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

 

 

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

Latest Fecal Transplant Study

Imagine a pilot study for an IBD biological* treatment that had:

  • No serious side effects
  • Required 5 days to administer (about an hour a day)
  • Produced clinical remission in 3 out 10 pediatric patients with ulcerative colitis
  • Resulted in continued remission for 4 weeks after the treatment

The good news: these are the actual results for a fecal transplant study conducted at Helen DeVos Children's Hospital in Grand Rapids, MI and released in late April.

The stool samples, from a 1st degree relative, were blended with saline, filtered through gauze, and administered via enema.  (Don't try this at home--more in the next post.)

Here's a further look at the stats:

  • 10 patients enrolled, ages 7 to 21
  • 9 completed the study (1 could not hold the enema)
  • 7 out of 9 showed a positive clinical response
  • 3 of these 7 went into remission
  • 6 out of 7 positive responders maintained the improvements 4 weeks later--this includes 3 remaining in remission

These types of results, especially the lack of serious side effects, could literally change standard IBD treatment.  None of the mainstream** IBD treatments purposely targets the gut flora.

With this pilot study complete, and more studies surely underway, the hoped for obsolescence of this site*** will perhaps speed up.

* The study noted: "When used to treat a disease, human stool constitutes a drug and a biologic. Therefore, an Investigational New Drug approval (IND#14993) was obtained from the United States Food and Drug Administration ..." ** Off the mainstream, gut flora targeting approaches include (a) the SCD, GAPS, and similar diets; (b) parasitic work therapy; and (c) fecal transplants.

*** Would diet in combination with the transplants improve the health of the study's non-responders, or further help those who did better but did not each remission?

more information: - Abstract: Safety, Tolerability, and Clinical Response after Fecal Transplantation in Children and Young Adults with Ulcerative Colitis

New SCD Cookbook!

A Taste of Wellness bookWe received the new Specific Carbohydrate Diet cookbook "A Taste of Wellness" by Rochel Weiss of Digestive Wellness in the mail a few weeks ago.We could not believe the size of it when we unwrapped it from the package! Acccording to our sources, this 450+ page book has taken quite a few years of dedication and we congratulate Rochel on the effort to bring these SCD recipes to a wider audience.

As an SCD author and blogger, we do appreciate this effort by Rochel (and Digestive Wellness) to put together a comprehensive yet easy-to-read cookbook that offers a range of items: from basics such as Hearty Chicken Soup and Almond Bread; to SCD dinner party favorites like Salmon Fillets with Creamy Lemon Sauce and Three Layer Vegetable Kugel. The Baked Goods section has wonderful sweet treats such as Quick-As-A-Wink Brownies and Lemon Drop Biscuits, alongside more savory offerings of Almond Crackers and Pretzels.

The book is organized neatly by food categories, and there is also a section that suggests different breakfast, lunch and dinner menu options. Some of the recipes are accompanied by photographs (see below) that are well thought-out and informative. This can serve as a hidden resource for those short on time who seek help in organizing their meals and shopping lists for the week.

We at scdrecipe.com are looking forward to delving into this great new cookbook and trying out some of these wonderful recipes as spring approaches!

 

Gluten-Free not Working for Celiac Disease? You're Not Alone

If you continue to suffer from diagnosed celiac disease while following a strict gluten-free (GF) diet, you're not alone.  Recent studies, found that 34% to 92% of adults do not show mucosal recovery on a GF diet. In other words, the intestines of many celiac sufferers do not heal while on a GF diet.  Although they may feel better on a GF diet, how much better?  Their intestines show that symptoms still exist. Far from being small or obscure, these studies range from 158 to 465 people and have been published in respected journals.  The Mayo conducted the first study listed, with 381 people.

# Subjects Year Title
(Journal)
Note
n=381 2010 Mucosal recovery and mortality in adults with celiac disease after treatment with a gluten-free diet
(Am J Gastroenterol 2010; 105:1412–1420; doi:10.1038/ajg.2010.10; published online 9 February 2010)
Mucosal recovery was absent in a substantial portion [34%] of adults with CD years after diagnosis (Kaplan–Meier 2-year and 5-year mucosal recovery rates of 34% and 66%, respectively). The median time to confirm mucosal recovery was 3.8 years. (Mayo clinic)
n=249 2007 Coeliac disease: a histological follow-up study
(Histopathology. 2007 Mar;50(4):465- 71. Bardella MT, Velio P, etc)
All patients showed an improvement in mucosal findings after starting a GFD, but complete histological normalization was observed in 74.1% of paediatric cases (diagnosed before 14 years of age) and in only 17.5% of adults.
n=158 2002 Histologic follow-up of people with celiac disease on a gluten-free diet: slow and incomplete recovery
(Am J Clin Pathol. 2002 Sep;118(3):459- 63.)
Histologic recovery in celiac disease after starting a gluten-free diet takes time and is incomplete or absent in a substantial subgroup of patients (10.1% villous atrophy after 5 years). [But 25.9% of recovered group classified as Marsh II. And 23.8% as Marsh I. Marsh II does not sense to classify as "recovered".] (10.1% + 23.8% = 33.9%)
n=465 2009 Complete recovery of intestinal mucosa occurs very rarely in adult coeliac patients despite adherence to gluten-free diet.
(Aliment Pharmacol Ther. 2009 Jun 15;29(12):1299-308. Epub 2009 Mar 3.)
429 out of 465 [92.2%] cases classified as Marsh III: increasing lymphocytes, larger-than-normal crypts, villi shrinking/atrophying

The SCD, or specific carbohydrate diet, was originally a treatment used for celiac disease. If a GF diet is not helping you for celiac disease, definitely read up on the SCD, as well as some of the introductory protocols in the GAPS diet.

(Note: These studies were examined after talking to a decades-long celiac disease sufferer--a fully diagnosed celiac patient for whom a GF diet wasn't working. Despite top medical care, the celiac disease still led to many years of antibiotics, respiratory ailments, and a host of other issues. This person has now spent 4 healthy years on the SCD.)

Roughage and IBD: The Law of Physics Still Applies

This is quick anecdote on why it is important to read a copy of  Breaking the Vicious Cycle* before starting the SCD. I recently talked to someone who followed the SCD for 5 weeks and continued to suffer from diarrhea. He followed the diet "strictly", including a daily salad without any added sugars, binders, or anything else that is SCD "illegal."

However, he had only read SCD information online and missed an important point:

Do not raw vegetables and fruits if diarrhea is active.  The exception is ripened bananas that have black spots beginning to appear on skin.

His daily salad did more harm than good!

According to mainstream IBD treatment, patients should avoid raw fruits and vegetables.  (I don't think it's uncommon for an IBD sufferer to spend years wary of the raw vegetable.)  His quick glance of SCD foods online showed that raw vegetables and fruits are OK.  However, these foods are only OK after IBD symptoms, especially diarrhea, have stopped.

The mechanical action of roughage on an injured bowel will be harmful--whether you are on the SCD or not.

Bottom Line:  If you're going to use this diet, be diligent: read Breaking the Vicious Cycle at least twice, and then plan for at least a week before suddenly switching to a new eating regimen.  Equally important, make sure you are under medical supervision--e.g. consult with your doctor.

* Disclosure:  Similar to other sites, clicking the link above will give this site a % of the amazon sale price.  However, you can ask your library for this book or order a used copy.

Autism Research Institute Conference: SCD & GAPS

Autism Research InstituteThis Saturday, at the Autism Research Institute Spring Conference, Pamela Ferro will be giving a presentation titled: Gastrointestinal Pathology and the Use of the SCD and the GAPS protocol in ASD. Her talk is scheduled as part of the Nutrition Session where Dr. Martha Herbert will give the keynote address.

For interested healthcare practitioners and parents in the Greater New York area, there is still time to attend the conference.  The panel has experts on autism diets and there will be a chance to talk about different aspects of each.

In addition the conference has hired Chris from Back on Tract, which specializes in SCD food, to prepare food for 250 people during the Nutrition session.

So if you have a chance to attend, it's definitely recommended.  Nothing will be sugarcoated*, including information on how already frazzled parents can change the diets of the pickiest of picky eaters.

* bad pun:)

Turtle Soup Cookbook, Recipes from an SCD Mom

Just in time for holiday cooking, Beth Spencer has written Turtle Soup: Recipes for the Specific Carbohydrate Diet from an SCD Mom. Tonight my copy of the cookbook officially earned it's place in the kitchen, with a finger tip of muffin batter "breaking in" one of the pages (it's obvious which of my cookbooks are well-used:) I appreciated the care in which Beth wrote the

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Tucker Sweeney's Book: "Two Steps Forward, One Step Back"

Go Tucker!  Last night I read the book Two Steps Forward, One Step Back: A Journey Through Life, Ulcerative Colitis, and the Specific Carbohydrate Diet. I planned on reading a chapter or two but flew through it in one sitting.  Quick paced and well written, the book details Tucker Sweeney's experience with ulcerative colitis and how he started using the SCD. Tucker starts out as a super-healthy, low-key but intense 23-year-old in Idaho: an experienced carpenter, a serious climber**, and a college student with the enviable job of

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