What is the Cleveland Clinic specific carbohydrate diet?

First developed in the 1920s to treat celiac disease, the Specific Carbohydrate Diet (SCD) is a restrictive eating plan that eliminates certain hard-to-digest carbohydrates to promote intestinal healing. The Cleveland Clinic acknowledges the potential benefits of the SCD for managing inflammatory bowel disease (IBD) and other digestive disorders.

Quick Summary

The Specific Carbohydrate Diet, as discussed by the Cleveland Clinic, is a restrictive plan that cuts out complex carbs to limit bacteria growth and reduce gut irritation in people with digestive issues.

Key Points

• Dietary Restriction: The SCD eliminates complex carbohydrates and processed sugars to alter the gut microbiome and reduce inflammation.

• IBD Focus: It is most commonly used as a nutritional strategy for managing inflammatory bowel diseases like Crohn's disease and ulcerative colitis.

• Homemade Yogurt: Homemade yogurt fermented for 24 hours is allowed due to its minimal lactose content.

• Risk of Deficiency: The restrictive nature poses a risk of nutrient deficiencies and requires careful planning, often with dietitian guidance.

• Consult a Provider: As advised by the Cleveland Clinic, consultation with a healthcare provider is essential before starting the SCD.

• Mixed Evidence: While anecdotal evidence is strong, research is still emerging, and some studies show no superiority over less restrictive diets.

The Specific Carbohydrate Diet (SCD) is a specialized eating plan that has been used for decades to help manage symptoms associated with inflammatory bowel disease (IBD) and other gastrointestinal conditions. The approach, as detailed in resources from the Cleveland Clinic, focuses on the elimination of complex carbohydrates that are believed to contribute to an imbalance in the gut microbiome. By restricting these complex sugars and starches, the diet aims to starve pathogenic bacteria, thus reducing inflammation and promoting intestinal healing.

The Vicious Cycle of Intestinal Inflammation

How the Theory Works

At the core of the SCD is the theory of the “vicious cycle,” popularized by Elaine Gottschall in her book Breaking the Vicious Cycle. The theory suggests that certain complex carbohydrates are not fully digested or absorbed in the gut of individuals with compromised digestive systems. These undigested carbs then feed bacteria in the intestines, causing them to proliferate. This overgrowth of harmful bacteria produces waste products that can damage the intestinal lining and perpetuate a cycle of inflammation, irritation, and malabsorption. The diet's goal is to break this cycle by consuming only easily digestible simple carbohydrates (monosaccharides), ensuring that no fuel is left for the harmful bacteria.

Conditions Targeted by SCD

While originally developed for celiac disease, the SCD is most commonly discussed today in the context of IBD. The Cleveland Clinic notes that the diet is often followed by people with conditions like:

• Crohn's disease
• Ulcerative colitis
• Chronic diarrhea
• Diverticulitis

Allowed Foods vs. Foods to Avoid on the SCD

Navigating the SCD requires a clear understanding of which foods are considered “legal” and which are “illegal.” The diet permits specific, unprocessed foods while strictly prohibiting others, including most grains and starches.

Allowed Foods ("SCD Legal")

• Proteins: Fresh, unprocessed meats, poultry, fish, shellfish, and eggs.
• Dairy: Aged cheeses (e.g., sharp cheddar, Colby, Swiss) and homemade yogurt fermented for at least 24 hours.
• Fruits: Fresh, frozen, or dried fruits with no added sugar.
• Vegetables: Most fresh, frozen, raw, or cooked vegetables (with some exceptions).
• Legumes: Dried beans (navy beans, lentils, split peas) and unroasted nuts.
• Sweeteners: Honey.
• Fats: Additive-free oils, butter.

Foods to Avoid ("SCD Illegal")

• Grains: All grains and grain products, including wheat, corn, rice, barley, oats, and quinoa.
• Processed Sugars: All processed sugars, corn syrup, high-fructose corn syrup, molasses, and maple syrup.
• Starchy Vegetables: Potatoes, sweet potatoes, turnips.
• Lactose-Heavy Dairy: Milk, cream, ice cream, commercial yogurts, and most unaged cheeses.
• Processed Meats: Deli meats and other processed meats with additives.
• Additives: Canned vegetables with additives, preservatives, and other unlisted ingredients.

Potential Benefits and Risks of the SCD

Benefits

The Cleveland Clinic reports that a significant number of people with IBD find symptom relief through the SCD. Potential benefits include:

• Symptom Improvement: Reduction of pain, bloating, diarrhea, and fatigue.
• Reduced Inflammation: In some studies, the diet has been associated with decreases in inflammatory markers.
• Encourages Whole Foods: The emphasis on unprocessed foods means individuals consume a diet rich in fruits, vegetables, and lean proteins.

Risks

Despite potential benefits, the SCD carries significant risks and challenges, which the Cleveland Clinic advises patients to discuss with a healthcare provider.

• Nutritional Deficiencies: The restrictive nature of the diet can lead to inadequate intake of certain vitamins and minerals, such as calcium, folate, and vitamin D.
• Malnutrition and Weight Loss: Unhealthy weight loss can occur, particularly for those with already compromised digestive function.
• Adherence Difficulties: The strict regimen requires extensive food preparation and can be challenging to maintain long-term, especially in social settings.

The Scientific Evidence and Expert Perspective

Scientific research on the SCD, while growing, is still considered to be in its early stages. Many of the success stories come from anecdotal reports and patient surveys, which suggest a strong perceived benefit. However, robust clinical trials have yielded mixed results.

For example, a 2021 randomized controlled trial compared the SCD to a Mediterranean diet for adults with Crohn's disease and found that the SCD was not superior in achieving symptomatic remission after six weeks. This led researchers to suggest that the easier-to-follow Mediterranean diet might be a better option for many patients. This highlights a key consideration for patients and providers: while the SCD may be effective for some, its restrictiveness must be weighed against other, potentially more manageable dietary approaches.

Conclusion

The Specific Carbohydrate Diet, as described by the Cleveland Clinic and other health organizations, is a highly restrictive nutritional approach aimed at managing inflammatory bowel disease and other digestive disorders by altering the gut microbiome. By cutting out complex carbohydrates that can feed harmful bacteria, the diet has shown promise in improving symptoms for some individuals. However, it comes with significant challenges, including the risk of nutritional deficiencies and difficulty with long-term adherence. It is imperative for anyone considering the SCD to first consult with a healthcare provider and a registered dietitian to ensure proper nutritional support and to determine if it is the best course of action.

Comparison Table: SCD vs. A Standard Diet

Feature	Specific Carbohydrate Diet (SCD)	Standard Diet
Carbohydrate Type	Exclusively simple, easily digestible carbohydrates (monosaccharides).	Includes a wide range of simple and complex carbohydrates.
Grains	Completely eliminated.	Forms a staple part of the diet for most people.
Processed Sugars	Prohibited.	Frequently consumed in many packaged foods and drinks.
Dairy	Limited to certain aged cheeses and homemade fermented yogurt.	Includes milk, ice cream, and a broad range of cheese products.
Food Preparation	Time-consuming; requires making many items from scratch.	Wide availability of ready-made and processed foods.
Medical Supervision	Strongly recommended due to restrictive nature and potential deficiencies.	Not typically required, though nutritional counseling can be beneficial.

Frequently Asked Questions

Who is the Cleveland Clinic specific carbohydrate diet for?

The diet is for individuals with inflammatory bowel disease (IBD) such as Crohn's disease and ulcerative colitis, as well as celiac disease and other digestive disorders, as a method to manage symptoms.

What is the key theory behind the SCD?

The central theory is that by eliminating complex carbohydrates, you cut off the food source for harmful bacteria in the gut. This helps to reduce bacterial overgrowth, irritation, and the cycle of intestinal inflammation.

What kind of carbohydrates are allowed?

Only simple carbohydrates, known as monosaccharides, are allowed. These are easily absorbed by the body and include the natural sugars found in fruits, vegetables, and honey.

Are there any risks associated with the SCD?

Yes. The SCD's restrictive nature increases the risk of nutritional deficiencies (e.g., calcium, vitamins D, B6) and unhealthy weight loss. It also requires a significant time commitment for meal preparation.

What dairy products can I consume on the SCD?

Lactose-free homemade yogurt fermented for 24 hours and specific hard, aged cheeses like sharp cheddar, Colby, and Swiss are permitted. Most other dairy products are restricted.

Is the SCD a lifelong diet?

For some, the SCD is a long-term approach to manage symptoms. However, many individuals are able to slowly reintroduce certain foods after an extended period of remission, often with professional guidance.

How does the SCD compare to a low-FODMAP diet?

Both diets restrict certain carbohydrates for digestive health, but their approaches differ. The SCD restricts based on carbohydrate type, while the low-FODMAP diet restricts specific fermentable sugars and is often a temporary elimination protocol.