Reviews of Elaine Gottschall's first book, "Food and the Gut Reaction", as well as of the present version of the book, entitled "Breaking the Vicious Cycle" Date: Sat, 19 Jul 1997 10:50:13 -0700 From: Dempsey <stellar1@PACBELL.NET> Subject: Book Review For Archives I found this review of Elaine's first book while perusing some old Townsend Newsletter magazines. I thought it would be valuable to put here as a possible resource for people just learning about the diet or who are looking for concise resources that could help explain it to family and friends. -- Denise Intestinal Health Through DietReviewed by Irene Alleger(In the Townsend Letter for Doctors, February/March, 1994, #127/128) Food and the Gut Reaction by Elaine Gottschall, B.A., M.Sc. The Kirkton Press R.R.1 Kirkton, Ontario, Canada N0K, 519-229-6795 1987 softcover, $16.95 + shipping, 143 pp. The title of this small book reflects the academic background of the author, a research biochemist and nutritionist, working in Canada. Although written primarily for those people who suffer from specific digestive and intestinal disorders, she documents the results of her years of research on diet-related illness, an area in which many physicians could educate themselves, as well. The author clearly explains the role of microbes and intestinal flora in the maintenance of a healthy digestive system, and how an imbalance triggers an unhealthy milieu, leading to intestinal disorders. The author's research focused on the gut's reaction to different kinds of diet, in the treatment of Crohn's disease, ulcerative colitis, diverticulitis, celiac disease, cystic fibrosis, and chronic diarrhea. From this data a surprising diet emerged, showing the most optimal results from the restriction of carbohydrates. The Specific Carbohydrate Diet is the centerpiece of this book, with each segment of the diet explained in terms of how it works in the gut, and the scientific rationale for including or excluding different foods. Research has shown that the underlying problem in intestinal disorders is the inability to digest carbohydrates due to microbial overgrowth and toxins. The process that results in illness is begun in the altered milieu of the digestive system, a progressively more inflammatory condition, leading to the inability to digest a major part of our Western diet, with concomitant malabsorption and its resulting nutritional deficiencies. Good explanations are given of the breakdown of foods by enzymes and their role in the digestive process. The author also explains the different kinds of carbohydrates found in food and the few, such as legumes, fruit, and yogurt, which are digestible by patients with intestinal disorders. Although celiac disease is explored in more depth than some of the other digestive disorders, the general thesis is that all of these (above named) intestinal disorders are simply earlier or later stages of the same process. The Specific Carbohydrate Diet is highly nutritious, and by judicious choice of foods, can be well-balanced. The case histories cited often speak of subjective improvement within days of beginning the diet, and symptomology significantly improved within months. Although no large-scale studies have yet been done, patient populations in Canada that were put on the diet were often cured completely after several years. The value of this dietary treatment is in the scientific work done which is so completely ignored by the orthodox medical community. I dare say a chunk of the pharmaceutical profits are generated by drug treatments of these disorders, as well as keeping a large force of specialists in the style to which they've become accustomed. This diet is not merely a listing of foods allowable and not allowable, it is much more. In just the discussion of allowable fruits, for instance, distinctions are made between "loose" California dates (okay), and dates which stick together in a mass, showing they have had syrup or sugar added. Nothing is overlooked; one must be committed to improving one's health to stay with this diet, but the outcome is worth it. The most restrictive part of the diet is of course, with grains; no cereals or flour, no potatoes, But once the gut is healthy again, these can be re-introduced slowly. The purpose of the Specific Carbohydrate Diet is to deprive the microbial worlds of the intestine of the food it needs to overpopulate, the sugars from the carbohydrates. By using a diet which contains predominantly "predigested" carbohydrates, the individual with an intestinal problem can be maximally nourished without overstimulation of the intestinal microbial population. The diet presents a method for breaking the dysfunctional cycle by allowing only carbohydrates requiring minimal digestive processes which are absorbed and leave virtually none to be used for furthering microbial growth in the intestine. As the microbial population decreases due to lack of food (while being balanced by lactobacilli), its harmful by-products also decrease, freeing the intestinal surface of injurious substances. No longer needing protection, the mucus producing cells stop producing excessive mucus, and carbohydrate digestion improved. Intestinal disorders are becoming endemic, and worse, the conventional medical wisdom has little to offer. Anyone with any of these disorders would be prudent to give this diet serious attention. Date: Tue, 9 Sep 1997 19:30:48 -0400 From: Ellen Adams <EllenAdams@AOL.COM> Subject: SCD Cited in Wellness Book Hi Guys! I recently bought "Digestive Wellness" by Elizabeth Lipski, M.S., C.C.N. (has anyone read it? if so, what did you think?) Under IBD she refers to the SCD: "There is no one diet that helps all people with IBD, although the Elemental Diet and Haas Specific Carbohydrate Diet work well for many people....The Specific Carbohydrate Diet eliminates all simple sugars. As discussed under IBS, many people are unable to split disaccharide sugars (lactose, sucrose, maltose, and isomaltose) into single molecule sugars. This may explain, in part, why the diet is so successful. The Specific Carbohydrate Diet also eliminates grains, which generally cause inflammation of the intestines in people with IBD. Leo Galland, MD, has found that the Specific Carbohydrate Diet works well for people with IBD." Later on, she specifically references Elaine's book as a resource and lists what is allowed on the diet. Then she goes on to say "This diet is beneficial because it eliminates most foods that cause sensitivities--grains and dairy products. Similar to the candida diet, it helps restore intestinal balance." [I thought it was interesting that she cites it as dairy free, when it is actually lactose free.] Ellen Date: Tue, 16 Feb 1999 13:53:21 -0700 Hi all: This was forwarded to me by a local CD sufferer who is recent to the diet.
He will be on the list when he gets time to breath - he was also at our
local SCD get together. Here's a very interesting article re: Elaine's books!! They by no means
wholly endorse her but they certainly don't seem to simply dismiss it as
having no value. I'll be seeing a new GI guy in about a month so I think
I'll take this article along from him to read.
Let me know what you think...... Duncan McKenzie wrote: Hi Randy Here's a text copy of the article. It's taken straight from the
desktop publishing program, so some parts may not display correctly,
but it should be OK for a casual read.
The Canadian Journal of Gastroenterology - Volume 10 Number 2 - March/April 1996:
The 'specific carbohydrate diet': Nutritional quackery or of possible benefit for some IBD patients?VIVIANE ALBERT MSc PDt, ILENE GILBERT DHec PDt, GORDON GREENBERG MD FRCPC, SEYMOUR MISHKIN MD FRCPC,ON BEHALF OF THE IBD NUTRITION REVIEW FORUMBreaking the Vicious Cycle: Intestinal Health Through Diet, by Elaine Gottschall (1994). Kirkton Press, RR #1, Kirkton, Ontario N0K 1K0. 160 pages; $16.95. Food and the Gut Reaction, by Elaine Gottschall (1987). Kirkton Press, RR #1, Kirkton, Ontario N0K 1K0. 143 pages; $16.95. The following critique of Breaking the Vicious Cycle: Intestinal Health Through Diet (and the author's earlier publication, Food and the Gut Reaction) is based on a review of both books, a meeting with the author when she spoke to our group on October 24, 1994 and feedback from patients who read the book and/or tried the 'specific carbohydrate diet'. Elaine Gottschall BA MSc, both in print and in real life, portrays the image of a dedicated, caring individual who believes with all her heart that the 'specific carbohydrate diet', if followed with "fanatical adherence" for a minimum of two years ("at least one year after the last symptom has disappeared"), will provide a cure for Crohn's disease and ulcerative colitis (page 52). (The reaction of a Forum member to this material, in particular this sentence, was "this would appear to be a book on fundamentalism rather than gastrointestinal science (even pseudo-science). I think that the handling of this type of material calls for great, great care.") Although the specific carbohydrate diet does not meet the criteria of a chemically defined elemental regimen, the author equates the rationale and efficacy of her approach to that of the elemental diet whose efficacy in Crohn's disease is accepted with known limitations by the medical community. A recently published meta-analysis of enteral nutrition as a primary treatment of active Crohn's disease (1) indicated that corticosteroids are more effective than enteral nutrition. Furthermore, the study did not demonstrate an advantage to elemental feedings compared with a polymeric formulation. Once the patient is asymptomatic, presumably after following her diet for two to three years, one "forbidden food" at a time can be introduced weekly, progressing from small amounts initially. In the event of symptoms the specific carbohydrate diet should be resumed. The rationale for the specific carbohydrate diet is that "predigested" carbohydrates can easily be absorbed in a poorly functioning intestine. This, in turn, breaks the vicious cycle involving malabsorption of disaccharides, bacterial overgrowth and bowel injury (page 9). The origin of this approach dates back to an 1888 article, On the
celiac affliction by Samuel Gee (2), in which he stated "what the
patient takes beyond his ability to digest does harm". The basic
principle of the diet is that "no food should be ingested that
contains carbohydrates other than those found in fruits, honey,
properly-prepared yoghurt, and those vegetables and nuts listed. By
using a diet that contains predominantly 'predigested' carbohydrates,
the individual with an intestinal problem can be maximally nourished
without overstimulation of the intestinal microbial population." The
essentials of the specific carbohydrate diet according to Elaine
Gottschall follow.
PROTEIN -Proteins are well tolerated and not restricted except for gluten (page 5). -"Any cereal grain is strictly and absolutely forbidden, including
corn, oats, wheat, rye, rice, millet, buckwheat or triticale in any
form."
FAT -Fat is handled moderately well (page 5). Some animal products are permitted. -"Although grains are not permitted, salad and cooking oils made from
grains may be used" (ie, corn and soy bean oils); "olive oil is highly
recommended."
CARBOHYDRATE -No sucrose - "Do not use products made with refined sugar" (page 58). -No starch from grains - "any cereal grain is strictly and absolutely forbidden" (page 49). -No starch from roots. -No lactose (no enzyme-treated milk, no acidophilus milk) (page 56). -Some allowable legumes; "in general squash, tomato, string beans and carrots, all in cooked form are well tolerated (page 45) ... raw vegetables should not be introduced until diarrhea is under control (page 43) ... no canned vegetables permitted" (page 53). -Honey to be used to sweeten foods ("as much as desired ... when the
diarrhea has cleared") (page 43).
FIBRE -No cereal bran (page 49). -No raw fruits and no raw vegetables until diarrhea is under control (page 43). -No seeds for the first three months (page 59). -No allowable legumes for the first three months (page 52). -No commercial pectin (page 52). -Nuts must be ground until diarrhea has cleared up(page 55).
VITAMIN SUPPLEMENTATION -Very large doses of added vitamins are unnecessary. -B complex vitamins may be taken as a supplement, especially for women on contraceptives (page 47). -Vitamin B12 levels to be up to high normal (page 47). -At least 100 mg of vitamin C/day to be taken. -Vitamin D in combination with vitamin A is recommended in northern
climates during winter (page 47) - caution is advised against the use
of vitamin D in the summer (page 49).
MINERAL SUPPLEMENTATION -Mineral supplements to be taken if mineral levels are low (page 48). -The importance of maintaining proper calcium levels is stressed.
MISCELLANEOUS -Soy products, including tofu, are not permitted.
When asked about the differences between her books, Elaine Gottschall replied as follows. "The revised edition of Food and the Gut Reaction, Breaking the Vicious Cycle: Intestinal Health Through Diet, has four major differences. "1. A four-page foreword by Ron Hoffman MD (graduate of Albert Einstein Medical College in New York City). "2. A summary (page 7) of the chapter in the 1990 edition Inflammatory Bowel Disease entitled 'Dietary factors in the aetiology of inflammatory bowel disease' by Dr KW Heaton (3), which discusses results of 20 international studies on the eating patterns of people before the onset of inflammatory bowel disease. "3. A new chapter on the 'brain connection'. I discuss epilepsy, etc, in this chapter based on many cases of children especially. As you may know the Ketogenic diet for epilepsy (Johns Hopkins) has been ignored by mainstream and has been the basis of the Charley Fund (Jim Abrahams, Hollywood writer whose child was cured by it). The researchers haven't a clue as to why ketone bodies reverse epilepsy. I suggest that because it is a mainly high fat diet, it is the elimination of carbohydrates/gut connection where they should be looking. "4. About 12 new recipes with a fabulous sliceable bread recipe."
It is of interest that Dr Ronald Hoffman who wrote the very flattering foreword proposes a somewhat different diet for inflammatory bowel disease (IBD) patients in his book (attributed to Dr Lamar Gibbons) Seven Weeks to a Settled Stomach (4). Honey and sorbitol, which are not restricted by Elaine Gottschall except in very active disease, are on Dr Gibbon's "vigorously avoid" list. This point is made to indicate that apparently empiric and/or arbitrary differences exist between the popular diets offered as curative for IBD patients. Elaine Gottschall credits Drs Sidney and Merrill Haas, who introduced her to the specific carbohydrate diet that proved to be a cure for the "incurable ulcerative colitis" in her eight-year-old daughter who had not responded to treatment with sulphonamides or cortisone. Disappearance of gastrointestinal symptoms occurred after two years on this diet which was faithfully followed for seven years. Apparently the "first symptoms to disappear were a type of seizures which occurred after she had fallen asleep. They were characterized by delirium, lasted about 1 h and reoccurred several times weekly" (page 38). In our collective experience we have not encountered ulcerative colitis patients with seizure symptoms similar to those experienced by the author's daughter. A symptom-free interval of more than 20 years is another unusual event in the course of IBD, diagnosed according to currently accepted criteria. According to Elaine Gottschall, relief has been observed in, in addition to IBD patients, "celiac disease (not cured by a gluten-free diet), diverticulitis and various types of chronic diarrhea.... Some of the most dramatic and fastest recoveries have occurred in babies and young children with severe constipation and among children who, along with intestinal problems, had serious behavior problems. These included autistic-type hypoactivity as well as hyperactivity, often accompanied by severe and prolonged night terrors" (pages 1-2). Claims regarding the efficacy of the specific carbohydrate diet in treating emotional problems associated both with gastrointestinal and nongastrointestinal disorders (ie, schizophrenia) are outlined in chapter 7 ("The brain connection"). Except for rapid improvement in mood in celiac patients once they adhere to a gluten-free diet, we are not aware of any evidence of "psychoses from digestive origins". Our overall reaction to the book is that Elaine Gottschall's strengths are most evident when she is presenting the various aspects of the specific carbohydrate diet. Despite the restrictions imposed this diet is nutritionally balanced, palatable and varied. Nevertheless patients often lose weight while trying to adhere to this diet. The advice regarding vitamin and mineral supplements, especially calcium, is appropriate. Weaknesses become apparent when Elaine Gottschall attempts to tie together the myriad confusing medical and scientific literature. Her concern about possible hepatotoxic effects of lactose hydrolyzed milk (page 45) is unlikely to be a problem except in exceptionally rare cases of galactosemia. Her emphasis on the work of Jones, Hunter and other members of that Cambridge-based group is excessive. The claims made by this group in publications between 1985 and 1993 (6-9) regarding the incidence of 'food allergies' and the major therapeutic efficacy of elimination diets following a remission induced by an elemental diet in Crohn's disease patients have been seriously questioned by subsequent controlled studies involving double-blind challenges (10,11). In her favour it must be admitted that there is some scientific evidence to support a limited nutritional agenda for IBD patients. For example in severe ulcerative colitis there is evidence that improvement can be achieved by severely restricting all starches and sugars (12). In addition, necrotizing enterocolitis, a severe type of gastroenteritis, is often observed in premature infants (in whom lactase enzyme levels have not yet reached maturity) who were fed lactose containing (whey-based) formulas (13). The unifying hypothesis proposed is that unabsorbed carbohydrate (ie, lactose) combines with casein or other proteins to form toxic compounds (14). A recent study showed that oligofructose and inulin, naturally occurring indigestible carbohydrates, promoted the growth of bifidobacteria in the human colon (15). The authors concluded that small changes in diet can alter the balance of colonic bacteria towards a potentially healthier microflora. We can only speculate whether the polysaccharides present in the legumes and nut flours permitted in the specific carbohydrate diet, rather than the avoidance of various sugars, may be responsible for the benefits claimed. To Elaine Gottschall's credit she is prepared to tackle a murky field which many physicians and nutritionists prefer to avoid (page iii). She is attempting to provide a unifying and scientifically valid hypothesis for her diet. Appropriate warnings to continue under conventional medical supervision and therapy appear at the beginning of the book as well as in chapter 8 (page 46). She also indicates that the diet is unlikely to be helpful if no improvement is seen after a one-month trial (page 50). She also warns against the use of any foods known to cause allergic reactions. The feedback we received from a limited number of IBD patients indicates an appreciation for her style of writing and her attempt to explain certain aspects of IBD within the context of a unifying hypothesis, albeit incomplete. However, they envisage the diet as time-consuming, restrictive in terms of social interactions (ie, eating at restaurants and friends' homes) and expensive, but worth trying should all else fail. Another potential problem with restrictive diets is weight loss, an inappropriate risk for IBD patients especially if they are not benefiting from the diet. It should be noted that the drop-out rate from clinical studies involving long term elimination diets usually exceeds 33% and is especially high among adolescents (11). We welcome Elaine Gottschall's willingness to participate in an objective controlled study of her diet, which we believe to be essential. Clearly Elaine Gottschall is doing something right in the eyes of
patients with IBD and/or other gastrointestinal problems. As of May
1995 she has sold over 90,000 copies of Food and the Gut Reaction and
Breaking the Vicious Cycle: Intestinal Health Through Diet. A second
printing of at least 12,000 copies of her latest book is planned.
Interest shown by IBD patients (according to Canadian statistics there
are approximately 250,000 Canadian IBD sufferers, 50% of whom have
active disease) in these books is probably a reflection of the
inability of conventional medicine to cure IBD and of the rising
popularity of alternative or holistic approaches for the treatment of
chronic illness. Whether the Gottschall diet adds to the therapeutic
armamentarium of IBD management remains an area for proven scientific
study.
CONCLUSIONS We believe that the specific carbohydrate diet must be validated under controlled conditions before its use can be endorsed. We strongly advise that patients who undertake to follow this diet should do so under the supervision of their physicians and nutritionists. We urge our colleagues to familiarize themselves with the pros and cons of various nutritional approaches to IBD. This may help control the widespread use of untested popular diets and alternative forms of medicine (16). In the absence of a properly designed placebo controlled trial, it remains uncertain which subgroups of IBD would benefit from this diet and whether the response is superior to that achieved with conventional medical treatment or experimental drug trials. ACKNOWLEDGEMENTS: The costs involved in the preparation of this
manuscript were defrayed by contributions from the corporate and
private sponsors of the IBD Nutrition Review Forum. We appreciate the
secretarial services of Antse Beer.
REFERENCES 1. Griffiths AM, Ohlsson A, Sherman PM, Sutherland LR. Meta-analysis of enteral nutrition as a primary treatment of active Crohn's disease. Gastroenterology 1995;108:1056-67. 2. Gee S. On the coeliac affliction. St Bartholomew's Hospital Report 1888;24:17. 3. Heaton KW. Dietary factors in the aetiology of IBD. In: Allan RN, Keighley MRB, Alexander-Williams J, Hawkins CF, eds. Inflammatory Bowel Diseases. New York: Churchill Livingstone, 1990. 4. Hoffman RL. Seven Weeks to a Settled Stomach. New York:Simon J Shuster, 1990. 5. Baruk H. Psychoses from digestive origins. In: Hemmings G, Hemmings WH, eds. The Biological Basis of Schizophrenia. Baltimore: University Park Press, 1978. 6. Jones VA, Workman E, Freeman AH, Dickinson RJ, Wilson AJ, Hunter JO. Crohn's disease: maintenance of remission by diet.Lancet 1985;ii:177-80. 7. Jones VA. Comparison of total parenteral nutrition and elemental diet in induction of remission of Crohn's disease. Dig Dis Sci 1987;32:12(Suppl):1005-75. 8. Riordan AM, Hunter JO. Multicenter controlled trial of diet in the treatment of active Crohn's disease. Gastroenterology 1992;102:A685. 9. Riordan AM, Hunter JO, Cowan RE, et al. Treatment of active Crohn's disease by exclusion diet: East Anglian Multicentre Controlled Trial. Lancet 1993;342:1131-4. 10. Giaffer MH, Cann P, Holdsworth CD. Long-term effects of elemental and exclusion diets for Crohn's Disease. Aliment Pharmacol Ther 1991;5:115-25. 11. Pearson M, Teahon K, Jonathan L, Bjarnson I. Food intolerance and Crohn's Disease. Gut 1993;34:783-7. 12. Montgomery RD, Frazer AC, Hood C, Goodhard JM, Holland MR, Schneider R. Studies of intestinal fermentation in ulcerative colitis. Gut 1968;9:521-6. 13. Lifshitz F. Necrotizing enterocolitis and feedings. In: Lifshitz F, ed. Pediatric Nutrition. New York: Marcel Dekker, Inc,1982:513-30. 14. Clark DA, Miller MJS. Intraluminal pathogenesis of necrotizing enterocolitis. J Pediatr 1990;117:564-7. 15. Gibson GR, Beatty ER, Wang X, Cummings JH. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin. Gastroenterology 1995;108:975-82. 16. Moser G, Tillinger W, Bogelsang H, et al. Disease related concerns of patients with inflammatory bowel disease and the use of unconventional therapies. Gastroenterology 1995;108:A880.
© The Canadian Journal of Gastroenterology - Volume 10 Number 2 - March/April 1996
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