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Specific carbohydrate diet: irritable bowel syndrome patient case study

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Purpose – The purpose of this paper was to investigate the impact of specific carbohydrate restriction (polysaccharides and disaccharides) in the form of the specific carbohydrate diet (SCD) in treating irritable bowel syndrome (IBS). Design/methodology/approach – A female patient diagnosed with diarrhea predominant IBS was assigned to the SCD for six months. The diet occurred in phases and was advanced based on the individual’s tolerance level under the guidance of a registered dietitian. Quality of life was measured by a pre- and post-IBS severity score questionnaire. Gastrointestinal symptoms were measured by self-assessment of IBS symptoms using a seven-point Likert-like scale, with −3 = substantially worse to +3 = substantially better. Probiotics were consumed throughout the duration of the study. Findings – The quality of life severity score significantly improved from a severity of 315 (with 500 being the most severe) to 15. The initial symptoms from the first day on the diet compared to the total period for bloating, abdominal pain/discomfort, flatulence/wind, diarrhea, bowel urgency, stool consistency, stool frequency, energy levels, incomplete evacuation and abdominal rumbling were improved significantly (p < 0.0005). The SCD diet significantly improved the quality of life and IBS symptoms in a female patient with IBS-diarrhea. Originality/value – This study is the first of its kind to evaluate the efficacy of the SCD to treat IBS. The SCD should be considered a therapeutic option to treating IBS after fermentable carbohydrate restriction.
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Specic carbohydrate diet:
irritable bowel syndrome patient
case study
Darla D. O’Dwyer
School of Human Sciences, Stephen F. Austin State University,
Nacogdoches, Texas, USA, and
Ray L. Darville
Department of Social and Cultural Analysis,
Stephen F. Austin State University, Nacogdoches, Texas, USA
Abstract
Purpose The purpose of this paper was to investigate the impact of specic carbohydrate restriction
(polysaccharides and disaccharides) in the form of the specic carbohydrate diet (SCD) in treating
irritable bowel syndrome (IBS).
Design/methodology/approach – A female patient diagnosed with diarrhea predominant IBS was
assigned to the SCD for six months. The diet occurred in phases and was advanced based on the
individual’s tolerance level under the guidance of a registered dietitian. Quality of life was measured by
a pre- and post-IBS severity score questionnaire. Gastrointestinal symptoms were measured by
self-assessment of IBS symptoms using a seven-point Likert-like scale, with 3substantially worse
to 3substantially better. Probiotics were consumed throughout the duration of the study.
Findings – The quality of life severity score signicantly improved from a severity of 315 (with 500
being the most severe) to 15. The initial symptoms from the rst day on the diet compared to the total
period for bloating, abdominal pain/discomfort, atulence/wind, diarrhea, bowel urgency, stool
consistency, stool frequency, energy levels, incomplete evacuation and abdominal rumbling were
improved signicantly (p0.0005). The SCD diet signicantly improved the quality of life and IBS
symptoms in a female patient with IBS-diarrhea.
Originality/value – This study is the rst of its kind to evaluate the efcacy of the SCD to treat IBS.
The SCD should be considered a therapeutic option to treating IBS after fermentable carbohydrate
restriction.
Keywords Carbohydrate restriction, Irritable bowel syndrome, Specic carbohydrate diet
Paper type Case study
Introduction
Irritable bowel syndrome (IBS) is dened as a functional gastrointestinal disorder that
has no organic cause, despite the presence of chronic or reoccurring gastrointestinal
symptoms (Fukudo et al., 2015). IBS affects 5-10 per cent of people worldwide and results
The authors are very grateful to the patient volunteer who took part in the study as well as Dr Carl
Jones, a gastroenterologist, who referred the patient and helped with the design of the study. This
study was conducted under a grant from the Stephen F. Austin State University Research
Enhancement Program. The study was approved by Stephen F. Austin State University
Institutional Review Board (Case No. AY2013-1183).
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0034-6659.htm
Specic
carbohydrate
diet
1
Received 12 May 2015
Revised 25 June 2015
Accepted 29 June 2015
Nutrition & Food Science
Vol. 45 No. 6, 2015
p. 000
© Emerald Group Publishing Limited
0034-6659
DOI 10.1108/NFS-05-2015-0056
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in a considerable reduction in quality of life. In a 2010 study, IBS patients indicated that
they would give up 25 per cent of their remaining life span (average 15 years), and 14 per
cent of the respondents indicated that they would risk a 1/1,000 chance of death to
receive a treatment that would make them symptom free (El-Salhy et al., 2010). In total,
12-14 per cent of primary care patient visits, and 28 per cent of referrals to
gastroenterologists are IBS patients, making this a more common reason for a visit to a
physician than diabetes, hypertension or asthma (El-Salhy et al., 2010).
Diet strategies that have had a positive impact on IBS have focused recently on
the restriction of fermentable carbohydrates; oligo, di, monosaccharides; and
polyols (FODMAPS) (Shepherd et al., 2013) and gluten sensitivity (Verdu, 2011). The
FODMAPS diet has shown excellent symptom reduction in patients with IBS. Ong
and others have proposed that FODMAPs induce luminal distention through the
fermentative activity of intestinal bacteria in combination with osmotic effects (Ong
et al., 2010). Dietary restriction of FODMAPS has led to symptomatic improvement
in a large majority of IBS patients (Shepherd and Gibson, 2006). Gluten has also been
implicated in symptomatology, and in fact, some authors speculate that gluten
contributes to the pathogenesis of IBS (Verdu, 2011). Two placebo controlled trials
using food challenges containing either gluten containing foods or a placebo found
that non-celiac wheat sensitivity existed in patients with IBS (Biesiekierski et al.,
2010;Carroccio et al., 2012). Despite advances in diet therapy, there is a subset of IBS
sufferers who may require further carbohydrate restriction, in addition to gluten
restriction and, if necessary, FODMAPS, to alleviate symptoms of IBS.
“Carbohydrate fermentation is the single most important force driving the
metabolic activities of the large intestinal microbiome, and it is quantitatively more
important than amino acid catabolism”(Group and Kingdom, 2012). In one study, 13
overweight and obese participants with moderate to severe IBS-diarrhea were
provided four weeks of a very low carbohydrate diet (VLCD) (20 g carbohydrates/d)
after a two-week washout period with a standard diet. Symptom changes were
monitored. In total, 77 per cent of patients had signicant improvement in
symptoms (reduced stool frequency, pain and quality of life). Overweight and obese
individuals initiating a VLCD had a profound clinical response in their IBS-diarrhea
symptoms (Austin et al., 2009).
Probiotics in the treatment of IBS have been advocated widely. Probiotics are live
bacteria that exert benecial effects on the host through numerous mechanisms. It is
believed that probiotics should be prescribed routinely as therapy in IBS (Hosseini
et al., 2012). The mechanism of action for probiotics includes the maintenance of
intestinal barrier function (Ukena et al., 2007), inhibition of pathogen growth and
adherence and production of chemicals such as cytokines and butyric acid (Rana
et al., 2012).
The specic carbohydrate diet (SCD) restricts polysaccharides and disaccharides
and allows monosaccharides (to an extent) and probiotics. Monosaccharides do not need
the aid of digestive enzymes for absorption and, therefore, can easily be absorbed in
people who have inamed and compromised digestive tracts. It is thought that the diet
alters the gut microbiome (Nieves and Jackson, 2004). The SCD diet was developed in the
1950s by Dr Sidney Haas. A study by Haas (1955) in the American Journal of
Gastroenterology reported that 191 pediatric patients with purported celiac disease were
treated with the SCD. These patients were followed for over 18 months. For a period of
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12 months, carbohydrates other than monosaccharides were eliminated from the diet,
while protein and fats were given in moderate quantities. In a large majority of the cases,
the nutritional status normalized after six-nine months. After 12 months, starches and
sugars were added. If symptoms reoccurred, then the patient was put back on the diet for
three-six months. Only one patient required the diet for greater than 18 months, and this
was due to non-compliance. Within 18 months of the therapeutic diet, all but one of the
children (175 within 15 months) were able to tolerate a reintroduction of starches and
sugars without any recurrence of symptoms (Haas, 1955).
A few studies have shown success with using the SCD to treat inammatory bowel
disease (IBD). Crohn’s disease and ulcerative colitis are two distinct conditions of IBD
and are characterized by inammation in the gastrointestinal tract. It is reasonable to
believe that there will be positive outcomes using the SCD in IBS given its favorable
response in IBD.
New and immerging research makes it clear that diet plays a role in the pathology of
IBS. Anecdotal evidence indicates that the SCD is successful in treating functional bowel
disease; however, a clinical study has never been published for the use of this diet in the
IBS population. It is the intent of this research project to provide scientically valid data
on the effects of the SCD on IBS symptoms.
Methodology
Subject
One female subject with IBS was referred from a local gastroenterology clinic and met
the following inclusion criteria: diagnosis of IBS (made by the referring physician and
fullling the Rome III criteria), over 18 years of age, all ethnicity groups are included,
male or female. The exclusion criteria were positive for celiac disease, IgA deciency,
pregnancy, breastfeeding, hereditary fructose intolerance, IBD and any other condition
associated with serious morbidity.
Study design
A registered dietitian, also the principle investigator, enrolled the patient and counseled
the patient throughout the duration of the study. The patient was asked to complete an
initial IBS severity score questionnaire and IBS symptoms scale. A 1-month supply of
Bio-Kult, a 14 strain commercial probiotic, was provided by the gastroenterologist. The
diet was explained in full during the initial visit. Responsibilities regarding food diaries
and symptom surveys were outlined, and informed consent was obtained. The protocol
was approved by the Stephen F. Austin State University Internal Review Board. At the
end of each day, the patient was instructed to complete a food diary and symptom
survey daily for two weeks. After two weeks, the symptom survey and food diaries were
to be completed two times per week by random assignment for the remainder of the
six-month period. At the end of the study, the patient completed another IBS severity
score questionnaire. Symptom surveys and food diaries were emailed monthly to the
principle investigator.
Dietary intervention for the SCD
The patient was introduced to the diet by the dietitian at the initial visit and was
followed regularly by the dietitian for the duration of the study period. The quantity of
food was not restricted. The diet was initiated in phases, starting with soft foods that
were tolerated easily. The phase chart, foods allowed and foods not allowed were
3
Specic
carbohydrate
diet
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adapted from two published books written about the SCD (Campbell-McBride, 2010;
Gottschall, 1994) as well as resources published on the Internet, including
Pecanbread.com Kids and SCD (2015) and SCDLifestyles (Reasoner and Wright, 2015).
Progression through the phases resulted in an increase in texture complexity, starting
with well-cooked or pureed food to raw, whole foods to maximize absorption of nutrients
in patients whose digestive capacity may be compromised. FODMAPS were discussed,
and the patient was told to restrict FODMAPS initially if any signs of intolerance
developed. Gluten was strictly forbidden. The patient was instructed to introduce new
foods one at a time and slowly increase serving size while monitoring symptoms, and to
wait 3 days before trying new foods. This elimination diet approach allowed the patient
to identity foods that were included on the diet but may not be tolerated on an individual
basis. Each phase may last one-ve days depending on individual tolerance levels
(Table I). The full SCD diet was implemented after the patient was able to tolerate Phase
4. Once on the full SCD, the patient was provided a chart indicating foods to avoid
(Table II) and foods allowed (Table III), with instructions to continue to introduce new
foods one at a time over a three-day period.
Duration
The patient was enrolled on May 29, 2013, and the duration of the study was six
months.
Assessment of gastrointestinal symptoms
Quality of life indicators were assessed using the IBS severity score questionnaire
with permission (Francis et al., 1997). This questionnaire contained categorical
questions and visual analog scales to assess quality of life and symptoms. It
consisted of four pages, and for this study’s purpose, only the rst and second pages
were utilized. The rst page collected demographic data and provided instructions
for completing the survey. The second page consisted of 5 scored questions for a
total maximum score of 500. Questions in this category were related to the severity
of abdominal pain, abdominal distention/tightness, bowel habit satisfaction and the
impact of IBS on general quality of life.
In addition, specic symptoms characteristic of IBS were recorded using a
seven-point scale, with 3substantially worse to 3substantially better. Use of a
seven-point scale has been shown to be a sensitive indicator of symptom changes
(Gordon et al., 2003). Symptoms related to IBS include bloating, abdominal pain, altered
motility patterns, gas production and luminal distention (Gibson, 2011). Specic
symptom categories included bloating, abdominal pain/discomfort, atulence/wind,
bowel urgency, diarrhea, constipation, nausea, heartburn, energy levels, incomplete
evacuation, abdominal rumbling and burping. To properly identify diarrhea and
constipation, the patient was taught the appropriate stool characteristics based on the
Bristol stool scale.
Statistical analysis
This was a pretest post-test study. Data were analyzed using the Statistical Software for
Social Sciences, SPSS Version 22 software. Multiple procedures were run to assess data
from the IBS global symptoms scale. Univariate descriptive processes were used to
examine central tendency and variability among all variables in the study. Pre-test and
post-test statistics were run on the IBS global symptoms scale using paired sample t-test
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Table I.
Phase chart for the
introduction of the
SCD
Meats Vegetables Fruit
Fat, nuts and
sweeteners, dairy and
non-dairy Probiotics
Introduction – this is your safe
zone. Wait until your
symptoms subside before
adding foods in the next phase
Beef, pork, chicken, turkey,
lamb, sh, sardines, meat
broth
Carrots, green beans,
summer squash,
zucchini (onions and
garlic to avor only)
100% grape juice diluted by
half (made into gelatin)
Fat: coconut oil and
olive oil
Start with 1/4to 1/2of
recommended amount
Take probiotics with
each meal
Sweeteners: honey (keep
to small amounts) and
stevia
Phase 1 (in addition to the
introduction phase)
Eggs Butter and coconut milk Increase to 1/2of
recommended amount
Homemade yogurt or
ker, fermented
vegetables
Phase 2 (in addition to Phase 1) Sausage, no MSG, sugar-free Avocado
a
, winter
squash except for
spaghetti
Bacon (sugar free if
available) and nut butter
Increase to 3/4to full
amount
Phase 3 (in addition to Phase 2) Applesauce
a
Nut ours such as
coconut and almond
our (you can make
mufns, cookies, etc.
with these ours)
Full amount
Raw banana (must be ripe,
indicated by multiple black
spots)
Phase 4 (in addition to Phase 3) Raw vegetables starting
with lettuce and peeled,
deseeded cucumber
Full amount
Full SCD diet See foods to avoid and foods allowed, introduce foods one at a time over a three-day period as instructed. Monitor for tolerance
Notes:
a
Fermentable oligosaccharides, disaccharides, monosaccharides and polyols (reduce/eliminate if gastrointestinal symptoms increase after addition); cooking method/preparation
style for the introduction phase, Phases 1 and 2. All meats should be boiled, broiled, pan-fried, grilled or roasted. Incorporating the meats and vegetables into a soup works best initially. All
vegetables and fruits should be peeled, deseeded, well-cooked and, for maximum digestion, pureed
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Specic
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Table II.
Foods to avoid on the
SCD
Additives Beverages Condiments Dairy Grains, ours, starches Sweets/sweeteners Vegetables
Agar-agar Bark tea Balsamic vinegar American cheese Amaranth our Agave syrup Algae
Arrowroot Beer Bouillon cubes Buttermilk Arrowroot Corn syrup Artichokes (Jerusalem)
Carrageenan Brandy Ketchup Chevre cheese Barley Cyclamate Barley
Cellulose gum Coffee (instant) Margarine Cocoa powder Buckwheat Date sugar Bean sprouts
Cornstarch Cordials Soy sauce (unless gluten free) Cottage cheese Bulgur Dextrose Okra
FOS Evaporated cane juice Tamari Cow and goat milk cream cheese Chestnut our Isoglucose Bitter gourd
Guar gum Juice from concentrate Dried milk solids Corn Maltitol Black-eyed peas
Gums Port wine Feta cheese Durum our Maple syrup Butter beans
HFCS Sake Gjetost Ezekiel bread Marshmallow Cannellini beans
Inulin Sherry cheese Garfava our Molasses Chick peas
Lignin Vegetable juice Heavy cream Millet Sorbitol Chickoryroot
Maltodextrin Ice cream lactaid milk Oats Xylitol Fava beans
Mannitol Lactose Pasta Splenda Garbanzo beans
MSG Mozzarella cheese Pea our Sucralose Jicama
Neufchatel cheese Psyllium husks Sucrose Kohlrabi
Primost cheese Quinoa Tagatose Mungbeans
Processed cheeses Rice Turbinado Nettles
Ricotta cheese Rice bran Okra
Sour cream Rice our Parsnips
Tofutti cheeses® Rye Pinto beans
Yogurt Seed our Potatoes
Soy Sweet potatoes
Spelt Taro
Sprouted grain bread Turnips
Tapioca our Yams
Triticale Yucca root
wheat
Wheat germ
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Table III.
Foods allowed on the
SCD
Additives Beverages Condiments Dairy Fruits Meats Nuts/seeds Fats/oils Spices/herbs Sweets/sweeteners Vegetables
Baking soda/
powder
Gelatin (unavored)
Potassium sorbate
Sulphates
Almond milk
Club soda
Coconut milk
Coffee
Ethanol
Gin mead
Green tea
Peppermint tea
Scotch whisky
Spearmint tea
Vodka
Wine (dry red
and white)
All vinegars (except
balsamic)
Apple cider
Capers
Citric acid
Horseradish sauce
Soy sauce (gluten
free)
Tabasco brand-
pepper Sauce
Hard natural
cheese
Yogurta
Applesa
Apricotsa
Avocadoesa
Bananas
(ripe)
Berries
(blackberry)a
Canned fruits
(fruits
canned in
their own
juice are
allowed)
Cantaloupe
Cherriesa
Dates
Figs
Grapefruit
Grapes
Kiwi fruit
Kumquats
Lemons
Limes
Mangoesa
Melon
Nectarinesa
Olives
Oranges
Papayas
Passion fruit
Peachesa
Pearsa
Persimmonsa
Pineapple
Plumsa
Prunesa
Raisins
Tangerines
Watermelona
Anchovies
Bacon
Beef
Eggs
Fish (canned
and fresh)
Fowl
Ham
Lamb
Pork
Pork rinds
Poultry
Sashimi
Shellsh
Almonds
Almond butter
Brazil nuts
Cashews
Chestnuts
Coconut
Hazelnuts
Macadamia nuts
Peanut butter
Peanuts
Pecans
Pine nuts
Pistachio nuts
Seeds
Sesame seeds
Walnuts
Water chestnuts
Almond oil
Avocado oil
Canola oil
Coconut oil
Corn oil
Flax seed oil
Ghee (claried
butter)
Grapeseed oil
Macadamia oil
Mustard
(plain)
Olive oil
Peanut oil
Safower oil
Sesame oil
Sunower oil
Walnut oil
Allspice
Basil
Bay leaf
Cilantro
Cinnamon
Echinacea
Garlica
Ginger
Nutmeg
Oregano
Paprika
Peppers
Rosemary
Sage
Salt
Tarragon
Thyme
Aspartame
Glycerin
Glycerol
Honeya
Saccharine
Stevia
Artichoke (French)a
Asparagusa
Beetsa
Bell peppers (green)a
Bok choy
Broccolia
Brussels sproutsa
Cabbagea
Carrots
Cauliowera
Celery
Chard
Collard greens
Cucumbers (peeled, de-seeded)
Eggplant
Green beans
Haricot beans
Jalapenos
Kale
Leeka
Lentilsa
Lettuce
Lima beans
Mushroomsa
Onionsa
Parsley
Peas
Pumpkin
Rhubarb
Rutabaga
Spinach
Split peas
Squash (summer, butternut
and spaghetti)
String beans
Tomato juice (canned)
Tomatoes
Turnip
Wasabi
Watercress
Zucchini
Note: aFermentable oligosaccharides, disaccharides, monosaccharides and polyols (reduce/eliminate if gastrointestinal symptoms increase after addition)
7
Specic
carbohydrate
diet
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with intra-group design. Categorical data were analyzed using chi-square. All
inferential tests used p0.05. The IBS severity score questionnaire was administered
as a one-time pre-test and post-test to assess quality of life. The severity score could
range from 0-500, with 0 indicating no impact on quality of life and 500 indicating a
severe impact on quality of life.
Results and discussion
IBS symptoms
In total, 14 known IBS symptoms were tracked over a 6-month period. Constipation,
nausea and heartburn were not an issue for this particular patient and were eliminated
from the analysis, resulting in 11 symptoms included in the analysis.
Basic univariate statistics demonstrated essential IBS symptom outcomes (Table IV)
with 62 possible observations per symptom. Symptoms were rated from 3
(substantially worse during the three months prior to starting the diet) to 3
(substantially improved during the three months prior to starting the diet). A zero value
indicated “no change” in a particular symptom. To examine whether the patient showed
statistically signicant improvement with these 11 IBS symptoms, a set of one-sample
t-tests was executed with the initial symptom value used as the test value. Shown below
are the results of the t-tests (Table IV). All 11 symptoms showed a signicant
improvement (p0.0005). The patient exhibited the most improvement in bowel
urgency (mean difference 5.27), bloating (mean difference 4.92) and energy (mean
difference 4.92).
Quality of life
The main reason for her visit to the gastroenterologist on May 13, 2013, was due to
generalized abdominal pain and diarrhea. The patient’s quality of life was poor due
to the severity of her symptoms. She was unable to travel and feared leaving her
Table IV.
Statistical values
related to IBS
symptoms
IBS symptom First value
a
Mean value
b
No. of
data points
Mean
difference
c
t-value p-value
Bowel urgency 3 2.27 62 5.27 24.15 0.0005
Bloating 3 1.92 62 4.92 20.85 0.0005
Energy 3 1.92 62 4.92 19.04 0.0005
Abdominal rumbling 3 1.89 62 4.89 19.64 0.0005
Stool frequency 2 2.64 53 4.64 28.68 0.0005
Stool consistency 2 2.62 53 4.62 27.06 0.0005
Flatulence or wind 2 2.03 62 4.03 19.25 0.0005
Abdominal pain or
discomfort 2 1.97 62 3.97 17.613 0.0005
Incomplete evacuation 2 1.82 62 3.82 13.46 0.0005
Diarrhea 1 2.34 62 3.34 15.57 0.0005
Burping 0 1.92 62 1.92 8.42 0.0005
Notes:
a
Symptoms at initiation of the study, rated from 3 (substantially worse during the three
months prior to starting the diet) to 3 (substantially improved during the three months prior to
starting the diet);
b
mean of the symptoms out of 62 data points;
c
difference between the rst value and
the mean value
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home to go out to eat or attend church. The patient’s IBS severity score from the IBS
severity scoring system questionnaire upon enrollment was 315 points (Francis
et al., 1997). According to the authors who developed the questionnaire, a score
between 75-175 points is considered a mild case, moderate is 75-300 points and
300-500 points indicates a severe case of IBS. At the end of the study period, the
patient’s severity score was 15 points, showing a marked improvement in quality of
life.
Symptoms
When starting the SCD, it is expected that symptoms get worse before they get better.
This is termed the herxheimer reaction. It is hypothesized that upon deprivation of
carbohydrate substrate, the microbrial residents in the intestinal track start to die,
resulting in the release of toxins and microbial by-products. This reaction initially
increases the symptoms that the diet is attempting to reduce. Figure 1 includes the mean
of the 11 symptoms and indicates the erratic pattern experienced during the rst 38
days. Anecdotal evidence indicates that this is normal, and the patient was advised of
this and to remain on the diet. After 22 days, the overall symptoms stabilized, and there
were no change in symptoms throughout the remainder of the six-month study period.
Therefore, we only reported specic symptom data for the rst 38 days of the study
period.
Food diary
The patient’s food diary indicated that she was on the introduction phase for 3 days
and reached the full SCD within 16 days. Symptom resolution was seen on Day 22
and beyond. Almost all foods on the SCD allowable list were tolerated well except for
strawberries – both raw and cooked. There were certain times when she strayed
012345678910111213141516172229313638
Index −2 −0 −0 −1 −0 −0 −0 −0 −1 −0 −1
−3.0
−2.0
−1.0
0.0
1.0
2.0
3.0
4.0
IBS Symptom Mean
−1 1. 0.0.2.1.1.3.3.3.3.3.
Figure 1.
Means of the 11
irritable bowel
syndrome symptoms
rated from 3
(substantially worse
during the three
months prior to
starting the diet)
to 3 (substantially
improved during the
three months prior to
starting the diet) for
a period of 23 data
points represented
in days
9
Specic
carbohydrate
diet
F1
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from the diet which precipitated a return of symptoms. Popcorn was one of the worst
offenders. She did not have any problems with FODMAPS, indicating that she
tolerated broccoli, mushrooms and apples well. In some cases, the SCD typically
involves a decrease in carbohydrate from the standard American diet. However, the
diet is not considered a low carbohydrate diet, and in fact, because the patient had
Type 2 diabetes, the carbohydrate was not severely restricted. The patient was
advised to keep her carbohydrate at 45 grams per meal and to check her blood sugar
ve times per day – upon awakening, 2 hours after breakfast, lunch, dinner and
before bed. She used glucose tablets, sometimes four at a time, to keep her blood
sugar stable if she experienced low blood sugar. She did not need to use the glucose
tablets after reaching the full SCD. The patient verbally indicated that she had
reduced her insulin requirement while on the diet; however, this was not
documented in her medical record from her primary care physician. The commercial
probiotics were used during the rst month of the study period. During that time, the
patient was taught how to make her own yogurt and to ferment it for 24 hours to
decrease lactose content. The homemade yogurt was consumed daily.
Other medical parameters
Other medical parameters were not obtained as a goal of this study; however,
it is worthy to note that the patient’s weight recorded at the gastroenterologist’s
ofce on July 19, 2013, was 199 pounds and on September 17, 2013; her weight was
recorded at 188 pounds, indicating an 11 pound weight loss in approximately three
months.
Limitations
There are a couple of limitations that need to be addressed. The rst limitation was
the fact that dysbiosis or small intestinal bacteria overgrowth (SIBO) were not
measured. Abnormalities in the bacterial population of the gut, known as dysbiosis,
have been associated with the pathophysiology of IBS (Balsari et al., 1982;Carroll
et al., 2012;Codling et al., 2010;Kassinen et al., 2007;Kerckhoffs, 2009;Matto et al.,
2005;Maukonen et al., 2006;Si et al., 2004). These bacteria, rather than being
conned to the large intestine, can also propagate the small intestine in large
numbers, leading to SIBO (Majewski and McCallum, 2007). SIBO has been found in
30-75 per cent of irritable bowel sufferers (Anderson et al., 2010;Ewaschuk et al.,
2008;Lin, 2004;Lupascu et al., 2005;Pimentel et al., 2003;Sapone et al., 2011;Ukena
et al., 2007). Some researchers have implicated SIBO as the cause of IBS (Ghoshal
et al., 2012;Parkes et al., 2008;Pimentel et al., 2000,2006). It is difcult to measure
the gut microbiota and subsequent changes. The proposed mechanism of the SCD is
manipulation of the gut microbiome by bacterial substrate reduction and probiotic
administration in patients with IBS through long-term dietary intervention. The
patient populations who will best benet from this diet are those with dysbiosis and
SIBO. Culturing microorganisms that reside in the gut are difcult, and molecular
techniques also have limitations (Lee and Bak, 2011). Hydrogen breath testing can
be simple and useful, although research has shown wide variations in sensitivity
and specicity, making it an unreliable test to detect SIBO (Parrish, 2008).
Further research will need to be developed to quantify the diet’s exact mechanism of
action. Quality of life and symptom reduction was an appropriate tool to measure
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success, and a statistically signicant reduction in symptoms (p0.05) from initial
symptom assessment was considered successful over the six-month study period.
Another limitation is diet adherence. Patients may nd it difcult to adjust to the diet
restrictions and may nd the labor intensive aspects of the diet difcult to incorporate
into their lifestyle. One way to account for this is to only assign patients to the SCD who
have exhausted all other treatment efforts (including FODMAPS and gluten exclusion).
It is anticipated that participants will have a signicant reduction in symptoms, which
will encourage adherence. To ensure successful adherence to the diet, a signicant
amount of education may be required regarding the specics of the diet, cooking
techniques and regular intervals for follow-up.
Conclusion
The SCD signicantly improved this female patient’s quality of life and global IBS
symptoms within 22 days of starting the diet. This is the rst account of using the
SCD to treat IBS. However, there have been several studies published using the SCD
diet to treat IBD. Researchers from the University of Massachusetts completed a
study using a modied version of the SCD called the anti-inammatory diet (AID) to
treat IBD (Olendzki et al., 2014). Patients were put on the AID diet for approximately
6-10 months. Out of 11 patients, 9 were able to discontinue anti-tumor necrosis factor
therapy, and symptoms were reduced in 100 per cent of the study population. Rush
University Medical Center is currently conducting a study using the SCD in patients
with IBD while monitoring changes in the intestinal microbiota (Mutlu, 2015).
Suskind et al. (2014) reviewed medical records of seven children with Crohn’s
disease who were on the SCD and no immunosuppressive meds. The researchers
found through chart review that stool calprotectin and C-reactive protein
(inammatory markers) were greatly improved or normalized. Although the exact
time frame could not be ascertained, it was estimated that within three months of
adopting the SCD, all symptoms were notably resolved (Suskind et al., 2014).
Because there are possible overlaps between IBS and IBD (Spiller and Lam, 2011),
this diet can produce the same positive outcomes in IBS, as it has in IBD. Larger
populations need to be studied using the SCD in people who have IBS.
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About the authors
Darla D. O’Dwyer (PhD in Food and Nutrition from Texas Tech University, 2003) is an Associate
Professor and Registered Dietitian in the School of Human Sciences. She is Coordinator of the
Food, Nutrition and Dietetics program and the Dietetic Internship Director. Her primary research
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interest is gastrointestinal nutrition. She teaches a wide range of courses, including food science,
medical nutrition therapy, nutrition through the lifecycle, advanced nutrition and pediatric
nutrition. Darla D. O’Dwyer is the corresponding author and can be contacted at:
dodwyer@sfasu.edu
Ray L. Darville (PhD in Sociology from University of North Texas, 1984) is a Professor of
Sociology at Stephen F. Austin State University. His primary teaching areas in sociology are
introduction to sociology, social science research methods and data analysis. His research areas
include nutrition, interior design, natural resource interpretation and human dimensions. He also
teaches and conducts research in the Arthur Temple College of Forestry and Agriculture and in
the School of Human Sciences. He has about 30 publications. He was selected as Regents Professor
at SFA for 2015-2016.
For instructions on how to order reprints of this article, please visit our website:
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Or contact us for further details: permissions@emeraldinsight.com
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... SCD diyet uygulamasının Crohn ve Irritabl Bağırsak Sendromu (IBS) tedavisinde kullanıldığında, semptomları iyileştirici etkileri olduğunu gösteren bulgular mevcuttur (O'Dwyer & Darville., 2015;McCormick & Logomarsino., 2017). Bir çalışmada, OSB ve Frajil X Sendromu (Kadak,2019) olan 4 yaşındaki bir çocuğa belirli bir süre SCD uygulanması sonucunda çocuğun büyüme ve gelişmesinin ilerlediği, gastrointestinal semptomların azaldığı ve sosyal davranışların iyileştiği gözlenmiştir (Barnhill & ark.,2020). ...
Chapter
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Yetersiz beslenme ve engellilik durumu birçok ortak noktası nedeniyle yakından ilişkili iki kavramdır. Besine ulaşmanın zor olduğu durumlarda ya da yüksek düzeyde besin çeşitliliğinin bulunduğu fakat yetersiz beslenmenin yaygın olduğu ülkelerde yaşamını sürdüren çocuklarda gelişimsel bozukluklar, gecikmeler ve engellilik oranlarının yüksek olduğu bildirilmektedir. Bu oranların açıklayıcısı veya iki kavramın bağının oluştuğu noktalar ise yetersiz beslenmenin çocuklarda çeşitli farklı engellilik durumlarına neden olması veya katkıda bulunması ile birlikte; engellilik durumlarının da yetersiz beslenmeye neden olması veya katkıda bulunmasıdır. Özel gereksinimli çocuklarda beslenmenin önemi, gebelik döneminde annenin beslenmesine kadar dayandırılmaktadır. İlk 1000 gün boyunca, yani gebelikten 2. doğum gününe kadar optimal düzeyde beslenmenin, yeni doğanın sağlıklı gelişimi ve yaşamı için kritik öneme sahip olduğu yönünde görüş birliği vardır .......
... SCD diyet uygulamasının Crohn ve Irritabl Bağırsak Sendromu (IBS) tedavisinde kullanıldığında, semptomları iyileştirici etkileri olduğunu gösteren bulgular mevcuttur (O'Dwyer & Darville., 2015;McCormick & Logomarsino., 2017). Bir çalışmada, OSB ve Frajil X Sendromu (Kadak,2019) olan 4 yaşındaki bir çocuğa belirli bir süre SCD uygulanması sonucunda çocuğun büyüme ve gelişmesinin ilerlediği, gastrointestinal semptomların azaldığı ve sosyal davranışların iyileştiği gözlenmiştir (Barnhill & ark.,2020). ...
Chapter
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OSB, yaşamın ilk yıllarında ortaya çıkmakta ve etiyolojisi kesin olarak bilinmemektedir. OSB oluşumunda tek bir faktörden çok, genetik ve çevresel faktörlerin çoklu mekanizmalar halinde etkili olduğu ileri sürülmektedir (Risch & ark.,2014). Bir meta-analizde, genetik faktörlerin OSB oluşumunda %74-93 oranında katkıda bulunmakla birlikte yine de tek başına yeterli olmadığı belirlenmiştir (Tick & ark.,2016). Ebeveyn yaşının ileri olması, endokrin bozucu kimyasal ve radyasyon maruziyeti, ilaç alımı, civa/kurşun/alimünyum gibi çevresel toksinlerin OSB oluşumunda etkili olabileceği bildirilmiştir (Lyall vd., 2017 & Cekici ve Sanlier., 2019). Prematüre doğum, annenin gebelik boyunca başta folik asit olmak üzere yeterli vitamin ve mineral alamaması, bozulmuş otoimmünitenin OSB oluşumunda etkili mekanizmalar arasında sayılmaktadır (Lyall & ark., 2017; Cekici & Sanlier., 2019). Anne-çocuk arasındaki psikososyal bağın yetersiz olmasının da OSB gelişiminde etkili olabileceği düşünülmektedir (Özeren,2013). İlk 6 ay ve 2. yaşa kadar elzem olan anne sütü tüketiminin, OSB riskini azalttığını gösteren bulgular mevcuttur (Say, Babadağı & Karabekiroğlu, 2015; Huang & ark., 2021)...........
... Before the FODMAP approach gained its current popularity, it had been found that restriction of simple sugars and refined carbohydrates could result in important relief of functional digestive symptoms in some people [56][57][58]. Furthermore, the specific carbohydrate diet has also been reported to be of benefit [59]. It is interesting to speculate that higher intake of refined sugar and carbohydrates could contribute to the development of IBS in some individuals. ...
Article
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Significant shortcomings in irritable bowel syndrome (IBS) diagnosis and treatment may arise from IBS being an "umbrella" diagnosis that clusters several underlying identifiable and treatable causes for the same symptom presentation into one classification. This view is compatible with the emerging understanding that the pathophysiology of IBS is heterogeneous with varied disease mechanisms responsible for the central pathological features. Collectively, these converging views of the pathophysiology, assessment and management of IBS render the traditional diagnosis and treatment of IBS less relevant; in fact, they suggest that IBS is not a disease entity per se and posit the question "does IBS exist?" The aim of this narrative review is to explore identifiable and treatable causes of digestive symptoms, including lifestyle, environmental and nutritional factors, as well as underlying functional imbalances, that may be misinterpreted as being IBS.
Article
Background: Functional gastrointestinal symptoms in irritable bowel syndrome (IBS) and quiescent inflammatory bowel disease (IBD) cause significant morbidity and a reduction in quality of life. Multiple dietary therapies are now available to treat these symptoms, but supporting evidence for many is limited. In addition to a further need for studies demonstrating efficacy and mechanism of action of dietary therapies, the risk of nutritional inadequacy, alterations to the microbiome and changes in quality of life are key concerns requiring elucidation. Identifying predictors of response to dietary therapy is an important goal as management could be tailored to the individual to target specific dietary components, and thereby reduce the level of dietary restriction necessary. Purpose: This review discusses the available dietary therapies to treat symptoms in patients with IBS and patients with quiescent IBD suffering from IBS symptoms, with the aim to understand where current dietary evidence lies and how to move forward in dietary research in this field.
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Irritable bowel syndrome (IBS) is a chronic disorder of the gut that is common in the world, causing a financial burden to health service and people. IBS is generally divided into several types including diarrhea-predominant IBS (IBS-D), constipation-predominant IBS (IBS-C), and mixed IBS (sometimes constipation, sometimes diarrhea). Despite the high prevalence of IBS, the exact pathophysiology of IBS is not clear but autonomous nervous system dysfunction seems the most important factor [1]. The management of IBS is often based on severity of disease, and the patient or practitioner preferences. Effective medications for treating symptoms in all IBS subtypes include tricyclic antidepressants (TCAs) [2], antispasmodics [3], selective serotonin reuptake inhibitors (SSRIs) [4], fiber supplements, loperamide, rifaximin, pregabalin, and complementary and alternative medicine therapies such as probiotics, herbal therapies [5] and acupuncture [6, 7]. According to evidence, until this time no complete effective curable drug is known for IBS and thus most of the drugs are still in evaluation. In recent years many drugs from synthetic or natural sources have been introduced. Most researchers in recent years have focused on phosphodiesterase inhibitors [8], melatonin [9], herbal products [5], and probiotics [10].
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