protective against IBD development, and show a greater association with IBD. Whatever, sugar intake is likely a weak risk factor.

What about omega 6 fatty acid induced dysbiosis? lack of omega 3's ? as many dietary risk factors, when the effects of one variable are so minute its hard to show an association or studies will tend to conflict, but at least they are trying to look.
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09-30-2014, 03:56 PM   #6
VeganOstomy
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What about omega 6 fatty acid induced dysbiosis? lack of omega 3's ?
Omega-6 (or at least an imbalance of it) is a known risk factor as well.

Omega-3 hasn't been shown to be of much benefit in the prevention of IBD http://www.ncbi.nlm.nih.gov/pubmed/16155275 , nor the remission of IBD http://www.ncbi.nlm.nih.gov/pubmed/20564531 .
09-30-2014, 04:45 PM   #7
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A couple of comments about the study (from the perspective of a parent whose child with Crohn's is doing wonderfully well on the Specific Carbohydrate Diet).

First, the authors don't say what the lowest quintile (bottom 20% of the population) represents, in terms of carbohydrate consumption. But if the population is representative of the US, it's possible to look that up:

For US adults, the 25th percentile of

- daily added sugar = 9.3 teaspoons (http://appliedresearch.cancer.gov/di...table_a40.html).

- starchy vegetables = 1/3 cup

- total grains = 5 ounces, equivalent to 2.5 cups of cooked pasta per day

- milk = 0.4 cups

and probably some other items that are "illegal" on the Specific Carbohydrate Diet.

That's actually the boundary of the 25th percentile, so that's higher than what the average in the lowest quintile would be. But in fact the 10th percentile is only moderately lower. So it's representative of what they tested.

If Elaine Gottschall insisted that even trace amounts of these specific carbohydrates could cause problems, I believe her.

The upshot is that the low end of the variation that they observed in diets was probably not adequate to prevent development of Crohn's in susceptible people. It's not even close to the low starch and sugar levels of SCD.

My second critique is that this only tested yes/no, not severity. I'll bet that there's a dose-response relationship between severity of symptoms and starch consumption, just as was shown with the 1990s research on the low starch diet for ankylosing spondylitis. I believe that a high-grain/high-fiber diet comes through consistently as being associated with worse symptoms, but I cannot be sure I am recalling that right.
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After four months of little improvement with Pentasa and Prednisone, we tried the Specific Carbohydrate Diet. Almost overnight, all the symptoms resolved. Currently off all meds. Bloodwork is completely normal.
09-30-2014, 05:00 PM   #8
VeganOstomy
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First, the authors don't say what the lowest quintile (bottom 20% of the population) represents, in terms of carbohydrate consumption. But if the population is representative of the US, it's possible to look that up
I'd love to find the full-text of the study, but I haven't been able to locate it - the abstract was only just published.

Keep in mind that these researchers were all in Europe, so I'd imagine they were studying the European population.
09-30-2014, 06:52 PM   #9
baistuff
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I am no fan of SCD, but I will say adults are not big kids and kids are not little adults. The immune and GI systems are completely different. How diet interacts can be completely different.
09-30-2014, 06:55 PM   #10
VeganOstomy
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I am no fan of SCD, but I will say adults are not big kids and kids are not little adults. The immune and GI systems are completely different. How diet interacts can be completely different.
We have some data on kids: http://www.ncbi.nlm.nih.gov/pubmed/18092347

"..meats, fatty foods, and desserts, was positively associated with CD ... vegetables, fruits, olive oil, fish, grains, and nuts and was inversely associated with CD in both genders"
09-30-2014, 11:24 PM   #11
wildbill_52280
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Omega-6 (or at least an imbalance of it) is a known risk factor as well.

Omega-3 hasn't been shown to be of much benefit in the prevention of IBD http://www.ncbi.nlm.nih.gov/pubmed/16155275 , nor the remission of IBD http://www.ncbi.nlm.nih.gov/pubmed/20564531 .
sorry i dont have a link handy, but i was referring to a mouse study that showed omega 6 induced dysbiosis, which was protected by presence of omega 3 fats in another group of mice, the mice lost some diversity in bifidobacteria as i recall, i suppose it is just one theory of how some forms of dysbiosis may occur in humans, maybe these variables contribute to IBD or even other diseases.
09-30-2014, 11:40 PM   #12
VeganOstomy
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sorry i dont have a link handy, but i was referring to a mouse study that showed omega 6 induced dysbiosis, which was protected by presence of omega 3 fats in another group of mice, the mice lost some diversity in bifidobacteria as i recall, i suppose it is just one theory of how some forms of dysbiosis may occur in humans, maybe these variables contribute to IBD or even other diseases.
I saw that study. I don't like inferring human links based on rodent data.

Looking at human studies, again we see a pattern when it comes to disease risks, even when relating to our microbiome:
http://www.ncbi.nlm.nih.gov/pubmed/19120872

"An analysis of Japanese epidemiological data suggested that the registered number of patients with CD or UC started to increase more than 20 years after an increased daily consumption of dietary animal meat and fats, and milk and dairy products, and after a decreased consumption of rice."

I don't think we can say that omega-6/3 ratios have a profound impact on IBD risks, but it's possible that the foods which throw off that balance have other components which increase risks further.

I'm interested in the implications of MAP in Crohn's disease. With all this research into so many different areas, we can only hope a breakthrough is imminent!
10-01-2014, 11:41 AM   #13
mf15
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They finally published the complete study online.
Just click on pdf to the right.
Old Mike
http://journals.lww.com/ibdjournal/p...&type=abstract
10-01-2014, 12:04 PM   #14
VeganOstomy
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They finally published the complete study online.
Just click on pdf to the right.
Old Mike
http://journals.lww.com/ibdjournal/p...&type=abstract
Awesome!

I'm surprised at how much sugar people in the study were eating (up to a 1/2lb per day!!).
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