Specific Carbohydrate Diet Case Series Published

Thanks for providing links to your work.

It is somewhat concerning that you actively recruited 50 people, from "scd message boards and websites" and some of your own clinics, and that the data was gained from self reporting via those recruits (some of whom are still talking immune suppressants).
It seems a skewed method of gathering case reports, particularly as those websites tend to attract only positive aspirants. It is hard to identify what knowledge can be gleaned from 50 self reporting patients in remission, who may perhaps credit their response to their diet (even when concomitant therapies were being used.)

One day a proper study will hopefully be performed (with the realization that this particular diet is outdated), and which takes into account that personal tailoring of all diets is absolutely vital in achieving any real benefit for patients.

Thanks again for posting.

ambling makes very good points about self-reporting and positive reports, not a credible barometer for medical studies. SCD failed to get me to remission although diet modification of another kind did do the job.

Randomized control trials would indeed be a positive step.
Diet modification makes for a very difficult study to design, so many variables with diet alone and then adding in Rx meds (concomitant therapies as ambling said) makes conclusions even more difficult.
It took me many years to work my own diet out and reports from this forum indicate others have different diets that led to their own remission.

SCD_Study: thanks for writing this case study and hope you will continue in this field which has the potential to help UC people who get no relief from RX meds. I think it has applications far beyond UC and IBD into all conditions that exhibit an auto-immune response.

Thanks for posting your review Samir.

My long time suspicion is that the primary reason for the effect of SCD is purely a reduction in inflammatory response to food antigen, and that the altered, less dysbiotic microbiome in SCD followers is a direct result of this (i.e increase in clostridium species diversity etc in SCD followers). These same increased diversity bacterial family classes of SCD followers are highly susceptible to our inflammatory response, whereas those (e.g. proteobacteria) that are increased in non-treated IBD patients and even treated symptomatic etc have multiple inflammatory response defences and can proliferate in inflammatory states..

When you look at the molecular components of SCD foods, and pay attention to common patient "self-adjustments" you find you have a diet composed of low molecular weight, non-complex, readilly soluble components - so essentially all the components that make a diet full of generally non-immunogens. Or least likely immunogenic, however you want to word it.

The same effect can be found in Enteral Nutrition patients where the dysbiotic state can be restored to the same state as normal healthy controls after time on the diet. The same can also be achieved by maintaining diets of certain low molecular weight, non-complex starches etc. In all of these, the components are all the same. Low to non-immunogenic.

Hopefully at some point researchers will realize that inflammatory food-antigen response can be one of the the primary drivers between dysbiotic and non-dysbiotic states in IBD patients. Antigen processing is, for whatever reason, altered in IBD patients. So even though one remains on SCD indefinitely and perhaps relatively symptom free, the underlying cause of the disease remains. Same with Enteral Nutrition etc. Add any high molecular weight, complex, non-soluble components back into the diet and you find inflammation (and dysbiosis) returns rather quickly.

Any diet, aside from SCD that can reduce likely antigens will help.

Much research goes towards inflammatory response in general and in relation to bacteria, but I think they stumble somewhat on food-antigen processing and inflammatory response to food antigens as they are somewhat unsure exactly how to study it. Peripheral tolerance can be pretty complex and they are used to studying primarily proteins for allergy etc.

Post Edited (Canada Mark) : 7/25/2015 1:57:21 PM (GMT-6)

Unfortunately, there is often little benefit in studies (or collections of case reports) that do not take into account currently available information. And in reality, they can do more harm than good.
Holding up one specific diet as a treatment option, can mean that a more vital message about the uniqueness and individuality of an IBD patient's requirements, may be obscured.

As imagardener2 and many others have found, each path is generally unique. Attempts to follow any arbitrary diet can have many potential downfalls.
And, as CM has touched upon, minimizing the antigen load presented to the immune system and to the host environment (unique to each person) may be, in part, what provides benefit for IBD patients.

It is well recognized that any sustained dietary changes will, over time, alter the gut flora – individually impacting a patient's health in either a positive, negative or neutral way.

The individuality of; response, symptoms, disease phenotype, and personalized chemistry/genetics, mean that more thoughtfully designed studies are what is required. Until then GI's quite reasonably do not promote any one type of diet. Rather, they generally suggest eating whatever lessens symptoms – which often includes a period of low residue dieting, followed by careful reintroduction of foods.

Thank you for your work on this study. While I agree with some of the other posters' concerns, I am glad time and effort are being put into studying the effects of diet on IBD. I certainly agree that patients that already follow SCD forums are going to have a natural tendency to be pro-SCD when self-reporting. This study, though limited, is enough to reinforce my current regimen of following SCD until further studies are done and I greatly appreciate your efforts.

You are correct Uniform Charlie and the discussion section of the paper talks about that weakness.  A case series study design does not tell you anything about the efficacy of a treatment in a real-world, clinical setting. The purpose of this case series is to study this particular group of people who say they are doing well on the SCD and to prove they actually do have inflammatory bowel disease. A lingering question has always been if these patients who do well on SCD actually have IBD (as opposed to some other diagnosis) and we have confirmed this.  I also wanted to see how these people were following the diet since there are many variations in implementation (i.e. probiotics, using the yogurt, etc.). This information may be helpful to people who are considering trying it. As someone else has mentioned, SCD may help some people, but for others it can serve as a starting point to determine which foods are really a problem.  As you know, no treatment modality (including medications) works for everyone. I have personally seen many people not respond to the diet at all even after being very strict with it. I've also seen people who believe they have responded partially and can only achieve complete symptomatic remission after both using medications and diet (which represents almost all of the cases in the series who were on medications and is the approach I favor).

Post Edited (SCD_Study) : 7/28/2015 10:05:46 AM (GMT-6)