Diet for IBD

“Dining with Inflammatory Bowel Disease” is such a great article by Dr. Gu and Dr. Feagins. It’s a review covering research about the dietary causes and treatment of IBD. If you can, read the whole thing. It was limited access before, which motivated me to write up this summary, but now it’s open access.

In terms of what *may* trigger, or increase the likelihood of IBD:

IBD is increasing…and associated with a Western lifestyle. Many suspect diet is a main component of that.

General beliefs

  • Nearly half of people with IBD believe diet contributes to the development of the disease
  • 69% of people say they get little to no info from providers.
  • Info found on online is often restrictive, conflicting and of poor quality.

What diet components might contribute?

  • Meat—especially red meat, may be a component. When meat is digested and broken down in the gut, it releases hydrogen sulfide, which might be a part of the development of UC. There are several potential mechanisms, including that the gut mucosa may be more permeable to pathogens. While studies are mixed in their findings of the relationship between meat and IBD, there is generally a trend toward finding that relationship, and a prospective study showed that people with UC who had a higher red meat consumption had a greater risk of relapse.
  • Fat—a Western diet tends to have inflammatory fats. There’s been a lot of interest, and suggestion that omega 3 fats might be protective. One large study showed that women consuming healthier fats had lower risks of UC, particularly.
  • Emulsifiers—Much of the research is on animals, showing that these may cause bacterial changes through less diversity in the microbiome, a general increase in inflammation, less butyrate (a helpful short chain fatty acid) and may cause increased intestinal permeability and changes in the mucosa (!!!) Not good! Few studies have looked at humans, the little study that has been done suggests that carrageenan may cause problems for IBD patients.
    • These are nearly ubiquitous in anything found on a shelf in the grocery store in a package. This means things like carrageenan, polysorbate 80, carboxymethylcellulose and the range of gums found in so many foods on the shelves.
  • Microparticles: these are small particles of aluminum, titanium dioxide and silicon—more study is needed to see where these fit and what impact they may have.

Beneficial effects

Finally! Research is starting to support the protective effect of fiber. Most studies are suggestive of a protective effect, although not all are statistically significant. Fiber may help with mucosal function because it supports the production of short chain fatty acids.

Preventing relapse

One study reports that ~68% of people make diet changes to prevent relapse, with 66% giving up favorite foods. But what are they choosing? And does it help?

  • Spicy, dairy, fatty foods and fibrous foods and possibly alcohol were what patients ID’d as a problem, but studies haven’t backed it up.
  • There is brief, but important mention that many test positive for lactose malabsorption, but a smaller portion have symptoms, mainly diarrhea—43% with CD, and 32% with UC. That’s a lot, but it isn’t all patients, either.

The diets…oh, the diets.

Exclusive Enteral Nutrition (EEN)

This means only 100% liquid feeding, either orally or by tube feeding. This is generally done for pediatrics, and it is unknown why it works, but it does for Crohn’s. Polymeric is as helpful as elemental. Studies are good for children, as good as steroids are; this isn’t the case for adults. (Cheryl’s note—my understanding is that EEN is often used in Japan with good rate for success—and many adults are unwilling to do it. I can’t blame them!) EEN does not seem to help UC.

CD-TREAT/ CDED (Crohn’s Disease Exclusion Diet) are two diets that try to mix EEN and “whole foods” to increase tolerability for children. This is very promising. (Cheryl’s note—details of the CDED have not been fully released because studies are still ongoing. While some info is available, it isn’t enough to fully design a diet. It’s frustrating as a clinician. Stay tuned.)

SCD—Specific Carbohydrate Diet

The SCD removes many foods that are believed to be poorly absorbed. It removed all grains, and focuses on fruits, vegetables, proteins, nuts. Etc. While studies are still limited, there is indication of improvement, including reduction in medications, and results have been promising, especially in pediatric patients.

(Cheryl’s note: I wrote a review of the research on the SCD for RDs a few years back which is mostly up to date.)

There are ongoing studies, including the DINE SCD and PRODUCE study, which looks at comparing a strict SCD diet with a modified SCD. These will be great additions to our overall knowledge.

Low FODMAP

Low FODMAP is generally used for IBS. It restricts rapidly fermentable carbs, and if patients benefit, reintroduces them in a systemic way to identify culprit foods.

There have been only a few studies, but those found that people on a low FODMAP diet did see decreases in symptoms for people with IBD. Changes were in symptoms like pain, bloating, etc.—fecal calprotectin did not change.

  • Low FODMAP is not intended as a long-term diet—it is an elimination diet. Following the elimination long term might lead to nutrient deficiencies. Don’t do it!

Cheryl’s note: The article notes that low FODMAP is notoriously hard to follow. May I suggest that with the support of an experienced professional, it really should be quite manageable. 🙂 Monash University has a list of RDs around the world who are extensively trained. I do have some resources for low FODMAP here.

Semi-vegetarian diet

A small, prospective study found benefits in Japan. This has not been duplicated in other places by other researchers. However, studies of reducing meat in other circumstances have not yielded benefits. This may be about different diet practices or adherence.

Curcumin may be a helpful adjunctive therapy. There is some data for mild to moderate UC. There is also now data for patients with CD showing endoscopic improvements as well. (Chery’s note—exciting!)

Moral of the story—more data is needed. And give lots of love to providers who you see who know and care about diet and IBD, because they are awesome!

Many thanks to Phillip Gu, MD and Linda A Feagins, MD.

October G-Free Newsletter

Halloween toys as treats
Halloween toy treats

Halloween candy lists are out for 2019. As many of you know, sometimes candies that are normally GF are not gluten-free when they are in holiday shapes. But those of you who have been reading for a while know my feelings on Halloween candy—skip it, and go for toys! It’s more inclusive, and you’re less likely to eat the leftovers.

HuffPo has a GF bread roundup. Is your favorite there? Maybe your new favorite will be.

ghost-shaped meringues
Spooky Meringues

Looking for a fun recipe? Spooky meringues are a staple around here. Meringues are a regular here because they’re simple…. And I appreciate that they are gluten-free, dairy-free, soy-free, low FODMAP, gastroparesis friendly, GERD friendly…and delicious! The recipe is here for the bunnies, just draw a squiggle instead of a bunny. ?

Interesting research

Why get relatives screened for Celiac? Because they’re more likely to have it, even without symptoms. 44.4% had Celiac, 28% with no symptoms.

Isn’t this fascinating–> different probiotics may be able to suppress or even reverse food allergies. Granted, studies are currently only in mice, but it’s still a neat and encouraging concept.

Ah, the new cross-contamination study…I have so many thoughts. First, food anxiety is real. It’s a problem. I see it in clients, and I experience it, too. It’s no fun to get sick when eating out, or with friends. And study after study has shown that people with Celiac often have incomplete healing from intestinal damage. And then there’s a new study showing that it’s safe to be less concerned with casual contact and cross contamination at home. It’s a very small study, and that’s been a major concern. It addresses components (toasters, pasta water, etc.) when the real question is, what would the implication be for a real person over a typical day? The study contradicts all of the major Celiac orgs and what I’ve seen with clients over the years. I’m really curious to see if/when it’s repeated, and I have very mixed feelings. And, of course, if people are getting all the “allowed” contamination at home, what happens when they inevitably go out?

Bottom line:

  1. This is a very small study
  2. The test methods seem to be inadequate (my background isn’t in this arena)
  3. People with Celiac can only tolerate trace amounts of gluten. It’s often easier to control contamination at home than out.
  4. I absolutely agree with study authors in articles saying this study means that people should feel safe traveling without bringing their own pots and pans and utensils with them as they travel. I have rarely encountered clients who do that, and if this study provides peace of mind on that front, great.
  5. As summed up by Dr. Fasano from the Center for Celiac research: interesting, but it’s not enough to change any of the current guidelines at this point.

I look forward to more research on this as it comes out…and will keep you all posted.

And re: food fears, there’s a great post here from Kate Scarlata on food fears.

A new study on the AIP diet shows that it helps IBD (Crohn’s & UC). This is great news! The AIP is a very restrictive diet that removes grains, sugars, nuts, seeds, eggs, nightshade veggies, beans, and more. But…the rates of improvement were about the same as studies that were less restrictive, which is disappointing. It’s possible it helped people who had more severe damage. But the study doesn’t try to separate the effect of unlimited RD support, a health coach and a community focused on stress reduction better sleep, etc. and attributes all the positive changes in quality of life to diet change, which isn’t reasonable.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, food allergies, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

G-Free On the Go

Cheryl and blueberry plant

August is often a great time for road trips! I’ve been having conversations with clients about dining out gluten free more than usual lately, so I wanted to share some tips:

Cheryl and blueberry plant
Cheryl Harris with her blueberry plant in July 2019

Local NoVA gal Karen runs GlutenfreetravelSite.com, which is a great resource and has an app. Find  Me Gluten Free is also a wonderful resource that also has an app for restaurants. Of course, reviews are only a starting point, you need to ask good questions—unless you’ve gone somewhere that’s dedicated gluten-free. Here’s a list for places from DC to Maine, and another dedicated GF restaurants in the DMV. Of course, these places can only exist if our community supports them!

My favorite question is, how do you make sure that xyz stays gluten free? If the waitstaff has an answer like, oh, we have a process with separate fryers, separate workstations, or that they grill on foil, or use different utensils or a process of whatever kind, I feel somewhat comfortable. They’ve thought through the pitfalls and that’s a big plus.

If I get a blank stare, that tells me that either I need to educate them and talk through each step carefully, or I may want to reconsider eating at that place. It’s just not worth it to get sick.

I also like the dining cards from Triumph dining, which are on Amazon…unfortunately the only have disposable ones now, but they are still helpful tools when out to eat.

What to pack? I have my grab and go list of bars and etc. in addition to naturally GF staples.

Enjoy the rest of your summer!

G-Free Preparedness, Classes

What a month. We’ve gone from a sauna to monsoon season. At least my green beans love the water!

Here’s a quick g-free update:

Do you have food supplies for a natural disaster? The good news is it sounds like DC Metro won’t be hit very hard, but it’s always a good idea to make sure you’re stocked up…just in case. If/when there is need, food banks likely won’t be prepared to take care of the gluten-free community, so it’s a great idea to be as prepared as possible. This list gives a bunch of shelf stable options.

I’ve also updated my “grab and go” list that has healthier g-free bars, snacks, etc.

————————————————

Got g-free kids? Children’s Celiac Disease Program has new classes in VA, MD and DC that sound like great fun, and they’ve asked me to share with you all (and please share widely with others you know with children with Celiac)

“The Celiac Disease Program is proud to continue working with parents and children through our Peer Mentorship and Community Education Programs. They are meant to give you in-person support and access to our Education Team as well as opportunities to meet and socialize with other gluten-free families. Our Community Education classes will expose you to a range of topics about living a gluten-free lifestyle and will meet three times a month. Please check the listing to find the class that is most convenient for you.”

Stay safe & dry!

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

Digestive News

Digestion—New Celiac Research, FODMAPs & more!

Hope you’re having a happy and healthy summer. It’s one of my favorites because I love the fresh yummy stuff!  Before we talk about digestion, here are tips on g-free eating at summer events and some easy grab and go options good for travel.

Maybe it’s just me, but I find everything related to digestion fascinating! At the end of the day, we aren’t what we eat, we’re what we absorb. So how well the gut functions is key to every aspect of our health.
Here’s a quick snippet of new digestive studies and tips:

  • A new drug might help keep people with Celiac safe from cross-contamination with gluten. Exciting stuff, but also not yet available.
  • Poop! Everyone poops, most people don’t love talking about it. So many clients ask about fecal microbial transplants and what they’re used for. Currently, they’re used for c. diff infections, but there’s curiosity if it can help with autoimmune diseases, too! Digestive Disease Week 2018 was a few weeks ago and they gave a great explanation of FMT, and they cover keeping a healthy microbiome more broadly.
  • All you ever wanted to know about gluten and oats from Gluten Free Watchdog.
  • The gut and the brain—what’s the connection? This article gives a great overview, and specific therapies that may be helpful to ease tummy troubles.
  • What’s the problem, is it the gluten, or is it something else? For Celiac disease, it’s definitely the gluten. But for people without Celiac, the jury is still out as to the component of wheat that’s most irritating. Of course, bottom line, for many wheat is an irritant even if it’s not the gluten for some.
  • A review from Medscape of the top 5 digestive research topics in the last year. It includes studies on Celiac, PPIs and more.
  • Reader’s digest did a post on favorite supplements—and my pick was one that I often use with digestive clients. Any guesses?
  • Low FODMAP friends—it’s garlic scape season! Garlic scapes are the green shoots that grow out of the ground when you plant garlic. The good news is that they’re perfectly FODMAP friendly and give garlic flavor.  If you’ve learned that garlic and onions are not friendly to your tummy, this is your time of year! It’s pretty easy to find garlic scapes at the Farmers’ Market (as you can see above), and also spring onions with the greens on them. You can get a bunch, puree the greens (not the white part!) and freeze them in an ice cube tray. Then, when you need a little of that flavor, pop a cube in whatever you’re making.
  • What is a FODMAP, anyhow? FODMAP is an acronym for classes of carbohydrates that are poorly digested, which is why they can cause obnoxious symptoms. There’s a growing amount of research supporting it for people with tummy troubles of all sorts, especially IBS or IBD (Crohn’s, Ulcerative Colitis) and SIBO (Small Intestinal Bacterial Overgrowth). Reducing these FODMAPs help about 75% of people with IBS problems. Obviously, this is a big deal for many people who experience ongoing gastrointestinal distress.

If you are on a low FODMAP diet, I try to keep updating my list of FODMAP friendly products.

  • Also, I had an hour-long radio chat with host Eli Marcus on the Motivation show on a range of topics, including gluten, digestive disorders, supplements, meditation, self compassion and more. Take a listen!

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

G-free Thanksgiving ’17

Thanksgiving tips & Recipes

Happy almost Thanksgiving! I’m sure this is already on your radar if you’re gluten-free.

AnchorThanksgiving tips:

It takes a little planning ahead to guarantee a great Thanksgiving. In many ways, it’s easier if you’re hosting, because you’ve already got the most familiarity with the diet. Most people hate to impose on their hosts, but it’s easier on you AND your host to ask beforehand than sit through a four-hour meal and watch others eat. Remember, nothing is more important that staying safe! I love these tips from Shirley of GFE and from GF Jules.
My 3 favorite tips:

  • Plan ahead, and try to bring along safe options when possible.
  • Bring along or order ingredients online that might be a problem. This includes broth, gravy, butter without crumbs, soups, flour for thickening, etc.
  • Keep it as simple as possible.

Turkey:
Though it’s always good to check, the good news is that all plain, fresh turkey is naturally gluten-free. Again, that’s ALL plain, fresh or frozen turkeys. I know there are emails that go out every year about warnings of “hidden gluten” in the turkeys, but ironically, the turkey usually the easiest and safest part of the meal. For the past 6 years I’ve been looking, calling and asking around if any of the brands of un-stuffed turkeys have gluten, and I haven’t found a single one in all that time. If you’ve seen one, email me or leave me a comment below. So you do have to look out for stuffed turkeys, and you do want to look out for gravy packets and of course, the preparation of the turkey.

The only exception Tofurky, which has gluten, and some glazed hams DO contain gluten. As always, read carefully! I have a gluten-free turkey list, with has manufacturer contact info.

As always, there can still be risks in the ingredients used on or in the turkey, and cross-contamination always needs to be on your radar. You’ll need to talk to your host about:
* Preparation method: Broth used for basting, or even the butter used for basting. This also includes the kind of flour used if a turkey is cooked in a bag.
* Seasonings
* Stuffing in the turkey
* Cross contamination<–and this is the most common problem.

AnchorGravy

Many regular canned gravy and gravy packets are not gluten-free. Gluten-free gravy is available online, and Whole Foods, Trader Joe’s, Wegman’s, etc. sell  some now. Even Mc Cormick’s has a gluten-free gravy packet that’s certified GF! Also, it’s pretty easy to make a simple gravy with gluten-free broth and cornstarch instead of wheat (and if corn is a problem for you, arrowroot can be substituted 1:1 instead).

Herb Gravy From Elana’s Pantry

My favorite gravy (paleo/starch free)

Gravy using Cornstarch from Simply Recipes

Side dishes

There are lots of good options here. Green bean casserole works, just sub the french onion–Aldi’s even has GF version in stores now, or use Fritos, or almonds, and buy a GF cream soup–Pacific is in most stores. Or get creative–we do roasted green beans, baked yams, cranberry relish, gelatin salads, butternut squash soup, mashed potatoes, roasted veggies, applesauce…all of these things are easy to adapt to food restrictions, and they’re healthy and delicious to boot.

Stuffing:

This is obviously requires a bit more planning. You can go the nontraditional route and do a wild rice, buckwheat or quinoa stuffing. You could use a gluten-free cornbread or pre-made GF bread crumbs, too. Aleia’s and Arrowhead mills are easy to find locally.

Make sure that “regular” stuffing is not used to stuff the turkey. Not only does that raise the risk of food poisoning, but the whole turkey would be cross-contaminated with gluten.

Cornbread stuffing with roasted acorn squash from the Gluten-Free Goddess

The NY Times Blog had a G-Free Stuffing section with a few recipes

Dessert!

For many people (myself included!) dessert is the highlight of the Thanksgiving route. If you’d like to use your standard old-school recipes, you can easily make a crustless pumpkin or sweet potato pie or check out Whole Foods’ GF crusts. Or, you can easily make a crust from crushed up gluten-free cookies, shredded coconut or almond meal. Apple crisps are also simple, too. And, of course, now with the GF Wegman’s or Betty Crocker mixes, a cake or brownies are pretty simple, even if they’re not traditional.

The Best Pecan Pie (one of my very favorites)

Sweet Potato Pie (vegan)

Easy, Crustless Apple Pie from Gluten Free Easily

Super-cute baked apples from GF Jules

Ginger Lemon Girl’s Pecan Pumpkin Pie bars

Apple Crisp: simple, delish!

T Day Recipes:
It’s dangerous when someone asks about food while I’m hungry. Here are a bunch of  wonderful things that would make for an absolutely amazing gluten-free feast some of my favorite GF bloggers and around the web.

And as a bonus, the Happy Tart has a bakery in Falls Church in addition to the Alexandria location, so it’s even easier to get a g-free pie without pulling out a rolling pin. Same goes for Rise in DC, Lilit Cafe, and the new Red Bandana

  • Wanting to make sure you’re not overdoing it through the holiday season? Here are my tips for keeping food balanced.
  • For those of you up in Maryland or who are up for a drive, Dr. Fasano of the Center for Celiac Research is speaking in Baltimore November 18th at In Good Health Holiday Expo. He’s always an informative and engaging speaker.

As always, wishing you and yours a joyful, peaceful and yummy holiday season.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax, VA.  She helps people with a range of dietary issues, including Celiac Disease, digestive issues, food allergies, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742. 

GF Halloween & News

Happy almost Halloween!
First things first: if you’re getting Halloween candy, make sure you’re checking the gluten-free status. Many brands that are typically gluten-free have special versions of holiday candy with different ingredients, which can include gluten, or other allergens.Celiac Disease Foundation has a great list with gluten and other allergen info listed.
Simply Gluten-free has a list of candy out, too.

But…maybe it’s time to go the non-candy treat route instead? I’m a fan, and I’ve been doing it for years. We give away slinkies, rubber duckies, and other fun toy assortments. Less temptation, of course, but great for kids (or parents) with Celiac or food allergies, too. If you decide to go the non-food-treat option, Food Allergy Resource & Education (FARE) launched the Teal Pumpkin Project. It now has an interactive map so that children with food restrictions can find safe houses to visit and you can add your house to the map so children and parents know that safe options are available.

News:

  • Some of you know I’ve long been concerned about the reports of contamination issues in Cheerios. The Canadian Celiac Association just announced a decision by the  Canadian Food Inspection Agency that by Jan 2018, the words “gluten-free” must be removed from boxes of Cheerios sold in Canada. Per the release: “Based on the advice of the members of our Professional Advisory Board, the experts of the Gluten-Free Certification Program, and other professionals working in the field, we believe that there is not adequate evidence to support the claim. When added to many reports from consumers with Celiac disease reacting to eating the cereal, we believe this is the safe recommendation for Canadians.”

My take: there is no indication that the FDA will take a similar step. However, I am hopeful this will push General Mills to take additional steps for safety and monitoring to ensure that their cereals are labeled accurately and appropriately.

  • A new study suggests that there’s a test on the horizon sensitive enough to detect Celiac accurately, even if gluten was consumed one time. This should make diagnosis much easier, and reduce the need for a long gluten challenge when this test is available.

Fall recipes:

One of the things I love most about autumn is the beauty of the leaves.  The food is a close second! Here are some of my favorites:

  • Butternut Squash Bisque: The tastiest way to get vitamin A! A wonderful soup for the fall or winter. Allergen friendly with a dairy free option.
  • Hot Mulled Apple Drink: a favorite at our annual pumpkin carving party. It’s the perfect drink for a crisp autumn day.
  • Pumpkin Seeds: several variations on this classic snack.
  • Roasted Green Beans: So easy to get green beans this time of year. Yum yum yum!

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

 

Summer fun–Aug ’17

Summertime recipe, hydration & office change.

Summer rolls:
One of my long-term goals is getting my husband to eat more veggies. When we met as teens, he remarked that the only green food he liked was mint chocolate chip ice cream, so I’ve had lots of practice converting a non-veggievore. He’s come a long way, and happily eats roasted broccoli, grilled peppers, even roasted cauliflower and a few others. But like so many picky kids and spouses, left to his own devices, veggies would rarely happen.

Summer rolls are often an easy way of getting in more veggies, and they’re a lot easier than they look. There’s something about the rice paper that serves as a veggie cloaking device…I don’t understand it, but somehow I’ve consistently seen carnivores chow down on my summer rolls.

Ingredients:
12 lettuce leaves, halved
1 cup shredded carrots
about 1/3 napa cabbage, sliced very thinly
1/2 yellow, red or orange pepper, sliced thinly
1 cup bean sprouts (optional)
1/3 cup mint leaves, cilantro or basil
15 rice paper wraps (a few extra in case of mistakes)

So here’s the general idea:
Have a large dish of warm water and all of your veggies arranged. Put the rice paper in warm water for ~15-20 seconds. It should be firm, but not mushy.

Fish out your rice paper and arrange it on the plate.

Put down the lettuce leaf and add a little cabbage, carrots, pepper and herb of choice.

If you overfill, it won’t close. Less is more.

Roll up! If the paper rips, you can double wrap.

That’s it! Chopping the napa cabbage is the most time consuming part, and start to finish, this recipe is just 30 min.

Gluten-free, vegan, FODMAP friendly. Good stuff. I serve it with peanut sauce or another dipping sauce.

Is hydration a challenge for you during the summer? In addition to adding fruits or mint leaves into your water, consider adding in more hydrating fruit and veggies. A few good ones:

Many veggies and fruit can be a great source of hydration, including

  • Cucumbers
  • Lettuce
  • Zucchini
  • Radishes
  • Celery
  • Tomato
  • Cabbage
  • Peppers
  • Strawberries
  • Watermelon
  • Grapefruit
  • Cantaloupe

and my personal favorite for today, peaches!

As we’re talking about veggies and fruit, here’s an article on buying organic on a budget.

Change in the air…
As of Sept 1st, 2017, I’ll be only seeing clients in my Fairfax office, 9675 A Main Street.

I’ve enjoyed working in Alexandria for the past 10 years, both on Duke Street and in Kingstowne. When my husband and I moved further west, having two offices seemed like a good temporary solution, and the plan was to stay a year or two. Six years later (how does time fly so quickly?), it’s finally time to move to Fairfax full-time. After juggling two leases, managing requirements for two tax localities, sending out two different sets of directions and still having some clients end at the wrong place, and making sure the right folders in the right spot, I’m looking forward to the simplicity of this change.

The Fairfax office is right on Main Street, across from Woodson High School, and about 3 miles from 495. I’ve got an overflowing lending library, and I love the spot.  It’s a great place for nutrition sessions.

So…I will be in the Alexandria office through 8/31/17. if you’re hoping to get a time slot in at the Alexandria office, please drop me a line ASAP. And I look forward to seeing many of you in Fairfax.

Last but not least, Summertime always flies by for me, and I hope you get a chance to get away and savor whatever most delights your heart.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax  VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, veg/vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

G-Free News

Often the summer is a slow time for news and research, but not this year! A rundown on communion wafers,

possible changes in Celiac diagnosis guidelines, FDA GF labelingnot-so-gluten-free pizza, the Specific Carb Diet & IBD and and office change.

Communion wafers:
The Vatican caused a stir when they released a statement that gluten-free communion wafers are not permitted, and the statement itself was a bit confusing. But this actually isn’t new. Church requirements have always stated that at least small amounts of wheat must be present in communion wafers, so truly 100% gluten-free wafers don’t meet that standard. Since 2004, the church has allowed low gluten hosts, which contain trace amounts of gluten that are high enough to meet church requirements, but low enough to get approval from Dr. Fasano and many Celiac organizations. For people who react to even the smallest amounts, having wine only is an option—but only from a separate glass.

The end of biopsies? Not so fast…
A new study showed that a biopsy may not be needed to confirm a Celiac diagnosis in children, and this debate has been happening for the last few years. But make sure you’ve read the fine print. The study showed that people with a tTG (antibody) level more than 10 times above the normal level, and a positive EMA (other Celiac antibody) were normally accurately diagnosed, even without a biopsy. Guidelines for children in the U.S. still recommend a biopsy, and there hasn’t yet been exploration for adults.

My take—Celiac is a lifelong disease, so getting a firm diagnosis is a really important thing, especially for a child. I frequently see clients who are preemptively diagnosed with Celiac based on labs…but when we look at their labs, they don’t meet either criteria–and of course, we don’t know for sure this applies to adults. Working with a knowledgeable gastroenterologist is a big plus, and should always happen.

Move over, Domino’s—there are other not-so-gluten-free crusts
Papa John’s just debuted a gluten-free crust…sort of. According to the company, “it is possible that a pizza with gluten-free crust could be exposed to gluten during the in-store, pizza-making process. Therefore, the brand does not recommend its Gluten-Free Crust made with Ancient Grains for customers with Celiac Disease or serious gluten intolerances.”
My take? I really appreciate companies offering gluten-free products, because I’ve seen people have a much easier time with the diet over the last decade or so. But if they’re going to do it, do it right.

FDA and gluten-free labeling
As many of you know, it was hard enough to get the gluten-free labeling rules passed. Now there has been ongoing difficulty getting the FDA to actually enforce the gluten-free labeling regulations—and of course, if the rules aren’t enforced, they don’t do much to protect the gluten-free community.  Here’s a video letter to the FDA from Gluten-free Watchdog, and if you’re so inclined, feel free to tweet to @US_FDA, tag the FDA on Facebook and/or write letters to the FDA in support of meaningful gluten-free labeling.

Heard of the Specific Carbohydrate Diet?
The SCD has been around for ages…close to a century, actually. The author of the diet, Sidney Haas, MD was quite a pioneer. The SCD was initially intended for the treatment of Celiac disease before doctors even understood what caused Celiac, or could test for it. In recent years, it’s been used for people with IBD (Crohn’s and Ulcerative colitis). Clients have always asked me about it, but there’s never been good studies on it until very recently. Here’s a rundown on what the research shows. Putting this together was a labor of love for me. I find it fascinating and have been delighted to see clients feel better.  I’d encourage you to share with anyone with IBD.

Change in the air…
As of Sept 1st, 2017, I’ll be only seeing clients in my Fairfax office, 9675 A Main Street.

I’ve enjoyed working in Alexandria for the past 10 years, both on Duke Street and in Kingstowne. When my husband and I moved further west, having two offices seemed like a good temporary solution, and the plan was to stay a year or two. Six years later (how does time fly so quickly?), it’s finally time to move to Fairfax full-time. After juggling two leases, managing requirements for two tax localities, sending out two different sets of directions and still having some clients end at the wrong place, and making sure the right folders in the right spot, I’m looking forward to the simplicity of this change.

The Fairfax office is right on Main Street, across from Woodson High School, and about 3 miles from 495. I’ve got an overflowing lending library, and I love the spot.  It’s a great place for nutrition sessions.

So…I will be in the Alexandria office through 8/31/17. if you’re hoping to get a time slot in at the Alexandria office, please drop me a line ASAP. And I look forward to seeing many of you in Fairfax.
Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax  VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, veg/ vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.

Veggies galore!

For many people, getting in more veggies is a big plus for good health. If it’s been a struggle, you may want to dress up your options, and/or head to a local farmers’ market for inspiration. It can also be fun to stop at a local community garden. I know I’ve got a bunch of beautiful things growing in my garden!

Here are some easy, quick, veggie-rich trades for traditional carby sides:

Cauliflower rice: You can buy bags of pre-chopped little pieces of cauliflower that are the consistency of rice, but with a ton more nutrients. It has a pretty neutral flavor, and takes on the taste of the rest of the dish. Bonus–it only takes 15 minutes to cook on the stovetop.

Zoodles (AKA zucchini noodles)—or similar carrot, sweet potato or beet noodles. You can buy them at many stores, or make them yourself with a spiralizer. These make a great swap for pasta noodles, and can be fun to make, too. Dress them up the “noodles” with herbs & you’re good to go.

Collard (or Swiss chard) wraps–upgrade your wrap; consider using a collard leaf.

Spaghetti squash:

Quick, simple, delicious. Cut it in half, rub with olive oil, roast. Done. Then you can scrape up the “noodles” and enjoy as a side to your favorite dish.

Jicama: ever had jicama? More on how to peel and cut them here. This crisp root veggie has all sorts of health prebiotics, and more nutrients than a bowl of tortilla chips. It’s a great swap for dipping your salsa or guac.

Or portabella pizzas:

Take a portabella mushroom, top with sauce & cheese & you’ve got a mini pizza right there!

Cauliflower pizza crust:

I’ve only heard good things about this new crust from Trader Joe’s–and you can easily top with your favorites to suit you taste.

For those of you with tummy troubles who are getting indigestion just looking at these veggie recipes, spaghetti squash and carrot noodles are good options. Also, I just posted an updated list of low FODMAP shopping guide.

I’m sure I’m missing some of your favorites. Feel free to leave me a comment on this post.

Cheryl Harris, MPH, RD is a Registered Dietitian Nutritionist and Certified Wellcoach in Fairfax VA.  She helps people with a range of dietary issues, including Celiac Disease, GI issues, food allergies, pregnancy, breastfeeding, vegetarian and vegan diets, preventing diseases and “whole foods” eating. Let’s get you on your way to achieving your goals and feeling great!  Email or call 571-271-8742.