SCD
SCD
SCD
Home   >   Medical Journal Articles

This page contains medical journal articles related to the Specific Carbohydrate Diet.
Beneath each article is at least one link. Links to "PDF" and "PMC" go to the full text of the article.

For fun, the list also includes early SCD-related articles: 1963, 1955, 1950, even 1924.

2018

Barnhill, Kelly, Morgan Devlin, Hannah Taylor Moreno, Amy Potts, Wendy Richardson, Claire Schutte, and Laura Hewitson. "Brief Report: Implementation of a Specific Carbohydrate Diet for a Child with Autism Spectrum Disorder and Fragile X Syndrome." Journal of Autism and Developmental Disorders (2018): 1-9.
https://link.springer.com/article/10.1007/s10803-018-3704-9

This brief report examines the implementation of dietary intervention utilizing the specific carbohydrate diet (SCD) for the management of gastrointestinal issues in a 4 year old boy diagnosed with Autism Spectrum Disorder (ASD) and Fragile X Syndrome (FXS). Data relating to anthropometrics, dietary intake, blood markers, gastrointestinal (GI) symptoms, sleep issues, and behavioral concerns were gathered at baseline and after 4 months of dietary intervention. The dietary intervention was well tolerated. Improvements in nutrient status, GI symptoms, and behavioral domains were reported. The use of the SCD protocol in children with ASD/FXS and GI symptoms warrants further investigation.


Suskind DL, Wu B, Braly K, Pacheco MC, Wahbeh G, Lee D. "Clinical Remission and Normalization of Laboratory Studies in a Patient With Ulcerative Colitis and Primary Sclerosing Cholangitis Using Dietary Therapy." Journal of pediatric gastroenterology and nutrition 67.1 (2018): e15-e18. pubmed: 29570558
https://www.ncbi.nlm.nih.gov/pubmed/29570558

CASE HISTORY

The patient was a 13-year-old girl presenting with abdominal pain, weight loss, and bloody diarrhea. One month before diagnosis, she was treated with a course of azithromycin for pneumonia. Two weeks later, she developed crampy abdominal pain and bloody diarrhea, occurring 3 to 4 times per day. She developed fevers, increased fatigue, nausea, and vomiting. Initial evaluation at an outside emergency department (ED) revealed normal complete blood count and urinalysis. Clostridium difficile antigen/toxin as well as stool cultures were negative. Erythrocyte sedimentation rate (ESR) was elevated at 54 mm/hour. The patient was transferred to Seattle Children's Hospital. On examination, she was afebrile with normal vitals. She had diffuse abdominal tenderness on examination, but no peritoneal signs. Given a history of bloody diarrhea with negative stool studies, she underwent endoscopic evaluation, which revealed erythema, edema, and friability in the stomach, and duodenal bulb. Colonoscopy revealed moderate-to-severe erythema, edema in the entire colon, and ulceration in the proximal colon. The terminal ileum was also erythematous and edematous. Biopsies revealed moderate-to-severe chronic and mild-to-moderate active colitis with chronic active ileitis (Fig. 2). Given endoscopic findings in the ileum, an initial diagnosis of Crohn disease was given and patient was initiated on exclusive enteral nutritional (EEN) therapy. Patient was reclassified later as UC after review of biopsies, imaging, serology, and conferencing with proceduralist. The patient responded well with gradual resolution of abdominal pain and decreased stooling to 2 to 3 semi-formed nonbloody stools per day. C-reactive protein decreased from a maximum of 4.2 to 1.6 mg/dL before discharge from hospital. At follow-up after discharge, CRP completely normalized (Fig. 1).

Initial laboratory studies at Seattle Children's also revealed elevation of alkaline phosphatase (1378 IU/L; normal 130–560 IU/L) and GGT (851 IU/L; normal 5–55 IU/L) (Fig. 1). Magnetic Resonance Cholangiopancreatography (MRCP) during hospitalization showed common bile duct dilatation with regions demonstrating a beaded appearance as well as an abrupt transition at the distal common bile duct suggestive of possible stricture. There was evidence of mild dilatation and beading appearance of the intrahepatic bile duct as well. Further evaluation revealed an elevated immunoglobulin G titer with a normal IgG subclass, antimitochondrial antibody and anti-liver kidney microsomal antibody negativity, and serum carbohydrate antigen (SCA) 19-9 elevation of 906 U/mL (normal <55 U/mL). She was ASCA IgA- and IgG negative and ANCA positive (Table 1). She underwent percutaneous liver biopsy as well as endoscopic retrograde cholangiopancreatography with sphincterotomy and stricture dilatation. Biopsy results were consistent with biliary ductal obstruction and PSC (Fig. 2).

She was maintained on EEN for 10 weeks and then transitioned to the SCD. She remained asymptomatic and clinically well for over a year. She has 2 bowel movements per day, formed, nonbloody, nonmucousy. She has had good weight gain, good energy, no oral ulcerations, no joint pains, and no rashes. She has had complete normalization of her labs with normal ESR, C-reactive protein, haemoglobin, and albumin as well as her liver enzymes including GGT and alkaline phosphatase (Fig. 1). Initial calprotectin done 6 weeks after initial diagnosis was 1127 mg/kg (normal <163 mg/kg). This normalized at 14 (108 mg/kg) and 34 weeks (78 mg/kg). In addition, repeat SCA 19-9 as well as immunoglobulins normalized (Table 1). Repeat endoscopy/colonoscopy 1 year after diagnosis, revealed normal appearing mucosa in the stomach, duodenum, terminal ileum, and colon. Biopsies revealed mild chronic colitis with focal activity (Fig. 2). MRE results showed focal regions of minimal intrahepatic biliary duct prominence within hepatic segment IV.

DISCUSSION

PSC is generally a progressive disease, which ultimately leads to severe complications including cholestasis and hepatic failure. Hepatic transplant is the only curative therapy. Approximately 50% of symptomatic patients do not survive beyond 15 years from diagnosis unless transplanted. Currently, there is no effective medical therapy that alters PSC disease progression, although ursodeoxycholic acid and vancomycin have been associated with biochemical improvements in PSC (8).

The intestinal microbiota of patients with PSC is characterized by decreased microbial diversity, and a significant overrepresentation of Enterococcus, Fusobacterium, and Lactobacillus genera. This dysbiosis is present in patients with PSC with and without concomitant IBD and is distinct from IBD without PSC (9). As the relationship between PSC, IBD, and the intestinal microbiome is becoming better elucidated, therapeutic options aimed at manipulating the intestinal microbiome will likely play an important role in treatment. A prime example is vancomycin, which has been shown to have a beneficial effect in PSC (10). Although dietary therapy has not been rigorously studied in PSC, a disease without known therapy to prevent progression, we suggest that diet may play a critical role. It is known that immunosuppressive therapy can help control symptoms, but the effect on the intestinal microbiome from immunosuppression differs from the changes resulting from dietary therapies. Whereas immunosuppression may help control IBD-associated enteral inflammation, it may not address underlying triggers of pathogenesis such as the microbiota, dietary exposures, and the resultant metabolites produced. This case is the first to report clinical remission and laboratory normalization of PSC with dietary therapy. Though IBD activity may be a confounder, we suggest that both control of IBD activity and alterations in the intestinal microbiota may be within the pathway of effective therapy for PSC. Further prospective studies are merited and will help elucidate the role of diet in either primary or adjunctive therapy for PSC.


Dubrovsky, Alanna, and Christopher L. Kitts. "Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient." Cureus 10.2 (2018).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890963/

A 20-year-old female was diagnosed with ulcerative colitis (UC) at age 14 and primary sclerosing cholangitis (PSC) at age 16. The PSC was successfully treated with high doses of oral vancomycin; however, the UC was more difficult to manage. After many drug treatments failed to treat the UC, the patient began following the specific carbohydrate diet (SCD). This report documents fecal microbiome changes resulting from following the SCD for two weeks. The DNA extracted from fecal samples was subjected to 16S rRNA gene sequencing to quantify bacterial species abundance. Not only were substantial changes in the fecal bacterial composition detectable within two weeks, but all UC symptoms were also controlled as early as one week following the start of the diet. The patient's fecal microbiota was dramatically different from those of three healthy control subjects and showed remarkable loss of bacterial diversity in terms of species richness, evenness, and overall diversity measures. Other specific changes in bacterial composition included an increase in Enterobacteriaceae, including Escherichia and Enterobacter species. A two- to three-fold decrease was observed in the prevalence of the most dominant fecal bacterial species, Fusobacterium ulcerans, after two weeks on the SCD. Overall species diversity and evenness increased to levels near the controls, although species richness remained low. These findings provide information on the fecal bacteria from a patient with PSC and UC, following prolonged oral vancomycin treatment, and identifies a potentially specific microbial effect for the SCD.


Suskind, David L., et al. "Clinical and fecal microbial changes with diet therapy in active inflammatory bowel disease." Journal of clinical gastroenterology 52.2 (2018): 155-163.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484760/

GOAL:

To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND:

IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY:

Pediatric patients with mild to moderate IBD defined by pediatric Crohn's disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS:

Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS:

SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.


2017

Kakodkar S, Mutlu EA. "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease." Gastroenterology clinics of North America 46.4 (2017): 745-767.
https://www.ncbi.nlm.nih.gov/pubmed/29173519

Abstract

There are many mechanisms to explain how food may drive and ameliorate inflammation. Although there are no consistent macronutrient associations inflammatory bowel disease (IBD) development, many exclusion diets have been described: IgG-4 guided exclusion diet; semivegetarian diet; low-fat, fiber-limited exclusion diet; Paleolithic diet; Maker's diet; vegan diet; Life without Bread diet; exclusive enteral nutrition (EEN), the Specific Carbohydrate Diet (SCD) and the low FODMAP diet. The literature on diet and IBD is reviewed with a particular focus on EEN, SCD, and low FODMAP diets. Lessons learned from the existing observations and strengths and shortcomings of existing data are presented.


Braly K, Williamson N, Shaffer ML, Lee D, Wahbeh G, Klein J, Giefer M, Suskind DL. "Nutritional Adequacy of the Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease." Journal of pediatric gastroenterology and nutrition 65.5 (2017): 533-538. pubmed: 28825603
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653423

Abstract

INTRODUCTION:

The specific carbohydrate diet (SCD) is an exclusion diet used as a therapy in inflammatory bowel disease. The aim of this study was to evaluate the nutritional adequacy of the SCD.

METHODS:

Prospective dietary data for 12 weeks were analyzed for pediatric patients on the SCD. Intake of 20 key nutrients was compared to dietary recommended intake levels and nutrient intake data from similarly aged children from The National Health and Nutrition Examination Survey National Youth Fitness Survey in 2012.

RESULTS:

Nine patients enrolled, with 8 patients completing the study. Six of 8 individuals completing the study had gained weight, 1 individual had weight loss, and 1 had no change in weight. Energy intake was significantly greater than 100% of the recommended daily allowance (RDA)/adequate intake for 64% of daily intakes completed for this study. The majority of participants' daily intakes met or exceeded the RDA for vitamins B2, B3, B5, B6, B7, B12, C, A, and E. One hundred percent of participants' intakes were below the RDA for vitamin D. Seventy-five percent of daily intakes were less than the RDA for calcium. The upper limit was met or exceeded for magnesium in 42% of daily intakes. Average vitamin A intake was significantly greater than the upper limit (P = 0.01).

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. Close monitoring with a multidisciplinary team for patients using the SCD as an alternative or adjunct therapy is recommend to ensure positive outcomes for overall patient health.


Nakayuenyongsuk W, Christofferson M, Nguyen K, Burgis J, Park KT. "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." Digestive diseases and sciences 62.10 (2017): 2686-2689.
https://link.springer.com/article/10.1007/s10620-016-4446-1

1. Dig Dis Sci. 2017 Oct;62(10):2686-2689. doi: 10.1007/s10620-016-4446-1.

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.

Nakayuenyongsuk W(1), Christofferson M(2), Nguyen K(2), Burgis J(2), Park KT(2).

Author information:
(1)Stanford Children's Inflammatory Bowel Disease Center, Stanford University
School of Medicine, Stanford, CA, USA. warapan@stanford.edu.
(2)Stanford Children's Inflammatory Bowel Disease Center, Stanford University
School of Medicine, Stanford, CA, USA.

DOI: 10.1007/s10620-016-4446-1
PMID: 28084605


McCormick, Nora Maeve, and John V. Logomarsino. "The Specific Carbohydrate Diet in the Treatment of Crohn’s Disease: A Systematic Review." Journal of Gastroenterology and Hepatology Research 6.4 (2017): 2392-2399.
http://ghrnet.org/index.php/joghr/article/view/1957/2437

2016

Suskind DL, Cohen SA, Brittnacher MJ, Wahbeh G, Lee D, Shaffer ML, Braly K, Hayden HS, Klein J, Gold B, Giefer M, Stallworth A, Miller SI. "Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease." Journal of clinical gastroenterology (2016): 1539-2031.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484760

Abstract

GOAL:

To determine the effect of the specific carbohydrate diet (SCD) on active inflammatory bowel disease (IBD).

BACKGROUND:

IBD is a chronic idiopathic inflammatory intestinal disorder associated with fecal dysbiosis. Diet is a potential therapeutic option for IBD based on the hypothesis that changing the fecal dysbiosis could decrease intestinal inflammation.

STUDY:

Pediatric patients with mild to moderate IBD defined by pediatric Crohn's disease activity index (PCDAI 10-45) or pediatric ulcerative colitis activity index (PUCAI 10-65) were enrolled into a prospective study of the SCD. Patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

RESULTS:

Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change.

CONCLUSIONS:

SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.


Suskind DL, Wahbeh G, Cohen SA, Damman CJ, Klein J, Braly K, Shaffer M, Lee D. "Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease." Digestive diseases and sciences 61.11 (2016): 3255-3260.
https://www.ncbi.nlm.nih.gov/pubmed/27638834

Abstract

BACKGROUND:

Recent studies suggest that dietary therapy may be effective for patients with inflammatory bowel disease (IBD), but limited published data exist on the usage and efficacy of dietary therapy.

AIM:

To evaluate the perspective of IBD patients using the specific carbohydrate diet (SCD).

METHODS:

An anonymous online survey was conducted using REDCap, a Web-based survey tool. Survey links were sent to known Web sites as well as support groups in an attempt to characterize patient utilization of the SCD and perception of efficacy of the SCD.

RESULTS:

There were 417 respondents of the online survey on the SCD with IBD. Mean age for individuals on the SCD was 34.9 ± 16.4 years. Seventy percent were female. Forty-seven percent had Crohn's disease, 43 % had ulcerative colitis, and 10 % had indeterminate colitis. Individuals perceived clinical improvement on the SCD. Four percent reported clinical remission prior to the SCD, while 33 % reported remission at 2 months after initiation of the SCD, and 42 % at both 6 and 12 months. For those reporting clinical remission, 13 % reported time to achieve remission of less than 2 weeks, 17 % reported 2 weeks to a month, 36 % reported 1-3 months, and 34 % reported greater than 3 months. For individuals who reported reaching remission, 47 % of individuals reported associated improvement in abnormal laboratory values.

CONCLUSIONS:

The SCD is utilized by many patients as a primary and adjunct therapy for IBD. Most patients perceive clinical benefit to use of the SCD.


Obih C, Wahbeh G, Lee D, Braly K, Giefer M, Shaffer ML, Nielson H, Suskind DL. "Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center." Nutrition (Burbank, Los Angeles County, Calif.) 32.4 (2016): 418-25.
https://www.ncbi.nlm.nih.gov/pubmed/26655069

Abstract

OBJECTIVE:

Despite dietary factors being implicated in the pathogenesis of inflammatory bowel disease (IBD), nutritional therapy, outside of exclusive enteral nutrition (EEN), has not had a defined role within the treatment paradigm of pediatric IBD within IBD centers. Based on emerging data, Seattle Children's Hospital IBD Center has developed an integrated dietary program incorporating the specific carbohydrate diet (SCD) into its treatment paradigm. This treatment paradigm uses the SCD as primary therapy as well as adjunctive therapy for the treatment of IBD. The aim of this study was to evaluate the potential effects of the SCD on clinical outcomes and laboratory studies of pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC).

METHODS:

In this retrospective study, we reviewed the medical records of patients with IBD on SCD.

RESULTS:

We analyzed 26 children on the SCD: 20 with CD and 6 with UC. Duration of the dietary therapy ranged from 3 to 48 mo. In patients with active CD (Pediatric Crohn's Disease activity index [PCDAI] >10), PCDAI dropped from 32.8 ± 13.2 at baseline to 20.8 ± 16.6 by 4 ± 2 wk, and to 8.8 ± 8.5 by 6 mo. The mean Pediatric Ulcerative Colitis Activity Index for patients with active UC decreased from a baseline of 28.3 ± 10.3 to 20.0 ± 17.3 at 4 ± 2 wk, to 18.3 ± 31.7 at 6 mo.

CONCLUSION:

This retrospective review provides evidence that the SCD can be integrated into a tertiary care center and may improve clinical and laboratory parameters for pediatric patients with nonstructuring, nonpenetrating CD as well as UC. Further prospective studies are needed to fully assess the safety and efficacy of the SCD in pediatric patients with IBD.


Ferro, P., & Prasad, R. (2016). Diets for Autism Spectrum Disorder: Learning from IBD and IBS Treatments. Alternative and Complementary Therapies, 22(2), 1–5.
http://online.liebertpub.com/doi/10.1089/act.2016.29046.pfe

In this article, we focus on children who have been diagnosed with autism spectrum disorder (ASD) and also have gastrointestinal (GI) issues. In particular, we are interested in the connection between GI issues, the microbiome, and ASD-related symptoms. We put forward the concept that diets recently shown to be advantageous in managing chronic digestive ailments such as Crohn’s disease and irritable bowel syndrome (IBS) have components that may benefit a subset of children with autism. In addition, we see a (not too distant) day in which behavioral problems often associated with ASD, particularly irritation, aggression, and self-harm, are well managed by a variety of interventions that modulate the microbiome.

Burgis JC, Nguyen K, Park KT, Cox K. "Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease." World journal of gastroenterology 22.6 (2016): 2111-7.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726683

Abstract

AIM:

To investigate the specific carbohydrate diet (SCD) as nutritional therapy for maintenance of remission in pediatric Crohn's disease (CD).

METHODS:

Retrospective chart review was conducted in 11 pediatric patients with CD who initiated the SCD as therapy at time of diagnosis or flare. Two groups defined as SCD simple (diet alone, antibiotics or 5-ASA) or SCD with immunomodulators (corticosteroids and/or stable thiopurine dosing) were followed for one year and compared on disease characteristics, laboratory values and anthropometrics.

RESULTS:

The mean age at start of the SCD was 11.8 ± 3.0 years (range 6.6-17.6 years) with five patients starting the SCD within 5 wk of diagnosis. Three patients maintained a strict SCD diet for the study period and the mean time for liberalization was 7.7 ± 4.0 mo (range 1-12) for the remaining patients. In both groups, hematocrit, albumin and ESR values improved while on strict SCD and appeared stable after liberalization (P-value 0.006, 0.002, 0.002 respectively). The majority of children gained in weight and height percentile while on strict SCD, with small loss in weight percentile documented with liberalization.

CONCLUSION:

Disease control may be attainable with the SCD in pediatric CD. Further studies are needed to assess adherence, impact on mucosal healing and growth.


Faller, L., Scudiere, J., Davies, Y., "Case Study: Treatment of a Male, Pediatric Crohn's Disease Patient with the Specifc Carbohydrate Diet (SCD)." UC Davis Health Student Review. Vol. I (2016).
https://myhs.ucdmc.ucdavis.edu/web/uc-davis-health-student-review/volume-1

Here we report the treatment of a pediatric Crohn's disease patient with the Specific Carbohydrate Diet (SCD) and without medications. The SCD excludes most dairy products and complex carbohydrates to reduce bacterial growth. This is thought to decrease local inflammation and allow the gastrointestinal tract to heal. Some studies suggest that this diet can help control and improve symptoms of Crohn’s disease.


2015

de Silva, P. S., Ahrens, S., Cole, W., & Korzenik, J. R. (2015). Tu1266 Response to the Specific Carbohydrate Diet Amongst Individuals With Inflammatory Bowel Disease-A Survey of 122 Patients. Gastroenterology, 148(4), S-842.
https://doi.org/10.1016/S0016-5085(15)32854-7

O'Dwyer, D. D., & Darville, R. L. (2015). Specific carbohydrate diet: irritable bowel syndrome patient case study. Nutrition & Food Science, 45(6).
https://doi.org/10.1108/NFS-05-2015-0056

Purpose

The purpose of this paper was to investigate the impact of specific carbohydrate restriction (polysaccharides and disaccharides) in the form of the specific carbohydrate diet (SCD) in treating irritable bowel syndrome (IBS).

Design/methodology/approach

A female patient diagnosed with diarrhea predominant IBS was assigned to the SCD for six months. The diet occurred in phases and was advanced based on the individual’s tolerance level under the guidance of a registered dietitian. Quality of life was measured by a pre- and post-IBS severity score questionnaire. Gastrointestinal symptoms were measured by self-assessment of IBS symptoms using a seven-point Likert-like scale, with −3 = substantially worse to +3 = substantially better. Probiotics were consumed throughout the duration of the study.

Findings

The quality of life severity score significantly improved from a severity of 315 (with 500 being the most severe) to 15. The initial symptoms from the first day on the diet compared to the total period for bloating, abdominal pain/discomfort, flatulence/wind, diarrhea, bowel urgency, stool consistency, stool frequency, energy levels, incomplete evacuation and abdominal rumbling were improved significantly (p < 0.0005). The SCD diet significantly improved the quality of life and IBS symptoms in a female patient with IBS-diarrhea.

Originality/value

This study is the first of its kind to evaluate the efficacy of the SCD to treat IBS. The SCD should be considered a therapeutic option to treating IBS after fermentable carbohydrate restriction.


Khandalavala BN, Nirmalraj MC. "Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet." Case reports in gastroenterology 9.2 (2015): 291-5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560333/

Abstract

A 73-year-old female of Asian origin was diagnosed with ulcerative colitis (UC) after initial gastrointestinal symptoms of abdominal pain and bloody diarrhea. She had a relatively benign course over the subsequent 12 years. In 2009, she had increased left-sided abdominal pain, bloody diarrhea and progressive weight loss, due to a severe exacerbation. In spite of a variety of standard treatments, her condition continued to decline with a significant impact on normal life and functioning. In December of 2010, repeat colonoscopy and microscopy confirmed pancolitis, without diverticulitis. The Specific Carbohydrate Diet (SCD) was initiated due to failure of conventional therapies. Following this highly restricted diet, within a period of 3-6 months, improvement was noted, and within a year, no abdominal pain or diarrhea were present, and she returned to her baseline functioning and career. Two years later, repeat colonoscopy showed resolution of the pancolitis, confirmed with microscopic evaluation. Successful use of the SCD in children with UC has been documented. We describe previously unreported, highly beneficial results with both symptomatic and clinical improvement and complete remission of UC in an adult female with the SCD.


Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. "The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series." Journal of the Academy of Nutrition and Dietetics 115.8 (2015): 1226-32.
http://www.sciencedirect.com/science/article/pii/S2212267215005043

Neither the characteristics of patients who are following the SCD nor the benefits of this diet have been well described in the medical literature. Herein, we report on the largest series of patients with IBD following the SCD to date and describe their clinical characteristics.


2014

Cohen SA, Gold BD, Oliva S, Lewis J, Stallworth A, Koch B, Eshee L, Mason D. "Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease." Journal of pediatric gastroenterology and nutrition 59.4 (2014): 516-21.
https://www.ncbi.nlm.nih.gov/pubmed/24897165

Abstract

OBJECTIVE:

The aim of the study was to prospectively evaluate clinical and mucosal responses to the specific carbohydrate diet (SCD) in children with Crohn disease (CD).

METHODS:

Eligible patients with active CD (Pediatric Crohn's Disease Activity Index [PCDAI] ≥ 15) underwent a patency capsule and, if passed intact, capsule endoscopy (CE) was performed. Patients taking SCD were monitored for 52 weeks while maintaining all prescribed medications. Demographic, dietary, and clinical information, PCDAI, Harvey-Bradshaw Index (HBI), and Lewis score (LS) were collected at 0, 12, and 52 weeks. CEs were evaluated by an experienced reader blinded to patient clinical information and timing.

RESULTS:

Sixteen patients were screened; 10 enrolled; and 9 completed the initial 12-week trial-receiving 85% of estimated caloric needs before, and 101% on the SCD. HB significantly decreased from 3.3 ± 2.0 to 0.6 ± 1.3 (P = 0.007) as did PCDAI (21.1 ± 5.9 to 7.8 ± 7.1, P = 0.011). LS declined significantly from 2153 ± 732 to 960  ± 433 (P = 0.012). Seven patients continued the SCD up to 52 weeks; HB (0.1 ± 0.4) and PCDAI (5.4 ± 5.5) remained improved (P = 0.016 and 0.027 compared to baseline), with mean LS at 1046 ± 372 and 2 patients showed sustained mucosal healing.

CONCLUSIONS:

Clinical and mucosal improvements were seen in children with CD, who used SCD for 12 and 52 weeks. In addition, CE can monitor mucosal improvement in treatment trials for pediatric CD. Further studies are critically needed to understand the mechanisms underlying SCD's effectiveness in children with CD.


Walters, S. S., Quiros, A., Rolston, M., Grishina, I., Li, J., Fenton, A., & Nieves, R. (2014). Analysis of gut microbiome and diet modification in patients with Crohn’s disease. SOJ Microbiol Infect Dis, 2(3), 1-13.


Objective: The human intestine harbors trillions of commensal microbes that live in homeostasis with the host immune system. Changes in the composition and complexity of gut microbial communities are seenininflammatoryboweldisease (IBD),indicating disruption in host-microbe interactions. Multiple factors including diet and inflammatory conditions alter the microbial complexity. The goal of this study was to develop an optimized methodology for fecal sample processing and to detect changes in the gut microbiota of patients with Crohn’s disease receiving specialized diets.

Design: Fecal samples were obtained from patients with Crohn’s disease in a pilot diet crossover trial comparing the effects of a specific carbohydrate diet (SCD) versus a low residue diet (LRD) on the composition and complexity of the gut microbiota and resolution of IBD symptoms. The gut microbiota composition was assessed using a high-density DNA microarray PhyloChip.

Results: DNA extraction from fecal samples using a column based method provided consistent results. The complexity of the gut microbiome was lower in IBD patients compared to healthy controls. An increased abundance of Bacteroides fragilis (B. fragilis) was observed in fecal samples from IBD positive patients. The temporal response of gut microbiome to the SCD resulted in an increased microbial diversity while the LRD diet was associated with reduced diversity of the microbial communities.

Conclusion: Changes in the composition and complexity of the gut microbiome were identified in response to specialized carbohydrate diet. The SCD was associated with restructuring of the gut microbial communities.

Keywords: IBD; Crohn’s Disease; Fecal microbiome; Diet Modification; PhyloChip


Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. "An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report." Nutrition journal 13 (2014): 5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3896778

Abstract

BACKGROUND:

The Anti-Inflammatory Diet (IBD-AID) is a nutritional regimen for inflammatory bowel disease (IBD) that restricts the intake of certain carbohydrates, includes the ingestion of pre- and probiotic foods, and modifies dietary fatty acids to demonstrate the potential of an adjunct dietary therapy for the treatment of IBD.

METHODS:

Forty patients with IBD were consecutively offered the IBD-AID to help treat their disease, and were retrospectively reviewed. Medical records of 11 of those patients underwent further review to determine changes in the Harvey Bradshaw Index (HBI) or Modified Truelove and Witts Severity Index (MTLWSI), before and after the diet.

RESULTS:

Of the 40 patients with IBD, 13 patients chose not to attempt the diet (33%). Twenty-four patients had either a good or very good response after reaching compliance (60%), and 3 patients' results were mixed (7%). Of those 11 adult patients who underwent further medical record review, 8 with CD, and 3 with UC, the age range was 19-70 years, and they followed the diet for 4 or more weeks. After following the IBD-AID, all (100%) patients were able to discontinue at least one of their prior IBD medications, and all patients had symptom reduction including bowel frequency. The mean baseline HBI was 11 (range 1-20), and the mean follow-up score was 1.5 (range 0-3). The mean baseline MTLWSI was 7 (range 6-8), and the mean follow-up score was 0. The average decrease in the HBI was 9.5 and the average decrease in the MTLWSI was 7.

CONCLUSION:

This case series indicates potential for the IBD-AID as an adjunct dietary therapy for the treatment of IBD. A randomized clinical trial is warranted.


Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. "Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet." Journal of pediatric gastroenterology and nutrition 58.1 (2014): 87-91.
https://www.ncbi.nlm.nih.gov/pubmed/24048168

Abstract

OBJECTIVES:

Crohn disease is characterized by chronic intestinal inflammation in the absence of a recognized etiology. Nutritional therapy in the form of exclusive enteral nutrition (EEN) has an established role within pediatric Crohn disease. Following exclusive enteral nutrition's success, many dietary therapies focusing on the elimination of specific complex carbohydrates have been anecdotally reported to be successful.

METHODS:

Many of these therapies have not been evaluated scientifically; therefore, we reviewed the medical records of our patients with Crohn disease on the specific carbohydrate diet (SCD).

RESULTS:

Seven children with Crohn disease receiving the SCD and no immunosuppressive medications were retrospectively evaluated. Duration of the dietary therapy ranged from 5 to 30 months, with an average of 14.6±10.8 months. Although the exact time of symptom resolution could not be determined through chart review, 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.

CONCLUSIONS:

This chart review suggests that the SCD and other low complex carbohydrate diets may be possible therapeutic options for pediatric Crohn disease. Further prospective studies are required to fully assess the safety and efficacy of the SCD, or any other low complex SCDs in pediatric patients with Crohn disease.


2012

Cohen, Stanley A., et al. "Sa1992 Mucosal Healing With the Specific Carbohydrate Diet in Pediatric Crohn's Disease: Preliminary Results of a Prospective Pilot Study." Gastroenterology142.5 (2012): S-376.
https://doi.org/10.1016/S0016-5085(12)61418-8

Due to both perceived and real risks of current medical therapies for Crohn's disease (CD), other safe and effective approaches, particularly those utilizing nutrition and enteral therapy, have been sought. The specific carbohydrate diet (SCD) has become one alternative for CD considered by parents and patients, yet no prospective pediatric trials which employ mucosal healing as an outcome exist. Methods: Pts with active CD (PCDAI ≥ 15) interested in the SCD as adjunctive therapy and able to swallow a video capsule (VC), were eligible for this study. Subjects underwent a patency capsule, and if passed intact, VC was administered. They were maintained on their prescribed medications and reviewed the SCD with a dietician who then monitored their intake. VC was then repeated at 12 weeks(wk). Demographic, dietary and clinical information were collected at both time points. VC at wks 0 and12 were evaluated by a reader blinded to patient results and timing. PCDAI, Harvey Bradshaw (HB) and Lewis score (LS) were calculated at study visits as well. Means for outcome variables are reported here because of the few pts enrolled as yet. Results: The SCD has been offered to 10 pts to date. Two declined because of the stringency of the SCD; 2 were unable to ingest the VC; with 6 enrolled. Four (2 M, 2 F; average age 13.5 y; disease duration 4.5 y) have completed the trial to date; 1 (20 yo F) ceased at 8 wk because of difficulty with the SCD. The 4 completers received an average of 72.4 % of their estimated caloric needs, respectively, prior to the SCD, and 82.6 % on the SCD. Weight, Hgb, WBC, ESR, and albumin were essentially unchanged. Mean HB decreased from 3 to 1 and PCDAI from 20 to 6.2. Small bowel (SB) ulcers seen on initial VC in 3 were not seen on the 12 wk VC, with LS decreasing in all pts. In1 pt not rigidly adherent to the SCD, the number of stenotic areas decreased and the LS declined, but additional aptha developed in a new location. Impressions: Mucosal and clinical improvement were seen in the first 4 patients completing this pilot study (with SB mucosal healing in 2). VC appears to offer an important means to monitor mucosal improvement even over a relatively short interval. Completion of this trial and additional studies are needed to understand the changes described here and the mechanisms contributing to this improvement.


2011

Olendzki, B., Silverstein, T., Persuitte, G., Baldwin, K., Ma, Y., & Cave, D. (2011). An anti‐inflammatory diet for Inflammatory Bowel Disease; the IBD‐AID: P‐133. Inflammatory Bowel Diseases, 17, S53-S54.


This case series indicates the potential for the IBD-AID to be used as an adjunctive or alternative therapy for the treatment of IBD. Notably, 9 out of 11 patients were able to be managed without anti-TNF therapy, and 100% of the patients had their symptoms reduced. To make clear recommendations for its use in clinical practice, randomized trials are needed alongside strategies to improve acceptability and compliance with the IBD-AID.


2004

Nieves, R., & Jackson, R. T. (2004). Specific carbohydrate diet in treatment of inflammatory bowel disease. Tennessee medicine: Journal of the Tennessee Medical Association, 97(9), 407-407.
https://www.ncbi.nlm.nih.gov/pubmed/15497569

Over the years, there have been numerous studies examining diet and Inflammatory Bowel Disease (IBD). Six decades ago, prior to the identification of gluten as the principal offending agent, S.V. Haas successfully developed the Specific Carbohydrate Diet (SCD) for the treatment of celiac disease. The SCD has as its basis a strict grain-free, sugar-free, and complex carbohydrate-free dietary regimen. In theory, it is similar to an elemental diet, the thought being that foods easily absorbed provide bowel rest. The SCD, however, strives to use readily available foods such as fruits, meats, nuts, eggs, and vegetables. In addition, it is thought the SCD may alter gut flora and thus remove bacterial antigens thought to be responsible for the immune hypersensitivity seen in IBD.

After reviewing two cases in which individuals adhering to a strict SCD showed a positive outcome, it was decided to conduct an internet survey to ascertain whether there were other cases to support such findings.


Fridge, J. L., J. Kerner, and K. Cox. "P0637 The Specific Carbohydrate Diet-A Treatment For Crohn’s Disease?." Journal of Pediatric Gastroenterology and Nutrition 39 (2004): S299-S300.
https://journals.lww.com/jpgn/Fulltext/2004/06001/P0637_THE_SPECIFIC_CARBOHYDRATE_DIET___A_TREATMENT.761.aspx

Journal of Pediatric Gastroenterology and Nutrition


----------------------------------------------
Volume 39 Supplement 1 June 2004 pp S299-S300
----------------------------------------------

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.


1963

Celiac disease. - May 1, 1963

Haas S.V.. "Celiac disease." New York state journal of medicine 63 (1963): 1346-50.
https://www.ncbi.nlm.nih.gov/pubmed/13951608

1. N Y State J Med. 1963 May 1;63:1346-50.

Celiac disease.

HAAS SV.

PMID: 13951608 [Indexed for MEDLINE]


1955

Haas S.V., Haas M.P. "The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases." The American journal of gastroenterology 23.4 (1955): 344-60.
https://www.ncbi.nlm.nih.gov/pubmed/14361377

In 1950, we reported on 603 cases of celiac disease treated by us in private practice. During the three-year period following that report, we observed 213 additional cases long enough and closely enough to draw further conclusions concerning the diagnosis, prognosis, treatment, and clinical course under therapy of this disease. Of these, 22 were still open and under active treatment when the data for this paper were compiled. The remaining 191 have been followed-up after discharge with sufficient care and over a sufficiently lengthy period of time to warrant evaluation of total progress and outcome. Neither the data nor the conclusions reported here will deal with 64 cases which were seen by us only a few times in consultation or 127 cases which remained under our direct treatment and observation so briefly that their consideration in a scientific report is unjustified.

1950

Haas, S.V., Haas, M.P. Diagnosis and Treatment of Celiac Disease. Report of 603 cases. Postgraduate Medicine. Vol 7 (1950): 239-250.
https://doi.org/10.1080/00325481.1950.11693902

We present in this paper the results of our experience with 603 cases of celiac disease from which has emerged a useful method of diagnosis of this confusing condition and, more important, an effective cure by diet which we have found successful in cases of all types and degrees of severity.

Since the etiology of celiac disease is unknown and its symptoms occur in many other conditions, it may be helpful to review briefly the history of attempts to find a cure, especially by dietary methods, and to describe the clinical picture of the disease. We shall then outline our diet in detail, report statistically on our 603 cases, and suggest further lines of study.


1932

Haas, Sidney V. "Celiac Disease: Its Specific Treatment And Cure Without Nutritional Relapse." Journal of the American Medical Association. 99, no. 6 (1932): 448-452.
https://doi.org/10.1001/jama.1932.02740580016004

It is not generally realized that celiac disease occurs at all ages, although Gee, who first described it, called attention to this fact. It usually occurs before the fifth year, beginning most frequently in the latter half of the first year. The onset is usually so gradual that the date is difficult to set; occasionally it is abrupt. The course is chronic, and there is a marked tendency to relapse. The symptoms are usually characteristic. There is a marked hypotonia. The face is edematous, distressed, pale and emaciated, but is less emaciated than the extremities, which the patient may be unable or disinclined to move. There is great irritability, and usually complete anorexia. The abdomen is very large, protuberant and soft, except when distended by gas. The stools are frequent, large, pale and foul-smelling, rarely watery, and appear to be greater in bulk than can be accounted for by the intake. There is a marked retardation in growth.


1924

Haas, S. V. . The Value Of The Banana In The Treatment Of Celiac Disease. Archives of Pediatrics & Adolescent Medicine. 28.4 (1924):421-437.
https://doi.org/10.1001/archpedi.1924.04120220017004

Some years ago I treated a child, aged 3 years, who suffered from a severe case of anorexia nervosa. She had reached a serious state of depletion and weakness from her self imposed starvation, refusing all food and regurgitating that fed to her by gavage. She finally accepted a banana, with the result that other food was taken in a more or less normal amount within forty-eight hours. There was a complete relapse when the banana was withheld, and food was taken normally only with bananas.

This experiment was repeated to test the validity of the observation, always with the same result, until a time came when her appetite was normal whether bananas were included in the diet or not. The action was such as is attributed to a hormone. It was natural, therefore, to test bananas in a case of celiac disease where anorexia was a prominent symptom.