Two months after diagnosis with ulcerative colitis, I decided to try the Specific Carbohydrate Diet (SCD). I’d been reading avidly about colitis, autoimmunity, and digestion; by now I was on something like my seventh book. I chose this diet very carefully, thinking it had the best chance of helping me.
By now I had encountered several different diets for ulcerative colitis and other gut ailments, but I was skeptical of their effectiveness. My current diet of refined grains, meat, and overcooked veggies wasn’t working. I wasn’t convinced any of the others would work, either.
The various diets broke into categories. Some were meaty and paleo-esque, including the SCD, the closely related GAPS Diet, and the Autoimmune Protocol Diet. Others were more or less vegan, like the macrobiotic, raw-foods, and anti-inflammatory diets. Still others were in between, like the low-FODMAP diet or the one I was already on.
Part of my skepticism came from the common dismissiveness of conventional medicine that I heard from some diets’ proponents. The argument went that science hadn’t embraced food-based solutions because Big Pharma paid for most studies and had no incentive to study diet. I was sure that was partly true. But only partly—I had found a few studies of diet, and medicine had embraced the effectiveness of dietary changes with celiac disease and diabetes. For all my hope that diet could help me, I was a trained scientist and unwilling to throw out the whole establishment.
I also felt wary of a cultishness I sensed around some of the diets. It always rankled me when a proponent implied that their diet, alone, could help me. This was one reason the Specific Carbohydrate Diet stood out from many others. Its main advocate, Elaine Gottschall, openly stated that it didn’t work for everyone. For me, that honesty greatly boosted her credibility.
A Tried-and-Tested Diet
Gottschall discovered the diet in the 1950s, as the desperate mother of a young daughter whose colitis wasn’t responding to treatment. Just when surgery seemed like the only option, Gottschall found Drs. Sidney V. and Merrill P. Hass, who had developed a novel treatment for celiac disease. This was before it was understood that strict avoidance of gluten was needed for that disease, but the Drs. Hass had figured out that by eliminating a swath of foods from their diet, celiac patients could heal.
Gottschall’s daughter was placed on this diet to see if it would also work for colitis. Within two years, she was symptom-free. Gottschall went on to study digestion and nutrition herself, and to write Breaking the Vicious Cycle: Intestinal Health Through Diet. First published in 1994, the book popularized the Specific Carbohydrate Diet.
By the time I learned of it, this diet was the most tried and true of all the options I’d encountered. As of May 2014, Breaking the Vicious Cycle had 4.5 out of 5 stars on Amazon.com from 567 customer reviews. Here were the titles of the first several reviews I’d read, all with 5 stars:
- nothing short of a miracle
- Proof positive – the SCD works!
- I am slowly getting my life back.
- Tough at first, but it will cure you.
By comparison, David Dahlman’s book about the diet I’d been following was at four stars from thirty customer reviews. It seemed much less tried-and-true than Gottschall’s diet…and Gottschall, unlike Dahlman, wasn’t selling thousands of dollars’ worth of supplements.
The SCD’s Key Concepts
The SCD has some reasonable logic behind it. Its main focus is the small intestine, where enzymes break down foods and help absorb them. Here’s a diagram of the small intestine, highlighting the villi, or intestinal cells:
The diet’s premise is that an injured intestine can’t digest complex carbohydrates, the hardest-to-digest foods we eat. When they remain undigested, they provide a feast for “bad” bacteria, which then proliferate and produce toxins, which further damage the intestinal lining in a vicious cycle. Digestive enzymes need healthy villi to function properly. If the villi are damaged, then the enzymes don’t work.
To break this cycle, the SCD eliminates all complex carbs. No grains at all are to be eaten—no wheat, rice, oats, barley, corn, etc. Few or no legumes are allowed either, including soy, since legumes also contain complex carbs. Instead, you eat lean meat, eggs, and fish for protein; and lots of veggies, except potatoes, which, you guessed it, have complex carbs.
Carbs are allowed in the SCD, but only in simpler, easier-to-digest forms—aka sugars. You can eat various fruits and veggies, as well as honey, a very simple sugar. All of these foods’ chemical structures are easier on an injured intestine.
Without complex carbs, the “bad” bacteria get gradually starved out. You replace them with good bacteria found in homemade probiotic yogurt, a hallmark of this diet. Your intestines slowly heal, and the good bacteria help make it easier to digest a wider variety of foods in the future.
If the diet works for you, proponents say it takes perhaps one to two years to send your symptoms into remission. Afterwards, you can attempt eating normally again, monitoring your symptoms in case of a flare.
(I’ll go into more detail about the diet’s intricacies in my next post.)
A Month’s Trial
I didn’t understand all the reasoning behind the SCD. Proponents describe the damage as being in the small intestine, but I knew my colitis was in the colon. As far as I knew, my small intestine was functioning perfectly.
Also, most gut bacteria reside in the colon. How would “bad” colon bacteria make their way up into the small intestine and damage the cells there? The bacteria would have to move against the flow of traffic and get past a one-way valve separating the two spaces.
It occurred to me that perhaps the diet’s logic applied to Crohn’s disease but not to colitis. But even if its reasoning wasn’t quite right for me, it seemed clear that the diet did work for many colitis patients; I could see that in their testimonials. For whatever reason, avoiding complex carbs must also often help the colon heal, not just the small intestine.
In many ways, the SCD sounded even harder than the diet I was already on. I’d get to add some dairy back in, but no rice? No corn? It was a little hard to picture.
I wanted to give it a month, which is Gottschall’s advice.
Many people have approached the dietary program by planning to give it a one month trial. If followed carefully for only one month, there should be changes for the better. These improvements provide the encouragement and support needed to commit oneself for the necessary longer period… If you see no improvement after a one month trial, the diet will probably not work for you. It is your decision at this point to return to your old pattern of eating or to continue eating according to the outlined diet. Your decision, of course, will depend upon your overall state of well being.
(From Breaking the Vicious Cycle: Intestinal Health Through Diet by Elaine Gottschall.)
I could do this, I thought. One month wasn’t so bad—not after what I was already going through. By now I was used to eating separately from my friends, as lonely as it was, and to spending more time in the kitchen. If this new diet didn’t help me after a month, then perhaps I would try the dreaded prednisone.
