If you don’t feel like you have strong willpower be sure you have eaten before going anywhere there is going to be food, and try to cancel out of all the obligations you can for the 3-4 weeks you are on the ECD.  When you’re on the ECD is not a good time to have business lunches, dinners, parties or other celebrations.  DON’T plan on doing the ECD around birthdays or the holidays.

More on the ECD coming soon.

What are your thoughts?  We’d love to hear them.  Please post them in the comments section below.

Let me give you an example.  A woman had severe seasonal allergies, she dreaded pollen season with a passion.  She was on the maximum doses of all the allergy medications and was still barely keeping her allergies under control.  Blood allergy testing showed that she was very reactive to wheat, dairy, and eggs (the big 3).  She cried a little bit at hearing this because it meant that virtually everything she ate on a regular basis was out.  But she took to the challenge with relish, and decided that this was going to be her chance to get back into the kitchen and experiment, finding tasty foods that she could eat and enjoy.  Within a few weeks her allergies were gone completely.  She stopped all of her allergy medication and has had no sign of her allergies, unless she eats some dairy, wheat, or eggs.  She is thrilled with her results and couldn’t be happier she took the plunge and did an elimination diet.  And for those who worry about giving up groups of foods forever, I expect over time as her gut heals and her immune system normalizes she will be able to reintroduce most of those foods back into her diet.

Before undertaking an ECD it’s important to determine your motivation.  What is going to give you the drive to persist through the early cravings?  What is going to allow you to say no when you get in situations where it would be so much easier to simply say yes?  Unless you plan to be a hermit for the 3-4 week duration of the elimination part of the diet, you need to have motivation.  One strong source of motivation is others.  Most of us don’t tell anyone about any diet or lifestyle changes we’re trying to make, that way if we fail, no one knows.  Turn that around, and tell all your friends, tell your co-workers.  Enlist their help and let them hold you accountable.  That way when you are tempted to reach for that food you know you others are going to know.

For me, I have three sources of motivation.  The first is simply curiosity.  As mentioned in my previous post when we saw the changes a change in diet caused in our pets, I became curious.  What changes would I see in myself if I did the same?  So this is an experiment to see what happens.  The second source of motivation is my desire to have experienced the therapies I ask my patients to go through.  It is a belief of mine to, whenever possible, try the therapies out on myself that I recommend to my patients.  That way I know what the therapies feel like, and it helps me understand what my patients are going through.  The ECD is one that I have held out on, because without any major health problems I simply did not want to give up the foods that I enjoy.  The third source of motivation is others, when my wife and I first came up with the idea, the first thing I did was quickly post the idea to my blog and to my mailing list.  That way, many people know about this, and are going to hold me accountable for completing it.

If possible, get your friends or family to join you on the ECD (often easier said than done).  It’s especially important to have the help of people you are living with.  If you can all go on the diet together it creates a shared camaraderie and helps to keep the foods that have been removed out of the house.

Stay tuned as this series on the ECD will continue.

Do you have any thoughts on the ECD?  Have you tried one?  We’d love to hear your comments, please post them in the comments section below.

So, when I came upon this recipe for a gluten free pizza, I thought I would give it a try (originally posted here).

Ingredients:
Crust:
2 Cups Almond Meal/Flour
2 Eggs
2 Tsp Extra Virgin Olive Oil
1 Tsp salt

Sauce:
1 Can Tomato Paste
1-2 Cups Water (To desired thickness)
1 Tsp Dried Oregano
1 Tsp Garlic

Toppings:
Whatever you want!  We used fresh shredded swiss and mozzarella, chicken, bacon and onion!

Instructions:
Crust:
1. Pre-heat oven to 350 degrees
2. Mix all ingredients in a large mixing bowl. This should give you a ball of “dough”. If your dough is too “mushy” (like mine was), continue to add almond flour until you get a good consistency.
3. Make a pizza sheet or baking tray non-stick. This is VERY important if you want your pizza slices to come off in one piece.
4. Press your dough on the sheet nice and even about 1/4 inch in the middle and 1/2 inch at the edges.
5. Put crust in the oven for 15 minutes. It should look slightly golden brown when you take it out.

Sauce:
1. In a saucepan, combine all ingredients. Use water to desired thickness. We like ours pretty thick. Feel free to add more spice if you want it, too.
2. Simmer on stove for approximately 15 minutes.

Toppings:
You will want to pre-cook any meat going on your pizza. Veggies can go on fresh and raw, or cooked depending on your preference. Your favorite cheese will do, but I recommend the 50/50 mix of mozzarella and swiss that we used. It melted perfectly and tasted great!

Put it all together:
1. After crust comes out of the oven, spread sauce evenly over crust.
2. Add your cheese and toppings evenly on top of sauce.
3. Put back in the oven and bake at 350 degrees for approximately 15 more minutes. Cheese should be evenly melted.
4. Slice and enjoy!

Results:  Two thumbs up!

We were very pleasantly surprised by the result.  The almond flour (the “secret” ingredient) made a very passable dough.  My oven took a little longer at 350 F than in the recipe, about 23 minutes.  We added the tomato sauce (very easy to make and in a pinch you could use a ready made sauce), plenty of cheese (we used a mix of mozzarella and cheddar), red peppers, onions, garlic, and a good quality pepperoni.

We found this pizza surprisingly filling.  Almond flour is denser, it did not have the light and bubbly texture of traditional pizza dough, but it was not a brick either.  Almond flour  has significantly more fat and less carbs than wheat flour, making the dish much healthier than conventional pizza.  In my day I could pack away plenty of pieces of pizza, but I found that after two pieces I was very pleasantly full.  My wife didn’t even make it through her second piece.  And the good news is that it tasted just as good the next morning.

Both my wife and I were very pleased with this recipe and have added it to our cooking list.  We’ll definitely make this again.  The only downside, almond flour is spendy, but that’s probably a blessing in disguise or we’d be having pizza more often than we should.  I will be recommending it to patients who cannot tolerate wheat but are longing for pizza.

What are your thoughts?  Have you cooked with almond flour before?  We’d love to hear about it.  Share your experiences below.

Celiac has been getting a lot more attention lately, but I find in my practice there is still a lot of confusion about what celiac actually is.

What is celiac (briefly)?

Celiac is an autoimmune disease triggered when a susceptible person eats gluten.  Celiac is not a “wheat allergy”; it is possible to have an allergy or reactivity to wheat or other grains and not have celiac disease.  What makes celiac different from other problems with wheat, grains and gluten is autoimmunity, in celiac disease the body is attacking itself.

What is gluten?

Gluten is a family of proteins found in wheat (gliaden & glutenin) and wheat relatives such as spelt and kamut, triticale, barley (hordein), and rye (secalin).  There is conflicting information on whether oats contain gluten (avenin).  Most of the gluten in oats appears to come from contamination with wheat during harvesting, storage, and processing.  Certified gluten-free oats seem to be tolerated by many people with celiac disease.

What happens in celiac disease (briefly)?

Gluten is an irritating and mildly inflammatory substance to all humans.  In susceptible individuals (with celiac disease) inadequate digestion of gluten leads to inflammation and damage of the cells of the small intestine.  This allows gluten proteins to enter the damaged cells where they are exposed to enzymes (tissue transglutaminases) which modify them and make them more inflammatory.  This sets up a vicious circle of inflammation leading to the formation of autoantibodies (antibodies against the body) which leads to the characteristic destruction of the intestines in celiac disease.

This damage to the small intestines can severely damage the body’s ability to absorb nutrients leading to significant nutrient deficiencies.

Celiac & Osteoporosis – Nutrient deficiencies

In order to form healthy bone the body needs calcium, magnesium, vitamin D, vitamin K, sufficient protein and a host of other vitamins and trace minerals.  In celiac disease  the damage to the intestines can prevent the body from absorbing enough of these nutrients.  Over time the body is not able to build bone and this can lead to early and severe osteoporosis.

Celiac & Osteoporosis – Autoimmunity

A recent study by scientists at the University of Edinburgh found that in 20% of celiac patients tested, they found antibodies to a protein called osteoprotegerin which is important in maintaining bone strength.  The antibodies prevented osteoprotegerin from functioning effectively and are thought to be an additional reason for osteoporosis in at least some patients with celiac disease.

How to prevent osteoporosis?

While the study authors were quick to propose a drug to block the antibodies interfering with osteoprotegerin as an answer to celiac induced osteoporosis, there are far more effective therapies that you can do now.

1. The most important is the avoidance of all gluten.  This is much easier said than done as gluten is widely used both as a food in the form of breads, pastas, pastries and other flour containing foods.  More difficult to detect is the fact that gluten is widely used as a flavoring, stabilizing or thickening agent in virtually all processed foods.  The celiac patient must become an expert at label reading and understand all of the names that gluten goes by.  Here is a good place to begin educating yourself on safe and unsafe gluten containing foods.  Gluten can also be found in dietary supplements, pharmaceutical drugs, and health and beauty aids.
2. The person must ensure adequate nutrients to build healthy bones.  The levels of these nutrients such as calcium, magnesium and vitamin D may need to be substantially higher than for a normal person without celiac disease.
3. The person should engage in regular weight-bearing exercise.  Putting stress on our bones is the single greatest stimulus to make and keep them strong.
4. From the perspective of a Naturopathic doctor, I also incorporate the following additional strategies in the treatment of celiac disease
   1. Modulation and normalization of the autoimmune response.  By reducing the inflammatory load on the body and using broad-spectrum anti-inflammatory and immune modulating herbs and nutrients, we are often able to reduce or normalize the autoimmune process.  This may help in the newly discovered autoimmune process in celiac disease with osteoprotegrin noted above.
   2. Gut repair.  Using a variety of nutrients and other substances such as glutamine and probiotics we are able to restore normal gut function and structure.  This can help those with celiac disease absorb nutrients from their diet more effectively.

What are your thoughts? We’d love to hear them. Feel free to post them below.

Our society tends to be germ-phobic.  And we have good reasons.  In the past most of the things that killed people were infections; infected wounds led to loss of limbs and lives, and epidemic diseases like fevers and plagues have swept through societies killing untold millions.  Plus today we face a new wave of antibiotic resistant diseases created through the overuse, improper use, and abuse of antibiotics such as MRSA.

But many scientists and doctors, myself included, feel that our germ phobia has gone too far.  The hygiene hypothesis states that exposure to bacteria both good and bad is necessary to develop a properly functioning immune system.  The hygiene hypothesis is one attempt to make sense of the sky-rocketing rates of allergies and auto-immune diseases in children.  Keeping children excessively clean does not give their bodies and immune system sufficient exposure, and thus education to learn to function normally.

The role of good bacteria in the maintenance of health is becoming increasingly understood.  New studies are showing that every exposed part of our body, every square inch of our skin, and our digestive tract from our mouth to our rectum are home to a huge diversity of bacteria.  In fact the Human Biome project is setting out to map the genetic code of bacteria that live with us in a similar way the Human Genome project set out to map our genetic code. Far from being simply passengers we are gaining greater and greater understanding that bacteria are necessary for our health and well-being.  They protect us from pathogenic (‘bad’) bacteria and parasites, help us digest food, and help our immune system to function properly.  If you are interested in learning more about the role of good bacteria, here is an interesting article, and here is a TED talk on it (see my post on TED).

A recent study published last month in the scientific journal Pediatrics has shown that using probiotic supplements (‘good’ bacteria) can dramatically reduce the chance that your children will get the cold or flu.  And with tremendous concern over Swine Flu this year, using natural methods to strengthen our immunity can alleviate fear and help keep us healthy.

In the double-blind, placebo-controlled study 326 kids aged 3-5 were assigned to take either placebo, a single strain probiotic (containing 1 type of bacteria; L. acidophilus) or a double strain probiotic (containing L. acidophilus and Bifidobacterium) twice a day for 6 months.

The results were dramatic.  Compared to kids on placebo (not taking probiotics), kids taking probiotics:

• Fever incidence – 53% less for kids taking the single strain, 72.7% less for kids taking the double strain
• Coughing incidence – 41.4% less with the single strain, 62.1% less with the double strain
• Runny nose incidence – 282.% less with the single strain, 58.8% less with the double strain
• Duration of fever, coughing and runny nose were decreased 32% with the single strain, and 48% with the double strain
• Need for antibiotics was reduced by 68.4% with the single strain, and 84.2% with the double strain
• Days absent from day care were reduced by 31.8% with the single strain, and 27.7% with the double strain

Bottom line:  Giving your kids a quality multi-strain probiotic with at least 10 billion cfu (colony forming units) every day as was done in the study can reduce their risk of getting a fever, cough, and runny nose by about 2/3.  If they get a cold it would be reduced in duration by ½.  Their need for antibiotics would be reduced almost 85% and the number of days they would need to miss day care would be reduced by 1/3.

This is a huge benefit for a generally moderately priced supplement that is virtually without side effects.  While many supplements are as good over the counter as through practitioners, probiotics are one supplement I do highly recommend you purchase from a practitioner.  Studies have shown that many over the counter probiotics are poorly manufactured and do not contain the levels of beneficial bacteria stated on the label, and some even were found to be contaminated with harmful bacteria.  The practitioner brands Naturopathic doctors use as well as other practitioners tend to be a little more expensive but are produced with very stringent quality control, making them safe and therapeutically effective.

If you would like to look up the study yourself it is:

Pediatrics. 2009 Aug;124(2):e172-9. Epub 2009 Jul 27. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC.

What are your thoughts?  Should we be so germ phobic?  We’d love to hear your thoughts.  Please feel welcome to post below.