SCD and ulcerative colitis: Benefits, risks, and more

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The specific carbohydrate diet (SCD) is a popular restrictive diet that eliminates certain carbohydrates and focuses on whole, unprocessed foods. It aims to restore balance in the gut microbiome that ulcerative colitis alters or destroys.

Gastroenterologist Dr. Sidney Haas initially developed SCD to treat celiac disease. The diet also gained popularity when biochemist Elaine Gottschall published Breaking The Vicious Cycle: Intestinal Health Through Diet in 1994.

People with inflammatory bowel disease (IBD), including Crohn’s disease, diverticulitis, and cystic fibrosis, also follow this diet.

The diet requires strict adherence and restricts a person from eating “illegal” foods that may trigger inflammation in the gut. It promotes eating “legal” foods that may help ease or improve symptoms.

This article discusses the SCD diet for people with ulcerative colitis, how it works, how it helps, and its potential challenges and risks.

The incidence of IBD has significantly increased worldwide. Ulcerative colitis is the most common type of IBD, with 9–20 people in every 100,000 developing it every year.

Crohn’s disease is another type of IBD. In adults, the rates of ulcerative colitis and Crohn’s are similar. However, twice as many children develop Crohn’s than ulcerative colitis.

Ulcerative colitis is due to environmental triggers and genetics leading to abnormal immune responses in the gut, causing persistent colon inflammation. It also leads to symptoms such as:

At present, there is no cure for IBD. However, diet is an environmental trigger that plays a significant role in its development by altering the gut microbiome. There are certain foods that doctors may recommend that people with ulcerative colitis eat and avoid.

Specialized diets that restrict certain types of food are becoming increasingly popular among people with this condition.

Read more about ulcerative colitis here.

SCD is a strict elimination diet that promotes unprocessed and nutrient-rich foods. It restricts the types of carbohydrates a person eats based on how easy they are to digest.

It allows simple carbohydrates because they are easy to absorb and do not need digestive enzymes to break down.

Meanwhile, it restricts complex carbohydrates because they are harder to digest. Avoiding complex carbohydrates can help prevent:

Read more about simple vs. complex carbohydrates.

When to start?

A person who wants to initiate the SCD diet may start at any time but may wish to consult a gastroenterologist or IBD nurse to confirm disease activity or inflammation. A person can also work with a dietitian to ensure adequate nutrition.

How does the diet work?

Breaking the Vicious Cycle states that a person can begin step 1: the introductory period where they can only eat certain very simple foods. This period typically lasts 1–2 days.

This stage is crucial to clear harmful microbes by “starving them” and feeding the body with easy-to-digest, nutritious foods.

It is important to maintain close contact with a healthcare professional at the start of the diet. A doctor will check a person’s weight to assess if they have gained or lost any weight and perform a complete blood count.

Anti-inflammatory foods may include:

Legal and illegal foods

After a few days on Step 1, a person can move on to the regular SCD diet, gradually adding solid foods. They should try to introduce only one new food at a time.

Recommendations include leaving a 2-day interval between introducing each new food to determine how a person tolerates them. Keeping a food journal can also help people track their foods and note how they affect their symptoms. This helps a person identify what to eliminate.

Certain resources provide steps that can help guide a person in food introduction. These steps are not part of the official diet but can be helpful.

Legal foods include:

  • all fresh and unprocessed fruits (peeled and cooked at first)
  • most non-starchy organic vegetables (peeled and cooked at first)
  • fresh juices and specific juices for UC
  • most fresh, unprocessed meats, poultry, and fish, as long as unbreaded
  • certain legumes, such as black beans, lentils, and regular peas, cooked per SCD rules
  • most dried beans and seeds
  • hard cheeses, such as cheddar cheese, and aged cheeses
  • plant-based milk
  • eggs
  • homemade yogurt fermented for at least 24 hours
  • nuts and nut butter
  • most fresh and dried herbs and spices
  • honey
  • fermented foods, such as kimchi
  • most teas and coffees allowed

Illegal foods include:

  • canned fruit
  • fruit juices made from additives or concentrate
  • starchy vegetables, such as sweet potato and potatoes
  • processed meats or fish
  • soft cheeses, milk, and cream
  • all grains, including corn and certain seeds, such as chia, hemp, and flaxseeds
  • canned beans
  • all sugar and most artificial sweeteners
  • condoms

Once individuals start gaining weight and doctors begin to see clinical improvements, they can decrease their follow-up appointments to every 2–4 weeks.

food reintroduction

The third step of the diet allows the reintroduction of illegal foods. However, some illegal foods might trigger a flare.

This step has no set time frame. Some people may reintroduce illegal foods after 3 months on the diet, whereas other individuals may wait at least a year.

At this phase, doctors will closely monitor the person’s symptoms and perform any checks where necessary.

Modifications during flares

During a flare, a person may have to return to the initial steps in the SCD diet, which focuses on foods that are easy to digest and do not aggravate inflammation.

Research since 2021 shows that genetics plays a role in IBD development. IBD causes intestinal inflammation, which disrupts the interaction of diet with the gut microbiota. This gut microbiota imbalance, or dysbiosis, may affect how the body absorbs dietary nutrients.

The theory behind SCD is that making dietary changes can improve the altered gut microbiome. The SCD not only aims to eliminate the factors that lead to gut dysbiosis but also to restore the microbiome in people with ulcerative colitis.

Read more about the gut microbiome here.

In a 2016 study evaluating people’s perception of IBD, 33% reported remission within two months after starting the diet, while 42% reported remission within 6–12 months.

Benefits of SCD

Commonly reported benefits of SCDs include:

  • total remission of symptoms
  • changes in the gut microbiome
  • possibility of discontinuing medications for ulcerative colitis

A 2018 case study reported substantial changes in the fecal microbiome in a person with ulcerative colitis in the 2 weeks after they started SCD. The person was able to see changes as early as a week after starting the diet.

However, this same result may not apply to a larger population.

Most support for the diet comes from anecdotal reports and small case studies. More extensive controlled studies are needed to determine its effect, safety, and effectiveness for all people with ulcerative colitis.

People with IBD are at risk of nutritional deficiency, making it harder for them to gain weight.

Being on restrictive diets, such as SCD, puts a person at risk of not getting enough nutrients, including:

Due to the strict adherence required, many people may find it challenging. It can be time-consuming and require a lot of preparation. However, with long-term support from dietitians and family and friends, a person can adapt to their new diet and way of life.

Due to the restrictive nature of SCD, it makes the risk of developing orthorexia nervosa almost unavoidable. People with this condition have an obsessive focus on:

  • food choice
  • meal planning
  • buy
  • preparation
  • consumption of food with the belief that this can control or reverse disease

A gastroenterologist and person should monitor the overall effect and impact on quality of life. This will help to determine if the SCD is helping and worth continuing.

However, this diet may not be helpful for certain individuals with IBD, especially people with Crohn’s disease who have small bowel strictures. The high fiber content of this diet may cause bowel obstruction in these people.

Read more about Crohn’s disease and strictures.

The best way to prevent a nutritional deficiency that may come with restrictive diets such as SCD is to ensure adequate nutrition from food substitutes and vitamin supplements allowed in the diet. People can buy supplements on-line.

It may also help a person plan their diet or meals with a dietitian to ensure they include all the essential vitamins and nutrients they need. This support may also reduce any anxiety or concerns about what to cook and how.

Doctors may also prescribe people with IBD medications to control their symptoms in case of flares. Regular blood tests can also help monitor inflammation and deficiencies.

Learn more about managing ulcerative colitis from our IBD hub.

A week-long SCD diet plan may look like this:

  • Day 1: banana pancakes, oven-baked chicken nuggets, and chicken and coconut milk curry
  • Day 2: bacon and cheese bake, rosemary lemon chicken, and chicken cabbage stir fry
  • Day 3: homemade yogurt, salmon with tomato basil relish, and roasted duck breast
  • Day 4: eggs and avocado salad, beef meatballs and broccoli, and chicken and cauliflower rice casserole
  • Day 5: grain-free breakfast pumpkin oatmeal, chicken stew, and chicken parmesan
  • Day 6: banana bread or muffins, chicken wings, and salmon burger
  • Day 7: pumpkin spice cookies, beef stew, and sundried tomato and basil chicken

Alongside breaking the vicious cycle, other recipe books include Recipes for the Specific Carbohydrate Diet.

People can also get ideas from websites offering healthy recipes and diet plans, such as Food Network and Cooking Light. However, they should check the ingredients to ensure that they are legal. People may be able to switch out certain ingredients when they feel comfortable following SCD.

Find more about ulcerative colitis diet recipes here.

Other IBD diets that can benefit a person with ulcerative colitis include:

A person should consult a dietitian or IBD nurse before starting any diet or switching between diets.

At present, there is no cure for ulcerative colitis. However, medication and following diets, such as SCD, can help a person manage symptoms.

Research on the benefits and effectiveness of SCD for UC is still in its early stages.

However, anecdotal reports and case studies indicate that staying on an SCD can help people with ulcerative colitis control their symptoms. Some people achieve remission.

Depending on a person’s genetics, it may help change the gut microbiome and help reverse the damage. More tightly controlled human studies are needed.

SCD is a strict elimination diet that aims to help people with ulcerative colitis and other conditions.

It allows people to eat simple carbohydrates. The diet restricts certain complex carbohydrates, and a person may add others as they move into the later phases of the diet.

A person interested in exploring SCD should first talk with their doctor and dietitian to help them prepare for the transition.

People following SCD may be at risk of nutritional deficiency, weight loss, and development of orthorexia nervosa.

It is vital that people following SCD attend checkups with healthcare professionals to monitor their nutritional intake to avoid risks and challenges that the diet may entail.

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