| Revision as of 21:15, 18 November 2018 editBeall4 (talk | contribs)38 edits I have updated the core content. As a doctor of pharmacy with experience in analyzing and presenting medical data, and as an organizer of the "Nutritional Therapy for IBD" exhibit at NASPGHAN in which four of the referenced published authors participated, I felt the need to reflect the current science supporting the role of dietary therapy and SCD.Tags: nowiki added Visual edit← Previous edit | Latest revision as of 21:36, 19 May 2022 edit undoOzzie10aaaa (talk | contribs)Autopatrolled, Extended confirmed users, New page reviewers213,809 editsm Cleaned up using AutoEd | ||
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| {{short description|Restrictive diet which limits the use of complex carbohydrates}} | |||
| '''Specific Carbohydrate Diet''' ('''SCD''') is a therapeutic eating plan utilized to treat a variety of conditions with primary use in inflammatory bowel disease (IBD), (categorized as Crohn’s disease or ulcerative colitis), irritable bowel syndrome (IBS), diverticulitis and celiac disease (CD) with benefits in other illnesses known to have gut bacterial disturbances such as autism and cystic fibrosis. The diet eliminates all grains (wheat, barley, rye, rice), soy, starchy vegetables like potatoes, sugar, and processed foods. A complete list of accepted foods can be found on the breaking the viscous cycle website under "legal/illegal". To achieve the end result, fanatical adherence is considered necessary for a prolonged period at this time, but studies evaluating a broader array of foods and slightly expanded diets with their roots in SCD like the Crohn's Disease Exclusion Diet (CDED), Gut and Psychology Syndrome diet (GAPS) and modified SCD are ongoing. The largest area of research with SCD is in IBD with positive findings in small patient trials with large clinical trials now underway. | |||
| The '''specific carbohydrate diet''' ('''SCD''') is a restrictive diet originally created to manage ]; it limits the use of complex carbohydrates (] and ]). ]s are allowed, and various foods including fish, aged cheese and ] are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products.<ref name=brown/> It is a ] since no grains are permitted.<ref name=hou/> | |||
| == |
==Origins== | ||
| In 1924, ] (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the ] diet.<ref name=hou>{{cite journal |vauthors=Hou JK, Lee D, Lewis J |title=Diet and inflammatory bowel disease: review of patient-targeted recommendations |journal=Clin. Gastroenterol. Hepatol. |volume=12 |issue=10 |pages=1592–600 | date=October 2014 |pmid=24107394 |doi=10.1016/j.cgh.2013.09.063 |type=Review |pmc=4021001}}</ref><ref name=nytimes>{{cite news|url=https://www.nytimes.com/1964/12/01/dr-sidney-valentine-haas-dies.html|title=Dr. Sidney Valentine Haas Dies|work=The New York Times|date=December 1, 1964|access-date=2017-04-28|archive-url=https://web.archive.org/web/20180312022426/https://www.nytimes.com/1964/12/01/dr-sidney-valentine-haas-dies.html|archive-date=March 12, 2018|url-status=live}}</ref> Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died.<ref name=uchicago/> The banana SCD was the cornerstone of celiac therapy for decades until bread shortages in the Netherlands caused by World War II caused children with celiac disease to improve, which led to the isolation of wheat proteins, not starches, as the cause of celiac disease.<ref name=uchicago>{{cite news | title = A Brief History of Celiac Disease | publisher = Impact: The University of Chicago Celiac Disease Center, Summer 2007 | date = Summer 2007 | url = http://www.cureceliacdisease.org/wp-content/uploads/2011/09/SU07CeliacCtr.News_.pdf | access-date = 2017-04-28 | archive-url = https://web.archive.org/web/20160304103246/http://www.cureceliacdisease.org/wp-content/uploads/2011/09/SU07CeliacCtr.News_.pdf | archive-date = 2016-03-04 | url-status = live }}</ref> Before the banana SCD, one out of four children with celiac died.<ref name=nytimes/> After more research, he described the SCD as a treatment for celiac disease and ] (IBD) in his 1951 medical textbook ''The Management of Celiac Disease''; Haas never accepted the finding that wheat gluten was the damaging part of wheat; he insisted it was starch and called the discovery about a gluten a "disservice."<ref name=Guandalini>{{cite book|last1=Guandalini|first1=S|editor1-last=Fasano|editor1-first=Alessio|editor2-last=Troncone|editor2-first=Riccardo|editor3-last=Branski|editor3-first=David|title=Frontiers in celiac disease|date=2008|publisher=Karger|location=Basel|isbn=9783805585262|page=6|chapter=Historical Perspective of Celiac Disease|chapter-url=https://books.google.com/books?id=gqaDD3jkcfYC&pg=PA6}}</ref> | |||
| The diet was later re-popularized by biochemist Elaine Gottschall, the mother of one of Haas's patients, in her 1996 book ''Breaking the Vicious Cycle.''<ref name=hou/><ref name=fitz/> Gottschall's daughter was reported to been cured of ulcerative colitis in two years by SCD.<ref name=brown/> Gottschall described the theory of how restricting diet might reduce gut inflammation associated with various medical conditions.<ref name=hou/> Gottschall asserted that the diet could "cure" a number of medical conditions without providing data.<ref name=fitz>{{cite journal |author=Fitzgibbon EJ |year=1998 |title=Breaking the Vicious Cycle. Intestinal Health Through Diet |type=Book review |journal=Journal of Nutritional & Environmental Medicine |volume=8 |issue=1 |page=86 |quote=I was looking for data to support the claims of cure, but nothing}}</ref> Gottschall advocated using SCD to treat ], ], ], ], ], and ].<ref name=brown>{{Cite journal|last1=Brown|first1=Amy C.|last2=Roy|first2=Minakshi|date=2010|title=Does evidence exist to include dietary therapy in the treatment of Crohn's disease?|journal=]|volume=4|issue=2|pages=191–215|type=Review|doi=10.1586/egh.10.11|issn=1747-4132|pmid=20350266|s2cid=207210268}}</ref> | |||
| The Specific Carbohydrate Diet was developed by Sydney Haas, MD who along with John Howland, MD served as assistants at Vanderbilt Clinic to L. Emmett Holt, Sr, MD, a physician at the turn of the twentieth century taking a lead role in the US studying celiac disease. Holt, together with Christian Herter, MD, a physician and pathologist from Columbia University, reported that the condition is associated with abnormal forms of bacteria and “may confidently be ascribed to the action of putrefactive products”. Howland reports “that of all the elements of food, carbohydrates is the one which must be excluded rigorously”. Howland’s treatment was very successful, but the need for some tolerable carbohydrate remained. Haas discovered a paper on “The value of Banana in the Treatment of Celiac Disease” and began incorporating carefully specific carbohydrates into the diet to determine the tolerability. The SCD, also known at the time in the 1940s’ as the “banana diet”, was met with great success in treating patients with gastrointestinal conditions diagnosed at the time as celiac disease based on symptoms, as no laboratory tests specific to celiac disease existed. <ref>{{Cite book|title=The Management of Celiac Disease|last=Haas|first=Sidney Valentine|last2=Haas|first2=Merrill Patterson|publisher=JB Lippincott Company|year=1951|isbn=978-1-258-19621-9|location=JB Lippincott Company|pages=}}</ref><ref>{{Cite journal|last=HAAS|first=SV|last2=Haas|first2=MP|date=April 1955|title=The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases|url=|journal=American Journal of Gastroenterology|volume=4|pages=344-60|via=}}</ref><ref>{{Cite journal|last=Haas|first=SV|date=May 1963|title=Celiac Disease|url=|journal=NY State J Med|volume=63|pages=1346-50|via=}}</ref> | |||
| ==Unconfirmed claims== | |||
| SCD was popularized by Elaine Gotschall with the publication of her book, ''Food and the Gut Reaction: Intestinal Health through die''t first edition published in 1987, with name change and now 15<sup>th</sup> edition, ''Breaking the Vicious Cycle: Intestinal Health through d''i''et.'' <ref>{{Cite book|url=http://worldcat.org/oclc/1048262387|title=Breaking the vicious cycle : intestinal health through diet|last=author.|first=Gottschall, Elaine Gloria, 1921-|isbn=9780969276814|oclc=1048262387}}</ref> Elaine’s daughter, Judy, diagnosed with UC at a very young age, was facing imminent colectomy but was restored to full health following the SCD. Soon after, Sydney Haas, MD passed away. Elaine was concerned that the knowledge of this diet was likely to fade with him as this diet was not recognized or utilized by most gastroenterologists. Only after much desperate seeking did she find Dr. Haas. Gotschall pursued her master’s degree in biology, nutritional biochemistry and cellular biology and with lifelong interest in the gastrointestinal system and diet she served as a consultant to hundreds of patients and with her publications she has helped thousands to restore their health. <ref>{{Cite web|url=1. http://www.breakingtheviciouscycle.info/p/about-the-author/|title=About the Author|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref> | |||
| The claims that the SCD is beneficial for children with autism are based on the supposition they have too much harmful bacteria in their gut. <ref name=deisinger/> While limited evidence suggests the SCD can be beneficial, there is a concern the restrictive nature of the diet may cause ].<ref>{{Cite journal|title=Nutritional interventions for autism spectrum disorder|url=http://www.fau.edu/education/centersandprograms/card/documents/nutritional-interventions.pdf|journal=Nutrition Reviews|volume=78|issue=7}}</ref> Parents adopting the SCD for their children are at risk of experiencing guilt when their expectations of improvement are dashed.<ref name=deisinger>{{cite book |author=Deisinger JA |title=Chapter 14: Scientifically unsupported treatments for students with special needs |work=Current Issues and Trends in Special Education: Identification, Assessment and Instruction |series=Advances in special education |volume=19 |veditors=Obiakor FE, Bakken JP, Rotatori AF |publisher=Emerald |isbn=978-1-84855-668-3 |issn=0270-4013 |page=220 |year=2010 |doi=10.1108/S0270-4013(2010)0000019017}}</ref><ref name=levy>{{cite journal| author=Levy SE, Hyman SL| title=Novel treatments for autistic spectrum disorders. | journal=Ment Retard Dev Disabil Res Rev | year= 2005 | volume= 11 | issue= 2 | pages= 131–42 | pmid=15977319 | doi=10.1002/mrdd.20062 |type=Review}}</ref> The SCD is one of many unevidenced treatments offered for children with ] that have the characteristic signs of being ].<ref name=deisinger/> | |||
| A 2013 review on SCD and other exclusion diets concluded: "However, we lack large prospective controlled trials to provide the dietary recommendations patients’ desire. Taken together, studies of exclusive enteral nutrition, exclusion diets, and semi-vegetarian diets suggest that minimizing exposure of the intestinal lumen to selected food items may prolong the remission state of patients with inflammatory bowel disease. Even less evidence exists for the efficacy of the SCD, ], or ]. "<ref name=hou/> It also said that the diet risks imposition of an undue financial burden and potentially causes malnutrition.<ref name=hou/> | |||
| == Mechanism of Action == | |||
| Although old but not forgotten, the SCD is now gaining renewed interest in the community as well as the medical profession with the publication of a number of small patient trials and reports showing benefit in attaining remission for IBD. The postulated mechanism of benefit from the diet is that the condition of IBS or IBD is due to an overgrowth or imbalance of gut bacteria that can be corrected by the avoidance of specific carbohydrates that feed the overgrowth, hence the name Specific Carbohydrate Diet. The technology at the time of the development of this diet was not able to evaluate this hypothesis. However, with the current technology of gene sequencing combined with the improvements in data software analysis, the bacterial, viral, and fungal components encompassing the human microbiome are now analyzable and this is among the most active and exciting areas of research for all human diseases and in particular IBD. | |||
| {{asof|2017}} there was preliminary evidence that the SCD may help relieve the symptoms of adults with inflammatory bowel disease.<ref name="pmid29173519">{{cite journal| author=Kakodkar S, Mutlu EA| title=Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease. | journal=Gastroenterol Clin North Am | year= 2017 | volume= 46 | issue= 4 | pages= 745–767 | pmid=29173519 | doi=10.1016/j.gtc.2017.08.016 | pmc=5821251 |type=Review }} </ref> | |||
| It is now commonly accepted that dysbiosis (disruption of gut bacterial balance from normal) is the hallmark of IBD. <ref>{{Cite journal|last=Nagalingam|first=Nabeetha A.|last2=Lynch|first2=Susan V.|date=2012-05|title=Role of the microbiota in inflammatory bowel diseases|url=https://doi.org/10.1002/ibd.21866|journal=Inflammatory Bowel Diseases|language=en|volume=18|issue=5|pages=968–984|doi=10.1002/ibd.21866|issn=1078-0998}}</ref> <ref>{{Cite journal|last=Zuo|first=Tao|last2=Ng|first2=Siew C.|date=2018|title=The Gut Microbiota in the Pathogenesis and Therapeutics of Inflammatory Bowel Disease|url=https://www.frontiersin.org/articles/10.3389/fmicb.2018.02247/full|journal=Frontiers in Microbiology|language=English|volume=9|doi=10.3389/fmicb.2018.02247|issn=1664-302X|pmc=PMC6167487|pmid=30319571}}</ref><ref>{{Cite journal|last=Hoarau|first=G.|last2=Mukherjee|first2=P. K.|last3=Gower-Rousseau|first3=C.|last4=Hager|first4=C.|last5=Chandra|first5=J.|last6=Retuerto|first6=M. A.|last7=Neut|first7=C.|last8=Vermeire|first8=S.|last9=Clemente|first9=J.|date=2016-09-20|title=Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease|url=http://dx.doi.org/10.1128/mbio.01250-16|journal=mBio|volume=7|issue=5|doi=10.1128/mbio.01250-16|issn=2150-7511}}</ref> Overall richness of the bacterial community is decreased with certain species found to be commonly overgrown in particular the phylum of Proteobacteria and members of the family of Enterobacteriaceae, and fungus including candida tropicalis and candida albicans, while other species tend to be either absent or under represented such as faecalibacterium prausnitzii of the Clostridium clade. <ref>{{Cite journal|last=Ni|first=J|last2=Shen|first2=TCD|date=Nov 2017|title=A role for bacterial urease in gut dysbiosis and Crohn's disease|url=|journal=Sci Transl Med|volume=9|pages=416|via=}}</ref> <ref>{{Cite journal|last=Pascal|first=V|last2=Pozuelo|first2=M|date=2017|title=A microbial signature for Crohn's disease|url=|journal=Gut|volume=|pages=1-20|via=}}</ref><ref>{{Cite journal|last=Eom|first=Taekil|last2=Kim|first2=Yong Sung|last3=Choi|first3=Chang Hwan|last4=Sadowsky|first4=Michael J.|last5=Unno|first5=Tatsuya|date=2018-02-28|title=Current understanding of microbiota- and dietary-therapies for treating inflammatory bowel disease|url=https://link.springer.com/article/10.1007%2Fs12275-018-8049-8|journal=Journal of Microbiology|language=en|volume=56|issue=3|pages=189–198|doi=10.1007/s12275-018-8049-8|issn=1225-8873}}</ref><ref>{{Cite journal|last=Aleksandrova|first=Krasimira|last2=Romero-Mosquera|first2=Beatriz|last3=Hernandez|first3=Vicent|last4=Aleksandrova|first4=Krasimira|last5=Romero-Mosquera|first5=Beatriz|last6=Hernandez|first6=Vicent|date=2017-08-30|title=Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention|url=https://www.mdpi.com/2072-6643/9/9/962|journal=Nutrients|language=en|volume=9|issue=9|pages=962|doi=10.3390/nu9090962|pmc=PMC5622722|pmid=28867793}}</ref><ref>{{Cite journal|last=Aleksandrova|first=Krasimira|last2=Romero-Mosquera|first2=Beatriz|last3=Hernandez|first3=Vicent|last4=Aleksandrova|first4=Krasimira|last5=Romero-Mosquera|first5=Beatriz|last6=Hernandez|first6=Vicent|date=2017-08-30|title=Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention|url=https://www.mdpi.com/2072-6643/9/9/962|journal=Nutrients|language=en|volume=9|issue=9|pages=962|doi=10.3390/nu9090962|pmc=PMC5622722|pmid=28867793}}</ref>The SCD has been shown to alter this balance of bacteria and shift it more toward that found in healthy population without disease. <ref>{{Cite journal|last=Walters|first=Sumathi Sankaran|date=2014|title=Analysis of Gut Microbiome and Diet Modification in Patients with Crohn’s Disease|url=http://dx.doi.org/10.15226/sojmid/2/3/00122|journal=SOJ Microbiology & Infectious Diseases|volume=2|issue=3|doi=10.15226/sojmid/2/3/00122|issn=2372-0956}}</ref><ref>{{Cite journal|last=Suskind|first=DL|last2=Cohen|first2=SA|date=2016|title=Clinical and Fecal Microbial Changes with Diet Therapy in Active Inflammatory Bowel Disease|url=|journal=J Clin Gastroenterol|volume=|pages=|via=}}</ref> | |||
| The Gut and Psychology Syndrome Diet (GAPS Diet) is an even more restrictive variant of the SCD, devised by a Russian neurologist.<ref name=connor>{{cite book |author=Connor Z |work=Clinical Paediatric Dietetics |title=Autism spectrum disorders |editor=Shaw V |publisher=John Wiley & Sons |edition=4th |year=2015 |isbn=978-0470659984 |page=686}}</ref><ref name=hall>{{cite web |publisher=Science-based medicine |author=Hall HA |author-link=Harriet Hall |title=GAPS Diet |date=7 May 2013 |url=https://sciencebasedmedicine.org/gaps-diet/ |access-date=14 December 2018 |archive-url=https://web.archive.org/web/20181221131810/https://sciencebasedmedicine.org/gaps-diet/ |archive-date=21 December 2018 |url-status=live }}</ref> The diet is promoted with claims it can treat a wide variety of conditions including autism, schizophrenia and epilepsy.<ref name=connor/><ref name=hall/> Like the SCD, claims of the diet's usefulness for children with autism are not supported by scientific studies.<ref name=connor/> ] has described the GAPS diet as "a mishmash of half-truths, pseudoscience, imagination, and untested claims",<ref name=hall>{{cite web |publisher=Science-based medicine |author=Hall HA |author-link=Harriet Hall |title=GAPS Diet |date=7 May 2013 |url=https://sciencebasedmedicine.org/gaps-diet/ |access-date=14 December 2018 |archive-url=https://web.archive.org/web/20181221131810/https://sciencebasedmedicine.org/gaps-diet/ |archive-date=21 December 2018 |url-status=live }}</ref> and ] includes the GAPS Diet in its ''Index of questionable treatments''.<ref name=qw>{{cite web |publisher=Quackwatch |url=https://www.quackwatch.org/01QuackeryRelatedTopics/treatmentindex.html |date=3 September 2018 |title=Index of questionable treatments |access-date=14 December 2018 |archive-url=https://web.archive.org/web/20181024083250/http://www.quackwatch.org/01QuackeryRelatedTopics/treatmentindex.html |archive-date=24 October 2018 |url-status=live }}</ref> | |||
| ==Research== | |||
| ==See also== | |||
| The SCD has been shown to induce remission of Crohn’s disease, with reduction or elimination of symptoms, normalization of serum inflammatory markers and evidence of improved mucosal tissue by endoscopy,<ref>{{Cite journal|last=Cohen|first=SA|last2=Gold|first2=BD|date=Oct 2014|title=Clinical and Mucosal Improvement with the Specific Carbohydrate Diet in Pediatric Crohn’s Disease|url=|journal=J Pediatr Gastroenterol Nutr|volume=59(4)|pages=516-21|via=}}</ref><ref>{{Cite journal|last=Obih|first=Chinonyelum|last2=Wahbeh|first2=Ghassan|last3=Lee|first3=Dale|last4=Braly|first4=Kim|last5=Giefer|first5=Matthew|last6=Shaffer|first6=Michele L.|last7=Nielson|first7=Heather|last8=Suskind|first8=David L.|date=2016-04|title=Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center|url=http://dx.doi.org/10.1016/j.nut.2015.08.025|journal=Nutrition|volume=32|issue=4|pages=418–425|doi=10.1016/j.nut.2015.08.025|issn=0899-9007}}</ref> including remission in seven children with active Crohn’s disease without the use of concomitant medications. <ref>{{Cite journal|last=Suskind|first=DL|last2=Wahbeh|first2=GH|date=2014|title=Nutritional Therapy in Pediatric Crohn Disease: The Specific Carbohydrate Diet|url=|journal=JPGN|volume=58|pages=87-91|via=}}</ref> These positive findings are considered a result of shifts in the microbiome due to dietary changes. | |||
| * {{annotated link|Low-carbohydrate diet}} | |||
| * {{annotated link|DASH diet}} | |||
| These small patient trials in combination with patient reports of improvements <ref>{{Cite journal|last=Kakodkar|first=Samir|last2=Farooqui|first2=Azam J.|last3=Mikolaitis|first3=Sue L.|last4=Mutlu|first4=Ece A.|date=2015-08|title=The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series|url=http://dx.doi.org/10.1016/j.jand.2015.04.016|journal=Journal of the Academy of Nutrition and Dietetics|volume=115|issue=8|pages=1226–1232|doi=10.1016/j.jand.2015.04.016|issn=2212-2672}}</ref> <ref>{{Cite journal|last=Suskind|first=David L.|last2=Wahbeh|first2=Ghassan|last3=Cohen|first3=Stanley A.|last4=Damman|first4=Christopher J.|last5=Klein|first5=Jani|last6=Braly|first6=Kim|last7=Shaffer|first7=Michele|last8=Lee|first8=Dale|date=2016-09-16|title=Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease|url=http://dx.doi.org/10.1007/s10620-016-4307-y|journal=Digestive Diseases and Sciences|volume=61|issue=11|pages=3255–3260|doi=10.1007/s10620-016-4307-y|issn=0163-2116}}</ref> have prompted the renewed interest of dietary therapy for IBD. Two large scale ongoing trials of over 100 patients each are currently underway, PRODUCE (comparing SCD with modified SCD in pediatric patients),<ref>{{Cite web|url=https://www.improvecarenow.org/produce_study|title=PRODUCE Study - ImproveCareNow|last=ImproveCareNow|website=www.improvecarenow.org|language=en|access-date=2018-11-18}}</ref> and DINE-CD (comparing SCD with the Mediterranean diet in adult patients).<ref>{{Cite web|url=https://www.pcori.org/research-results/2016/comparative-effectiveness-specific-carbohydrate-and-mediterranean-diets-induce|title=Comparative Effectiveness of Specific Carbohydrate and Mediterranean Diets to Induce Remission in Patients With Crohn's Disease|website=www.pcori.org|language=en|access-date=2018-11-18}}</ref> Additionally, there are over twenty smaller ongoing interventional trials evaluating aspects of diet, microbiome and IBD, many of which are utilizing SCD. <ref name=":0">{{Cite news|url=https://clinicaltrials.gov/ct2/results?cond=Inflammatory+Bowel+Diseases&term=diet&cntry=&state=&city=&dist|title=Search of: diet {{!}} Inflammatory Bowel Diseases - List Results - ClinicalTrials.gov|access-date=2018-11-18|language=en}}</ref> | |||
| * ] | |||
| As current research documents the role of diet in the pathogenesis and treatment of IBD, there are five ongoing large epidemiologic studies evaluating the relationship to diet and IBD, including the Prognostic Effect of Environmental Factors in Crohn’s and Colitis (PREdiCCT), Inflammation, Microbiome and Alimentation: Gastrointestinal and Neuropsychiatric Effects (IMAGINE), Chronic Inflammatory Disease, Lifestyle and Treatment Response (BELIEVE). <ref name=":0" /> | |||
| == Conclusion == | |||
| Although the data from the small clinical trials described above have not drawn the attention of most gastroenterologists, the interest in dietary therapy for IBD is growing with the increased focus on the microbiome and the implications of it in the pathogenesis of IBD and the potential to manipulate it. Dietary therapy is welcomed by patients because, when utilized either alone or in combination with drug therapy, there is great potential to heal with no potential to harm. | |||
| ==References== | ==References== | ||
| {{reflist |
{{reflist}} | ||
| ==Further reading== | ==Further reading== | ||
| * {{cite journal|doi=10.1586/egh.11.29|pmid=21651358|title=Existing dietary guidelines for Crohn's disease and ulcerative colitis|year=2011|last1=Brown|first1=Amy C|last2=Rampertab|first2=S Devi|last3=Mullin|first3=Gerard E|journal=]|volume=5|issue=3|pages=411–425|s2cid=207210512|name-list-style=vanc}} | |||
| *Kakodkar S, Mutlu EA 2017 "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease" Gastroenterol Clin N Am 46 (2017) 745-76 <nowiki>http://dx.doi.org/10.1016/j.gtc.2017.08.016</nowiki> | |||
| *Lane ER, Lee D, Suskind DL"Dietary Therapies inPediatric Inflammatory Bowel Disease An Evolving Inflammatory Bowel Disease Paradigm" Gastroenterol Clin N Am 46 (2017) 731–744 <nowiki>http://dx.doi.org/10.1016/j.gtc.2017.08.012</nowiki> | |||
| {{diets|collapsed}} | |||
| ] | ] | ||
| ] | |||
| ] | ] | ||
Latest revision as of 21:36, 19 May 2022
Restrictive diet which limits the use of complex carbohydratesThe specific carbohydrate diet (SCD) is a restrictive diet originally created to manage celiac disease; it limits the use of complex carbohydrates (disaccharides and polysaccharides). Monosaccharides are allowed, and various foods including fish, aged cheese and honey are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products. It is a gluten-free diet since no grains are permitted.
Origins
In 1924, Sidney V. Haas (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the banana diet. Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died. The banana SCD was the cornerstone of celiac therapy for decades until bread shortages in the Netherlands caused by World War II caused children with celiac disease to improve, which led to the isolation of wheat proteins, not starches, as the cause of celiac disease. Before the banana SCD, one out of four children with celiac died. After more research, he described the SCD as a treatment for celiac disease and inflammatory bowel disease (IBD) in his 1951 medical textbook The Management of Celiac Disease; Haas never accepted the finding that wheat gluten was the damaging part of wheat; he insisted it was starch and called the discovery about a gluten a "disservice."
The diet was later re-popularized by biochemist Elaine Gottschall, the mother of one of Haas's patients, in her 1996 book Breaking the Vicious Cycle. Gottschall's daughter was reported to been cured of ulcerative colitis in two years by SCD. Gottschall described the theory of how restricting diet might reduce gut inflammation associated with various medical conditions. Gottschall asserted that the diet could "cure" a number of medical conditions without providing data. Gottschall advocated using SCD to treat Crohn's disease, ulcerative colitis, diverticulitis, cystic fibrosis, chronic diarrhea, and autism.
Unconfirmed claims
The claims that the SCD is beneficial for children with autism are based on the supposition they have too much harmful bacteria in their gut. While limited evidence suggests the SCD can be beneficial, there is a concern the restrictive nature of the diet may cause nutritional deficiencies. Parents adopting the SCD for their children are at risk of experiencing guilt when their expectations of improvement are dashed. The SCD is one of many unevidenced treatments offered for children with special needs that have the characteristic signs of being pseudoscientific.
A 2013 review on SCD and other exclusion diets concluded: "However, we lack large prospective controlled trials to provide the dietary recommendations patients’ desire. Taken together, studies of exclusive enteral nutrition, exclusion diets, and semi-vegetarian diets suggest that minimizing exposure of the intestinal lumen to selected food items may prolong the remission state of patients with inflammatory bowel disease. Even less evidence exists for the efficacy of the SCD, FODMAP, or Paleo diet. " It also said that the diet risks imposition of an undue financial burden and potentially causes malnutrition.
As of 2017 there was preliminary evidence that the SCD may help relieve the symptoms of adults with inflammatory bowel disease.
The Gut and Psychology Syndrome Diet (GAPS Diet) is an even more restrictive variant of the SCD, devised by a Russian neurologist. The diet is promoted with claims it can treat a wide variety of conditions including autism, schizophrenia and epilepsy. Like the SCD, claims of the diet's usefulness for children with autism are not supported by scientific studies. Harriet Hall has described the GAPS diet as "a mishmash of half-truths, pseudoscience, imagination, and untested claims", and Quackwatch includes the GAPS Diet in its Index of questionable treatments.
See also
- Low-carbohydrate diet – Diets restricting carbohydrate consumption
- DASH diet – Diet to control hypertension
- List of diets
References
- ^ Brown, Amy C.; Roy, Minakshi (2010). "Does evidence exist to include dietary therapy in the treatment of Crohn's disease?". Expert Review of Gastroenterology & Hepatology (Review). 4 (2): 191–215. doi:10.1586/egh.10.11. ISSN 1747-4132. PMID 20350266. S2CID 207210268.
- ^ Hou JK, Lee D, Lewis J (October 2014). "Diet and inflammatory bowel disease: review of patient-targeted recommendations". Clin. Gastroenterol. Hepatol. (Review). 12 (10): 1592–600. doi:10.1016/j.cgh.2013.09.063. PMC 4021001. PMID 24107394.
- ^ "Dr. Sidney Valentine Haas Dies". The New York Times. December 1, 1964. Archived from the original on March 12, 2018. Retrieved 2017-04-28.
- ^ "A Brief History of Celiac Disease" (PDF). Impact: The University of Chicago Celiac Disease Center, Summer 2007. Summer 2007. Archived (PDF) from the original on 2016-03-04. Retrieved 2017-04-28.
- Guandalini, S (2008). "Historical Perspective of Celiac Disease". In Fasano, Alessio; Troncone, Riccardo; Branski, David (eds.). Frontiers in celiac disease. Basel: Karger. p. 6. ISBN 9783805585262.
- ^ Fitzgibbon EJ (1998). "Breaking the Vicious Cycle. Intestinal Health Through Diet". Journal of Nutritional & Environmental Medicine (Book review). 8 (1): 86.
I was looking for data to support the claims of cure, but nothing
- ^ Deisinger JA (2010). Obiakor FE, Bakken JP, Rotatori AF (eds.). Chapter 14: Scientifically unsupported treatments for students with special needs. Advances in special education. Vol. 19. Emerald. p. 220. doi:10.1108/S0270-4013(2010)0000019017. ISBN 978-1-84855-668-3. ISSN 0270-4013.
{{cite book}}:|work=ignored (help) - "Nutritional interventions for autism spectrum disorder" (PDF). Nutrition Reviews. 78 (7).
- Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev (Review). 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID 15977319.
- Kakodkar S, Mutlu EA (2017). "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease". Gastroenterol Clin North Am (Review). 46 (4): 745–767. doi:10.1016/j.gtc.2017.08.016. PMC 5821251. PMID 29173519.
- ^ Connor Z (2015). Shaw V (ed.). Autism spectrum disorders (4th ed.). John Wiley & Sons. p. 686. ISBN 978-0470659984.
{{cite book}}:|work=ignored (help) - ^ Hall HA (7 May 2013). "GAPS Diet". Science-based medicine. Archived from the original on 21 December 2018. Retrieved 14 December 2018.
- "Index of questionable treatments". Quackwatch. 3 September 2018. Archived from the original on 24 October 2018. Retrieved 14 December 2018.
Further reading
- Brown AC, Rampertab SD, Mullin GE (2011). "Existing dietary guidelines for Crohn's disease and ulcerative colitis". Expert Review of Gastroenterology & Hepatology. 5 (3): 411–425. doi:10.1586/egh.11.29. PMID 21651358. S2CID 207210512.
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