Concise Summary of SCD Studies

March 24, 2017 Patricia Carter 27 Comments

Last Updated on October 12, 2020 by Patricia Carter

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

Crohn’s Disease [Cohen et al. 2014; Suskind et al. 2014,Walters, et al.2014; Kakodkar et al. a 50 cohort, 2015; Suskind, et al, 2016] and
UC [Obih et al. 2016; Suskind, et al, 2016].

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. 2014; Chassaing et al. 2015; Gewirtz et al. 2015; Nickerson 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. 2014; Suskind, 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-AID, University 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 a “SCD 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 that patient 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]:

Half of a 417 patient survey use the SCD because of hesitation with medications used for IBD, and
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,

♥ Last updated: October 12, 2020 at 14:07 pm 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.
Suskind Dietary Treatment YouTube, 2016, Dr. Suskind discusses SCD integration into dietary IBD clinical therapeutics.
Seattle Children’s Hospital presented for Continuing Medical Education, a program detailing how to integrate SCD into clinic, 2016.
Cohen et al.2014, Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. 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). 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.
Suskind et al. 2014, Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. Significant improvement in multiple parameters including albumin and hemoglobins. 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.
Walters, et al.2014, Analysis of Gut Microbiome and Diet Modification in Patients with Crohn’s Disease. Fecal samples were obtained from patients with Crohn’s disease in a pilot diet crossover trial comparing the effects of a specific carbohydrate diet (SCD) versus a low residue diet (LRD) on the composition and complexity of the gut microbiota and resolution of IBD symptoms. The gut microbiota composition was assessed using a high-density DNA microarray PhyloChip. Findings: At baseline, before diet 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. Patient diet COMPLIANCE was about 80%, and The SCD MICROBIOME DIVERSITY REMAINED despite a 30 day washout between diets. Changes in the composition and complexity of the gut microbiome were identified in response to specialized carbohydrate diet. The SCD was associated with restructuring of the gut microbial communities. Microbiome changes due to SCD, included increased microbial diversity (134 bacteria belonging to 32 different classes and the bacterial families over represented in the increase in SCD included over 20 species of the non-pathogenic clostridia family).
Kakodkar et al.a 50 cohort, 2015, The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series. SCD is an effective tool in the management of patients with with colonic and ileocolonic IBD who made up the majority of our study group. Some patients with moderate to severe disease who follow this diet were able to discontinue immunosuppressive agents. All but one of this 50 cohort had a college or graduate degree.
Suskind, et al, published online 2016, see here for full text which published in J Clin Gastroenterol, 2018 Feb; 52(2): 155–163,
Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. Prospective open-label study examining the effects of the SCD on clinical disease activity, biological markers of inflammation, and fecal microbial composition in patients with active CD and UC. The study was registered with ClinicalTrials.gov (number: NCT02213835). Mild to moderate IBD patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. At the time of entrance into the study, patients were on methotrexate (n = 1), azathioprine (n= 2), mesalamine (n= 4), adalimumab (n= 1), ustekinumab (n = 1), and no medication (n = 5). PCDAI/PUCAI, laboratory studies were assessed. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1± 22.3 to 7.1± 0.4 mg/L at 12 weeks in Seattle Cohort (nL< 8.0 mg/L) and decreased from 20.7± 10.9 to 4.8 ± 4.5 mg/L at 12 weeks in Atlanta Cohort (nL< 4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change. Conclusions: SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome.
Obih et al.2016, Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center.
W. A. Walters et al. 2014, Meta-analyses of human gut microbes associated with obesity and IBD. IBD has a consistent microbiome signature across studies and allows high classification accuracy of IBD from non-IBD subjects.
Hoarau et al., 2016, Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease. mBio, September 2016 DOI: 10.1128/mBio.01250-16. 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.
Martinez-Medina et al. 2014, Western diet induces dysbiosis with increased E coli in CEABAC10 mice, alters host barrier function favouring AIEC colonisation. High fat/High sugar diet led to dysbiosis in WT and transgenic CEABAC10 mice, with a particular increase in E coli population in HF/HS-fed CEABAC10 mice. These mice showed decreased mucus layer thickness, increased intestinal permeability, induction of Nod2 and Tlr5 gene transcription, and increased TNFα secretion. These modifications led to a higher ability of AIEC bacteria to colonise the gut mucosa and to induce inflammation.
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.
Gewirtz et al. 2015 study. The correct citation is Chassaing et al. 2015, with final version available in Nature. Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome.
Nickerson et al. 2015, Deregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin.
Suskind, et al,2016, The intestinal microbiome, barrier function, and immune system in inflammatory bowel disease: a tripartite pathophysiological circuit with implications for new therapeutic directions.
Healthlink Special: Specific Carbohydrate Diet. Lead SCD investigator, Dr. David Suskind explains that dietary therapy changes what the immune system reacts to. Dietary therapy changes the microbiome in the gut. The published studies now show that removing gut irritating food changes the gut microbiome.
Crohn’s & Colitis. First-Ever National Study of Dietary Interventions to Treat Crohn’s Disease Receives Funding, 2016. $2.5 million awarded from the Patient-Centered Outcomes Research Institute to study SCD and Mediterranean Diet to induce remission in Crohn’s.
UMass IBD-AID, University of Massachusetts Medical School, Center for Applied Nutrition.
UMass IBD-AID microbiome clinical trial.
Olendzki, et al.2014, UMass IBD-AID, An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report, 2014.
Burgis et al.2016, Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. 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.
Lee et al., 2016, Individualized Food-Based Dietary Therapy for Crohn’s Disease: Are We Making Progress? The need for personalization of dietary therapy for IBD is likely due to microbiome differences and food intolerances.
Knight-Sepulveda et al.2015, Diet and Inflammatory Bowel Disease. Discusses many dietary therapies for IBD including the efficacy of the FODMAPs diet for IBD.
Nanayakkara et al, 2016, Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Functional gut symptoms or IBS-type symptoms are common in patients with inflammatory bowel disease (IBD), with a greater prevalence seen in Crohn’s disease than in patients with ulcerative colitis [69]. Gearry et al [70] have demonstrated that restriction in FODMAPs improved overall abdominal symptoms as well as abdominal pain, bloating, wind, and diarrhea in patients with IBD in a retrospective study. Similarly, reduction in dietary FODMAPs intake improved stool output and consistency in patients with ulcerative colitis following ileorectal anastomosis or ileal pouch formation and colectomy.[71]
Inflammatory Bowel Disease (IBD) Research Priorities from IBD Priority Setting Partnership 2015, James Lind Alliance Priority Setting Partnerships, see PDF here.
Sandra C. Kim, MD presentation, Probiotics, Special Diets, and Complementary Therapies: We Know Patients Want Them, so What do We Tell Them? Annual 2014 Advances in Inflammatory Bowel Diseases, Crohn’s & Colitis Foundation’s Clinical and Research Conference. See time 15:35 for SCD discussion and time 18:31 where she recommends specifically asking patients about CAM interests.
Hass 1955, The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases. Am J Gastroenterol. 1955 Apr;23(4):344-60. No abstract available. SCD was first described by Dr. Sidney Haas in 1924 as a means to treat celiac disease
Breaking the Vicious Cycle.

References from a PubMed search conducted March 21, 2017, for “specific carbohydrate diet” returned these 17 Items. Those with a “♥” are cited in the above post.

Diet to the Rescue: Cessation of Pharmacotherapy After Initiation of Exclusive Enteral Nutrition (EEN) Followed by Strict and Liberalized Specific Carbohydrate Diet (SCD) in Crohn’s Disease. Nakayuenyongsuk W, Christofferson M, Nguyen K, Burgis J, Park KT. Dig Dis Sci. 2017 Jan 13. doi: 10.1007/s10620-016-4446-1. [Epub ahead of print] No abstract available. PMID:28084605
♥ Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. Suskind DL, Cohen SA, Brittnacher MJ, Wahbeh G, Lee D, Shaffer ML, Braly K, Hayden HS, Klein J, Gold B, Giefer M, Stallworth A, Miller SI. J Clin Gastroenterol. 2016 Dec 27. doi: 10.1097/MCG.0000000000000772. [Epub ahead of print] PMID: 28030510
Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Lewis JD, Abreu MT. Gastroenterology. 2017 Feb;152(2):398-414.e6. doi: 10.1053/j.gastro.2016.10.019. PMID: 27793606. Diets low in fruits and vegetables and high in saturated animal fats are associated with increased risk of IBD. Low vitamin D levels and processed food may also be associated with increased IBD risk. Soluble fiber and omega-3 fatty acids may decrease inflammation, although no definite benefit has been found in patients with IBD. The authors conclude that diet may affect IBD risk and relapse, and they recommend a Mediterranean-style diet low in processed foods for individuals with IBD.
♥ Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease. Suskind DL, Wahbeh G, Cohen SA, Damman CJ, Klein J, Braly K, Shaffer M, Lee D. Dig Dis Sci. 2016 Nov;61(11):3255-3260. PMID: 27638834
Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. A Systematic Review. Penagini F, Dilillo D, Borsani B, Cococcioni L, Galli E, Bedogni G, Zuin G, Zuccotti GV. Nutrients. 2016 Jun 1;8(6). pii: E334. doi: 10.3390/nu8060334. Review. PMID: 27258308 Free PMC Article.
♥ Diet and Inflammatory Bowel Disease. Knight-Sepulveda K, Kais S, Santaolalla R, Abreu MT. Gastroenterol Hepatol (N Y). 2015 Aug;11(8):511-20. PMID: 27118948 Free PMC Article,
Smoking and Diet: Impact on Disease Course? Cosnes J. Dig Dis. 2016;34(1-2):72-7. doi: 10.1159/000442930. Review. PMID: 26981632
♥ Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. Burgis JC, Nguyen K, Park KT, Cox K. World J Gastroenterol. 2016 Feb 14;22(6):2111-7. doi: 10.3748/wjg.v22.i6.2111. PMID: 26877615 Free PMC Article,
♥ Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Obih C, Wahbeh G, Lee D, Braly K, Giefer M, Shaffer ML, Nielson H, Suskind DL. Nutrition. 2016 Apr;32(4):418-25. doi: 10.1016/j.nut.2015.08.025. PMID: 26655069
Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet. Khandalavala BN, Nirmalraj MC. Case Rep Gastroenterol. 2015 Aug 7;9(2):291-5. doi: 10.1159/000438745. PMID: 26351419 Free PMC Article This case study demonstrates the easy tolerability and lack of significant side effects of the SCD. Confirmation of healing with endoscopy and microscopy validates the clinical improvement experienced by this patient. The diet requirements were relatively simple to incorporate though highly restrictive and are similar to those undertaken with celiac disease but included a prominent component of fermented dairy. A major strength of this case study is the ease of translation into clinical practice by busy clinicians, without the need for additional resources.
♥ The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series. Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. J Acad Nutr Diet. 2015 Aug;115(8):1226-32. doi: 10.1016/j.jand.2015.04.016. No abstract available. PMID: 26210084 Free Article
♥ Deregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin. Nickerson KP, Chanin R, McDonald C. Gut Microbes. 2015;6(1):78-83. doi: 10.1080/19490976.2015.1005477. Review. PMID: 25738413 Free PMC Article
♥ Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. Cohen SA, Gold BD, Oliva S, Lewis J, Stallworth A, Koch B, Eshee L, Mason D. J Pediatr Gastroenterol Nutr. 2014 Oct;59(4):516-21. doi: 10.1097/MPG.0000000000000449. PMID: 24897165
Diet and inflammatory bowel disease: review of patient-targeted recommendations. Hou JK, Lee D, Lewis J. Clin Gastroenterol Hepatol. 2014 Oct;12(10):1592-600. doi: 10.1016/j.cgh.2013.09.063. Review. PMID: 24107394 Free PMC Article
♥ Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):87-91. doi: 10.1097/MPG.0000000000000103. PMID: 24048168
Specific carbohydrate diet in treatment of inflammatory bowel disease. Nieves R, Jackson RT. Tenn Med. 2004 Sep;97(9):407. No abstract available. PMID: 15497569
♥ The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases. HAAS SV, HAAS MP. Am J Gastroenterol. 1955 Apr;23(4):344-60. No abstract available. PMID: 14361377

27 thoughts on “Concise Summary of SCD Studies”

Patricia Carter says:

October 12, 2020 at 3:05 pm

2019 Kaplan. Evaluating the Comparative Effectiveness of Two Diets in Pediatric Inflammatory Bowel Disease: A Study Protocol for a Series of N-of-1 Trials, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6956096/

This paper explains the N=1 trial now occurring for the PRODUCE version of SCD.

N-of-1 trials may be particularly informative in this case because considerable heterogeneity in dietary treatment effects in IBD is expected, given the variation in food metabolism, microbiota, and disease pathology across patients. This makes a study design that provides personalized results very appealing. Beyond individual results, aggregating the data across the series of N-of-1 trials to obtain estimates of population effectiveness of dietary therapy will contribute to the evidence base for the role of the SCD in IBD. Here, we outline our approach to performing a series of N-of-1 clinical trials to assess the effects of dietary modification on symptoms and inflammation in children with IBD.

Patients will be randomized to begin with either the SCD or the modified SCD. By randomizing the initial diet, we will determine whether effects differ based on the diet a patient starts with. Currently, there is uncertainty regarding whether starting on the full SCD diet before liberalizing is important. Patients will be randomized with a 1:1 allocation ratio using a centralized, stratified, block randomization approach. We will stratify within sites and by disease type (UC/indeterminate colitis (IC) or CD).

In total, there will be four eight-week periods that alternate between the SCD and modified SCD (Figure 1). The eight-week treatment period duration was selected based on preliminary studies indicating that symptoms improve in approximately one month and markers of inflammation within two months.

At the time of manuscript submission, 33 patients have been enrolled and 9 have completed at least one treatment pair (4 completed the entire N-of-1 trial, 5 completed one treatment pair).

Read more in the paper!

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Patricia Carter says:

October 12, 2020 at 1:31 pm

Kimberly Braly RDN LDN (worked with Dr. Suskind on the SCD and the PRODUCE version of SCD with pediatric patients from 2013-2018) has her own business and website with loads of great info and contact info for those interested. Catchup here –> Kimberly Braly Nutrition, https://kimbralynutrition.com/scd-food-staples/

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Patricia Carter says:

October 12, 2020 at 1:27 pm

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

FIGURE 1 is a great figure showing IBD diet differences but note that some diet nuances are not accurately represented. Nonetheless, the diagram is is close!

In conclusion, the renewed interest in dietary research in IBD is welcomed and further adequately conducted clinical research will eventually set the stage for the role of diet in treatment of IBD as monotherapy or in combination.

In this context, the results of ongoing trials, such as the DINE-CD trial comparing the SCD diet with the Mediterranean diet (NCT03058679), the DIETOMICS-CD trial comparing CDED diet with EEN and PEN (NCT02843100), and the PRODUCE trial comparing SCD with modified SCD (NCT03301311) are eagerly awaited. As illustrated in Figure 1, there is huge variability and sometimes contradiction across diets that are currently being tested regarding which component should be
recommended or avoided.

For now, simple dietetic recommendations such as consuming a well-balanced diet prepared largely from fresh ingredients and thereby
avoidance of emulsifiers and other additives and processed
foods are appropriate for all patients. In select patients, such
as those with a short segment of inflammatory, nonpenetrating, nonstricturing Crohn’s disease and mild to moderate symptoms, a trial of dietary therapy alone with a diet such as CDED could be attempted for a short period of time, with close follow-up, and with agreement with the
patient that failure to fully respond is an indication to escalate therapy.

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Patricia Carter says:

October 12, 2020 at 1:20 pm

2018. Can the Specific Carbohydrate Diet Treat Inflammatory Bowel Disease? https://www.seattlechildrens.org/about/stories/can-the-specific-carbohydrate-diet-treat-inflammatory-bowel-disease/

Dr. Suskind studies began w family and foundations funding for the initial studies. The positive outcomes has resulted in Fedl funding of the SCD PRODUCE study. SCD is relaxed in the PRODUCE version. Traditional medicine says what you eat doesn’t affect disease. But we’re proving that a diet can stop a lifelong disorder.

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Patricia Carter says:

September 18, 2019 at 12:00 pm

PRODUCE version of SCD, now in clinical trial, ClinicalTrials.gov Identifier: NCT03301311, Personalized Research on Diet in Ulcerative Colitis and Crohn’s Disease (PRODUCE),
See trial details at: https://clinicaltrials.gov/ct2/show/NCT03301311?term=produce+ibd&rank=10

PRODUCE is an acronym that stands for Personalized Research on Diet in Ulcerative Colitis and Crohn’s Disease.

This diet relaxes strict SCD adherence to include:

1. Organic rice, oats, and sweet potatoes:
Per Day: Maximum of two servings of any item or combination of items.
Per Week: Minimum of 3 servings and maximum of 6 servings of any item or combination of items, Serving size: 1 cup.

2. Grade A Maple syrup and cocoa: Per week: Maximum of ½ cup of each item.

Brief Summary: A series of N-of-1 trials will be used to determine the effectiveness of a specific carbohydrate diet (SCD) versus a modified SCD in patients in reducing symptoms and inflammatory burden at both the individual and population level. This is a four-year study. The study staff will recruit 50 patients across up to 21 sites in patients aged 7-18 with mild to moderate disease activity.

The Study Protocol and Statistical Analysis Plan is at https://clinicaltrials.gov/ProvidedDocs/11/NCT03301311/Prot_SAP_004.pdf

The History of Changes for Study: NCT03301311 is at https://clinicaltrials.gov/ct2/history/NCT03301311

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Patricia Carter says:

October 18, 2018 at 3:36 pm

June 2017 Issue https://www.todaysdietitian.com/newarchives/0617p42.shtml

Great summary of SCD and studies.

CPE Monthly: Specific Carbohydrate Diet for Inflammatory Bowel Disease — Learn About the SCD to Support Clients With IBD and How It Compares With Other Evidence-Based Nutritional Therapies
By Cheryl Harris, MPH, RD
Today’s Dietitian
Vol. 19, No. 6, P. 42

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Patricia Carter says:

July 1, 2018 at 11:18 am

[Haskey et al 2017] An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372922/

The aim of this review is to summarize the current data available on dietary management of inflammatory bowel disease and to demonstrate that dietary modulation may be an important consideration in managing disease. By addressing the relevance of diet in inflammatory bowel disease, health professionals are able to better support patients and collaborate with dietitians to improve nutrition therapy.

7. Conclusions
As our knowledge of the associations between a disrupted intestinal microbiota (dysbiosis) and chronic inflammatory diseases expands, the influence of diet becomes increasingly important. Clearly, diet and nutrition are of major interest for patients with IBD. Patients use a variety of diet strategies in attempt to manage underlying disease, as well as to provide relief from symptoms. Diet plays a key role in IBD pathogenesis, and there is a growing appreciation that the interaction between diet and microbes in a susceptible person contributes significantly to the onset of disease [128]. Several lines of evidence point to aspects of the typical Western diet that may promote the development of IBD. A low-residue diet is frequently recommended for IBD by health professionals [19] to reduce symptoms may be adding further insult. A diet that lacks dietary fiber may accelerate dysbiosis in IBD [94,95].

Pre-illness studies in IBD and intervention trials provide convincing evidence that a plant-based diet, with increased consumption of fruit/vegetables and less red meat intake could be suggested to patients with IBD in remission. Several of the diets/supplements discussed in this review appear to hold promise for in the maintenance of remission in IBD, especially when provided in addition to standard medical therapy.

There is a plethora of information on the internet that assert that certain diets improve or exacerbate symptoms, yet few rigorous nutrition studies have examined specific dietary factor(s) as being detrimental or protective against UC or CD. Implementation of diet strategies and approaches into clinical practice are slow and limited.

Common barriers to implementation into practice include issues relating to knowledge management, such as access to research evidence sources, time to review evidence-based sources and a lack of skills to appraise and understand research evidence [18]. In addition to knowledge management, financial barriers, inappropriate skill mix and problems working with and across professional disciplines contribute to the lag in knowledge translation [18].

This review attempts to consolidate the existing evidence on diet/pharmoconutrition and maintenance of remission in IBD, including studies that evaluate the association between pre-illness intake of nutrients and food groups and the risk of a subsequent diagnosis of IBD, diet intervention studies in maintaining remission in IBD, as well as existing guidelines [19,20,21], in light of the most current limitations in evidence and practice. Evidence-based dietary recommendations for IBD patients are summarized in Table 1 and Table 2 and Figure 1.

3.2. Carbohydrate Intake as a Risk Factor for IBD… Overall, this suggests that while refined and processed carbohydrates and intake of sweetened beverages are risk factors for IBD, complex carbohydrates including fruit, vegetables and fiber should be included in the diet to manage IBD.

3.3. Protein Intake as a Risk Factor for IBD. A large prospective cohort study (n = 67,581) completed over a 10.5-year period found that high protein intake, specifically animal protein (meat, not dairy products) was positively associated with an increased risk of IBD [31]. A systematic review (n = 2609 IBD patients; 19 studies) reported an association with high total protein intake with the development of UC (OR range 0.2–3.7) and CD (OR range 0.45–3.34) [22]. High protein intake was associated with a 3.3-fold increased risk of IBD, suggesting a diet high in animal protein is a major risk factor for the development of IBD.

3.4. Dairy Intake as Risk Factor for IBD… Overall, the consumption of dairy products is not a risk factor for IBD.

3.5. Dietary Fat Intake as a Risk Factor for IBD… Overall, it does not appear that full fat diets should be avoided, however fat including diets rich in olive oil, dairy products and fish but not fish oil pills should be consumed while avoiding large intakes of vegetable oils rich in n-6 PUFA.

4. Diet Interventions and IBD
4.1. Low Residue Diet
4.2. Semi-Vegetarian Diet
4.3. FODMAPs Diet
4.4. Exclusion Diets
4.5. Novel Anti-Inflammatory Diet Therapies
4.6. Fiber Supplements
4.6.1. Oat Bran
4.6.2. Wheat Bran
4.6.3. Psyllium
4.6.4. Germinated Barley Foodstuff
4.7. Role of Fat in the Diet

4.8. Popular Diet Plans with Patients. The Specific Carbohydrate Diet™

5. Pharmaconutrition
5.1. Curcumin (Turmeric)
5.2. Probiotics
5.3. Vitamin D

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Patricia Carter says:

July 1, 2018 at 6:51 am

Another website for DINE-CD: SPECIFIC CARBOHYDRATE DIET
A guide to help DINE-CD Research Study participants follow the Specific Carbohydrate Diet, http://www.dinescd.org/

This site includes educational materials, recipes, lists of permitted foods and unpermitted foods, Frequently Asked Questions, and brief videos with tips for following the diet. A dietitian is also available via email to answer all of your dietary questions. Go to the “Ask the Dietitian” section of the website for the dietitian’s email address. The dietitian will reply to your email within 72 hours.

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Patricia Carter says:

July 1, 2018 at 6:46 am

Trial of Specific Carbohydrate and Mediterranean Diets to Induce Remission of Crohn’s Disease (DINE-CD), https://clinicaltrials.gov/ct2/show/NCT03058679 (27 locations participating)

Study Type : Interventional (Clinical Trial)
Estimated Enrollment : 194 participants
Allocation: Randomized
Recruitment Status : Recruiting
First Posted : February 23, 2017
Last Update Posted : June 11, 2018
Official Title: Open Label, Randomized, Multicenter, Comparative Effectiveness Trial of Specific Carbohydrate and Mediterranean Diets to Induce Remission in Patients With Crohn’s Disease
Actual Study Start Date : September 29, 2017
Estimated Primary Completion Date : May 2019
Estimated Study Completion Date : July 2019

Brief Summary: This protocol is designed to compare the effectiveness of two dietary interventions for patients with Crohn’s disease (CD): the Specific Carbohydrate Diet (SCD) and a Mediterranean style diet (MSD) that has been demonstrated to have numerous other health benefits. The two diets will be compared in terms of their ability to resolve both the symptoms and bowel inflammation that characterize this debilitating disease.

Inclusion Criteria (not inclusive):
Age ≥18
Documented diagnosis of Crohn’s disease
sCDAI score >175 (but under 400)
Active inflammation documented by a FCP concentration >250ug/g or high sensitivity C-reactive protein (hs-CRP)>5 mg/L measured at screening.

Exclusion (not inclusive)
Anticipated need for surgery within 6 weeks of randomization
Use of the Specific Carbohydrate Diet within 4 weeks of screening
Start or change dose of thiopurines (azathioprine and 6-MP), methotrexate, natalizumab, or vedolizumab within 12 weeks prior to randomization
Start or change dose of anti-TNF agents (including infliximab, adalimumab, certolizumab pegol, golimumab) or ustekinumab within 8 weeks prior to randomization
Start or change dose of corticosteroids within 1 week of screening or a dose >20mg/day prednisone or equivalent*
Known symptomatic intestinal stricture.
Presence of an ostomy
Baseline stool frequency >4 bowel movements/day when well
BMI <16
BMI ≥40
Celiac disease
Documented C difficile colitis within four weeks of screening
Diabetes Mellitus requiring medication
Albumin<2.0mg/dl, within 4 weeks of screening (if tested as part of routine clinical care)
Known allergy to nuts

Contacts
Contact: Adam M Hawkins 215-746-4218 ahawkeye@pennmedicine.upenn.edu
Contact: Lisa C Nessel, MSS, MLSP 215-573-6003 nessel@pennmedicine.upenn.edu

Sponsors and Collaborators
University of Pennsylvania
Patient-Centered Outcomes Research Institute
Crohn’s and Colitis Foundation
University of North Carolina, Chapel Hill

Investigators
Principal Investigator: James D Lewis, MD, MSCE University of Pennsylvania

United States, California
UCSF Colitis and Crohn’s Disease Center Recruiting
San Francisco, California, United States, 94115
Contact: Michael Berman 415-514-8947 Michael.Berman@ucsf.edu
Principal Investigator: Uma Mahadevan, MD

United States, Georgia
Atlanta Gastroenterology Recruiting
Atlanta, Georgia, United States, 30342
Contact: Christine Wolf 404-257-9000 ext 2142 mailto:christine.wolf@atlantagastro.com
Principal Investigator: Douglas Wolf, MD

United States, Illinois
NorthShore University HealthSystem Recruiting
Evanston, Illinois, United States, 60201
Contact: Obaid Ansari 847-570-3708 OAnsari@northshore.org
Principal Investigator: Eugene Yen,, MD
Northwestern University Recruiting
Evanston, Illinois, United States, 60208
Contact: Lisa Kim 312-926-5250 lisa.kim@northwestern.edu
Principal Investigator: Stephen B Hanauer, MD

United States, Indiana
Indiana University Health University Hospital Recruiting
Indianapolis, Indiana, United States, 46202
Contact: Debbie Drenzyk 317-948-9212 robinsd@iu.edu
Principal Investigator: Monika Fischer, MD

United States, Kentucky
The University of Louisville Recruiting
Louisville, Kentucky, United States, 40202
Contact: Suzanne Mann, LPN 502-852-1919 mailto:susie.mann@louisville.edu
Principal Investigator: Gerald W Dryden, MD

United States, Maryland
University of Maryland Baltimore Recruiting
Baltimore, Maryland, United States, 21201
Contact: Thelma Harrington 410-706-5943 THarrington@som.umaryland.edu
Sub-Investigator: Sandra Quezada, MD

United States, Massachusetts
Boston Children’s Hospital Recruiting
Boston, Massachusetts, United States, 02115
Contact: Caroline Rourke 617-919-4592 Caroline.Rourke@childrens.harvard.edu
Principal Investigator: Bridget Hron, MD

United States, Michigan
University of Michigan Recruiting
Ann Arbor, Michigan, United States, 48109
Contact: Kimberly Brunette 734-647-4548 mailto:ksauder@med.umich.edu
Principal Investigator: Peter D Higgins, MD
Clinical Research Institute of Michigan Recruiting
Chesterfield, Michigan, United States, 48047
Contact: Aaron Ryder 586-598-3329 aryder@researchmi.com
Principal Investigator: Ronald P Fogel, MD

United States, Minnesota
Minnesota Gastroenterology, P.A Recruiting
Plymouth, Minnesota, United States, 55446
Contact: Irena Davies 612-870-5587 Irena.Davies@mngastro.com
Principal Investigator: Robert McCabe, MD
Mayo Clinic – Rochester Recruiting
Rochester, Minnesota, United States, 55905
Contact: Brenda Becker 507-284-5486 becker.brenda1@mayo.edu
Principal Investigator: Sunanda Kane, MD

United States, New Hampshire
Dartmouth-Hitchcock Medical Center Recruiting
Lebanon, New Hampshire, United States, 03756
Contact: Penny Doughty 603-653-6048 Penny.J.Doughty@hitchcock.org
Principal Investigator: L. Campbell Levy, MD

United States, New York
NYU Langone Medical Center Recruiting
New York, New York, United States, 10016
Contact: Gregory Pappas 646-501-7984 Gregory.Pappas@nyumc.org
Principal Investigator: David Hudesman, MD
Weill Cornell – NewYork Presbyterian Recruiting
New York, New York, United States, 10021
Contact: Fatiha Chabouni 212-746-5109 fac2005@med.cornell.edu
Principal Investigator: Ellen J Scherl, MD
Icahn School of Medicine at Mount Sinai Recruiting
New York, New York, United States, 10029
Contact: Amy Nolan 212-824-7699 amy.nolan@mssm.edu
Contact: Sari Feldman 212-824-7669 sari.feldman@mssm.edu
Principal Investigator: Benjamin Cohen, MD
Lenox Hill Hospital Recruiting
New York, New York, United States, 10075
Contact: Laura Durbin, MPH 212-434-3941 ldurbin@northwell.edu
Principal Investigator: Arun Swaminath, MD

United States, North Carolina
The University of North Carolina Recruiting
Chapel Hill, North Carolina, United States, 27599
Contact: Susan Jackson, MPA 919-843-9071 susan_jackson@med.unc.edu
Principal Investigator: Hans Herfarth, MD, PhD
Wake Forest Baptist Medical Center Recruiting
Winston-Salem, North Carolina, United States, 27157
Contact: Alisha Davis 336-713-7319 atdavis@wakehealth.edu
Principal Investigator: Patrick Green, MD

United States, Ohio
University of Cincinnati Recruiting
Cincinnati, Ohio, United States, 45267
Contact: Missy Randolph 513-558-5529 RANDOLLJ@ucmail.uc.edu
Principal Investigator: Bruce Yacyshyn, MD
University Hospitals Cleveland Medical Center Recruiting
Cleveland, Ohio, United States, 44106
Contact: Lynn Richardson 216-844-7214 Lynn.Richardson@UHhospitals.org
Principal Investigator: Jeffry Katz, MD

United States, Pennsylvania
University of Pennsylvania Recruiting
Philadelphia, Pennsylvania, United States, 19104
Contact: Adam Hawkins 215-746-4218 ahawkeye@pennmedicine.upenn.edu
Principal Investigator: James D Lewis, MD
University of Pittsburgh Medical Center Recruiting
Pittsburgh, Pennsylvania, United States, 15213
Contact: Kimberly Goldby-Reffner, RN 412-648-9173 mailto:goldbyreffnerka@upmc.edu
Principal Investigator: Marc Schwartz, MD
United States, Tennessee
Vanderbilt University Medical Center Recruiting
Nashville, Tennessee, United States, 37232
Contact: Erin Laundry 615-322-4573 erin.vozar@Vanderbilt.edu
Principal Investigator: Sara Horst, MD

United States, Utah
University of Utah Recruiting
Salt Lake City, Utah, United States, 84112
Contact: Julie Will 801-587-9060 Julie.will@hsc.utah.edu
Principal Investigator: Ann Flynn, MD
United States, Washington
Virginia Mason Medical Center Recruiting
Seattle, Washington, United States, 98101
Contact: Angie Neal 206-341-1413 Angie.Neal@virginiamason.org
Principal Investigator: Michael Chiorean, MD

United States, Wisconsin
University of Wisconsin-Madison Recruiting
Madison, Wisconsin, United States, 53706
Contact: Lindsay Luedke 608-262-5404 leluedke@medicine.wisc.edu
Principal Investigator: Sumona Saha, MD

Reply
Patricia Carter says:

July 1, 2018 at 6:37 am

DINE-CD RESEARCH STUDY, A diet intervention trial in adults with Crohn’s disease, http://dinecd.web.unc.edu/

DINE-CD study is recruiting having the goal of comparing the efficacy of two different dietary strategies to reduce symptoms and intestinal inflammation of Crohn’s disease. The two diets that will be studied are the Mediterranean style diet and the Specific Carbohydrate Diet.

Adults with Crohn’s disease that is currently causing mild to moderately severe symptoms and who have elevated markers of inflammation will be eligible to participate in the study. Participants will be randomly assigned to follow one of the two diets for 12 weeks. For the first 6 weeks, participants will be provided with all of their food. For the last 6 weeks of the study, participants will be asked to follow the diet on their own, although they will have the option to buy some or all of their meals from the same vendor who will be providing the food during the first six weeks. Participants will complete 3 study visits at one of our study sites located throughout the United States.

For more information or for information about locations where you can meet with a physician to be screened for eligibility, please see our clinicaltrial.gov page: https://clinicaltrials.gov/ct2/show/NCT03058679

Please note: you must meet with a physician at one of our participating sites and meet all eligibility criteria to enroll in this study.

For general questions please e-mail the coordinating center at the University of Pennsylvania: DINECDStudy@mail.med.upenn.edu

For questions about food deliveries, contact Healthy Chef Creations by phone at 1-866-575-2433.

For all other questions about the study, contact your local Study Coordinator. If you do not know your Study Coordinator’s contact information, email: DINECDStudy@mail.med.upenn.edu.

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Patricia Carter says:

May 14, 2018 at 11:13 am

Dr. James George (Mt Sinai) – Does the SCD Diet help for Crohn’s & Colitis? July 2015,
https://www.youtube.com/watch?v=GCVrAuTnVIw

It takes a motivated person to eat SCD; SCD is “harder” to implement than meds because you need to learn it, and cook. Ms Weiss educated Dr. George. As a docs/GI in 1992 medical school, he was taught diet has nothing to do with IBD. But he saw patients using diet successfully so he decided it was time to learn diet and IBD. Lifestyle changes too improve IBD. Stress management is hugely important: The evidence finds stress instigates and promotes exoneration of IBD. Exercise (just moving the body, walking counts) helps tons too.

Dr George tells patients that SCD can address ALL their concurrent medical problems (IBD, blood pressure, cardiovascular disease, diabetes…). For one patient (Ravi Graystein), 3 months post-SCD, he saw large weight loss, all health issues got better, meds were reduced from 19! Remarkable outcome!

Crohn’s affects typically the right side of the bowel where the ileum is and some portion of the large colon. Many have Crohn’s for years but don’t know it because asymptomatic until some event occurs (blockage, anemic, growth stops…). The cause of IBD is: Must have a genetically susceptible host, it is more common in the Jewish population and is not seen in Africa, 3rd world countries, tropics, but if they move to Europe or US, some environmental thing triggers IBD (diet, pollution, plastics…). IBD involves the interaction with genes, microbiome, and the environmental triggers. Each person’s IBD is personalized and unique.

Medicine and surgery. David Sakar and Dan Present taught him the most: Surgery is not failure. Surgery is necessary for: Cancer, hemorrhaging, perforations, toxicity in the intestine that shuts down the body, abscesses. Surgery is also appropriate for patients that fail ALL other treatments including diet changes, and for those with repeated blockages (those typically occur due to scar tissue from inflammation).

TWO goals for medicine AND diet are: Improve how the patient feels AND prevent natural progression of IBD by putting IBD into remission. 1/2 to 2/3 Chron’s patients will require 1 surgery in their lifetime (typically 7 to 10 yrs after diagnosis). After that first surgery, 1/2 of those having one surgery will require a second surgery. He’d use medicines if there is a long segment of inflammation (3 to 4 foot). If it is a short segment 3 or 4 inches he would not use meds because they may need only surgery in 7 to 10 years. All rest of inflammation lengths are in between the medicine/no medicine/diet arena.

The meds. Mesalamine (use with UC, has few side effects, many tolerate it well). Dr. George tries to not frequently use predisone but they work quickly short term. Injected/oral type meds suppress immune system: 1/3 to 1/2 patients don’t get better on mesalamaine only.

6MP tablet suppresses immune system by lowering a type of white blood cell, has been around since 1970s. Can get pregnant on 6MP. Side effects: infections and other.

Methotrexate is an injection he uses infrequently. Women cannot get pregnant on it.

Biologics. Anti-TNF meds work in 40-70% patients, are: Remicade Humira, and Cimzia. These block a protein that white blood cells secrete when they are activated by inflammation. Side effects include the body rejects it. They add 6MP to lower rejection risk, but this further increase the risk of infection and lymphoma (cancer of lymph nodes).

Entivio med works in 40 to 60% patients: Blocks the action of the molecules that pull white blood cells out of blood vessels and into the intestine. This doesn’t occur elsewhere in the body; it occurs at the intestine only so no throughout body increased risk of disease.

DIET WORKS, but not in everyone. Evidence finds that pediatric Crohn’s given ENN, completely digested food (amino acids, proteins) immediately absorbed heal same as if given prednisone, IF Crohn’s patients stop eating, the inflammation goes away. Elaine Gottshall’s daughter (BTVC book on SCD) had celiac and UC. She achieved remission on SCD. SCD alters the microbiome and that alters the immune system so the intestine heals. Ms Weiss and Dr. George wrote the 12pg protocol for SCD. Mt Sinai docs are finally starting to agree that diet helps to address microbiome, immunity pre-post SCD. A study requires $450 K so there is no funding. SCD is not a drug so no pharma funding.

Diet: Using diet, the body no longer promotes inflammation. The body no longer attacks itself. Dr. George recommends strict SCD for at least a couple years, get immune system to change, then add in foods one at a time and see if can tolerate. Also need to reduce stress, exercise. You will never go back to eating things that are not meant to be inside of us. Celiac, psoriasis, eczema all go away with diet. Gluten free diet strengthens intestine and stops penetration of bacteria into it. IBDers are use to being on “diets” because you know you feel better. It takes inner strength to say I won’t eat that because ramifications are it will affect your health. He tells patients to remember what you felt like before the diet. Patients using diet needs physician follow (preferably someone familiar with IBD) to ensure in remission.

Once you achieve remission, the real Q is: How long must you continue to take med? How long must you continue to be on diet? 6MP used for UC (his paper 1999) if in remission then stop 6MP, 90% flare within 1 yr bc immune system goes back to the way it was. You will need to go back and re-change the white blood cells…

For Biologics. Only 20% will be able to make 4yrs with remission, but for those that do: They are in remission (meaning blood tests, CAT, scope all normal) only 1/2 or less will stay in remission.

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Patricia Carter says:

May 14, 2018 at 9:16 am

Dr. Suskind How to Do SCD Everyday YouTube, Oct 2017, https://www.youtube.com/watch?v=WR0NuGyM4_U

There are 3 steps to the SCD Diet (Introduction and anti-inflammation, Foundation and Maintenance, Food Reintroduction).These are not “Stages”, as other websites discusses. Rather these are the NIMBAL steps that are used to monitor success of SCD dietary intervention. There is a 2 week followup after initiating SCD, and patients are re-seen thereafter every 2 weeks for followup until they feel well. Factors looked at in follow-up are: How are they feeling, symptoms, weight, and lab markers.

Step 1 (Introduction and Anti-inflammation). Step 1 takes a few weeks or months. What to Eat: Broth is a staple. Other foods included are: applesauce, SCD yogurt, diluted fruit juices, meat patties, and eggs. There can be abdominal discomfort but typically it is milder than an IBD flare. This can be related to hunger pains or bad bacteria dying off. Gradually, other SCD foods are added and they include fresh fruits, vegs, nut flours, lentils, beans. Eventually, diet is advanced to the full SCD which leads to Step 2.

Step 2 (Foundation and Maintenance). Here you are eating all SCD foods though still introducing them in a step-wise manner. Goal in Step 2 is clinical remission (all symptoms have gone away). Clinical remission can occur within days, weeks, or few months. If SCD alone is not working, so the patient is asymptomatic but still has elevated fecal calprotectin, medicine should be added.

Step 3 is Food Reintroduction, which adds more variety and choices, but it isn’t necessary. Foods added having the most success are rice, oats, quinoa, and cocoa. Dr. Suskind prefers strict SCD. The problem with adding in new foods is: They may trigger a flare, and some find it hard to STOP eating the new foods. If symptoms return or if lab studies are elevated at one month out, the food is omitted. Each person’s end diet is personalized and individualized, focusing on each person’s needs, to adjust the dietary therapy based on those individual needs.

It is important to continue follow-up even if doing well to catch inflammation early to be sure it doesn’t advance.

Dr. Suskind’s nutritionist Kim Braly says it takes a full month to learn SCD. At month 2, she suggests patients move out of their comfort zone and try new recipes such as SCD homemade ice cream, cashew cheesecakes, and cauliflower “rice” stir fry. These are things we’d never had known that can be used to make dishes that taste great! Braly notes that children’s palettes grow tons on SCD comparing pre-post SCD, and that is truly inspirational!

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Patricia Carter says:

April 20, 2018 at 10:21 am

[Suskind et al 2018] Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease, https://journals.lww.com/jcge/Fulltext/2018/02000/Clinical_and_Fecal_Microbial_Changes_With_Diet.13.aspx

Prospective study IBD mild to moderate patients started SCD with follow-up evaluations at 2, 4, 8, and 12 weeks. PCDAI/PUCAI, laboratory studies were assessed.

Results: Twelve patients, ages 10 to 17 years, were enrolled. Mean PCDAI decreased from 28.1±8.8 to 4.6±10.3 at 12 weeks. Mean PUCAI decreased from 28.3±23.1 to 6.7±11.6 at 12 weeks. Dietary therapy was ineffective for 2 patients while 2 individuals were unable to maintain the diet. Mean C-reactive protein decreased from 24.1±22.3 to 7.1±0.4 mg/L at 12 weeks in Seattle Cohort (nL<8.0 mg/L) and decreased from 20.7±10.9 to 4.8±4.5 mg/L at 12 weeks in Atlanta Cohort (nL<4.9 mg/L). Stool microbiome analysis showed a distinctive dysbiosis for each individual in most prediet microbiomes with significant changes in microbial composition after dietary change. The degree of mucosal healing in this study was not assessed with ileocolonoscopy, but objective evaluation of inflammation with both CRP and fecal calprotectin did support the improvements seen in clinical disease activity.

Conclusions: SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome. With clinical studies showing a positive impact of the SCD on symptoms and laboratory values,25,26,43,44 animal studies linking diet to the development of IBD in the setting of genetic predisposition,39,40,42 and broad patient interest in diet as therapy, the integration of diet into the treatment paradigm of IBD is likely to evolve over the coming years. The results of the study suggest an overall benefit for patients on the SCD with the majority of patients going into clinical remission and many showing an alteration of the microbiome.
Further prospective studies are required to fully assess the safety and efficacy of dietary therapy in patients with IBD.

Study Intervention: Patients went on to the SCD as the sole intervention for the entire 12 weeks of the study. Patients received one-on-one education and counseling by a dietitian trained in the SCD during each visit. Before each visit patients completed a 3-day food intake record to help assure compliance with the diet. Dietary education included overview of the SCD; which foods are included and excluded. The dietitian counseled on weight loss prevention/management and provided several resources to help with meal planning, recipe books, meal, and snack recommendations. A staged approach was used introducing new SCD foods in a stepwise manner, working toward the complete SCD. Patients followed-up and were in contact with the dietitian, research assistant, and primary gastroenterologist for questions and problem intervention with the diet over the 12-week study.

Assessment of Participants
Study subject initial evaluation included history, physical examination, and laboratory tests including complete blood count with differential, C-reactive protein (CRP), erythrocyte sedimentation rate, albumin, vitamin D level, a stool study for Clostridium difficile, bacterial pathogen culture and ova and parasites was performed, as well as stool calprotectin and microbiome analysis.

Patients had clinical follow-up at 2, 4, 8, and 12 weeks. Standardized questionnaires, including the PCDAI or PUCAI were completed during each study visit.20,21 In addition, patients had a physical examination and standard blood work including complete blood count, sedimentation rate, CRP, albumin, and stool for microbiome analysis at each follow-up visit. Stool calprotectin was carried out at weeks 4 and 12. Vitamin D level was measured at baseline and again at week 12.

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Patricia Carter says:

April 20, 2018 at 8:47 am

[Dubrovsky et al 2018] Effect of the Specific Carbohydrate Diet on the Microbiome of a Primary Sclerosing Cholangitis and Ulcerative Colitis Patient.

This case study (IBD UC patient on Remicade, then off Remicade adding in SCD) supports the hypothesis that the SCD’s therapeutic actions stem from a change in microbiome composition. This case study identifies Fusobacterium ulcerans, a species not already noted in the literature as associated with IBD, as another potential target for dietary intervention. This study also documents the therapeutic success and intestinal microbial changes in an adult IBD patient as opposed to the pediatric patients in the Suskind et al. study.

Although Fusobacterium dramatically decreased in relative abundance following the SCD, they remained the dominant species in this patient’s microbiome. Thus, the subject’s improved symptoms could be due in part to an increase in other microbial species, rather than a decrease in Fusobacterium. In addition, Veillonella remained among the dominant species in the post-diet sample, which is concerning since Kasai et al. report an increased risk of adenocarcinoma in the presence of both species [8]. In fact, Veillonella abundance was not clearly affected by the SCD, given the large pre-diet variation in Veillonella. This may be an important species to study in the future, considering its presence in many PSC patient microbiomes and rarity in healthy microbiomes. Despite a substantial post-diet increase in some species abundance, overall diversity did not rise to the level seen for control samples. While the short duration of the study and the patient’s antibiotic regimen may have limited visible effects, the SCD may not be able to fully correct IBD-related dysbiosis.

Conclusions. The SCD was an effective therapy for IBD in this patient with IBD and PSC. Determining factors for SCD efficacy may involve the dominant intestinal bacterial species and may thus be patient specific, arguing for microbiome analysis as a diagnostic tool. While there are effective and potent downstream medications, it would be more advantageous to treat upstream causes of IBD. More research is needed to illuminate interactions between vancomycin dosing, PSC, microbial composition, and IBD symptoms and how they may differ between individual patients.

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Patricia Carter says:

April 8, 2018 at 2:06 pm

[Marion-Letellier et al 2016] IBD: In Food We Trust, https://www.ncbi.nlm.nih.gov/pubmed/27194533.

this report goes through innate immunity with focus on IBD impact (so IL-6 and NOD2…) for specific nutrients, emulsifiers, maltodextrin, glutamine, arginine, tryptophan, fermented milk, curcumin, ginger, garlic extract, green tea EGGG, probiotics, FODMAPs prebiotics inulin, apple oligolactatan, honey.

Authors note that patients rely on lay website for diet and IBD impact. Need GI, dietitian, and nutritionist to use evidence based nutrition counseling.

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Patricia Carter says:

February 7, 2018 at 4:45 pm

Here is the July 2017 Webinar that explains SCD and the PRODUCE study, Dietary Therapy for IBD in the PRODUCE Study (PRODUCE Site Training #1). https://www.youtube.com/watch?v=rcikdE_pE98

In sum, PRODUCE is an acronym that stands for Personalized Research on Diet in Ulcerative Colitis and Crohn’s Disease. This study is a first of its kind nutrition intervention study in IBD. With evidence showing dietary intervention has an impact on disease activity for patients with IBD, the PRODUCE study aims to determine the effectiveness of the SCD in reducing symptoms and inflammatory burden in patients with IBD and compare this to a modified form of the SCD. Over the course of this project, a series of N-of-1 studies will be used to examine how the SCD affects individual patients. In addition, we will combine the results of approximately 100 individual N-of-1 studies to look at the effectiveness of the SCD in the pediatric IBD population.

Food relaxation requirements from strict SCD adherence:

Oats, rice, organic sweet potatoes:
Per Day: Maximum of two servings of any
item or combination of items,
Per Week: Minimum of 3 servings and
maximum of 6 servings of any item or
combination of items,
Serving size: 1 cup.

Maple syrup, cocoa: Per week: Maximum of ½ cup of each item.

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Patricia Carter says:

February 7, 2018 at 3:21 pm

An Interview With Dr. David Suskind: Why Diet Therapy Helps IBD. Posted on Caleb’s Cooking Company at: https://calebscookingcompany.com/an-interview-with-dr-david-suskind-why-diet-therapy-helps-ibd/

SCD diet works by not only changing the fecal micro biome or the bacteria within the GI tract. As you and many people know, the fecal micro biome is this diverse world within our GI tract, made up of a hundred trillion bacteria with diverse different species. Some of them are helpful, and some of them can instigate an inflammatory response. Diet actually shifts the type of bacteria you have in the GI tract. With the SCD, we believe it’s shifting it to a less inflammatory community of bacteria, but it’s probably not only the micro biome.

In addition, the SCD Diet removes many foods that are known to break down the intestinal integrity, or the wall that keeps out the bacteria from the body. There are many foods like emulsifiers and food additives that have been placed into the diet of a lot of processed foods that have been shown to break down that wall and make for a leaky gut, for lack of a better term. It’s probably those two components, the changing of the micro biome, as well as the breakdown of the wall, which can have a positive or negative effect on IBD.

The PRODUCE study is a phenomenal multi-center study, which is looking at how the SCD affects individuals with Crohn’s disease and Ulcerative Colitis. It is phenomenal primarily because it is a push by the medical establishment, medical world to really start answering the question of how diet affects patients with IBD. This is the first of its kind.

On other IBD diet studies: Actually, there has been a significant push with a number of studies that are being done on diet and IBD. We ourselves have four additional studies here at Seattle Children’s, looking at diet and IBD. The University of Washington, a fellow by the name of Tim Zisman has two studies that are undergoing. There are multiple other studies across the nation that have begun, as well. I think for patients who are interested or individuals who are interested, the best way of finding out these studies are by going clinicaltrials.gov. You can get a list of all the studies that are being done in the US in any area.

What is special about his facility? I think we’ve had a very supportive hospital, division and very supportive patient population. We have been very lucky as a center to have all the pieces fall into place rather well.
We have a hospital, which really wants to make sure and advocate for the patient, as well as advocating for interventions that are nutrition-based. Our hospital actually has made a new kitchen, which produces all the food, which is fresh, for patients and families, as well as staff. The other phenomenal thing about our hospital is that through our research and through what we’ve been able to show the hospital, they’ve become very supportive of the concept of dietary therapy in IBD and actually produce SCD foods for individuals who are in the hospital who want to start the diet or who are on the diet.

My hope is multifold. My hope is that the SCD is a part of any center’s treatment options and care. My hope is that we are studying the SCD further so we really know the impact of the different foods that we’re eating. I know from the studies that we’re doing that there are some foods that are SCD illegal that we’ve been able to add in without issue. Making this diet more doable for patients, making it easier for patients is another hope and desire. I think another and extremely important hope and desire from not only the SCD, but the research that is being done in SCD is really giving us a clear idea of the cause, the etiology of IBD, because we do know that the genes are an important component of IBD, but we also know the micro biome is. You’re really studying the micro biome in IBD, and I think that’s going to give us answers for a cure one day.

There are individuals who should not be on the SCD. Patients who are significantly malnourished, with stricturing disease should not use the SCD. In addition patients with abscesses should not use the SCD as primary therapy. Treatment needs to be tailored to the individual; it needs to be personalized. For example for patients who are malnourished, there is EEN or Exclusive Enteral Nutrition which has been shown to have a very positive effect with clinical and biochemical remission in at least 80% of patients. From there patients can go on to the SCD. Medicine needs to really focusing on the individual to make sure that the dietary therapy is right for any patient at any one given point in time.

Cindy Frei:

Pam Ferro and I are starting to work together to raise awareness around SCD and the Autistic community. They’re seeing tremendous improvement in autistic symptoms with kids on SCD. Kids that are moving from non-verbal to verbal, and repetitive movements resolve and cognition is improving, really dramatic results. Have you worked with or heard about SCD with the autistic community or other conditions utilizing the SCD Diet? David Suskind: Yeah, I definitely have heard of it. I don’t have any personal experience with it. It would be outside of my area of expertise. Hopefully, just like in the IBD world, there will be individuals in the Autism world that will take this cause up and further research. It is the push forward of the families. It’s the push forward of individual investigators that hopefully will make that work.

The key really is to make sure that patients advocate for themselves, that they learn as much as their healthcare providers know, and that they work as a team with their healthcare providers, because nutrition, diet, is a lifestyle change. The doc is definitely there to help and make sure things go well, but nobody knows everything.

On diet therapy: Especially in terms of nutrition, being an advocate for yourself is very important. This is something I think is new for many healthcare providers, but if patients are positive and proactive, they can definitely get their docs onboard.

Change comes. It always comes very slowly, but it comes. I really do think that in the next five, ten years that dietary therapy will be a central part of everybody’s therapy.

Even if individuals are not on the SCD as their primary therapy, making sure individuals eat an overall healthy diet, removing as much of the food additives and increasing as much of the fruits and vegetables in an individual’s diet is going to have a big impact on IBD itself. Yeah, I think that may be the biggest message.

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Patricia Carter says:

January 19, 2018 at 1:04 pm

[Konijeti et al 2017] Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647120/

For the autoimmune protocol, patients underwent 6-week elimination followed by 5-week maintenance phase. Clinical indices, laboratories, and biomarkers were assessed at baseline and weeks 6 and 11. Endoscopy was performed at study completion.

Results:
The final cohort included 15 patients with IBD, with mean disease duration 19 years (SD 14.6) and active biological use in 7 (47%) patients. Nutrient repletion was initiated for deficiencies in vitamin D (n = 3) and iron (n = 6). From week 0 to weeks 6 and 11, mean partial Mayo score significantly improved from 5.8 (SD 1.2) to 1.2 (SD 2.0) and 1.0 (SD 2.0) for ulcerative colitis, and mean Harvey–Bradshaw index significantly improved from 7 (SD 1.5) to 3.6 (SD 2.1) and 3.4 (SD 2.6) for Crohn’s disease. C-reactive protein did not significantly change during study. Mean fecal calprotectin improved from 471 (SD 562) to 112 (SD 104) at week 11 (P = 0.12). Among those with follow-up endoscopy at week 11 (n = 7), improvements were noted in simple endoscopic score for Crohn’s disease (n = 1), Rutgeerts score (n = 1), and Mayo endoscopy subscore (n = 4).

In conclusion, our study demonstrates that dietary modification focused on elimination of potentially immunogenic or intolerant food groups has the potential to improve symptoms and endoscopic inflammation in patients with IBD. Dietary change can be an important adjunct to IBD therapy not only to achieve remission but perhaps improve the durability of response and remission. Perhaps for a subset of patients, dietary and lifestyle modification alone may be sufficient to control underlying luminal inflammation. Patients wishing to incorporate dietary therapy should be counseled on options assessed for micronutrient deficiencies and monitored routinely. Integrating and coordinating care with health coaches and registered dieticians can allow for effective education and implementation of dietary modification over time, in accordance with unique patient goals as well. Larger randomized trials are needed to validate these findings and examine the long-term course of patients during reintroduction.

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Patricia Carter says:

January 19, 2018 at 12:59 pm

[Braly et al 2017] Nutritional Adequacy of the Specific Carbohydrate Diet in Pediatric Inflammatory Bowel Disease

This article has a delayed release (embargo) and will be available in PMC on November 1, 2018.

Kimberly Braly, Nila Williamson, Michele L. Shaffer, Dale Lee, Ghassan Wahbeh, Jani Klein, Matthew Giefer, David L. Suskind

https://www.ncbi.nlm.nih.gov/pubmed/28825603
Abstract
INTRODUCTION:
The specific carbohydrate diet (SCD) is an exclusion diet used as a therapy in inflammatory bowel disease. The aim of this study was to evaluate the nutritional adequacy of the SCD.

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

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

CONCLUSIONS:
Nutrient intake of pediatric inflammatory bowel disease patients on the SCD was adequate when compared with a healthy peer reference population, but adequacy was variable when compared with the dietary recommended intakes. Close monitoring with a multidisciplinary team for patients using the SCD as an alternative or adjunct therapy is recommend to ensure positive outcomes for overall patient health.

J Pediatr Gastroenterol Nutr. Author manuscript; available in PMC 2018 Nov 1.
Published in final edited form as: J Pediatr Gastroenterol Nutr. 2017 Nov; 65(5): 533–538. doi: 10.1097/MPG.0000000000001613
PMCID: PMC5653423
Related Manuscript ID: NIHMS870022
Reason: This article has a delayed release (embargo) and will be available in PMC on November 1, 2018. An abstract of the article is available in PubMed, which may also have a link to the full text at the journal site.
URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653423/
Message ID: 53429879 (ipmc12)
Time: 2018/01/19 12:54:49

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Patricia Carter says:

August 18, 2017 at 5:36 pm

The microbiota in inflammatory bowel disease: current and therapeutic insights, June 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473501/

This review will characterize the factors involved in the development of the intestinal microbiome and will describe the typical alterations in the microbiota that are characteristic of inflammatory bowel disease. Additionally, this manuscript will summarize the early but promising literature on the role of the gut microbiota in the pathogenesis of inflammatory bowel disease with implications for utilizing this data for diagnostic or therapeutic application in the clinical management of patients with these diseases

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Patricia Carter says:

August 18, 2017 at 8:55 am

Crohns has 2 signature microbiomes. EEN did not change microbiome, but changed SCFAs! June 2017.

See PDF full text at: http://orbit.dtu.dk/files/133980137/gix050.pdf

See Pubmed at: Two distinct metacommunities characterize the gut microbiota in Crohn’s disease patients, https://www.ncbi.nlm.nih.gov/pubmed/28655159

Prior analyses of the gut microbiota in CD have used 16S rDNA amplicon sequencing. Here we employed metagenomic shotgun sequencing to provide a detailed characterization of the
compositional and functional features of the CD microbiota, comprising also unannotated bacteria, and investigated its modulation by exclusive enteral nutrition (EEN).

Found: Enrichment in producers of the pro-inflammatory hexa-acylated lipopolysaccharide variant and a reduction in the potential to
synthesize short chain fatty acids. Disruption of ecological networks was evident in CD, coupled with reduction in growth rates of many bacterial species. Short-term EEN elicited limited impact on the overall composition of the CD microbiota, although functional changes
occurred following treatment.

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Patricia Carter says:

May 6, 2017 at 10:16 am

Keep an eye on the PRODUCE study coming from ImproveCareNow. This study, recruiting in July 2017, looks at the effectiveness of the SCD in reducing symptoms in patients with IBD as compared to a liberalized SCD or unrestricted diet. Study details are: http://www.pcori.org/research-results/2016/using-single-subject-n-1-designs-answer-patient-identified-research-questions

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Phoebe Spanier says:

March 25, 2017 at 8:57 pm

This article was posted on the Yahoo BTVC group. Thanks for taking the time to pull together all this information and resources. I will definitely save and refer to this.

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1. Patricia Carter says:
  
  March 26, 2017 at 2:13 pm
  
  Thank you for your kind words. I truly hope the article helps and encourages people to give SCD a try (no matter their disease condition). For SCD to induce remission in what was a highly compromised IBD gut, SCD must be doing MANY great things for the microbiome!
  
  Reply