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Dietary Guidelines for Patients Who Wish to Live Healthy

Posted By Frank O. McGehee, MD, CCN, Monday, April 6, 2015
Our bodies are 70 to 90% made of water. Sufficient hydration with water is critical for health. Few if any patients who come to us drink enough water. For those people who wish to nourish their kidneys and bodies, people should drink only spring water, or reverse osmosis filtered water. Green and white tea is good for your immune system, and the kidneys read these teas as hydration. For however much you weigh, you should drink ½ your body weight in water (in oz.) daily. Ex: 100 lbs = 50 oz. water. This amount of water is without any extra physical exertion. The ideal water purification system for the home is called Reverse Osmosis, or R.O. The R.O. System should be connected to the home at the point where the water enters the home. The reason for the water treatment system location is the toxic elements found in municipal and well water sources. A 15 minute shower in chlorinated municipal water imparts the equivalent of drinking a cup of chlorinated swimming pool water.

Soy products should be avoided, unless the soy has not been modified. The body “registers” the soy as Estrogen. Women do not need any additional Estrogen with the prevalence of birth control pills, hormones in meat and dairy, and “convenient Estrogen patches”. Most of the soy in America has been genetically modified, and humans cannot assimilate it. The GMO or Genetically Modified Organism process alters the DNA of the fruit or vegetable. When we humans ingest GMO food, the food re­ arranges our DNA!

Unknown to most Americans, 70% of all processed, foods in the supermarkets contain GMO ingredients. Nearly 90% of all corn and soy products sold in the United States age GMO. Many European countries have recognized the danger and have rejected these crops, as have most African countries; the poorest countries on Earth.

Exactly what are GMO foods? GMO foods were critiqued in a recent article in the Journal of Biological Sciences. (2009; 5:706-726) "In this critique, they show that data, when analyzed demonstrated potential kidney and liver problems, as well as damage to the heart, adrenal glands, and spleen, resulting from eating all three varieties of GMO corn." 1

Microwave cooking should be strictly avoided. Plastic containers should never be placed in a microwave, nor should plastic wrap be placed in this cooking source. Many prepared foods advise you to pop the dish into the microwave, and enjoy. Unfortunately, the heat from the oven releases plasticides and chemicals into your food.

Routinely, in the grocery store we witness cases of diet soft drinks being purchased by obese mothers for their family. Carbonated drinks, with sugar or sugar free, are particularly worrisome. In addition to the health danger of the sugar or aspartame in carbonated sodas, additional health dangers lie elsewhere. The “fizzy” part of the drink is phosphate. The pH of a carbonated drink is 2.3, which is extremely acid. Ideal pH level for the body is alkaline: 6.5 to 7.0; acid is a disease state; which allows cancer and other diseases to thrive. Ingestion of one carbonated beverage keeps body pH in the basement for three hours!

Canned foods and drinks are lined with a preservative called Bisphenol A. It is a preservative, and also a poison. Bisphenol A is a poison used to kill pests in crops. It is also a preservative for food. Health conscious people should never consume anything packaged in a can, unless it is certified organic.

An acceptable substitute for sugar is Stevia. Stevia is available packaged in individual packets, or in a liquid form. Stevia sweetener is derived from is a plant grown in South America. Ingestion of stevia does not raise glucose in diabetics, nor is it full of calories like sugar. The “sweet level” is one hundred times that of a teaspoon of sugar.

Most other sugar replacements are to be avoided at all cost. Aspartame found in Sweet and Low is a chemical, which studies have linked to brain cancer and other illnesses. Splenda begins as sugar. The manufacturers remove one molecule from the configuration, and substitute chlorine! Chlorine is commonly used to disinfect swimming pools and unfortunately municipal water. It is toxic!

Bread should be wheat and gluten free, unless it is organic. The reason for this is that the majority of wheat seeds have also been genetically modified. Unfortunately, we humans cannot assimilate genetically modified grain, nor the herbicides and pesticides infused into the seed. Today, we are witnessing a pandemic of gluten sensitivity and allergic responses to the food consumed in our country. Without a doubt, the genetically engineered wheat, corn, and soy seeds are reason for this phenomenon.

Some delicious alternatives to genetically modified wheat bread are available in the frozen food section of most large grocery stores. We enjoy flax and rice seed bread. Other alternatives are sprouted grain bread and Ezekiel bread. Patients with of over growth of fungus, (and most of America) should avoid bread with yeast. Traditional trade pasta is not recommended, nor are white potatoes. Sweet potatoes are fabulous for our health when baked, (no sugar added). The Glycemic Index should be consulted to determine how quickly foods turn into sugar. Some fruits and other foods turn to sugar more quickly than others. Blueberries, blackberries, and strawberries rank low on the index.

Any fruit with a non-porous skin is desirable to protect us against pesticides. Berries and peaches of any kind should be organic; because the skin of the fruit is porous. Conventionally grown fruit has tested routinely positive for at least ten pesticides/herbicides.

For breakfast, we usually juice fresh fruit such as organic baby spinach, kale, organic strawberries, blackberries, oranges, McIntosh apples, egg or hemp protein powder, and 1 cup of almond milk (no sugar added). In addition, a container of yogurt adds creaminess. This delicious drink will carry us until lunchtime. If we are hungry mid-morning, we consume one organic hard cooked egg/or ½ protein bar.


Lunch could be roasted chicken breast, avocado, tomato, cucumber, and a salad of field greens. The dressing is organic balsamic vinegar, extra virgin olive oil, and a 1/2 teaspoon of Dijon mustard. The next day, we will probably make chicken salad with the leftover chicken with celery, boiled eggs, organic mayonnaise, and fresh dill. Mid afternoon snack could be organic whole roasted almonds with Celtic salt or a small piece of fruit or string cheese, or a boiled egg or ½ protein bar. The more raw food you can ingest, the healthier you will be; our goal is to eat 80% raw food daily.

Dinner can be an organic hamburger patty, chicken, steak, or fresh caught Pacific fish, with a baked sweet potato, usually with vegetables or a salad. Soups and stews in a crock pot are great because you can freeze them in small quantities. NO FAST FOOD- IT IS POISON!

I know this probably sounds hard, but please believe me, you will feel a lot better if you observe this diet, at least until you are better. If you want to read about Candida or yeast, Dr. Sherri Rogers has written extensively on yeast. If you want to have a "cheat day" once a week, by all means do so. What you will find though is once you start eating "clean" you won't really want the stuff you should not have. Your body is capable of “speaking” to you once you clean it up. When bad foods or good foods are eaten, the body will tell you how it feels about what you have eaten. People just need to “learn to listen”.


Please email: drmcgehee@hotmail.com
or call Vivienne McGehee, BA, CN at (936)291-3351
Our office is located at:
1909 22nd Street, Huntsville, Texas 77340



1 Dr. Russell Blaylock, M.D.. "Genetically Modified Food: Is the Food Industry Serving Up Poison?" Vol. 7 No. 6 Newsletter, June 2010

Tags:  diet  guidelines  healthy  McGehee  nutrition 

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Five Foods to Keep you Healthy and Well

Posted By Administration, Wednesday, April 13, 2011
Updated: Friday, April 18, 2014

Dr. Magaziner was interviewed live by Pat Ciarrochi on CBS' "Talk Philly" on April 12th. During the segment, he served up valuable information about the five foods he deems fabulous for health and wellness.
 
These super foods include salmon, which is high in Omega-3 fatty acids and helps reduce inflammation, risk of heart disease and triglycerides, while helping combat depression, memory loss and arthritis; sweet potatoes, which are high in Vitamin A, antioxidants and calcium to help in maintaining bone density; celery, which can help lower blood pressure and stress; buckwheat, which stabilizes both blood sugar and blood pressure and cinnamon, which can help reduce blood sugar.

For more info on "meals that heal," please visit http://www.drmagaziner.com/health-resources/meals-that-heal/.

 

Tags:  diet  food and drink 

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A Not-So-Sweet Loss for Organic Sugar

Posted By Administration, Tuesday, February 8, 2011
Updated: Friday, April 18, 2014

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The US Department of Agriculture last Friday gave farmers the go-ahead to resume planting Roundup Ready sugarbeets—claiming it’s the only way to avoid a nationwide shortage of sugar!

Hot on the heels of the deregulation of genetically engineered (GE) alfalfa, the USDA said it would once again allow the GE sugarbeet to be planted, contrary to the order of district court judge Jeffrey S. White, who said a full environmental impact statement (EIS) needed to be done first. As the Wall Street Journal points out, an EIS of the type ordered by the judge is usually thousands of pages long and takes years to conduct. That would have kept the genetically modified sugarbeets out of the hands of farmers at least through 2012.

This would allow farmers to begin planting GE sugarbeets this spring. But the environmental and organic seed groups that originally sued the USDA said Friday they would ask Judge White to block this latest move by the USDA.

Processors say there aren’t enough non-GE sugarbeet seeds around for farmers to plant this spring. A study conducted for the sugar industry predicted that US sugar production would plunge 20% if the judge’s ban stays in place, and it appears this study alarmed food companies enough that they were able the pressure USDA into acting now. (For more on sugar and sweeteners, see our article elsewhere in this issue.)

In this case, the sugarbeets are being “partially deregulated”: USDA is permitting farmers to plant genetically modified sugarbeets this year only if they adhere to rules designed to prevent the plant’s wind-blown pollen from reaching organic fields, where its biotechnology traits could spread—though if the rules themselves prove ineffective, organic sugarbeets will be contaminated.

That contamination is what is most worrisome. The Organic Consumers Association had this to say about the deregulation of alfalfa: “[It is] guaranteed to spread its mutant genes and seeds across the nation; guaranteed to contaminate the alfalfa fed to organic animals; guaranteed to lead to massive poisoning of farm workers and destruction of the essential soil food web by the toxic herbicide, Roundup; and guaranteed to produce Roundup-resistant superweeds….” Health advocates have the same concerns about sugarbeets.

If you haven’t already done so, please visit the Aliance for Natural Health's Action Alert page where you can write to President Obama, Congress, and the USDA, and tell them to reverse this terrible decision. Please contact them today!


Tags:  diet  food and drink 

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Endometriosis and Diet - The Role of Fats

Posted By Administration, Thursday, September 30, 2010
Updated: Friday, April 18, 2014

by Fiona McCulloch, ND 2339180861_ae94f7d9c3_o

A recent study completed at Harvard Medical School found that eating a diet high in trans fat was associated with a 48% higher risk of developing laparoscopically confirmed endometriosis. It was also found that there was a 22% reduction in endometriosis in the group of patients in the highest fifth of long-chain omega 3 fatty acid consumption.

This was a prospective study of participants in the famous Nurses Health Study which followed 116 607 female registered nurses ranging in age from 25 to 42. This study initially found many correlations between infertility and nutrition.  Harvard researchers recently looked at the relationship specifically between fat consumption and the risk of developing endometriosis over 12 years for the nurses who had participated in the study.

The study also found that this association was even worse for women suffering from infertility. In these women, the association between trans fat consumption and endometriosis rose to to 78%.

Another fatty acid which was significantly correlated to endometriosis risk through this research was palmitic acid. Palmitic acid is mostly found in animal products such as red meat and dairy products and oils such as palm oil.  It was also found that women in the highest fifth of animal product intake were also 20% more likely to have endometriosis than those in the lowest fifth of animal product intake.

Other saturated (myristic, stearic) and monounsaturated (oleic, palmitoleic) fatty acids were not correlated to endometriosis. Total fat intake was also not related to the development of endometriosis, which was strongly correlated to the type of fat ingested.

It was calculated that if a woman were to increase by 1% of her calories from long chain omega 3 fatty acids (such as might be found in a high quality and high potency fish oil supplement) rather than from monounsaturated, saturated or omega 6 fatty acids (typical fat from animal or vegetable sources), this would give her a 50% reduction in risk for endometriosis.

Beware of labels: although recently on grocery shelves we see many packages labeled “0 trans fats” , many of these products may still actually contain hidden trans fats that can accumulate.  By law, in Canada, products with less than 0.2 grams trans fat per serving are allowed to be labeled free of trans fat and will be listed on the nutrition panel as having a total trans fat content of zero.  In the USA products that contain less than 0.5 grams trans fat per serving can be labeled free of trans fat.  This actually can allow a significant amount of trans fat to accumulate in the diet, unknown  and in some cases misleadingly to the consumer, so read labels carefully.  Even a couple of accumulated grams of trans fat per day can cause risks for health.  For endometriosis or other inflammatory diseases,  keep total trans fats to less than 1% of total calories per day (around 2 grams or less for an average woman) and increase long chain omega 3 fatty acids such as DHA and EPA found in high quality fish oil.

What to beware of:

  • Products labeled 0 trans fat, but which contain partially hydrogenated vegetable oil.  All partially hydrogenated oils contain trans fat.  Most trans fat free margarines do indeed contain trans fat, just in a smaller amount.
  • Palm oil, or palmitic acid.  This is often substituted in “trans fat free” products, and has been found to have many of the same detrimental health effects as trans fat.  Palmitic acid intake was found in this study to be corrleated to endometriosis, and is also correlated to other health risks such as cardiovascular disease
  • Excessive animal products.  These naturally contain 2-5% trans fat.

References:

Stacey A. Missmer, Jorge E. Chavarro, Susan Malspeis, Elizabeth R. Bertone-Johnson, Mark D. Hornstein, Donna Spiegelman, Robert L. Barbieri, Walter C. Willett, and Susan E. Hankinson.  A prospective study of dietary fat consumption and endometriosis risk .  Hum. Reprod. 2010 25: 1528-1535.

Government of Canada.  Trans Fat monitoring program 2006. http://www.hc-sc.gc.ca/fn-an/nutrition/gras-trans-fats/tfa-age_tc-tm-eng.php

FDA Guidance for Industry: Trans Fatty Acids in Nutrition Labeling, Nutrient Content Claims, Health Claims; Small Entity Compliance GuideAugust 2003

Tags:  diet  endometriosis  food and drink 

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The Specific Carbohydrate Diet

Posted By Administration, Wednesday, September 15, 2010
Updated: Friday, April 18, 2014

by Zina Kroner, DO 3375488854_0ed378b021_b  

Patients with inflammatory bowel disease (IBD) suffer from diarrhea and abdominal pain; this is often accompanied by difficulty in absorbing nutrients which results in weight loss. With ulcerative colitis, the large bowel (colon) is involved; Crohn’s disease can affect everything from the mouth to the anus, although usually small and/or large bowel disease usually predominates. Medical treatment of IBD is aimed at reducing the intestinal inflammation. 

Medications including sulfasalazine and related drugs and corticosteroids, taken orally or topically may be able to cause improvement in many patients. Stronger medications are frequently needed, with more side effects, including azathioprine, 6-mercaptopurine, methotrexate, and injectable anti-tumor necrosis antibody preparations. 

Surgery may be needed if medical treatment fails. In the case of ulcerative colitis, surgical procedures can be as drastic as removal of the entire colon with a permanent stoma (ostomy). Patients with Crohn’s disease may require surgery after surgery removing affected parts of the bowel.

For many patients, medical interventions are not enough, and surgery may be undesirable. There is another approach to treating IBD on a more basic level. This involves a significant change in diet for most people, to what is called the “Specific Carbohydrate Diet.” This diet can be undertaken along with any medical treatment.

This diet is available to anyone wanting to try it because of the late Elaine Gottschall (d. 2005). Gottschall was both a mother and a scientist who was able to find a way to help her own child, and decided to share her knowledge. In 1958, her eight-year-old daughter was suffering from ulcerative colitis that failed to respond to medical treatment. Looking for an alternative to surgery, Gottschall took her daughter to Dr. Sidney Haas, a 92-year-old physician who had published a textbook outlining his nutritional approach to healing the intestines. 

Dr. Haas quickly started the young girl on his specific carbohydrate diet. After a few months on the diet, her intestinal symptoms started to improve and she began to gain weight. After two years, she was well and free of symptoms of the disease. However, Dr. Haas had died in the interim and could no longer provide guidance.

Gottschall decided to learn more about the science behind the diet. She studied biology, cellular biology and nutritional biochemistry, earning a master’s degree and doing research on carbohydrate metabolism in the intestine. She published the Specific Carbohydrate Diet in a book first entitled Food and the Gut Reaction. It is now in its 13th printing, and called Breaking the Vicious Cycle: Intestinal Healing Through Diet. Over a million copies have been sold, and the book has been translated into seven other languages.

The Specific Carbohydrate Diet is based on the way carbohydrates are digested in the intestine, and what may be going wrong with the digestion in people with IBS and other intestinal disorders. Single sugars, including glucose, fructose and galactose can be transported from the intestine into the bloodstream without requiring digestion, in this case, splitting of molecules by enzymes. The cells of the small intestine must work harder to digest carbohydrates, as well as two-sugar molecules. 

 


Carbohydrates are broken down into disaccharides by salivary enzymes and pancreatic enzymes as they pass through the digestive tract. Disaccharides, comprised of two sugars, must be split into their component parts by enzymes located in the outer membrane of the cells in the small intestine. The cell membranes have small finger-like projections called microvilli that line the intestinal walls. The enzymes are located in the microvilli. There are four key disaccharide/enzyme pairs.

•Lactose, found in milk and milk products, must be broken down into glucose and galactose by the enzyme lactase.

•Sucrose, or table sugar, must be metabolized into glucose and fructose. Sucrose is fruit derived (cane sugar, beet sugar). As fruits ripen, sucrose can be broken down into glucose and fructose, so that ripe fruits may have less sucrose.

•Isomaltose is broken down into two molecules of glucose by isomaltase.

•Maltose is similarly metabolized into two glucose molecules by maltase.

A deficiency of any of these enzymes prevents the final digestion of disaccharides. They stay in the intestine where they can cause physical symptoms. For example, sugars can ferment and cause gas. 

Many people are affected by a lack of lactase, leading to the inability to fully digest the lactose in milk. This is called “lactose intolerance” which causes symptoms of gas, pain and diarrhea. The incidence of lactase deficiency varies between different ethnic groups, and is also more prevalent in older people than children. People with simple lactose intolerance can take a tablet containing lactase, or they can consume milk products which have lactase added. They can also usually tolerate milk products in which the lactose has been digested already. For example, in properly prepared yoghurt, the right kind of bacteria have already split and digested the lactose.

It has been postulated that in IBS, all of the disaccharidases are not functioning. Consequently, carbohydrate residues and disaccharides cannot be digested. These comprise so much of an average diet that the undigested material is a very significant amount. The symptoms of pain, gas and diarrhea are severe. 

The undigested disaccharides can feed the bacteria living in the intestine, causing an overgrowth of bacteria. Many kinds of bacteria normally live in the large intestine, and to a lesser degree, in the terminal ileum that connects to the large intestine. These can multiply and migrate up into the small intestine where they do not belong. 

Bacteria in the wrong place can cause damage to the lining of the small intestine, to the microvilli lining the small intestinal walls. This further reduces the amount of functional enzymes and perpetuates the cycle. Decreased digestion of carbohydrates and disaccharides allow bacteria to grow that damage the intestine and decrease the digestion of disaccharides even more. Additionally, the bacteria can release toxic byproducts that cause some of the symptoms of IBS.

Whatever begins the cycle of the intestinal damage, the decreased ability to digest carbohydrates and disaccharides leads to further damage, with more symptoms and even less digestive ability. The Specific Carbohydrate Diet interrupts the cycle.

The main principle of  the Specific Carbohydrate Diet is that only so-called “legal” carbohydrates are permitted. These are found in fruits, honey, properly-prepared yoghurt, and certain vegetables and nuts, and are to be used as follows:

•Fruits: Not introduced during the first one to two weeks. Then ripe, peeled and cooked. No raw fruits until diarrhea is under control. First raw fruit should be ripe mashed banana. No canned fruits with added sugar.

•Vegetables: No raw vegetables (such as salad greens and cucumbers)  until diarrhea is under control. Only frozen or fresh vegetables are allowed, not canned.

•Dairy products: No fluid milk. Specific cheeses are allowed. Homemade yoghurt is a large part of the diet. Dry curd cottage cheese is also important.

The following foods can also be eaten:

•Eggs: Added when diarrhea is less severe.

•Meats

•Fats: Well tolerated in association with meat, butter, and allowed cheese and yoghurt.  Use of low-fat milk is not advised unless there is another reason.

Forbidden “illegal” carbohydrates:

•All cereal grains, including but not limited to corn, oats, wheat, rye, rice, millet, buckwheat, triticale or any other “new” grains such as quinoa. No products made from these grains are allowed, which means no bread, pasta, cakes, or other baked goods. Ground nut flours replace grains for baking. 

•No table sugar is allowed as a sweetener or in candy. It is sucrose, a disaccharide. Honey is the allowed sweetener. It contains glucose and fructose separately.

•No processed food, as starch (or disaccharides) are often added.

•No starchy vegetables, including potatoes and yams.

The diet should be as varied as possible. It is very difficult to follow the diet if you are a vegetarian, but not impossible. Consultation with a dietitian would probably be best if you want to follow the diet without any animal products. Anyone with a severe nut allergy will also have a very difficult time with the diet, since nut flour replaces all other carbohydrate flours.

Beginning the Diet

There are recipes in the SCD book, and specific foods you must buy and make before you can start the diet. There are suggestions for where to obtain needed products, and guidelines as to which brands are best. Beyond the information in the book, there are also cookbooks available as well as information on the SCD website. Whoever is going to prepare the food must be able to follow the recipes. In Gottschall’s words, the diet must be followed with “fanatical adherence” in order to work. Instructions on how to make the food for the beginning diet are on the website (http://www.breakingtheviciouscycle.info/index.htm).

Sample menu for beginning the diet

 

  • Breakfast:

oDry curd cottage cheese (moisten with homemade yogurt)

oEggs (boiled, poached, or scrambled) – not if diarrhea is very severe

oPressed apple cider or grape juice mixed 1/2 and 1/2 with water. 

oHomemade gelatin made with juice, unflavored gelatin, and sweetener (honey)

 

  • Lunch: 

oHomemade chicken soup

oBroiled beef patty or broiled fish 

oHomemade Cheesecake

 

  • Dinner:

oVariations of the above

The above diet needs to be followed strictly. If you have a lot of diarrhea and cramping, you may need five days before you can add other foods. Some people only need a couple of days.

After diarrhea and cramps have stopped, you can add cooked fruit, ripe banana, and other vegetables, as well as egg if you did not start it earlier. You still need to avoid vegetables in the cabbage family. As you add a food, do it slowly, starting with a small portion and increasing it over a week.

Many people decide to try the diet for a month. Gottschall says that it usually takes three weeks to see an improvement, so if you feel absolutely no better after a month, you might want to reconsider whether or not you want to stay on the diet. Keeping a food journal may be the best way to document your symptoms and see if there is a trend toward improvement.

There is also a chance of a relapse of symptoms around the second or third month, which may occur because of a viral infection. Even if there is no specific cause, the symptoms will go away, so you should not be discouraged.

The Specific Carbohydrate Diet

The best way to collect all the information about the diet is from Gottschall’s book, other recommended cookbooks, recipes and tips, as well as places to buy the cookware and other items needed to make the foods, on the website (http://www.breakingtheviciouscycle.info/index.htm).

You do not have to buy anything beyond the book if you are used to cooking and understand some of the more unusual foods you have to make, such as homemade yoghurt. There are no controls on portion or size in general. You can eat as much of “legal” foods as you want.

Here are some general instructions.

Allowable proteins

Essentially all fresh or frozen beef, lamb, pork, poultry, fish, eggs, specified cheeses, homemade yoghurt and dry curd cottage cheese, as well as fish canned in oil or water are allowed. No processed meats are allowed because they may contain filler carbohydrates (like in hot dogs) or they may have had added  sugars. No canned meats.

Allowable vegetables

Fresh or frozen, no canned vegetables or vegetables in jars. Dried peas and certain beans can be introduced after special preparation and when symptoms are better. No grains, no starchy root vegetables. Soybeans and soy products are not allowed

Allowable fruits

Fresh, raw or cooked, frozen or dried. Canned “in its own juice” with no added sugar is acceptable. Just about all fruits are allowed.

Allowable nuts

Just about all nuts in shells. Shelled nuts are acceptable if they have not been coated with starch when salted, which is usually the case with peanuts. 

Nuts should only be used as nut flour until diarrhea has stopped. Then they can be eaten whole.

Beverages

Tomato juice is allowed, as is grapefruit juice, freshly squeezed. Orange juice should not be used in the morning when diarrhea is still active. If buying juice, avoid brands with added sugar. Many companies do not state this on the label. Bottled grape juice is usually without added sugar. Apple cider can be used, but not apple juice because sugar has been added. Juice boxes should be avoided.

You may also drink weak tea or coffee, and peppermint or spearmint herb tea. Other herb teas can worsen diarrhea. Only sweeteners allowed are honey or saccharin. Soft drinks with aspartame or NutraSweet may contain lactose and should be avoided. Instant coffee, tea and Postum are not permitted.

No liquid milk is allowed; no soy milk is allowed. 

General

You can use oils made from “illegal” foods for cooking, because the carbohydrates have been removed. Unflavored gelatin is used in dessert recipes. Sweets are allowed, made from honey, nuts and dates.

Some alcohol is allowed, including very dry wine, gin, Scotch, vodka and other similar. No cordials or liqueurs.

Once symptoms are under control and you are on the diet with all allowed foods, there is a great amount of variety allowed. There is generally no limit on portion sizes; you can eat as much as you want of allowed foods. There are sweets and treats, baked goods made with nut flour, substitutes suggested for pasta, and many clever ways to prepare food. 

Gottschall recommends that you stay on the diet for one year after your illness is  gone. She then suggests that you start “illegal” foods slowly, one at a time

While the diet is restrictive, it is balanced and able to provide a good source of most nutrients. Vitamin supplements are usually necessary, and you should discuss this with your physician. Many people begin this diet underweight because of their illness, and are able to gain weight. 

Does this diet work?

Thousands of people have used this diet successfully. Their stories have been documented on the website, in the form of testimonials as well as surveys.

One article was published in the journal Tennessee Medicine using data from the SCD site as well as follow-up conducted by two doctors. Two case studies were reported, one of a patient with Crohn’s disease and one patient with ulcerative colitis. Both were inadequately controlled on medication and had symptoms resolve on the diet. In these two cases, a physician reviewed colonoscopy reports and biopsies before and after the diet. In these two cases, the patients had demonstrable abnormalities which resolved.

In addition, survey material from the SCD website was used. 51 patients responded, 31 with Crohn’s disease and 20 with ulcerative colitis, Most of them were either in remission or much improved on the diet. Many of these individuals did not follow up with their physicians. 16 patients did have repeat colonoscopies, 12 of which were normal. This article ends with the following statement, “Proper randomized clinical trials are warranted to investigate the merits of this treatment (Nieves and Jackson, 2004).”

Large-scale randomized trials may never be done. Without a medication to study, there is no financial incentive to doing such a trial, and no source of funding. Many physicians will not accept treatments that have not been studied in such trials, and will not accept the Specific Carbohydrate Diet. However, other physicians will, and many patients have done very well on it. 

Should you decide to try the Specific Carbohydrate diet, you should actively discuss your progress with your doctor. As noted, you may need specific vitamins. You may also be able to lower medications, which you should do under a doctor’s care.

Resources:

The  Specific Carbohydrate Diet website: http://www.breakingtheviciouscycle.info/index.htm

Breaking the Vicious Cycle: Intestinal Health Through Diet by Elaine Gloria Gottschall. Kirkton Press; Revised edition (August 1994). 13th printing, May 2010. (Available on Amazon.com, from Barnes and Noble, and elsewhere.)

Nieves R, Jackson RT. Specific Carbohydrate Diet in Treatment of Inflammatory Bowel Disease. Tennessee Medicine. 2004 Sep; 97(9):407. (This article can be viewed on the website). 

Tags:  diet  food and drink 

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Role of Diet in the Management of Inflammatory Bowel Disease

Posted By Administration, Friday, April 30, 2010
Updated: Friday, April 18, 2014

ABSTRACT

Many studies have looked at connections between diet, etiology, signs and symptoms associated with inflammatory bowel disease (IBD). Although these connections are apparent to clinicians, they are difficult to prove qualitatively or quantitatively. Enteral feeding and polymeric diets are equally effective at bringing about remission in Crohn’s disease (CD). Parenteral feeding is also effective, although none of these methods is as effective as corticosteroid therapy. However, enteral feeding is preferred in the pediatric population because linear growth is more adequately maintained via this route. Exclusion diets in patients brought into remission using an elemental diet have been shown to maintain remission for longer periods. Studies that aim to isolate culpable food groups have shown that individuals react differently on exposure to or exclusion of various foods. The commonly identified food sensitivities are cereals, milk, eggs, vegetables and citrus fruits. Studies that have looked at gut mucosal antigen behavior have shown higher rectal blood flow, in response to specific food antigens, in those with CD over healthy subjects. Exclusion of sugar shows little evidence of amelioration in CD. Omega 3 fatty acids show promise in the treatment of IBD but await larger randomized controlled trials. Patients frequently notice that specific foods cause aggravation of their symptoms. Whilst it has been difficult to pinpoint specific foods, with advances in the laboratory tests and food supplements available, the aim is to prolong remission in these patients using dietary measures, and reduce the need for pharmacotherapy and surgical intervention.

INTRODUCTION

The etiology of inflammatory bowel disease (IBD) is considered multifactorial. Genetic, infective and environmental theories exist, as well as those centered around host immunity, intraluminal gut flora, food allergies and hypersensitivity.

Whilst pharmacological therapy plays a major role, many patients prefer to control their symptoms by the most conservative means possible. Our aims in IBD therapy are to downregulate inflammation, and reduce the incidence of relapse and the healing time.

Dietary therapy encompasses dietary modifications suggested by physicians and those that patients make autonomously. The putative mechanisms of action are due to bowel rest, provision of nutrients, alteration of bowel flora or alteration of antigenic stimuli. The gastrointestinal flora and its interaction with nutritional factors has a huge impact on the environment, especially in genetically predisposed individuals. Nutrients as components of cell structure or antigens can induce inflammatory mediator expression and suboptimal levels of nutrients, which may have an impact on tissue repair and other cellular processes. Other reviews have concluded that nutrients that tend to affect the immune responses of the host (n-3 fatty acids, antioxidants) are likely to play a role in the treatment of IBD.

In this review, we examine the literature for dietary interventions in IBD, such as exclusion/elimination diets, enteral nutrition and total parenteral nutrition (TPN), and review the evidence that they induce and/or maintain remission in patients with IBD.

METHODOLOGY

Elemental/polymeric diets

Elemental diets were chanced upon as a therapeutic option for CD patients when they were used to bolster their nutritional status and reduce inflammation. Liquid feeds are thought to work by reducing mucosal antigen exposure, partly due to the nature of the feed and partly to faster transit times. They also alter the fecal flora, which causes local immunomodulation downscaling, which enhances nutritional status and allows relative bowel rest.

Compliance may be poor as elemental diets are not known for their palatability and are often delivered via a nasogastric tube, whereas the polymeric drinks are far more palatable. Several trials and meta-analyses have shown no significant difference in the efficacy of elemental diets over polymeric diets.

Elemental diets offer a cheaper way of bringing about remission and without the side effect profile of TPN. In both adult and pediatric populations, elemental and polymeric feeds have been shown to be as effective as corticosteroid therapy in treating active CD. However, a Cochrane review by Zachos et al has shown, in a meta-analysis, that enteral nutrition is not as effective as steroid therapy for inducing remission.

However, enteral therapy for CD has its role in selected cases, in particular, in children in whom steroids may cause growth retardation. Food exclusion with liquid diet is very difficult to maintain, therefore, these are rarely long-term solutions. Unfortunately, a staged return to normal feeding often leads to relapse.

Exclusion diets

The East Anglia Multicentre Controlled Trial showed that various food intolerances were perceived in individual patients, and among the more common were cereals, dairy produce and yeast. This work looked at the use of exclusion diets as an intervention in active CD. The exclusion diet was based around daily reintroduction of a single food type. If it caused diarrhea or pain, it was eliminated. All patients were treated initially with an elemental diet, and those who attained remission followed a reduced prednisolone course or the exclusion diet pathway. Jones et al have shown that maintenance of remission, by identification and avoidance of food intolerances, is possible, often without pharmaceutical adjuncts. Testing for these sensitivities has proven difficult, because testing shows a large number of sensitivities in unselected populations, which are of doubtful clinical significance. Jones et al have tested a diet rich in unrefined carbohydrate against an exclusion diet. Seven out of 10 patients on the exclusion diet stayed in remission for 6 mo, while none of those on the carbohydrate-rich diet remained in remission. Pearson et al have conducted a study of 42 CD patients after induction of remission by elemental diet. Single foods were investigated using open and double blind rechallenge over 5 d. Fourteen patients dropped out due to flare-ups that were thought to be unrelated to food, and caused by inability to comply with the regimen. Twenty of the remaining patients identified food intolerances and eight did not. This research group has concluded that food intolerance is not as frequent as claimed in other studies, and that it is variable in its intensity and occurrence.

Parenteral feeding in CD

TPN allows bowel rest while supplying adequate calorific intake and essential nutrients, and removes antigenic mucosal stimuli. However, TPN is expensive, invasive and has a number of side effects. TPN has been shown to bring about remission in CD. Müller et al have found that, in 30 consecutive complicated CD patients, 3 wk of TPN as an inpatient followed by an additional 9 wk at home, during which time, no medication or oral intake was allowed, 25 patients avoided surgery. These patients returned to work and needed no further medication and ate normal meals subsequently. In a prospective randomized controlled trial (RCT), 51 patients with active CD refractory to medical treatment were treated with TPN and nil by mouth, defined formula diet via a nasogastric tube, or partial parenteral nutrition. Clinical remission was obtained in 71% of the patients on TPN, 58% on enteral feeding, and 60% on partial parenteral feed.

Enteral vs parenteral feeding

There has been controversy regarding the enteral vs parenteral route for feeding in patients with IBD. Comparison of TPN against elemental diet in a group of 36 patients showed no significant difference in the number of days to remission, the drop in Crohn’s disease activity index (CDAI) score, the erythrocyte sedimentation rate (ESR), or albumin. However, in other studies that have agreed with this finding, neither was proven to be as beneficial as corticosteroids, except one study in a pediatric population. In that study, Sanderson et al entered 17 children into an RCT, in which eight were given an elemental diet for 6 wk via a nasogastric tube, and seven were given adrenocorticotrophic hormone injections and oral prednisolone and sulfasalazine. The elemental diet was equally effective at improving the Lloyd-Still disease activity index scores, C-reactive protein (CRP), ESR and albumin. The elemental diet was markedly better at maintaining linear growth. Whilst strong evidence exists supporting the primary use of enteral feeding in children with CD, it is not commonplace in the treatment of adults.

Omega-3 fatty acids

Shoda et al have noted that the gradual replacement of n-3 polyunsaturated fatty acids with n-6 polyunsaturated fatty acids results in an increased incidence of CD. This implies that there is the potential to modulate immune responses by altering the ratio of polyunsaturated fatty acids in favor of n-3 rather than n-6. Meister and Ghosh have shown that fish-oil-enriched enteral diet, when incubated with intestinal tissue from 11 subjects with IBD and four controls, reduced inflammation modestly in CD and significantly in UC. Inflammatory improvement was assessed by analyzing the interleukin (IL)-1 receptor antagonist/IL-1β ratio. The greater the ratio, the less inflamed the tissue. A systematic review of the effects of n-3 fatty acids in IBD by MacLean et al has identified 13 controlled trials that investigated the effects of n-3 fatty acids. The results were mixed but in the three studies that looked at steroid requirements, this was found to be reduced. However, this was statistically significant in just one of these studies.

 

MAINTENANCE OF REMISSION IN CD

Exclusion diets

Jones has looked at exclusion diets for the maintenance of remission of CD and has shown that, in personalized exclusion diets, 62% of the patients maintained remission at 2 years and 45% at 5 years, with no other medical intervention. This was compared to the European Cooperative Crohn’s Disease Study in 1984 in which the placebo arm of the study had no patient who maintained remission after 2 years of follow-up.

A Cochrane review of the maintenance of remission in CD has suggested that larger, high-powered controlled trials are required to confirm current hypotheses relating to diet and maintenance of remission. Trials of diet against azathioprine and infliximab also have been suggested to investigate quantitative effects of nutritional supplements and their impact on cost-effectiveness and quality of life.

Enteral feeding

Enteral feeding has been shown to have a role in preventing relapse in inactive CD patients (predominantly in children), but the effect has also been observed in a Japanese study of adult CD patients. Esaki et al have demonstrated in a trial of 145 patients with CD (mostly induced into remission with TPN) that, under maintenance with elemental/polymeric nutrition, the risk of recurrence was lower in those with small bowel rather than large bowel involvement.

 

DIETARY MANAGEMENT IN UC

Maintenance of remission in UC

UC does not seem to be ameliorated by bowel rest and elemental diets in the same way as CD is. However, patients still express concern about specific food types, and there does appear to be an association with a western diet. In a study that has investigated self-reported food intolerance in chronic IBD, patients with CD and UC have reported that they felt intolerant to specific dietary triggers and restricted their diet accordingly. The same study has shown that the pattern and frequency of food intolerance did not differ between CD and UC patients. This has been reinforced by work from our own group that has investigated food intolerances detected by measuring IgG4 antibodies to specific food antigens. There is no evidence to support the use of elemental/polymeric feeding in the treatment of UC.

Omega-3 fatty acids

Omega-3 fatty acids derived from fish oils have been shown to be of benefit in a double-blind RCT that looked at patients with distal UC. That study found that the group treated with 3.2 g eicosapentaenoic acid or 2.4 g docosahexaenoic acid daily had significantly better clinical and sigmoidoscopic scores compared with the control group who took sunflower oil, after 3 and 6 mo. This supports the idea that omega-3 oils suppress natural cytotoxicity.

 

ADDITIONAL DIETARY FACTORS

Fiber

Dietary fiber has been investigated as a means of increasing short-chain fatty acid (SCFA) production. IBD has been linked with impaired SCFA production. SCFAs are mainly produced by the anaerobic bacterial fermentation of undigested carbohydrates and fiber polysaccharides. In 1995, Galvez et al reviewed a number of studies that concluded that dietary fiber confers clinical benefits in patients with IBD because it maintains remission and reduces colonic damage. This is thought to occur by increasing SCFA production and by altering the gut flora towards predominantly non-pathogenic bacteria.

Fats

The properties of omega-3 fatty acids have been discussed elsewhere in this review. Other studies have revealed an inverse correlation between the percentage of energy derived from long-chain triglycerides and the efficacy of enteral feeds in achieving remission.

Sugars

A high intake of sugar has been shown to be linked to CD in a number of trials, hence its possible etiological role has led to therapeutic trials of sugar avoidance. Most of these trials also have promoted a high fiber intake. The only trial to look solely at sugar avoidance has shown no statistically significant benefit.


 

ANTIGENIC RESPONSE TO FOOD

 

Van den Bogaerde et al have published a trial in which the reactivity of peripheral lymphocytes to food, yeast and bacterial antigens was studied. They found that 23 out of 31 patients with CD responded to one or more antigens, compared to five out of 22 in the control group. They also correlated in vitro sensitization and in vivochanges with histological and blood flow changes. Skin testing and rectal exposure to six food antigens and saline were tested in 10 patients and 10 controls. The results showed that CD patients demonstrated in vitro and in vivo sensitization to food antigens and this was gut specific.

Levo et al have shown that patients with IBD have higher serum concentrations of IgE. They also have shown that the levels are higher still in those with active disease over those in remission. However, this difference is not statistically significant. In 1998, another study was performed to investigate food-specific IgE as well as IgG, and IgE anti-IgE autoantibodies using serum from normal subjects, patients with CD and those with food allergies. They found that food-specific IgE was not detected at all in the CD group but they did have higher levels of IgG and IgE anti-IgE autoantibodies. They concluded that, even if IgE is an autoantigen in CD, it is not thought to take part in the pathophysiology of the adverse food reactions commonly reported by the patients.

Western diets are more strongly associated with CD. There are several theories as to whether this may relate to the increased intake of sucrose, refined carbohydrate, and omega-6 fatty acids, and reduced intake of fruit and vegetables. Urban diets contain large quantities of microparticles such as natural contaminants like dust, and food additives which may be antigenic. CD patients allocated to a low microparticle diet experienced a reduction in disease activity and in steroid requirement compared to a control group on a normal diet.

SUMMARY

Although many studies have looked at diet therapy and IBD, mixed opinions exists as to the importance that food intolerance plays in the pathophysiology of IBD. In those that have looked at food sensitivity, this was done using different methods. Riordan et al have observed sensitivity to corn in seven patients; wheat, milk and yeast in six; egg, potato, rye, tea and, coffee in four; and apples, mushrooms, oats and chocolate in three. Ballegaard et al have found sensitivity, using questionnaires, to vegetables (particularly onions and cabbage), fruits (apples, strawberries, and citrus fruits) and to meat (especially beef). Van den Bogaerde et al have shown in a case-control study using lymphocyte proliferation that, out of 31 CD patients, 16 reacted to cabbage and peanuts, 14 to cereals, 13 to milk, and nine to citrus fruits.

As observed by Hunter, epidemiologists tend to look at statistical relationships that lead to studies of sugar, sweet, coke and chocolate intake because patients with CD eat and drink more of these substances than control subjects. Clinicians focus on the foods that patients associate with their symptoms and therefore avoid. As a result, exclusion diets have tended to concentrate more on dairy products, cereals and yeast. Other work is being carried out on polyunsaturated fatty acids, especially omega-3 oils, and their anti-inflammatory effects.

Current elemental and polymeric diets have a role to play in the management of CD, particularly in children. Exclusion diets are of use particularly for maintenance of remission. TPN is of value and has been shown to be as effective as elemental diets, but none have proven as effective as corticosteroid therapy. However, TPN remains a crucial method for administering nutrition in patients with severe disease, who are not able to tolerate enteral feeding.

Despite early ideas about the involvement of sugars in the etiology of CD, the omission of sugar has not been found to be of benefit. Omega oil has shown promising results, particularly in reducing inflammation in UC, and to a lesser degree, in CD.

CONCLUSION

IBD has a multifactorial etiology but food sensitivity/intolerance appears to play a role, and the culpable foods vary on an individual basis. Techniques to identify food intolerance require refining. Progress has been made by looking at factors such as IgG4 responses to food antigens, but a large expanse of work exists in trying to determine people’s food sensitivities and the degree to which these affect disease activity. Without further research, it remains unclear whether dietary manipulation will continue to have a role solely in symptom control, or whether complete remission may be possible using these methods in combination with pharmacological agents.

 

FOOTNOTES

 

Peer reviewer: Wallace F Berman, MD, Professor, Division of Pediatric GI/Nutrition, Department of Pediatrics, Duke University Medical Center, Duke University School of Medicine, Durham, Box 3009, NC 27710, United States

S- Editor Tian L L- Editor Kerr C E- Editor Ma WH

 

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Source: Nirooshun Rajendran and Devinder Kumar. 

World J Gastroenterol. 2010 March 28; 16(12): 1442–1448.

Published online 2010 March 28. doi: 10.3748/wjg.v16.i12.1442

 

 

 

 

Tags:  diet  inflammatory bowel disease 

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