Foreword by Ronald L. Hoffman, M.D.
Upon discovering Food and the Gut Reaction, the first edition of Breaking the Vicious Cycle: Intestinal Health Through Diet, I realized that it contained a useful solution for the dietary treatment of many gastrointestinal disorders. By introducing the approach of the “Specific Carbohydrate Diet™,” it enables patients to thrive on a varied diet that very often reduces symptoms and allows healing of an inflamed intestinal tract. Simply presented, yet sophisticated in its conception, the “Specific Carbohydrate Diet™” transcends several oversimplifications to which patients with gastrointestinal problems and their physicians often fall prey.
Four years ago my book, Seven Weeks to a Settled Stomach (Simon and Schuster), was published. Since that time, I have earned a reputation as a trouble-shooter for gastrointestinal problems. Patients from many parts of the country have consulted me. Many complain of symptoms consistent with irritable bowel syndrome. Others have been diagnosed formally with classic inflammatory bowel disease. And though some patients have responded well to the usual arsenal of natural digestive aids, intestinal flora replacement, elimination diets, conventional antifungal drugs and antibiotics, still others found no relief.
Food and the Gut Reaction, the first edition of this book, was introduced to me by a colleague and friend, Dr. Leo Galland. He mentioned the book after one of his patients brought the book to his attention. I immediately recognized Elaine Gottschall’s book as a potential godsend to my patients. Its value lay in providing a palatable but potent alternative to those dietary approaches commonly in use for management of gastrointestinal problems: the high-fiber diet; the low-fat diet; the low-residue diet; the anti-yeast diet; the gluten-free diet; and other elimination diets.
Based on my experience with patients, I already had reason to question the complex carbohydrate plan as the most healthy eating program, especially for patients with gastrointestinal complaints. Many gastroenterologists, like most North American physicians, propound this “low-cholesterol” diet plan. Fat, it is reasoned, is the bane not only of arteries but also of the intestinal tract: in combination with excess animal protein, so it is said, fat sets the stage for a host of Western ills from diverticulosis to appendicitis and colon cancer.
Unquestionably, some patients are excellent fiber-responders, but others do poorly with common sources of roughage. The radical alternative, a meat and salad diet that eliminates all sugars and starches, is unpalatable and unenforceable for all but the most dedicated patients. In fact, this strict vegetable and protein diet, sometimes referred to as the “caveman diet,” is dangerous for marginally-nourished, underweight patients with Crohn’s disease or ulcerative colitis.
One oversimplification Elaine Gottschall’s book avoids is the notion that food allergy is the source of many gastrointestinal complaints. Since dietary manipulation can produce results, it is, perhaps, natural to assume this. But over-reliance on the ambiguous results of allergy testing leaves many patients incompletely treated. The more sophisticated belief that it is not individual foods themselves but the byproducts of ingestion of certain foods that cause intestinal problems is fast replacing the concept of food allergy.
This theory was first set forth by Dr. J. O. Hunter in a landmark Lancet article underscores the frequency of intolerances to corn, wheat, milk, potatoes, and rye. This may be the reason why patients who derive inconsistent benefits from the gluten-free and lactose-free diets respond so completely to the regimen set forth in Elaine Gottschall’s book. This diet addresses carbohydrate intolerance more broadly than other approaches. The second edition of Food and the Gut Reaction, Breaking the Vicious Cycle: Intestinal Health Through Diet, should be among the vital resources of every gastroenterologist.
Other corrective strategies amount to a preoccupation with eradicating intestinal pathogens. Those who take this approach believe in the “find a bug, use a drug” philosophy. Elaine Gottschall substitutes the more holistic goal of reestablishing the healthy balance of intestinal flora.
As I began placing patients on the “Specific Carbohydrate Diet™,” using Food and the Gut Reaction as a comprehensive guide, I became impressed with the results. Many patients with Crohn’s disease, ulcerative colitis, irritable bowel syndrome and even refractory constipation, found relief although their progress had been stymied previously with elaborate but unsuccessful elimination schemes. The clinical value of the “Specific Carbohydrate Diet™” was unquestionable, but, interestingly, I began to notice other unanticipated benefits. Patients with muscle aches, stiff joints and, even full-blown arthritis, registered a distinct diminution of symptoms. Headaches, chronic skin rashes, psoriasis, generalized fatigue and “spaciness” were alleviated. Elaine Gottschall’s diet had probably reduced intestinal toxicity.
Unfortunately, the chances of wider acceptance of dietary approaches like this one are small. While many of my innovative, nutritionally-oriented colleagues have availed themselves of Food and the Gut Reaction and introduced patients to this approach, most gastroenterologists are, sadly, not even curious. They scarcely acknowledge the role diet can play. For example, a recent Lancet article demonstrating the efficacy of the exclusion diet in the treatment of Crohn’s disease has not prompted a single gastroenterologist in my large metropolitan community to administer a facsimile of the successful diet to patients - even when their diseases do not respond to the most skillfully administered drug treatment.
Fortunately, increasing numbers of patients are recognizing the need to break away from total dependency on drugs and symptom-oriented medical care. Many have endured years of suffering, coupled with economic and mental stress, and they are willing to try a wholesome diet, grounded in medical research, which makes sense. The reception given to Food and the Gut Reaction (the first edition of this book) by patients has the makings of a true grassroots uprising. Patients, en masse, are willing to try the diet and many are finding that it works.
Elaine Gottschall is a tireless crusader on behalf of her natural approach to digestive problems. She selflessly gives of her time, love, compassion, attention, and concern to patients and clinicians alike. She has become an energetic cheerleader for many of my patients and has provided invaluable direction when progress has faltered. Her reward is surely the secure knowledge that she has made a difference in the lives of thousands of patients with gastrointestinal disorders.
Ronald L. Hoffman, M.D.
This popular book, written by a biochemist and cell biologist, got its start when Gottschall's daughter was diagnosed with Crohn's Disease at a young age. She developed the "Specific Carbohydrate Diet," a strict grain-free, lactose-free, and sucrose-free regimen, as an alternative to medication and surgery. The diet is intended to starve anaerobic bacteria in the intestinal tract, similar to the use of antibiotics for Crohn's. No clinical trials have been conducted on its effectiveness for IBD as far as I know, but if you are looking for alternative approaches you might try this dietary approach.
- Mikhail Duntz