The Specific Carbohydrate Diet for Crohn’s

It’s worth noting: While some people with Crohn’s disease report symptom improvement, the diet is highly restrictive, and experts emphasize that it should only be followed with guidance from your IBD team, including a gastroenterologist and a registered dietitian experienced in Crohn’s disease management.

As bacteria ferment these carbohydrates, you may encounter symptoms like gas, intestinal irritation, and changes in the gut microbiome, says Danielle Gaffen, RDN, a San Diego–based registered dietitian-nutritionist and the founder of Eat Well Crohn’s Colitis, which provides personalized nutrition counseling for people living with IBD and other digestive conditions.

“The goal (of the SCD) is to reduce the amount of undigested carbohydrates reaching the colon and create an intestinal environment that may be less supportive of harmful bacterial overgrowth,” she explains.

“The underlying hypothesis is that complex carbohydrates fuel ‘bad’ bacteria in the gut, and avoiding them aids ‘good’ bacterial survival,” says Elena Ivanina, DO, a gastroenterologist in New York City and the founder of the Center for Integrative Gut Health.

Gaffen says, “The mechanisms likely involve multiple factors, including the microbiome, food additives, and overall dietary patterns.”

Allowed Foods

• Fresh fruits
• Most nonstarchy vegetables
• Meat, poultry, fish, shellfish, and eggs
• Additive-free and sugar-free coffee, tea, and fruit juice
• Cheeses like sharp cheddar, Colby, Swiss, and dry curd cottage cheese
• Certain legumes including navy beans, lentils, and split peas
• Nuts and nut flours (such as almond flour)
• Honey (as the primary sweetener)
• Homemade yogurt fermented for 24 hours

Restricted Foods

The SCD excludes complex carbohydrates, all refined and processed foods, like processed meats and packaged sweets, and starchy vegetables like potatoes.

• Grains such as wheat, rice, corn, barley, and oats
• Grain-based products like bread, cereal, and pasta
• Starchy vegetables like potatoes and sweet potatoes
• Processed foods and refined sugars like candy, chocolates, and other products made with sugar, additives, and high-fructose corn syrup
• Certain legumes including soybeans, chickpeas, and bean sprouts
• Powdered spices, which may include starch to prevent caking
• Sugars including molasses, corn syrup, maple syrup, fructose, sucrose, and other processed sugars.
• Sugar substitutes including sucralose and sugar alcohols

While interest in the SCD has grown, there isn’t a lot of scientific evidence about its usefulness in IBD.

In that study, 43.5 percent of patients following the Mediterranean diet achieved remission, compared with 46.5 percent of patients who followed the SCD at the six-week mark.

The study was small though — just 10 participants completed it. The authors noted that larger trials are needed to confirm the results.

The research so far has hinted that the whole foods element is key, Gaffen says. “[The SCD] may not necessarily be more effective than other healthy, whole-foods-based diets.”

While the SCD may sound straightforward in theory, it’s an eating plan that can be difficult to maintain in practice.

The Strictness Factor One of the biggest challenges is how limiting the diet can be. “It is quite restrictive and requires eliminating many common foods … it also relies heavily on cooking from scratch using whole foods, so it often requires a significant amount of meal planning, grocery shopping, and food preparation,” Gaffen says.

It can be even more challenging for patients who already feel restricted because of multiple food intolerances, Dr. Ivanina says.

Some proponents believe that even small deviations from the diet could disrupt the intended effects on the gut microbiome. But Ivanina notes that there is no direct clinical evidence showing that occasionally veering off track resets the bacterial cycle.

The Social Aspect and Lifestyle Challenges The diet can also be difficult to maintain in everyday social settings.

It will require advance planning to eat at restaurants, travel, and attend family gatherings, because many foods served in these situations, including breads, sauces, and processed ingredients, are not allowed on the SCD.

“Some people feel pressure to follow the diet very precisely,” which can add stress when they’re eating meals outside of the home, Gaffen says.

Nutritional Risks Because the diet removes several food groups, meeting daily nutritional needs can become more complicated.

• Vitamin D
• Calcium
• B vitamins
• Vitamin E

“Some people may experience unintended weight loss if the diet is not carefully planned,” Gaffen says.

Working with a registered dietitian specializing in IBD can help address these challenges by providing strategies for meal planning, dining out, and maintaining adequate nutrition.

“For example, it would not be recommended for fistulizing Crohn’s disease or for patients who have recently been hospitalized,” she says.

Candidates for the SCD should not have a history of disordered eating or nutritional deficiencies either, Gaffen says. “It tends to work best for people who have the time, resources, and access to fresh foods, and who are willing to do some meal planning and preparation,” she says.

If you’re considering trying the specific carbohydrate diet, experts recommend approaching it with guidance and preparation rather than jumping in on your own.

Work with your IBD team. Before starting the diet, talk with your Crohn’s disease care team.

“I recommend meeting with a multidisciplinary team, including your gastroenterologist and a nutritionist, to ensure this is the appropriate next step in your healing journey,” Ivanina says.

Your team can help you figure out appropriate nutrition and energy intake, and help you navigate meal planning, dining out, and maintaining a sustainable approach to the diet, Gaffen says.

Establish baseline health assessments. Ivanina also recommends getting baseline measurements before beginning the diet so your doctor can track how your body responds.

She says these may include:

• Inflammatory markers such as C-reactive protein (CRP) and fecal calprotectin
• Nutritional labs to identify vitamin D, calcium, B12, and iron levels
• Weight and body mass index (BMI)

Tracking these markers can help determine whether the diet is improving inflammation and identify deficiencies early, she says.

Do your research and plan ahead. Gaffen says many patients benefit from preparation — learning which foods are allowed and building a small rotation of simple meals before starting the diet.

Have fun with it, Ivanina says. “Find interesting meals, new recipes, and fun swaps to previous food choices.” Use almond flour instead of grain flour for baking bread, muffins, and pizza crusts, or make breakfast with almond flour pancakes with blueberries and a honey drizzle, she suggests.

Ivanina also recommends scheduling a check-in around six weeks after starting the diet so your healthcare team can review your symptoms and overall progress.

• The specific carbohydrate diet for Crohn’s disease eliminates complex carbohydrates with the aim of reducing bacterial overgrowth in the gut and easing digestive symptoms like gas, bloating, and intestinal irritation.
• The diet focuses on whole, unprocessed foods such as fruits, vegetables, meats, nuts, and honey, while restricting grains, starchy vegetables like potatoes, all processed foods, and most refined sugars.
• Because the SCD removes multiple food groups and can be challenging to maintain, experts recommend trying it only under the guidance of a gastroenterologist and a registered dietitian experienced in inflammatory bowel disease.
• If you’re interested in the SCD, start by discussing it with your IBD care team and establishing baseline health markers so your doctors can monitor whether the diet is helping your symptoms and whether you’re getting enough nutrients.