Tuesday, June 28, 2005

Specific Solution

Seven years ago, a friend who suffers from Crohn's disease wanted to get pregnant (which normally isn't problematic for Crohn's sufferers), but she was dealing with a particularly bad flare-up of the disease. Her doctor gave her two options. She could go on the drug 6-MP, which brought with it risks that include allergy, leukopenia (a serious reduction in white blood cells), pancreatitis and nausea and that takes up to six months to take effect, and even longer to taper off. Or she could have surgery to remove the diseased portion of her intestine. Neither option appealed to her, so she started digging. Eventually, she found the book that made the difference: Breaking the Vicious Cycle: Intestinal Health Through Diet, by Elaine Gottschall, BA, MSc. Testimonials about the book and the diet it outlines -- known as the Specific Carbohydrate Diet (SCD) -- gushed about how well it worked, so she tried it, faithfully following its rigid guidelines. Six months later, the disease was in remission, and she was pregnant. Now, years later, she has slacked off on the diet and her symptoms have reemerged, so she is contemplating using the diet again. While the SCD requires commitment, for those who suffer the pain of chronic intestinal illness and/or the misery of side effects from damaging drugs such as 6-MP or prednisone, it is definitely an option worth considering. Generally speaking, the SCD is a strict grain-free, lactose-free, sucrose-free regimen intended to treat a broad range of inflammatory bowel diseases -- ulcerative colitis, celiac disease, diverticulitis, Crohn's, etc. The idea behind it -- our bodies had millions of years to adapt to a diet consisting mainly of meat, fish, eggs, vegetables, nuts and low-sugar fruits, but we're not as equipped to digest more recent introductions to our diet, such as starches, grains, pasta and legumes, not to mention the refined sugars and chemical additives so common today. The remnants of the undigested nutrients overfeed opportunistic intestinal microbes, and the resulting by-products lead to inflammation. The book specifically outlines which foods are allowed and which ones aren't -- and those guidelines need to be followed exactly. There are two major challenges to the diet. First and foremost, I won't kid you -- it's a lot of work. Because many processed foods contain emulsifiers and additives that use the wrong type of carbohydrates, dieters are forced to prepare their own ingredients. (Eating out is not a good idea, because you won't know exactly what's in your food.) This goes beyond simply shopping at a natural-food store. Need flour? Grind some almonds into a fine powder. Ketchup? Mayonnaise? You need to make your own. It's time consuming and tedious, though Gottschall is quick to point out that if a parent has a child suffering from a bowel disease, the inconvenience is worth the outcome. "Why not hire a retired grandmother to come in once a week and cook for you?" she says. Anecdotal evidence, such as that found on Gottschall's Web site, (www.breakingtheviciouscycle.info), and reviews of the book at Amazon.com and elsewhere support Gottschall's claim that thousands of people suffering from inflammatory bowel disease (IBD) have been helped by the diet. For medical science, though, that's not enough. "The diet is a neat idea, but we actually have no real proof that it's beneficial," says Edward Loftus, Jr., MD, associate professor of medicine in the division of gastroenterology and hepatology at the Mayo Clinic College of Medicine in Rochester, Minnesota. "The best kind of evidence is from randomized control trials, where there are two groups of patients and neither the patients nor their physicians know if they're getting the actual intervention or a placebo. Then you see which group improves. Unfortunately, it's incredibly difficult to design a randomized trial of diet." "I try to be open-minded about these things," Dr. Loftus continues, "but these diets haven't been subjected to the level of scrutiny needed for us to recommend them. Studies are needed to prove that this diet works." Though Dr. Loftus is willing to talk to his patients about diets such as the SCD, he feels that many gastroenterologists likely wouldn't be. "Doctors want to help their patients," he says, "but they're naturally skeptical about therapies unless the therapies are proven." Contributing editor Andrew L. Rubman, ND, feels that, in many cases, the problem is more than mere skepticism, and is instead a reaction to the litigious nature of our society. "If gastroenterologists do mention a connection to diet, it means they need to be experts in that diet in order to give you care," he says. "If they aren't experts and give advice on the diet, they're being negligent and that opens them up to litigation." Also, according to Dr. Rubman, designing a study to "scientifically" evaluate the many components of this diet is virtually impossible. Diets are difficult to test scientifically because there are so many ways that food can affect the body. Whatever the reason, Gottschall has been hearing skepticism from the medical community for the past 40 years. "To this day, if you have a child with chronic diarrhea, and you ask a gastroenterologist what to feed that child, he will say food has nothing to do with it," she claims. "This is lunacy." All the skepticism does is strengthen the 84-year-old author's resolve to promote the diet, even if it only reaches one person at a time. When it comes to an individual's health, Ms. Gottschall, Dr. Loftus and Dr. Rubman all agree on this: The better informed a patient is about his or her situation, the better his decisions will work for him. "If the doctor and the patient can work with each other and understand each other," said Dr. Loftus, "then that's going to be a much more beneficial relationship going forward." If you suffer from one of the IBDs and are considering trying the SCD, here's how to start...
*Find the right doctor. If you're interested in trying the SCD as part of your treatment, read Gottschall's book and talk to your doctor about it. He/she should be open to the idea and willing to help. If not, find another doctor. Or, consult a naturopathic physician who specializes in gastroenterology. He is more likely to be open to treatment protocols such as this. To find a naturopathic physician in your area, visit the American Association of Naturopathic Physicians' Web site at www.naturopathic.org.
*Get diagnosed. If your symptoms aren't the result of an IBD, the diet won't help. "I won't talk to anybody unless they've been diagnosed," states Gottschall. "What if it's a tumor causing the problem?"
*Get tested. People who suffer from IBD often have nutritional deficiencies -- low levels of folic acid, vitamin B-12, calcium and iron are common. Get a blood or urine test to check your levels. You may need to take supplements to make up the difference. Don't just buy what you think you need from a health-food store or on-line. Have your health-care practitioner prescribe the exact dose of what you need.
Note: Because of the relationship between intestinal health, hormone regulation and blood glucose management, people with diabetes, those undergoing hormone therapy and people taking selective serotonin reuptake inhibitors (SSRIs) should seek additional input from their physicians before trying the diet.
Stay informed. In the end, you're responsible for the decisions regarding your own health. Read as much about the pros and cons of any diet before moving forward with it, and don't be afraid to ask for several medical opinions before you decide what's right for you. After first seeing friends and family suffer, live on dangerous medications or have surgery -- and then seeing the improvement this diet can make -- you would certainly want to consider it as an option.


At 12:04 PM, Anonymous Anonymous said...

Really amazing! Useful information. All the best.

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