And Yet MORE Evidence of the Efficacy of the Specific Carbohydrate Diet in Inflammatory Bowel Diseases

I continue to make my way through the stacks of articles I’ve collected these last few months and decided today to treat myself to a description of a paper from 2015 that used survey data to analyze the effects of the Specific Carbohydrate Diet (SCD) on those suffering from inflammatory bowel disease. Of course there are issues with using such data, and this is far from the gold-standard double-blind, placebo controlled cross-over studies that eventually prove scientific certainty (or…at least as much certainty as science ever gets). Still, it’s a valuable paper, especially as there is dearth of studies on using diet to treat disease (there’s simply no money, and thus no motive, to do them).  In spite of that fact that the few studies that have been done have been 100% successful,   SCD continues to get generally ignored by the medical community.

My regular readers know I have a very personal SCD story: the diet saved my son, Alex, from inflammatory bowel disease hell. It was my experience with SCD, in fact, that led me to change careers from teaching special education to becoming a nutritionist. I witnessed a miracle that changed me forever. You can read more about that here.

Thus, I am always thrilled to be able share any kind of published study on SCD.

50 patients filled out a survey and also included their medical records, a 3 day diet diary and validation from an American physician confirming their diagnosis of IBD (via endoscopy, radiology, and pathology reports by a board certified gastroenterologist). The survey included a wide variety of accepted measurements of disease severity, quality of life measurements and so forth. 36 of the patients had Crohn’s disease, 9 had ulcerative colitis, and 5 had other forms of IBD. A few interesting notes on the breakdown of the patients:

a. “The mean time the SCD was followed was 35.4 months.” I found that fascinating as I have always told my nutrition clients that the diet must be strictly followed for 3 years (minimum) to achieve full effect and not risk relapse.
b. “The patients followed SCD strictly with a mean adherence rating of 95.2%.” Good for them!  Compliance is crucial to success!
c. “Mean time to see some improvement when following SCD was 29.2 days. Thirty-three subjects (66%) noted complete symptom resolution, which did not occur until a mean of 9.9 months after starting the SCD.” I am truly astounded by the nearly exact match, in terms of time frame, with what I have seen in using the diet for the last 16 years with clients. I personally found that most patients begin to see improvement in symptom closer to 35-48 days but still…my anecdotal experience is not far off this paper’s findings. And almost everyone I have ever worked with, my own son included, got complete resolution of symptoms between 9 and 10 months on the diet. The consistency is truly incredible.

From the paper’s conclusion: “This is the first clinical description of a large series of patients with IBD following the SCD. Our survey results suggest that SCD can potentially be an effective tool in the management of some patients with IBD…”

Not to sound like the world’s biggest cynic, but if you are wondering then why SCD is not recommended as the medical norm as a part of a treatment plan for those suffering with IBD, you probably need look no further than this sentence: “Our results also suggest that in some patients with moderate to severe disease who follow this diet, discontinuation of immuno-suppressive agents has been feasible.”

The authors point out the strengths and weaknesses in their study, many of which are apparent. But they conclude:

“…we now show that at least a subgroup of patients with IBD may notably improve as a result of following the SCD and/or dietary interventions in general. Our findings enhance those of prior limited case reports of dietary therapy with SCD…Further evidence suggesting diet can be an effective treatment for some patients with IBD stems from the fact that diet has the potential to change the intestinal luminal environment, specifically the intestinal microbiome. Our prior preliminary findings hint at a change in the microbiome of patients with IBD who follow the SCD. If following the SCD changes the microbiome significantly and/or reverses some of the dysbiosis reported in patients with IBD, this may be a low-cost intervention to induce and maintain remission with little or no known adverse reactions. As such, further interventional studies of SCD and diet therapies in general for IBD are urgently needed.”

I’m not holding my breath.

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Kakodkar, S, Farooqui, AJ, Mikolaitis, SL, Mutlu, EA. The Specific Carbohydrate Diet for inflammatory bowel disease: A cases series.  Journal of the academy of nutrition and dietetics. 2015. 115(8):1226-1232.  doi: 10.1016/j.jand.2015.04.016.