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.
Table of Contents:
Who came up with the Specific Carbohydrate Diet?
What is the Specific Carbohydrate Diet?
What is the theory behind the Specific Carbohydrate Diet?
Is the theory valid?
Is there any clinical evidence for the Specific Carbohydrate Diet?
What’s the deal with “illegal” foods?
Should I try the Specific Carbohydrate Diet?
Resources
Review of the literature
We are faced, then, with intestinal disorders which involve microbial populations which have been altered in number, in kind, or both. The normal contractions (peristalsis) of the intestinal muscles are not able to remove them; they appear to be tenacious. Indeed, there is evidence that intestinal microbes will not cause disease unless they develop methods of adhering to the gut wall. Antibiotic therapy is of limited usefulness while other drugs of the cortisone and sulfa families have side-effects if continued too long.
A sensible and harmless form of warfare on the aberrant population of intestinal microbes is to manipulate their energy (food) supply through diet. Most intestinal microbes require carbohydrates for energy, and the Specific Carbohydrate Diet severely limits the availability of carbohydrates. By depriving intestinal microbes of their energy source, their numbers gradually decrease along with the products they produce.
Elaine Gottschall, Breaking the Vicious Cycle p. 16
Who came up with the Specific Carbohydrate Diet?
The earliest iteration of the SCD was developed in the 1930’s by Dr. Sidney Haas to treat patients with celiac disease. He lays out his protocol, along with the supporting science and case studies, in his 1951 book “Management of Celiac Disease.” (If anyone is interested, you can read much of the book for free at the above link. It’s quite fascinating reading medical perspectives from the early 1900s; the language is so different! One referenced paper is titled “The Value of Banana in the Treatment of Celiac Disease.” Fun right?)
The SCD hit the mainstream in the 1990s thanks to Elaine Gottschall, whose daughter was diagnosed with UC and was successfully treated by Dr. Haas using his version of the specific carbohydrate diet. (Apparently she was free from symptoms after two years and returned to a normal diet after seven, reportedly remaining in excellent health on a normal diet for over 20 years thereafter.)
Gottschall took Dr. Haas’ specific carbohydrate diet as a starting point and expanded upon it to create the modern version of the SCD. The diet as described in her 1987 book Breaking the Vicious Cycle is, for all intents and purposes, the “official” version of the SCD.
What is the Specific Carbohydrate Diet?
The SCD only allows carbohydrates in the form of monosaccharides (ie “simple sugars” like fructose, glucose, or galactose), which are found in fruits, non-starchy vegetables, and honey. Thus, it excludes all starches, as well as lactose and table sugar (ie sucrose), which are disaccharides. In practical terms, this means:
Yes: Meats, fish, fruits, vegetables, hard cheeses, homemade 24-hour-fermented yogurt (to remove all the lactose), nuts, seeds, honey
No: Grains (wheat, corn, rice, oats, etc), potatoes, lactose-containing dairy (milk, ice cream, soft cheeses), sugar
Legumes (beans and lentils) are allowed if properly prepared once someone has been on the diet for at least three months
While this is not a low-carbohydrate diet, it often ends up being low carb in practice, since most dense sources of carbohydrates are removed.
Also, of note, there is a specific order recommended for the introduction of foods. If someone has diarrhea and/or significant digestive symptoms, Gottschall recommends starting with the “intro” diet, which emphasizes meats and avoids most plant foods. At this point, the diet is certainly low carb.
The purpose of the Specific Carbohydrate Diet is to deprive the microbial world of the intestine of the food it needs to overpopulate. By using a diet which contains predominantly “predigested” carbohydrates, the individual with an intestinal problem can be maximally nourished without over-stimulation of the intestinal microbial population.
Elaine Gotschall, Breaking the Vicious Cycle
What is the theory behind the Specific Carbohydrate Diet?
The theory behind the SCD is fairly simple: people with digestive disease have damaged small intestinal microvilli and therefore a compromised ability to break down and absorb carbohydrates. These unabsorbed carbohydrates feed bacteria, leading to bacterial overgrowth in the small intestine, whose metabolic actions and by-products further damage the microvilli of the small intestine. This is the “vicious cycle” referred to in the book Breaking the Vicious Cycle.
To get more specific: carbohydrates are molecules of varying size and complexity that are made up of three building blocks: glucose, fructose, and galactose. These three building blocks are “monosaccharides,” and do not need to be broken down any further to be absorbed. Two monosaccharides stuck together is a “disaccharide,” examples being sucrose, ie table sugar (glucose + fructose) and lactose (glucose + galactose). More complex carbohydrate molecules include starches, which are long chains of many glucose units.
The whole idea behind the SCD is that by only allowing monosaccharides, they will be absorbed by the body rather than feeding bacteria in the gut, and without a food source, the bacteria in the gut will die, allowing the intestine to heal.
Although there is still insufficient evidence to link a specific microbe to each of the chronic intestinal disorders, it is generally agreed that intestinal microbes are not innocent bystanders.
Elaine Gottschall, Breaking the Vicious Cycle
Is the theory valid?
Yes and no.
In many ways, Elaine Gotschall was ahead of her time. Her focus on intestinal bacteria as centrally important to digestive illness was well ahead of the curve, considering she was researching and writing this book in the 1980s. If you search the word “microbiome” in PubMed, you can see that the explosion of microbiome-related research didn’t start picking up until years later around 2010, and even now in 2021, the standard of care for IBD is still focused on suppressing the body’s immune response rather than modulating intestinal bacteria.
That said, many aspects of Gotschall’s theory are too simplistic in light of more recent research. I delve deeper into the science behind the Specific Carbohydrate Diet in my post here, but the short version is that, while Breaking the Vicious Cycle gets a lot right, it understates the complexity involved in bacterial dysbiosis. It can’t be denied that the SCD works for many people, but ultimately, there are probably different approaches to addressing dysbiosis in UC that are less restrictive, easier to follow, and/or are more effective.
Is there any clinical evidence for the Specific Carbohydrate Diet?
You can scroll down to the Reference list for a full lit review/annotated bibliography of sorts, but aside from a couple case reports, there’s no UC-specific evidence. The vast majority of research so far has been done in Crohn’s disease, specifically in pediatric patients, although a few chart reviews, surveys, and other relatively low-quality studies have included both CD and UC patients.
This CD focus is consistent with the literature as a whole, where diet seems to be used more readily by the medical community as an intervention for CD than for UC. For instance, an elemental diet is first-line therapy for CD, especially pediatric CD, in many places. The same is not true of UC. (In light of that, it’s interesting to note that Gottschall saw the SCD as a whole-food elemental diet of sorts.)
My attempt to summarize the evidence: if we mentally lump UC and CD together as simply “IBD,” the body of evidence certainly shows promise for the effectiveness of the SCD. However, the trend seems to be that symptoms and lab markers resolve more readily than mucosal inflammation, and many patients do have trouble sticking strictly to the diet (which is a significant practical concern). Additionally, the largest and most rigorously designed trial we have to date did not find that the SCD was more beneficial for CD than a Mediterranean diet, indicating that it may be possible to achieve similar benefits to the SCD through less restrictive and easier-to-follow diets.
What’s the deal with “illegal” foods?
“The strictness of this diet cannot be overemphasized nor should the difficulty of adhering to it be minimized. Faithful observance requires intelligence and vigilance on the part of those taking care of the individual or on the part of the person who cooks for himself or herself. It is surprising how many times a child will manage, despite the best supervision, to get hold of forbidden food. It is equally surprising how many parents will decide, despite all warnings, that “just a taste” of ice cream, cookie, or candy will do no harm. Such infringements will seriously delay recovery and it is unwise to undertake this regimen unless you are willing to follow it with fanatical adherence.”
Elaine Gottschall, Breaking the Vicious Cycle (p. 68); emphasis in original text
As you can see from the above quote, one of the notable characteristics of the SCD is its rigidity. Unlike many other diets, where the “80/20” (or 90/10, or 95/5) concept may be employed and guidelines are simply taken as guidelines, this diet has rules. And it is repeatedly emphasized that breaking any of these rules will significantly compromise healing.
This rigidity is especially apparent in the diet terminology, where foods are either “allowed” or “illegal.” Yes, illegal. As if eating a bowl of oatmeal is a crime.
It even functions as a noun in the community. As in, “I accidentally ate some illegals today.”
I probably don’t have to tell you that that kind of language does not foster a healthy and well-balanced attitude towards food. And for some susceptible people (such as, ahem, myself), the community and overall framing of the SCD is a recipe for orthorexia.
Some might argue that the rigidity – even verging on orthorexia – is a necessary and worthwhile sacrifice for healing. I myself was of that opinion for years, and still believe that a certain amount of discipline and sacrifice can be good and necessary to achieve the health outcomes you want. But here’s the thing: aside from anecdotal reports, I see no support for that stance in this case.
Now, I’m not saying that the SCD isn’t helpful (it obviously is for many people!), nor am I saying the theory behind it is totally bunk. I have no doubt that the SCD does alter the microbiome, and it likely does dramatically reduce the usable food for bacteria in the small intestine, especially compared to a diet rich in processed grains and sugar.
What I am saying is that it’s not as clear cut as the book makes it out to be. First of all, even on strict SCD, you aren’t only eating monosaccharides, since most fruits and many vegetables contain sucrose. But even if you were, malabsorption of fructose (a monosaccharide) is quite common, especially in people with digestive disorders, so even sticking to monosaccharides isn’t remotely a guarantee that you aren’t “feeding the bacteria.” Anyone who has ever over-eaten fruit knows this.
There’s much more that could be said (and has been said, by me, in this other post), but my point is this: in a situation where even following the dietary rules to a T by no means perfectly deprives the intestinal bacteria of all food, I don’t think it’s reasonable to maintain such rigid “legal/illegal” designations for foods, nor to demand “fanatical adherence.” A perfectly “legal” meal including more honey or fruit than the person can absorb could easily cause more problems for them than trying a bite of ice cream, but the framing of the SCD does not facilitate that kind of nuanced thinking – to the detriment of the patient, in my opinion.
Lest you think I’m overreacting, I’d like to share just a few more quotes from the book:
“One basic principle of the diet must be firmly established and persistently repeated: no food should be ingested that contains carbohydrates other than those found in fruits, honey, properly-prepared yogurt, and those vegetables and nuts listed. While this principle may be clearly understood, it is sometimes difficult in practice to recognize the existence of carbohydrates in various foods. Small quantities of carbohydrates other than those designated often creep into the diet unless the strictest attention is paid to every item of food. Reading labels, although a good policy, is inadequate for those on the specific carbohydrate diet since one ingredient sometimes has numerous names and may not be easily recognized as a forbidden carbohydrate.” p. 61
“Canned vegetables, or vegetables packed in jars, are not permitted because many have added sugar or starch which the labels often do not indicate.” p. 63
“Apple juice, formerly an allowable beverage, has become a problem because some manufacturers are adding corn syrup and sugar which is not listed on the label. Therefore, choose an apple cider packed by a local company you feel is responsible. You can call or write to them to ensure that it is pure apple cider without added sweetener.” (p. 74)
To have a big issue with some sugar added to canned peas or bacon while allowing foods like apple juice and honey that can very easily result in malabsorbed carbohydrate is, to me, silly. If someone finds that they can chug a glass of apple juice no problem but has terrible bloating after eating sugar-cured bacon, then by all means, abide by those rules! But I think there are quite a few cases where an IBD patient might actually make worse, less-intuitive food choices for themselves trying not to break any of the SCD rules.
So should I try the Specific Carbohydrate Diet?
Generally, my philosophy is to provide information without telling anyone what to do. But since the SCD is the UC intervention I probably have the most experience with, I feel I would be remiss to not give you my take.
And my take is this: if you feel drawn to it, if you feel like it’s something you can maintain, and/or if you’ve tried other approaches without success, absolutely give it a shot. Just don’t let the trappings surrounding it make you so neurotic about food that you forget the other important things in life.
Also, one principle of the diet that I think is often lost is that Gotschall never intended this to be a forever diet. (Recall that her own daughter went off the diet after seven years, and reportedly maintained excellent health on a normal diet thereafter).
And finally, remember Elaine Gottschall’s words: “If you see no improvement after a one month trial, the diet will probably not work for you.” Don’t get so caught up in the theory behind the diet that you forget to assess whether it’s working for you. And if it isn’t, move on.
Resources
- The Specific Carbohydrate Diet in Inflammatory Bowel Disease: The Evidence and Execution. (PDF) This is included in the Reference list below, but I wanted to include it as a resource as well because the full PDF (published in 2019) is available at that link, and it’s part scientific review and part practical guide and is an excellent place to start for anyone wanting to learn more, as well as a good all-in-one resource to print and give to a doctor or parent.
- Breaking the Vicious Cycle Website. Central repository for all things SCD. Note that the purpose of this website is to promote and expound on the diet (including the science behind it) as laid out in the book Breaking the Vicious Cycle. In other words, it’s not objective, and you probably won’t find any critiques of the diet or science, so take the information there with a grain of salt and don’t use it as a be-all-end-all guide to treating your IBD. That said, it’s an excellent practical resource for following the diet if you decide to give it a shot!
- Pecanbread Website. Perhaps even more comprehensive than the official Breaking the Vicious Cycle website, but just as one-sided, so again – use as an excellent resource if you try the SCD, but be aware that the SCD is not the only and final solution to IBD.
- Elana’s Pantry. Great source for SCD recipes.
- Danielle Walker is a popular Paleo blogger/cookbook author who actually started out on the SCD, but never fully went into remission on it, and over time modified her diet to be more akin to Paleo than SCD.
- Jordan and Steve found relief from gut issues through SCD and were well-known advocates of the diet for quite a while through their website SCDLifestyle.com, but they’ve now rebranded as “Healthy Gut” and appear to have shifted focus to selling supplements, and perhaps also a more holistic view of health.
Review of the Literature
Below is a fairly comprehensive collection of all published papers involving the SCD for IBD (in reverse chronological order). I included all research for both UC and CD, because research on UC specifically is almost nonexistent. The majority of research is in CD patients (mostly pediatric) and is relatively low quality in design: chart reviews, case reports, or very small uncontrolled studies. The first paper listed is the first (and only) large RCT on the SCD.
Lewis et al. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn’s Disease. 2021. Gastroenterology.
- This is the first large-scale randomized trial in the U.S. showing that diet can significantly benefit adult patients with IBD (see article on Crohn’s and Colitis Foundation website summarizing the results and significance)
- 194 adult CD patients were randomized to receive either the SCD or a Mediterranean diet
- At 6 weeks, just under half of the participants in each cohort had achieved symptomatic remission (43.5% for Mediterranean diet, 46.5% for SCD)
- SCD was not significantly more beneficial than Mediterranean diet, so study authors recommend Mediterranean diet due to easier adherence and other health benefits
- Of note – this study was instigated based on web-based reported patient interest
Mehrtash, Farhad. Sustained Crohn’s Disease Remission with an Exclusive Elemental and Exclusion Diet: A Case Report. 2021. Gastrointest. Disord.
- “This case shows clinical and biochemical remission and radiologic healing in a 25-year-old male, who is considered to have a moderate-to-severe form of CD due to ileocolonic and perianal disease, without using any medications through an exclusive elemental diet and an exclusion diet.” (The “exclusion diet” was the SCD)
- “One of the limitations of this case report was that mucosal healing was not assessed with colonoscopy. Other objective measures, such as CRP and fecal calprotectin, however, showed significant decreases in disease activity.”
Turner, Dan and Hanauer, Stephen B. Which Diet for Crohn’s Disease? Food for Thought on the Specific Carbohydrate Diet, Mediterranean Diet, and Beyond. 2021. Gastroenterology.
- Comment on Lewis et al RCT; good overview of dietary strategies that have been studied for Crohn’s disease
Britto, Savini Lanka and Kellermayer, Richard. Durable Clinical and Biochemical but Not Endoscopic Remission in Pediatric Crohn’s Disease on Specific Carbohydrate Diet Monotherapy. 2020. Ann Clin Lab Sci.
- Conclusions: We report three pediatric CD patients who achieved clinical remission on SCD monotherapy, but failed to demonstrate complete mucosal healing with a minimum of one year follow up. This case report highlights that SCD monotherapy in male pediatric CD patients can sustain durable clinical and biochemical remission, but not full mucosal healing.
Suskind et al. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. 2020. Nutrients.
- 16 Crohn’s patients at Seattle Children’s Hospital were randomized to one of three diets (only 10 patients completed the study):
- Strict SCD
- modified SCD (mSCD): SCD + oats and rice
- “whole food” diet: elimination of wheat, corn, milk, sugar, and food additives
- By week 12, all 10 participants who completed the study had achieved and maintained clinical remission
- the MSCD group had normalization and the SCD group had near normalization of ESR and CRP, the whole foods group did not
- A detailed analysis of the patients’ microbiomes was done, but no significant trends in microbial composition were identified (this is consistent with previous findings that the microbiome is highly individualized)
Chitnavis, Maithili V and Braly, Kimberly L. The Specific Carbohydrate Diet in Inflammatory Bowel Disease: The Evidence and Execution. 2019. Practical Gastro.
- Full PDF that’s part scientific summary/review and part practical guide. An excellent place to start for anyone wanting to learn more, and a good all-in-one resource to print and give to a doctor or parent
Suskind et al. Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. 2018. J Clin Gastroenterol.
- In a small cohort of pediatric IBD patients, most experienced clinical and/or biochemical improvement over 12 weeks on the SCD, although a few enrolled patients dropped out of the study due to not being able to adhere to the diet
- The researchers also measured microbiome changes over the course of the study, and suggest that improvements in disease state may be mediated by changes in the microbiome due to diet (as the SCD theory posits)
Dubrovsky, Alanna and Kitts, Christopher L. Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient. 2018. Cureus.
- Case report of a 20-year-old girl whose UC was refractory to multiple drug treatments; started SCD and had all UC symptoms controlled within a week
- Report reviews changes in microbiome; overall, species diversity and evenness increased to near control levels, but species richness remained low
Xiong et al. The role of specific carbohydrate diet in pediatric inflammatory bowel disease. 2018. Chinese Journal of Applied Pediatrics.
- This appears to be a review article originally written/published in Chinese; concludes that SCD shows promise/benefit, but more research is needed
McCormick, Nora Maeve and Logomarsino, John V. The Specific Carbohydrate Diet in the Treatment of Crohn’s Disease: A Systematic Review. 2017. J Gastroenterol Hep Research.
- All 8 studies included in the review showed benefit to patients with CD
Nakayuenyongsuk et al. Diet to the Rescue: Cessation of Pharmacotherapy After Initiation of Exclusive Enteral Nutrition (EEN) Followed by Strict and Liberalized Specific Carbohydrate Diet (SCD) in Crohn’s Disease. 2017. Dig Dis Sci.
- Case report of a 15-year-old boy with Crohn’s disease; had clinical improvement with EEN, but still had elevated inflammatory markers, so tried SCD
- Strict SCD steadily reduced inflammatory markers, and patients was able to stop methotrexate use after 2 months on the diet (timeline image below)
- Intro has pretty good overview/lit review of SCD evidence as of 2017
Wahbeh et al. Lack of Mucosal Healing From Modified Specific Carbohydrate Diet in Pediatric Patients With Crohn Disease. 2017. J Pediatr Gastroenterol Nutr.
- This is another retrospective chart review of pediatric patients at Seattle Children’s Hospital; in this case, only Crohn’s patients with SCD/modified SCD (mSCD) as the exclusive therapy were included
- 7 patients were included; none were on strict SCD (all were mSCD), and had been on the diet for a range of 13-62 months;
- Conclusions: In 7 asymptomatic patients with CD on an mSCD as sole therapy with normal or mildly abnormal albumin, CRP, and hematocrit but elevated stool calprotectin >50 μg/g, complete endoscopic mucosal healing was not demonstrated
Cohen, Stanley A. Alas, Who and What Can We Trust? Patients, Parents, Surrogate Markers, or the Specific Carbohydrate Diet. 2017. J Pediatr Gastroenterol Nutr.
- Interesting comment/editorial on Wahbeh et al study underlining the importance of mucosal healing as an endpoint, the unreliability of symptoms and biochemical markers as surrogate endpoints, the limitations of diet as a therapy, and the overall challenges faced attempting to manage IBD
Braly et al. Nutritional Adequacy of the Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease. 2017. J Pediatr Gastroenterol Nutr.
- Conclusions: Nutrient intake of pediatric inflammatory bowel disease patients on the SCD was adequate when compared with a healthy peer reference population, but adequacy was variable when compared with the dietary recommended intakes.
Chutkan et al. Effect of the Specific Carbohydrate Diet on Inflammatory Bowel Disease: A 5-Year Longitudinal Study. 2017. Am J Gastroenterol.
- Assessed 8 IBD patients who followed SCD (with varying levels of compliance) for 66 months
- The average improvement in modified IBDQ score after implementation of SCD was 62%. The average time to see improvement after starting the diet was 30 days (range 3 days to 4 months). 4 out of 8 patients were able to discontinue biologics or immunosuppressive therapy as a result of the diet. Colonoscopy showed complete mucosal healing in 3 out of 8 patients, and active inflammation but with improvement from pre-SCD colonoscopy in 5 out of 8 patients.
Suskind et al. Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease. 2016. Dig Dis Sci.
- A survey of IBD patients on the SCD with 417 respondents
- 33% reported remission after 2 months; 42% at both 6 and 12 months
Burgis et al. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. 2016. World J Gastroenterol.
- Retrospective chart review of 11 pediatric CD patients
- Most lab values improved while on strict SCD (alone or in combination with medication) and appeared stable after SCD liberalization
Obih et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. 2016. Nutrition.
- The Seattle Children’s Hospital uses the SCD in some of its pediatric IBD patients; this paper is based on a chart review of 26 patients treated with the SCD, either alone or in combination with medication
- Success was mixed, but almost all achieved some clinical improvement with the diet; 12 of the patients experienced both clinical and biochemical improvements, and some were able to phase out medication to maintain remission through diet alone
- Note that adherence was a challenge, and not all patients maintained a strict SCD; many added selected “illegal” foods
Kakodkar et al. The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series. 2015. J Acad Nutr Diet.
- The intro of this paper has the most thorough explanation of the theory behind the diet (as laid out in Breaking the Vicious Cycle) that I’ve seen in the literature, for anyone curious
- 50 patients with IBD were surveyed, and the study authors collected food diaries, medical records, and questionnaires; the paper reviews various findings and trends
- All 50 patients surveyed were in clinical remission, and the mean self-reported adherence rate to the diet was very high (about 95%)
Khandalavala, Birgit N and Nirmalraj, Maya C. Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet. 2015. Case Rep Gastroenterol.
- First documented case report of an adult with UC going into remission using the SCD
- 85-year-old woman experiencing a severe UC flare had symptom improvement within 3 months on SCD, clinical remission after one year, and resolution of pancolitis on colonoscopy after two years; all conventional treatment had failed to improve her condition
Cohen et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. 2014. J Pediatr Gastroenterol Nutr.
- Prospective study of 10 pediatric patients with CD; 9 stayed on SCD for the first 12 weeks, and 7 stayed on for the full 52 weeks; others dropped out due to difficulty adhering to diet, and most still in the study admitted to “cheating”
- Similar to other results, most participants experienced significant clinical improvement, with several going into clinical remission; mucosal healing was less consistent, but was observed in some patients
Suskind et al. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. 2014. J Pediatr Gastroenterol Nutr.
- Retrospective chart review of 7 pediatric CD patients
- All symptoms were notably resolved at a routine clinic visit 3 months after initiating the diet. Each patient’s laboratory indices, including serum albumin, C-reactive protein, hematocrit, and stool calprotectin, either normalized or significantly improved during follow-up clinic visits
Walters et al. Analysis of Gut Microbiome and Diet Modification in Patients with Crohn’s Disease. 2014.
- Very small but interesting crossover trial where 5 CD patients followed the SCD or a low-residue diet for 30 days each, with a 30-day washout period in between diets
- SCD resulted in increased microbial diversity, including an increase in F. prausnitzii, an anti-inflammatory commensal; low-residue resulted in decreased microbial diversity
- Of note, microbial profile did not return to baseline during the washout period
Oliva et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. 2014. Dig Liv Dis.
- Unclear what this is from the abstract
Kakodkar et al. The Bacterial Microbiome of IBD Patients on the Specific Carbohydrate Diet (SCD). 2013. Am J Gastroenterol.
- Characterization of the fecal microbiomes of 20 IBD patients on SCD and 20 IBD patient controls; half had CD, half had UC
- Some differences were observed, but none of much significance
Tieman, Jill. A Case Study of Inflammatory Bowel Disease in a ten year old girl and the use of the Specific Carbohydrate Diet. 2008. Nutritional Perspectives: Journal of the Council on Nutrition.
- Improvements seen immediately in 10-year-old girl with UC upon beginning SCD.
Nieves, Raquel and Jackson, Roger T. Specific carbohydrate diet in treatment of inflammatory bowel disease. 2004. Tenn Med.
- No abstract available, and can’t find full text anywhere
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