Patient overview
Ethical Considerations
Intervention results
Case no. | Disease | Location | Age | Sex | Duration of disease (mo) | Duration of diet (mo) | Level of education | Forbidden food(s) | Medication(s) |
---|---|---|---|---|---|---|---|---|---|
1 | UC | Pancolitis | 56 | M | 288 | 76 | College | None | LDN |
2 | UC | Rectosigmoid | 56 | F | 384 | 216 | College | None | None |
3 | UC | Pancolitis | 41 | F | 36 | 9 | College | None | Mesalamine (Asacol), LDN, azathioprine |
4 | UC | Rectosigmoid | 35 | F | 108 | 82 | College | None | LDN |
5 | UC | Rectosigmoid | 38 | F | 204 | 40 | College | None | Mesalamine suppositories |
6 | UC | Rectosigmoid | 41 | M | 48 | 13 | Graduate degree | None | Mesalamine (Lialda), mesalamine enema |
7 | UC | Rectosigmoid | 32 | F | 132 | 7 | College | None | Infliximab |
8 | UC | Proctitis | 35 | M | 24 | 4 | Graduate degree | None | Mesalamine (Lialda) |
9 | UC | Pancolitis | 25 | F | 324 | 2 | Graduate degree | None | Prednisone (1 mg), sulfasalazine (Azulfadine), mesalamine enema |
10 | CD | Ileocolonic | 29 | M | 324 | 19 | Graduate degree | None | Mesalamine (Pentasa), infliximab |
11 | CD | Colonic | 61 | F | 36 | 10 | High school | None | Mesalamine |
12 | CD | Colonic | 48 | M | 24 | 6 | Graduate degree | None | None |
13 | CD | Ileocolonic | 27 | M | 156 | 8 | College | None | Adalimumab, LDN, budesonide |
14 | CD | Colonic | 40 | F | 72 | 60 | Graduate degree | Chocolate | None |
15 | CD | Upper GI+colonic | 10 | M | 60 | 39 | Middle school | Ice cream | None |
16 | CD | Upper GI+ileocolonic | 11 | F | 24 | 8 | Middle school | Rice | Mesalamine (Asacol) |
17 | CD | Ileocolonic | 31 | F | 156 | 14 | College | None | Prednisone (1.5 mg), infliximab, LDN |
18 | CD | Upper GI+ileocolonic | 11 | M | 24 | 7 | Middle school | None | None |
19 | CD | Upper GI+ileocolonic | 9 | M | 84 | 66 | Middle school | None | None |
20 | CD | Ileum | 52 | M | 36 | 14 | College | None | Mesalamine (Pentasa) |
21 | CD | Upper GI+ileum | 49 | M | 384 | 5 | College | None | None |
22 | CD | Ileocolonic | 41 | M | 192 | 31 | College | None | Balsalazide |
23 | CD | Upper GI+colonic | 13 | F | 36 | 14 | Middle school | Cream, canned vegetables, eucharist host | None |
24 | CD | Ileocolonic | 44 | M | 348 | 72 | College | Coffee | None |
25 | CD | Colonic | 19 | F | 24 | 1 | College | None | None |
26 | CD | Colonic | 37 | F | 36 | 16 | Graduate degree | None | None |
27 | CD | Ileum | 65 | M | 420 | 132 | Graduate degree | None | Mesalamine (Asacol), mesalamine enema, colestipol |
28 | CD | Ileocolonic | 49 | F | 120 | 12 | College | Espresso | 6-MP |
29 | CD | Colonic | 44 | M | 300 | 2 | College | None | None |
30 | CD | Colonic | 30 | F | 36 | 14 | College | Coconut water, chocolate | Mesalamine (Lialda) |
31 | CD | Ileocolonic | 31 | F | 132 | 111 | College | None | None |
32 | CD | Colonic | 39 | M | 276 | 158 | Graduate degree | Salad dressing | None |
33 | CD | Ileocolonic | 58 | F | 384 | 24 | Graduate degree | None | LDN |
34 | CD | Ileum | 51 | F | 48 | 6 | Graduate degree | None | None |
35 | CD | Colonic | 43 | F | 24 | 9 | College | None | None |
36 | CD | Colonic | 29 | F | 36 | 17 | College | Potatoes | None |
37 | CD | Upper GI+ileum | 19 | M | 36 | 13 | High school | Brown rice, corn | 6-MP |
38 | CD | Upper GI+colonic | 52 | F | 168 | 162 | College | Matzah once a year | None |
39 | CD | Colonic | 42 | F | 48 | 10 | Graduate degree | None | Mesalamine (Asacol) |
40 | CD | Colonic | 49 | F | 24 | 4 | College | None | Mesalamine (Lialda) |
41 | CD | Colonic | 59 | F | 84 | 12 | College | Milk, candy, cookies | Mesalamine (Lialda) |
42 | CD | Ileocolonic | 11 | F | 24 | 8 | Middle school | None | Loperamide (Imodium) |
43 | CD | Ileocolonic | 15 | F | 12 | 6 | High school | None | Mesalamine (Asacol), 6-MP |
44 | CD | Gastric | 12 | M | 36 | 22 | Middle school | School lunches | None |
45 | CD | Ileocolonic | 29 | M | 60 | 60 | Graduate school | None | LDN, adalimumab |
46 | ID | Sigmoid to distal transverse, rectal sparing | 31 | F | 84 | 6 | Graduate degree | None | Mesalamine (Asacol) |
47 | ID | Right colon | 17 | M | 60 | 8 | High school | Corn tortillas, potatoes | Methotrexate |
48 | ID | Rectosigmoid | 56 | F | 48 | 16 | College | None | None |
49 | ID | Pancolitis, sparing rectum | 39 | M | 240 | 72 | Graduate degree | Spelt bread, raw milk, baked goods | None |
50 | ID | Right colon, rectosigmoid | 46 | M | 108 | 48 | College | Pizza | Hydrocortisone enema |
GSSC item | Crohn’s Disease (n=36) | Ulcerative Colitis (n=9) | Indeterminate Colitis (n=5) | |||
---|---|---|---|---|---|---|
% >0 | Mean | % >0 | Mean | % >0 | Mean | |
Upper abdominal pain or discomfort | 27.8 | 0.6 | 33.3 | 0.7 | 20.0 | 0.2 |
Lower abdominal pain or discomfort | 44.4 | 0.8 | 55.6 | 1.4 | 20.0 | 0.2 |
Upper abdominal cramping | 16.7 | 0.4 | 11.1 | 0.1 | 0 | 0 |
Lower abdominal cramping | 22.2 | 0.4 | 22.2 | 0.6 | 0 | 0 |
Pain associated with eating | 11.1 | 0.4 | 22.2 | 0.4 | 0 | 0 |
Bloating | 30.6 | 1.3 | 33.3 | 1.2 | 40.0 | 0.8 |
Belching | 33.3 | 0.7 | 33.3 | 0.6 | 20.0 | 0.4 |
Passing gas | 66.7 | 1.8 | 77.8 | 2.2 | 40.0 | 0.6 |
Excessive gas overall | 38.9 | 1.2 | 66.7 | 1.2 | 20.0 | 0.2 |
Heartburn | 16.7 | 0.6 | 33.3 | 0.7 | 20.0 | 1.6 |
Indigestion | 13.9 | 0.3 | 33.3 | 0.7 | 0 | 0 |
Nausea | 13.9 | 0.6 | 22.2 | 0.6 | 20.0 | 0.4 |
Nausea associated with eating | 13.9 | 0.5 | 11.1 | 0.3 | 20.0 | 0.4 |
Frequent bowel movements | 13.9 | 0.9 | 33.3 | 0.6 | 20.0 | 0.2 |
Vomiting | 13.9 | 0.4 | 0 | 0 | 0 | 0 |
Alternating bowel movements between constipation and diarrhea | 22.2 | 0.4 | 33.3 | 0.8 | 20.0 | 0.2 |
Constipation >70% of the time | 22.2 | 0.5 | 11.1 | 0.3 | 0 | 0 |
Diarrhea >70% of the time | 33.3 | 1.0 | 11.1 | 0.1 | 0 | 0 |
Irregular bowel habits | 30.6 | 0.8 | 33.3 | 0.4 | 20.0 | 0.2 |
Infrequent bowel movements | 27.8 | 0.5 | 33.3 | 0.7 | 0 | 0 |
Hard stools | 36.1 | 1.0 | 33.3 | 0.7 | 20.0 | 0.4 |
Watery stools | 47.2 | 1.6 | 44.4 | 0.9 | 20.0 | 0.6 |
Soft stools | 41.7 | 1.6 | 66.7 | 3.6 | 60.0 | 1.4 |
Passage of mucous in the stool | 19.4 | 0.5 | 33.3 | 1.3 | 20.0 | 0.2 |
Passage of blood in the stool (without presence of hemorrhoids) | 27.8 | 0.8 | 33.3 | 0.8 | 20.0 | 0.2 |
Straining with bowel movements | 38.9 | 0.9 | 11.1 | 0.4 | 0 | 0 |
Fecal urgency | 41.7 | 1.4 | 66.7 | 1.1 | 40.0 | 1.0 |
Bowel incontinence | 13.9 | 0.5 | 0 | 0 | 0 | 0 |
Sensation of incomplete emptying of bowels | 38.9 | 0.7 | 55.6 | 0.8 | 20.0 | 0.2 |
Loss of appetite | 11.1 | 0.5 | 22.2 | 0.2 | 0 | 0 |
Weight loss | 27.8 | 0.9 | 55.6 | 1.8 | 40.0 | 1 |
Decreased food intake because of symptoms | 13.9 | 0.6 | 11.1 | 0.1 | 0 | 0 |
Difficulty swallowing | 2.8 | 0 | 0 | 0 | 0 | 0 |
Pain with swallowing | 0 | 0 | 0 | 0 | 0 | 0 |
Food coming up to mouth | 2.8 | 0.1 | 0 | 0 | 0 | 0 |
Acid taste in mouth | 5.6 | 0.1 | 0 | 0 | 20.0 | 1.6 |
Intolerance to multiple foods | 38.9 | 1.8 | 33.3 | 0.7 | 20.0 | 1.6 |
Overall | 86.1 | 27.1 | 88.9 | 25.9 | 80.0 | 13.6 |
Patient’s condition | SIBDQ Subscale Scores (mean±standard deviation) | ||||
---|---|---|---|---|---|
Bowel | Systemic | Emotional | Social | Total | |
Overall (n=50) | 18.9±2.4 | 11.7±2.2 | 16.7±3.3 | 13.5±1.1 | 60.9±6.5 |
Crohn’s disease (n=36) | 18.8±2.6 | 11.9±2.1 | 16.6±3.5 | 13.5±1.3 | 60.9±6.9 |
Ulcerative colitis (n=9) | 18.4±2.1 | 11.3±2.3 | 16.7±2.7 | 13.4±0.9 | 59.9±5.7 |
Indeterminate colitis (n=5) | 20.4±0.9 | 11.6±2.9 | 17.2±3.4 | 14.0±0.0 | 63.2±4.3 |
Day 1 | |
Breakfast | 2 eggs, yogurt with farmer’s cheese, honey |
Lunch | Cube steak, apples, green beans, carrots |
Dinner | Steak, carrots, green beans |
Snacks | Grape juice, gelatin, peanut butter brownies, apples |
Day 2 | |
Breakfast | 2 eggs, yogurt with farmer’s cheese, honey |
Lunch | Steak, apples, asparagus |
Dinner | Turkey burger (no bun), apples, carrots, boiled shrimp |
Snacks | Peanut butter brownies, grape juice |
Day 3 | |
Breakfast | 3 eggs, yogurt, honey |
Lunch | Chicken thighs, asparagus, baked apples, honey |
Dinner | Pork with pineapple, carrots, asparagus, peaches |
Snacks | Peanut butter brownies, grape juice |
Reason | Cases (n) | % |
---|---|---|
Fear of long-term consequences of medications | 41 | 82 |
Efficacy of SCD compared with medications | 32 | 64 |
Medications not effective | 32 | 64 |
Adverse reactions to medications | 28 | 56 |
Recommendation from Internet forum | 22 | 44 |
Recommendation from family/friends | 15 | 30 |
Breaking the Vicious Cycle book 7 | 4 | 8 |
Cost of medications | 1 | 2 |
Seeking alternative treatment to medications | 1 | 2 |
Fear of need for surgery | 2 | 4 |
Fear of colon cancer | 1 | 2 |
Discussion and lessons learned
References
- What can we learn from inflammatory bowel disease in developing countries?.Curr Gastroenterol Rep. 2013; 15: 1-9
- Clinical applications of advances in the genetics of IBD.Rev Gastroenterol Disord. 2003; : S9-S17
- Disorders of a modern lifestyle: Reconciling the epidemiology of inflammatory bowel diseases.Gut. 2008; 57: 1185-1191
- Role of diet in the development of inflammatory bowel disease.Inflamm Bowel Dis. 2010; 16: 137-151
- Is there a link between food and intestinal microbes and the occurrence of Crohn's disease and ulcerative colitis?.J Gastroenterol Hepatol. 2008; 23: 1794-1801
- Management of Celiac Disease.Lippincott, Philadelphia, PA1951
- Breaking the Vicious Cycle.2012 ed. The Kirkton Press, Baltimore, Ontario, Canada2012
- A simple index of Crohn's-disease activity.Lancet. 1980; 1: 514
- A comparison of oral prednisolone given as single or multiple daily doses for active proctocolitis.Scand J Gastroenterol. 1978; 13: 833-837
- GSRS—A clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease.Dig Dis Sci. 1988; 33: 129-134
- Shortened questionnaire on quality of life for inflammatory bowel disease.Inflamm Bowel Dis. 2004; 10: 383-391
- Nutritional therapy in pediatric Crohn disease: The specific carbohydrate diet.J Pediatr Gastroenterol Nutr. 2014; 58: 87-91
- The Specific Carbohydrate Diet—A treatment for Crohn’s disease?.J Pediatr Gastroenterol Nutr. 2004; 39: S299-S300
- Specific carbohydrate diet in treatment of inflammatory bowel disease.Tenn Med. 2004; 97: 407
- An anti-inflammatory diet as treatment for inflammatory bowel disease: A case series report.Nutr J. 2014; 13: 5
- Polymeric enteral diets as primary treatment of active Crohn's disease: A prospective steroid controlled trial.Gut. 1993; 34: 778-782
- Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn's disease.Dig Dis Sci. 1987; 32: S100-S107
- Lifestyle-related disease in Crohn's disease: Relapse prevention by a semi-vegetarian diet.World J Gastroenterol. 2010; 16: 2484-2495
- The effect of the Specific Carbohydrate Diet (SCD) on gut bacterial fingerprints in inflammatory bowel disease.Gastroenterology. 2012; 142: S395
- The bacterial microbiome of inflammatory bowel disease patients on the Specific Carbohydrate Diet (SCD).Gastroenterology. 2013; 144: S552
Article info
Publication history
Footnotes
This article was written by Samir Kakodkar, MD, gastroenterology fellow, Azam J. Farooqui, MD, resident in internal medicine, Sue L. Mikolaitis, MS, RDN, dietitian and research coordinator, and Ece A. Mutlu, MD, MSCR, MBA, associate professor of medicine, Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, Rush University, Chicago, IL.
DISCLOSURES
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Departmental funds were used exclusively to fund this study.
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