SCD Survey Form

This is a survey for everybody on the Internet who has tried or still follows the Specific Carbohydrate Diet as described in the book "Breaking the Vicious Cycle - Intestinal Health Through Diet" by Elaine Gottschall.

Your answers should be sent to: oddb@stovner.vgs.no - or you can simply fill out the form on this page, and press the "Submit it!""-buttom.

Your answers will be stored in an Access database and eventually, the results will be published on the mailing list for IBD-sufferers on the net.

The intention is not to scientifically determin whether or not the Specific Carbohydrate Diet works, but simply to get some statistics that will indicate in which way and to what extend the diet is useful to people.

1. Which illness(es) do you suffer from?



2. If you have Crohn's Disease, in which part of your bowel is it?



3. Year of birth and gender (male/female?):



4. State the year when your intestinal disease(s) started:



5. What date / year did you first start the Specific Carbohydrate Diet (SCD)?



6. What was the date / year if you have stopped being on the SCD?



7. After being on the diet for one month was your situation:

- worse
- the same
- better

8. How did you start the diet?

- with fanatical 100% adherance
- by gradually introducing one allowable food at a time
- by following the limited "introductory diet" as recommended in the book

9. How many surgeries did you have before starting the SCD, and what kind?



10. How many surgeries did you have after entering SCD and what kind?



11. Have you reduced or eliminated any types of medicine during the SCD?



12. Have your symptoms during SCD changed? Is it...

- much worse
- slightly worse
- the same
- slightly better
- much better

13. Write down items that tests have shown that you are allergic or intolerant to:



14. Have you done anything else that has improved your health during the SCD (like killing off bacteria, amoebas and/or yeasts, homeopathy, accupuncture etc.)

15. Estimate how symptom-free you are at this time:



16. Write down symptoms that has really improved during the SCD:



17. Write down symptoms that has not improved or gotten worse during SCD:



18. How many serious flare-ups have you had during the SCD?



19. If you stopped being on the SCD: what was the reason?



20. If you stopped being on the SCD: what was you health status when you stopped the diet?



21. What is your health status right now?





22. The following is optional, you can leave the fields empty if you wish.
Please keep in mind that we can only offer to keep you informed about the outcome of this survey if we have your (correct) email-address:

E-mail address:


Name:

Real-mail address:


Zip code & city:

Country:
 
Telephone:




23. When you are ready, press the button:



 

If you regret and wish to start all over again, press here:





 

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