Alyssa Luck

Semi-Vegetarian/Plant-Based Diet for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: Hospitals in Japan routinely implement a specific diet in the treatment of IBD patients that they call a “semi-vegetarian diet” (SVD), or, in later publications, a “plant-based diet” (PBD), which consists mostly of brown rice, miso soup, vegetables, fruits, potatoes, legumes, eggs, plain yogurt, pickled vegetables, and green tea, with fish once per week and meat every two weeks. This group of doctors and researchers has achieved impressive results in both Crohn’s disease and ulcerative colitis using the diet alone or in combination with medical intervention. Of note is the markedly different mindset surrounding treatment of IBD in Japan compared with the US and other Western countries.

This article is part of the IBD Index. Last updated April 22, 2022.

“Semi-vegetarian diet? What a dumb and nonspecific name, Alyssa. Are you going to write an article about a “semi-carnivore” diet too? Ever heard the word omnivore?”

Yeah, I know. But believe it or not, the “semi-vegetarian diet” is a diet with fairly specific parameters that is used to treat IBD in Japan.

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Nutrition for IBD

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This post is part of the IBD Index. I plan to flesh out the topic of nutrition for IBD (arguably the only topic I’m technically qualified to speak on, on the basis of formal education) in far greater detail as soon as I’m able, but for now, this page will serve as a placeholder and a gentle reminder that ensuring adequate nutrition is of the utmost importance when dealing with chronic illness.

This isn’t “diets for IBD.” IBD diets are, more often than not, more about what you don’t eat than what you do. This page is about nutrition: making sure your body has all the nutrients – both macro and micro – that it needs in order to function, grow, and repair. This is, after all, the entire reason we eat food to begin with, but that fact is often forgotten amidst frantic attempts to quell symptoms by eliminating foods.

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The Specific Carbohydrate Diet (SCD) for IBD: Everything You Need to Know

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: The Specific Carbohydrate Diet is an increasingly popular dietary intervention for IBD patients that involves limiting dietary carbohydrate to monosaccharides, or simple sugars. In practical terms, this involves eliminating all sources of starch, as well as sugar (sucrose) and lactose. It has anecdotally been extremely helpful for a variety of digestive issues, and some published clinical research is beginning to accumulate suggesting benefit for IBD patients, although the best-designed trial thus far does not demonstrate any benefit over a “Mediterranean” diet. Further, the scientific theory underlying the SCD principles does not stand up to our current understanding of the role of intestinal bacteria in IBD, and more importantly, does not support the “fanatical adherence” called for. Ultimately, the diet has helped a great number of IBD sufferers and may be right for some people, but there are likely other dietary and lifestyle approaches that could deliver similar or greater benefit with less restrictiveness and easier-to-follow guidelines.

This article is part of the IBD Index. Last updated on March 14, 2022.

This article aims to give a high-level overview of the Specific Carbohydrate Diet, as well as practical guidance. For a deep (deep, deep) dive into the science, check out The Science Behind the Specific Carbohydrate Diet (SCD): Brilliant or Bunk?.

Ah, the Specific Carbohydrate Diet. I’ll save my experience with it for another time and keep this page as objective as possible, but as a disclaimer: this is the diet I stuck to religiously for the vast majority of the ~3 years between being diagnosed with UC in 2008 and having my colon removed in 2011. (So at the very least, I’m writing from a place of experience!)

From the looks of it, the diet has only grown in popularity since that time. Even giant online health websites like WebMD, VeryWellFit, and Healthline are chiming in about it. (You don’t need to go read those pages. Just keep reading this one; it’s better.)

This post will give you an overview of the SCD, where it came from, the rationale behind it, pros/cons, and things to watch out for. I also link some relevant resources, and at the bottom of the post (as usual) you’ll find a literature review of sorts. An annotated bibliography, if you will.

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The Science Behind the Specific Carbohydrate Diet (SCD): Brilliant or Bunk?

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: In her 1987 book Breaking the Vicious Cycle, Elaine Gotschall proposed the hypothesis that digestive diseases – including IBD – are perpetuated by a vicious cycle of carbohydrate malabsorption, bacterial overgrowth, and intestinal injury, and can therefore be resolved by removing specific carbohydrates from the diet to break the cycle. Much of her research was quite prescient, but key claims fail to stand up to scrutiny, and the science does not support adherence to SCD principles. A modern look at Gottschall’s hypotheses reveal that modulating the intestinal bacteria through diet is indeed as important as she suspected, but that strategies other than the SCD are better able to accomplish that goal.

This article is part of the IBD Index. Last updated April 20, 2022.

This article is a deep dive into the science behind the Specific Carbohydrate Diet, and is a companion post to the high-level summary post: The Specific Carbohydrate Diet (SCD) for IBD: Everything You Need to Know.

The Specific Carbohydrate Diet as laid out in the 1987 book Breaking the Vicious Cycle (BTVC) by Elaine Gotschall is respectably science-driven. She lists dozens of references in the back of the book to support her recommendations (which is impressive considering she was conducting this research in the pre-internet era), and the book itself has been cited in the literature over 100 times. The SCD is also increasingly showing up as an intervention in clinical research, first in case studies and more recently in a large randomized controlled trial.

I said this in my main post on the SCD, but in many ways, Gottschall was truly ahead of her time with the theories she lays out in her book, although of course she leaned heavily on the work of Dr. Haas. In researching this post, I was struck by how relevant her work still is, and how many modern lines of inquiry flow naturally from her hypotheses.

That said, the big wheel of science keeps on turning, and there’s much to be critiqued in BTVC, with quite a few issues that are – in my view, at least – highly relevant to patients. When you have a dietary protocol with rules that are as specific as those of the SCD – and when the diet originator claims they must be followed with “fanatical adherence” – you gotta make sure they stand up to scrutiny, right?

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Is the Low-FODMAP Diet Effective for IBD?

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: A low-FODMAP diet, which is a common intervention for IBS, is being increasingly studied in IBD patients. Unfortunately, the diet does not currently show efficacy for reducing inflammation, but has been shown in clinical trials to be effective at managing functional gastrointestinal symptoms in patients whose disease is in remission. Although a common concern with low-FODMAP diets is potential adverse effects on the microbiome from removing fermentable substrates, its actual effects on the microbiome in practice have not yet been clearly characterized, with inconsistent results across studies. For those who wish to support their microbiome on a low-FODMAP diet, resistant starch and Sunfiber are good low-FODMAP prebiotic options.

This article is part of the IBD Index. Last updated on April 20, 2022.

The low-FODMAP diet is somewhat unique among IBD interventions because it promises to intervene in the common but oft-overlooked situation of continuing functional gastrointestinal symptoms even in the absence of inflammation.

I cover the basics and practical aspects of a low-FODMAP diet in The Low-FODMAP Diet for IBD: Everything You Need to Know. In this article, I take a deep dive into all the evidence regarding the effectiveness of a low-FODMAP diet for IBD, both from the perspective of reducing inflammation and managing symptoms. I also address the most common concern about a low-FODMAP diet: its effects on the microbiome.

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The Low-FODMAP Diet for IBD: Everything You Need to Know

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: The low-FODMAP diet originated in 2005 out of a hypothesis about IBD pathogenesis, but quickly became a go-to treatment for IBS. For IBD, the diet has found its niche as an intervention for addressing lingering functional gastrointestinal symptoms in patients whose IBD is in remission. For this purpose, the diet has demonstrated successful symptom reduction in clinical trials, but no evidence yet indicates that it is helpful for quelling inflammation. The biggest risk associated with a low-FODMAP diet is adverse effects on the microbiome from depriving it of fermentable carbohydrates, but this can be addressed by including low-FODMAP prebiotics (such as Sunfiber and resistant starch) and by reintroducing FODMAP-containing foods as tolerated.

This article is part of the IBD Index. Last updated on April 20, 2022.

This article aims to give a high-level overview of the low-FODMAP diet, as well as practical guidance. For a deeper dive into the science, you can check out my article Is the Low-FODMAP Diet Effective for IBD?.

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Hypnotherapy for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: Hypnotherapy is a mind-body therapy that may have therapeutic potential for IBD, although it’s a bit less practical to implement at home compared to other mind-body therapies such as meditation. Thus far, clinical trials in IBS have shown more impressive results than those in IBD, but there is some preliminary evidence that hypnotherapy could help maintain remission in UC patients who are already in remission, and reduce heart rate and inflammatory markers in those with active disease. The precise mechanism of action behind hypnotherapy remains to be elucidated, but the research of Robert Becker into the electrical systems of the body provides some fascinating glimpses into what may be happening to the mind and body in states of hypnosis.

This article is part of the IBD Index. Last updated on March 14, 2022.

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Meditation and Mindfulness for Ulcerative Colitis and Crohn’s Disease

Alyssa Luck · Mar 14, 2022 · Leave a Comment

Summary: Meditation and mindfulness are becoming increasingly popular in the health sphere, and rightly so – ample evidence indicates that these practices are extremely beneficial for health. However, as far as their practical efficacy in managing IBD, the jury is still out. Clinical trials in IBD have fairly consistently shown improvements in overall quality of life, but thus far haven’t demonstrated improvements in flare rate or severity. That said, trials in a variety of patient populations have shown that mindfulness appears to down-regulate NF-κB activity, reflecting an overall less inflammatory gene expression profile. Other evidence supports the idea that mindfulness markedly changes how the central nervous system physiologically responds to stressors, including down-regulation of sympathetic nervous system and HPA-axis activity. Taken together, it appears likely that mindfulness could confer more measurable benefits with regards to inflammation and disease progression in IBD over the long term.

This article is part of the IBD Index. Last updated on March 14, 2022.

Mind-body medicine is currently an area of particular research focus for me, so you can expect this post to be expanded and updated in the near future! Follow me on Instagram for personal content related to mind-body medicine, as well as snippets of interesting research that might not make it into a blog post.

Mindfulness is one of those golden health practices that I call “no brainers” – in other words, you have nothing to lose and everything to gain. At the outset, I can say that I’d recommend some type of mindfulness practice to every person with IBD, almost without exception (and anyone who knows me knows that I’m not usually in the business of recommending things).

So if you want to learn more, read on. Otherwise, save your time and go meditate!

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Hyperbaric Oxygen Therapy for Ulcerative Colitis

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This article is part of the IBD Index. Last updated on March 14, 2022.

I initially focused on either UC-specific or general IBD evidence, but hope to eventually update this post to include Crohn’s-specific evidence as well.

What is hyperbaric oxygen therapy?
Hyperbaric oxygen therapy (HBOT) involves inhaling 100% oxygen at greater than atmospheric pressure for a period of time, usually between 30-120 min. This is done either in a single-person pressurized chamber, or in a multi-person room where oxygen is delivered via hoods or masks. Treatments can take place in hospitals or outpatient clinics, or at home with soft hyperbaric oxygen chambers (although the efficacy of soft chambers is debated).

HBOT is most commonly used for refractory wound healing in situations like advanced diabetes, severe burns, and skin grafts, but it’s being investigated for therapeutic potential in a number of different conditions (including IBD!). Few clinical trials have been conducted so far, but the ones that have (plus the documented case studies) are extremely promising (see references below).

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Small Intestinal Bacterial Overgrowth (SIBO) and IBD

Alyssa Luck · Mar 14, 2022 · Leave a Comment

This article is part of the IBD Index. Last updated on March 14, 2022.

Small intestinal bacterial overgrowth, or SIBO, is one area of research in the field of intestinal health that has gone from relative obscurity to almost totally mainstream just in the past decade. As research has progressed, the name “overgrowth” has become a bit of a misnomer, with recent evidence indicating that the issue isn’t bacterial overgrowth per se, but rather bacterial dysbiosis in the small intestine.

In any case, SIBO is often identified in patients with IBD*, and can both affect and be affected by other IBD-related disease processes. Therefore, the question of whether and how to treat it is highly relevant. While treatment of SIBO is certainly a lever one can pull that may affect symptoms and overall disease state, SIBO is also often a symptom of other dysfuctions and environmental factors, such that addressing those other factors could resolve the SIBO without explicit treatment. And because testing for and treating SIBO is often quite complicated, it’s best to take it in context and consider whether there are other “no-brainer” levers that could be pulled first.

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