A Dietary Approach to Treating Some Gut Disorders

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On the Third Birthday of the BTVC-SCD group, (http://health.groups.yahoo.com/group/BTVC-SCD) Marilyn L. Alm posted her speech to the Kiwanis Club on Irritable Bowel Diseases (IBD), treatment with the Specific Carbohydrate Diet and her vision of the future. Her speech may help explain to family and friends what you are doing as you start the healing journey of SCD.

Marilyn's Introductory Comments in posting her 2003 Speech on the Specific Carbohydrate Diet (SCD)

There’s a saying that it takes a village to raise a child. I think this could be paraphrased to say, “It takes a community to heal a person.”

When I began SCD in 2001, people from the Long Island List (then the primary and, as far as I know, the only SCD list) gave generously of their time to help me learn what I needed to know in order to implement SCD in my daily life, and in order to heal. I cannot pay those folks back – they’ve moved on from SCD lists because they have healed, and they are getting on with "Real Life."

What I have chosen to do is what a writer-friend of mine calls, “Paying forward.” Teaching those who come after you what you were taught. That is why, when Rachel Turet, owner of the Long Island List, decided to retire, I opened BTVC-SCD. The success of this group is due to the amazing range of knowledge the members bring. Each and every one of us have dealt with feeling lousy – some of us with more straightforward symptoms, and others with a bewildering array of complex issues.

Each and every one of us came here hoping that the Specific Carbohydrate Diet would be the answer. Most of us have found that SCD is the foundation of our healing, because if we are not absorbing nutrients, we cannot heal. For many of us, SCD is the only answer needed. For some, adding mind/body work, acupuncture, Low Dose Naltrexone(LDN) or even continuing with conventional IBD medicines on top of this marvelous healing diet is the key.

Healing is hard work. Healing requires support, something we often do not find enough of in the either the medical community or, regrettably, our own families. Support is what the BTVC-SCD group is all about. Finding something you can eat without getting nausea. Having days when you do not have to worry about diarrhea or constipation. Actually finding a restaurant where you can occasionally eat out. The triumph of making (and tolerating!) your first yogurt or nut bread. Tracking down solutions to the three-month flare, and on and on. Only people who have been there and done that understand the setbacks and the triumphs.

I’d like to share with you a speech I made in 2003, when I had been on SCD less than 18 months.

Speech given by Marilyn L. Alm to the Kiwanis Club of Algiers 9 April 2003 in New Orleans, Louisiana

Good evening. I’ve been told that the topic of my speech tonight is supposed to be A Holistic Approach to Treating Some Gut Disorders. Actually, it’s A Dietary Approach. Gut disorders, including constipation, diarrhea, Crohn’s Disease, and Ulcerative Colitis affect on the order of 60 to 70 million people worldwide.

They account for almost 200,000 deaths, 10 million hospitalizations (13 percent of all hospitalizations), and over 50 million office visits to physicians, but they are, despite all the advertisements on TV for Maalox, Ex-lax, Imodium A-D and other over the counter drugs, one of the least talked about.

Gut disorders are essentially a taboo subject in North American and Western European cultures. How do we know this? Profanity is usually linked to taboo subjects, and if you think about it, most of the profanity we see scrawled as graffiti or which assails our ears on the street is related to religion, sex, and bodily functions.

What exactly are some of these gut disorders? Crohn’s disease (CD) causes inflammation in the lower part of the small intestine, although it can affect any part of the digestive tract. Ulcerative colitis (UC) causes inflammation and ulcers in the large intestine. Irritable bowel syndrome (IBS) is characterized by recurring abdominal discomfort or pain, bloating, and altered bowel function such as constipation, diarrhea, or alternating constipation and diarrhea.

I’ve perused an awful lot of web sites and books regarding these disorders over the last 27 years. Almost all of them, including the Crohn’s and Colitis Foundation of America state that diet has nothing to do with these diseases. In fact, the Times-Picayune (Time-Picayune / States-Item, local newspaper in New Orleans) ran an article a couple of weeks ago which stated unequivocally that diet could do nothing to help the nearly 3,000 Louisiana children who suffer from Crohn’s Disease.

To my mind, the idea that the food we eat has no effect on the very organs intended to digest it for our use is pretty foolish. Dr. J.O. Hunter, in an article in Lancet, the British medical journal, confirms this fact, as does Dr. Ronald Hoffman of New York City. Other Lancet articles also state that persons with gut disorders frequently have intolerances to corn, wheat, milk, potatoes and rye. What these substances have in common are complex carbohydrates, not gluten. Yet the gluten-free diet, popularized in the last 40 or so years as the gut diet, yields variable results, perpetuating the myth that diet has nothing to do with the management of gut disorders.

Dr. Sidney Valentine Haas, coauthor with his son, Dr. Merrill P. Haas, of Management of Celiac Disease, which was published in 1951, might not be surprised at his successors in the field of gastroenterology, but he would probably be saddened by the amount of pain and suffering caused by failure to recognize a simple fact stated by Dr. Samuel Gee: We must never forget that what the patient takes beyond his ability to digest does harm. The Haas book, based on many years of clinical experience, documented the experience of these doctors in treating and curing hundreds of cases of celiac disease.

The Specific Carbohydrate Diet as delineated in Elaine Gottschall’s Breaking the Vicious Cycle came about because in 1958, the Gottschalls took their eight year old daughter Judy to see Dr. Haas. Judy had ulcerative colitis. Years of medication had done nothing. Her condition was deteriorating. Surgical removal of her colon seemed to be the only option. Dr. Haas, then in his 90s, asked one simple question: “What has this child been eating?” The result was that Judy was placed on the Specific Carbohydrate Diet. Two years later, she was symptom free. Nearly forty years later, she eats about 85-90% SCD, and remains symptom free, with no medications.

Elaine Gottschall, though, wanted to know why the diet worked. Unfortunately, she could not consult with Dr. Haas, as he had passed away. So, in her late 40s, she decided to return to college and get the knowledge she needed to find out why. And she did, earning a bachelor’s degree in biology, magna cum laude from Montclair State College in New Jersey. She also did work in graduate studies in nutrition at Rutgers. After a move to Canada, she obtained a Master of Science degree in from the Department of Cell Biology at the University of Western Ontario, where she spent four years investigating the effects of various sugars on the digestive tract. Not wanting to see others suffer as her daughter had, she wrote and published, first Food and the Gut Reaction, and then Breaking the Vicious Cycle, now in its tenth edition.

But why does the Specific Carbohydrate Diet work? Some gut diseases are the consequence of an overgrowth and imbalance of intestinal microbial flora. By altering our diet, we can bring our system back into balance, healing our digestive tracts and restoring proper absorption.

The intestinal tract is an astoundingly rich ecosystem, home to over 400 bacterial species. Some are harmless, and others not. In a healthy persons gut, these various communities of microbes balance each other.

Yet this balance can easily be upset by what we eat. Overgrowths can occur, triggered by overuse of antacids, reduced stomach acidity due to aging, weakening of the immune system through malnutrition or poor diet, or antibiotic therapy.

Carbohydrates, contrary to the gluten theory, play an enormous role in our gut health. If carbohydrates are not fully digested and absorbed, they feed the bacteria we host, causing a population explosion.

Bacterial overgrowth inhibits absorption, which leads to even more undigested carbohydrates. Excessive protective mucus is produced, which also inhibits digestion and absorption. Eventually, though, the mucus-making cells become exhausted, and the intestinal surface is laid bare. It may be ulcerated. As even more carbohydrates are left in the gut, they cause water and nutrients to be pulled from the body into the colon, resulting in chronic diarrhea. Absorption is further hindered as diarrhea increases the rate with which food travels through the gut. Truly a vicious cycle.

So the question then is, “How do we break the vicious cycle?”

And the answer lies in Dr. Samuel Gee’s statement, We must never forget that what the patient takes beyond his ability to digest does harm. By changing one’s diet to what one can absorb, the gut can heal. The symptoms disappear, one by one.

What, then, is the Specific Carbohydrate Diet?

People with IBD can’t fully break down complex chains of carbohydrates. Thus, the Specific Carbohydrate Diet excludes most complex carbohydrates, such as processed sugars, grains, potatoes and most legumes. Even the slightest bit of these carbohydrates can cause symptoms to flare up.

Yet grains are imbedded in our thought patterns as food. Wheat is the staff of life. Who ever heard of Creole or Cajun food that wasn’t served on a bed of rice? Grain even infuses our patriotism, O beautiful for spacious skies, for amber waves of grain. Its almost un-American not to eat grain and if we are not eating grain and potatoes, what are we to eat? That’s easy. We eat:

  • Fresh or frozen beef, lamb, poultry, pork, fish, eggs
  • Vegetables – fresh or frozen, raw or cooked (with no added sugar or starch)
  • Homemade yogurt, fermented at least 24 hours
  • Natural cheeses with little or no lactose, such as Cheddar, Colby, havarti, Swiss, dry curd cottage cheese
  • Fruits – fresh or frozen, raw or cooked (with no added sugar)
  • Salad and cooking oils
  • Honey, nuts and nut flours, spices
  • Very dry wine, occasionally gin, rye, Scotch, bourbon, vodka, etc.

What we DO NOT eat includes:

  • Grains, including bread, rice, pasta, cereal, and corn products
  • Processed meats, like hot dogs, cold cuts, fast food
  • Potatoes (or starchy roots)
  • Milk, margarine, soy products
  • Chocolate (alas!), starches, added sugar, including corn syrup, cane sugar, molasses
  • Beer, sherry, cordials, liqueurs or brandy

SCD, though, is not a diet which you can follow Sunday through Thursday, and then go out and eat whatever you want on Friday and Saturday. Strict adherence is critical since that one little bite of pasta, a single Saltine cracker, even a little bit of grain flour in gravy or coating a veal cutlet is a veritable smorgasbord to the bacteria in your gut.

I recall, for instance, a year ago Christmas Eve. The kitchen of the restaurant where we went messed up my order, coating the meat in flour. New to SCD, I figured a little bit of flour wouldn’t hurt. After weeks of no trouble, I barely made it home before the diarrhea hit, and I spent the next four hours in the bathroom. The next time a restaurant did not do my order correctly, I sent it back. I’m not generally confrontational, but nothing is worth those hours of pain.

In addition to strict adherence, SCD also requires label reading, because our food is becoming more and more processed and so, more adulterated. Years ago, vanilla extract, which adds a lovely flavor to SCD ice cream, smoothies and baked goods (made from finely ground nuts, not grain flour), was just vanilla bean and alcohol. The new McCormick’s vanilla, however, has high-fructose corn syrup in it! Packaged grated cheese from the market often has potato starch as an anti-caking agent. Glance at a tuna fish label in the market, and you’ll see “packed in spring water.” What could be a problem with fish packed in water? Read the fine print. It’s water, vegetable broth and tuna. And that vegetable broth almost always contains both soy and MSG. Even worse, sometimes, labels lie. Canned foods, even if they don’t say so on the label, often contain sugar and starch, to make the food taste better, you know!

The Specific Carbohydrate Diet can be challenging, requiring a significant change in lifestyle for the patient and his or her family. No longer can you stop at Burger Thing or Taco Whistle on your way home from work. You have to plan ahead and cook.

Yet it can be done. And lest you think that taking away grains and potatoes and convenience foods means dull, boring meals, my parents, Ross and Marge Lessentine, have been coming over for an SCD dinner on Monday nights.

How about starting with a tossed salad of green leaf lettuce, vine-ripened heirloom tomatoes, and crimini mushrooms topped with grated cheddar cheese and your choice of homemade ranch dressing, homemade honey-mustard dressing, or homemade Italian dressing? Then move on to grilled boneless chicken breast Florentine, topped with freshly grated parmesan cheese and thick, home-cooked tomato sauce. And then let’s wind up with something a little light – egg nog ice cream topped with fresh Bing cherries.

Or maybe we’ll start with nice, ripe slices of California avocadoes, interlaced with tomato wedges and topped with old-fashioned creamy-style French dressing, made with oil, vinegar, and spices. Next, a piled high platter of flat-style beef and bean burritos, with lettuce, tomato, and sour dressing. And afterwards, a butter-pecan satin pudding.

For a casual night, how about a Creole style pot roast, simmered for hours with a bit of red wine and spices, with sides of mushrooms and baby new carrots? For dessert, fresh strawberries.

This week, we started with grilled Portobello mushrooms topped with a large mound of crab claw meat and a creamy lemon-pepper sauce. Then we went to lightly steamed new asparagus, and thick-cut pork chops seasoned with homemade blackened seasoning. For dessert, we finished up the leftover eggnog ice cream, and added some blue berries for good measure.

A side benefit is that because I make everything, it’s easy to customize a dish, as for my mother, who is on a salt-free diet.

There is one problem to mentioning all this yummy food. Thankfully, everyone here has already eaten, or I might have the lot of you following me home!

Still, the question which comes to mind when someone claims that its possible to cure these diseases which threaten not only our lives but the quality of them is, If there is a diet which can put these scourges into remission, especially a diet which allows such fabulous food, why aren't the doctors shouting it from the rooftops?

Let's take a look at some figures, provided by the Crohns and Colitis Foundation of America:

  • It is estimated that up to 1,000,000 people in the United States suffer from inflammatory bowel disease.
  • In 1990, the total annual medical costs for IBD patients was estimated at 1- 2 billion dollars.

Reducing this cost in both money and suffering would seem to be a priority. Yet the CCFA and many gastroenterologists continue to insist that diet has nothing to with gut diseases. Why?

The answer, sadly, may be that medicines for gut diseases are highly profitable. So is cheap food.

  • Proctor and Gamble’s Asacol, one of the primary drugs for these diseases, made $300 million in 2002.
  • Also in 2002, revenue from Remicade, another IBD drug, increased 80 percent, to $379 million.
  • Many CCFA corporate donors include the manufacturers of these and similar drugs. As a consequence, former CCFA members who have regained their health through SCD are inclined to wonder if those donations are why the organization continues to maintain that unprofitable diet has nothing to do with gut disease.

According to Eric Schlosser’s Fast Food Nation, Americans spent $110 billion in 2000 on fast food, more than on higher education, personal computers, software or new cars. America’s service economy creates 90 percent of all new jobs, and most of those are in the fast food realm. The golden arches are better known around the world now than the Christian cross, according to Schlosser. And every product made by this industry is illegal on the Specific Carbohydrate Diet. Is it possible that there is a link between the rise of fast food, and the proliferation of gut diseases? Surely not – the experts assure us that diet has nothing to do with disease!

Doctors also say, “But there are no studies!” and conveniently forget Dr. Haas’ Management of Celiac Disease, based on decades of observation and evaluation of more than 600 cases. Then again, most medical research is funded by pharmaceutical firms who have everything to gain from patentable drugs and nothing to gain from assisting people to eat a biologically appropriate diet.

So the bottom line would seem to be money. Physicians and surgeons, pharmaceutical firms, the CCFA, and all the fast food companies in the world stand to lose significant revenue if people do something as radical as changing their diets to healthy food which they can digest.

There’s another problem with managing gut diseases by diet. In our modern world, we want things now, fast, yesterday, even. We don’t like taking time. Very few people wish to acknowledge that it has taken many years for them to become ill, and that it may take months or years to heal. As a consequence, entirely too many people would rather pop a dozen pills than give up French fries and wheat bread.

Yet many will do anything to live a normal life. There are over a thousand members of an Internet community dedicated to the implementation of the Specific Carbohydrate Diet. A thousand active members, that is, with an average span on the list of about a year. People come, learn how to implement SCD, regain their health, and then go on about their lives. Some of us stay to teach.

True, SCD is not an easy diet. Still, approximately 90% of the people with Crohn’s Disease who follow it regain their health. Approximately 75% of the people with Ulcerative Colitis also heal. That’s a far better percentage than any of the drugs currently on the market.

How did I find SCD? Backwards, actually. My husband Harry and I have had dachshunds and cats for most of our married life. Most people find a healthy diet for themselves, then look for one for their pets. We did the reverse. In 1998, we became mom and dad to a pair of gorgeous long-haired red dachshunds, Shadow and Sunny. We were determined they would get the best food money could buy – our vet and the breeder recommended several kinds of kibble. But despite really small servings of this premium, and mostly grain kibble, Shadow and Sunny both ended up very overweight, with soft, mushy stools. I was frustrated, because this was the same situation I was in eating very small amounts, continuously hungry, and still gaining weight.

Through research, I learned about species-appropriate diets, that is, diets made of the kinds of foods an animal evolved to eat.

My dachshunds lost weight on a biologically appropriate grain-free diet. So, I began a search for a grain-free diet for humans.

I found it in the Specific Carbohydrate Diet.

When I first read Breaking the Vicious Cycle, I didn’t think I had IBD, so it was a shock to discover the urgency and soft, mushy stools I had suffered with for 25 years was not normal as I had been told by various physicians. Nor was my overweight because I refused to “get a little exercise by pushing myself away from the table.” It, too, was a symptom of undiagnosed malabsorption.

I have now been following SCD for 17 months. Without limiting what I eat, I have, by healing my gut, lost 120 pounds. For the first time in many years, I’m confident that I will re-achieve a healthy weight. I no longer have the problems which made it necessary to carry spare underclothes in my purse, and a plastic bag to put the soiled ones in. I don’t enter a building and immediately look to see where the restrooms are and I’m no longer acquainted with every rest stop between here and wherever.

The Specific Carbohydrate Diet has truly given me my life back. The time I spend cooking is minimal compared to the amount of time I used to spend in restrooms, doing extra laundry, or generally feeling too ill to accomplish anything.

Will the SCD ever become the first standard treatment of gut diseases, rather than the last resort of desperate people whom conventional medicine has failed? I don’t know. It’s a dream.

In a write up on SCD in the Wall Street Journal last autumn, the Journal noted, “The failure of the IBD diet to gain widespread acceptance within the medical community is a lesson in the grim financial reality of medical research. Doctors don’t accept treatments that aren’t validated by controlled studies, and drug companies, which fund most medical research, pay to study pills, not diets.”

And yet, this method of treatment does not, as its detractors hope, die. Dr. Sidney Valentine Haas passed the torch to Elaine Gottschall. Now 82, Mrs. Gottschall regularly updates Breaking the Vicious Cycle, and participates in areas which support treatment of gut disease by diet. She has trained several assistants to carry the torch into the future. And it is to be hoped that one day, when a patient first goes to his or her health care professional with a gut problem, that after carefully noting symptoms and doing whatever tests seem indicated, the physician of the future will ask, “And what have you been eating?”

* * * * *

BTVC-SCD is now more than 1800 strong, averaging 2000 messages a month. You, the members, from Australia to the US to Canada to the UK, to India and beyond have made this group what it is: dedicated to the support of the Specific Carbohydrate Diet as it was written by Elaine Gottschall, who passed on to us what she learned from Dr. Sidney Valentine Haas.

Thank you, to all of the people who come here for help and who end up helping.

Thank you to all of the longer-term and dedicated members who spend so many hours each week answering questions and helping others.

Thank you for making this group a healing place.

I like to think of both Dr. Haas and Elaine looking down and smiling as their healing legacy moves forward into the future.

Happy Third Birthday to BTVC-SCD!!

– Marilyn

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