Dave - you asked this this:
CanadaMark
I took away from your posts - "It's simply the reduction in dietary antigens" or in layman speak irritants. If we reduce the irritants we will heal. You did not say it but if that is the case it must NOT be about
dysbiosis.
1) What research have you seen that supports your position of it is all about
dietary antigens?
2) SCD is about
getting the gut bacteria back in balance, is SCD a good diet?
3) If we remove antigens will it result in measurable healing?
4) What is the best diet to effect the greatest healing? Can you provide research?
Dave,
First, I agree with others that state SCD is outdated. I also agree with what Ambling states that diet alterations can be effective as part of a broad “strategy” or range in treatment option - or perhaps “symptom management” would be a good term.
Second, as others have pointed out, it’s completely irresponsible and untrue to state that research (and subsequent testing) of medications provided by GI’s in incomplete. It’s also completely and highly irresponsible to tell others not to take meds.
Though many of us (myself included) would LOVE to be able to ditch the meds - sadly it seems it’s not always possible.
The simple fact is this; Even yourself, should flare severely at some point and should you find yourself in the situation where you cannot get out of the flare via diet (SCD or whatever) you will literally RUN to your GI and beg for medication to help find relief - or you will give into surgery. There’s no getting around this. Happens to many.
Some (the very lucky ones), however, do manage to avoid this situation solely by dietary adjustment alone. There are many people that
manage their symptoms either by diet alone or combination of diet and meds. But the vast majority used meds first to get into remission or at least pointed in that direction, then used dietary adjustments in combination with meds to help maintain remission and some are able to taper off meds altogether and use the diet alone to remain in remission. Others, again, are not so lucky.
SCD is outdated, after all it was written ages ago. Does this mean that it’s concepts are completely “invalid”? certainly not. Does this mean that individuals with IBD will not stand to benefit? Certainly not.
What many have learned (over time and personal trial ) and have tried to point out to you on here is that results are very individual. And as NCOT and others point out is it a great way to live? (such dietary restriction) - well that again is solely up to the individual and personal belief to determine.
In a nutshell - SCD does not equal remission/resolution of symptoms for ALL people. Unfortunately, neither does any diet for that matter.
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In regards to antigens - No, that’s not what I am saying.
First, and quickly, Dysbiosis: The term "dysbiosis" is not a standardized medical term. Apparently similar concepts are also described as "microbial imbalance", "bacterial imbalance", or "increased levels of harmful bacteria and reduced levels of the beneficial bacteria” - This I cut and pasted directly form Wiki as it provides a great answer to any that are confused by the term.
In people with IBD there are structural changes (tissue, cellular morphology etc), physiological changes (mucin secretion/inflammatory cytokines etc) and bacterial (altered flora) changes present in all of us with IBD that differ from normal healthy people. As for the why - again, the truth is simply no one knows. No getting around that one for the time being.
Alterations/changes in one seemingly (though not always) leads to alterations and changes in others. Example: Altered bacterial flora can lead to altered physiological changes (change in mucins/secretions/inflammatory cytokines etc) and this can lead to a change in structure (cellular morphology i.e. altered appearance). Conversely, structural changes (cellular damage/morphology ) can lead to altered physiological changes (altered mucin secretion/cytokines) and this can lead to changes/shift in bacterial flora (dysbiosis). And so on, and so on, and so on. It’s seems to be much like pressure, temperature, volume relations - a change in one induces change in the others.
What’s very unknown (as many things are) is inflammation or chronic inflammation - so a physiological change like inflammation (inflammatory cytokines) in IBD for example: we go through periods of barrier injury “mucosal damage” or “structural damage” followed by periods of repair to restore the damaged parts and their normal functioning - but this does not always seem to happen correctly. The detailed effects inflammation (or inflammatory cytokines) have on our barrier (epithelium) and how they in turn influence normal epithelial regeneration and function is somewhat unknown - at least in the very detailed sense. But none the less, inflammation and chronic inflammation seems to cause damage that we are not always able to repair properly.
Addressing inflammation (think Remicade etc) at it’s best, blocks inflammation and this in turn (again at it’s best) allows our barrier to heal properly. But sadly this is often not lasting and much like diet, results vary both individually and pharmaceutically (Remicade, Humira etc) .
In normal, healthy people their barriers are working just fine. Dietary and bacterial antigens are kept at bay/tolerated/dealt with by the proper physical structure of our intestinal tract, the proper physiological responses, and a seemingly complimentary microflora.
Those of us with IBD have altered barrier function.
Something (or multiple things) have gone all “wonky”.
Food antigens - Even in normal healthy people with a perfect working physical barrier and mucus and all that good stuff, a percentage of food or dietary sourced antigen ultimately passes through. I believe it is somewhere around <5% but am not 100% sure. In any case, even in normal healthy folks, these dietary antigens pass through in a form that can induce an active immune response. Because of this, small amounts of food specific IgG, IgA etc are measurable in normal healthy people at any given time. These are called immunoglobulins and are antibodies, so super tiny specific proteins that attach to “bad” or non-self things like food and bacteria etc. Think of them as like little tiny identification flags that say hey “I’m a bad guy” - or more correctly “I COULD be a bad guy” and these flags notify the immune system that it needs to deal with them either through a reaction to rid the body of them, or tolerate them without any response.
In those of us with IBD, researchers can measure and compare IgG, IgA etc responses with healthy people and what they find is that levels of these are increased in those of us with IBD. The increase seems to correspond to how bad or severe or disease or flare is. Many researches suggest that this stems from increased barrier permeability - our damaged intestines allow larger amounts of food antigens to pass through into our systems in an immunologically active form.
Generally, its thought that our bodies deal with these antigens via a TH2 response (adaptive immune response) but not much is known in this territory yet and ultimately when our immune systems are functioning properly we become tolerant through a series of immune system processes. At least in normal healthy people. But, as is the case, we are unlucky and have IBD - so even these processes (or what’s known about
them) seem to have gone “wonky” for some unknown reason.
Much like everything else, there’s a whack of unknowns in this department. But it is clear, that if tolerance is lost or not properly developed that in some cases there can be a strong TH2 (adaptive immune) response that is thought to go somewhat like this in very broad and 1,000 foot above view: - TH2 (Helper T cell Response)> Stimulatory Cytokine Release > B Cell Activation > Stimulatory Cytokine Release > Mast Cell Degranulation > Stimulatory Cytokine Release > Smooth Muscle Contraction/Mucus Release etc etc. Now this is more of a standard pure “Allergic Reaction” response chain however. Take IgG for example, so specific food antigens kicking around with IgG “flags” sticking to them - instead of ultimately ending up with Mast Cell activation, IgG generally results in recruitment of neutrophils and white blood cells and such. We all have our levels of white blood cells and such monitored/checked by our GI’s. This is because these cells are sort of like the garbage and clean up crew. They deal with the mess caused by the inflammatory & immune response to certain antigens and our GI’s monitor the amounts present as it’s indicative of how bad our inflammation is.
This whole process is very complex in the super fine details. More so very little is even understood as there are crossovers between the various factions and what cell types are activated and well… it’s complex. At the same time it’s very amazing. And very much still unknown. But again, intestinal response from food-sensitive components seem to induce a strong TH2 (adaptive) immune response and this results in inflammation (which can be varying). More so, in animal models these responses usually results in weight loss, loose stool, structural changes in the intestinal walls (villi erosion) and very severe inflammation.
Sound familiar??
Many studies show that Elemental Formulas can be quite successful in inducing remission in Crohn’s disease. Even in adults if I’m not mistaken.
What is an elemental formula?
These are formulated (classified) from least to most allergenic:
The least allergenic ones are comprised solely of individual amino acids as their protein source, glucose (derived from corn syrup) as their carbohydrate source and fat content is from oils. With added vitamins and minerals. So this is the Hypoallergenic version.
The most allergenic ones contain whole proteins, complex carbs and fats with added vitamins and minerals.
When it comes to allergenic classification though this is always based on the proteins (whole versus specific individual amino acids).
SCD, the intro diet portion is very, very close to the least allergenic of elemental formulas or maybe mid point. The difference being the chicken soup and such in the intro diet provides whole protein sources vs specific amino acids in elemental formulas. The “well” cooking and puree’ing of the carrots breaks down the fiber and provides a source of simple carbs - again in the form of glucose. Fats come from the chicken fat and well… you can see the similarities. Vitamins from the carrots again and minerals are released from the bones during cooking.
So you see, SCD at it’s roots is similar to elemental formulas for, well, pretty much the same reasons.
The fact is though, that no one wants to stay on either for a long time. They both suck as far as taste and you’re eternally hungry and well, it’s just not fun.
In any case the more hypo-allergenic a formula is, the least likely it is to produce not only a true allergic reaction (think protein allergy) but also a tolerance or IgG mediated type reaction (think wheat, grain, nuts etc).
As Ambling also pointed out to you, studies also show Liquid Polymeric diets can be equally (or very close) to elemental diets in achieving remission. I’ve read things like 60+% remission rates which is pretty darn good! Liquid Polymeric formulas contain complex carbs and ‘illegals' - so as he stated, what the heck? These are “illegals” according to the diet.
So this is where SCD sort of begins to fall apart.
The complex carbs source in Liquid Polymeric Formulas are generally Maltodextrin or something similar. Though these are technically “complex carbs” they are essentially just multiple glucose molecule chains which will very by source and manufacturing process and are not that long (in chain length) even when compared to say Corn Syrup derived carb sources in Elemental Formulas which are simply singe glucose molecules. The complex carbs in Liquid Polymeric Formula is obviously nowhere near as complex and complete as say wheat flour or bread crumbs or anything of that nature. These are huge, very complex and some parts are non-soluble.
For an immune reaction to take place against an antigen is basically goes like this:
The more complex the molecule (molecular complexity), the heavier the molecule (molecular weight), the least soluble the molecule is the most likely it is to be an “immunogen”. An immunogen is an antigen that produces an immune response.
Think “Gluten” which is a wheat protein. Wheat gluten is a very complex molecule, very heavy, and is non-soluble - in fact Alcohol is require to break it down basically versus the other other starches in breads where water causes them to break down. Put bread in water and mix it up, what is left or the lump of stuff left over at the bottom of the glass is “Gluten”… Put this in alcohol and and stir it up and see what then happens. So gluten is a very good immunogen because of its molecular properties.
Liquid Polymeric Formulas are essentially “partially pre-digested” nutrient sources made of low molecular weight, non-complex, soluble, minimally-immunogenic molecules.
With SCD, more so the intro and initial introductory staged portions, long cooking times and puree’ing is used in place of manufacturing processes to physically break down foods into “partially pre-digested forms” making it easier for our damaged barriers and altered physiological processes to access and absorb nutrients in forms that are less likely to cause either an allergic and or tolerance issue. Think smaller molecules like glucose and such.
As others have pointed out, many who follow or “tweak” SCD realize at some point that they can handle potatoes, some starches like white rice (though a bit of a wildcard on this one especially with brown and whole grain rice) to varying degrees. And there seems to be a lot of benefit for those that can handle them. Mainly the fullness factor! A satisfying meal one could say.
As Ambling pointed out, many report resistant starch leads to an improvement of symptoms as it is used by many on here (Maybe more so the UC board) as an eventual source of Butyrate - which is the preferred energy source of colon cells as studies have shown. In colon cells it seems butyrate is preferred first as an energy source, followed by glutamine and then glucose.
The main source of Butyrate is bacterial fermentation of starches and fiber. Bacteria such as Clostridium, which again are consistently shown to be low in people with IBD and IBS for that matter metabolize these starches and fibers and produce primarily Butyrate, Acetate and Proprionate as and end result or “product” of their metabolism. It appears as though Butyrate is used by our colon cells, Acetate by our other tissues and Proprionate is taken up by our livers.
Why is Butyrate low in those of us with IBD and IBS? Well, one reason is simply the reduction in fermenting bacteria. Why do we have less fermenting bacteria such as Clostridium? No one really knows. It could be a result of inflammation damaging them, it could be our immune systems attacking them (as innocent bystanders during infection) it could be antibiotic use hit them hard or it could be simply that the massive diarrhoea that we all endure in times of flare causes resistant stach and fiber source to shoot right through us! - quick transit time of these fiber and starches can make for a short supply of food for these bacteria, ultimately reducing their population. They are all ideas and hypothesis that are currently under investigation.
Here is an interesting paper on Clostridium you could read:
Commensal Clostridia: leading players in the maintenance of gut homeostasis
www.gutpathogens.com/content/pdf/1757-4749-5-23.pdfHere is a paper on the effect of diet on dysbiosis: *** there’s a nice little chart a short ways down.
Diet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/The Human Genome project actually list some studies on diet induces changes in the microbiome as well.
Much of this latter part (Resistant Starches) was unknown back in the dawn of SCD… Same with the ability to sample mucosal bacteria and it is very fast progressing research. Much research today shows that some of the thinking behind SCD is outdated and has not been revised to account for new findings.
Does that mean one should not bother trying SCD? Heck no - go for it, if it work’s then all the power to you. If it doesn’t or you cannot handle all the cooking, well then “tweak it a bit” and see if that makes a difference.
When it comes to food tolerance issues and wanting to know how much “diet” or “food issues” effect/contribute to your disease status - Perhaps do this - simply FIRST get yourself in remission by any means possible (most likely meds), or meds combined with easily digestible foods (SCD intro/Elemental Formula/Polymeric Formula)
so get on top of the inflammation and get back to solid or semi-solid bowel movements if at all possible. Then if you can at least, by some miracle get to this point, start introducing foods in at a time just like SCD suggests and see what effect they have. If you get massive “D”, cramping and so on, well stop them. See if you go back to normal upon removal and then try it again and see if the same reaction occurs. And sort of mess around until you find a basic “safe” diet that you can always revert to. Once you can achieve a “safe diet” it becomes easier and easier to flush out what does not work of you. Same with getting to solid stool again.
Many, many people on here have done elimination diets with success. But again they are hard to do!
As everyone keeps pointing out diet and “food tolerance” are very individual.
But at the end of the day, paying attention to and adjusting your diet can yield remarkable benefits, but sometimes you have to get lucky in this regard. It’s tricky territory.
And again, as Dr. Chiodini said in an email:
“Conventional therapy in Crohn's disease (except for a few lucky ones) is supportive at best and effective in lasting remission (>1 year) in only about
30% of patients. That includes all the new biologics at $7-10,000 a treatment. With those odds and success rates, why not try unconventional treatments – they cannot be much worse.”
In my personal view, if diet is truly considered an “alternative therapy” or “unconventional therapy” then you really have nothing to loose and perhaps all to gain. Just take some time to learn more than what’s written in SCD as well as whats new and more updated. SCD could honestly could use some updating.
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Here is some other papers that relate to the above that you may or may not find of interest - But most comes from text books and other school resources:
Food antigen-induced immune responses in Crohn’s disease patients and experimental colitis mice:
www.ncbi.nlm.nih.gov/pubmed/25099432 Commensal Clostridia: leading players in the maintenance of gut homeostasis
www.gutpathogens.com/content/pdf/1757-4749-5-23.pdfDiet-Induced Dysbiosis of the Intestinal Microbiota and the Effects on Immunity and Disease:
www.ncbi.nlm.nih.gov/pmc/articles/PMC3448089/Post Edited (Canada Mark) : 1/17/2015 3:18:13 PM (GMT-7)