Specific Carbohydrate Diet for Inflammatory Bowel Disease — Learn About the

SCD to Support Clients With IBD and How It Compares With Other Evidence-
Based Nutritional Therapies
By Cheryl Harris, MPH, RD

Suggested CDR Learning Codes: 5000, 5220, 5420; Level 2

Suggested CDR Performance Indicators: 8.1.5, 8.3.1, 8.3.6

Inflammatory bowel disease (IBD) is an often-debilitating inflammatory condition of the

gastrointestinal (GI) tract that’s becoming more common both in the United States and
abroad. While medications are available, they’re expensive, may cause significant side
effects, and often are ineffective at controlling the disease process. Consequently,
there’s a push from both a health and economic standpoint for nonpharmacologic
treatments. The Specific Carbohydrate Diet (SCD) has been touted for decades as a
means of establishing or maintaining remission, and, after nearly a century, research is
finally available to assess the potential utility of this strategy.

This continuing education course examines the evidence that the SCD may be used to
support clients with IBD and explores how the SCD compares with other evidence-
based nutritional therapies for IBD.

The two primary types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC).

IBD most commonly occurs in developed countries and urban areas.1 There are many
theories about the etiology of IBD, and current research suggests that genetics,
environmental factors, hygiene, the microbiome, and lifestyle factors—including
smoking, diet, stress, and even medications—may play a role.1,2 Studies indicate that
IBD is becoming more common both in the United States and worldwide and that it
affects people at a younger age.1 This is concerning, since an earlier age at diagnosis
has been associated with increased risk of colorectal cancers and a worse prognosis.3

While UC and CD often present with similar and often overlapping symptoms such as
abdominal pain and diarrhea, the pathophysiology often is distinct. UC typically affects
the rectum and all or parts of the colon.2 It usually involves only the mucosal and/or the
submucosal layers of tissue, and the damage seen in UC usually is continuous.

CD often affects the ileum, or the terminal section of the small intestine, and the colon,
and it may affect any part of the GI tract from the mouth to the anus and any or all
layers of the mucosa.2,3 The presentation of CD may be patchy, with both areas of
affected and unaffected tissue.2

Collectively, IBD affects approximately 1.4 million Americans.2 It’s a costly condition.
The Centers for Disease Control and Prevention estimates that as of 2008 direct

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treatment costs are $6.3 billion yearly, with an additional $5.5 billion annually in indirect
costs due to lost productivity,4 and the cost likely has increased since then.
Approximately 1.3 million physician visits per year and 92,000 hospitalizations are due
to IBD.4

People with IBD often also incur significant indirect costs, including decreased quality of
life, lower productivity at work, and decreased leisure time.5 In addition, IBD has a
profound effect on nutritional status and often is associated with malnutrition.

Nutrient Deficiencies
Severe and active disease often is associated with protein and energy malnutrition;
however, micronutrient deficiencies are common across a range of patients with IBD.6
Nutritional deficiencies may be due to decreased food intake, increased nutrient losses
and malabsorption, increased nutrient needs due to the disease state, nutrient
depletions due to medications, decreased absorptive capacity following a surgical
resection, and even dietary restrictions intended to control symptoms. 6 Typically,
micronutrient deficiencies are more common in people with CD, since it may affect a
larger proportion of the GI tract, including the small intestine, where the majority of
nutrient absorption and assimilation occurs.6

The most frequent nutritional deficiencies in patients with IBD include folate, vitamin A,
vitamin D, calcium, and iron. Magnesium and zinc deficiencies also are believed to be
common, and lower levels of B1, B12, vitamin E, vitamin K, and selenium also are
documented.6 Appropriate testing and supplementation as needed will support the
nutritional care of patients with IBD.

Treatment Options
One of the mainstays of treatment for IBD is pharmacotherapy aimed at inducing and
maintaining remission. In adults, this typically involves the long-term use of various
medications, from the milder aminosalicylates to corticosteroids, thiopurines,
immunomodulatory medications, and biologics.7 These medications can have significant
consequences for weight, blood sugar, and bone health in adults, and may have a
profoundly negative impact on the growth potential of children with IBD.

More important, patients have a variable response to the medications and often a
diminished response over time. While every person has a different response, the reality
is that most of the commonly used medications, including oral 5-aminosalicylates (5-
ASA) treatments, steroids, thiopurines, and antitumor necrosis factor medications, are
effective at inducing or maintaining remission in fewer than one-half of patients with
IBD.7 Although many new medications and treatments are underway, a large
percentage of people with IBD experience inadequate relief from medications.

If patients don’t remain in remission and the disease process continues, surgical
removal of diseased areas of the GI tract often are necessary, with significant
physiologic consequences. Because of the difficulty in establishing and maintaining

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remission and the physical damage due to IBD, there’s been great interest in finding
alternative approaches both for inducing and maintaining remission.

The Specific Carbohydrate Diet

There’s an increasing body of evidence that the SCD is a viable option for both
improving symptom management and inducing or maintaining remission among people
with IBD. The SCD was first proposed by Sidney V. Haas, MD, in the 1920s as a way to
manage celiac disease, and it was described in a textbook by Haas and his son, which
was published in 1951.8 The diet was popularized by Elaine Gottschall, BA, MSc, based
on her experiences with her daughter’s healing from UC under Haas’ care and
subsequent decades of advocacy with patients. She published the definitive SCD guide,
Breaking the Vicious Cycle: Intestinal Health Through Diet in 1994.8 For many
decades, clients have experimented with the SCD to reduce or resolve IBD symptoms,
largely relying on anecdotal reports.

The premise of the SCD as described by Gottschall is that humans evolved to digest
simple, single molecules of carbohydrates, or monosaccharides, efficiently, because
they’re easily absorbed and assimilated by the body. Fruits, many vegetables, and
honey are comprised of carbohydrates with simple sugars. According to this theory,
complex carbohydrates, such as disaccharides or polysaccharides, aren’t immediately
absorbed; this can lead to an overgrowth of bacterial flora and inappropriate bacterial
fermentation. Acidic and inflammatory byproducts of this process can cause damage to
the intestines and interrupt normal enzyme function, a situation that can lead to
malnutrition and diarrhea.8 To date, the hypothesis concerning the underlying
physiological mechanism hasn’t been adequately elucidated.

The SCD permits the consumption of almost all fruits, most vegetables, nuts, eggs, fish,
poultry, meat, fats, specially fermented yogurt, and dry curd cottage cheese. Added
sugar is limited to honey. On the SCD, clients must strictly avoid complex
carbohydrates, including grains such as corn, pseudograins, potatoes, most dairy
products aside from specially prepared yogurt, soy, canned beans, seaweeds and
derivatives, most sweets including chocolate, many preservatives and additives, and
processed foods.8 The SCD isn’t necessarily a low-carbohydrate diet, but it’s extremely
specific about the types of carbohydrates that are permitted.

Detailed lists of the foods permitted, known as “legal,” and the foods that must be
avoided, known as “illegal,” are summarized in Table 1 on page 45.8

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According to Gottschall, the SCD is extremely strict, and the author’s recommendation
is to follow the diet with “fanatical adherence.”8 Per Gottschall, patients often experience
improvements by one month on the diet, although the author specifically recommends
that people with IBD remain on a strict SCD diet for a minimum of two years. 8 Although
Breaking the Vicious Cycle is very clear on the strictness and length of time
necessary for remission, the ideal length of time for the diet and degree of adherence
are topics of considerable debate and active research.

A range of studies on the SCD are now available, from case studies and reports to
prospective studies, many of which are summarized in Table 2. The primary goal of the
research is to determine whether the SCD is a safe and effective option for establishing
and maintaining remission of IBD in children and adults.

Research on the SCD

Suskind and colleagues at Seattle Children’s Hospital did a 12-week prospective study
on the effectiveness of the SCD with 12 children who had UC or CD and were
experiencing mild to moderate disease activity. According to the results, published
online in December 2016 in the Journal of Clinical Gastroenterology, RDs provided
individual counseling and support throughout the study. The diet was ineffective for two

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children, and two children were unable to maintain the diet. The remaining eight children
experienced disease remission within the 12 weeks, with statistically and therapeutically
significant decreases in disease activity scores and inflammatory markers. Moreover,
researchers performed fecal studies before and after the dietary change showing
significant changes in microbial composition, and further study is needed to understand
potential relevance of microbial changes.

A 2016 retrospective chart review by Burgis and colleagues examined 11 pediatric

patients with CD following the SCD. The patients either had experienced a flare or were
newly diagnosed at the time of SCD introduction. Some were only following the SCD,
while others also were taking antibiotics or other medications. After participants began a
strict SCD, hematocrit and albumin values significantly improved, sedimentation rate
improved for all patients, and 90% of children gained weight. Most children also grew
taller. The second phase of the study involved mild liberalization of the SCD after
approximately 7.5 months on the diet. The degree of liberalization was individualized,
ranging from an illegal ingredient or meal daily to an illegal meal every two weeks. Most
improvements seen with the strict SCD were maintained on the liberalized diet,
however, researchers observed a small decrease in weight percentile. The authors
conclude, “A strict SCD was effective to improve laboratory values and maintain growth
parameters in pediatric patients with CD.”9

A 2016 retrospective study at Seattle Children’s Hospital involved 26 patients with UC

with active IBD who adhered to the SCD. The primary reason the majority of
participants followed the SCD was to avoid medication (17 of 26 patients, or 65%); nine
of the 26 (34%) patients followed the diet due to inadequate improvement or side effects
of the medications. Some used the SCD as the primary treatment modality, while others
used medications concurrently. Of the 26 who followed the SCD, 12 experienced
improvements in clinical and inflammatory markers. Of the 15 who were on medication,
two were able to discontinue medications and maintain remission solely on the SCD. In
this study, the children took part in the decision process regarding their diets; about
one-half opted to follow an “SCD-like” diet with liberalization. The authors also note that
many had difficulty with compliance because of the strict nature of the diet, and there
were some concerns with weight loss for nine patients, even though a nutritionist on
staff provided support.10

The Journal of the Academy of Nutrition and Dietetics published a 2015 case series
review on adult patients with IBD who reported achieving and maintaining remission on
the SCD. Both the diagnosis of IBD and remission were independently corroborated
with medical records. Twenty-two of the 50 were off all medications, and 16
discontinued their medications while on the SCD and maintained remission. The self-
report of dietary compliance ranged from 71% to 100%, with an average of 95%
compliance. The main motivators for following the SCD were fear of long-term
consequences of medication (82%), medications weren’t effective (64%), belief that the
SCD is more effective than medications (64%), and adverse reactions to medications
(56%). Overall, the group was highly educated and most had college or graduate
degrees. Subjects estimated that food preparation time was 10.8 hours weekly and

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most noticed symptomatic improvement approximately one month after starting the
SCD.11

A case report by Khandalavala and Nirmalraj describes a 73-year-old Asian physician

with UC who didn’t respond to conventional pharmacologic therapies. She noticed
symptomatic improvements after three months on the SCD, and a colonoscopy at two
years indicated a complete remission of her UC. Accidental consumption of foods that
were disallowed on the SCD caused acute flares in symptoms.12

Cohen and colleagues performed a prospective study using the SCD with children with
active CD, and nine of the 10 children completed the study. Researchers saw clinical
improvement in disease status of 80%, and 60% achieved remission by 12 weeks. Six
of the seven patients who remained on the diet for a full year achieved clinical
remission. Data weren’t collected on “cheating” on the diet and whether it might have
affected clinical response to the SCD.13

Suskind and colleagues at Seattle Children’s Hospital examined charts of seven

children with mild, moderate, or severe CD who followed the SCD. All experienced a
resolution of symptoms after three months on the diet and increased their height and
weight while following the SCD. Researchers observed normalization in hematocrit,
sedimentation rate, and stool calprotectin values.14

In 2014, Olendzki and colleagues at the University of Massachusetts studied the IBD
anti-inflammatory diet (IBD-AID), a modified version of the SCD. IBD-AID incorporates
many principles of the SCD, including consumption of lean proteins, fruits, vegetables,
and legumes, but it also encouraged the inclusion of products not allowed on the SCD,
such as prebiotic fibers, chia and flax seeds, kefir, yogurt, and other probiotic foods. The
researchers offered the diet to patients who were refractory to pharmaceutical therapies
or hadn’t experienced the degree of symptomatic improvement desired. Of the 40
people offered the diet, 13 declined, 24 had a positive response, and three had a mixed
response. Complete data were available only for 11 clients following the diet, and 100%
experienced symptomatic improvements and were able to decrease the amount of
medication used.15

A 2004 study examined two case studies. One patient with UC experienced flares
despite 5-ASA therapy and flared while tapering off steroids. She reported symptomatic
improvement within two weeks on the SCD, and a follow-up colonoscopy at one year
indicated disease remission. The second was a 24-year-old with CD who didn’t respond
to 5-ASA therapy and experienced a flare on prednisone. She experienced symptomatic
improvement within one week on the SCD, tapered off steroids after one month on the
diet, and remained in remission without medications for the next three years. This paper
also included a survey of patients using the SCD. Eighty-four percent of patients
reported they were in remission following the SCD; however, patient reports weren’t
confirmed through medical record review, so this can’t be corroborated. 16

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One area of great interest is why the SCD works. While there likely are many factors,
one answer is that the diet modifies the microbiome. A small pilot study examined stool
samples of patients with CD and healthy controls, comparing microbial changes on the
SCD with those in individuals following a low-residue diet. The patients with IBD had
lower microbial diversity and different bacteria than did healthy controls before the
dietary modifications.2,17 While following the SCD, patients had a significantly wider
range of microbial diversity, which generally is associated with better health.
Conversely, researchers saw a decrease in microbial expression on a low-residue
diet.17 Forthcoming research from Seattle Children’s Hospital will examine similar
themes of microbiome changes on the SCD.

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Other Nutritional Strategies
For adults in the United States, medications usually are the first line of therapy for IBD.
However, in children with CD, the primary nutritional strategy to induce remission is
exclusive enteral nutrition (EEN), or sole consumption of a nutritionally complete
formula for six to eight weeks with no additional food and only water. EEN is primarily
used for children, and studies show that EEN can bring more than 80% of children with
CD into remission. Beyond simple taste fatigue, EEN can be socially, emotionally, and
logistically challenging.18 EEN also may be effective in adults with CD, but it’s rarely
routinely used outside of Japan.19 Moreover, current guidelines recommend EEN only
for CD because EEN doesn’t induce remission in UC.20

Unfortunately, to date, no direct studies are published that directly compare the
effectiveness of EEN with the SCD, and only one 2017 case study examines both
strategies. A 15-year-old with CD who had persistently elevated inflammatory markers
was given EEN for eight weeks, which decreased his inflammatory markers, such as
fecal calprotectin and sedimentation rate. However, the levels were still elevated. He
then began the SCD, and his levels of inflammation decreased. After two months on the
SCD he was able to stop his medication; after six months on the SCD he was able to
liberalize his diet while inflammatory markers remained stable.21

While partial enteral nutrition (PEN) hasn’t been effective, a combination of PEN and a
restricted diet known as the Crohn’s disease exclusion diet may be effective. A 2014
pilot study examined the use of a partial enteral diet with 47 children and adults with
mild to moderate CD. In addition to enteral feeds, the patients followed a strict gluten-
free, dairy-free diet without animal fat. The diet also removed all processed and canned
goods and called for avoidance of all thickeners and emulsifiers. Seventy percent of
children and 69% of adults went into remission while following the diet. 22 A larger trial is
underway.

A 2010 prospective study in Japan examined the use of a semivegetarian diet to

support remission among adults with CD. The semivegetarian diet involves a lacto-ovo
vegetarian diet with fish once per week and a small portion of meat every two weeks.
Researchers encouraged intake of vegetables, fruits, legumes, rice, and an abundance
of fermented foods, and they provided menu plans and nutritional support. Twenty-two
people in remission with CD were instructed about the diet, and 16 followed it for two
years. Ninety-four percent of those adhering to the diet maintained remission.23 It’s
uncertain which components of the diet were most supportive of maintaining remission.
This study is encouraging and hopefully larger investigations will follow; however, it was
aimed at maintaining remission, not inducing remission. It also wasn’t investigated in
patients with UC.

Other dietary strategies proposed for managing symptoms of IBD include low-FODMAP
(fermentable oligo-, di-, and monosaccharides and polyols), gluten-free, lactose-free, or
Paleo diets.20 A small body of research supports a low-FODMAP diet for symptomatic
relief.24 In addition, IBD patient surveys report a reduction in symptoms on a gluten-free,
lactose-free, and/or Paleo diet. However, there’s no evidence to suggest that these

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diets have the potential to induce or maintain remission.20 The primary role of these
diets is likely symptom management.20

A low-fat, low-fiber diet for IBD has long been standard nutritional practice, especially
right after a disease flare. The theory was that there might be scarring or stricturing in
CD, and fiber could potentially worsen symptoms or cause a blockage. However, newer
research challenges this idea. A meta-analysis on IBD and fiber indicates that fiber may
have a slightly beneficial impact on UC, and that there’s no evidence that fiber should
be limited, except in cases of a bowel obstruction.25 In addition, a 2016 study of patients
in remission with CD showed that the people with the highest quartile of fiber had a 40%
lower risk of a CD flare compared with the people in the lowest quartile of fiber intake. 26

There’s a growing body of research investigating the use of probiotic supplements for
IBD. According to the 2015 Consensus Opinion from the Yale/Harvard Triennial
Workshop on Probiotic Recommendations, there’s significant evidence of benefit from a
multistrain probiotic brand such as VSL#3 and E coli Nissle 1917 for UC. Evidence is
weaker for the use of probiotics in CD, and some studies support the use of E coli
Nissle 1917, Saccharomyces boulardii, and Lactobacillus rhamnosus GG.27 For more
detail, see “Probiotics & IBD” in the April 2013 edition of Today’s Dietitian.

While some patients were successful using only the SCD, in many cases, the SCD was
used in conjunction with medications and other treatments. All patients will have
different nutritional, social, cultural, and logistical needs and preferences, and dietary
changes should be tailored to the individual with active collaboration between the RD
and the rest of the patient’s health care team. While patients may be eager to stop
treatments when they notice symptomatic improvements, they should be actively
discouraged from changing or discontinuing medications without oversight and the
consent of the team.

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Practical Applications
Both CD and UC can be challenging conditions associated with physical and emotional
costs. As IBD becomes more common globally, the economic burden of disease
symptoms, surgeries, and medications will only grow, and this makes dietary strategies
even more valuable. For a segment of people with IBD who don’t see adequate
improvement on the medications, experience intolerable side effects, can’t afford the
medications, or simply want an alternative option with a lower side effect profile, the
SCD may be an effective therapeutic option. However, as mentioned throughout this
course, implementation of the diet requires significant time and commitment.

As seen in Table 3, there are several nutritional options for patients with CD, including
the SCD, EEN, and PEN in conjunction with the Crohn’s disease exclusion diet.
Research isn’t yet available to directly compare the efficacy of each treatment; it’s
unknown whether there are specific patient characteristics (eg, type of IBD, location of
damage, and degree of damage) that affect the relative efficacy of each diet. Additional
research will begin to fill in these gaps so health care professionals can guide patients
toward the most efficacious dietary strategies. The semivegetarian diet also may be an
option for maintaining (not inducing) remission among people with CD. Thus far, none of
the alternative dietary options besides the SCD have been researched for patients with
UC.

The current research suggests the SCD belongs on the table as a viable option for
inducing or maintaining remission and health care professionals can present it as an
evidence-based option. According to David Suskind, MD, of Seattle Children’s Hospital,
“Eating healthful foods and removing processed foods reduces disease activity for IBD.
But if you’re using nutrition and diet as a therapy and want to limit intestinal
inflammation, we lean towards the SCD. A low-FODMAP diet works well to decrease
symptoms, but not necessarily the inflammation.”

While there’s evidence that the SCD is helpful, it requires commitment. It’s important
that nutrition professionals develop more comprehensive strategies to aid in the
implementation of the SCD. In most studies, some participants declined to undertake
the diet or dropped out due to the intensity of requirements. There’s ample indication
that degree of compliance also may affect physiologic improvement. It’s necessary that
dietitians assess what supports are needed to raise the likelihood of success on the diet
and develop appropriate strategies to fill in those needs. This may include SCD recipe
books and websites, personal chefs that can make SCD-compliant meals, stores that
carry SCD-legal products, cooking classes, and support groups, especially for children.

Given the high rate of nutritional deficiencies in people with IBD and at least some
indications for particular concerns with weight loss in children on the SCD, particular
attention should be paid to nutritionally balanced, accessible meals and appropriate
supplementation to complement the diet.

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Conclusion
Based on studies done thus far, the SCD appears to be an effective way to both
establish and maintain remission for people with UC or CD. Both prospective and
retrospective studies at different institutions with slightly different protocols have
demonstrated benefits, and improvements have been observed in people of different
ages and genders and with different locations and disease severity. Variants on the
SCD, such as IBD-AID or “SCD-like” diets also may prove to be viable strategies—in
fact, Seattle Children’s Hospital is investigating the effectiveness of the SCD compared
with a modified SCD with added foods, such as rice and oats, vs a more whole-foods
based diet to see which strategy yields the best clinical results. Several additional
clinical trials are underway or in review for publication, with research projects underway
at Stanford and University of Massachusetts. Forthcoming research is aimed at
determining the degree of adherence necessary to achieve clinical remission and a
better understanding of the physiological underpinnings of the diet that lead to positive
results, especially as it relates to the gut microbiome.

In addition, larger and more robust prospective studies will give a better idea of the
percentage of people with IBD who will benefit from the SCD, and the physical
characteristics and lifestyle factors that help contribute to the patient’s success on the
SCD.

- Cheryl Harris, MPH, RD, specializes in gastrointestinal disorders and autoimmune

disease in private practice in Northern Virginia.

Click Here For Tip Sheet

RESOURCES FOR FURTHER STUDY

• Official website on implementing the Specific Carbohydrate Diet:

www.breakingtheviciouscycle.info

• Original guidebook on the Specific Carbohydrate Diet: Breaking the Vicious Cycle:
Intestinal Health Through Diet by Elaine Gottschall, BA, MSc

• Guide for Specific Carbohydrate Diet implementation for children with inflammatory
bowel disease: NIMBAL Therapy by David L. Suskind, MD, available at
www.nimbal.org.

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References

1. Ye Y, Pang Z, Chen W, Ju S, Zhou C. The epidemiology and risk factors of

inflammatory bowel disease. Int J Clin Exp Med. 2015;8(12):22529-22542.

2. Abraham C, Cho JH. Inflammatory bowel disease. N Engl J Med.

2009;361(21):2066-2078.

3. M’Koma AE. Inflammatory bowel disease: an expanding global health problem. Clin
Med Insights Gastroenterol. 2013;6:33-47.

4. An expensive disease without a cure. Centers for Disease Control and Prevention
website. http://www.cdc.gov/ibd/pdf/inflammatory-bowel-disease-an-expensive-
disease.pdf. Accessed August 1, 2016.

5. Kawalec P. Indirect costs of inflammatory bowel diseases: Crohn’s disease and

ulcerative colitis. A systematic review. Arch Med Sci. 2016;12(2):295-302.

6. Hwang C, Ross V, Mahadevan U. Micronutrient deficiencies in inflammatory bowel

disease: from A to zinc. Inflamm Bowel Dis. 2012;18(10):1961-1981.

7. Peyrin-Biroulet L, Lémann M. Review article: remission rates achievable by current

therapies for inflammatory bowel disease. Aliment Pharmacol Ther. 2011;33(8):870-
879.

8. Gottschall E. Breaking the Vicious Cycle: Intestinal Health Through Diet. 12th
printing. Baltimore, Ontario, Canada: Kirkton Press Ltd; 2007.

9. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific
carbohydrate diet in pediatric Crohn’s disease. World J Gastroenterol.
2016;22(6):2111-2117.

10. Obih C, Wahbeh G, Lee D, et al. Specific carbohydrate diet for pediatric
inflammatory bowel disease in clinical practice within an academic IBD center.
Nutrition. 2016;32(4):418-425.

11. Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. The Specific Carbohydrate Diet
for inflammatory bowel disease: a case series. J Acad Nutr Diet. 2015;115(8)1226-
1232.

12. Khandalavala BN, Nirmalraj MC. Resolution of severe ulcerative colitis with the
Specific Carbohydrate Diet. Case Rep Gastroenterol. 2015;9(2):291-295.

13. Cohen SA, Gold BD, Oliva S, et al. Clinical and mucosal improvement with specific
carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr.
2014;59(4):516-521.

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14. Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. Nutritional therapy in
pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr.
2014;58(1):87-91.

15. Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-
inflammatory diet as treatment for inflammatory bowel disease: a case series report.
Nutr J. 2014;13:5.

16. Nieves R, Jackson RT. Specific carbohydrate diet in treatment of inflammatory

bowel disease. Tenn Med. 2004;97(9):407.

17. Walters SS, Quiros A, Rolston M, et al. Analysis of gut microbiome and diet
modification in patients with Crohn’s disease. SOJ Microbiol Infect Dis. 2014;2(3):1-
13.

18. Ruemmele FM, Veres G, Kolho KL, et al. Consensus guidelines of

ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns
Colitis. 2014;8(10):1179-1207.

19. Wall CL, Day AS, Gearry RB. Use of exclusive enteral nutrition in adults with
Crohn’s disease: a review. World J Gastroenterol. 2013;19(43):7652-7660.

20. Shah ND, Parian AM, Mullin GE, Limketkai BN. Oral diets and nutrition support for
inflammatory bowel disease: what is the evidence? Nutr Clin Pract. 2015;30(4):462-
473.

21. Nakayuenyongsuk W, Christofferson M, Nguyen K, Burgis J, Park KT. Diet to the

rescue: cessation of pharmacotherapy after initiation of exclusive enteral nutrition (EEN)
followed by strict and liberalized specific carbohydrate diet (SCD) in Crohn’s disease
[published online January 13, 2017]. Dig Dis Sci. doi: 10.1007/s10620-016-4446-1.

22. Sigall-Boneh R, Pfeffer-Gik T, Segal I, Zangen T, Boaz M, Levine A. Partial enteral

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23. Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease:

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24. Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, Gibson PR. Reduction
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25. Wedlake L, Slack N, Andreyev HJ, Whelan K. Fiber in the treatment and
maintenance of inflammatory bowel disease: a systematic review of randomized
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26. Brotherton CS, Martin CA, Long MD, Kappelman MD, Sandler RS. Avoidance of
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Quiz

1. Which of the following correctly describes Crohn’s disease (CD) and ulcerative
colitis (UC)?
A. They are two forms of irritable bowel syndrome.
B. UC affects the small intestine; CD affects the large intestine.
C. CD can affect anywhere in the gastrointestinal tract, from mouth to anus.
D. UC affects all layers of tissue in the intestine.

2. What are factors that promote the development of inflammatory bowel disease
(IBD)?
A. Genes, hygiene, infections, medications, and smoking.
B. Eating more fruits and vegetables.
C. Not getting enough sleep.
D. An excess of supplemental beta-carotene.

3. The premise of the Specific Carbohydrate Diet states which of the following?
A. Complex carbohydrates have a lower glycemic load and are therefore beneficial and
supportive.
B. Animal protein raises cholesterol and causes intestinal harm.
C. Humans are not designed to digest complex carbohydrates, and they cause intestinal
damage.
D. An excess of fats and oils leads to intestinal inflammation.

4. Foods permitted on the Specific Carbohydrate Diet include which of the

following?
A. All fruits, vegetables, beans, nuts, and seeds
B. Any kind of dairy
C. Gluten-free whole grains in moderation
D. Any kind of plain beef, poultry, fish, and eggs

5. Studies show that the Specific Carbohydrate Diet may best benefit which of the
following?
A. Only children
B. Only people with CD
C. Only people with mild disease
D. People with any form of IBD at a range of ages

6. Which of the following has evidence-based research to demonstrate that it may

help people with CD induce remission?
A. Paleo diet
B. Low-FODMAP diet
C. Food allergy or food intolerance testing
D. Enteral feedings

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7. Which of the following has evidence-based research to demonstrate that it may
help people with UC induce remission?
A. Semivegetarian diet
B. Specific Carbohydrate Diet
C. Grain-free or Paleo diet
D. Gluten-free diet

8. For people with CD, which of the following dietary strategies is supported by
research to maintain remission?
A. A low-fat, low-fiber diet to manage strictures
B. High omega-3 foods daily
C. A higher-fiber diet, as tolerated
D. A sugar-free diet

9. The current recommendations on probiotics for IBD include which of the

following?
A. Strict avoidance of all probiotic supplements and probiotic foods
B. Twice daily consumption of unsweetened yogurt
C. Use of VSL#3 or E coli Nissle 1917 for UC
D. Consumption of Lactobacillus acidophilus and L reuteri for CD

10. Which of the following is among the main challenges in implementing the
Specific Carbohydrate Diet?
A. Because it’s so new, there isn’t yet consensus on what foods are permitted.
B. Significant time requirements for food preparation are involved.
C. It hasn’t yet been utilized in hospitals or medical settings.
D. It tends to cause significant and inappropriate weight gain.

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