Introduction: Many diet therapies for Crohn’s disease are known to be effective. It is not known which components of diets give the benefit, or which component of a regular diet is perpetuating the disease. We report two children with Crohn’s disease who made a complete recovery on the Specific Carbohydrate Diet (SC Diet). One child received no other therapy, the other was steroid dependent prior to the diet. The diet eliminates all complex carbohydrates and refined sugars. In theory the diet deprives intestinal bacteria of the substrates they need to survive, reducing bacterial growth and the harmful products of fermentation.
Methods: This is a case series to describe a novel diet therapy.
Results: Case 1: An 11 year old girl presented with abdominal pain, weight loss and diarrhea. Laboratory examination revealed an albumin of 3.0 g/dL, hemoglobin (Hb) 11.6 g/dL and erythrocyte sedimentation rate (ESR) 17 mm/Hr. Serologies were positive with ASCA IgA 27.7 EU/ml and IgG 53.9 EU/ml, but pANCA was negative. Upper GI series (UGIS) showed multiple areas of stricture and mucosal cobblestoning in the jejunum and ileum, and a 5–6 cm stricture in the terminal ileum. Pathology was non-specific. The family refused standard care and following their own research elected to start the SC Diet. After 6 months on the diet her UGIS is normal, labs including ASCA antibodies have normalized and the patient is growing and symptom free.
Case 2: A 9 year old boy presented with a history of diarrhea, abdominal pain, poor appetite and no weight gain for 2 years. Laboratory examination revealed albumin 3.4 g/dL, Hb 12.0 g/dL and ESR 43 mm/Hr. ASCA IgA, IgG and pANCA were negative. UGIS showed narrowing of the distal ileum and proximal cecum. Pathology demonstrated focal acute colitis with crypt abcesses and granuloma formation. The patient responded well to treatment with sulfasalazine, prednisone and 6 mercaptopurine. Ten weeks after starting medications, during a steroid taper, his symptoms flared and his anemia returned. His prednisone was increased, but at this time the family elected to start the SC Diet. After 3 months on the diet the patient is off steroids, symptom free and all blood tests have normalized.
Conclusion: The apparent effectiveness of the Specific Carbohydrate Diet in Crohn’s Disease warrants more study. There is current interest in the manipulation of intestinal flora using probiotics and prebiotics. If this diet works by changing the bacterial flora of the bowel, then it adds weight to the role of bacteria in the pathogenesis of Crohn’s Disease.
Gottschall, Elaine: Breaking the Vicious Cycle - Intestinal Health Through Diet. Baltimore, Ontario, The Kirkton Press 2002.