50 IBD SCD remission patients: RUSH paper

SUMMARY:  In August, 2015, RUSH University published  their study of 50 IBD Specific Carbohydrate Diet (SCD) remission patients: The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series. This is the largest report on a series of patients with IBD following the SCD to date and describes their clinical characteristics.  50 patients in remission eating SCD case series are reported which comprise: 36 subjects had Crohn’s Disease, 9 subjects had Ulcerative Colitis, and 5 subjects had in-determinant IBD.  

Proponents of the SCD report that eating such can induce remission for IBD.  Neither the characteristics of patients who are following SCD , nor the benefits of this diet, have previously been well described in the medical literature.  Thanks RUSH for this important work; it is sincerely appreciated!  Besides IBD, autism (and others) use SCD for its gut healing benefits.

50 IBD SCD remission patients: RUSH paper Conclusions
  1. Our survey results suggest that SCD can potentially be an effective tool in the management of some patients with IBD and specifically in patients with colonic and ileocolonic CD who made up the majority of our study group.
  2. A highly educated group of patients follow the SCD; all but one of the adults in our study had a college or graduate degree.
  3. Our results also suggest that in some patients with moderate to severe disease who follow this diet, discontinuation of immunosuppressive agents has been feasible.

Empowering patient real time reporting social media sites such as Crohnology and CureTogether have reported treatment efficacy for IBD. Tip: for the CureTogether charts, read the data as four quadrants: two above the horizontal center line are better performing treatments whereas the two quadrants below the center line are not good performing treatments.  Treatments in the top right quadrant have greater usage than the left.  However, the caveat is, not many are aware of a lot of the treatments in that top left quadrant.  Increasing awareness of those treatments and their efficacy could increase their usage which could then move treatments over to the right quadrant.   Generally, SCD, with no side effects, continues to be rated higher than many drugs, most of which have significant high risk of serious side effects:

Other relevant links for SCD and microbiome research:
  1. NICE, SCD INCREASED F. PRAUSNITZII… HUGH?!?  What’s the role of F. Prausnitzii?  F. prausnitzii, part of the clostridial clusters, that do the opposite of CDiff in a gut —they keep the gut barrier tight and healthy, and they soothe the immune system… In East Asian populations the gene variants associated with IBD differ from the gene variants in European populations. Yet the same bacterial species—F. prausnitzii—was reduced in the guts of those in whom the disease developed. This suggested that whereas different genetic vulnerabilities might underlie the disorder, the path to disease was similar: a loss of anti-inflammatory microbes from the gut. And although Sokol suspects that other good bacteria besides F. prausnitzii exist, this similarity hinted at a potential one-size-fits-all remedy for Crohn’s and possibly other inflammatory disorders: restoration of peacekeeping microbes. –Among Trillions of Microbes in the Gut, a Few Are Special 
  2. FOOD MANAGING IBD & AUTISM: THE STUDIES There are many SCD studies discussed in this post, beyond those even mentioned by Dr. Sandra Kim below.
  3. IBD CAM [LDN, PROBIOTICS, SCD…] & INTEGRATIVE MEDICINE BENEFITS GUT HEALTH. This post presents Dr. Sandra Kim, MD, presentation at the Dec. 2014  Advances in IBD conference entitled, IBD CAM “Probiotics, Special Diets [SCD], and Complementary Therapies:  We Know Patients Want Them, So What Do We Tell Them? (which also is her PowerPoint link but the post also includes the YouTube of her presentation.)

embellishment7Bottom line:  there really is disease activity indices improvement and mucosal healing taking place with these modalities.embellishment7

In summary, relative to SCD, Dr. Kim noted:

  1. Prebiotics did not help significantly in changing typical probiotic strains like bifidobacteria or F. prausnitzii.  But… see the study discussed above that did show this change for IBD-Crohn’s for F. prausnitzii for those eating SCD.
  2. 2 more SCD study results (1 year consumption, individual patients are charted):
    1. Stan Cohen, 2014 JPGN study: disease activity indices and endoscopic for mucosal healing showed improvement in PCDAI as well as Lewis Scores (measurement of mucosal healing when undergoing capsule endoscopy.)  Study conclusion, or  (here for full text)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.
    2. Also Suskind  2014 JPGN study from Seattle Childrens found significant improvement in multiple parameters including albumin and hemoglobins.  Study 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.
What does inflammation look like in the gut…  All should see this as most all have this occurring:

To truly appreciate and understand the role and power that diet has in managing chronic inflammation in the gut, as it must be for IBD SCD in remission, watch this video presentation, Immunology in the Gut Mucosa: 

Congratulations!  You’ve discovered the key cells and molecular players involved in gut immunohomeostasis and disease: the crypts, Tcells, dendritic cells (regulators of innate and adaptive immunity by acquiring, processing, and presenting antigens to T cells), antigens, tolerogenic activation (tolerogenic cells induce regulatory Tcells), anti-inflammatory response, Tregs (specialized T cells that exert immunosuppressive function), IL-10, tumor necrosis factor, and neutraphils just to name a few!

What is the SCD?   Eloquently explained from RUSH’s study:

SCD is a dietary program that claims to induce and maintain drug-free remission in patients with IBD. It was initially developed by gastroenterologist Sidney Haas in 1951 and later popularized by biochemist Elaine Gottschall in the book Breaking the Vicious Cycle: Intestinal Health Through Diet. 6 and 7.

The diet allows carbohydrate foods consisting of monosaccharides only and excludes disaccharides and most polysaccharides (such as linear or branch-chained multiple sugars or starches).

The diet is supplemented by homemade yogurt fermented for 24 hours to free it of lactose, a disaccharide not allowed in the SCD. Recommended cultures include Lactobacillus bulgaricus, Lactobacillus acidophilus, and Streptococcus thermophilus.

The SCD allows:

  • almost all fruits,
  • vegetables containing more amylose (a linear-chain polysaccharide) than amylopectin (a branch-chained polysaccharide),
  • nuts, nut-derived flours,
  • dry-curd cottage cheese,
  • meats,
  • eggs,
  • butters, and oils.

SCD excludes sucrose, maltose, isomaltose, lactose, grainderived flours and all true and pseudograins, potatoes, okra, corn, fluid milk, soy, cheeses containing high amounts of lactose, as well as most food additives and preservatives.

The typical starting dieter begins eating foods that are thought to be well tolerated, including cooked, peeled, and seeded fruits and vegetables, and over time other foods are added slowly to partially liberalize the diet.

lightbulb2The SCD is not a low-carbohydrate diet, but rather a diet that is predominantly composed of monosaccharaides, solid proteins, fats, a high ratio of amylose to amylopectin vegetables, fruits, and nuts.

Gottschall7  hypothesized that patients with IBD can only optimally absorb the monosaccharides glucose, galactose, and fructose due to a dysfunction of the host’s disaccharidases that are necessary for digestion and absorption of disaccharides and high amylopectin foodstuffs. This dysfunction is posited to arise from excessive mucus production preventing the brush border intestinal enzymes from making contact with the disaccharidases and amylopectin causing maldigestion. Further, toxic substances produced by dysbiosis of the luminal microbiota (eg, the overgrowth of yeast and bacteria) in the small intestine may cause damage to intestinal cell membranes and destroy brush boarder enzymes.7  A diet containing carbohydrate from primarily monosaccharide sources such as fructose (as in fruits and honey) and higher amylose:amylopectin vegetables, butter or oils, and solid proteins could optimally nourish a patient with IBD and result in lower amounts of disaccharide sugars entering the colon, preventing and reversing a signifi- cantly altered and dysfunctional microbiota postulated to be present in the gastrointestinal tract of patients with IBD7 

What comprises a typical SCD day’s worth of eating?
SCD study typical daily meals
Source: The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series http://www.sciencedirect.com/science/article/pii/S2212267215005043
What motivates one to eat SCD?

The majority of the SCD followers prefer SCD due to fear of long term consequences of medications (82%,) efficacy of SCD compared wtih medications (64%,),  ineffectiveness of medications (64%,), adverse reactions to medications (56%.) RUSH’s complete Table is shown below.

What’s up with mostly the educated knowing about SCD for IBD?

I was saddened to learn that 49 of the 50 SCD eaters are all college/grad school educated.  Practically implementing SCD is not difficult once learned; it has always been a goal of mine to make knowledge of SCD accessible to everyone.  Hopefully through efforts like RUSH and the other lab researchers, knowledge of SCD will rise to the level where the standard of care legally requires physicians to disclose SCD.  Personally, I wonder (putting on my attorney’s hat) if it isn’t already there and actionable for nondisclosure.  UMass is amazing; UMass has even begun teaching the IBD-AID evidence based diet cooking class and  you can read about that in this post, it is the second study listed under the lightbulb or “IBD Studies” section.

Another reason I love UMass, Children’s Healthcare in Atlanta, and the Woodward family:

Out of this families desperation and doctors that have the courage to do the right thing, a foundation, Woodward Crohn’s and Colitis Foundation, is borne that helps others to learn SCD.

In 2010, the Woodward family traveled from SC to UMass to learn what was wrong with their 7 year old. UMass diagnosed UC and strongly recommended Dr. Benjamin Gold at Children’s Healthcare in Atlanta* for follow-up care noting: “We [MGH] tried to recruit Dr. Gold to come up here but he’s not willing to trade the Georgia weather for Boston winters.”

From ages 7 to 8, Jack’s symptoms were more manageable ( using Pentasa and Entocorton medication) but he stopped growing. In October of 2011, Dr. Gold performed endoscopy and colonoscopy, found inflammation in the small intestine, and changed the diagnosis from UC to Crohn’s disease. Dr. Gold coincidentally was starting an SCD pilot study; many patients in his practice had been helped with SCD.

The Woodward family decided to begin SCD as another daughter was diagnosed with UC in 2012.  Mr. Woodward was diagnosed with Crohn’s in 1989. They did not participate in the SCD study but followed the same protocol and stayed under Dr. Gold’s care. The family went through the work of understanding the diet, reading labels, and reconfiguring their household food supply.  Results: Six months post SCD, Jack went from no growth for one year (from age 7 to 8) to growth of an inch in the first 6 months of SCD.  Their daughter’s symptoms resolved by 6 months of SCD and 3 1/2 years into SCD, she remains med-free; Jack’s meds are only Pentasa.  They both continue to grow taller and gain weight. Thus,  Woodward Crohn’s and Colitis Foundation, to increase awareness of SCD.

Live your beliefs and you can change the world.
 As always,  eating whole nutrient rich anti-inflammatory nourishing food that seems to be optimizing the gut health and managing autoimmunity, here IBD, seems most wise.  
Given the results reported by RUSH and others,
What do you have to lose?  
Give SCD a try.

In health through awareness,

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