On a few occasions, I have been asked by families in the clinic about the specific carbohydrate diet (SCD) as a treatment option in IBD. SCD was initially used to treat coeliac disease in the mid-20th century and was subsequently popularised in the 1990s. SCD excludes grains like wheat, barley, corn and rice, and uses flours such as almond and coconut flours to make bread and other baked food items. Additionally, sugar is limited to honey, and milk restricted to fully fermented yogurts. Although the mechanism is not entirely clear, it is hypothesised that SCD decreases intestinal inflammation by changing the faecal microbiome from a pro-inflammatory state to a non-inflammatory state. Based on emerging data, Seattle Children’s Hospital IBD Center has developed an integrated dietary programme incorporating SCD into their treatment protocols.
In this paper* published by the Seattle group, the authors evaluate the potential effects of the SCD, both as a primary therapy as well as an adjunctive therapy in patients with IBD. In this study, a retrospective review of medical records was conducted in 26 children with IBD who were on the SCD. The study demonstrated that SCD had a positive effect on both symptoms and inflammatory markers in patients with IBD. Some of the limitations of the study include the small size of the patient cohort, retrospective and descriptive nature of the study, variation of diet monitoring and compliance of patients while on the SCD, and the likely influence of concurrent drugs on the assessed clinical outcomes of the study. Although the disease severity scores improved while on this diet, approximately 35% of patients lost weight during the study period.
SCD is not without potential adverse outcomes. Apart from an inadequate weight gain, ensuring a ‘normal’ quality of life can be challenging on a rigorous diet such as the SCD. Diet can be a significant stressor between the patient and the parent, and there’s a potential risk of isolation from one’s peers.
Despite the limitations, the authors believe that SCD could be a possible therapeutic option in IBD, although further studies with larger cohorts may be necessary to evaluate its precise role.
*(Journal Nutrition, April 2016)