Specific carbohydrate diet

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The specific carbohydrate diet (SCD) is a restrictive diet originally created to manage celiac disease; it limits the use of complex carbohydrates (disaccharides and polysaccharides). Monosaccharides are allowed, and various foods including fish, aged cheese and honey are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products. [1] It is a gluten-free diet since no grains are permitted. [2]

Contents

Origins

In 1924, Sidney V. Haas (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the banana diet. [2] [3] Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died. [4] The banana SCD was the cornerstone of celiac therapy for decades until bread shortages in the Netherlands caused by World War II caused children with celiac disease to improve, which led to the isolation of wheat proteins, not starches, as the cause of celiac disease. [4] Before the banana SCD, one out of four children with celiac died. [3] After more research, he described the SCD as a treatment for celiac disease and inflammatory bowel disease (IBD) in his 1951 medical textbook The Management of Celiac Disease; Haas never accepted the finding that wheat gluten was the damaging part of wheat; he insisted it was starch and called the discovery about a gluten a "disservice." [5]

The diet was later re-popularized by biochemist Elaine Gottschall, the mother of one of Haas's patients, in her 1996 book Breaking the Vicious Cycle. [2] [6] Gottschall's daughter was reported to been cured of ulcerative colitis in two years by SCD. [1] Gottschall described the theory of how restricting diet might reduce gut inflammation associated with various medical conditions. [2] Gottschall asserted that the diet could "cure" a number of medical conditions without providing data. [6] Gottschall advocated using SCD to treat Crohn's disease, ulcerative colitis, diverticulitis, cystic fibrosis, chronic diarrhea, and autism. [1]

Unconfirmed claims

The claims that the SCD is beneficial for children with autism are based on the supposition they have too much harmful bacteria in their gut. [7] While limited evidence suggests the SCD can be beneficial, there is a concern the restrictive nature of the diet may cause nutritional deficiencies. [8] Parents adopting the SCD for their children are at risk of experiencing guilt when their expectations of improvement are dashed. [7] [9] The SCD is one of many unevidenced treatments offered for children with special needs that have the characteristic signs of being pseudoscientific. [7]

A 2013 review on SCD and other exclusion diets concluded: "However, we lack large prospective controlled trials to provide the dietary recommendations patients’ desire. Taken together, studies of exclusive enteral nutrition, exclusion diets, and semi-vegetarian diets suggest that minimizing exposure of the intestinal lumen to selected food items may prolong the remission state of patients with inflammatory bowel disease. Even less evidence exists for the efficacy of the SCD, FODMAP, or Paleo diet. " [2] It also said that the diet risks imposition of an undue financial burden and potentially causes malnutrition. [2]

As of 2017 there was preliminary evidence that the SCD may help relieve the symptoms of adults with inflammatory bowel disease. [10]

The Gut and Psychology Syndrome Diet (GAPS Diet) is an even more restrictive variant of the SCD, devised by a Russian neurologist. [11] [12] The diet is promoted with claims it can treat a wide variety of conditions including autism, schizophrenia and epilepsy. [11] [12] Like the SCD, claims of the diet's usefulness for children with autism are not supported by scientific studies. [11] Harriet Hall has described the GAPS diet as "a mishmash of half-truths, pseudoscience, imagination, and untested claims", [12] and Quackwatch includes the GAPS Diet in its Index of questionable treatments. [13]

See also

Related Research Articles

Diarrhea Loose or liquid bowel movements

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination, loss of skin color, a fast heart rate, and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed, however, are normal.

Crohns disease Type of inflammatory bowel disease

Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever, abdominal distension, and weight loss. Complications outside of the gastrointestinal tract may include anemia, skin rashes, arthritis, inflammation of the eye, and fatigue. The skin rashes may be due to infections as well as pyoderma gangrenosum or erythema nodosum. Bowel obstruction may occur as a complication of chronic inflammation, and those with the disease are at greater risk of colon cancer and small bowel cancer.

Coeliac disease Autoimmune disorder that results in a reaction to gluten

Coeliac disease is a long-term autoimmune disorder, primarily affecting the small intestine, where individuals develop intolerance to gluten, present in foods such as wheat, rye and barley. Classic symptoms include gastrointestinal problems such as chronic diarrhoea, abdominal distention, malabsorption, loss of appetite, and among children failure to grow normally. This often begins between six months and two years of age. Non-classic symptoms are more common, especially in people older than two years. There may be mild or absent gastrointestinal symptoms, a wide number of symptoms involving any part of the body, or no obvious symptoms. Coeliac disease was first described in childhood; however, it may develop at any age. It is associated with other autoimmune diseases, such as Type 1 diabetes mellitus and Hashimoto's thyroiditis, among others.

Ulcerative colitis Inflammatory bowel disease that causes ulcers in the colon

Ulcerative colitis (UC) is a long-term condition that results in inflammation and ulcers of the colon and rectum. The primary symptoms of active disease are abdominal pain and diarrhea mixed with blood. Weight loss, fever, and anemia may also occur. Often, symptoms come on slowly and can range from mild to severe. Symptoms typically occur intermittently with periods of no symptoms between flares. Complications may include abnormal dilation of the colon (megacolon), inflammation of the eye, joints, or liver, and colon cancer.

Dietary fiber Portion of plant-derived food that cannot be completely digested

Dietary fiber or roughage is the portion of plant-derived food that cannot be completely broken down by human digestive enzymes. Dietary fibers are diverse in chemical composition, and can be grouped generally by their solubility, viscosity, and fermentability, which affect how fibers are processed in the body. Dietary fiber has two main components: soluble fiber and insoluble fiber, which are components of plant foods, such as legumes, whole grains and cereals, vegetables, fruits, and nuts or seeds. A diet high in regular fiber consumption is generally associated with supporting health and lowering the risk of several diseases.

Irritable bowel syndrome Functional gastrointestinal disorder

Irritable bowel syndrome (IBS), referred to previously as spastic or nervous colon, and spastic bowel, is a functional gastrointestinal disorder characterized by a group of symptoms accompanied together that include abdominal pain and changes in the consistency of bowel movements. These symptoms occur over a long time, often years. It has been classified into four main types depending on whether diarrhea is common, constipation is common, both are common (mixed/alternating), or neither occurs very often. IBS negatively affects quality of life and may result in missed school or work. Disorders such as anxiety, major depression, and chronic fatigue syndrome are common among people with IBS. IBS does not lead to malabsorption.

Inflammatory bowel disease Medical condition

Inflammatory bowel disease (IBD) is a group of inflammatory conditions of the colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine and large intestine, as well as the mouth, esophagus, stomach and the anus, whereas ulcerative colitis primarily affects the colon and the rectum.

Gluten-free diet Diet excluding proteins found in wheat, barley, and rye

A gluten-free diet (GFD) is a nutritional plan that strictly excludes gluten, which is a mixture of proteins found in wheat, as well as barley, rye, and oats. The inclusion of oats in a gluten-free diet remains controversial, and may depend on the oat cultivar and the frequent cross-contamination with other gluten-containing cereals.

Colitis Inflammation of the colon (large intestine)

Colitis is an inflammation of the colon. Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.

Proctitis is an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum.

A low-fiber/low-residue diet is a diet whose goal is fewer and smaller bowel movements each day. The diet may be used as part of the bowel preparation before a diagnostic procedure such as colonoscopy or as a short-term therapy for acute stages of gastrointestinal illnesses such as Crohn's disease, diverticulitis, bowel obstruction, and ulcerative colitis. In addition, a low-fiber diet is often prescribed before and/or after abdominal surgery or cancer treatments.

Abdominal distension Physical symptom

Abdominal distension occurs when substances, such as air (gas) or fluid, accumulate in the abdomen causing its expansion. It is typically a symptom of an underlying disease or dysfunction in the body, rather than an illness in its own right. People suffering from this condition often describe it as "feeling bloated". Sufferers often experience a sensation of fullness, abdominal pressure, and sometimes nausea, pain, or cramping. In the most extreme cases, upward pressure on the diaphragm and lungs can also cause shortness of breath. Through a variety of causes, bloating is most commonly due to buildup of gas in the stomach, small intestine, or colon. The pressure sensation is often relieved, or at least lessened, by belching or flatulence. Medications that settle gas in the stomach and intestines are also commonly used to treat the discomfort and lessen the abdominal distension.

Descending colon

In the anatomy of humans and homologous primates, the descending colon is the part of the colon from the splenic flexure to the beginning of the sigmoid colon. The function of the descending colon in the digestive system is to store the remains of digested food that will be emptied into the rectum.

Gluten-related disorders Set of diseases caused by gluten exposure

Gluten-related disorders is the term for the diseases triggered by gluten, including celiac disease (CD), non-celiac gluten sensitivity (NCGS), gluten ataxia, dermatitis herpetiformis (DH) and wheat allergy. The umbrella category has also been referred to as gluten intolerance, though a multi-disciplinary physician-led study, based in part on the 2011 International Coeliac Disease Symposium, concluded that the use of this term should be avoided due to a lack of specificity.

Vedolizumab, sold under the brand name Entyvio, is a monoclonal antibody medication developed by Millennium Pharmaceuticals, Inc. for the treatment of ulcerative colitis and Crohn's disease. It binds to integrin α4β7. Blocking the α4β7 integrin results in gut-selective anti-inflammatory activity.

FODMAPs or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols are short chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon. They include short chain oligosaccharide polymers of fructose (fructans) and galactooligosaccharides, disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols), such as sorbitol, mannitol, xylitol, and maltitol. Most FODMAPs are naturally present in food and the human diet, but the polyols may be added artificially in commercially prepared foods and beverages.

Sidney Valentine Haas, M.D. (1870–1964) was a U.S. pediatrician whose research determined a dietary means of combating celiac disease.

Serum-derived bovine immunoglobulin/protein isolate (SBI) is a medical food product derived from bovine serum obtained from adult cows in the United States. It is sold under the name EnteraGam.

A low-FODMAP diet consists of a concerned individual's global restriction of consumption of all fermentable carbohydrates (FODMAPs), that is recommended only for a short time. A low-FODMAP diet is recommended for managing patients with irritable bowel syndrome (IBS) and can reduce digestive symptoms of IBS including bloating and flatulence.

Segmental colitis associated with diverticulosis Medical condition

Segmental colitis associated with diverticulosis (SCAD) is a condition characterized by localized inflammation in the colon, which spares the rectum and is associated with multiple sac-like protrusions or pouches in the wall of the colon (diverticulosis). Unlike diverticulitis, SCAD involves inflammation of the colon between diverticula, while sparing the diverticular orifices. SCAD may lead to abdominal pain, especially in the left lower quadrant, intermittent rectal bleeding and chronic diarrhea.

References

  1. 1 2 3 Brown, Amy C.; Roy, Minakshi (2010). "Does evidence exist to include dietary therapy in the treatment of Crohn's disease?". Expert Review of Gastroenterology & Hepatology (Review). 4 (2): 191–215. doi:10.1586/egh.10.11. ISSN   1747-4132. PMID   20350266. S2CID   207210268.
  2. 1 2 3 4 5 6 Hou JK, Lee D, Lewis J (October 2014). "Diet and inflammatory bowel disease: review of patient-targeted recommendations". Clin. Gastroenterol. Hepatol. (Review). 12 (10): 1592–600. doi:10.1016/j.cgh.2013.09.063. PMC   4021001 . PMID   24107394.
  3. 1 2 "Dr. Sidney Valentine Haas Dies". The New York Times. December 1, 1964. Archived from the original on March 12, 2018. Retrieved 2017-04-28.
  4. 1 2 "A Brief History of Celiac Disease" (PDF). Impact: The University of Chicago Celiac Disease Center, Summer 2007. Summer 2007. Archived (PDF) from the original on 2016-03-04. Retrieved 2017-04-28.
  5. ↑ Guandalini, S (2008). "Historical Perspective of Celiac Disease". In Fasano, Alessio; Troncone, Riccardo; Branski, David (eds.). Frontiers in celiac disease. Basel: Karger. p. 6. ISBN   9783805585262.
  6. 1 2 Fitzgibbon EJ (1998). "Breaking the Vicious Cycle. Intestinal Health Through Diet". Journal of Nutritional & Environmental Medicine (Book review). 8 (1): 86. I was looking for data to support the claims of cure, but nothing
  7. 1 2 3 Deisinger JA (2010). Obiakor FE, Bakken JP, Rotatori AF (eds.). Chapter 14: Scientifically unsupported treatments for students with special needs. Current Issues and Trends in Special Education: Identification, Assessment and Instruction. Advances in special education. Vol. 19. Emerald. p. 220. doi:10.1108/S0270-4013(2010)0000019017. ISBN   978-1-84855-668-3. ISSN   0270-4013.
  8. ↑ "Nutritional interventions for autism spectrum disorder" (PDF). Nutrition Reviews. 78 (7).
  9. ↑ Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev (Review). 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID   15977319.
  10. ↑ Kakodkar S, Mutlu EA (2017). "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease". Gastroenterol Clin North Am (Review). 46 (4): 745–767. doi:10.1016/j.gtc.2017.08.016. PMC   5821251 . PMID   29173519.
  11. 1 2 3 Connor Z (2015). Shaw V (ed.). Autism spectrum disorders. Clinical Paediatric Dietetics (4th ed.). John Wiley & Sons. p. 686. ISBN   978-0470659984.
  12. 1 2 3 Hall HA (7 May 2013). "GAPS Diet". Science-based medicine. Archived from the original on 21 December 2018. Retrieved 14 December 2018.
  13. ↑ "Index of questionable treatments". Quackwatch. 3 September 2018. Archived from the original on 24 October 2018. Retrieved 14 December 2018.

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