P-012 The Specific Carbohydrate Diet

Abstract

Inflammatory bowel disease (IBD) is a chronic immune-mediated illness of unknown etiology associated with a dysregulated mucosal immune response to intestinal microorganisms in a genetically susceptible host. IBD affects up to 0.5% of the human population in developed countries, and numbers are on the rise in developing countries. IBD treatment employs a combination of anti-inflammatory and immunosuppressive therapy; however, the pharmacological approach alone at times is not by itself curative. This has resulted in exploring other adjunct therapies such as diet. “The Specific Carbohydrate Diet (SCD),” by Elaine Gottschall, evoking passionate testimonials from its followers. The SCD is a grain-free, lactose-free, and sucrose-free diet that is very restrictive. The SCD premise is that carbohydrates are the primary energy source for the intestinal microbes that contribute to the inflammatory process. By eliminating the food supply to these pro-inflammatory bacteria, it will result in their demise and encourage beneficial bacteria, such as Lactobacillus acidophilus to repopulate the bowel flora resulting in the resolution of the microbiata dysbiosis. Here we present a case of a 33 year old female with long-standing history of ulcerative colitis (UC) for more than 13 years failing all medical therapy who sought adjunct therapy through the SCD and within less than a month under direct supervision by her treating gastroenterologist and nutritionist demonstrated dramatic symptomatic remission. A 33 year old female with aggressive UC failing all medical therapy, that is, adalimumab, mercaptopurine, mesalamine, and 8-week course of both prednisone taper then budesonide ER. Unfortunately, the patient had prior exposure to infliximab earlier in her disease course with notable antibodies to infliximab. Despite aggressive medical management over an 8-month period, her symptoms continued to progress: 15–20 loose watery bloody bowel movements per day, nocturnal awakenings, severe abdominal cramping culminating in extreme fatigue and significant weight loss. During this time, the patient was adhering to a low-residue, soft diet. The patient refused surgical intervention. The SCD was recommended and an agreement was made, that if in 1-month symptomatic improvement was not achieved then she would pursue surgical intervention. She remained on 6-mercaptopurine and adalimumab while adhering to the SCD. Within 1-week, the patient had dramatic symptomatic improvement and by the end of the month, she endorsed 2-3 formed, non-bloody, bowel movements and complete resolution of abdominal pain. After being on the SCD for a year, the patient was able to reduce her immunosuppressant and has since been in complete remission. One study has shown that IBD patients on the SCD develop greater intestinal bacteria diversity compared with those in the control group (IBD patients not on the SCD) (ACG 2013, P1619). Our case clearly demonstrates that there is a potential role for diet to be used as an adjunct to standard therapy in IBD. Hence, the need for further studies of this diet in the form of a controlled trial looking deeper at microbiome diversity as well as measuring endoscopic healing and clinical disease activity is warranted to help elucidate the specific role in IBD. N/A. N/A. N/A.