Breaking the Vicious Cycle: Intestinal Health Through Diet
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
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
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.
40 East 30th St.
New York, New York 10016