Gastrointestinal Disease and Diet

According to the Centers for Disease Control and Prevention, there are just over 7 million visits to the emergency room each year with a digestive system diagnosis and nearly 40 million visits to office based physicians for digestive system symptoms.[1] Between 60 and 70 million people are affected by digestive diseases, a classification which includes a wide variety of diseases.[2] The cause of inflammatory bowel disease “is unknown,” and is not “caused by tension, anxiety or any other psychological factor or disorder,” contrary to popular belief.[3] Common symptoms include “blood in…stool, changes in bowel habits, severe abdominal pain, unintentional weight loss, and heartburn not relieved by antacids.”[4] Despite the large number of people affected by digestive diseases, gastroenterologists maintain a less than optimal course of treatment.  The medical community has largely ignored the role that diet plays in treating and often curing gastrointestinal diseases.  In this paper, I will explain, through my own experiences and through the work of those who have promoted a specific diet for the treatment of gastrointestinal diseases, how the medical community is oblivious to an important treatment for patients struggling with digestive disease.

Last year, I was diagnosed with Crohn’s disease, an inflammatory bowel disease.  My gastroenterologist made it clear that there was no way to cure this disease, that it was “chronic.”  The course that it would take would be determined at about two years, he said.  If it did not get worse by then, it probably never would.  If it did get worse, then it would need to be treated with steroids, and if steroids proved insufficient, then surgery was the next and last alternative.  At about nine months my condition started to get noticeably worse.  My doctor doubled the amount of pills I was taking, which seemed to help, but at the same time was expensive and not curing the actual disease.

Shortly after going on the increased pill dosage I went on a raw vegan diet, which I found in a book that promised to cure ulcerative colitis and Crohn’s.  This diet seemed to be working but was very restrictive.  A few weeks later, I found out about the Specific Carbohydrate Diet (SCD), as described in Elaine Gottschall’s book Breaking the Vicious Cycle:  Intestinal Health Through Diet.  I have been on this diet ever since and found my condition to be improved to the point where I was able to stop taking my pills just three weeks after I was on the diet.  My doctors made no mention of diet playing a part in my disease, except when I was first diagnosed and my doctor told me that I probably should not eat fried food.  Although the SCD was not invented by Gottschall, she was the first to present all the material in a way that the non-specialist can understand.  The SCD is important because it is the most common diet used by patients to treat a wide variety of gastrointestinal diseases and although it is probably impossible to find out its success rate, especially without the support of the medical community, it is certainly more successful than pills, which frequently fail at effectively controlling inflammatory bowel diseases, only to be replaced by steroids and surgery.

The number of gastroenterologists who recommend the SCD or other similar diets to their patients is unknown.  There are about sixty doctors listed on the official website for the book, who use the diet in treatment, half of those being in the United States.[5] Other doctors remain either unaware or skeptical of the diet.  Neither of the gastroenterologists who I talked to had heard about it.  One of the doctors acknowledged that he was not trained in nutrition in medical school and as a result knew very little about the effects that diet can have in treating diseases (especially in his field of specialization).  My doctors encouraged me to continue with this diet if it worked but seemed to doubt that it would be effective.  In medical school, soon-to-be doctors learn all about the composition of the body and the effects that chemicals have on the processes of the body but apparently not much mention is given to the effect that diet can have on the functioning of the body.  Gottschall explains the Specific Carbohydrate Diet in her book in a way that would seem to get the attention of the medical community.

Gottschall describes gastrointestinal diseases as resulting from “bacterial overgrowth in the stomach and small intestine.”  This overgrowth can be caused by “continual use of antacid…decrease in acidity of stomach” due to aging, “malnutrition or a diet of poor quality” causing a weakened immune system, and/or “antibiotic therapy resulting in a wide range of microbial changes.”[6] Gottschall explains how the healthy digestive system operates:  “In the healthy intestinal tract, intestinal microbes appear to live in a state of balance; an overabundance of one type seems to be inhibited by the activities of other types.  This competition between microbes prevents any one type from overwhelming the body with its waste products or toxins.”[7]

The basis of the SCD is “the principle that specifically selected carbohydrates, requiring minimal digestive processes are absorbed and leave virtually none to be used for furthering microbial growth in the intestine.”[8] These specifically selected carbohydrates are single sugars or monosaccharides which “require no further splitting in order to be transported into the bloodstream.”[9] Foods that contain disaccharides and polysaccharides cannot be digested easily because “the structure of the intestine is dramatically altered during intestinal disease.”[10] “The last step in the digestion of starch” occurs in the microvilli, which become “injured and blunted” with this disease.[11] The SCD takes these damaged digestive processes into account and recommends a diet consisting mostly of fruits, vegetables, and meat, and absent of foods that contain complex carbohydrates and added sugar, such as most commercially prepared foods.

The SCD is not the only diet used to treat gastrointestinal disease. There are many different diets expounded in books written by people who have beaten gastrointestinal disease.  Many of these diets are very similar to the SCD and nearly all condemn the use of enriched flour and sugar by people affected with digestive diseases.  The Cleveland Clinic, on its website, says, “Our diets can contribute to digestive system difficulties.  Many people eat too much processed food and sugar, and not enough fiber, fruits, and vegetables.”[12] Another perspective is offered by David Klein, Ph.D. in Self Healing Colitis and Crohn’s.  Klein takes a position contrary to most doctors who try to cure diseases “externally.”  Klein says, “Disease is not something which invades our bodies from outside, nor is it something to be cured or stopped…disease symptoms are a manifestation that the body is ‘curing’ itself.”[13] The causes of disease, according to Klein, are “toxic diet, drugs,” and “mental/emotional, lifestyle stress.”[14] A healthy diet according to Klein is “a low-fat, fruit-based alkalinizing, properly combined vegan diet”[15] None, if any, of the gastrointestinal diets are as restrictive as Klein’s, but they all maintain the importance of strict adherence to their diet in achieving a cure.

The authors of diet books for gastrointestinal disease patients are aware that the medical community is ignoring their advice.  Ronald L. Hoffman, M.D., in the foreword to Breaking the Vicious Cycle, writes, “Unfortunately, the chances of wider acceptance of the dietary approaches like this one are small…gastroenterologists…scarcely acknowledge the role diet can play.”[16] The Specific Carbohydrate Diet is not new and does not seem to be on the verge of gaining acceptance.  Breaking the Vicious Cycle was first published in 1994 under the title Food and the Gut Reaction.  In 1951, Sidney V. and Merrill P. Haas, the originators of the Specific Carbohydrate Diet wrote a book entitled Management of Celiac Disease, which was written for the medical community and “documented the doctors’ experiences in treating and curing hundreds of cases of celiac disease,” a gastrointestinal disease, with the SCD “for a minimum of one year,” after which they returned to “a normal diet with complete and permanent disappearance of symptoms.”[17] A group of faculty members from the University of Birmingham later published an article that seemed to shed new light on Haas’ findings. The article blamed “the protein, gluten in wheat and rye flour” instead of “the starch in the grains” for celiac symptoms.[18] The problem with a “gluten-free” diet is that even in patients whom the diet seems to be helping, the “biopsy samples, as viewed under a microscope, showed intestinal cells that were still markedly abnormal.”[19] The SCD eliminates “all grains which contain gluten or gluten-like proteins” and “has been shown to completely cure most cases of celiac disease if followed for at least one year.”[20]

The founders of the SCD, Drs. Haas, cured “hundreds of cases of celiac disease”[21] with the diet they formulated specifically for that purpose.  The medical community has cured nobody with pills, steroids and surgeries.  The goal of the medical community is simply to control the digestive disease, whereas the goal of the SCD is to cure the patient.  Although it does not work for all patients, it is based on sound medical research and does not rely on the holistic or occult remedies some of the other gastrointestinal diets use.  I am convinced that the SCD works, because it has worked for me.  After my condition started getting worse, I discovered the SCD and after about a month and a half on it, practically all of my symptoms have disappeared.  Doctors who are skeptical of the diet may say that my disease just went into remission without any help from the diet.  What gastroenterologists think of the diet concerns me less now since I hopefully will not need one anymore.  I tried their methods for a year and then tried Haas’ method for a month and its clear which method works.

The fact that the medical community has ignored the role of diet in treating gastrointestinal diseases just means that it might be necessary for patients to realize that there are other treatments and that if they want to be cured they might have to find a  source other than the medical community.  The good news is that there are no risks associated with going on a diet to treat gastrointestinal disease.  However there are risks in not going on a diet, such as the SCD, for example the risk of the disease getting worse and the patient possibly having to undergo surgery.  After a year or two on the SCD, most patients can return to their old diets.  The reason why doctors do not recognize the importance of diet in treating digestive disease is a matter of debate, but more important is the fact that diet actually works to treat and cure these diseases.