if you're not finding symptom relief, here's something to consider
#363310 - 02/03/11 07:00 PM
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I mean absolutely no disrespect to Heather or the Eating for IBS diet, both which have helped countless people manage their symptoms. But, seeing as this is a message board meant to help people dealing with IBS, I feel strongly that I have something worth sharing.
A quick background on me: I've had IBS and tummy issues pretty much my whole life. My worst symptoms were bloating, gas, and constipation (alternating with diarrhea). In August 2009, I was desperate for relief, so I committed myself to the EFI diet completely. I followed it for four months without a cheat and unfortunately, I didn't find relief. I decided to give up on controlling my IBS with diet, instead pursuing therapy to deal with my emotional issues that seemed to perpetuate my gut problems. Despite all my hard work, my symptoms persisted.
September 2010 my husband was diagnosed with Ulcerative Colitis. After trying multiple drugs, his bloody diarrhea persisted, and his doctor prescribed steroids and immune-suppressors. Nasty stuff. After much deliberation, we decided to try the Specific Carbohydrate Diet together, to see if it would help his colitis and my IBS.
The SCD is the antithesis of the EFI diet. It requires complete abstinence from grains, starches, and table sugar. Natural sugar from fruit and honey is allowed, as well as most veggies (except potatoes), nuts, seeds, beans, lactose-free dairy, and meats. In short, it requires a higher amount of insoluble fiber and fat than many IBS people think they can tolerate, including myself.
I'll be honest. I was scared. In the past when I've tried to increase my consumption of vegetables and fruits, I ended up doubled over in pain. But I wanted to help my husband be successful and I wanted to try to erase any beliefs I had about food, and start again.
We've been on the SCD for a month now, and I can honestly say that it has made a difference. For my husband, it has completely turned around his UC symptoms, medication free. Although I am not symptom free like my husband, I have found a 95% reduction of bloating and gas compared to pre-SCD. My bowel movements are more stable now, not varying from constipation to diarrhea from one day to the next. All this, and I've increased my consumption of insoluble fiber and fats considerably.
SCD is based on the idea of eliminating polysaccharide carbohydrates. These are the kind that ferment in the gut and feed the bad bacteria that cause gas, bloating, cramping, and diarrhea. On SCD, you also focus on repopulating the gut with good bacteria through eating homemade yogurt (fermented for 24 hours so there is no lactose).
IBS is definitely not all about the food, so I don't believe any diet will get rid of 100% of the symptoms. However, I wanted to share my story in hopes of helping those of you out there who are not finding relief with the EFI diet. Again, I don't mean this to any way disrespect Heather's diet, because she's helped many people manage symptoms. But if it isn't for you, please look into the Specific Carbohydrate Diet and the related GAPS diet. Both are extremely nutritious, albeit difficult to follow strictly. But the results are worth it.
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Glad to see you found something that works for you.
Thanks for sharing.
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IBS-D since 1999...mostly stable..i do cheat too.Bad me.
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The Specific Carbohydrate diet is the antithesis of a good diet for managing IBS and nutritionally it isn't a well balanced diet. In particular it excludes starchy vegetables and grains eliminating dietary sources of short-chain fatty acids a important source of energy for colon cell. And it contains many well-known IBS triggers.
Before making any decisions to follow the specific carbohydrate diet you might read the excellent article on the Crohn's and Colitis Foundation of America web site titled The Specific Carbohydrate Diet: Does It Work?
There is a clinical trial for the SCD and IBD going on at the moment. It might be wise to see what results it produces. 
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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I can only speak from personal experience, as I am not an expert in nutrition. The SCD has provided me a huge amount of relief from my IBS symptoms of gas and bloating, and motility. As I said, not a complete elimination of symptoms, but much more relief than when I was eating lots of starches (which is what I've done my whole life), or even when I spent several months gluten and dairy free.
The article you posted did have some interesting tidbits. It mentions the fact that the SCD hasn't been well studied because, unlike pharmaceutical studies, it is difficult to get funding. It's also difficult to create a control group to compare the effects. I am aware of the clinical trial. My husband is considering participating.
Another interesting thing in the article is that doctors agree that there may be subtypes of IBD, which explains why some people respond to the diet, and others respond to drugs. I think IBS also has subtypes. Most doctors in the article agreed that if the diet helped their patients, then it was worth a try.
The article does not accurately represent the science behind the SCD. It mentions doctors saying that the diet is contradictory, in that table sugar is not allowed, but fruit sugar is. This has to do monosaccharides (such as fructose) versus disaccharides (such as sucrose), and how they are fermented in the gut. The science of this process is well explained by the medical doctor who originally designed the Specific Carbohydrate Diet.
Finally, you mention that the SCD is nutritionally lacking in foods that convert to short-chain fatty acids. And, based on my research, all dietary fiber, including vegetables, fruits, legumes, and nuts, convert to short-chain fatty acids in the gut. There is no shortage of fiber on the SCD. You may be interested in this article on this topic.
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Sugars
#363324 - 02/04/11 12:47 PM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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Quote:
The article does not accurately represent the science behind the SCD. It mentions doctors saying that the diet is contradictory, in that table sugar is not allowed, but fruit sugar is. This has to do monosaccharides (such as fructose) versus disaccharides (such as sucrose), and how they are fermented in the gut. The science of this process is well explained by the medical doctor who originally designed the Specific Carbohydrate Diet.
You are right the digestion of monosaccharides is different that disaccharides. And this is the foundation of the SCD diet. Dr Haas and Elaine Gottschall (a biochemist not a doctor) believed that since monosaccharides require no splitting by digestive enzymes in order to be absorbed by the body. They did not consider how monosaccharides and disaccharides are transported (absorbed) across the wall of the GI tract. This is were the problem lies.
Sucrose is digested in the stomach where it is split into fructose and glucose. The glucose facilitates the transport of the fructose across the intestinal wall. When a fructose molecule is not accompanied by a glucose molecule (i.e. some fruits and honey) as it is in sucrose it can be malabsorbed. In other word, instead of being absorbed into the blood stream it can go directly to the colon where it may act as fast food for colonic bacteria which can produce IBS symptoms. Unfortunately, this information was discovered long after Dr. Haas died and after Elaine Gottschall, a biochemist, published her book. You can read about how sucrose and fructose are actually digested using modern science in the reference below and the articles in my signature.
There are many kinds of short chained fatty acids. Not all are beneficial to colonic health. Many of the benefical short chained fatty acid come from the fermentation of soluble fiber and resistant starches.
It is problems with the basic science of the SCD that need to be sorted and clinical trials performed before reliable conclusions can be drawn about its efficacy. I look forward to seeing what the clinical trials show.
Good luck with the diet
Reference
Skoog, S. M. & Bharucha, A. E. Dietary fructose and GI symptoms: A review. . American Journal of Gastroenterology 99, 2046-2050 (2004).
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Interesting reading. If fructose malabsorption is so prevalent, then what is the explanation for people's success on the Specific Carbohydrate Diet, despite a relatively high fructose load? For instance, why am I experiencing less gas and bloating now, despite eating plenty of fructose containing foods, than before when I was eating a significant amount of rice and oatmeal and bread?
Why is my husband, who was running to the toilet up to 10 times a day with bloody D and cramps, even on medication, now 100% symptom free (without medication)? He is consuming apples, dates, oranges, squash, etc on a daily basis.
I think that part of the reason is that neither of us have a problem absorbing fructose.
I think that the other part is that there is something about grains and starches that cause gastrointestinal symptoms. I accept the fact that I don't understand the science. As you pointed out, Dr. Haas developed the SCD in the 1950s, so I acknowledge that there have been new discoveries since then. But I also know that this diet works. Not just for us, but for plenty of people with IBD. I can't point you to a study, but I can point you to websites with plenty of personal testimonials, of people who had taken every drug, who were facing surgery and even death, and sticking to the SCD turned everything around.
I am genuinely interested to understand the science, if the reasons given by Dr. Haas aren't the right ones.
My point in posting in the first place was to advocate for something that has helped my IBS. Maybe I don't understand fully why, but it does, and that's the bottom line. I'm sure fructose malabsorption is a problem for some people, but it most definitely isn't the answer for everyone.
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Re: Sugars
#363326 - 02/04/11 01:48 PM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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There has been some recent speculation by knowledgeable GI researchers that one reason some individuals benefit from the SCD diet is because some of the FODMAPs (see my signature), but not all, are restricted.
Not everyone is sensitive to all FODMAPs. For example, I am very sensitive to fructose but I am not particularly sensitive to fructans (long chains of fructose molecules). Others on the board can handle a considerable amount of fructose but have problems with fructans in wheat. The malabsorption profile of individuals with GI disorders can differ from individual to individual. You may belong to the subgroup that is particularly sensitive to a subset of FODMAPs that are partially restricted in the SCD diet (e.g. wheat).
Fructose malabsorption is only one of a complex collection of malabsorbed molecules that can exacerbate many functional GI disorder including IBS. It need not be singled out.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Hi Frygirl, so glad to see you post again! I kind of doubted you would every come back.
But I know you are a kind person and only want to share and help others. I have heard and read up on the diet, and I know that it has helped many. As they say, there is always more than one path.... There is a poster named Kim, who posts often about her IBD, I believe, and she has been helped tremendously by this diet or something similar.
You know how I feel about this issue. If it is working, don't question it, don't dissect or analyze it, don't try to defend or explain it, don't try to figure out why?, don't look for the science behind it, and most of all don't try to prove it to others. Bottom line is...it is working. Go with what works for you and thanks for sharing again.
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It's interesting to me that the foods considered low in FODMAPS is similar to the legal foods for the Specific Carbohydrate Diet, with some exceptions like allowed sweeteners (table sugar versus honey).
My final word in this debate is that it is unreasonable to state that the SCD is more nutritionally deficient than say a FODMAPs approach. There are a larger number of nutritious foods excluded if one was to strictly follow the guidelines for a low FODMAP diet, compared to the SCD, where nearly all fruits and veggies are allowed.
However, none of that matters if we're feeling sick all the time. So we each have to eat in a way that helps us to manage our symptoms. The SCD is one such option that this IBSer has found relief with.
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Hey Gerikat!
I am only replying to make a case so others are not dissuaded from researching or even trying out different diets to control their symptoms. But no worries, I will carry on with what works for me. Thanks for saying hi!
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