SCD and Beyond: Using Diet as Medical Treatment

On a sunny April day in Seattle a new milestone in the science of “diet as medicine” was reached, as Seattle Children’s Hospital held its 7th Nutrition Symposium: Nutrition in Immune Balance: Using Diet to Treat Inflammatory Bowel Disease.

The GI team at Seattle Children’s Hospital is researching the efficacy of dietary treatment, and the connection between microbiome balance and IBD. Just as importantly, they are actively developing a comprehensive standardized medical protocol for dietary therapy. This is key to allowing SCD to become a widely acceptable treatment option within the medical community. This symposium provides much needed outreach to other care providers, allowing broader insight within the medical community to the latest developments in this space.

Signs of attention to details and care for the comfort of all attendees were a reflection of this hospital’s commitment to excellence on all fronts, combining cutting edge scientific leadership with the best quality care.

One of the many examples was the food that was provided throughout the day, which included many SCD friendly staples: hard boiled eggs, yellow bananas and fresh salads. A large special SCD table, covered with an amazing collection of SCD treats, courtesy of Liberated Specialty Foods allowed medical professionals to sample the delicious potential of grain-free goods, while the SCD dieters in the audience indulged in this abundance of diet-safe foods!

Below are just a few of the many highlights from the presentations:

The Microbiome in Inflammatory Bowel Disease: An Instigator of Disease

Chris Damman, MD  from the University of Washington delivered a beautifully illustrated, fascinating presentation about the importance of microbiome studies, leading the audience through a methodical description of why and how we currently study the microbiome, as well as its potential in developing new treatments for IBD.

Fecal Microbial Transformation:  Using Diet as Primary or Adjunctive Therapy in IBD

In his first presentation, Dr. David Suskind of Seattle Children’s Hospital and
Professor of pediatrics at the University of Washington School of Medicine, described multiple studies conducted by himself and other leading scientists, proving the impact of diet on microbiome and on disease activity in IBD. He concluded: “We modulate our fecal microbiome (via nutritional and environmental factors) and our microbiome modulates us.”

Dietary Treatment for IBD at Seattle Children’s Hospital:  A Stepwise Process

In his second presentation Dr. Suskind described how Seattle Children’s Hospital developed a methodical system to utilize diet as an optional treatment in managing IBD. The GI team at SCH emphasizes a team approach, harnessing the patient, the family, the doctor, the dietitian, and even the psychologist, in the healing effort. They use standardized tools to assess disease activity and diet efficacy, and to monitor wellness maintenance.

Dr. Suskind concluded, there is still much to learn, but this we already know:

• Dietary intervention works and fills a current treatment void
• Patient selection is important (based on disease type, disease severity and patient commitment)
• Close medical follow-up is essential
• Patient support is mandatory

Nutritional Adequacy of the Specific Carbohydrate Diet:  A Dietary Viewpoint

Kimberly Braly, a clinical dietitian for the GI team at SCH, presented a nutritional analysis of the Specific Carbohydrates Diet in pediatric patients. The team examined nutritional adequacy of the diet and found that dietary intake of most nutrients met or exceeded the guidelines of national and international health organizations. Seattle Children’s is utilizing periodical lab tests to monitor key nutrients such as vitamin D, and provides ongoing nutritional counseling to IBD patients and their families.

A Center Approach to Treating Patients with Inflammatory Bowel Disease

Dr. Ghassan Wahbeh, the director of the Inflammatory Bowel Disease Center at SCH described the multidisciplinary approach that is used at the center to ensure optimal IBD care. These therapy standards include:

• Applying the same standards to ANY therapy
• Reducing use of steroids, antibiotics and acid blockers.
• Identifying treatable genetic IBD phenotype
• Offering nutrition-based steroid-free therapy backed by solid research
• Establishing clear end-points of steroid-free deep remission by 4-6 months
• Educating patients and their families

Psychologic Impact of Inflammatory Bowel Disease:  Insight and Interventions

Carin Cunningham, PhD.  is the team psychologist. She emphasized that the comprehensive care at SCH is based on looking at the patient as a whole person, not just as a GI disorder. Integrating psychological screening into standard clinical practice can help ensure adherence to medical plan and harness self-care to wellness management.

Patient Panel –  Impact of Diet on Life

If you listen to these eloquent kids and teens, it might convince you that the SCD diet doesn’t just keep them healthy, but also somehow enhances their executive skills and allows them to be insightful beyond their age.

Points of consensus that they all shared:

• Starting SCD was difficult, but after a steep learning curve they all adjusted well to living on an extremely restrictive diet.
• In theory, social challenges seem to be overwhelming. In reality, they each found practical ways to take food everywhere they go, and participate in all social functions (including going to restaurants or movies with friends, and sleep-away summer camps).
• They all developed kitchen skills that will serve them well in life.
• They enjoy their healthy delicious SCD foods and treats. Their friends also enjoy these foods – which may turn into a comic situation when the “regular” kids may forego commercial junk food preferring instead to finish the precious and limited SCD supply.

Parent Panel – Parents Supporting the SCD

All the parental panelists agreed:

• The diet requires multiple new adjustments in the household and constant effort in planning special menus, shopping for food, preparing meals, washing dishes, packing food for every activity and mentoring the child for diet independence.
• As difficult as this diet is – parents are grateful when it is working well.
• Ways to make the diet easier to practice include developing a master plan for shopping and cooking similar versatile staples every week, and teaching the kids to help in the kitchen.
• The diet can be difficult but it is worth it.