Therapeutic Diets

The SCD was originally developed by Sydney V. Haas, MD, for the treatment of celiac disease and was popularized and refined by Elaine Gottschall for the treatment of IBD in her book, Breaking the Vicious Cycle. It eliminates high starch vegetables, grains, processed/added sugars (honey is allowed), dairy containing lactose, processed foods, additives, preservatives, and artificial ingredients from the diet. It focuses on a diversity of healthy fruits and vegetables, nuts/nut flours/nut butters, fish, poultry, meat, homemade yogurt, and aged cheeses.

Modified SCD is a diet that is derived from SCD but attempts to add back in a few select healthy whole foods to offer patients expanding options and to potentially feed a more diverse microbiome. Note that the definition of modified SCD is evolving. The specifics as to how the diet is modified could be as vague as the diet was not followed strictly (early uses of the term), to a very defined list of added foods allowed in specified amounts if tolerated.

The IBD-AID was derived from the Specific Carbohydrate Diet and modified to include more prebiotic and probiotic foods in order to restore a healthy microbiome balance. More specifically, it includes specific sources of carbohydrates, fruits and vegetables, and nut and legume flours. It includes omega-3 eggs, fish, poultry, and lean meats; limited aged cheeses made with cultures and enzymes; probiotic food sources like yogurt, kefir, and miso; and honey. Prebiotic food sources such as bananas, oats, blended chicory root, and flax meal are suggested. The diet is divided into 3 phases that correlate with symptoms and which are based on food textures (Olendzki BC et al).

The AIP is also known as Paleo Autoimmune Protocol because it is derived from the Paleolithic diet (which is based on meat, fish, vegetables, nuts, and seeds) (Medical News Today), although it is a stricter version, eliminating foods that may be antigenic, stimulate the immune system, or create dysbiosis. There are three phases: the initial elimination phase removes grains, legumes, nightshade vegetables, sugar, dairy, eggs, nuts, seeds, alcohol and coffee, processed foods, and industrial seed oils; the reintroduction phase, where items are individually reintroduced while monitoring for symptoms or progression of disease; and the maintenance phase, in which patients sustain their personalized restrictions and reintroductions as long as they are symptom free.

The CDED is a whole foods diet designed to exclude or limit exposure to foods that may adversely affect the microbiome or alter intestinal barrier function (Levine A et al) (Sigall-Boneh et al). The CDED is initiated in three phases and is always combined with Partial Enteral Nutrition (PEN) from formula (Modulen IBD®) in declining amounts, with the last stage maintaining 25% of daily intake from PEN. In patients unwilling to use Exclusive Enteral Nutrition, CDED is an effective alternative for inducing remission (Sigall-Boneh et al)(Herrador-López M et al), and it may provide a more effective option than standard PEN for maintaining it.