Talk:Specific carbohydrate diet

Specific Carbohydrate Diet website link removed

82.42.215.121 left a message at Alexbrn's Talk page asking about removal of the link in the EL section. 82', please note that a) there are many things WP is not, including a how-to guide (see WP:NOTHOWTO) and please note that along those lines, we do not give medical guidance here. Also please note that there are guidelines for sourcing health content in WP - please see WP:MEDRS. Jytdog (talk) 15:16, 1 February 2015 (UTC)

A wrong turn

The article took a bad course back in May with this edit (badly sourced & Pov-laden). I have repaired I think, but would appreciate a sanity check from other editors ... Alexbrn (talk) 12:10, 21 July 2015 (UTC)

Slight Edit to Page to Reflect Lack of Any Medical Evidence.

I first heard of the Specific Carbohydrate diet from IBD patients and after a Google search found the Wikipedia article to be the only hit that does not actively promote this unproven treatment. Since IBD has natural prolonged remissions, improvement is expected with any diet (post hoc ergo propter hoc fallacy) and I added this medical fact to the article. I also added basic references to the fact that this book is not consistent with the pathophysiology of IBD. In addition, I cited the relevant studies, listed in the article as "supplemental reading" even though they are are bad studies and would normally not be wikipedia-worthy becaus of 1) sample sizes of <30 patients with little attempt to avoid selection bias 2) Except for the 2014 Suskind study most patients were actually taking evidence-based therapy for IBD which is expected to cause improvement 3)Publication in minor journals. Given that there are no meta-analyses or reviews available and the topic is not reviewed in any other publications, I just wanted to put all the "evidence" out there. Interestingly, the latest study (Obih 2016) is somewhat of a case-control trial, and includes a modicum 4-person control group. In this case, no difference is seen between control and patients on SCD diet. 129.137.26.27 (talk) 00:44, 25 March 2016 (UTC)

You're writing at a secondary level. As an encyclopedia we must be tertiary, based on WP:MEDRS for such content. Alexbrn (talk) 07:12, 25 March 2016 (UTC)

Sorry I am not a regular Wikipedia editor! That kind of information was more appropriate for a review in gastroenterology (sorry I am more familiar with medical literature than Wikipedia). Really the article as it was succinctly summarized the evidence at an encyclopedia level. I was simply trying to do the public a service.129.137.26.71 (talk) 18:54, 25 March 2016 (UTC)

New sources to be evaluated (existing article is overly negative and outdated)

I really like skeptics. You normally do us a service, but I believe that it has gone well past NPOV with this article. I made an attempt to reign it in on the first paragraph, but it was reverted twice, and the revert was finally explained as missing two words ("health risk") in regards to nutritional quality. The referenced statement about nutritional quality and health risk is scientifically unproven and is speculation. Frankly, there is a "health risk" in any diet.

There are a number of new sources which invalidate much of the existing article. Looking at the edit history of the article, I am not confident that any attempt to introduce them will be successful (or that they'll be introduced in a way that minimizes their significance). So I'll document them here. Include them at your own risk, eh?

Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease: "SCD therapy in IBD is associated with clinical and laboratory improvements as well as concomitant changes in the fecal microbiome." That speaks boldly to effectiveness. The article incorrectly claims, "scientific evidence is lacking." The article also referenced an older source which says the diet confers no proven health benefit". "Support for the diet's effectiveness comes only from users' testimonials" can also be reworded as "Support for the diet's effectiveness has been documented in both users' testimonials as well as laboratory testing". Source:

Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease: "The SCD is utilized by many patients as a primary and adjunct therapy for IBD. Most patients perceive clinical benefit to use of the SCD." Describing even that as just "testimonal evidence" is insufficient. Source:

Diet as a Trigger or Therapy for Inflammatory Bowel Diseases: "There is compelling evidence from animal models that emulsifiers in processed foods increase risk for IBD." The article quotes an older source which says "there is no evidence to suggest that any particular food or diet causes, prevents or cures inflammatory bowel disease". Source:

Nutrition in Pediatric Inflammatory Bowel Disease: From Etiology to Treatment. A Systematic Review: "there are pediatric data, mainly from case-control studies, which suggest that some dietary habits (for example consumption of animal protein, fatty foods, high sugar intake) may predispose patients to IBD onset." It further supports the previous source. Source:

Deregulation of intestinal anti-microbial defense by the dietary additive, maltodextrin: "Dietary and environmental factors are implicated in the initiation and perpetuation of IBD; however, a singular causative agent has not been identified." Again, supporting. Source:

Response to strict and liberalized specific carbohydrate diet in pediatric Crohn's disease: "Disease control may be attainable with the SCD in pediatric (Crohn's Disease)." A little bit weaker, but still supporting. Source:

Resolution of Severe Ulcerative Colitis with the Specific Carbohydrate Diet: "Successful use of the SCD in children with UC has been documented. We describe previously unreported, highly beneficial results with both symptomatic and clinical improvement and complete remission of UC in an adult female with the SCD." Again, supporting research, and effectiveness. Source:

IN SUMMARY: The entire article's POV which paints the Specific Carbohydrate Diet as unsupported by scientific evidence and ineffective is completely inaccurate in light of new sources.

Thank you for your attention. Please revise the article based on new sources and also return to NPOV.

70.177.88.88 (talk) 20:36, 22 February 2017 (UTC)

References

Biomedical claims must be sourced to WP:MEDRS. We'd need some of those.Alexbrn (talk) 20:40, 22 February 2017 (UTC)

Point taken. I'm satisfied just to present accurate and truthful information from trusted sources. I realize that none of these may be primary considerations, so I'll let others Wikilawyer each other on how to include or exclude it. Best wishes, all. 70.177.88.88 (talk) 20:51, 22 February 2017 (UTC)

WP:MEDRS effectively means trusted sources; we don't use primary research in junky journals. Alexbrn (talk) 21:04, 22 February 2017 (UTC)

I understand enough of the Wikipedia game to know that I don't want to play it:

1. There is no evidence to support this diet.
2. Here is the evidence! [Provides seven published articles.]
3. Your evidence is inadmissible because it is published in reputable medical journals!
4. " ... "
5. There is no evidence to support this diet. :)

Hey, I'm happy to let someone else wikilawyer from here. Again, just wanted to introduce accurate and truthful information from trusted sources. As mentioned, I realize that none of these may be primary considerations to Wikipedia. Best wishes. Or, in the words of another amateur editor in the conversations above, "I give up." 70.177.88.88 (talk) 21:40, 22 February 2017 (UTC)

WP:MEDRS and recentism

Alexbrn has reverted the summary of the Brown reference, which is a review article in secondary source, in a reputable medical journal, saying about the 2011 article that "It's too old. Also irrelevant."[1]. However, this is the most up-to-date review article available about the SCD diet, and has an entire section about SCD, so I don't see how it can be irrelevant even if it's old. It's not ideal, sure, but per WP:MEDRS, it doesn't mean that the results can't be mentioned so long as the appropriate disclaimers are included. It's a far cry from an in-vitro study or a mouse study.

Seems to me like SCD (which was first used in 1923) has its time in the spotlight, and now the research spotlight has moved on to more nuanced and individualized diets:

• the SCD diet is a low FODMAP diet ("The SCD is low in carbohydrates, specifically disaccharides (lactose, sucrose, maltose and isomaltose) and digestible poly-saccharides (starches). Monosaccharides (glucose, fructose and galactose) are permitted."), which now has strong evidence in support of efficacy.
• the SCD diet is a wheat-free diet. Wheat was only tied to celiac disease in 1952, decades after SCD was first described. But it goes further than that, and is also a gluten-free diet as pointed out by this 2014 review article which says "There is a growing body of evidence of non-celiac gluten intolerance, which may also be addressed with these dietary restrictions.".
• the SCD diet is also a low-dairy diet, which would help those with lactose intolerance or milk protein allergies.

The four medium-sized studies in Brown's 2011 review article are from 1979, 1981, 1986, and 1991. There have been a number of small studies since then, it seems unlikely that there will ever be large scale study as it would be considered a waste of money to combine these three very different dietary restrictions into a single study, and with a few extra restrictions thrown in for good measure (confounders galore!). Science has moved on, and I think we should include the data that was generated while SCD was being actively investigated with large (>100 person) studies in the 1970s and 1980s under the "history" section. But I have a feeling it would be quickly reverted like all other edits made to the page unless consensus is found first.

So: I propose to include a more nuanced and verbose description in the text about possible reasons that the SCD could have been effective for adherents back in the 19th century. We should be avoiding recentism on this historical angle, even if there are still some people that are trying it in the modern era. Pro crast in a tor (talk) 13:10, 28 April 2017 (UTC)

Your edit asserted this as current knowledge: "Some people with Crohn's disease show improvement by observing an elimination diet very similar to SCD". That's a pretty extraordinary claim. An old review which is critical about the research quality is not sufficient. And is the review even about the Haas/Gottschall diet (the subject of this article) anyway? Alexbrn (talk) 13:38, 28 April 2017 (UTC)

A direct quote from the Brown review article under the heading "SCD clinical trials": "Four clinical trials with relatively weak methodology and a conference proceeding support using the SCD to reduce GI symptoms in CD patients". To only say that the review article is "critical about research quality" is cherry picking just the first half of this summary sentence. I even added this quote to the reference, an edit which you also reverted.

And if you're asking me, _after_ reverting my edit and calling the review "irrelevant", "is the review even about the Haas/Gottschall diet", then you clearly didn't read the source. It includes under the "SPECIFIC CARBOHYDRATE DIET" section a brief history of Haas/Gottschall. And Brown was and still is the primary reference used in the article. I'm having a hard time assuming good faith with your apparent kneejerk reverts.

Perhaps I paraphrased poorly by changing "reduce GI symptoms" as "show improvement", but the review is clear that clinical trials support using SCD-like diets for CD patients. Brown et al also go through each of the clinical trials and document the methodology, each slightly different, and none of them a strict SCD, which I summarized as "elimination diets like SCD". All four were included under the "SCD clinical trials" heading, just below a so yes, according to a review article, they are SCD diets. This could be stated more clearly, too.

No opinion on including SCD's relationship to other diets that have attracted medical interest and shown efficacy? Pro crast in a tor (talk) 21:06, 28 April 2017 (UTC)

What the quoted sentence is saying, if you actually care about evidence, is "this shitty evidence says it works". If I went to you and said "Hey here is a napkin with scribbles on it that say I own this house. Want to buy it for $50K? Half the cost of the neighbor's house!" Will you give me $50K? I hope not. If I said - "Here is an umbrella that is probably full of holes, take it, it might rain!" wouldn't you look at me like i was an idiot? The review is not clear about SCD-like diets being useful for CD. Jytdog (talk) 21:20, 28 April 2017 (UTC)

I feel like the goalposts keep moving on your evidentiary standards. First you say the review article is irrelevant. Then you say it's an old study. Then you say it's not clear. Instead of trying to interpret the words to your POV, how about we just include exactly what it says, that weak evidence shows that SCD can reduce GI symptoms for CD? I've added this to the lede. Also, there is half a century of strong evidence that eliminating gluten from the diet helps celiac patients, and the SCD eliminated gluten (as well as a number of other things) from the diet in 1924, decades before the etiology of celiac disease was discovered in the mid-1950s. This also seems worth mentioning.

Also, you recently added a statement purported supported by Hou, "such claims are not supported by medical evidence", but Hou in fact says the exact opposite: "There is scientific evidence that dietary factors may influence both the risk of developing IBD and intestinal mucosal inflammation." Another direct quote from Hou is "There is a growing body of evidence of nonceliac gluten intolerance, which may also be addressed with these dietary restrictions. Avoidance of these foods is likely of little danger and could potentially improve gastrointestinal symptoms." Finally, you also added a reference to Hou to support the statement that "Support for the diet's effectiveness comes only from users' testimonials", but that's only him talking about internet websites, and not at all what Hou is saying if you read the whole review article such as the Clinical Trials section, which directly contradicts your statement. I've removed the unsupported Hou references, and added almost direct quotes from Hou instead, which is the most recent (2014) review article to talk about SCD specifically. I've also made a number of other changes, such as a number of improved ref links and ref date updates/fixes. Please work with me rather than reverting wholesale yet again. Pro crast in a tor (talk) 23:58, 28 April 2017 (UTC)