Study: The specific carbohydrate diet in chronic inflammatory bowel diseases

From a clinical point of view, I found that the SCD is an indispensable instrument in the treatment of patients with CED.

Changes in the fecal microbioma of the patients were also measured in order to estimate the extent of the dysbiosis. DNA specified from the chair of 9 of the 12 patients identified 201 bacterial species that either decrease or increase.

important knowledge

No unwanted events were reported; However, 2 patients dropped the study due to difficulties in compliance with the diet. In the 2-week follow-up examination, 5 of the 12 patients were in clinical remission. Eight of the remaining 11 patients reached a remission after 8 weeks, and 8 out of 10 remained in remission after 12 weeks. In 2 of the patients who maintained the diet for the entire 12 weeks, the therapy was ineffective.

After 2 weeks, all of them had improvements or normalization of their CRP. The middle CRP remained below the starting values ​​after 8 weeks and 12 weeks.

Compliance with the diet over the 12-week period was correlated with significant changes in the microbial composition. Earlier studies have shown that the changes in primary microbiota in patients with celiac disease decrease in firmicutes and bacteroid Bacteria and an increase in pro -inflammatory bacteria such as z enterobacteria . Except for someone who had an unusually high prototobacterial level. There was a reverse abundance of bacteroids and firmicutes , from 67% or 31% at the beginning of the study to 30% and 70% after 2 weeks. In this study, bacteroid and parabacteroides had the greatest decline in medium frequency.

practice implications

The SCD limits the recording of most carbohydrates considerably. After the book was published in children with CED , the diet was popularly broken through the vicious circle by Elaine Gottschall, whose 5-year-old daughter suffered on Colitis Ulcerosa.

• Use of nut flours such as almond and coconut flour for the production of bread and baked goods
• added sugar limited to honey
• dairy products are limited to fully fermented yogurt
• Avoiding wheat, barley, corn and rice

Since this diet is very restrictive, compliance is a problem. In addition, it is not known why some patients have positive results and others.

The results of this study match previously published reports, including a study from 2016 published in nutrition by Obih et al. ^{4.5 in the retrospective review of OBIH, PCDAI and Pucai improved in the majority of children in the study significant.}

From a clinical point of view, I found that the SCD is an indispensable instrument in treating patients with CED. It does not always work to create remissions as an independent intervention, but at least it rarely fails to relieve the symptoms. The reactions vary from patient to patient and depend on the long -term loyalty to therapy, which is a challenge.

A further support of the effectiveness of the diet is my frequent clinical observation that patients who are initially successful with the SCD tend to learn about losing illnesses when they lose their compliance.

The reason for nutrition is the change in the microbiome by interrupting the circulation of the increase in the increase in pathetic intestinal bacteria. Current theories about the causes of IBD underline the role of the microbiota in the triggering of the cytokicascade, which leads to barrier disorders and inflammation. The change in the nutritional substrate for microbial growth can suppress harmful species and enable the reaction of a healthy microbiome that is beneficial for healing.

The SCD shows some similarities to the paleo, low-fodmap (Fodmap stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, short-chain carbohydrates that are incompletely absorbed from the gastrointestinal tract) and the intestinal and psychology syndrome (gaps) diet. of which it is also assumed that they influence the dar ancology.

I found food and intestinal reaction 1987, later renamed the Teufels circle . The book has sold well over a million times, and I was invited to write the introduction to a subsequent edition.

Gottschall came into contact with the diet for the first time when she was looking for an alternative to the colectomy for her 8-year-old daughter, who suffered from ulcerative colitis. "Infantile schizophrenia" was also diagnosed with her daughter, a now rejected term for a likely autism spectrum disorder.

After consulting numerous specialists who gave her little hope beyond a radical operation, she looked for help from a 92-year-old in Germany, Dr. Sidney Valentine Haas. In 1951 Dr. Haas in his book a prototype of the SCD before Treatment of celiac disease .

Gottschall introduced the Haas diet, and the gastrointestinal (gi) symptoms of her daughter subsided and finally reached a complete remission. It is even more remarkable that their neurological development problems decreased. Gottschall was so impressed that she made degrees in nutritional biochemistry and cell biology in order to better understand and communicate the advantages of the SCD. In this way she anticipated our current understanding of the role of dysbiosis as a driving force of the GI pathology by several decades.

Nevertheless, Crohn’s and Colitis Foundation (CCFA) published this official position on the SCD in 2012: "There is no evidence that a certain food or a certain diet causes, prevents or heals inflammatory bowel diseases."

But with the advent of this recent study and other previous small studies, the evidence that support the advantages of the SCD becomes irrefutable. Surcks of diet supporters document improvements. 10 Especially due to the activism of the SCD community, the CCFA recently accepted a price of $ 2.5 million from the patient-centered outcomes research institute (PCORI) in order to be effective in the specific carbohydrate diet compared to the Mediterranean diet for an induction To examine remission in patients with Crohn's disease. ¹¹

In my experience, the challenge for the clinician is to correctly adapt the parameters of the SCD in order to take into account the patient's individual circumstances. Although I often use it as a starting point, the SCD may have to be changed.

While the SCD, for example, allows dairy products in the form of homemade yogurt (because fermentation significantly reduces lactose content), some patients do not tolerate the lactose content of milk, but casein or lactalbumin. Other patients may have problems predominating nuts that are baking substances in the SCD.

In addition, the introduction of SCD foods must be carefully staggered, especially in patients with acute episodes or strictures. Some may only tolerate a low -back version of the SCD, which mainly consists of brewing and well -cooked animal protein, whereby raw fruit and vegetables are avoided. Calorie support can be achieved with coconut oil or medium -chain triglyceride oil (MCT).

Some theorize that hydrogen sulfide can contribute to the pathogenesis of ulcerative colitis. It has been shown that high concentrations increase the intestinal permeability and change the barrier function, which leads to mucous membrane ulcers. ^{12 One of the most important food sources for sulfur are red meat, fish, nuts, eggs and Brassica vegetables, which are included in the SCD. In some patients, an attempt to reduce sulfurized foods could prove justified if they do not respond to the SCD.}

A possibility of weakening the effect of hydrogen sulfide and supporting the metabolism of the colon mucosa is the provision of short -chain amino acids, in particular butyrat. The best way to increase the intestinal butyrat is to eat fiber, which supply intestinal microbes with a fermentable substrate for the synthesis of short -chain fatty acid metabolites. But these are the very "resistant strengths" that are prohibited on the SCD.

Hence "Gibson’s Conundrum", proposed by Peter Gibson, a researcher at Monash University in Australia, whose department for gastroenterology is known for researching low-FodMap diet. Gibson notes that there can be two competing reasons for a change in diet at IBD: a low-Fodmap diet like the SCD that weakens the symptoms, and a highly resistant starchedia that promotes the production of short-chain fatty acids. He writes:

The conclusion is that while both approaches can relieve the symptoms in both IBS [irritable bowel syndrome] and IBD, there is not yet enough data to determine whether both approaches lead to equivalent bacterial effects when calming down the immune system. This is particularly relevant at CED. Therefore, caution is advised to use a long-term carbohydrate withdrawal at IBD in remission to control IBS-like symptoms.

A possible solution is to add resistant strength to the SCD. The effectiveness of resistant strength at IBD has been proven in some studies. ^{14 I normally consider this option after an acute thrust has subsided and the patient shows the SCD signs of improvement with reduced stool frequency and/or abdominal pain after a few weeks or months. Well-tolerated sources for resistant strength are cooked and then cooled potatoes or parboiled rice; Green bananas; Bananas; Or unmodified potato strength (none of which is acceptable on the SCD). The addition of these foods offers variety and alternative calorie sources and can help to maintain remission for SCD responders.}