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The specific carbohydrate diet (SCD) is a restrictive diet originally created to manage celiac disease; it limits the use of complex carbohydrates (disaccharides and polysaccharides). Monosaccharides are allowed, and various foods including fish, aged cheese and honey are included. Prohibited foods include cereal grains, potatoes and lactose-containing dairy products.^[1] It is a gluten-free diet since no grains are permitted.^[2]

Origins

In 1924, Sidney V. Haas (1870–1964) described the first SCD for the treatment of children with celiac disease; this was known as the banana diet.^[2]^[3] Haas described a trial with 10 children; all 8 children treated with bananas went into remission, and the two control children died.^[4] The banana SCD was the cornerstone of celiac therapy for decades until bread shortages in the Netherlands caused by World War II caused children with celiac disease to improve, which led to the isolation of wheat proteins, not starches, as the cause of celiac disease.^[4] Before the banana SCD, one out of four children with celiac died.^[3] After more research, he described the SCD as a treatment for celiac disease and inflammatory bowel disease (IBD) in his 1951 medical textbook The Management of Celiac Disease; Haas never accepted the finding that wheat gluten was the damaging part of wheat; he insisted it was starch and called the discovery about a gluten a "disservice."^[5]

The diet was later re-popularized by biochemist Elaine Gottschall, the mother of one of Haas's patients, in her 1996 book Breaking the Vicious Cycle.^[2]^[6] Gottschall's daughter was reported to been cured of ulcerative colitis in two years by SCD.^[1] Gottschall described the theory of how restricting diet might reduce gut inflammation associated with various medical conditions.^[2] Gottschall asserted that the diet could "cure" a number of medical conditions without providing data.^[6] Gottschall advocated using SCD to treat Crohn's disease, ulcerative colitis, diverticulitis, cystic fibrosis, chronic diarrhea, and autism.^[1]

Unconfirmed claims

The claims that the SCD is beneficial for children with autism are based on the supposition they have too much harmful bacteria in their gut. ^[7] While limited evidence suggests the SCD can be beneficial, there is a concern the restrictive nature of the diet may cause nutritional deficiencies.^[8] Parents adopting the SCD for their children are at risk of experiencing guilt when their expectations of improvement are dashed.^[7]^[9] The SCD is one of many unevidenced treatments offered for children with special needs that have the characteristic signs of being pseudoscientific.^[7]

A 2013 review on SCD and other exclusion diets concluded: "However, we lack large prospective controlled trials to provide the dietary recommendations patients’ desire. Taken together, studies of exclusive enteral nutrition, exclusion diets, and semi-vegetarian diets suggest that minimizing exposure of the intestinal lumen to selected food items may prolong the remission state of patients with inflammatory bowel disease. Even less evidence exists for the efficacy of the SCD, FODMAP, or Paleo diet. "^[2] It also said that the diet risks imposition of an undue financial burden and potentially causes malnutrition.^[2]

As of 2017^[update] there was preliminary evidence that the SCD may help relieve the symptoms of adults with inflammatory bowel disease.^[10]

The Gut and Psychology Syndrome Diet (GAPS Diet) is an even more restrictive variant of the SCD, devised by a Russian neurologist.^[11]^[12] The diet is promoted with claims it can treat a wide variety of conditions including autism, schizophrenia and epilepsy.^[11]^[12] Like the SCD, claims of the diet's usefulness for children with autism are not supported by scientific studies.^[11] Harriet Hall has described the GAPS diet as "a mishmash of half-truths, pseudoscience, imagination, and untested claims",^[12] and Quackwatch includes the GAPS Diet in its Index of questionable treatments.^[13]

References

^ ^a ^b ^c Brown, Amy C.; Roy, Minakshi (2010). "Does evidence exist to include dietary therapy in the treatment of Crohn's disease?". Expert Review of Gastroenterology & Hepatology (Review). 4 (2): 191–215. doi:10.1586/egh.10.11. ISSN 1747-4132. PMID 20350266. S2CID 207210268.
^ ^a ^b ^c ^d ^e ^f Hou JK, Lee D, Lewis J (October 2014). "Diet and inflammatory bowel disease: review of patient-targeted recommendations". Clin. Gastroenterol. Hepatol. (Review). 12 (10): 1592–600. doi:10.1016/j.cgh.2013.09.063. PMC 4021001. PMID 24107394.
^ ^a ^b "Dr. Sidney Valentine Haas Dies". The New York Times. December 1, 1964. Archived from the original on March 12, 2018. Retrieved 2017-04-28.
^ ^a ^b "A Brief History of Celiac Disease" (PDF). Impact: The University of Chicago Celiac Disease Center, Summer 2007. Summer 2007. Archived (PDF) from the original on 2016-03-04. Retrieved 2017-04-28.
^ Guandalini, S (2008). "Historical Perspective of Celiac Disease". In Fasano, Alessio; Troncone, Riccardo; Branski, David (eds.). Frontiers in celiac disease. Basel: Karger. p. 6. ISBN 9783805585262.
^ ^a ^b Fitzgibbon EJ (1998). "Breaking the Vicious Cycle. Intestinal Health Through Diet". Journal of Nutritional & Environmental Medicine (Book review). 8 (1): 86. I was looking for data to support the claims of cure, but nothing
^ ^a ^b ^c Deisinger JA (2010). Obiakor FE, Bakken JP, Rotatori AF (eds.). Chapter 14: Scientifically unsupported treatments for students with special needs. Advances in special education. Vol. 19. Emerald. p. 220. doi:10.1108/S0270-4013(2010)0000019017. ISBN 978-1-84855-668-3. ISSN 0270-4013. {{cite book}}: |work= ignored (help)
^ "Nutritional interventions for autism spectrum disorder" (PDF). Nutrition Reviews. 78 (7).
^ Levy SE, Hyman SL (2005). "Novel treatments for autistic spectrum disorders". Ment Retard Dev Disabil Res Rev (Review). 11 (2): 131–42. doi:10.1002/mrdd.20062. PMID 15977319.
^ Kakodkar S, Mutlu EA (2017). "Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease". Gastroenterol Clin North Am (Review). 46 (4): 745–767. doi:10.1016/j.gtc.2017.08.016. PMC 5821251. PMID 29173519.
^ ^a ^b ^c Connor Z (2015). Shaw V (ed.). Autism spectrum disorders (4th ed.). John Wiley & Sons. p. 686. ISBN 978-0470659984. {{cite book}}: |work= ignored (help)
^ ^a ^b ^c Hall HA (7 May 2013). "GAPS Diet". Science-based medicine. Archived from the original on 21 December 2018. Retrieved 14 December 2018.
^ "Index of questionable treatments". Quackwatch. 3 September 2018. Archived from the original on 24 October 2018. Retrieved 14 December 2018.