Specific Carbohydrate Diet

treatment for IBD

J E NI FE R LA
NOV. 2, 2014
K E E NE STA TE C O LLE GE D I E TE TI C I N TE R N

Irritable Bowel Disease

IBD

IBS

Chronic immune response/inflammation

Functional gastrointestinal disorder

Crohns disease, ulcerative colitis

Does not produce destructive

inflammation

Symptoms: diarrhea, abdominal pain,

fever, rectal bleeding, loss of appetite,
fatigue, anemia, weight loss, flare-ups,
increased risk for colon cancer
Pathophysiology unsure, caused by
immune response mistaking food as
foreign substances

Symptoms: abdominal pain,

constipation, diarrhea, increased mucus
in stool, nausea, anemia, bleeding,
weight loss
Caused by disturbance in the way the
brain and gut interact

Specific Carbohydrate Diet

Gluten-free, grain-free, starch-free, lactosefree, sucrose-free, additive-free diet
Theory: eliminating most carbs and
allowing only specific carbs that require
minimal digestion can reduce inflammation
Based on Sidney Haas, MD, and
popularized by Elaine Gottschall, MSc
Food label reading is critical

Specific Carbohydrate Diet (SCD)

ALLOWED
Limits the use of complex carbohydrates

Monosaccharides

All vegetables (not canned)

Unprocessed meats, poultry, fish, eggs
Natural cheeses
Homemade yogurt fermented 24 hours
Most fruits and juices w/o additives
Nuts, peanuts in the shell
Oils: olive, coconut, soybean, corn

PROHIBITED
Prohibited foods include:
All grains
Starchy vegetables: potatoes, parsnips,
seaweed
Lactose dairy products
Sugars
Canned vegetables, meats
Legumes
Candy

SCD vs FODMAP
SCD

FODMAP

Use of fructose Honey

Fructose elimination (no

honey/apples)

Low lactose/ fermented

yogurts are allowed
Philosophy: overall
adherence is needed to
ensure restoring of health

Granulated sugar allowed

Lactose is not allowed
Philosophy:
elimination/experimental
diet; focuses more on
eliminating IBS symptoms

Popular Resource Oprah

Kendall Conrad Eat Well, Feel
Well
Claims: People suffering from
Crohns, UC, celiac,
diverticulitis, and other
digestive conditions can
completely restore their health
by following SCD.

Popular Resource About.com

Discussed how SCD is used to correct the imbalance
of intestinal bacteria and yeast in the GI.
Claim: 80% recovery rate for patients with Crohns
disease and a 95% recovery rate for those with
diverticulitis. Recovery begins after as little as three
weeks and full recovery for those with diverticulitis,
IBS, and celiac after one year.

Dietary Factors in the Modulation

of IBD Activity Medscape General Medicine
Focused on multiple factors that impacts the management of
IBD
Factors includes: microparticles,elemental diets, sucrose,
fructose, lactose, probiotics, dietary fat, dietary fiber, glutamine,
vitamins and minerals (iron, vit E, flavonoids, vit D),
glycoalkaloids, colostrum, wheatgrass juice, lycopene, aloe vera,
and SCD
Claim: Reported that it SCD showed improvement for patients
however, further study in a controlled trial is needed to
determine how the diet specifically impacts IBD since the
pathogenesis of IBD is not yet determined.

Diet and IBD: Patient-Targeted

Recommendations Clinical Gastroenterology and Hepatology
Focuses on three diets: SCD, FODMAP, and Paleo
Claim: no formal published studies that support the
benefits of either SCD or Paleo diet in the
management/prevention of IBD and a small group of
pilot studies have been made to evaluate the
FODMAP diet
Treated as individualized approach

Food Group

SCD

Paleolithic

FODMAP

Include

Avoid

Include

Avoid

Include

Avoid

Fruits

All

----

All

----

Bananas
Blueberries
Grapefruit
Honeydew

Apples
Apricots
Cherries
Pears

Vegetables

Most

Potatoes
Yams
Legumes
Seaweed

All

Potatoes
Legumes

Carrots
Celery Corn
Eggplant
Lettuce

Brussel
sprouts
Cabbage
Legumes
Onions

Protein

Nuts Fresh
Meat

Processed
Meats

Game
Meats Fish
Nuts

Domesticate
Meats

All

----

Fiber

None

Grains
Quinoa

None

Grains

Rice Oats

Wheat Rye

Beverages/Dairy

Wine

Milk
Instant
Tea/Coffee
Soy milk
Beer

All Dairy
Soft drinks
Beer Fruit
Juice

Hard
Cheese

Milk Yogurt
Soft Cheese
Ice Cream

Other

Honey
Butter

Chocolate
Corn syrup
Margarine

Refined
Sugar

Maple
Syrup

Sweeteners
Honey
HFCS

Honey

Case Study: Pediatric IBD

Journal of the Council on Nutrition

Pt Profile:
10 y/o F with ulcerative colitis
PMHx: bloody diarrhea, abdominal pain, weight loss, fatigue, leaky
gut, lack of lactobacillus, imbalance of gut flora, possible candida,
severe allergies

Claim: Overall health improvement: growth, wt gain, ht

increase, loss of premature teeth in two months

Clinical and Mucosal Improvement w/

SCD in pediatric Crohns
Journal of Pediatric Gastroenterology and Nutrition

Focus: Patients with Crohns disease were monitored for 52 weeks on

the SCD.

16 patients were screened

10 enrolled
9 completed the first 12 week trial
7 completing the 52 weeks.

Claim: The study showed that there were both clinical and mucosal
improvements for patients particularly those that completed the diet
for over 12 weeks, however further studies are needed to understand
how SCD is effective for those with Crohns.

Nutritional Therapy in Pediatric

Crohns Journal of Pediatric Gastroenterology and Nutrition
Focus: Followed seven children with Crohns disease on the SCD
therapy from 5 to 30 months.
Lab values and medical charts/routine follow ups.
Improvement or normalization in serum albumin, C-reactive protein, hematocrit,
and stool calprotectin.

Claim: SCD diet and following a low complex carbohydrate diet may
be a therapeutic option for pediatric Crohns disease
The rule of thumb is if the gut works, use it!

Summary
SCD is a very strict diet with plenty of foods to avoid
Further research is needed to determine the effectiveness
Personalization on the diet is needed to continually
maintain/manage the diet
Overall, SCD may be a therapeutic/diet modification for
patients with IBD, but consistency and individualized
planning is required

References
Center for Disease Control. (2014). What is Inflammatory Bowel Disease?. Retrieved from http://www.cdc.gov/ibd/what-isibd.htm
Cohen, S., Gold, B., Oliva, S., Lewis, J., Stallworth, A., Koch, B., Eshee, L., & Mason, D. (2014). Clinical and Mucosal
Improvement with the Specific Carbohydrate Diet in Pediatric Crohns Disease: A Prospective Pilot Study. Journal of
Pediatric Gastroenterology and Nutrition, 59(4):516-21. doi: 10.1097/MPG.0000000000000449.
Greene, B. (2007). Treating Digestive Ailments. Retrieved from http://www.oprah.com/health/Treating-Digestive-Ailments
Hou, J., Lee, D., Lewis, J. (2013). Diet and Inflammatory Bowel Disease: Review of Patient-Targeted Recommendations.
Clinical Gastroenterology and Hepatology, 12(10), 1592-1900. doi: http://dx.doi.org/10.1016/j.cgh.2013.09.063
Shah, S. (2007). Dietary Factors in the Modulation of Inflammatory Bowel Disease Activity. MedGenMed. 9(1). Retrieved
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1925010/
Suskind, D., Wahbeh, G., Gregory, N., Vendettuoli, H., & Christie, D. (2014). Nutritional therapy in pediatric Crohn disease:
the specific carbohydrate diet. Journal of Pedatric Gastroenterology and Nutrition, 58(1), 87-91. doi:
10.1097/MPG.0000000000000103
Tieman, J. (2008). A Case Study of Inflammatory Bowel Disease in a ten year old girl and the use of the Specific
Carbohydrate Diet. Nutritional Perspectives: Journal of the Council on Nutrition, 31(3), 18.
Wong, C. (2014). Specific Carbohydrate Diet. Retrieved from
http://altmedicine.about.com/od/popularhealthdiets/a/specific_carb.htm