KEYWORDS: Inflammatory bowel disease, Specific Carbohydrate diet, Irritable Bowel Syndrome

The Specific Carbohydrate Diet: Transforming Primary Care for Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)

By Christine Bowen, ND

I begged the convenience store clerk to please let me use his bathroom, but he refused. I pleaded and was crying and repeated what the result would be if I couldn’t use a bathroom immediately; he still said no and that is when the dam cut loose and diarrhea leaked out of my pant leg and onto his floor. I left feeling humiliated and ashamed. This was definitely a low point in my health. How could I be an otherwise healthy 26-year-old woman and yet I had this horrible condition that plagued me night and day creating endless hours of pain, missed social engagements, and this ultimate episode of mortifying proportions.

Here I was a newly practicing Naturopathic Doctor (ND) with all of the inspiration to help others but completely unable to help myself. As you can imagine, I had tried every allergy elimination diet, probiotic, digestive enzyme, and intestinal healing product available. I even quit my job to reduce stress, all with no positive impact in my symptoms.

Then, one day I got a random email from a former patient of a colleague asking me if I was familiar with the Specific Carbohydrate Diet. She was thinking that I should definitely know about this diet therapy that had driven her ulcerative colitis into remission 10 years prior. I hadn’t heard about the Specific Carbohydrate Diet (SCD) but decided to dedicate some time and personal experience to learning the details in order to teach my patients (still holding no hope that it would do anything for me, personally). Three days into following SCD, I was symptom free for the first time since I was in my teens.

I learned SCD inside and out and never looked back. SCD removes lactose, sugar, grains, and starch from the diet. Patients who are in flare may have to modify the texture of their foods or reduce fiber to help assist healing. SCD includes some aged dairy and butter and emphasizes nutrient-dense foods such as honey (only approved and healthful sweetener allowed on this diet), nuts, seeds, protein, fruit, and vegetables. If the patient is underweight, it is important to ensure they are consuming more than adequate calories of allowed foods to make up for the calories lost from reducing starchy carbohydrates.

The theory behind this dietary approach is that by removing these foods from the diet that we shift the microbiome of the gut away from pro-inflammatory changes and toward a balanced immune system. Healthy microbial flora also helps with nutrient absorption and decreases overgrowth of unhelpful or opportunistic microbes.

SCD has been around since the 1920s, but I had not heard it mentioned in medical school—not in any of the three quarters of diet and nutrient therapy nor in any of our gastroenterology classes. Because it had helped me so profoundly, I made it my mission to use this diet therapy as first line intervention for all digestive conditions. No more probiotics, fiber, Imodium, or digestive enzymes, just diet change applied with an equal dose of compassion and knowledge and tailored to suit the needs of the patients I was seeing.

Since 2008, I have honed and refined this approach that has helped my patients with anything from autoimmunity, chronic pain, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), obesity, diabetes, mood imbalance and autism spectrum (sometimes a combination of several or all of the above). I have found that at least 80% of patients who follow a customized plan based on this dietary approach will have significant or complete symptom resolution. People have gotten off of meds, gained weight (when needed), lost weight (when needed), avoided colectomies, and regained their health and their lives after suffering for as long as 40 years prior to making this dietary change.

Despite the fact that many local gastroenterology (GI) specialists still held strongly that diet had nothing to do with these health conditions, I was reminded daily of the power of diet to transform the health of my patients with this simple, reproducible, and powerful therapy. Now, patients who fail traditional prescription therapies (or refuse them for fear of side effects) can have hope for a much better solution than just medication or surgery. In addition to this, GI docs and other practitioners have a safe treatment approach for their patients, especially those who ask for alternative suggestions.

One of my main goals is to educate practitioners about SCD so that more patients can be helped with this foundational approach. The Specific Carbohydrate Diet was originally created in 1924 by a US pediatrician named Sydney Valentine Haas (1870-1964). He used this diet (affectionately known as the banana diet) to help children with failure to thrive, protein malnutrition associated with celiac disease, and inflammatory bowel disease. He and his son, Merrill Hass, published a book in 1951 on their dietary approach and associated case studies that was titled The Management of Celiac Disease.¹ One of their more than 600 patients was the daughter of a remarkable woman. This patient’s mother, Elaine Gottschall, was so inspired by how much they helped her daughter that she published a book in 1987, Breaking the Vicious Cycle: Intestinal Health Through Diet,² which outlines the diet and provides guidelines and recipes. This book was and still is at the center of what grew to be a movement of patients and families helping themselves and each other to navigate diet change for management of celiac disease, IBS, IBD, and many more health conditions.

In 2014, at Children’s Hospital in Seattle, Washington, Dr. David Suskind gathered several known SCD-focused providers and national SCD specialists, including myself, to discuss potential clinical application and standardization of SCD and announced that he would be publishing his first SCD retrospective study. Also in attendance were Barbara Olendzki, RD, MPH, from the University of Massachusetts Medical Center who presented the first paper cited below, and Stan Cohen, MD, who presented the paper on capsule endoscopy and SCD.

In 2014, the University of Massachusetts Medical Center conducted a study on SCD for patients with IBD.³ They included oats and fish oil in addition to the strict SCD food list and the findings reported 100% symptom improvement in all of the study participants!!! 100%!

A pilot study from 2014 was done by Rush Medical Center.⁴ It showed results of capsule endoscopies for four patients with IBD and noted bowel ulcerations of these patients at day zero and then the capsule endoscopy was repeated at the end of 12 weeks on the Specific Carbohydrate Diet. The comparisons of ulcerations at day zero and 12 weeks later showed resolution of the vast majority of these lesions and overall patient improvement across the board.

Children’s Hospital publications to date: The first was a small retrospective study of seven children with IBD; the analysis of their health parameters over a period of time while on SCD led to the conclusion that it might be a viable treatment and would warrant another, larger SCD study which was published roughly a year later.⁵ The second study was another retrospective study analyzing 26 pediatric patients with IBD who were on SCD. Their labs and IBD symptoms scores were positively affected by being on SCD for 3-48 months. Across the board, patients responded favorably, and children were nourished and grew. SCD became a staple part of their treatment paradigm.

My approach is fairly standard in comparison to what is outlined in Breaking the Vicious Cycle but has been modified to include an introductory diet and stages of how to add more foods as the patient heals. I follow much of the information on the stages of SCD from www.pecanbread.com and gradually add foods with more texture and fiber as the patient heals and as they tolerate. The starting point is protein, broth, homemade jello, and completely overcooked (cook for four hours) and destroyed carrots. The introductory diet should be followed for no more than five days before introducing foods from stage I.

When one of my patients with IBD embarks on this diet change, I find it important to get baseline laboratory testing to establish a starting point for symptoms as well as lab work. I order a blood and stool panel, including fecal calprotectin, CMP, CBC, ESR, and CRP and patients’ vitals (especially weight, BP and pulse) as baseline tests so we will have a point of comparison over the next months or years to assess progress and ensure their nutrient status and inflammatory markers are in good range. By staying on top of testing, an imminent flare may be detected and thwarted by using the intro diet as needed.

Empirical evidence and patient testimonials since the era of Dr. Sydney Hass and, later, the popularization of SCD by Elaine Gottschall weren’t enough to push this therapy to the front lines of standard digestive health treatments, but some few open-minded physicians and researchers were listening and couldn’t deny the stories of so many patients helped by this diet. Their collective action of testing and publishing their findings lends legitimacy to this approach in the eyes of conventional medical providers. SCD has now become integral in care of patients with IBD at a few select clinics in the United States, and I look forward to the day when it is accepted as first-line therapy for IBD around the world. If you are planning on helping your patients follow this diet, my strongest suggestion is that you do your homework or, better yet, eat this way for a period of time so you can identify the pros, cons, and troubleshooting solutions that your patients will be expecting of you.

This dietary approach is very manageable with the support of recipe resources, medical guidance, and creativity. Batch cooking makes for fewer hours spent preparing food each week. One of the largest obstacles to finding success in this diet is breaking the addiction to bread and sugar. While the diet may expand to include sweet potatoes or rice once the patient has been in remission for months, it doesn’t ever really encourage these patients to return to eating the Standard American Diet.

So, it may have taken nearly 100 years, but now the medical community is starting to rediscover that food plays a vital role in digestive health and healing.

Essential SCD resources

:

• Books

  : Breaking the Vicious Cycle by Elaine Gottschall; Recipes for the Specific Carbohydrate Diet by Raman Prasad

• Websites

  : www.pecanbread.com, www.btvc.com

• Shopping

  : Lucy’s Kitchen Shop, Digestive Wellness, Wellbee, US Wellness Meats, Liberated Specialty Foods.

References

1. Haas SV, Haas MP. The Management of Celiac Disease. Literary Licensing; 2011. ISBN 1-258-19621-2.

2. Gottschall, Elaine, G. Breaking the Vicious Cycle: Intestinal Health Through Diet (Revised ed.). Kirkton Press; 1994. ISBN 0-9692768-1-8.

3. Olendzki BC, et al. Pilot Testing a Novel Treatment for Inflammatory Bowel Disease. Clinical and Translational Science Research Retreat. May. 2011. Available at http://works.bepress.com/barbara_olendzki/46

4. Cohen SA, et al. Sa1992 Mucosal healing with the specific carbohydrate diet in pediatric Crohn’s disease: preliminary results of a 12-week pilot study. Gastroenterology. 2012:142(supp AB); S-376.

5. Suskind DL, et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):87-91.

6. Chinonyelum O, et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition. April 2016; 32(4): 418–425.

Author’s Bio

:

Dr. Christine Bowen is a Naturopathic Doctor who currently practices in Bothell, Washington. Christine is a Northwest native and a graduate of Bastyr University. She specializes in restoring digestive function mainly through dietary change. She has recently accepted the position of medical director of a holistic non-profit community clinic, Inside Health Institute, where they will be collaborating with local universities and health centers to be able to offer affordable holistic care in a community health center setting. www.bothellnaturalhealth.com www.insidehealthinstitute.org