The Specific Carbohydrate Diet (SCD) is an effective dietary approach for many suffering from inflammatory digestive disorders. However, many people are not comfortable implementing this diet on their own. Therefore, this article explains the basics of the SCD plan, why it is effective (with research to prove it), and how to start it.
What is the Specific Carbohydrate Diet (SCD)?
The SCD is a dietary approach popularized by Elaine Gottschall in her 1994 book Breaking the Vicious Cycle: Intestinal Health Through Diet. This book was based on previous theories and hypotheses including:
- The 1991 food intolerance hypothesis set forth by Dr. J.O. Hunter
- The 1951 Management of Celiac Disease monograph by Dr. Sidney V. and Dr. Merrill P. Haas
- The 1888 published report On the Celiac Affection by Dr. Samuel Gee
Elaine, a biochemist, formalized the SCD after her young daughter was diagnosed with severe Ulcerative Colitis (UC). Her daughter was treated by Dr. Haas, using dietary changes as the primary intervention, with drastic improvement in digestive symptoms. To read more about Elaine’s story, check out this page.
Essentially, the SCD helps to heal an inflamed gastrointestinal tract. The diet addresses the digestibility of foods, carbohydrates in particular, to allow relief of digestive symptoms. Additionally, SCD offers healing and nutrient-dense foods for continued digestive recovery and optimal health.
How does the Specific Carbohydrate Diet improve digestion?
Often, those with certain digestive disorders have a damaged intestinal lining. Therefore, they are not able to secrete enough digestive enzymes or have enough healthy absorptive surface area for proper digestion. SCD removes complex carbohydrates from the diet and only allows simple to digest carbohydrates. These simple to digest carbohydrates are also referred to as monosaccharides.
Monosaccharides pass easily into absorption and do not stick around in the digestive tract as potential “food” for bacteria. Bacteria ferment excess complex carbohydrates, resulting in gas, bloating, and other digestive symptoms. Inadequate digestion of foods may contribute to bacterial imbalances, malabsorption, and leaky gut.
Overall, SCD benefits include:
- Bacterial balance
- Improved nutrient absorption
- Reduced intestinal inflammation
- Less intestinal permeability (leaky gut)
To learn more about the science behind the SCD, check out this article.
What do I eat on the Specific Carbohydrate Diet?
The diet includes fresh and frozen vegetables and fruits, unprocessed meat and fish, homemade yogurt and low lactose cheeses, healthy oils, honey, eggs, nuts and some legumes. The diet avoids processed meats and fish, starchy vegetables (i.e. potatoes), dried and canned fruits, all grains, high lactose dairy, food preservatives, some legumes, and most sweeteners.
Here is a SCD Grocery List you can download. Here’s another great article on getting started with SCD. Elaine uses the terms “legal” and “illegal” to describe the foods that are safe and unsafe to eat while following SCD. Here is a complete list of her legal/illegal SCD foods.
SCD Introductory Diet:
Initially, most follow a SCD introductory diet for a maximum of 5 days or until diarrhea subsides. Thereafter, the diet progresses to include a variety of foods in both cooked and raw forms.
Introduction Diet Tips-
- Avoid fruit. Then, try adding in ripe, peeled and cooked fruit. Start with ripe, mashed bananas.
- Avoid raw vegetables. Then, try adding cooked vegetables one at a time. Start with squash, tomato, string beans, and carrots. Avoid cruciferous vegetables until digestion improves significantly.
- Eliminate eggs until severe diarrhea subsides.*
- Avoid excess fat intake.
- Reduce and avoid legumes. Then, cautiously add them, one at a time, after about 3-months on the diet.
Sample Intro Diet Meal Plan-
- Breakfast- dry curd cottage cheese, scrambled eggs*, grape juice mixed with water, homemade gelatin
- Lunch- homemade chicken soup (broth, chicken, pureed carrots), homemade gelatin
- Dinner- soup, broiled fish
- Dessert- homemade cheesecake
Do not follow the introduction longer than 5 days. Move into the full SCD.
What does a typical day on SCD look like?
- Baked apples with honey, walnuts and spices.
- Grain free banana bread with almond and coconut flour. Smear nut butter on slice of bread for added protein.
- 2 egg, spinach and cheddar cheese scramble.
- Tuna fish salad, garnished with olives on a bed of lettuce or greens of your choice.
- Italian chopped salad with chicken and oil and vinegar or lemon dressing.
- Grilled chicken wrapped in lettuce topped with homemade guacamole and a side of applesauce.
- Roasted vegetable and chicken soup with butternut squash, onion, spinach and spices.
- Zucchini noodles with meatballs and tomato sauce.
- Broiled ground beef burger with cauliflower mash and roasted broccoli.
- 1/2 cup of dry curd cottage cheese (DCCC) with fruit.
- 1/4 cup mixed nuts.
- Homemade kale crisps with sea salt and garlic.
For SCD recipes, check out the book Recipe for the Specific Carbohydrate Diet by Raman Prasad.
Who should try the SCD?
While this is a healthy diet that anyone may follow, it is specifically intended for those with severe inflammatory gastrointestinal disorders.
Consider following SCD if you suffer from:
- Crohn’s disease
- Ulcerative colitis
- Celiac disease
- Cystic fibrosis
- Chronic diarrhea
How long should one follow SCD and is there a maintenance plan?
Trial the SCD for at least one month. If there is no improvement despite strong adherence, then this diet probably will not work for you. Most commit to this diet for at least one year, but the length of the diet is based on speed of recovery. It is okay to eventually relax the diet, but continue to follow its basic principles of eating clean, whole foods.
Is there research to support using the SCD?
Yes, the research on SCD is just starting to emerge! However, keep in mind that all of the studies listed below have a very small sample size, are prospective, and not placebo-controlled or blinded.
If you would like a copy of any of the research articles listed below and the links are not accessible to you, please contact me directly and I will send them as a PDF. Here are the published articles I could find on SCD:
- Nutritional Therapy in Pediatric Crohn Disease: The Specific Carbohydrate Diet. Journal of Pediatric Gastroenterology & Nutrition. 58(1):87-91, January 2014.
- “Results: Seven children with Crohn disease receiving the SCD and no immunosuppressive medications were retrospectively evaluated. Duration of the dietary therapy ranged from 5 to 30 months, with an average of 14.6 +/- 10.8 months. Although the exact time of symptom resolution could not be determined through chart review, all symptoms were notably resolved at a routine clinic visit 3 months after initiating the diet. Each patient’s laboratory indices, including serum albumin, C-reactive protein, hematocrit, and stool calprotectin, either normalized or significantly, improved during follow-up clinic visits.”
- Clinical and Mucosal Improvement With Specific Carbohydrate Diet in Pediatric Crohn Disease. Journal of Pediatric Gastroenterology & Nutrition. 59(4):516-521, October 2014.
- “Results: Sixteen patients were screened; 10 enrolled; and 9 completed the initial 12-week trial-receiving 85% of estimated caloric needs before, and 101% on the SCD. Harvey-Bradshaw Index (HB) significantly decreased from 3.3 +/- 2.0 to 0.6 +/- 1.3 (P = 0.007) as did the Pediatric Crohn’s Disease Activity Index (PCDAI) (21.1 +/- 5.9 to 7.8 +/- 7.1, P = 0.011). The Lewis Score (LS) declined significantly from 2153 +/- 732 to 960 +/- 433 (P = 0.012). Seven patients continued the SCD up to 52 weeks; HB (0.1 +/- 0.4) and PCDAI (5.4 +/- 5.5) remained improved (P = 0.016 and 0.027 compared to baseline), with mean LS at 1046 +/- 372 and 2 patients showed sustained mucosal healing.”
- Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease. Suskind, D.L., Wahbeh, G., Cohen, S.A. et al. Dig Dis Sci (2016) 61: 3255. doi:10.1007/s10620-016-4307-y
“Results: There were 417 respondents of the online survey on the SCD with IBD. Mean age for individuals on the SCD was 34.9 ± 16.4 years. Seventy percent were female. Forty-seven percent had Crohn’s disease, 43 % had ulcerative colitis, and 10 % had indeterminate colitis. Individuals perceived clinical improvement on the SCD. Four percent reported clinical remission prior to the SCD, while 33 % reported remission at 2 months after initiation of the SCD, and 42 % at both 6 and 12 months. For those reporting clinical remission, 13 % reported time to achieve remission of less than 2 weeks, 17 % reported 2 weeks to a month, 36 % reported 1–3 months, and 34 % reported greater than 3 months. For individuals who reported reaching remission, 47 % of individuals reported associated improvement in abnormal laboratory values.”
Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition. Volume 32, Issue 4, April 2016, Pages 418–425.
- “Results: We analyzed 26 children on the SCD: 20 with CD and 6 with UC. Duration of the dietary therapy ranged from 3 to 48 mo. In patients with active CD (Pediatric Crohn’s Disease activity index [PCDAI] >10), PCDAI dropped from 32.8 ± 13.2 at baseline to 20.8 ± 16.6 by 4 ± 2 wk, and to 8.8 ± 8.5 by 6 mo. The mean Pediatric Ulcerative Colitis Activity Index for patients with active UC decreased from a baseline of 28.3 ± 10.3 to 20.0 ± 17.3 at 4 ± 2 wk, to 18.3 ± 31.7 at 6 mo.”
- Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. World J Gastroenterol. 2016 Feb 14; 22(6): 2111–2117.Published online 2016 Feb 14. doi: 10.3748/wjg.v22.i6.2111
- “Results: The mean age at start of the SCD was 11.8 ± 3.0 years (range 6.6-17.6 years) with five patients starting the SCD within 5 wk of diagnosis. Three patients maintained a strict SCD diet for the study period and the mean time for liberalization was 7.7 ± 4.0 mo (range 1-12) for the remaining patients. In both groups, hematocrit, albumin and ESR values improved while on strict SCD and appeared stable after liberalization (P-value 0.006, 0.002, 0.002 respectively). The majority of children gained in weight and height percentile while on strict SCD, with small loss in weight percentile documented with liberalization.”
Let’s wrap it up…
In conclusion, SCD is an effective dietary intervention for those suffering from inflammatory bowel disease. Because the diet removes difficult to digest carbohydrates and adds nutrient-dense foods, it soothes the GI tract and allows it to heal. Additionally, there are many resources to help you start this plan. But, if you need more support in the SCD or other dietary approaches for gut health, contact me today to set up an individualized appointment.