In order to understand how the diet works, it is important to understand the disease process occurring in the gut or, WHY the diet works.

The Specific Carbohydrate Diet™ is predicated on the understanding that Ulcerative Colitis, Crohn's Disease, Irritable Bowel Syndrome, and gluten therapy resistant Celiac are the consequence of an overgrowth and imbalance of intestinal microbial flora. By altering the nutrition we take in, we can affect the constitution of our intestinal flora, and bring it back into balance, healing our digestive tracts and restoring proper absorption.

The intestinal tract forms a rich ecosystem, comprised of over 400 bacterial species. Some are harmless, and others not. In the gut of a healthy person, these various communities of microbes compete with each other for scarce nutritional resources. Consequently, they exist in a state of balance, and the stomach and small intestine harbour only a sparse population of microbial flora. In the large intestine, each type inhibits an overabundance of the others, and this prevents the waste products and toxins of a particular type of microbe from overwhelming the body. The stomach and upper intestine are also protected by high acidity, and the action of peristalsis.

The Vicious Cycle

When the balance in the gut is disturbed, an overgrowth of intestinal flora can result. Microbes migrate to the small intestine and stomach, inhibiting digestion and competing for nutrients. The gut then becomes overloaded with the byproducts of their digestion. This bacterial overgrowth can be triggered by overuse of antacids, reduced stomach acidity due to aging, weakening of the immune system through malnutrition or poor diet, and alteration of the microbial environment through antibiotic therapy.

The components of our diet, particularly carbohydrates, play an enormous role in influencing the type and number of our intestinal flora. When carbohydrates are not fully digested and absorbed, they remain in our gut, and become nutrition for the microbes we host. The microbes themselves must digest these unused carbohydrates, and they do this through the process of fermentation. The waste products of fermentation are gases, such as methane, carbon dioxide & hydrogen, and both lactic & acetic acids, as well as toxins. All serve to irritate and damage the gut. There is evidence that increased acidity in the gut due to malabsorption and fermentation of carbohydrates, may lead common harmless intestinal bacteria to mutate into more harmful ones. Further, lactic acid produced during the fermentation process has been implicated in the abnormal brain function and behavior sometimes associated with intestinal disorders. The overgrowth of bacteria into the small intestine triggers a worsening cycle of gas and acid production, which further inhibits absorption and leads to yet more harmful byproducts of fermentation. The enzymes on the surface of the small intestines are destroyed by the now present bacteria, and this further disrupts the digestion and absorption of carbohydrates, leading to further bacterial overgrowth. As both the microbial flora and their byproducts damage the mucosal layer of the small intestine, it is provoked to produce excessive protective mucus, which further inhibits digestion and absorption.

Damage to the mucosal layer involves injury to the microvilli of our absorptive cells. These microvilli act as the last barrier between the nutrition we take in and our bloodstream. As our absorption is inhibited, folic acid and vitamin B12 deficiency can lead to impaired development of microvilli, while an abnormally thick layer of mucus prevents contact between microvilli enzymes and the carbohydrates we ingest. The small intestine responds to this spiraling irritation by producing more goblet (mucus-making) cells, creating yet more mucus. Finally, as the goblet cells become exhausted, the intestinal surface is laid bare, and is further damaged, and possibly ulcerated. As more carbohydrates are left in the gut, they cause water and nutrients to be pulled from the body into the colon, resulting in chronic diarrhea. Absorption is further hindered as diarrhea increases the rate with which food travels through the gut.

The Diet:

"The Specific Carbohydrate Diet™ is based on the principle that specifically selected carbohydrates, requiring minimal digestive processes, are well absorbed and leave virtually none to be used for furthering microbial overgrowth in the intestine. As the microbial population decreases due to lack of food, its harmful byproducts also decrease, freeing the intestinal surface of injurious substances. No longer needing protection, the mucus-producing cells stop producing excessive mucus, and carbohydrate digestion is improved. Malabsorption is replaced by absorption. As the individual absorbs energy and nutrients, all the cells in the body are properly nourished, including the cells of the immune system, which then can assist in overcoming the microbial invasion." The simpler the structure of the carbohydrate, the more easily the body digests and absorbs it. Monosaccharides (single molecules of glucose, fructose, or galactose) require no splitting by digestive enzymes in order to be absorbed by the body. These are the sugars we rely on in the diet. They include those found in fruits, honey, some vegetables, and in yoghurt.

Double sugar molecules (disaccharides: lactose, sucrose, maltose and isomaltose) and starches (polysaccharides) are primarily avoided on the diet. Some starches have been shown to be tolerated, particularly those in the legume family (dried beans, lentils and split peas only). However, they must be soaked for 10-12 hours prior to cooking, and the water discarded since it will contain other sugars which are indigestible, but which are removed in the soaking process. Small amounts of legumes may only be added to the diet after about three months. The starches in all grains, corn, and potatoes must be strictly avoided. Corn syrup is also excluded since it contains a mixture of 'short-chain' starches.

Yoghurt:

Finally, the SCD™diet relies on properly fermented yoghurt, and in some cases, acidophilus supplements, to help repopulate the gut with healthy intestinal flora. By increasing the population of 'good' bacteria in the gut, the overgrowth of harmful bacteria is put in check. As the competition for nutrition between the various strains of bacteria resumes, the variety of intestinal flora is brought back into balance. Yoghurt must be properly prepared by fermenting it for 24 hours. This allows enough time for the bacteria in the yoghurt culture to break down the lactose (disaccharides) in milk, into galactose (a monosaccharide). All SCD™diet yoghurt is homemade, as commercially available yoghurts are not properly fermented.

At the beginning of the program, when symptoms such as diarrhea and cramping are severe, the following basic diet should be followed for about five days. In other cases, one or two days on this basic diet is sufficient. The amounts of the specified foods to be eaten depend upon the appetite of the individual; there is no restriction as to quantities eaten.

You may find that stool colour changes during the course of the introductory diet. This is most likely an initial die-off of bacterial overgrowth, which is one of the reasons the introductory diet is so important. It will help to clean your system out, so that you can begin to heal.

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. (See, SCD™ Legal / Illegal List for more information about allowable juices.)
• Homemade gelatin made with juice, unflavored gelatin, and sweetener (honey or saccharine)

Lunch:

• Homemade chicken soup
• Broiled beef patty or broiled fish
• Cheesecake
• Homemade gelatin made with juice, unflavored gelatin, and sweetener (honey or saccharine)

Dinner:

• Variations of the above

If the food specified in the diet is known to cause an anaphylactic reaction, remove it permanently from the diet. 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.

If you find it impossible to obtain dry curd cottage cheese, substitute the cream cheese recipe (drained homemade yoghurt)

When diarrhea and cramping subside, cooked fruit, very ripe banana (must have brown spots), and additional cooked vegetables may be tried. If they seem to cause additional gas or diarrhea when they are added to the diet, delay their use until later.

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 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 in various foods. Small quantities of carbohydrates other than those designated often creep into the diet unless the strictest attention is paid to every item of food. Reading labels, although a good policy, is inadequate for those on the SCD™ since one ingredient sometimes has numerous names and may not be easily recognized as a forbidden carbohydrate. Many can, 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 in Chapter 9 of Breaking the Vicious Cycle and listed as Legal on the Legal / Illegal list.

Homemade Chicken Soup

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

Cheesecake

• Filling
  • 3 eggs
  • 1/3 cup honey
  • 1/2 cup homemade yogurt or homemade cream cheese***
  • 2 cups uncreamed cottage cheese (dry curd cottage cheese)
  • 2 teaspoons vanilla extract
• Place all ingredients in blender or food processor (with a metal blade) putting eggs in first so that the blender blades will turn freely.
  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.
  Pour into loaf pan with or without crust.
  Bake in oven at 350°F (180°C) for about 30 minutes or until edges are brown. Cool and refrigerate
• Cream Cheese
  • Line a colander with a clean cloth (a dish towel is satisfactory).
    Place colander on a bowl.
  • Pour chilled yogurt into lined colander and allow to drain for about 6-8 hours (need not be refrigerated while draining).
    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.

A Food Journal

It's a really good idea to keep a food journal. Some bad reactions to things will show up very 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. You didn't get sick overnight and it will take time for you to heal. The process can also be two steps forward and one step back. A food journal can help you track the slow improvements you make over time and don't notice from day to day, and be a good tool for keeping yourself on the diet.

* avoid if diarrhea is very severe.

** regular apple juice is not allowed, and for grape juice, use Welch's 100% grape juice.