CHAPTER 6

The Specific Carbohydrate Diet (SCD) and Gut and Psychology Syndrome Diet (GAPS)

“Maintaining his special diet is very difficult, but not nearly as hard as living with a severely autistic child.”

—Mother of a recovering autistic son

“MY SON HAD BEEN ON THE SPECIFIC CARBOHYDRATE DIET (SCD) for about a year, which means he couldn’t (and still can’t) have any starch, sucrose or lactose. After exploring the Air and Space Museum, we went into the food court and I unpacked the turkey burgers and almond cookies I’d made and brought along. Unfortunately, eating with hundreds of other people who didn’t bring their own picnic means my son had to watch while all the other kids ate one of his favorite forbidden foods: French fries. Instead of going through the whole explanation of why he couldn’t have them, when he asked, I let him have some. In my defense, after a year on the SCD, you’re allowed to start slowly adding previously restricted foods back in to see how they’re tolerated. But impulsively giving him both potatoes and probably gluten (I doubt they fry battered food in separate oil from the oil in which they fry French fries in the food court) at the same time didn’t make sense. After thinking it through, I realized the reason for my lapse: I was mad that my son was deprived of something that most kids can eat. And as a parent, I felt deprived of having a kid who could not have something that most kids get to have. Apparently, this is normal.”

—KATHRYN SCOTT, in “Flirting with Disaster,” published in Living Without, Spring 2006

The Specific Carbohydrate Diet (SCD)

As previously discussed, many children with ADHD and autism have damage in their intestinal tracts. When the cells that produce digestive enzymes are damaged, fewer enzymes will be available for digestion. This occurs in the small intestine, where over 90% of digestion and absorption occurs. We have discussed the digestive problems resulting from gluten and milk products, but they are not the only potential culprits.

The SCD diet was developed by Sydney Haas and is described in the book by nutritional biochemist Elaine Gotschall, Breaking the Vicious Cycle—Intestinal Health Through Diet. It distinguishes between the two basic kinds of carbohydrates:

Simple, monosaccharide sugars, including fructose, glucose, and galactose

Double-sugar disaccharides, including lactose, sucrose, maltose, and isomaltose

Most people are familiar with lactose intolerance due to poor or no production of the enzyme lactase, which digests lactose sugar found in milk. When other disaccharide-digesting enzymes are missing, the symptoms and damage become more severe.

SCD is based on the principle that simple carbohydrates (monosaccharides) require minimal digestion, are well absorbed, and leave no undigested residues. The complex double-sugar carbohydrates (disaccharides) are hard to digest, especially for those who have damaged intestines and inadequate digestive enzymes. The residues of the undigested double sugars become food for intestinal “bad bugs” and yeast, resulting in a “cesspool” within the gut. This leads to digestive distress, including gas, bloating, cramps, abnormal stools, constipation, and diarrhea. The result is poor absorption of nutrients. Disaccharide intolerance is common in many bowel conditions, including Crohn’s disease, colitis, inflammatory bowel conditions, and irritable bowel syndrome.

“My children, Daniel and Ruth, are on the Specific Carbohydrate Diet and a casein-free diet. Daniel, who is eleven years old, has this to say about it: ‘I think the diet has helped me with gut problems. My gut used to feel tight and now it doesn’t.’ Ruth, who is eight years old, says, ‘I don’t usually get stomachaches anymore, and I now like cauliflower and broccoli. I didn’t used to eat them. I also like eating peas more than ever. The diet helped me read better, too.’”

—Mother of Daniel and Ruth,

both of whom are on SCD and casein-free diets

Avoiding the disaccharide carbohydrates causes the bad bugs and their harmful byproducts to starve and decrease while the good bugs thrive and increase. The intestinal lining heals, digestion and nutrient absorption improve, and overall health benefits.

WHAT FOODS ARE ALLOWED AND PROHIBITED ON SCD?

The only carbohydrates allowed on the SCD are the simple sugars. Acceptable foods include honey, most vegetables, most fruits, and noncarbohydrates such as fats, oils, meats, eggs, fish, poultry, some hard cheeses, some legumes, and well-fermented yogurt. The foods to avoid include sugars; canned vegetables and fruits; all grains; breads; pastas and other starchy foods; processed, canned meats; and milk and most milk products, especially those with lactose. See the chart on the pages that follow for a more thorough listing.

There are a number of foods that are allowed on a gluten-free casein-free diet but are prohibited on SCD. These include:

Grains: corn, rice, tapioca, and pseudo grains (amaranth, buckwheat, and quinoa)

Starchy vegetables and some beans

Double sugars (disaccharides): lactose, sucrose, maltose, and isomaltose

Lactose-free cheeses and well-fermented yogurt are not allowed on a casein-free diet but are allowed on SCD.

In addition to the diet, specific carbohydrate-digesting enzymes are prescribed in order to reduce the symptoms from minor infractions. The enzymes, however, cannot make up for not following the diet.

WHEN TO SPECIFICALLY CONSIDER THE SPECIFIC CARBOHYDRATE DIET

SCD, at least initially, is a very restrictive diet, especially if done along with gluten- and casein- elimination. This can be particularly challenging in children, who are often naturally picky about what they will eat. We suggest that SCD be considered as an additional treatment option for the following conditions or situations:

Chronic GI symptoms such as gas, bloating, or diarrhea that have not improved with gluten, casein, or lactose elimination and provision of probiotics

Intestinal yeast overgrowth that has not improved with more foundational treatments such as probiotics and anti-fungal medications, herbs, or supplements

Documented inflammatory bowel disease such as Crohn’s disease or ulcerative colitis, or small intestinal bacterial overgrowth (SIBO)

Children with autism whose behavioral and developmental symptoms have not improved in spite of pursuing other treatments such as special education and therapy supports, gluten- and casein-elimination, and biomedical treatments such as nutritional supplements

Gut and Psychology Syndrome Diet (GAPS)

The GAPS diet is a modification and expansion of the Specific Carbohydrate Diet and was developed by Dr. Natasha Campbell-McBride. According to Dr. Campbell-McBride’s website, the GAPS program is divided into three protocols: the Nutritional Protocol, the Supplementation Protocol, and the Detoxification Protocol.

THE NUTRITIONAL PROTOCOL involves removal of the same foods as detailed for SCD. It also removes milk products/casein. In addition, it emphasizes the importance of the use of homemade broths and fermented vegetables. The protocols are complicated, and it is recommended that the reader refer to Dr. McBride’s book, Gut and Psychology Syndrome, and her website, www.gapsdiet.com. For those individuals with severe GI issues (such as severe diarrhea or constipation, or inflammatory bowel disease), she recommends an “Introduction Diet” that is implemented in six stages, starting with homemade meat or fish broths and soups. She also recommends probiotic foods such as kefir (if dairy is tolerated) or homemade sauerkraut. The second stage adds raw organic egg yolks as well as stews and casseroles made with meat and vegetables. Fermented fish and homemade ghee can also be added. The third stage adds avocado, scrambled eggs, and “pancakes” (made from nut butter, eggs, and squash). Stage four incorporates additional meats, but only roasted or grilled; introduces cold-pressed olive oil and freshly pressed juices; and adds homemade bread made with nut flours. In stage five, cooked apple as a purée and raw vegetables are added. Stage six introduces peeled raw apple and other raw fruits as well as cakes and other sweets that are permitted on the diet.

There is also a “Full GAPS diet” option, which is recommended after the Introduction Diet has been completed and the individual is having normal stools. The majority of the diet consists of fresh meats, animal fats, fish, shellfish, organic farm-fresh eggs, fermented foods, and vegetables. Baked goods made from nut flours and foods are eaten in moderation during the healing process. Dr. McBride’s book and website give more information about the composition, balance, and timing of foods and meals.

THE SUPPLEMENTATION PROTOCOL includes probiotics, essential fatty acids, cod-liver oil/vitamin A, digestive enzymes, vitamins, and minerals. General guidelines are provided, but please consult a qualified health professional for optimal treatment and individualized recommendations.

THE DETOXIFICATION PROTOCOL focuses on supporting the body’s natural detoxification processes. It also discusses reducing the total toxic load on the body by restricting exposure to chemicals and toxins.

For those children who have severe GI issues and who need the Introduction Diet, we recommend consulting a nutritionist or functional medicine practitioner with familiarity with this diet to ensure that adequate nutrition can be maintained and that this can be done safely. For children who do not have severe GI issues, the introduction diet does not need to be done and the full GAPS diet may be implemented instead.

“My son, Robb, is on a gluten-free casein-free diet as well as the Specific Carbohydrate Diet. Although I saw nice improvements after several months on the GFCF diet, there was a remarkable change for him THE NEXT DAY after he started the SCD diet. He practically bounced out of bed and ran into our room—MUCH more energy.”

—Mother of Robb

a six-year-old with autism and Down syndrome

THE SPECIFIC CARBOHYDRATE DIET

DOUBLE SUGAR	SOURCES	BREAKS DOWN TO	MISSING ENZYMES = DISACCHARIDASES
Lactose	Milk products	Glucose and galactose	Lactase
Sucrose	Sugars	Glucose and fructose	Sucrase
Maltose	Starch	Glucose and glucose	Maltase
Isomaltose	Starch	Glucose and glucose	Isomaltase

CATEGORY	AVOID	INCLUDE
Protein Animal	Preserved meats	Poultry, meat, seafood
	Processed meats (deli meats, hot dogs)	Gelatin: unflavored
	Canned meats & seafood	Eggs
	Flavored gelatin	Yogurt: well-fermented, homemade
	Milk products (most)	Dry curd cottage cheese
		Hard cheeses
Protein Plant	Bean sprouts, pinto, cannellini	Lima beans
	Chickpeas, fava, soy, mung	Almonds, Brazil, chestnuts, coconut, filberts/hazelnuts, pecans, pistachios, walnuts
	Processed nuts	Nut butters (w/o sugar added)
	Flours from beans, seeds	Nut flours
Vegetables	Canned vegetables (unless organic w/o added sugar)	Artichokes (French), asparagus, beets, broccoli, Brussels sprouts, cabbage, carrots, cauliflower
Fresh or frozen	Artichoke (Jerusalem)	Celery, cucumbers, eggplant, garlic
May need to cook or steam	Butter beans	Kale, lettuce, mushrooms, olives, onions, parsley, peas, peppers
	Garlic and onion powder	Pumpkin, rhubarb, snowpeas, spinach, squash, string beans
	Potato, sweet potato, yams	Tomato, watercress, zucchini
	Parsnips and turnips
	Water chestnuts
Fruits	Canned in syrup	May use fruit sauces (apple or pear) or steamed, baked fruits.
	Dried fruits!	Apples, apple cider, applesauce w/o sugar
	Plantains	Avocado, apricot, banana, berries, cherries, dates, coconut flesh, grapes, kiwi, lemons, limes, mangoes, melons, nectarines, oranges, papayas, peaches, pears, prunes, raisins, tangerines
Grains	All grains to be avoided	Nut flours Spaghetti squash
Sugar	All artificial sweeteners	Some honey
	Candy, carob, chocolate
	Corn syrup, HFCS, dates
	Maple syrup, molasses, Sucanat
	Sugar alcohols, sucralose
Other	Gums: guar, xanthan	Cellulose
	Fried foods	Homemade mayo
	Mayonnaise, margarine	Oils: avocado, canola, coconut, olive, safflower
	Oils: corn, soy	Ketchup (homemade)
	Commercial ketchup	Balsamic (homemade) vinegar
	Soy sauce, Tamari	Olives
	Corn starch, tapioca starch
	Balsamic vinegar (commercial)
Beverages	Sodas, fruit punch	Water, coffee, herb teas
	V8 juice, V8 fusion	Tea, coffee
	Frozen fruit juice, apple juice	Dilute pure juice (1/3 juice)
	Soy milk	Nut milks
	Alcohol (most)	Splash of 100% juice to flavor items, apple cider

What Else May Be Helpful?

Supplements must all be “SCD legal.” SCD legal multiple vitamin mineral supplements are available. Probiotics and biotin are critical for improving the gut microbiota. Many benefit from the use of disaccharidase enzymes to improve digestion. Also commonly included are omega-3 fatty acids, methyl B12, and anti-fungal herbs.

SCD (SPECIFIC CARBOHYDRATE DIET) AND GAPS (GUT AND PSYCHOLOGY SYNDROME)

Chapter 6

Avoid: SCD: All disaccharides (lactose, sucrose, maltose, and isomaltose) found in sugars; grains, pseudo grains (buckwheat, millet, and quinoa); some beans, dried fruit, starchy vegetables, and some milk products GAPS: Expansion of SCD: additional removal of milk products and casein. Why Are the Diets Needed? SCD: Deficiencies of disaccharidase enzymes that digest double sugars (lactase, sucrase, maltase, isomaltose); leaky gut; digestive and intestinal conditions; and bacterial overgrowth. GAPS: Persistence of inflammatory bowel disease (IBD); irritable bowel syndrome (IBS); and digestive problems Symptoms the Diets May Help: SCD: Persistent belching; gas; cramping; constipation; diarrhea; yeast issues; celiac disease; diverticulitis; inflammatory bowel disease (IBD); SIBO; and other digestive problems GAPS: When the SCD has not been fully effective. GAPS is more strict. Diet Includes: SCD: Protein: healthy seafood; pastured source poultry, meat, and eggs; some hard cheeses; dry curd cottage cheese; lentils; lima beans; nuts; and seeds Vegetables: artichoke (globe); asparagus; beets; carrots; celery; greens; pumpkin; string beans; snow peas; tomato; and watercress Fruits: apple; apricot; avocados; banana; berries; cherries; citrus; dates; grapes; papaya; peaches; pears; prunes; and tropical fruits Individual spices of all kinds. Avoid spice mixtures. GAPS: Add homemade broths and fermented vegetables. Resources: Breaking the Vicious Cycle by Elaine Gottschall: www.breakingtheviciouscycle.info The SCD Diet: www.scdiet.net The GAPS Diet: www.gapsdiet.com The Best Method for Healing with SCD: www.PecanBread.com SIBO (small intestinal bacterial overgrowth): www.siboinfo.com/diet.html Gut and Psychology Syndrome by Natasha Campbell-McBride Cooking to Heal and Nourishing Hope for Autism by Julie Matthews