Dietary Factors in the Modulation of Inflammatory Bowel Disease Activity

Shinil Shah, DO, PGY-1

Disclosures

March 27, 2007

The Specific Carbohydrate Diet

The exact role of sucrose pathogenesis and progression of IBD has not yet been fully elucidated. Some believe that unrefined carbohydrates, starches and sucrose may play a role in dysbiosis (abnormal alteration of the colonic bacterial flora). This thinking is evident in a popular diet for IBD, Elaine Gottschall's specific carbohydrate diet.

The theory behind this diet is similar to elemental diets, in that the goal is to supply the body with fully digested building blocks. Complex sugars (eg, lactose and sucrose) and most starches (such as those found in corn, rice, and gluten containing products) are not to be consumed by patients. In IBD and other bowel conditions, Gottschall believes that the intestine is lacking in certain enzymes needed to break down complex sugars and starches. Because of excess undigested carbohydrates in the lumen of the gut as a result of these deficiencies, pathogenic bacteria are given a steady supply of substrates on which to feed. By decreasing the supply of these undigested carbohydrates, it is believed that the food supply to these pathogenic, but uncharacterized bacteria, will be decreased, causing death of these bacteria. Foods with so-called beneficial bacteria, such as Lactobacillus acidophilus (found in yogurt and certain over-the-counter supplements), are encouraged to repopulate the bowel flora. (These beneficial bacteria, also known as probiotics, are discussed later in this article.) As such, dysbiosis, or altered bacterial flora, is central to the theory behind this diet.

Although there have not been any controlled studies evaluating the effectiveness of this diet in patients with IBD, there is no shortage of testimonials proclaiming long-term improvement and remission (http://www.breakingtheviciouscycle.info/testimonies/testimonies.htm). A recent case report of 2 patients demonstrated symptomatic improvement following this diet was recently published.[48] Further study of this diet in the form of a controlled trial is warranted to elucidate the specific role, if any, in IBD.[12]

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