Special Diets

When we walked down to our local grocery store last night, we came upon this sign outside:

specialdiets

Years ago, when first starting the SCD in the mid-1990's, people would say "huh?" or "what" about special diets, food intolerances, always asking "you can't eat this or that"? Now it seems that even the local stores have caught up with health and dietary challenges by stocking items and moreover creating events that are focused on "special diets". It is very pleasing to see this change occur, albeit step-by-step over the past decade or two.

If you are on good terms with your local grocery store, you could always encourage them to host a similar event such as this. This allows other customers who might be suffering (or not) to learn about different diets, such as SCD, and what they have to offer. It is an awareness campaign for everyone concerned.

SCD mention in Seattle Times: Health & Fitness

The Specific Carbohydrate Diet got a mention in the Health & Fitness section of the award-winning Seattle Times. Below is the letter written in to the columnists from an SCD caregiver.

http://seattletimes.com/html/health/2023110800_pharmacy16xml.html
Originally published Sunday, March 16, 2014 at 6:16 AM

Q: My husband has had Crohn’s disease since he was 17, and he’s now 48. Fourteen years ago, just before our first child was born, he was in the hospital with a bad flare-up and was very close to surgery.

As he was recovering, the doctors wanted to put him on lifetime steroid meds. He didn’t want to go that route and did some research. He discovered the Specific Carbohydrate Diet (SCD), which would change his life forever.

His gas production significantly decreased within a day or two on the diet. He’s been med-free and has had no flare-ups ever since (14 years!).

The diet is very demanding. You essentially cut out all grains, even foods like soy and rice, and all forms of sugar except honey. I use a lot of almond flour in cooking. And yes, he eats a lot of coconut through macaroons and other baked goods I make. For my husband, the diet is not a cure for Crohn’s, but it keeps the disease in check.

A: Thank you for sharing this amazing story. A recent article in the Journal of Pediatric Gastroenterology and Nutrition (January 2014) offers a case series in which the SCD approach improved symptoms and lab results.

We have heard from dozens of readers that coconut can be helpful in controlling hard-to-manage diarrhea.

Kickstart the Seattle Children's Hospital's FMT/SCD Study!

The Seattle Children's Hospital is raising money to research the Specific Carbohdyrate Diet (SCD) and Fecal Microbial Transplant (FMT).

The most promising therapies for Crohn's Disease and ulcerative colitis are the SCD (and similar diets) and FMT.  In theory and in small trials, it works like this:

  1. FMTs restore the balance of healthy intestinal bacteria, lessening or completely removing symptoms of Crohn's or ulcerative colitis.  (e.g., The gut bacteria is returned to a diverse, healthy environment.  Think rain forest)
  2. The SCD has been shown to steadily improve the balance of intestinal bacteria.  However, if an FMT has already been done, the SCD can potentially maintain the diverse, healthy flora.
Dr. David Suskind

Dr. David Suskind

Please support Dr. David Suskind's work at Seattle Children's Hospital in this endeavor.  The hospital's fundraising web page contains the studies and stories related to the work they have already completed.

For more, read the following links:

 

 

Gut Bacteria and Crohn's: It's Official (447 Patients)

Damn!  In the dark ages of IBD, doctors believed that stress was a key factor in disease control and said that my diet of 80% processed complex carbs was fine.  When exercise, sleep, and "relaxation" didn't seem to help, I took "extra measures."   By some convoluted logic born out of a fermenting gut I thought working in an Alaskan cannery for the summer (with active IBD) would be a good idea.  The extra stress would somehow make the IBD go away . . . but it was really about the intestinal bacteria.

A Harvard-led study released in March examined the intestinal bacteria of 447 children newly diagnosed with Crohn's disease (CD).  These children had not yet received Crohn's specific treatment.  Compared with 222 health control subjects, the study found:

  • The intestinal bacteria of the CD children was unbalanced, with pathogenic bacteria flourishing
  • The CD children had less diverse intestinal bacteria
  • The imbalance of intestinal bacteria related disease severity: the greater the imbalance, the worse the symptoms.
  • Antibiotic exposure "amplifies" the imbalance of intestinal bacteria. (57 of the 447 children were on antibiotics)
  • Compared to tissue samples, stool samples had low accuracy for reflecting the state of intestinal bacteria

The study included a large sample size drawn from 28 North American GI centers--making it the most statistically relevant study of its kind.

Gevers, D., Kugathasan, S., Denson, L. a, Vázquez-Baeza, Y., Van Treuren, W., Ren, B., … Xavier, R. J. (2014). The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host & Microbe, 15(3), 382–92. doi:10.1016/j.chom.2014.02.005

SCD & India: From Elephanta Caves to Goa Beaches

This winter we spent the end of the year in India. For me, that means that my daughter and wife leave for a week before I do, so that they can prepare for my SCD arrival! (No, not really, they go so they can get some extra time in with the maternal side of the family...)

After negotiating two air flights with a pit-stop to stretch legs in London for a few hours, I arrived in Mumbai rather bedraggled but happy to enter the 75 degree weather difference. I had been accompanied (under my seat) with a packed lunch-bag containing numerous SCD snacks, sandwiches, a chicken entree, some stir-fry vegetables, and of course, fresh fruit and nuts. These items ensured that I made it through each flight with enough to eat.

At my wife's childhood home, the scents of spices and other local vegetables rose up to greet me. Rule #1: Have a home base from which one can launch off to other destinations. Without this, it would be very hard to have someone help me prepare SCD breads or bake some SCD cookies for me to snack on as I traverse Bombay traffic jams or take day trips out of the city.

For this particular visit, we managed to pack almond flour from Trader Joes in our bags and get it through security and baggage screening. This made it easier to bake with, rather than trying to hunt down almond meal in Mumbai, or grind the almond flour from whole almonds (which does not yield the same consistency). We were able to make cinnamon and ginger cookies, and savory breads. While my wife and daughter dug into homemade chapati's, poori's, and other traditional breads, I was able to enjoy fresh local (pomfret) fish, shrimps, roasted chicken with vegetables, and many other vegetarian preparations such as cauliflower with peas, string beans cooked gujurati-style, and other daily delicacies.

One of our day trips out of Bombay involved riding a 1-hour ferry to historical caves called Elephanta caves, that are rock-cut caves dating back many centuries. As we entered this small island off Bombay, we were warned about not taking any food out of our backpacks - as local monkeys would grab them! Since I was carrying SCD lunch and treats for myself, I held on to my bag with force. My wife, however, decided to take a snack out for our daughter, and promptly this male monkey was by her side trying to antagonize her and grab it away. Luckily, some local shop-vendors helped us shoo them off.

In the heat of the sun, all the roadside snacks started to look delicious and appealing. As a foreigner and someone who did not grow up in India, follow Rule #2: do not to eat roadside snacks, especially those that might involve raw foods, or having been cleansed in (unknown sources of) water. The one item I did end up eating was roasted peanuts, which seemed fairly safe as they were on a small charcoal fire and being kept fresh. A decade ago, when we travelled through Rajasthan and Northern India, a rule of thumb was to try and eat items that were cooked as much as possible - egg/omelets were always a safe option, as were fresh meat kebabs or other grilled preparations. The items to stay away from are definitely salads in local dives, or fresh gleaming cukes sprinkled with salt and chili powder. Two years ago, I made the mistake of eating one of these, and definitely paid the price for that roadside snack.

Traveling with one who follows SCD and also a 5-year old can prove challenging, so when we went to Goa for a few days, we decided to go to a kid-friendly family resort. For 4 days we enjoyed swimming, beaching, and I was able to eat fresh seafood every night customized to my SCD needs. They even went so far as to bring me dessert options (mainly fresh fruit) so that I would not feel left out. Rule #3: Try to visit and stay in places where one knows the quality of food is unquestionably high/safe.

Having made it there and back safely and with a secure gut atleast 8 times over the past fifteen years, I can say that in my experience it is an incredible country to travel within and the food and flavors change so much as you go from one end of the country to another (contrary to Indian restaurants peddling the same kind of food in the Western world). Although I gew up with one Indian parent (my dad is from North India) we primarily were in touch with my Italian-American mom's side who we lived close to. Unlike some other first generation children, I did not spend time going to India while growing up, so these later years of travel have made me appreciate the flexibility (IST - indian standard time - 1-2 hour delay of arrival to a dinner party), the warmth (I am married to one of them!), and the willingness of people to participate in anything (a crowd can materialize at a moments notice in event of one car scratching another in very slow moving traffic to proclaim who's right or wrong).

Elephanta Caves, Goa Beach Dining, Mumbai Family Meal

Elephanta Caves, Goa Beach Dining, Mumbai Family Meal

SCD Symposium in Seattle

It has been about 6 weeks since this symposium took place at Seattle Children’s Hospital on Friday, January 24, 2014. Although we can be accused of being tardy, we are still figuring out what an event like this means for the Specific Carbohydrate Diet community at a larger scale.

The event was hosted by Dr. David Suskind, MD, who is an attending physician at Seattle Children’s Hospital, and Associate Professor of Pediatrics at the University of Washington School of Medicine. He was published in the January 2014 issue of Journal of Pediatric Gastroenterology and nutrition (see 9/24/2013 blog entry) with the results of an SCD study he conducted.

Back in October 2013, we had heard some murmurings that there might be a one-day symposium hosted at Seattle Children’s, and we agreed to fly out to the west coast once this was finalized.

After a busy end of year spent in Mumbai, India, for 3 weeks (and being SCD-safe the whole time there), we barely recovered from our jet lag and boarded another flight, this time heading in the opposite direction towards the Northwest. Once we passed through security with our food travel bag FULL of SCD-safe meals and snacks - we were able to sit back and relax on the flight.

The next morning, we drove through downtown into the neighborhood of Seattle that is home to UofW. The space we entered into at Seattle Children’s Hospital was bright and cheery, with stories and images lining the corridors. The symposium was hosted in a large conference room, with space for about 50+ persons around an open “U” configuration.

The room was filled with a mix of medical professionals (MDs, nurses, and others) along with SCD practitioners and/or authors. The room buzzed with anticipation. Dr. Suskind began the symposium by sharing the results from his SCD study, which was followed by a few other presenters. I had a chance to present an overview/history of the SCD from the mid-1900's till present, outlining the work of Dr. Haas, Elaine Gottschall, and to where we are today.

We were served a delicious SCD lunch (with dessert as well!) prepared locally. Towards the late afternoon, there was a chance to have an “open discussion”, sort of like a brainstorming session, where everyone had a chance to float ideas on how SCD could be propelled forward through further research and collaboration.

The best part about being at this one-day event was connecting with others in this varied and diverse community that is often only accessed online (through forums, chats, email, etc). To be there together with others who understand the SCD – its benefits, its challenges, and ultimately, its ability to make one better – was reassuring and incredibly exciting at the same time.

We hope that this next chapter of communicating together as a larger group of practitioners, will allows us to take the Specific Carbohydrate Diet into the limelight: more investigative research studies and other platforms it needs to secure its’ spot as a standard treatment for UC, IBD, and Crohn's.

Dr. Suskind (at far right) with other SCD symposium attendees (R. Prasad at back in white collared shirt :)

Dr. Suskind (at far right) with other SCD symposium attendees (R. Prasad at back in white collared shirt :)

Pike's Place Market

While we were visiting Seattle for the first-ever SCD Symposium hosted at Seattle Children's Hospital, my wife and I decided to stay on for the weekend and explore the city.

One of the first places we hit bright and early on Saturday morning was Pike Place Market, the 100+ year old arcade market located downtown by the waterfront. Although part of the market has been taken over by non-edible offerings such as magic shops and touristy paraphernalia, we had fun exploring some of the foodie places, and admiring the neon food-oriented signage.

This old market is home to the original and first Starbucks coffee shop (across the street), to many eclectic local food shops ranging from sausages to dried fruits to fresh meats and vegetables. And of course, the infamous Pike’s Place Fish, where they throw and yell about fish from one end of their shop to another.

One of the first places we stumbled on when we arrived there, was a giant black and white circle with a hand pointing downstairs that led us to Britt’s Pickles. This tucked away vendor had many fermented offerings, from regular pickles to “curry” kraut that was cabbage fermented with mustard, turmeric, and other SCD-safe Indian spices. As we tasted samples, we immediately bought a couple of these offerings and lugged them back to our hotel room to enjoy!

A sampling display of kimchi and kraut at Britt's Pickles at Pike's Place Market in Seattle

A sampling display of kimchi and kraut at Britt's Pickles at Pike's Place Market in Seattle

We also ended up buying some delicious dried apple rings (plain) and beets (just oiled and salted) from another vendor shop that we chomped on as we traversed the funky artsy Pioneer Square neighborhood. When we left the Northwest to head back home on our flight, we decided that we would brave the airport security – the curry-kraut made it back to our home in Boston–and is happily residing in our fridge. We are doling it out frugally at meals to make sure this well-traveled condiment lasts long!

Bottled Soda’s made with Honey & Real Fruit

The three varieties of Green Bee Soda: Lemon Sting, Ginger Buzz, and Blueberry Dream.

The three varieties of Green Bee Soda: Lemon Sting, Ginger Buzz, and Blueberry Dream.

Ever since starting the SCD more than 17 years ago, it has always been a challenge to find alternative drink options for those following this diet. In the past, we would have to make our own fruit sodas or juices at home.

We have a new Whole Foods that opened 2 blocks from our home, and it is now so easy to just wander by there while picking up our daughter from pre-school, or when we are out for a walk with the dog. Besides offering fresh meats and groceries, you can peruse the shelves and find snacks that seem to be SCD-safe.

One of our favorite new drinks is Green Bee Soda!
http://greenbeesoda.com/

When we visited WF recently, we met Chris, the founder of this small, family-run business from Maine. Being patrons of this soda for a few months, we ran up to his special promotional display, and started asking him questions about how he came up with his flavors, how he brews them, etc.

As we sipped our samples, my daughter and I chatted with him about how he went from beekeeping, to creating these delicious soda’s (initially for his own children). The idea that this next young generation can grow up with healthy fruit sodas made with real fruit and sweetened with honey seems amazing!

We were surprised to find out that he had been contacted by other SCDers who wanted to make sure his drink was legal for those following the diet. For example, if you read the ingredients label, the Lemon Sting (lemonade) has Lemon Juice, Rosemary, Honey, and Carbonated Water.  Chris sent us this letter to clarify that there were no “hidden ingredients” in his soda recipes.

Please note: The blogger has not been compensated by Green Bee Soda for this post, we just were surprised to find an off-the-shelf drink that seems to be working for those on the diet. And one that is still very delicious!

Chris, the founder, of Green Bee Soda, at his display offering samples from the different soda brews.

Chris, the founder, of Green Bee Soda, at his display offering samples from the different soda brews.

Apple Picking = Apple Crumble

Last week we visited Parlee Farms located north of Boston. This clean, well-maintained farm had apples to pick, flowers to cut, and sheep/bunnies to feed.  Needless to sat it was a hit with our 4-year old daughter. She ran across haystacks, got licked by a mother goat, and raced through alleyways of flowers to cut as many pink ones as she could find.

The best part of the visit was going into the apple orchard with our pre-paid bags and loading up on Cortland and Gala apples (we also ate a few while we sat there amongst the trees!). On returning home we made our Apple Crumble recipe (p. 121) from our cookbook "Adventures in the Family Kitchen". Enjoy your October with this delicious recipe!

Apple Crumble

Filling:
4 large or 6 small apples
1 tablespoon butter
1/4 cup water (add more if required)
2 cinnamon sticks, broken into big pieces
2 tablespoons honey, or to taste

Crumble:
2 1/2 cups almond flour
1 cup butter (softened, not melted)
2 tablespoons honey

Instructions:
> Peel, core, and dice apples.
> Heat butter in a pot. Add in apples and all other filling ingredients.
> Simmer until apples are cooked/softened — adding water if required. Do not overcook the apples since they will be baked in the crumble.
> For crumble, mix almond flour, butter, and honey well with fingers. Consistency should remain crumbly, not pastry-like. Add in more almond flour if necessary.
> Put the apple filling in a baking dish.  Spread crumble on top of apples. Bake at 375ºF for approximately 20 minutes, or until top of crumble starts to brown.

Fermenting with Sandor Katz

A few weeks ago, we traveled up to close to Kennebunkport, Maine, to attend a Fermentation workshop by Sandor Katz. For those of you who are not familiar with his work, he is the author of Wild Fermentation among other books.

The workshop took place at a small, lovely farm: Frinklepod Farm, operated and run by a young family. When we arrived there we were greeted by the very friendly hosts and also, in the background, a rowdy crowing (territorial) rooster! A tent for seating about 50+ persons had been set up to accommodate attendees.  Originally, only I was going to attend, but on seeing other families and kids, my partner and daughter decided to stay on.

Under the later afternoon September sun, we listened to Sandor talk not only in detail about fermentation techniques and processes, but also the story of how he came to follow the path he has and become a recognized authority on this topic nationally. He wove together stories of experimentation, foods, nutrition, to create an informative fun event. During the whole lecture he continued to drop chopped cabbage into glass mason jars as he went through the steps of preparing basic sauerkraut.

We came away wanting to ferment all the foods in our kitchen! 

 

Seattle Children's Hospital and the SCD

Last week the Journal of Pediatric Gastroenterology and Nutrition published a paper titled Nutritional Therapy in Pediatric Crohn's Disease: The Specific Carbohydrate Diet.

This paper describes how doctors at the Seattle Children's Hospital evaluated the medical records of 7 children with Crohn's disease who used the SCD.  The ages of the children ranged from 7 to 16 years old.  The authors write:

"all symptoms were notably resolved at a routine clinic visit three months after initiating the diet [SCD]"

Resolution of all symptoms?  How were these children before starting the diet?  Since SCD studies are rare, this paper is definitely of interest to parents thinking of starting the diet. 

Information below describes the children's disease severity, medications (if any), and initial symptoms.  (Note: none of the patients had "penetrating or stricturing disease.")

Based on microscopic checks of their biopsies, the severity of the children's Crohn's inflammation was as follows:

  • 2 severe cases
  • 3 with moderate disease
  • 2 mild cases

In terms of medications, none of these patients received immunosuppressants (Remicade, Humira, Azathioprine, etc).  Levels of other medical treatment varied:

  • 3 started the SCD soon after diagnosis and received no other treatment
  • 2 patients received only entereal nutrition (tube feeding) for 2 months and then transitioned to the SCD
  • 1 began the SCD when mesalamine did not help
  • 1 began the SCD when neither prednisone nor mesalamine helped.  For this patient, the mesalamine was continued with the SCD

Regarding supplementation, the study notes that 2 patients took "over-the-counter supplements" but does not mention the types.   (Were they vitamins? probiotics? etc)

A list of initial symptoms included:

  • 4 suffering from abdominal pain
  • 4 children had lost weight
  • 4 had "blood per rectum"
  • 2 presented with chronic diarrhea
  • 3 complained of fatigue
  • All had at least one granuloma (cluster of inflammatory cells that confirm CD--they don't happen in ulcerative colitis)

This is a small study but it is notable in that:

  • The symptoms of all children resolved for a disease that supposedly cannot be helped by diet
  • All children had thorough medical tests (biopsies) and record checks

Suskind, D. L., Wahbeh, G., Gregory, N., Vendettuoli, H., & Christie, D. (2013). Nutritional Therapy in Pediatric Crohn’s Disease: The Specific Carbohydrate Diet. Journal of pediatric gastroenterology and nutrition, 98105. doi:10.1097/MPG.0000000000000103

http://www.ncbi.nlm.nih.gov/pubmed/24048168

 

Voluntary Childlessness for Crohn's Patients

record_player2.jpg

You’ve thrown the worst fear
That can ever be hurled
Fear to bring children
Into the world

- Bob Dylan

 

Many women with Crohn's Disease (CD) choose not to have children. 

Available studies show that the percent of women with CD who have children is 17% to 44% less than similarly-aged women without CD.  These are studies of CD patients who did not have CD-related surgery and are capable of having children. (1)

Much of this voluntary childlessness is attributed to fear, including:

  • Fear of IBD-related congenital abnormalities [birth-defects]
  • Concern about genetic risk of IBD in child [passing IBD to a baby]
  • Concern about medication teratogenicity (methotrexate and non-methotrexate) [meds causing cancer]
  • Medical advice that conception not possible/ inadvisable with IBD
  • IBD-related fatigue prohibitive (2)

Fortunately most of these fears are unfounded--especially fears of poor pregnancy outcomes. 

The choice not to have a child isn't limited to women.  For men with CD, the rate of voluntary childlessness ranges from 18% to 50% less than men without CD.(1)

 This is one of the sadder notes of IBD.  But no one needs to listen to Mr. Dylan for this one.  There are many, many healthy children of IBD dads and moms--both moms using special diets and those who do not.


Bob Dylan lyrics: http://www.bobdylan.com/us/songs/masters-war

(1) Tavernier, N., Fumery, M., Peyrin-Biroulet, L., Colombel, J.-F., & Gower-Rousseau, C. (2013). Systematic review: fertility in non-surgically treated inflammatory bowel disease. Alimentary pharmacology & therapeutics, (August), 1–7. doi:10.1111/apt.12478

(2) Mountifield, R., Bampton, P., Prosser, R., Muller, K., & Andrews, J. M. (2009). Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions. Inflammatory bowel diseases, 15(5), 720–5. doi:10.1002/ibd.20839

 

 

UMass Medical School recruiting for Crohn's study

For people who haven't tried the SCD (or a similar diet), the University of Massachusetts Medical School is recruiting Crohn's patients for a "before and after" study using their IBD Anti-Inflammatory Diet (IBD-AID). 

The University of Massachusetts Medical School  

The University of Massachusetts Medical School

 

BEFORE:  You have Crohn's disease and have not tried dietary interventions such as the SCD. 

DURING:  Includes sessions with dieticians and cooking lessons to start the IBD-AID.  The AID-IBD is "derived and augmented from The Specific Carbohydrate Diet (SCD)"

AFTER:  Follow-up health evaluation including standard test as well as checking the microbiome.

To learn more about the study, please use the contact information in the attached flyer.

  

SCD Lifestyle note from Elaine’s daughter

Please note.  The message below is from Elaine Gottschall’s daughter regarding the SCD Lifestyle website:

Many people have asked us if the SCD Lifestyle website and e-book are authorized or endorsed by the publishers of Breaking The Vicious Cycle. They are not.  The  Specific Carbohydrate Diet (SCD), which is outlined in the book, Breaking the Vicious Cycle, reflects years of extensive research by scientist Elaine Gottschall who had no association with and did not approve advice offered through SCD Lifestyle.  The only official website for the SCD is www.breakingthevicious.info.

Fecal Transplant: why NOT to do it yourself

ft_smI talked to someone last year who was engaged in a DIY fecal transplant.  There are good reasons why NOT to do this yourself.  For the recent study on ulcerative colitis patients, which had great success, the donors were screened* as follows:

Blood tests 

hepatitis A IgM, hepatitis B surface Ag, hepatitis B surface Ab, hepatitis B core Ab, hepatitis C Ab, EBV VCA IgM, CMV IgM, syphilis IgG, HIV I and II ELISA

Stool tests

Stool culture for Salmonella, Shigella, E. coli, Campylobacter, Yersinia, Vibrio, and Listeria, C. difficile toxin PCR, ova and parasite screening, fungal smear.

In other words, any donors should be properly screened--there is no reason to risk infection.  Discuss this option with a doctor.

This is a relatively low-cost, high impact type of treatment which is happening all over he country.  (Although unpublished, yesterday I heard of high success rate with pediatric Crohn's patients in Seattle undergoing fecal transplant.)

*Kunde, S., Pham, A., Bonczyk, S., Teri, C., Duba, M., Conrad, H., Cloney, D., et al. (2013). Safety, Tolerability, and Clinical Response after Fecal Transplantation in Children and Young Adults with Ulcerative Colitis. Journal of pediatric gastroenterology and nutrition, (616). doi:10.1097/MPG.0b013e318292fa0d

Autism, the SCD, and Fine Motor Skills

no_tearsI'm staring at a school worksheet which a mom happily shared. When her son "Joseph" (pseudonym), was diagnosed with ASD at age 2, she was told he would never talk. In addition, like most children suffering from autism, he was clumsy. Whether trying to run or catch a ball, his movements appeared uncoordinated. This lack of motor coordination is well-documented, even in high-functioning people suffering from autism. Even harder are finer motor skills, such as writing.

Joseph started a casein-free version of the SCD last fall. His moods quickly even out. Now , seven months later, he's starting to use words more AND, as shown in the image, he is now "Handwriting Without Tears." The image is from a school worksheet completed on March 26, 2013. The teacher also notes his speech.

With fine motor skills, it's not lack of effort. In a 2012 "consensus report"*--doctors agreed that with autism, there is continuous inflammation of the cerebellum--the part of the brain which coordinates motor movements.

Once Joseph's gut began to heal (and presumably became less "leaky"), the inflammation process effecting his cerebellum also lessened. As a result, he's starting to write.

* Fatemi, S. H., Aldinger, K. a, Ashwood, P., Bauman, M. L., Blaha, C. D., Blatt, G. J., Chauhan, A., et al. (2012). Consensus paper: pathological role of the cerebellum in autism. Cerebellum (London, England), 11(3), 777–807. doi:10.1007/s12311-012-0355-9