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Specific Carbohydrate Diet (SCD) is a therapeutic eating plan utilized to treat a variety of conditions with primary use in inflammatory bowel disease (IBD), (categorized as Crohn’s disease or ulcerative colitis), irritable bowel syndrome (IBS), diverticulitis and celiac disease (CD) with benefits in other illnesses known to have gut bacterial disturbances such as autism and cystic fibrosis. The diet eliminates all grains (wheat, barley, rye, rice), soy, starchy vegetables like potatoes, sugar, and processed foods. A complete list of accepted foods can be found on the breaking the viscous cycle website under "legal/illegal". To achieve the end result, fanatical adherence is considered necessary for a prolonged period at this time, but studies evaluating a broader array of foods and slightly expanded diets with their roots in SCD like the Crohn's Disease Exclusion Diet (CDED), Gut and Psychology Syndrome diet (GAPS) and modified SCD are ongoing. The largest area of research with SCD is in IBD with positive findings in small patient trials with large clinical trials now underway.

History

The Specific Carbohydrate Diet was developed by Sydney Haas, MD who along with John Howland, MD served as assistants at Vanderbilt Clinic to L. Emmett Holt, Sr, MD, a physician at the turn of the twentieth century taking a lead role in the US studying celiac disease. Holt, together with Christian Herter, MD, a physician and pathologist from Columbia University, reported that the condition is associated with abnormal forms of bacteria and “may confidently be ascribed to the action of putrefactive products”. Howland reports “that of all the elements of food, carbohydrates is the one which must be excluded rigorously”. Howland’s treatment was very successful, but the need for some tolerable carbohydrate remained. Haas discovered a paper on “The value of Banana in the Treatment of Celiac Disease” and began incorporating carefully specific carbohydrates into the diet to determine the tolerability. The SCD, also known at the time in the 1940s’ as the “banana diet”, was met with great success in treating patients with gastrointestinal conditions diagnosed at the time as celiac disease based on symptoms, as no laboratory tests specific to celiac disease existed. ^[1]^[2]^[3]

SCD was popularized by Elaine Gotschall with the publication of her book, Food and the Gut Reaction: Intestinal Health through diet first edition published in 1987, with name change and now 15^th edition, Breaking the Vicious Cycle: Intestinal Health through diet. ^[4] Elaine’s daughter, Judy, diagnosed with UC at a very young age, was facing imminent colectomy but was restored to full health following the SCD. Soon after, Sydney Haas, MD passed away. Elaine was concerned that the knowledge of this diet was likely to fade with him as this diet was not recognized or utilized by most gastroenterologists. Only after much desperate seeking did she find Dr. Haas. Gotschall pursued her master’s degree in biology, nutritional biochemistry and cellular biology and with lifelong interest in the gastrointestinal system and diet she served as a consultant to hundreds of patients and with her publications she has helped thousands to restore their health. ^[5]

Mechanism of Action

Although old but not forgotten, the SCD is now gaining renewed interest in the community as well as the medical profession with the publication of a number of small patient trials and reports showing benefit in attaining remission for IBD. The postulated mechanism of benefit from the diet is that the condition of IBS or IBD is due to an overgrowth or imbalance of gut bacteria that can be corrected by the avoidance of specific carbohydrates that feed the overgrowth, hence the name Specific Carbohydrate Diet. The technology at the time of the development of this diet was not able to evaluate this hypothesis. However, with the current technology of gene sequencing combined with the improvements in data software analysis, the bacterial, viral, and fungal components encompassing the human microbiome are now analyzable and this is among the most active and exciting areas of research for all human diseases and in particular IBD.

It is now commonly accepted that dysbiosis (disruption of gut bacterial balance from normal) is the hallmark of IBD. ^[6] ^[7]^[8] Overall richness of the bacterial community is decreased with certain species found to be commonly overgrown in particular the phylum of Proteobacteria and members of the family of Enterobacteriaceae, and fungus including candida tropicalis and candida albicans, while other species tend to be either absent or under represented such as faecalibacterium prausnitzii of the Clostridium clade. ^[9] ^[10]^[11]^[12]^[13]The SCD has been shown to alter this balance of bacteria and shift it more toward that found in healthy population without disease. ^[14]^[15]

Research

The SCD has been shown to induce remission of Crohn’s disease, with reduction or elimination of symptoms, normalization of serum inflammatory markers and evidence of improved mucosal tissue by endoscopy,^[16]^[17] including remission in seven children with active Crohn’s disease without the use of concomitant medications. ^[18] These positive findings are considered a result of shifts in the microbiome due to dietary changes.

These small patient trials in combination with patient reports of improvements ^[19] ^[20] have prompted the renewed interest of dietary therapy for IBD. Two large scale ongoing trials of over 100 patients each are currently underway, PRODUCE (comparing SCD with modified SCD in pediatric patients),^[21] and DINE-CD (comparing SCD with the Mediterranean diet in adult patients).^[22] Additionally, there are over twenty smaller ongoing interventional trials evaluating aspects of diet, microbiome and IBD, many of which are utilizing SCD. ^[23]

As current research documents the role of diet in the pathogenesis and treatment of IBD, there are five ongoing large epidemiologic studies evaluating the relationship to diet and IBD, including the Prognostic Effect of Environmental Factors in Crohn’s and Colitis (PREdiCCT), Inflammation, Microbiome and Alimentation: Gastrointestinal and Neuropsychiatric Effects (IMAGINE), Chronic Inflammatory Disease, Lifestyle and Treatment Response (BELIEVE). ^[23]

Conclusion

Although the data from the small clinical trials described above have not drawn the attention of most gastroenterologists, the interest in dietary therapy for IBD is growing with the increased focus on the microbiome and the implications of it in the pathogenesis of IBD and the potential to manipulate it. Dietary therapy is welcomed by patients because, when utilized either alone or in combination with drug therapy, there is great potential to heal with no potential to harm.

References

^ Haas, Sidney Valentine; Haas, Merrill Patterson (1951). The Management of Celiac Disease. JB Lippincott Company: JB Lippincott Company. ISBN 978-1-258-19621-9.
^ HAAS, SV; Haas, MP (April 1955). "The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases". American Journal of Gastroenterology. 4: 344–60.
^ Haas, SV (May 1963). "Celiac Disease". NY State J Med. 63: 1346–50.
^ author., Gottschall, Elaine Gloria, 1921-. Breaking the vicious cycle : intestinal health through diet. ISBN 9780969276814. OCLC 1048262387. {{cite book}}: |last= has generic name (help)CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
^ [1. http://www.breakingtheviciouscycle.info/p/about-the-author/ "About the Author"]. {{cite web}}: Check |url= value (help); Cite has empty unknown parameter: |dead-url= (help); horizontal tab character in |url= at position 3 (help)
^ Nagalingam, Nabeetha A.; Lynch, Susan V. (2012-05). "Role of the microbiota in inflammatory bowel diseases". Inflammatory Bowel Diseases. 18 (5): 968–984. doi:10.1002/ibd.21866. ISSN 1078-0998. {{cite journal}}: Check date values in: |date= (help)
^ Zuo, Tao; Ng, Siew C. (2018). "The Gut Microbiota in the Pathogenesis and Therapeutics of Inflammatory Bowel Disease". Frontiers in Microbiology. 9. doi:10.3389/fmicb.2018.02247. ISSN 1664-302X. PMC 6167487. PMID 30319571.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ Hoarau, G.; Mukherjee, P. K.; Gower-Rousseau, C.; Hager, C.; Chandra, J.; Retuerto, M. A.; Neut, C.; Vermeire, S.; Clemente, J. (2016-09-20). "Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn's Disease". mBio. 7 (5). doi:10.1128/mbio.01250-16. ISSN 2150-7511.
^ Ni, J; Shen, TCD (Nov 2017). "A role for bacterial urease in gut dysbiosis and Crohn's disease". Sci Transl Med. 9: 416.
^ Pascal, V; Pozuelo, M (2017). "A microbial signature for Crohn's disease". Gut: 1–20.
^ Eom, Taekil; Kim, Yong Sung; Choi, Chang Hwan; Sadowsky, Michael J.; Unno, Tatsuya (2018-02-28). "Current understanding of microbiota- and dietary-therapies for treating inflammatory bowel disease". Journal of Microbiology. 56 (3): 189–198. doi:10.1007/s12275-018-8049-8. ISSN 1225-8873.
^ Aleksandrova, Krasimira; Romero-Mosquera, Beatriz; Hernandez, Vicent; Aleksandrova, Krasimira; Romero-Mosquera, Beatriz; Hernandez, Vicent (2017-08-30). "Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention". Nutrients. 9 (9): 962. doi:10.3390/nu9090962. PMC 5622722. PMID 28867793.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ Aleksandrova, Krasimira; Romero-Mosquera, Beatriz; Hernandez, Vicent; Aleksandrova, Krasimira; Romero-Mosquera, Beatriz; Hernandez, Vicent (2017-08-30). "Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention". Nutrients. 9 (9): 962. doi:10.3390/nu9090962. PMC 5622722. PMID 28867793.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
^ Walters, Sumathi Sankaran (2014). "Analysis of Gut Microbiome and Diet Modification in Patients with Crohn's Disease". SOJ Microbiology & Infectious Diseases. 2 (3). doi:10.15226/sojmid/2/3/00122. ISSN 2372-0956.
^ Suskind, DL; Cohen, SA (2016). "Clinical and Fecal Microbial Changes with Diet Therapy in Active Inflammatory Bowel Disease". J Clin Gastroenterol.
^ Cohen, SA; Gold, BD (Oct 2014). "Clinical and Mucosal Improvement with the Specific Carbohydrate Diet in Pediatric Crohn's Disease". J Pediatr Gastroenterol Nutr. 59(4): 516–21.
^ Obih, Chinonyelum; Wahbeh, Ghassan; Lee, Dale; Braly, Kim; Giefer, Matthew; Shaffer, Michele L.; Nielson, Heather; Suskind, David L. (2016-04). "Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center". Nutrition. 32 (4): 418–425. doi:10.1016/j.nut.2015.08.025. ISSN 0899-9007. {{cite journal}}: Check date values in: |date= (help)
^ Suskind, DL; Wahbeh, GH (2014). "Nutritional Therapy in Pediatric Crohn Disease: The Specific Carbohydrate Diet". JPGN. 58: 87–91.
^ Kakodkar, Samir; Farooqui, Azam J.; Mikolaitis, Sue L.; Mutlu, Ece A. (2015-08). "The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series". Journal of the Academy of Nutrition and Dietetics. 115 (8): 1226–1232. doi:10.1016/j.jand.2015.04.016. ISSN 2212-2672. {{cite journal}}: Check date values in: |date= (help)
^ Suskind, David L.; Wahbeh, Ghassan; Cohen, Stanley A.; Damman, Christopher J.; Klein, Jani; Braly, Kim; Shaffer, Michele; Lee, Dale (2016-09-16). "Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease". Digestive Diseases and Sciences. 61 (11): 3255–3260. doi:10.1007/s10620-016-4307-y. ISSN 0163-2116.
^ ImproveCareNow. "PRODUCE Study - ImproveCareNow". www.improvecarenow.org. Retrieved 2018-11-18.
^ "Comparative Effectiveness of Specific Carbohydrate and Mediterranean Diets to Induce Remission in Patients With Crohn's Disease". www.pcori.org. Retrieved 2018-11-18.
^ ^a ^b "Search of: diet | Inflammatory Bowel Diseases - List Results - ClinicalTrials.gov". Retrieved 2018-11-18.

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+'''Specific Carbohydrate Diet''' ('''SCD''') is a therapeutic eating plan utilized to treat a variety of conditions with primary use in inflammatory bowel disease (IBD), (categorized as Crohn’s disease or ulcerative colitis), irritable bowel syndrome (IBS), diverticulitis and celiac disease (CD) with benefits in other illnesses known to have gut bacterial disturbances such as autism and cystic fibrosis. The diet eliminates all grains (wheat, barley, rye, rice), soy, starchy vegetables like potatoes, sugar, and processed foods.  A complete list of accepted foods can be found on the breaking the viscous cycle website under "legal/illegal".  To achieve the end result, fanatical adherence is considered necessary for a prolonged period at this time, but studies evaluating a broader array of foods and slightly expanded diets with their roots in SCD like the Crohn's Disease Exclusion Diet (CDED), Gut and Psychology Syndrome diet (GAPS) and modified SCD are ongoing. The largest area of research with SCD is in IBD with positive findings in small patient trials with large clinical trials now underway.
-'''Specific carbohydrate diet''' ('''SCD''') is a restrictive diet first described by [[Sidney V. Haas]] (1870–1964) in 1924 to treat [[celiac disease]],<ref name=hou>{{cite journal |vauthors=Hou JK, Lee D, Lewis J |title=Diet and inflammatory bowel disease: review of patient-targeted recommendations |journal=Clin. Gastroenterol. Hepatol. |volume=12 |issue=10 |pages=1592–600 | date=October 2014 |pmid=24107394 |doi=10.1016/j.cgh.2013.09.063 |url=http://www.cghjournal.org/article/S1542-3565(13)01512-7/abstract|type=Review |pmc=4021001}}</ref> and further refined in his 1951 medical textbook ''The Management of Celiac Disease''.<ref name=haas>{{cite book |author1 = Haas, Sidney Valentine |author2 = Haas, Merrill P. |title = The Management of Celiac Disease| publisher = Literary Licensing | year = 1951 | isbn = 978-1-258-19621-9 | url=https://books.google.com/books?id=cylNAAAAMAAJ}}</ref> It was later re-popularized in 1987 by Elaine Gottschall, the mother of one of Haas's patients.<ref name=brown>{{cite journal|doi=10.1586/egh.10.11|pmid=20350266|title=Does evidence exist to include dietary therapy in the treatment of Crohn's disease?|year=2010|last1=Brown|first1=Amy C|last2=Roy|first2=M|journal=[[Expert Review of Gastroenterology & Hepatology]]|volume=4|issue=2|pages=191–215|type=Review|url=http://www.cghjournal.org/article/S1542-3565(13)01512-7/fulltext|name-list-format = vanc}}</ref>
-The SCD is a [[gluten-free diet]] since no grains are permitted,<ref name=hou/> and the SCD was a popular treatment for celiac disease decades before gluten was discovered.<ref name=uchicago/> The diet can prevent further gut damage in people with celiac<ref name=brown/> and might help manage flares in people with Crohns disease.<ref name=ccfa/>
 == History ==
-In 1924, the first Specific Carbohydrate Diet for the treatment of children with celiac disease was the [[banana]] diet.<ref name=nytimes>{{cite news|url=https://www.nytimes.com/1964/12/01/dr-sidney-valentine-haas-dies.html|title=Dr. Sidney Valentine Haas Dies| publisher =The New York Times|date =December 1, 1964|accessdate=2017-04-28}}</ref> Haas described a trial with 10 children, and all 8 children treated with bananas went into remission, and the two control children died.<ref name=uchicago/> 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.<ref name=uchicago>{{cite news | author = | title = A Brief History of Celiac Disease | publisher = Impact: The University of Chicago Celiac Disease Center, Summer 2007| date =Summer 2007 | url = http://www.cureceliacdisease.org/wp-content/uploads/2011/09/SU07CeliacCtr.News_.pdf | accessdate=2017-04-28}}</ref> Before the banana SCD, one of four children with celiac died.<ref name=nytimes/> After more research, he described the Specific Carbohydrate Diet as a treatment for celiac disease and inflammatory bowel disease in his 1951 medical textbook ''The Management of Celiac Disease''.<ref name=haas/>  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".<ref name=Guandalini>{{cite book|last1=Guandalini|first1=S|editor1-last=Fasano|editor1-first=Alessio|editor2-last=Troncone,|editor2-first=Riccardo|editor3-last=Branski|editor3-first=David|title=Frontiers in celiac disease|date=2008|publisher=Karger|location=Basel|isbn=9783805585262|page=6|chapter=Historical Perspective of Celiac Disease|chapter-url=https://books.google.com/books?id=gqaDD3jkcfYC&pg=PA6}}</ref>
+The Specific Carbohydrate Diet was developed by Sydney Haas, MD who along with John Howland, MD served as assistants at Vanderbilt Clinic to L. Emmett Holt, Sr, MD, a physician at the turn of the twentieth century taking a lead role in the US studying celiac disease. Holt, together with Christian Herter, MD, a physician and pathologist from Columbia University, reported that the condition is associated with abnormal forms of bacteria and “may confidently be ascribed to the action of putrefactive products”. Howland reports “that of all the elements of food, carbohydrates is the one which must be excluded rigorously”. Howland’s treatment was very successful, but the need for some tolerable carbohydrate remained. Haas discovered a paper on “The value of Banana in the Treatment of Celiac Disease” and began incorporating carefully specific carbohydrates into the diet to determine the tolerability. The SCD, also known at the time in the 1940s’ as the “banana diet”, was met with great success in treating patients with gastrointestinal conditions diagnosed at the time as celiac disease based on symptoms, as no laboratory tests specific to celiac disease existed. <ref>{{Cite book|title=The Management of Celiac Disease|last=Haas|first=Sidney Valentine|last2=Haas|first2=Merrill Patterson|publisher=JB Lippincott Company|year=1951|isbn=978-1-258-19621-9|location=JB Lippincott Company|pages=}}</ref><ref>{{Cite journal|last=HAAS|first=SV|last2=Haas|first2=MP|date=April 1955|title=The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases|url=|journal=American Journal of Gastroenterology|volume=4|pages=344-60|via=}}</ref><ref>{{Cite journal|last=Haas|first=SV|date=May 1963|title=Celiac Disease|url=|journal=NY State J Med|volume=63|pages=1346-50|via=}}</ref>
-The diet was later re-popularized by biochemist Elaine Gottschall the mother of one of Haas's patients, whose 1987 book ''Breaking the Vicious Cycle: Intestinal Health Through Diet'' outlines the diet and provides guidelines and recipes.<ref name="Gottschall2004">{{cite book|last=Gottschall|first=Elaine|title=Breaking the Vicious Cycle: Intestinal Health Through Diet|url=https://books.google.com/books?id=SpzenQEACAAJ|year=2004|publisher=Kirkton Press}}</ref> Gottschall also claims SCD treats [[Crohn's disease]], [[ulcerative colitis]], [[diverticulitis]], [[cystic fibrosis]], [[chronic diarrhea]], and [[autism]].<ref name=brown/>
+SCD was popularized by Elaine Gotschall with the publication of her book, ''Food and the Gut Reaction: Intestinal Health through die''t first edition published in 1987, with name change and now 15<sup>th</sup> edition, ''Breaking the Vicious Cycle: Intestinal Health through d''i''et.'' <ref>{{Cite book|url=http://worldcat.org/oclc/1048262387|title=Breaking the vicious cycle : intestinal health through diet|last=author.|first=Gottschall, Elaine Gloria, 1921-|isbn=9780969276814|oclc=1048262387}}</ref> Elaine’s daughter, Judy, diagnosed with UC at a very young age, was facing imminent colectomy but was restored to full health following the SCD.  Soon after, Sydney Haas, MD passed away.  Elaine was concerned that the knowledge of this diet was likely to fade with him as this diet was not recognized or utilized by most gastroenterologists. Only after much desperate seeking did she find Dr. Haas. Gotschall pursued her master’s degree in biology, nutritional biochemistry and cellular biology and with lifelong interest in the gastrointestinal system and diet she served as a consultant to hundreds of patients and with her publications she has helped thousands to restore their health. <ref>{{Cite web|url=1.	http://www.breakingtheviciouscycle.info/p/about-the-author/|title=About the Author|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
-==Details and effectiveness==
-Gottschall's Specific Carbohydrate Diet limits the use of complex carbohydrates ([[disaccharides]] and [[polysaccharides]]). [[Monosaccharide]]s are allowed, and various foods including fish, aged cheese and honey are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products.<ref name=brown/>
+== Mechanism of Action ==
-A 2017 review on SCD and other exclusion diets said that SCD "is one such exclusion diet that appears to have a positive effect in IBD."<ref>{{cite journal|last1=Lane|first1=ER|last2=Zisman|first2=TL|last3=Suskind|first3=DL|title=The microbiota in inflammatory bowel disease: current and therapeutic insights.|journal=Journal of Inflammation Research|date=2017|volume=10|pages=63–73|pmid=28652796|pmc=5473501|doi=10.2147/jir.s116088}}</ref>
+Although old but not forgotten, the SCD is now gaining renewed interest in the community as well as the medical profession with the publication of a number of small patient trials and reports showing benefit in attaining remission for IBD.  The postulated mechanism of benefit from the diet is that the condition of IBS or IBD is due to an overgrowth or imbalance of gut bacteria that can be corrected by the avoidance of specific carbohydrates that feed the overgrowth, hence the name Specific Carbohydrate Diet. The technology at the time of the development of this diet was not able to evaluate this hypothesis.  However, with the current technology of gene sequencing combined with the improvements in data software analysis, the bacterial, viral, and fungal components encompassing the human microbiome are now analyzable and this is among the most active and exciting areas of research for all human diseases and in particular IBD.
+It is now commonly accepted that dysbiosis (disruption of gut bacterial balance from normal) is the hallmark of IBD. <ref>{{Cite journal|last=Nagalingam|first=Nabeetha A.|last2=Lynch|first2=Susan V.|date=2012-05|title=Role of the microbiota in inflammatory bowel diseases|url=https://doi.org/10.1002/ibd.21866|journal=Inflammatory Bowel Diseases|language=en|volume=18|issue=5|pages=968–984|doi=10.1002/ibd.21866|issn=1078-0998}}</ref> <ref>{{Cite journal|last=Zuo|first=Tao|last2=Ng|first2=Siew C.|date=2018|title=The Gut Microbiota in the Pathogenesis and Therapeutics of Inflammatory Bowel Disease|url=https://www.frontiersin.org/articles/10.3389/fmicb.2018.02247/full|journal=Frontiers in Microbiology|language=English|volume=9|doi=10.3389/fmicb.2018.02247|issn=1664-302X|pmc=PMC6167487|pmid=30319571}}</ref><ref>{{Cite journal|last=Hoarau|first=G.|last2=Mukherjee|first2=P. K.|last3=Gower-Rousseau|first3=C.|last4=Hager|first4=C.|last5=Chandra|first5=J.|last6=Retuerto|first6=M. A.|last7=Neut|first7=C.|last8=Vermeire|first8=S.|last9=Clemente|first9=J.|date=2016-09-20|title=Bacteriome and Mycobiome Interactions Underscore Microbial Dysbiosis in Familial Crohn’s Disease|url=http://dx.doi.org/10.1128/mbio.01250-16|journal=mBio|volume=7|issue=5|doi=10.1128/mbio.01250-16|issn=2150-7511}}</ref> Overall richness of the bacterial community is decreased with certain species found to be commonly overgrown in particular the phylum of Proteobacteria and members of the family of Enterobacteriaceae, and fungus including candida tropicalis and candida albicans, while other species tend to be either absent or under represented such as faecalibacterium prausnitzii of the Clostridium clade. <ref>{{Cite journal|last=Ni|first=J|last2=Shen|first2=TCD|date=Nov 2017|title=A role for bacterial urease in gut dysbiosis and Crohn's disease|url=|journal=Sci Transl Med|volume=9|pages=416|via=}}</ref> <ref>{{Cite journal|last=Pascal|first=V|last2=Pozuelo|first2=M|date=2017|title=A microbial signature for Crohn's disease|url=|journal=Gut|volume=|pages=1-20|via=}}</ref><ref>{{Cite journal|last=Eom|first=Taekil|last2=Kim|first2=Yong Sung|last3=Choi|first3=Chang Hwan|last4=Sadowsky|first4=Michael J.|last5=Unno|first5=Tatsuya|date=2018-02-28|title=Current understanding of microbiota- and dietary-therapies for treating inflammatory bowel disease|url=https://link.springer.com/article/10.1007%2Fs12275-018-8049-8|journal=Journal of Microbiology|language=en|volume=56|issue=3|pages=189–198|doi=10.1007/s12275-018-8049-8|issn=1225-8873}}</ref><ref>{{Cite journal|last=Aleksandrova|first=Krasimira|last2=Romero-Mosquera|first2=Beatriz|last3=Hernandez|first3=Vicent|last4=Aleksandrova|first4=Krasimira|last5=Romero-Mosquera|first5=Beatriz|last6=Hernandez|first6=Vicent|date=2017-08-30|title=Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention|url=https://www.mdpi.com/2072-6643/9/9/962|journal=Nutrients|language=en|volume=9|issue=9|pages=962|doi=10.3390/nu9090962|pmc=PMC5622722|pmid=28867793}}</ref><ref>{{Cite journal|last=Aleksandrova|first=Krasimira|last2=Romero-Mosquera|first2=Beatriz|last3=Hernandez|first3=Vicent|last4=Aleksandrova|first4=Krasimira|last5=Romero-Mosquera|first5=Beatriz|last6=Hernandez|first6=Vicent|date=2017-08-30|title=Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention|url=https://www.mdpi.com/2072-6643/9/9/962|journal=Nutrients|language=en|volume=9|issue=9|pages=962|doi=10.3390/nu9090962|pmc=PMC5622722|pmid=28867793}}</ref>The SCD has been shown to alter this balance of bacteria and shift it more toward that found in healthy population without disease. <ref>{{Cite journal|last=Walters|first=Sumathi Sankaran|date=2014|title=Analysis of Gut Microbiome and Diet Modification in Patients with Crohn’s Disease|url=http://dx.doi.org/10.15226/sojmid/2/3/00122|journal=SOJ Microbiology & Infectious Diseases|volume=2|issue=3|doi=10.15226/sojmid/2/3/00122|issn=2372-0956}}</ref><ref>{{Cite journal|last=Suskind|first=DL|last2=Cohen|first2=SA|date=2016|title=Clinical and Fecal Microbial Changes with Diet Therapy in Active Inflammatory Bowel Disease|url=|journal=J Clin Gastroenterol|volume=|pages=|via=}}</ref>
-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. "<ref name=hou/>  It also said that the diet risks imposition of an undue financial burden and potentially causes malnutrition.<ref name=hou/>
+==Research==
-The [[Crohn's & Colitis Foundation of America]] point out that there have been only limited studies of the SCD in relation to Crohn's Disease and ulcerative colitis, and while "there is no evidence to suggest that any particular food or diet causes, prevents or cures inflammatory bowel disease", they also say that "dietary recommendations are generally aimed at easing symptoms during flares".<ref name=ccfa>{{cite web |title= The Specific Carbohydrate Diet |url= http://www.ccfa.org/about/news/scd |accessdate= 28 April 2017 |date= 1 June 2012 |publisher= [[Crohn's & Colitis Foundation of America]]}}</ref>
+The SCD has been shown to induce remission of Crohn’s disease, with reduction or elimination of symptoms, normalization of serum inflammatory markers and evidence of improved mucosal tissue by endoscopy,<ref>{{Cite journal|last=Cohen|first=SA|last2=Gold|first2=BD|date=Oct 2014|title=Clinical and Mucosal Improvement with the Specific Carbohydrate Diet in Pediatric Crohn’s Disease|url=|journal=J Pediatr Gastroenterol Nutr|volume=59(4)|pages=516-21|via=}}</ref><ref>{{Cite journal|last=Obih|first=Chinonyelum|last2=Wahbeh|first2=Ghassan|last3=Lee|first3=Dale|last4=Braly|first4=Kim|last5=Giefer|first5=Matthew|last6=Shaffer|first6=Michele L.|last7=Nielson|first7=Heather|last8=Suskind|first8=David L.|date=2016-04|title=Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center|url=http://dx.doi.org/10.1016/j.nut.2015.08.025|journal=Nutrition|volume=32|issue=4|pages=418–425|doi=10.1016/j.nut.2015.08.025|issn=0899-9007}}</ref> including remission in seven children with active Crohn’s disease without the use of concomitant medications. <ref>{{Cite journal|last=Suskind|first=DL|last2=Wahbeh|first2=GH|date=2014|title=Nutritional Therapy in Pediatric Crohn Disease: The Specific Carbohydrate Diet|url=|journal=JPGN|volume=58|pages=87-91|via=}}</ref>  These positive findings are considered a result of shifts in the microbiome due to dietary changes.
-==See also==
-*[[FODMAP]]
+These small patient trials in combination with patient reports of improvements <ref>{{Cite journal|last=Kakodkar|first=Samir|last2=Farooqui|first2=Azam J.|last3=Mikolaitis|first3=Sue L.|last4=Mutlu|first4=Ece A.|date=2015-08|title=The Specific Carbohydrate Diet for Inflammatory Bowel Disease: A Case Series|url=http://dx.doi.org/10.1016/j.jand.2015.04.016|journal=Journal of the Academy of Nutrition and Dietetics|volume=115|issue=8|pages=1226–1232|doi=10.1016/j.jand.2015.04.016|issn=2212-2672}}</ref> <ref>{{Cite journal|last=Suskind|first=David L.|last2=Wahbeh|first2=Ghassan|last3=Cohen|first3=Stanley A.|last4=Damman|first4=Christopher J.|last5=Klein|first5=Jani|last6=Braly|first6=Kim|last7=Shaffer|first7=Michele|last8=Lee|first8=Dale|date=2016-09-16|title=Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease|url=http://dx.doi.org/10.1007/s10620-016-4307-y|journal=Digestive Diseases and Sciences|volume=61|issue=11|pages=3255–3260|doi=10.1007/s10620-016-4307-y|issn=0163-2116}}</ref> have prompted the renewed interest of dietary therapy for IBD.  Two large scale ongoing trials of over 100 patients each are currently underway, PRODUCE (comparing SCD with modified SCD in pediatric patients),<ref>{{Cite web|url=https://www.improvecarenow.org/produce_study|title=PRODUCE Study - ImproveCareNow|last=ImproveCareNow|website=www.improvecarenow.org|language=en|access-date=2018-11-18}}</ref> and DINE-CD (comparing SCD with the Mediterranean diet in adult patients).<ref>{{Cite web|url=https://www.pcori.org/research-results/2016/comparative-effectiveness-specific-carbohydrate-and-mediterranean-diets-induce|title=Comparative Effectiveness of Specific Carbohydrate and Mediterranean Diets to Induce Remission in Patients With Crohn's Disease|website=www.pcori.org|language=en|access-date=2018-11-18}}</ref> Additionally, there are over twenty smaller ongoing interventional trials evaluating aspects of diet, microbiome and IBD, many of which are utilizing SCD. <ref name=":0">{{Cite news|url=https://clinicaltrials.gov/ct2/results?cond=Inflammatory+Bowel+Diseases&term=diet&cntry=&state=&city=&dist|title=Search of: diet {{!}} Inflammatory Bowel Diseases - List Results - ClinicalTrials.gov|access-date=2018-11-18|language=en}}</ref>
-*[[Low carbohydrate diet]]
-*[[DASH diet]]
+As current research documents the role of diet in the pathogenesis and treatment of IBD, there are five ongoing large epidemiologic studies evaluating the relationship to diet and IBD, including the Prognostic Effect of Environmental Factors in Crohn’s and Colitis (PREdiCCT), Inflammation, Microbiome and Alimentation: Gastrointestinal and Neuropsychiatric Effects (IMAGINE), Chronic Inflammatory Disease, Lifestyle and Treatment Response (BELIEVE). <ref name=":0" />
+== Conclusion ==
+Although the data from the small clinical trials described above have not drawn the attention of most gastroenterologists, the interest in dietary therapy for IBD is growing with the increased focus on the microbiome and the implications of it in the pathogenesis of IBD and the potential to manipulate it. Dietary therapy is welcomed by patients because, when utilized either alone or in combination with drug therapy, there is great potential to heal with no potential to harm.
 ==References==
@@ Line 26: / Line 27: @@
 ==Further reading==
+*Kakodkar S, Mutlu EA 2017 "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease" Gastroenterol Clin N Am 46 (2017) 745-76 <nowiki>http://dx.doi.org/10.1016/j.gtc.2017.08.016</nowiki>
-*{{cite journal|doi=10.1586/egh.11.29|pmid=21651358|title=Existing dietary guidelines for Crohn's disease and ulcerative colitis|year=2011|last1=Brown|first1=Amy C|last2=Rampertab|first2=S Devi|last3=Mullin|first3=Gerard E|journal=[[Expert Review of Gastroenterology & Hepatology]]|volume=5|issue=3|pages=411–425|name-list-format=vanc}}
+*Lane ER, Lee D, Suskind DL"Dietary Therapies inPediatric Inflammatory Bowel Disease An Evolving Inflammatory Bowel Disease Paradigm" Gastroenterol Clin N Am 46 (2017) 731–744 <nowiki>http://dx.doi.org/10.1016/j.gtc.2017.08.012</nowiki>
-{{diets|collapsed}}
 [[Category:Gastrointestinal tract disorders]]