FROM THE JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION . . .
Tuesday, January 25, 2005
It recently came to the attention of the SCD community that the June 2004 volume of the Journal of Pediatric Gastroenterology and Nutrition contains an article describing two case studies involving the Specific Carbohydrate Diet. Each instance resulted in "complete recovery". The author of the article, Dr. Jacqueline Fridge, works as a Fellow in the Gastroenterology, Nutrition and Hepatology department of a Stanford, California children's hospital. Since public access to medical journals is limited, the full text appears below:
Journal of Pediatric Gastroenterology and Nutrition
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Volume 39 Supplement 1 June 2004 pp S299-S300
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P0637 THE SPECIFIC CARBOHYDRATE DIET - A TREATMENT FOR CROHN'S DISEASE?
Fridge, J. L.1; Kerner, J.1; Cox, K.1
1Pediatric Gastroenterology, Hepatology and Nutrition, Lucile Packard Children's
Hospital, Stanford Medical Center, Palo Alto, United States
Submitted by: jacqueline.fridge@medcenter.stanford.edu
Introduction:
Many diet therapies for Crohn's disease are known to be effective.
It is not known which components of diets give the benefit, or which component
of a regular diet is perpetuating the disease. We report two children with
Crohn's disease who made a complete recovery on the Specific Carbohydrate Diet
(SC Diet). One child received no other therapy, the other was steroid dependent
prior to the diet. The diet eliminates all complex carbohydrates and refined
sugars. In theory the diet deprives intestinal bacteria of the substrates they
need to survive, reducing bacterial growth and the harmful products of
fermentation.
Methods:
This is a case series to describe a novel diet therapy.
Results:
Case 1: An 11 year old girl presented with abdominal pain, weight loss
and diarrhea. Laboratory examination revealed an albumin of 3.0 g/dL, hemoglobin
(Hb) 11.6 g/dL and erythrocyte sedimentation rate (ESR) 17 mm/Hr. Serologies
were positive with ASCA IgA 27.7 EU/ml and IgG 53.9 EU/ml, but pANCA was
negative. Upper GI series (UGIS) showed multiple areas of stricture and mucosal
cobblestoning in the jejunum and ileum, and a 5-6 cm stricture in the terminal
ileum. Pathology was non-specific. The family refused standard care and
following their own research elected to start the SC Diet. After 6 months on the
diet her UGIS is normal, labs including ASCA antibodies have normalized and the
patient is growing and symptom free.
Case 2: A 9 year old boy presented with a history of diarrhea, abdominal pain, poor appetite and no weight gain for 2 years. Laboratory examination revealed albumin 3.4 g/dL, Hb 12.0 g/dL and ESR 43 mm/Hr. ASCA IgA, IgG and pANCA were negative. UGIS showed narrowing of the distal ileum and proximal cecum. Pathology demonstrated focal acute colitis with crypt abcesses and granuloma formation. The patient responded well to treatment with sulfasalazine, prednisone and 6 mercaptopurine. Ten weeks after starting medications, during a steroid taper, his symptoms flared and his anemia returned. His prednisone was increased, but at this time the family elected to start the SC Diet. After 3 months on the diet the patient is off steroids, symptom free and all blood tests have normalized.
Conclusion:
The apparent effectiveness of the Specific Carbohydrate Diet in
Crohn's Disease warrants more study. There is current interest in the manipulation
of intestinal flora using probiotics and prebiotics. If this diet works by
changing the bacterial flora of the bowel, then it adds weight to the role of
bacteria in the pathogenesis of Crohn's Disease.
Reference(S):
Gottschall, Elaine: Breaking the Vicious Cycle - Intestinal Health Through Diet.
Baltimore, Ontario, The Kirkton Press 2002.
