Tag Archives: biome

See My Microbiome Recipes on Instagram with practical insights

SUMMARY:  GREAT NEWS:  My Instagram @patty.carter is posting some of my gut flora supporting microbiome recipes!I will still continue to post recipes on this website (and other posts with direct links to the science) ⇔  I’m adding Instagram because it is a great work around for the Pinterest failure to post the entire description on images posted (at this time, they truncate descriptions when you view them)!  Of course, continue contacting me direct for those Pinterest recipes, all of which focus on the healing diet tenets from SCD, PALEO, Mediterranean Diet, and others!  The second reason for adding Instagram is that I will post practical insights for integrating microbiome support into your lifestyle effortlessly and seamlessly  like today’s Instagram post showed my Whole Foods Market food haul, and it linked to the newly published May, 2018 American Gut new findings ♥♥♥ The bottom line, for my Instagram…it is best if you follow me to get the full recipe and practical integration insights, (but you don’t need to) –> just link here @patty.carter! The balance of this website post shares what posted in my Instagram today which included my Whole Foods Market food haul, and the link to the newly published May, 2018 American Gut new findings  (which continues to confirm that 30 different vegetables consumed each week is best for microbiome diversity and health) ♥♥♥

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Town Hall Medicine Microbiome Talks

SUMMARY:  I’m sharing two weeks of FREE access to the Town Hall Medicine Microbiome Talks from twenty-one key microbiome researchers and includes clinicians integrating microbiome into therapeutics!  This educational series is presented by University of Toronto’s Heather Boon PhD, Dean of Leslie Dan Faculty of Pharmacy and Stewart Brown, Founder & CEO, Genuine Health, a science based natural health company.  These talks are short and to the point, AND you can download the transcripts for later reading.  There has been a ton going on in the ivory towers of academia and science research uncovering just how important the gut microbiome is to health and well-being and its impact on the immune system.  Microbiome associations are now known for hypertension (34 percent population prevalence ), atherosclerosis (39 percent), anxiety and depression (10 percent), weight gain, obesity (29+ percent), autoimmune diseases (20 percent — mostly women), Type 1 and 2 Diabetes (36 percent), metabolic syndrome (34 percent), IBD (10 to 15 percent), asthma allergy, autism, schizophrenia, Alzheimer’s, Parkinson’s, stress-induced and progressive neuropsychiatric diseases, AND prolonged low-grade inflammation which is behind most all disease (51% of adults have at least one chronic disease, 27% of kids have one or more chronic diseases).  Yet none of microbiome — disease impact is pouring down to us mere mortals none the less doctors — I would know; I teach Microbiome CME.  When twins having 100% identical human DNA only have 40 percent of the same gut microbiota, imagine how different your microbiota is from everyone else.  Spoiler alert:  Your gut microbiota is 99 percent different from everyone else and our microbiota explains why each and every one of our bodies (and minds) behave so differently!  Knowledge is power, and these talks share how microbiome understanding is being put on the forefront of therapeutic integration to reverse and prevent disease.  Now that is aggressive preventative medicine especially since 70 to 80 percent of our immune cells reside in the health of our gut microbiome.  Enjoy the listen, and Merry Christmas, Happy Holidays, early!

Background on Town Hall Medicine Microbiome Talks

This science based initiative shares my vision that knowledge is power They believe that through access to credible science-backed information, you can have the knowledge you need to take steps to live a healthier life. To give you that knowledge, they gathered top scientists, researchers, clinicians and thought leaders from around the world – some of the best of the best from such respected institutions as Harvard, UCLA, University of Western Australia, University of British Columbia and University of Toronto – to share their research findings directly with you. These experts are highly respected in their fields, and I’ve followed them for years.  Their work is changing how we think about our health and that diet and lifestyle can alter gene expression, and reverse and prevent chronic disease. For more on that, this post simply explains How Diet Pierces the Disease Epigenetics Process. The goal of Town Hall Medicine is to elevate the conversation on current health topics by providing information that is accurate, credible, proven and trusted

Sign up for your two-week FREE access, hop around the different talks, and jump UP the microbiome learning curve to better health.

Town Hall Medicine Microbiome Talks_FREE 2 week pass
Town Hall Medicine Microbiome Talks_FREE 2 week pass

Here are just some of the talks you may find interesting…  

  • Stress and aging is talked about under “The New Path to Health”. Noodle around these recent studies in this area:

[Kimball et al 2017] found that in women, skin gene expression progressively changes from the 20s to the 70s in pathways related to oxidative stress, energy metabolism, senescence, and epidermal barrier and that these changes accelerated in the 60s and 70s. The gene expression patterns from the subset of women who were younger-appearing were similar to those in women who were actually younger! Here’s a good ScienceDaily article on this study, and this post simply explains How Diet Pierces the Disease Epigenetics Process. Suffice it to say, these skin epigenetic findings makes all the sense in the world — Eating a diet that supports your gut microbiota does GREAT things both inside our bodies and on the outside — I see these “side effect facelift” transformations everyday! 

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Concise Summary of SCD Studies

SUMMARY:  Here is the Concise Summary of Specific Carbohydrate Diet, or SCD Studies with a focus on SCD for dietary treatment for Inflammatory Bowel Disease (IBD).  Actually though, SCD is used for many conditions, not just IBD.  This post focuses on the boatload of studies evaluating SCD for IBD because that is where most of the SCD research is happening.  Make sure you look at the comments below this post for even more links to studies that have published since I released this post.  You’ll even see that modified versions of SCD are also in study for IBD like PRODUCE, CDED, CD-TREAT, IBD-AID, Low FODMAP, Mediterranean! [Sabino et al 2019]. The findings support that once gut irritating foods are removed, the immune system changes because the gut microbiome changes. That should be true for whatever condition SCD is used for.  Take this Round-table of SCD studies to your doctor and ask for support especially if for IBD.  They should liaison with those already integrating the SCD into IBD dietary therapeutics.  SCD helps IBD with or without medications and can be used to induce remission for many with and without medications.  Always, the goal of treatment is IBD remission, not necessarily medication-free.  Half of the 417 patients surveyed [Suskind et al., 2016] use the SCD to induce remission; the other half use it adjunct to medications because of medication failure.  Think how many guts could be saved!  Dr. David Suskind (leading light GI at Seattle Children’s  Hospital integrating SCD into IBD clinical  dietary therapeutics) explains [Suskind Dietary Treatment  YouTube, 2016] that some use SCD alone if with mild to moderate symptoms at diagnosis.  Others use SCD along with medications and then once in remission, it may be possible to wean off medications.  Consider giving some of the SCD tenets (especially the emulsifier elimination) a try regardless of your disease, or for aggressive  preventative health.  Diet that removes gut irritants is that powerful because it changes up the microbiome where over 70% of immunity resides!  What do you have to lose????  

FYI:  Portions of the following are excerpts taken from a letter that I wrote for purpose of hospital affiliated clinical integration of SCD into IBD therapeutics!  IF you are similarly advocating, write me for insights!

Remission for IBD using the Specific Carbohydrate Diet (SCD)

SCD has been shown in small human case series to be effective for inducing and maintaining remission in

Furthermore, modified versions of SCD are now in study including: PRODUCE, CDED, CD-TREAT, IBD-AID, Low FODMAP, Mediterranean and more, see Figure 1 in  [Sabino et al 2019] for comparison of permitted and omitted components.  Also read the comments below this post for more!

The primary benefit of dietary therapies in IBD

The primary benefit of dietary therapies in IBD, as either primary or adjunctive therapy, has been the potential to decrease surgery (they keep their intestines), the exposure to immunosuppressive medications and their associated adverse effects, and seeing growth occur for these children.

SCD timing.  I can tell you from personal experience, acclimating children while still living with parents/primary care givers to SCD is incredibly easier for transition when moving into college then those only becoming aware of SCD while in college.  Dr. Suskind’s 2016 presentation specifically notes that they likely would not encourage use of the SCD for those newly diagnosed in the senior year of high school who are transitioning to living away from home at college.  My experience however… it can be done!

What SCD is Food-wise

For background, the SCD  was first described by Dr. Sidney Haas in 1924 as a means to treat celiac disease [Hass 1955].  It was popularized by biochemist Elaine Gottschall who added the science explaining how the diet works in the book (as well as the website), Breaking the Vicious Cycle.  Dr Gottschall studied and used SCD to cure her daughter of UC and avoided surgical colon removal.

What the SCD foods are in simpleton

SCD is an elimination diet

The SCD removes emulsifiers, maltodextrin and other processed food additives and preservatives, grains, grain derived flours and all true and pseudograins, milk (fermented lactose-free is permitted), some vegetables (potatoes, okra, corn), and sweeteners (except honey).

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, fish, poultry,
  • eggs,
  • Lactose-free cheeses. Lactose, a disaccharide not allowed in the SCD.
  • Lactose-free homemade yogurt using starter culture:  Lactobacillus bulgaricus, Lactobacillus acidophilus, Streptococcus thermophilus, and Lactobacillus rhamnosus — this was later added once it was discovered it had been included in probiotic capsules used for the yogurt from early days. SCD yogurt is fermented 24 to 30 hr to be free of lactose.
  • butters, and oils.

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.

Update April 22, 2017:  the Nutritional Adequacy of SCD is confirmed and explained by Dr. Suskind’s RD, Kimberly Braly in this April 9, 2016 presentation.

What the SCD foods are in techno verbage

The underlying theory of the SCD is that di- and poly-saccharide carbohydrates are poorly absorbed in the human intestinal tract resulting in malabsorption, bacterial and yeast overgrowth, and subsequent overproduction of mucus. These effects are hypothesized to result in small bowel injury thus perpetuating the cycle of carbohydrate malabsorption and intestinal injury.  This could cause compromised digestive enzymes, alterations in microbiome composition, intestinal gut inflammation, and consequent gut barrier dysfunction.

Another mechanism for IBD gut damage is the ubiquitous emulsifier additives in food.  In mice, they change the microbiome to pro-inflammatory which degrades the mucosal lining and induces IBD (as well as Metabolic Syndrome) [Gewirtz et al. 2015].

The SCD works around these gut irritants by eliminating processed foods (so no emulsifiers) and permitting carbohydrate foods consisting of monosaccharides only (so absorption is above the intestinal area of damage) and excludes disaccharides, most polysaccharides (such as linear or branch-chained multiple sugars or starches), and sucrose, maltose, isomaltose, lactose.

SCD mechanism of action and microbiome studies

The bacterial component of IBD.  It is unequivocal that IBD gut microbiome is skewed.  For those details, read the post where Dr. Rob Knight discusses the IBD microbiome skew, which also discusses W. A. Walters et al. 2014, Meta-analyses of human gut microbes associated with obesity and IBD.  The finding was that IBD has a consistent microbiome signature across studies and allows high classification accuracy of IBD from non-IBD subjects.

The fungal component of IBD.  Case Western researchers [Hoarau et al. 2016] are one of the first to look beyond the bacterial component of the microbiome and move to the fungal component.  Their study links two bacteria (Escherichia coli and Serratia marcescens) and one fungus (Candida tropicalis) as elevated and moving in lock step for Crohn’s.  In test tube they find  the three work together (with the E. coli cells fusing to the fungal cells and S. marcescens forming a bridge connecting the microbes) to produce a biofilm — a thin, slimy layer of microorganisms found in the body that adheres to, among other sites, a portion of the intestines — which can prompt inflammation that results in the symptoms of Crohn’s disease.

The literature explains that the mechanisms by which the SCD works may come from alteration of the gut microbiome or barrier function via differences in macronutrients or removal of certain dietary exposures such as emulsifiers and  maltodextrin [Martinez-Medina et al. 2014Chassaing et al. 2015; Gewirtz et al. 2015Nickerson et al. 2015].   The SCD eliminates emulsifiers.  For emulsifier induction of IBD in mice (and Metabolic Syndrome in mice having normal immune system) with consequent microbiome change, read the post, MICROBIOME, EMULSIFIERS, IBD & METABOLIC SYNDROME.

Suskind, et al, 2016 discusses that targeting two pathophysiological components of IBD, the microbiota and barrier function, as new primary or adjunctive therapies for IBD, holds great promise and his clinic is one of several on the forefront of integrating SCD into clinic therapeutics successfully.

The follow-up SCD human microbiome studies [Walters, et al. 2014Suskind, et al, 2016]; Suskind, et al, 2016] are providing further evidence of microbiome changes eating SCD that support the integration of SCD into IBD clinic therapeutics.  Lead SCD investigator Dr. Suskind explains in this Healthlink Special: Specific Carbohydrate Diet, that dietary therapy changes what the immune system reacts to.  Dietary therapy changes the microbiome in the gut. The published microbiome studies now show that removing gut irritating food changes the gut microbiome.

Walters, et al. 2014 found that:  

  • At baseline, before SCD implementation, overall microbial diversity was significantly decreased in IBD samples as compared to the healthy negative controls. IBD patients had more Bacteroides fragilis and a decreased abundance in Clostridium lactatifermentans, indicating a shift in the microbiota away from the composition of the microbial communities in the healthy controls.
  • SCD increased microbiome diversity whereas the low residual diet (LRD) decreased microbiome diversity.  
  • Interestingly, the SCD diet included an increased microbiota representation of F. prausnitzii, an anti-inflammatory commensal often called a peace-keeping microbe.  The post, NICE, EATING SCD INCREASED F. PRAUSNITZII… HUGH?!? explains the significance of F. prausnitzii in the microbiome.
  • Noteworthy:  Patient SCD diet COMPLIANCE was only about 80%.  Stanford child study Burgis et al. 2016, similarly found that non-compliance following varying lengths of strict SCD still maintained significantly reduced inflammatory IBD biomarkers and disease symptomology albeit those strict SCD had better results.   
  • Also noteworthy:  The SCD MICROBIOME DIVERSITY REMAINED despite a 30 day washout between diets when participants ate their pre-SCD diet.

UMass IBD-AID diet.  There is another diet being studied that is based on the SCD.  This diet is called the UMass IBD-AIDUniversity of Massachusetts Medical School, Center for Applied Nutrition. UMass IBD-AID is based on SCD with the addition of a few more microbiome supportive foods and is presently in  microbiome human clinical trial.  The Olendzki, et al. 2014 studies highlight five components by which diet modulates the IBD microbiome.   UMass showed in,  An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report, that aSCD modified dietary protocol can 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.” 

SCD and Mediterranean-style diet to induce remission.  The Crohn’s & Colitis Foundation of America awarded $2.5 million from the Patient-Centered Outcomes Research Institute  to study the effectiveness of the SCD and Mediterranean-style diet to induce remission in patients with Crohn’s disease.  See the release here.  

Understand that while medication-free is the goal for many eating the SCD, it does not work for all. Some still need medications along with SCD for remission due to the failure of medication alone. 

In this regard, the SCD microbiome studies find that the efficacy of the medications are improved when combined with eating SCD.

  • For example, Walters, et al. 2014 finds the IBD microbiome on medications moves from high dsybiosis pre-SCD to healthy (more diverse and rich) with SCD.  Also notable, this study found that one month of eating SCD allowed persistence of the more healthful microbiome (increased diversity) for a full following month of eating pre-SCD diet foods during the washout period.   
  • Dr. Suskind’s presentation dittos that SCD increases efficacy of medications and can be heard at YouTube:  Nutrition Suskind Dietary Treatment Of IBD 2016 04 09.

Increasing medication efficacy is important because surgery risk is great if remission is not sustained. Medication efficacy for IBD remission:   “[The] current mainstays of IBD treatment are expensive anti-inflammatory and immunosuppressive drugs. Among those who can afford to be on treatment, approximately 40% are either unresponsive to any of the available drugs or cannot tolerate them. The chances that an IBD patient responds to medications and remains flare-up-free after 1 year on even the most potent medications, such as TNF inhibitors, is as low as 20–25%. Furthermore, medical therapy of IBD carries significant risks, among which are life-threatening infections, cancers (especially lymphoma) and neurological complications, such as demyelinating disease…  By comparison, diet therapy has the potential to be safe, lifelong and relatively cheap.”  – “To diet or not if you have inflammatory bowel disease”, 2014,  Expert Review of Gastroenterology & Hepatology, Informa Healthcare.

Regarding SCD and noncompliance

Regarding SCD and noncompliance, Stanford child study Burgis et al. 2016, found that non-compliance following varying lengths of strict SCD still maintained significantly reduced inflammatory IBD biomarkers and disease symptomology albeit those strict SCD had better results.  These researchers are currently completing a prospective pilot study of pediatric patients with Crohn’s Disease on the SCD investigating the impact on disease activity, inflammatory markers including fecal calprotectin, cytokine profiles and intestinal microbiota populations.

Walters, et al. 2014 found thatatient SCD COMPLIANCE was about 80%, and for this study’s cohort, SCD increased microbiome diversity whereas the low residual diet (LRD) decreased microbiome diversity.  Further,  SCD INCREASED MICROBIOME DIVERSITY REMAINED despite a 30 day washout between diets.

Individualization of dietary therapy for IBD.

Lee et al., 2016 discusses the likely need for individualization of dietary therapy for IBD.  Personally, I see this need not just at the start of SCD, but throughout the mucosal and microbiome normalization time frame probably partly due to FODMAP.   Knight-Sepulveda et al. 2015 noted the efficacy of the FODMAPs diet for IBD and that efficacy increases with increasing diet compliance.  Nanayakkara et al, 2016 discusses FODMAPs in depth and notes that IBS symptoms were found to improve for both Crohn’s and UC using the FODMAPs diet.

Once in remission using diet, non-SCD foods can be successfully re-introduced

Once in remission using diet, Dr. Suskind [Suskind Dietary Treatment  YouTube, 2016] explains that non-SCD foods can be successfully re-introduced if the patient so chooses, in a structured manner that ensures tolerance evaluating symptoms, serum inflammation, and fecal calprotectin levels.  Different people respond differently to foods added.  Inflammatory biomarker labs and fecal calprotectin levels prior to food re-introduction are compared to levels following four weeks of eating the food three times each week.  Obviously, re-introduction stops if symptoms become apparent.  Common foods that have successfully been re-introduced (one at a time) in Dr. Suskind’s clinic include:  Gluten-free oats, rice, cocoa powder/nibs, quinoa, potatoes, chick peas.  It is interesting that some of the foods Dr. Suskind trials for re-introduction are those which the UMass IBD-AID (a somewhat more microbiome supportive diet heavily based on SCD) permits.

Dr. Suskind Conference on How to Integrate SCD into Clinic Therapeutics

In 2016, Seattle Children’s Hospital presented for Continuing Medical Education, a program detailing how to integrate SCD into clinic.  Dr. Suskind’s insightful presentation can be heard at YouTube:  Nutrition Suskind Dietary Treatment Of IBD 2016 04 09.  Key points are (but listen yourself for your own pearls):

  • The SCD is combined with laboratory markers of inflammation to ascertain tolerance and response for IBD.  Mild to moderate IBD may use SCD for induction of remission while more severe would combine medications with SCD to induce remission.  Weaning of medications may then be possible.  But the focus is not medication-free, rather remission.  One test run for a measure of gut inflammation is fecal calprotectin.  Most all people that I cross paths with have never heard of the fecal calprotectin.  I am grateful awareness is increasing for fecal calprotectin but note Pittsburgh gastroenterologists seem to not yet follow this protocol unless the outside physician prescribes the labs.
  • Typically, the SCD intro diet is eaten as short as possible but up to 1 to 2 weeks max and consists of broth, SCD yogurt, applesauce, meat and eggs. The maintenance diet follows with adds of one food (honey, nuts, meats, fish, fruit, vegetables) every 1 to 2 days.
  • At 2 week followup, there is mild improvement of symptoms and some weight loss of 1 to 2%.  If however there remains a lot of symptoms then medications can be added.  At the 4 week followup, clinical remission is achieved and inflammatory markers normalize.  Discussion centers around what is working, what isn’t working, and problem solving with emphasis on eating diversity of diet.  Clinically, mild symptoms can persist for about 2 months. Clinical response but mild inflammatory marker elevation can often occur for up to 3 months.
  • At 12 weeks, things are going really well.  Emphasis is to stay strict SCD because of such great health, but discussion occurs on food re-introduction which is controversial in the general SCD community.  If at 3 to 6 months, the patient is asymptomatic and in remission, they will entertain food re-intro in a step wise fashion that follows inflammatory markers and fecal calprotection comparisons prior to and after food re-introduction.  The trial is 3 times a week eat the one new food for four weeks. Common foods reintroduced are: rice, gluten-free oats, cocoa powder/nibs, quinoa, potatoes, and chick peas.  Different people respond differently to new foods.  Some are able to add in many new foods, others none.
  • Regarding probiotics, most families do the SCD yogurt and ferment component.  The best though is the SCD diet which is actually a prebiotic meaning the SCD diet feeds and promotes the growth of beneficial microbiome flora within the gut.
  • In 2016, they had about 60 patients eating SCD with most doing quite well.  It seems that Crohn’s has better success than UC.  Dr. Suskind estimated that it will take about 5 years until SCD will be available in clinics across the US.  Integration of the science into clinic therapeutics is slow.  Geez… That is a lot of gut harm happening because the meds don’t stop the inflammatory gut microbiome.
  • A 504 Plan for disability is very helpful to permit greater leniency for snacks in classes, etc.  My college SCD/IBD find it very helpful.
Patient interest in SCD is strong and sustained

Dr. Suskind’s 2016 presentation notes that IBD patient interest in SCD is strong and sustained.  This is consistent to that also found in the 2015 James Lind Alliance Priority Setting Partnerships  literature.  

Patient interest is two fold [Suskind et al., 2016]:

  1. Half of a 417 patient survey use the SCD because of hesitation with medications used for IBD, and
  2. The other half use SCD because the failure of medications to induce remission necessitates the add-on of SCD trial for induction of remission.

Details for the 417 patient survey [Suskind et al., 2016]:  This survey was conducted online using known SCD Web sites and support groups in an attempt to characterize patient utilization of the SCD and perception of efficacy of the SCD.  Most of the 417 respondents use the SCD as a primary and adjunct therapy for IBD.  Most patients perceive clinical benefit to use of the SCD.

In Kakodkar et al. a 50 cohort, 2015, the majority of the SCD followers prefer SCD due to fear of long term consequences of medications (82%,) efficacy of SCD compared with medications (64%,),  ineffectiveness of medications (64%), and adverse reactions to medications (56%). 

Listen to this Healthlink Special: Specific Carbohydrate Diet.  Dr. Suskind explains that dietary therapy changes what the immune system reacts to… removing gut irritating food changes the gut microbiome. One mom says, “It doesn’t take much more time than cooking for anyone else, ONCE you learn the How-Tos… [for my child to] have the power and strength to keep herself healthy and in remission without relying on medications is the greatest gift I can give her.”   Another child says, ” I GO out to eat; I GO out with friends. I can usually find food I can eat no matter where I go.”  Another mom says, “I have a kid with a chronic disease that is HEALTHY, quite a paradox!” 

I encourage the IBD families I make aware of the microbiome and SCD to travel and become patients of children’s hospital affiliated GI clinics which have integrated SCD into IBD clinic therapeutics across the US such as Dr. Suskind at Seattle Children’s, Washington State.  For most, their primary GI physician remains local.  I can tell you, these children have gone from fecal protectin levels of 400+ at time of diagnosis, to 200s within weeks of beginning SCD, to under 100 within months of eating SCD.  Symptoms resolve within a week for many, and lab inflammatory biomarkers normalize quickly.

What’s up with mostly only the educated knowing about SCD for IBD, AND when do we cross the threshold for legal liability for NOT offering effective SCD dietary therapy for IBD?

The [Kakodkar et al.a 50 cohort, 2015] found that 49 of the 50 SCD eaters all had college or graduate school degrees!   Why?  To implement SCD most people need to read a lot, including the PubMed studies, and learn on their own How-To eat SCD since few IBD centers add SCD into dietary therapeutics.  Dr. Suskind, [Suskind Dietary Treatment  YouTube, 2016] stresses that adequate support of SCD, including the community of those using SCD, is absolutely necessary for best patient success using SCD.

Practically, implementing SCD is not difficult once learned.  It is learning SCD however that is hard because only a few clinics integrate true support of SCD into IBD dietary therapeutics.  Most clinics only offer lame uneducated and unhelpful How-To’s if they even mention SCD at all to the patient.

For comparable, at Dr. Suskind’s clinic, the RD teaching SCD has personally eaten SCD for over three years!  It has always been a goal of mine to make practical How-to knowledge of SCD accessible to everyone.  Hopefully through efforts of the clinics therapeutically integrating SCD into IBD dietary therapy along with the microbiome researchers, knowledge of SCD will rise to the level where the standard of care legally requires physicians to disclose and integrate SCD into clinical therapeutics.  Dr. Suskind guessed that clincial integration of SCD was still 5 years away. [Suskind Dietary Treatment  YouTube, 2016]  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.

Dr. Sandra Kim 2014 presentation: “Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, so What do We Tell Them?

Last, I link to the 2014 Power Point presentation by Dr. Sandra C. Kim, MD, titled “Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, so What do We Tell Them?”   This presentation was given at the annual 2014 Advances in Inflammatory Bowel Diseases, Crohn’s & Colitis Foundation’s Clinical and Research Conference.  Dr. Kim talks about two SCD and IBD clinic studies, [Cohen et al. 2014] and [Suskind et al. 2014] and notes that there is significant disease activity indices improvement and endoscopic or mucosal healing happening for IBD patients eating SCD. Dr. Kim further notes, “…certainly there is some promise in at least thinking about this.”  See time 15:35.  As well, at time 18:31, Dr. Kim recommends specifically being proactive, open, and ask patients about CAM interests and usage.  I especially appreciate that Dr. Kim notes that being current in the literature is absolutely necessary so as to not lose credibility.  Recently, Dr. Kim was appointed co-director of the Inflammatory Bowel Disease Center, a Division of Pediatric Gastroenterology, Hepatology, and Nutrition at Children’s Hospital of Pittsburgh, but this group does not offer support of SCD for IBD!

Conclusion

I wrote this post to try to put in one place, the summary of studies conducted to date on the SCD.  It focuses on SCD for IBD because that is where most of the studies are happening.  Whatever your disease concern, try the tenets of SCD.  Diet changes the microbiome which changes the immune status.  You truly have everything to gain health wise.

The references used in this post, as well as the seventeen that came up on a PubMed search for “Specific Carbohydrate Diet,” are listed below my signature.

The microbiome studies and clinics integrating SCD for IBD are showing that SCD changes the gut microbiome and can induce remission for IBD without medications for many with mild to moderate IBD. For those with failure of medications, SCD can help the medication efficacy which is important to stave off surgical intervention which removes diseased intestine.  About half the patient population turns to SCD due to hesitation of medications as they have  great risks.  The other half turns to SCD due to failure of the medications to induce IBD remission.  Medications can’t modulate the inflammatory microbiome when you keep ingesting irritating foods.

Best in health through awareness,

Signature2

♥  to add the many other versions of SCD now in study.: You’ll even see that modified versions of SCD are also in study for IBD like PRODUCE, CDED, CD-TREAT, IBD-AID, Low FODMAP, Mediterranean! [Sabino et al 2019].” Figure 1 from this study was also added.
Prior update Feb 28, 2018 added “Make sure you look at the comments below this post for even more links to studies that have published since I released this post.”  Also, Suskind, et al, 2016 (which published online) was updated to link to the full text which published in J Clin Gastroenterol, 2018 Feb; 52(2): 155–163, for “Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease.” The prior update April 22, 2017 added that the Nutritional Adequacy of SCD is confirmed and explained by Dr. Suskind’s RD, Kimberly Braly in this April 9, 2016 presentation.
References I cited above, in order of appearance:

[Sabino et al 2019] Treating Inflammatory Bowel Disease With Diet: A Taste Test, https://www.gastrojournal.org/article/S0016-5085(19)41036-6/pdf

Suskind et al., 2016, Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease.  417 survey (online) of SCD Web sites and support groups in an attempt to characterize patient utilization of the SCD and perception of efficacy of the SCD.   47% had Crohn’s disease, 43% had ulcerative colitis, and 10% had indeterminate colitis. Individuals perceived clinical improvement on the SCD. 4% 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.

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Study Recruiting for Antibiotics, Autism Symptoms

Summary:  The 2014 1st International Symposium on the Microbiome in Health and Disease with a Special Focus on Autism brought out anecdotal parent findings that autism symptoms improved or worsened on antibiotics.  Baylor College of Medicine study in conjunction with Texas Children’s Hospital, is now investigating those findings!  If you have an autistic child, consider enrolling now before they are sick, so you have a test kit if prescribed an antibiotic over the next two years.  You would send microbiome samples pre and post the antibiotic.  Those are to be evaluated for changes to behavior and the microbiome — the bacteria, yeasts and fungi that also inhabit the gut, as well as examining metabolites (small chemical molecules) found in the GI tract. The study is free to participants and fully paid for by N of One: Autism Research Foundation which is founded by John Rodakis, the father of an autistic son who experienced symptom improvement due to an antibiotic dose Thanksgiving 2012.  Participate if you can to increase understanding of Antibiotics, Autism Symptoms which at present, has a gap in the published autism research. This initial data may more effectively sub-type autism and develop and deliver more effective microbial-based interventions.

Lots of children have autism.

Data from 2014, and confirmed in 2016, show 1 in 42 boys and 1 in 189 girls have autism.   This is often put as one in 68 children have autism.  The prevalence chart below shows the alarming autism increase since 2000.  Also startling, the number of children with autism varies widely by community, from 1 in 175 children in areas of Alabama, to 1 in 45 children in areas of New Jersey.  See CDC Autism State Report, 2014 and CNN Report, Autism rates now 1 in 68 U.S. children: CDC.

Autistic children’s microbiome metabolites (the exhaust of the gut microbiota) differs compared to children without autism.

Several studies have reported significantly higher oral antibiotic use in children with autism versus typical children (6, 1417).  Antibiotics cause collateral damage to the microbiome.  From the 2016 review, The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation:  The use of antibiotics heavily disrupts the ecology of the human microbiome (i.e., the collection of cells, genes, and metabolites from the bacteria, eukaryotes, and viruses that inhabit the human body).  A dysbiotic microbiome may not perform vital functions such as nutrient supply, vitamin production, and protection from pathogens [3].  Dysbiosis of the microbiome has been associated with a large number of health problems and causally implicated in metabolic, immunological, and developmental disorders, as well as susceptibility to development of infectious diseases [411].

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Why You Must Understand Epigenetics

SUMMARY:  Why Must You Understand Epigenetics?  Because  epigenetics is the real driver of your health status, and diet plays a major role in gene expression (aka epigenetics), at least in this post’s animal study!  Mention this fun fact at holiday gatherings as others notice and comment — good and bad — about your favor of healthy whole foods with resist of the nutritionally empty and microbiome harming options!  Epigenetics is a big word but it simply means the process by which your genes are turned on or off (aka expressed) in good or bad ways.  You already know, diet pre-selects “who” comprises the gut microbiome.  This post shares the University of Wisconsin-Madison mouse study which found that the molecules produced by the microbiome (aka metabolites) tells our genes what to do (turn on or off).  This study looked at two diets: a carbohydrate rich diet (one rich in plant carbohydrates similar to fruits and vegetables humans consume) and pitted it against the Western, Standard American Diet (SAD) (think high in simple refined carbs, added sugars,  and unhealthy fats — this is found in most all home cooked, grocery prepared, and restaurant meals as they use convenient processed ingredients).  Their results showed the plant based diet yielded a more rich microbiome which in turn, produced metabolites that seemed to favor host-microbe communication as they chemically communicated with cells, including cells FAR beyond the colon (the liver and white fat tissue), to dictate gene expression and health (metabolic  — insulin, lipid to name a few) in its host.  In contrast, the metabolites of the SAD did not provide this communication likely because it was MISSING the necessary metabolites to do so!  If you think this is awkward party talk, what is even MORE AWKWARD is feeling others watch what you eat so that they can learn what foods express their genes best!  You’ve worked hard to learn microbiome.  I am  in awe and proud of you.  Now it’s your turn to pay it forward and teach others by doing!  

lightbulb2Look… Your genes are not your destiny.  Disease is rooted in our DNA EXPRESSION.  
Epigenetics triggers disease in those predisposed.  
Time to learn a short EASY bit more about epigenetics now that you know THIS is the real driver of your health status.

I love this video analogy of epigenetics:  What is Epigenetics?  An Entertaining and Educational Primer”, GreenmedTV, April 2013.  Look through the below slides to see how they use only PUNCTUATION VARIANCE TO DRAMATICALLY CHANGE UP THE DIALOGUE CONTEXT.  This is a great analogy to what epigenetics does.  EPIGENETICS DOES NOT “CHANGE UP” HUMAN DNA — that is constant for a lifetime.  Rather, an EPIGENETIC CHANGE READS THE INFORMATION DIFFERENTLY AND EXPRESSES GENES ACCORDINGLY; THAT CAN BE BENEFICIAL OR DETRIMENTAL TO HEALTH AND DISEASE STATUS.  I want you to think of this analogy as you read through the short EASY technicals of epigenetics because epigenetics is easier to get than it sounds!  Here’s the bottom line:  Interactions with the environment do not change the genes, but they alter their expression by switching them on and off through chemical tags on the DNA“. — Gut microbes switch host genes on and off under influence of diet

Now for the technicals made EASY and simple:  A module from Learning Genetics, from the University of Utah, called The Epigenome at a Glance explains:

  • DNA contains the instructions for building all the parts of the body.  DNA is wrapped around proteins called histones.  Both the DNA and histones are covered with chemical tags.  This second layer of structure is called the epigenome.  See this in the below slide.
  • The epigenome shapes the physical structure of the genome.  It tightly wraps inactive genes making them unreadable.  It relaxes active genes making them easily accessible.  Different genes are active in different cell types. The human DNA code is fixed for life, but the epigenome is flexible. 
  • The epigenome changes in response to signals.  Signals come from inside the cell, from neighboring cells, or from the outside world (environment). The signals from the outside world or environment that epigenetic tags react to include diet (things we eat are broken down and circulate throughout the body), stress (physical, emotional, chronic inflammation, disease), sleep, toxins, and more (see parameters on the below Whole Health Pillars slide).  The epigenome adjusts specific genes in our genometic landscape in response to our rapidly changing environment. 

 

  • It is Proteins that Carry the Signals to the DNA.  Once a signal reaches a cell, proteins carry information inside. Like runners in a relay race, proteins pass information to one another. The specifics of the proteins involved and how they work differ, depending on the signal and the cell type. But the basic idea is universal. The information is ultimately passed to a gene regulatory protein that attaches to a specific sequence of letters on the DNA.
  • A gene regulatory protein attaches to a specific sequence of DNA on one or more genes. Once there, it acts like a switch, activating genes or shutting them down.  Gene regulatory proteins also recruit enzymes that add or remove epigenetic tags. Enzymes add epigenetic tags to the DNA, the histones, or both.  Epigenetic tags give the cell a way to “remember” long-term what its genes should be doing.

You can PLAY (so can your kidos!) with the epigenetic controls at this website to SEE and MAKE epigenetics happen!  Just Do it… NOW!

lightbulb2The PEARL:  Signals from the outside world can work through the epigenome to change a cell’s gene expression, moving towards health, or not.

Now for the University of Wisconsin-Madison diet study.

The study, Diet-Microbiota Interactions Mediate Global Epigenetic Programming in Multiple Host Tissues, with full text PDF here, found that gut microbes have a huge role in health as they alter the host gene expression in a diet dependent manner.  The two diets studied, a plant based carbohydrate rich diet (think fruit/vegetables) compared to the Western, Standard American Diet (SAD) (think low fiber and high in simple carbs, sugars, and unhealthy fats found in most all home cooked/grocery prepared/restaurant foods as they use processed ingredients), expressed genes very differently not just in the gut, but in the liver and fatty tissue FAR removed from the gut.  From the Wisconsin University News article, Gut’s microbial community shown to influence host gene expression

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Microbiome: Parkinson’s begins in the gut

SUMMARY:  Yesterday, Dec. 1, 2016, a major gut — brain animal study paper published finding for Microbiome:  Parkinson’s begins in the gut, at least in mice.   While this has been kicked around for years, this animal mouse study finally proves the theory.  This post documents the Dec 2016 Parkinson’s mouse study.  You’ll recognize some of the authors:  Rob Knight, Sarkis K. Mazmanian, Ali Keshavarzian, and Kathleen M. Shannon if you follow my work as I have worked with these labs or follow them closely.  If you have or are concerned with brain and cognition, be it autism, MS, cognitive decline, Alzheimer’s, Parkinson’s, depression, etc…  consider extending this papers findings and seriously start looking in your gut for answers to the why in your brain.   I can’t stand that it takes so long for folks to get real and realize that what goes into our body impacts the brain too.  Usually they don’t get it until they have major symptoms of impairment.  It’s also beyond me that folks don’t understand that bowel habits are windows into how our body handles what we put into it.  My pearl there is that you need to know what the Bristol Stool Chart is and how to use its incredibly useful information to learn what your body, especially what your microbiome or those trillions of beasties, thinks about the menu you feed it.  Though the human studies are far off, the writing is on the wall.  if you care about your brain, START fixing your gut.  This post was updated Jan 25 and 26, 2017 to include a webinar and podcast dated Jan 17 and 19, 2017, discussing the Mazmanium study along with insights for diet and the “Parkinson’s” microbiome.  Diets for Parkinson’s was further updated Sept 23, 2018.

The Study full text link is:

Gut Microbiota Regulate Motor Deficits and Neuroinflammation in a Model of Parkinson’s DiseaseDec 2016 and the PDF is here.  The study looks at if changes in the immune response to gut bacteria could affect neurological outcomes, in particular motor symptoms in Parkinson’s.  The study found that metabolites from the microbiome (this is the exhaust of the trillions of beasties) goes into circulation (it is not known yet if they make it into the brain) and these molecules impacted inflammation in the brain and motor symptoms.

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Fasano, FREE: Early Nutrition Influences Microbiome, Disease

SUMMARY:   Our food choices are fundamental for health.  The next Integrated Functional Medicine Grand Rounds installment with Cleveland Clinic is coming up on Tuesday, December 13, 2016. Listen, for FREE as Dr. Alessio FASANO, MD speaks on How Early Nutrition Influences Microbiome, Disease.  This is an incredible opportunity officially titled:  How Early Nutrition Influences Gut Microbiome and Metabolic Profiles in Health and Disease: Shifting From a Disease-Centered Approach to Patient-Oriented Functional Medicine.  For background, I have followed Dr. Fasano’s work for ages.  He is a leading gut inflammation light who put Celiac Disease, and Non Celiac Gluten Sensitivity, on the map in the US when all US health agencies literally told him those were “across the pond”.  When that happens, you know you are about to make a major break thru that will ruffle lots of feathers.  He persevered, and his findings will re-write the medical books.  Those findings opened the doors for what is now understood as:  Gut permeability ⇒ immune stimulation ⇒ inflammation ⇒ gut and systemic  ramifications ⇒ autoimmune and chronic disease.   Listen in to Dr. Fasano, FREE,  Early Nutrition Influences Microbiome, Disease!

Your doc wasn’t taught this nor are they likely talking to you about microbiome and inflammation and how to move off the spectrum of inflammation, autoimmune and chronic disease. That is sad because many are learning about microbiome and changing diet and lifestyle to reduce that inflammatory microbiome disease tone.  You can too by restoring and optimizing your microbiome.  Contact me for the EASY How-To — that doesn’t break the bank either.

Listen in to Dr. Fasano, FREE,  Early Nutrition Influences Microbiome, Disease!

REGISTER HERE,  How Early Nutrition Influences Gut Microbiome and Metabolic Profiles in Health and Disease: Shifting From a Disease-Centered Approach to Patient-Oriented Functional Medicine.

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Fiber Additives Starve Gut Microbes. They Eat Mucus Lining.

SUMMARY:  This is not a 1950s sci-fi movie. This is what is likely happening now in your gut according to an amazing study just now publishing in Cell. If you are eating the Standard American Diet, the normal, helpful bacteria in your gut are not getting natural whole food fiber. Instead they are being fed fiber additives supplemented in processed foods, or isolated fiber supplements you are buying. Surprisingly, both the fiber additives and the supplements FAIL to feed your microbiome, and instead, they CANNIBALIZE the mucus lining for fuel, at least for mice, according to this study. Repeat:  Fiber Additives Starve Gut Microbes. They Eat Mucus Lining.  That compromises the intestinal barrier role in preventing pathogen infection. Bottom line: EAT WHOLE FOOD BASED FIBER to feed your microbiome, AND DON’T COUNT ON THE FIBER ADDED IN PROCESSED FOODS OR THE SUPPLEMENTS YOU TAKE FOR THAT FIBER. No wonder so many are sick.

lightbulb2

While this work was in mice, the take-home message from this work for humans amplifies everything that doctors and nutritionists have been telling us for decades: Eat A LOT OF FIBER FROM DIVERSE NATURAL SOURCES, says Martens.Your diet directly influences your microbiota, and from there it may influence the status of your gut’s mucus layer and tendency toward disease. But it’s an open question of whether we can cure our cultural lack of fiber with something more purified and easy to ingest [fiber supplements or that added to processed foods] than a lot of broccoli.”  —Eric Martens, Ph.D., an associate professor of microbiology at the University of Michigan Medical School who led the research along with his former postdoctoral fellow Mahesh Desai, Ph.D., now at the Luxembourg Institute of Health.

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Move over gluten, ATI wrecks guts too.

SUMMARY.  This post looks at other ways beyond Celiac and NCGS, that wheat can affect EVERYONE and includes new groundbreaking research being presented in Vienna.  The bottom line:  Move over gluten, ATI wrecks guts too, and… we have a new picture of what the inflamed gut looks like!  ATIs, or amylase-trypsin inhibitors, are non-gluten proteins in wheat.  ATIs activate specific types of immune cells [toll-like receptor 4] in the gut and other tissues.   ATIs can trigger gut immune reactions that can spread to other tissues in the body.  How bad can this get?  “ATIs can lead to the development of inflammation in tissues beyond the gut, including the lymph nodes, kidneys, spleen and brain.   ATIs can worsen the symptoms of pre-existing inflammatory based conditions like RA, MS, asthma, lupus, IBD, and non-alcoholic fatty liver disease…”   The final big hit:  “ATIs may contribute to the development of non-coeliac gluten sensitivity (NCGS).”  No wonder so many feel better ditching wheat since you knock out both gluten and ATIs AND decrease inflammation not just in the gut, but systemically!  For an example, IBD and neurological  association to ATI is discussed below!  What about the  non-gluten containing staples you may be consuming?  Those displayed no or little of the toll like receptor 4 stimulating activity whereas ATIs displayed much! 

Move over gluten, ATI wrecks guts too, and the damage goes beyond the gut!

This is cutting edge research, presented at the Opening Plenary Session at UEG Week Vienna 2016, which began October 15 and ran to Oct 19, 2016!  You can listen live to these expert researchers, just sign into UEG.  Obviously I have been!  Regarding archiving content, I honestly don’t know UEG policy.

Proteins in wheat.  There are a lot of different proteins in wheat and they are classified into groups, known as gliadins, glutenins, albumins and globulins.  

Up to now, its been all about gluten (gliadin to be exact) and Celiac Disease and Non-Celiac Gluten Sensitivity (NCGS).  Celiac has been well characterized over the last 4 decades.  NCGS is the relative new comer.  But with both conditions, what has not been known was what and how the innate immune system interacted.  Researchers have been on the look out for the additional modulating factors, including cereal stimulants, of innate immunity, affecting signaling receptors for celiac disease, but until now, have not found the answer(s).

Now enters ANOTHER NEWLY FOUND WHEAT PROTEIN, a non-gluten wheat protein, called amylase-trpsin inhibitors (ATIs), that seems to be the what and how for activation of the innate system for wheat.  ATIs are a subset of the albumin protein in wheat; ATIs are enriched in wheat and related cereals.  

What does ATI innate immune activity do to the gut?

In sum,  ATIs causes inflammation at the gut level that extends to inflammation beyond the gut including lymph nodes, spleen, kidney, and brain.  When ATIs are fed to mice with autoimmunes or allergies, more severe disease and stronger antigen-specific adaptive immunity developed.  Researchers agree that clinical studies are needed to determine whether this observation applies to humans with chronic inflammatory diseases.  That would mean that consumption of wheat ATIs could worsen conditions such as RA, MS, IBD, asthma, lupus, alcoholic fatty liver disease, etc.  ATIs also may contribute to the development of NCGS which includes association to IBS along with keen interest in associations to neurological conditions like autism, depression, AD, PD, etc.

The Studies.

From the 2015 Schuppan, et al paper, 

Non-celiac wheat sensitivity: differential diagnosis, triggers and implications

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Defy Autoimmune Psoriasis: Green Tea, Black Tea, Lemon Juice Antioxidant

SUMMARY:  Plenty of studies find anti-inflammatory effects of dietary antioxidants such as green tea for chronic disease.  Even in IBD patients, who have a very messed up microbiome (a finding of the American Gut data), the  benefits of antioxidant therapy is well documented (see below studies).  Read here about a simple EASY N=1 hack for one IBD patient that shut down a mild psoriasis skin flare that began two years ago.  They flared psoriasis, but not the autoimmune IBD, eating strict healing diet Specific Carbohydrate Diet (SCD) probably due to a gluten/sugar airborne exposure.  The hack that worked for stopping psoriasis: Green Tea, Black Tea with Lemon Juice antioxidant blend!  I share their recipe here!   It is simple enough that you may want to add it to your immune calming anti-inflammatory arsenal too!  Make sure to see below for why it is important to NOT drink Green Tea for antioxidant benefit along with Iron.  

If the tea and lemon juice blend posted here isn’t your cup of tea, try extending the concept and increase other antioxidants.  For ideas, see below for the

Phytonutrients from Dana Farber Brigham and Women’s Cancer Center PDF

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