Integrative Medicine is an exciting field that has grown rapidly over the last decade. IM is a whole philosophy of care that is different from conventional medicine in that it adopts a broader scope and approach to healthcare. This model of care treats the whole person, and addresses all of the aspects of health, to not only treat the disease the best way possible, but also to help the person achieve an optimal level of wellness.
IM emphasizes the healing relationship between the patient and the care provider, and seeks to empower the patient to become proactive and educated in how to be responsible for their own wellbeing. Because of the collaborative relationship between patient and caregiver, IM treatments tend to be tailored to the individual patient to a greater degree than is found in conventional medicine. Currently, the American Board of Integrative Holistic Medicine is the primary certifying board of the specialty.
One popular definition of IM was developed by The Arizona Center for Integrative Medicine. In the world of IM, the Arizona Center is recognized as a leader in research and training, and developed the first comprehensive academic curriculum in the field. They define IM as “healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” This is consistent with how we view IM here at the Food Rx Project.
The distinctions between the two terms can be confusing, even to people familiar with this field of medicine. The National Center for Alternative and Complimentary Medicine says that CAM generally refers to “a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine (also called Western medicine).” Common CAM therapies include mind-body medicine, herbal medicines, acupuncture, vitamins, massage therapy, select exercise programs, and meditation, among others. The boundaries between CAM and conventional medicine are fluid, and can become blurred as CAM treatments become more commonplace. At first, this seems fairly straightforward.
Allow us to throw a small monkey wrench in the works. You may also hear people using the term “complementary medicine” by itself (without the “alternative” part). Here, they generally are referring to the use of CAM together with conventional medicine. An example would be the use of massage therapy in conjunction with traditional pain medication. When you hear someone use the term “alternative medicine” without the “complementary” part, they frequently are referring to the use of CAM in place of conventional medicine.
So how does IM relate to these two concepts? “Integrative medicine” is most similar to complementary medicine, in that it generally involves a provider practice that combines both conventional and CAM therapies. The added nuance is that when we think of a healthcare provider trained in IM, the CAM therapies they utilize tend to be ones for which ample evidence of effectiveness and safety is available.
We recommend certain therapies based on the clinical and anecdotal evidence available supporting the use of those therapies, and the level of endorsement given to those therapies by the medical community.
None of our volunteers, board members, or Medical Advisors receive any compensation for their service. Our policy is to use the donations we receive to purchase research tools for patients, to operate the website, and to fund research.
We are not compensated for recommending particular therapies or dietary approaches. We think objectivity should be extremely important to any group holding themselves out as your partners in research. Therefore, we do not recommend any products based on fees or a share of revenue from product sales. We want visitors to our site to know that we are solely concerned with helping them heal and achieve remission of their symptoms. Our policy is to recommend a certain therapy, product, or tool if we feel it will help you effectively treat your IBD and achieve a better level of health.
Food Rx absolutely supports the responsible use of conventional medicine. Our organization has a great deal of respect for conventional medicine and its role in our healthcare system. Every day we have the opportunity to talk with doctors and physicians who care deeply about their patients’ welfare, and believe in the oath they took to deliver exceptional care. We should all should feel incredibly lucky to live in a country where the standard of healthcare is so high and the pace of technological innovation is so rapid.
The internet is littered with websites that criticize conventional medicine and promote the use of often questionable alternative therapies in lieu of the standard of care. Food Rx is not one of those websites. We are not anti- conventional medicine. That said, we are pro- complementary and alternative medicine. There may be instances in which we suggest an alternative approach to treatment could be tried before a conventional approach is utilized, with surgery being such an example. In those instances, we will share our reasoning behind that position. Then it will be up to the patient to discuss the issue with their healthcare provider.
We recommend following your physician’s instructions regarding your medication. If you make progress utilizing a dietary approach and your symptoms improve, your doctor may elect to reduce your medication. Hopefully, over time, you will be able to eliminate the medication altogether. Please note that certain drugs must be gradually reduced, and immediately stopping their use could have negative side effects – some potentially serious.
If you have already read our founder’s story, you know that he never treated his ulcerative colitis with prescription medication. His treatment for the disease consists of dietary modification and the use of certain complementary therapies. His results with that program were very positive. However, it is important for you to remember that his situation is unique, and this may or may not work for other patients. Some research suggests that dietary approaches to treatment might be more effective when used immediately after diagnosis. These findings mirror research that has shown dietary intervention may be even more effective in pediatric patients than with adult patients, suggesting that the earlier a dietary intervention is attempted, the more effective this type of therapy might be.
In grade school, children learn never to answer a question with another question. So forgive us for asking a clarifying question: “what exactly is your definition of ‘cure’?” We assume that most people who ask this question mean medically cured- or that the biological conditions in the body have been altered so that the individual no longer has IBD. We want to be clear that as of now, there is no accepted medical cure for IBD.
However, two of the more commonplace definitions of “cure” in medical dictionaries don’t directly address the permanent reversal of biological conditions in the body. In fact, two common definitions of cure are (1) to heal, to make well, to restore to good health, and (2) medical treatment leading to remission of signs or symptoms of a disease especially during a prolonged period of observation [Merriam-Webster Medline Plus]. If the threshold for a treatment to be a “cure” is that it heals the body, brings about good health, and leads to the sustained, long-term remission of symptoms, then one could make the argument that in some instances diet can cure IBD.
If we are not careful, we can easily find ourselves in a semantic stalemate. Those who insist on the elimination of all biological conditions of the disease will say IBD simply can’t be cured. Proponents of dietary approaches will argue that if the ultimate goal of a cure is to remove the symptoms of a disease and restore a patient to good health, then treatments like the SCD seem to satisfy those criteria.
At the Food Rx Project, we prefer to talk about healing as opposed to curing. There is a subtle distinction that we think is important. Our founder, for example, has been in remission from the disease for the past decade. If you were to ask him his opinion, he would likely consider himself healed – but not cured. The reason he chooses his words so carefully is because he can’t be certain that if he went back to his old diet, he wouldn’t in time begin to experience the symptoms of ulcerative colitis. Of course, he enjoys the way he feels following the diet, so he would never go off of it in order to find out.
The core tenants of the SCD include nutritious meat, fish, poultry, fruits, vegetables, cheeses, almond flour, honey, nuts, almond milk, and standard milk that has been incubated into yogurt to remove the lactose and denature the casein. These foods are generally considered healthy by the mainstream nutritional community.
We receive this question every now and again, which suggests that some might have the perception that eliminating grains, starch, sugars, and other prohibited carbohydrates somehow limits the body’s ability to get the nutrients it requires. We have yet to see an argument put forth to show that the diet deprives patients of key nutrients- particularly nutrients that can’t be easily supplemented. We have read profiles of the diet that suggest – almost exclusively without any supporting evidence – that restricting grains and wheat might limit fiber availability, and potentially decrease energy (presumably because the conventional wisdom is “high carb equals high energy”).
As for the question of fiber availability, we note that vegetables and nuts can be good sources of fiber. And, of course, other forms of fiber supplementation are always an option. The energy argument is somewhat surprising, because the anecdotal evidence points to the exact opposite – people who go on the SCD often report that their energy level increases. They report finding that a diet of lean meats, vegetables, and nuts is so easily absorbed by the body that they rarely feel bogged down, bloated, or lethargic.
We have had members write and ask if it is difficult to follow a diet like the SCD when they are living an active lifestyle. This question arises from the same perception that grains and starches are an important fuel source for high-intensity activities. Again, anecdotal reports from members following the diet suggest the opposite is true. Many report improvements in endurance and stamina after beginning the diet.
This is a great question that comes up all the time. It is understandably one of the primary concerns people have about treating disease with diet. Following the SCD isn’t without its challenges. You have to constantly be on guard for sugars and starches, which are slipped into more foods than you might realize. When we suggest the diet to someone suffering from IBD and they decline to give it a try, their perception that the SCD is difficult to follow is the #1 reason they give. We certainly understand that concern.
However, once one adapts to the diet, it really can become second nature. Many people already enjoy chicken, beef, seafood, salads, vegetables, juices, and nuts, even before their diagnosis. So adapting to a diet rich in those foods may not be too painful for some. Furthermore, those who enjoy being creative in the kitchen will likely find the diet easier to follow. Some individuals, therefore, won’t find the diet very restrictive. And many others won’t find the diet restrictive enough to warrant giving it up and risking the symptoms of IBD again. Let’s put it this way: even if the many followers of the diet were medically cured of the disease, we doubt many would go back to eating the way they did before their diagnoses. They simply feel too healthy now.
There are so many foods allowed on the SCD that the list would take up this whole page. Of course, there is also an extensive list of prohibited foods. We refer you to our web page devoted to How to Follow the Diet. Also, please see our External Links for the SCD, which go into detail about which foods, ingredients, drinks, and condiments are allowed and prohibited (note: the terms “legal” and “illegal” are frequently substituted for “allowed” and “prohibited” on sites dedicated to the SCD).
This is a really great question to address here. Just because some doctors are not familiar with the SCD does not mean it is not a perfectly valid and effective treatment for IBD. We can tell you that many doctors are extremely loyal to the therapies they learned to use in medical school. And those therapies are almost always conventional therapies. While an increasing number of doctors are electing to be trained in integrative medicine, it is still incumbent on the patient to do their own research, and be thoroughly prepared to discuss alternative therapies with their doctors. And incidentally, helping you conduct that research is exactly why we started The Food Rx Project.
This question is a little more challenging to answer, because we don’t know the specific reason for your doctor’s reluctance. However, there are two reasons we hear every so often. Maybe speaking to those objections will help.
First, we sometimes hear that doctors are reluctant to recommend the diet because they feel there is insufficient clinical evidence supporting its efficacy. It is very important for those individuals who support the SCD to not dismiss this concern outright. After all, our medical system is built on a foundation of sound science, and we need to understand that it is usually not a willful refusal to accept anything “alternative” that drives this skepticism. Frequently, it is a healthy dose of caution on the part of the provider.
So why do some doctors feel the evidence supporting the SCD is insufficient? The answer has to do with what we refer to in medicine as a standard of care. A standard of care is a formal treatment process a doctor generally follows for a patient with a certain set of symptoms or a specific condition. The standard of care is a living concept, and evolves over time as a certain therapy is shown to be the most clinically advantageous over a wide population of patients. In addition to just being commonly used, standards of care get that designation because they have been shown through testing to be reliable and effective.
For a doctor to deviate from either the standard of care or another generally accepted conventional treatment, they often require compelling evidence. Unfortunately, very few recent research reports exist on the SCD. The main reason for this is that randomized, controlled studies are extremely expensive to conduct. And the reality is that most trials in this country are funded by pharmaceutical companies that can absorb the significant cost of product testing because of the profits they can earn on the commercialization of the drug.
In the case of a diet, there is nothing for a company to patent if the diet proves effective. Therefore, it has proven difficult to find any group willing to step forward and provide funding for a well-designed, controlled study on the diet’s effectiveness in treating IBD. In addition to the funding challenge, there could potentially be challenges in designing such a study. Researchers would have to be extremely careful to design the study in a manner so as to not invite criticism of investigator bias. And the study would have to be conducted using a large population of IBD patients. Finding that many study subjects willing to participate could be difficult.
So where does this leave us on the issue of clinical research? One thing to bring up when talking to your care provider is that the research conducted by Dr. Sidney Haas (who created the diet) showed very promising remission rates – commonly cited at over 75% – in the testing he performed on the diet. Also, just because there hasn’t been a large study evaluating the SCD doesn’t mean the diet doesn’t have a wealth of scientific research supporting it. Numerous carefully designed studies have implicated the body’s inability to properly break down certain carbohydrates in a host of diseases, including UC, Crohn’s, IBD, Celiac disease, autism, and other diseases of the brain. Also, there is a wealth of research on elemental diets, which are chemically similar to the SCD. Breaking the Vicious Cycle is the best source for information on this research. The book will provide you with more than enough supporting data for you to feel confident in a discussion with your doctor.
In addition to the research cited in the book, a number of recent, smaller studies have shown the diet to be extremely effective in bringing about remission. Please refer to our page that reviews the science of the diet. As we move forward, it will be increasingly important to appeal to patient advocacy groups like the Crohn’s & Colitis Foundation of America (CCFA) to request that they take a more active role in funding research for alternative therapies like the SCD. To date, the CCFA’s position on the diet has been one of neutrality – they neither recommend it nor dismiss it.
Our organization would love to see a large-scale, carefully designed test evaluating the efficacy of the diet. We believe that this will become a reality through the generous donations of individuals who support our organization. We will continue to look to fund scientific research into the area of diet’s effect on chronic disease. We want to point out that the support of organizations like the CCFA could greatly expedite the process of designing and funding such a study. We strongly urge the CCFA to consider allocating funding to a carefully-controlled, scientific study of the SCD in the near future.
Another reason why some doctors don’t recommend the diet is that they hear from a portion of their patients that it doesn’t work. While we don’t claim that the diet will work for everyone, we do believe that the diet’s success rate is much higher than anecdotal reports suggest. A story will illustrate our point.
Mike (not his real name) is a friend of the Food Rx community. Mike was diagnosed with Crohn’s disease recently. He was in very poor health, so we recommended he try the SCD. After being on it for about four months, he called us and told us was going to stop using it. He thanked us for the suggestion, and added “I guess for me it just didn’t work.” We were obviously disappointed that the diet had seemingly failed him. We decided to ask him a few questions to determine how carefully he followed the diet. Eventually, he admitted that he did what we suspect many people do – he treated it like a “traditional” diet. And by that we mean that he generally tried to follow it, but made exceptions when it wasn’t convenient.
In the morning, for example, Mike had a habit of enjoying a bagel with cream cheese. He really didn’t want to give that up, so “every couple mornings” he would have a bagel breakfast. And sometimes after work he didn’t have time to cook, so he would stop and grab fast-food. He assured us, however, that didn’t happen often. The difficulty is that the SCD is not a “when it is convenient diet.” It is an every day, every meal, no exceptions diet. But it frequently works when one follows it that way. Of course, Mike wasn’t willing to follow it that closely. Incidentally, we asked Mike what feedback he had given to his doctor. “I told him it didn’t work for me,” he said.
This story highlights the challenge with relying on patient testimonials. We suspect many individuals who try the diet don’t spend enough time upfront trying to understand what it will take to be successful. They do exactly what Mike did – they try to stay compliant, but regularly deviate from the diet, especially in those critical first few months. When the results don’t materialize fast enough, they dismiss the diet outright, and report to their doctor that the diet failed them. We suspect this happens quite frequently.
So to finally answer your initial question, what is a patient to do when confronted with a doctor who is reluctant to recommend the diet based on these grounds? First of all, we recommend trying to understand what their primary objection is. We also recommend having the available research on the diet in hand. Even though larger studies are needed, the work that has been done is relevant to the discussion. Also, as a patient, you are always entitled to a second opinion. If you are interested in discussing the diet with a provider trained in integrative medicine, please refer to our page that links to Doctor Locator tools.
We have a limited number of weekly spots available. There is no limit to the number of calls you can schedule, but we ask you to be thoughtful when requesting phone calls. We reserve the right to show preference to new members when scheduling calls, simply because we want to get people started on the path to healing as soon as possible.
We do our best to fit in as many calls as we can each week. However, many of the volunteers at Food Rx have full-time jobs that restrict their schedules. That said, we pride ourselves on trying extremely hard to accommodate patients who reach out to us for help and advice.
Generally speaking, we have greater availability on weekends. When you submit a request for a phone call, we will reply to your email account with a list of available upcoming dates and times from which you can choose. In the future, we hope to have expanded access to our representatives.
Food Rx is funded through generous tax-deductible gifts of individual donors and charitable foundations. We greatly appreciate the support of all of our generous benefactors!