SCD

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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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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