Navigating the Specific Carbohydrate Diet: An Introductory Guide

The Specific Carbohydrate Diet (SCD) is primarily a diet that excludes all grains, milk products (except for highly fermented yogurt), and sugar. Although different variations of the SCD have been around for over 100 years, the diet has not been studied extensively in medicine. The recommendations initially set up by Dr. Sidney Haas in the early 1900s were intended for individuals with celiac disease, and he later adapted the diet for inflammatory bowel disease using his clinical experience. Elaine Gottschall then adapted the diet and its recommendations based upon the experience of her daughter and others.

The SCD is a restrictive, grain-free eating plan designed to help manage gastrointestinal conditions such as Crohn’s disease, ulcerative colitis, celiac disease, diverticulitis, cystic fibrosis, and chronic diarrhea. Some people also claim it helps with gastrointestinal problems in children with autism.

Understanding the SCD Principles

The specific carbohydrate diet has the following principles:

• Carbohydrates: The SCD emphasizes simple carbohydrates that are easily absorbed, including certain fruits, honey, and specific vegetables. It restricts the consumption of complex carbohydrates such as grains, cereals, certain starchy vegetables, and most sugars.
• Protein and Fat Emphasis: The diet encourages the consumption of lean meats, poultry, fish, eggs, and non-processed fats like olive oil, avocados, and nuts.
• Probiotic Foods: Fermented foods are encouraged, as they contain beneficial probiotics that can help support gut health, especially home-made yogurt with specific strains of bacteria.
• Fiber-Rich Foods: Fiber-rich foods like vegetables and fruits are permitted, but only those low in complex carbohydrates.
• Nutrient-Dense Foods: The diet emphasizes nutrient-dense, whole foods, avoiding processed and artificial ingredients.

How the SCD Works

Medical experts are still researching how this diet helps. It may be that people with certain digestive disorders are unable to break down some carbohydrates. As a result, undigested food particles stay in the intestines where bacteria grow and feed on them. This can lead to an overgrowth of harmful bacteria that irritates the intestines, which may lead to worsened gut symptoms and inflammation.

The specific carbohydrate diet eliminates hard-to-digest carbs. You only eat carbohydrates that are easy for your digestive system to break down and absorb. This keeps the harmful bacteria from growing, which may help you feel better and reduce inflammation.

Read also: The Hoxsey Diet

This diet is also low in processed foods, food additives, and preservatives. Some of these foods, additives, and ingredients have been linked to gut inflammation. Avoiding these additives may be another reason people feel better on this diet.

Who Might Benefit from the SCD?

Children and adults with certain conditions may benefit from a specific carbohydrate diet. These chronic diseases include:

• Crohn’s disease
• Ulcerative colitis
• Celiac disease

In her book, Gottschall suggests that diet might also be helpful for diverticulitis, cystic fibrosis, and other chronic diseases.

SCD Diet Stages

At Seattle Children’s Hospital, we divide the SCD into three main dietary phases, with each step differing in terms of what can be eaten, its challenges, and how success is monitored. The final stage of SCD is described in the table. While SCD does not have official stages (it does have an introductory diet to last no more than 5 days and a short list of advanced foods). The stages described on pecanbread.com are often adopted by patients with symptoms and active disease. These stages are not part of the official diet but can be used as a guide when food introduction proves difficult. The SCD allows for introduction of other healthy foods outside the normal parameters of the diet after sustained remission (generally recommended to wait until 1 or 2 years of sustained remission). Because these food additions could be anything tolerated by the patient, they are not included in the food table. Many recommend sticking with the diet as written and not deviating outside the defined parameters, so addition of foods should be considered carefully.

Step 1: Introduction and Anti-Inflammatory Phase

When we initiate the SCD, we begin with Step 1-diet introduction and the anti-inflammatory phase. This initial step is often followed for just 1 to 2 days.

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Homemade broth is a staple of Step 1. Chicken broth is the easiest to start experimenting with first, but turkey and beef-bone broth are also great choices, depending on your family’s taste preferences. Broth can be either sipped by itself or mixed in a blender with cooked chicken and cooked vegetables to create a thicker soup or a savory smoothie. (To date, no commercial SCD-legal chicken broth exists.)

Homemade applesauce (using peeled, well-cooked apples) can be eaten cold or warm, with a bit of honey and cinnamon to taste. Homemade SCD cultured yogurt and yogurt smoothies made with very ripe bananas and cooked berries may also be included. Diluted fruit juice (100% juice with no sweeteners or additives) is a beverage option. Eggs can be added with caution, after a day. An egg sensitivity might be present, especially at the beginning of the diet.

It is a lot of work to make these foods from scratch. But there are good reasons to! When a person is experiencing active disease symptoms, we want to make sure that there is no possibility that illegal foods or additives that may cause the diet to be less effective accidently get into the patient’s meals.

Sample Day's Menu for the Introductory Diet:

• Breakfast: Dry curd cottage cheese (moisten with homemade yogurt), eggs (boiled, poached, or scrambled), pressed apple cider or grape juice mixed 1/2 and 1/2 with water, homemade gelatin made with unsweetened juice, unflavored gelatin and sweetener (honey or saccharine).
• Lunch: Homemade chicken soup, broiled beef patty or broiled fish, SCD Cheesecake, homemade gelatin made with unsweetened juice, unflavored gelatin, and sweetener (honey or saccharine).
• Dinner: Variations of the above.

Homemade Chicken Soup Recipe:

1. Using the largest pot you have, fill half of it with the chicken parts (legs and thighs make the most flavorful soup).
2. Peel about ten carrots and add to chicken.
3. Add about two large onions, a few stalks of celery and some parsley.
4. Season with salt.
5. Fill pot with water.
6. Simmer for about 4 hours and then strain soup through a colander or strainer.
7. Skim off top layer of fat (don't worry if you can't get it all).
8. Purée carrots in blender and return to broth.

Note: Onions, celery, and parsley should not be used at the start of the dietary regimen because the fibrous parts of these vegetables may cause problems.

SCD Cheesecake Recipe:

Filling:

Read also: Weight Loss with Low-FODMAP

• 3 eggs
• 1/3 cup honey
• 1/2 cup homemade SCD yogurt or homemade SCD cream cheese
• 2 cups uncreamed cottage cheese (dry curd cottage cheese)
• 2 teaspoons vanilla extract

Instructions:

1. Place all ingredients in blender or food processor (with a metal blade), putting eggs in first so that the blender blades will turn freely.
2. Blend until smooth stopping, if necessary, every 15 seconds to push ingredients down, scraping the sides of the container at the same time with a spatula.
3. Pour into loaf pan.
4. Bake in oven at 350°F (180°C) for about 30 minutes or until edges are brown.
5. Cool and refrigerate.

SCD Cream Cheese Recipe:

1. Line a colander with a clean cloth (a dish towel is satisfactory).
2. Place colander on a bowl.
3. Pour chilled SCD yogurt into lined colander and allow to drain for about 6-8 hours (need not be refrigerated while draining).
4. Lift cloth by two opposite ends, place on flat surface, and with a spatula, scrape "cream cheese" off and refrigerate. It will be quite tart; a little liquid honey may be worked in with a spatula to sweeten.

Note: The preparation of foods listed with an asterisk is explained in Breaking the Vicious Cycle. SCD Yogurt is explained on this site.

Step 2: Gradual Introduction of Solid Foods

After a few days of being on Step 1, you can move on to the regular SCD diet, gradually adding solid foods, including fresh fruits and vegetables, nut flours, lentils, and beans. Introduce only one new food at a time. A 2-day interval is a great (but not mandatory) guideline for introducing new foods. This will make it possible to determine whether each new food can be tolerated.

In Step 2, foods may be introduced in a stepwise fashion. Initially with food preparation, all vegetables and fruits should be peeled, seeded, and well-cooked. Within the fruit category, overripe bananas with brown spots as well as applesauce are allowed. As individuals show signs of tolerating these additional foods, new items should be introduced every day or 2 days, such as green beans, peppers, mushrooms, avocadoes, tomatoes, peaches, pineapple, and plums. If no symptoms or flares occur, the diet can be expanded further. Again, initially fruits and vegetables should be peeled, seeded, and well-cooked. Because new items should be introduced every day to 2 days, this initial step of Step 2 can last 3 to 4 weeks. If the diet is moving forward well, raw peeled vegetables and fruits may be added. Because this step often goes well, close follow-up with the physician is not always required. But it is important that if any issues or concerns arise, you call your doctor so a plan can be made.

Step 3: "Illegal" Food Reintroduction (Proceed with Caution)

With the third step of the diet comes so-called “illegal” food reintroduction. This is a very hotly debated step. Why? Because everybody has an opinion. With many of my patients, I am a purist and don’t recommend adding any illegal foods. The difficulty with adding an illegal food is twofold: It may not only trigger a flare of the disease, but also some individuals, once they start adding new foods back in, cannot stop.

This step has no set time frame. Many individuals may not want to even consider limited reintroduction of a small number of illegal foods. The earliest I have ever reintroduced illegal foods was after 3 months on the diet; this was done for individual children who said that they could not maintain the strict SCD any longer. The most important aspect of this step is to do things slowly and one step at a time. In addition, we very closely monitor symptoms and laboratory studies, as well as stool calprotectin levels to ensure that inflammation is not rebounding. Typically I will order a stool calprotectin test prior to initiating an illegal food, and then again 1 month after that food has been reintroduced. If the stool calprotectin significantly increases during that time, I will remove that food and recheck to ensure that these levels have normalized before restarting food introductions.

Monitoring Progress and Follow-Up

For individuals who are just beginning the diet and in the first step (the anti-inflammatory step), close follow-up is required on a regular basis. Once you begin the SCD, you should follow up with your healthcare provider in 1 to 2 weeks. During each visit, we recommend that patients review how they are doing and have a full physical, including a weight check. During this time, your healthcare practitioner should check PCDAI/PUCAI scores.

What are these? They are validated scores for inflammatory bowel disease, meaning that you can then have an objective measure of how well your son or daughter is doing. For Crohn’s disease, we follow the PCDAI, which is the pediatric Crohn’s disease activity index. This score helps individuals determine if they are in remission or having mild, moderate, or severe disease activity. For individuals with ulcerative colitis, we follow the pediatric ulcerative colitis activity index, or PUCAI. These scores are very important. Although our memories may seem reliable, sometimes days, weeks, or months pass, and it becomes much harder to remember exactly what happened when.

The goal of each checkup is good health and nutrition. Our expectation for these first visits with the healthcare professional is to ensure that individuals are maintaining their weight or at least have minimal weight loss. We also want to make sure that their symptoms are under control and that their laboratory studies are within an acceptable range. These follow-up visits can also be a good time for individuals to ask their healthcare providers and dietician about specifics in regard to the diet.

Once individuals start gaining weight and we are seeing clinical improvements, we then decrease visits to every 2 to 4 weeks. We expect clinical remission within 2 to 3 months of dietary change. If an individual goes into remission, meaning that they are not only growing well and gaining weight but their symptoms have also abated, we then go to the diet foundation and maintenance step, where we follow up with individuals on a 3- to 4-month timeframe. If an individual is completely asymptomatic, with no evidence of inflammation on screening labs such as sedimentation rate and C-reactive proteins, but still has elevated stool calprotectin, we will often repeat endoscopy and colonoscopy procedures to evaluate true inflammation levels. This helps us appropriately focus our therapeutic interventions. Young children and individuals with IBD may have mildly elevated calprotectins that may not signify active disease.

General Guidelines for Introducing Foods

Once you are past the intro diet, there is no specified schedule for introducing foods. The basic rules given in Chapters 9 and 10 are usually sufficient. For example, ripe fruits and vegetables should, initially, be peeled and cooked well. Raw fruits and vegetables (with the exception of very ripe bananas - must have brown spots) should not be introduced until diarrhea is under control. Going slowly and carefully is best determined by an individual's reactions. If foods seem to cause additional gas or diarrhea when they are added to the diet, delay their use until later. If a food specified in the diet is known to cause an anaphylactic reaction, remove it permanently. If, in the past, allowable foods did not agree with you, eliminate them for a short time (about a week), and try again in small amounts. If, after a week of eliminating it, a food continues to cause problems, do not include it in the diet.

One basic principle of the SCD diet must be firmly established and persistently repeated: no food should be ingested that contains carbohydrates other than those found in fruits, honey, properly prepared SCD yogurt, and those vegetables and nuts listed. While this principle may be clearly understood, it is sometimes difficult in practice to recognize the existence of carbohydrates (like starches) in various foods. Small quantities of illegal carbohydrates can creep into the diet unless strict attention is paid to every item you eat. Reading labels is essential but is not entirely adequate for those on the SCD since one ingredient may have numerous names and not be easily recognized as a forbidden carbohydrate. Many cans, jars, bottles, and packages do not list all ingredients because of different labeling laws in different parts of the country/world. It is recommended that nothing be eaten other than those foods listed on the Legal/Illegal list.

Keeping a Food Journal

It's a good idea to keep a food journal. Some bad reactions will show up quickly, but others can take a week or two, and a food journal is very helpful for seeing those connections. Every day, write down your symptoms, what you ate, and if you've added something new. In addition to allowing you to see connections between foods and reactions, the food journal can also provide you with a way to see your progress. Progress can be two steps forward and one step back. A food journal can help you track the slow improvements you make over time and may not notice from day to day.

Allowed and Restricted Foods

The book Breaking the Vicious Cycle outlines in detail all the foods that are allowed and not allowed in the SCD:

Foods Allowed:

• Fresh, unprocessed meat, as well as poultry, fish, shellfish, and eggs
• Certain legumes, including dried beans, lentils, split peas, raw cashews, and all-natural peanut butter
• Cheeses such as cheddar, Colby, Swiss, and dry curd cottage cheese
• Homemade yogurt fermented for at least 24 hours
• Most vegetables
• Fresh, frozen, or dried fruits with no added sugar
• Most nuts and nut flours
• Most oils, teas, coffee, mustard, cider or white vinegar, and juices with no additives
• Honey

Foods Not Allowed:

• Sugar, molasses, maple syrup, sucrose, processed fructose
• Grains, including corn, wheat, wheat germ, barley, oats, and rice
• Canned vegetables with added ingredients
• Some legumes
• Seaweed
• Starchy tubers such as potatoes, sweet potatoes, and turnips
• Canned or processed meats
• Canola oil and store-bought mayonnaise
• All milk and milk products high in lactose, such as mild cheddar, store-bought yogurt, cream, sour cream, and ice cream
• Candy and chocolate

Considerations and Potential Challenges

People on the Specific Carbohydrate Diet may not get enough of certain nutrients, including folate, thiamine, vitamin B6, calcium, and vitamin D. A study looking at nine children using the diet to treat IBD found that they didn’t get enough vitamin D and calcium.

Because it eliminates processed foods and limits a lot of other foods, it can be hard to stick to this plan. A study of 50 people on the diet found the average person spent nearly 11 hours a week preparing food. The diet may also make it harder for you to eat enough calories to maintain a healthy weight.

SCD Research Articles

The SCD has been in use for a long time by some individuals but has only recently been reported in the medical literature for use in IBD with the earliest publication in 2014. Although published patient data is relatively small, the SCD has been studied for use in both Crohn's disease and ulcerative colitis, in children and adults.

The effects of the SCD in pediatric Crohn’s disease were first published in the medical literature in 2014, with subsequent reports in children and adults with Crohn’s disease or ulcerative colitis. A large-scale comparison trial of SCD to MED in adults with CD was published in 2021, with ongoing trials in UC and CD.

A 2017 review of research on the Specific Carbohydrate Diet’s use in treating Crohn’s disease found that the diet shows promise as a nutritional treatment for both adults and children. It also concluded that more research and robust studies are needed before doctors can routinely suggest it.

A 2015 survey of 50 people who followed the diet while in remission from IBD suggested that the diet may be effective in managing the disease for some people. In a 2016 anonymous survey of 417 people with IBD, most said they benefited from the Specific Carbohydrate Diet. But, with self-reported surveys, it’s hard to know exactly what helped them.

Finally, a 2021 comparison of the Specific Carbohydrate Diet with a Mediterranean diet for people with IBD found that both diets led to symptom remission. A Mediterranean diet, however, may be easier to follow.

Additional SCD Resources

• Cookbooks: Cooking for the Specific Carbohydrate Diet, 2nd Edition, provides over 125 belly-friendly recipes with added nutritional information, updated photos, brand new recipes, as well as fan favorite treats, including Persian chicken, falafel, banana bread, almond toffee brownies, and more!
• Breaking the Vicious Cycle: Intestinal Health Through Diet by Elaine Gottschall: This book outlines the diet and includes recipes. However, we strongly advise you not to try to implement the diet beyond the introductory diet without first having read the book and feeling comfortable with the information it contains. The diet requires 100% commitment and adherence, and so without the book, it is not possible to successfully follow the Specific Carbohydrate Diet.
• Recipe Section: Our recipe section offers a wide range of options that align with various nutritional therapies, ensuring you can find meals and snacks that are both flavorful and supportive of your dietary needs.

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