January 29, 2014

Why Your Doctor Hasn't Recommended The Paleo Diet (Paleo, Gluten Free, GAPS, SCD)


As a medical resident I am constantly asked by patients if I can recommend a diet or supplement to help them with their medical conditions. As you know I am very interested in the impact that nutrition has on chronic disease so I am happy to have these conversations with patients. But I am the exception in the medical community. Most physicians are actually very uncomfortable discussing dietary changes with their patients for a number of reasons which I will discuss here. This is of no fault of their own, but patients probably don't realize this when they ask their doctors for advice and I wanted to give you some insight as to why this is the case.


1. Your Doctor Is Not A Nutrition Expert

I am not sure if you know this, but physicians receive very little education when it comes to nutrition. And I mean VERY LITTLE. I think I had 2-3 hours worth of nutritional education in my medical school. And when I say education, we are talking the very basics - i.e. what are carbohydrates, fats, proteins, what foods they can be found in etc. And the education we do receive is mainly based on the current food guide. We do not get taught nutrition specific to certain diseases, mainly because the time it would take to do this would be immense, and would take away from the rest of the things we need to learn in medical school. If any of you are dieticians out there, you know that it took years to learn what you know in a formalized educational program, and it just isn't feasible to give this education to physicians in addition to everything else we need to learn. In the hospital, when patients have specific dietary questions we automatically ask a dietician to see them to have these conversations since they have the specialized knowledge in this area that we lack. So unless your doctor has a specific interest in nutrition, they are unlikely to suggest anything other than "eating a balanced diet according to the food guide." 






2. There is no Evidence 

In medicine we always like to have scientific evidence for treatment methods so that we can justify what we are prescribing. And the more studies that show the same treatment outcomes the better. These studies then lead to medical guidelines which are put together by experts in the field so that there is a standard of care for physicians to follow. And not all studies are created equal. The highest level of evidence come from randomized control trials, while the lowest level come from observational type studies or anecdotal reports. When making treatment recommendations we like to have evidence from randomized control trials to support what we are suggesting. As you can imagine, studying dietary changes in a randomized control manner is very challenging. Especially when you are talking about something like the paleo diet. You are not simply asking people to take a new medication, you are asking them to change their entire lifestyle. This can not only be extremely daunting for patients, but can be expensive and time consuming. And as physicians designing these studies we have very little control over what patients actually do in the real world. Patients asked to follow a paleo diet may not actually do so, or may only partially change, and we have no way to control for that. So even if we do manage to study certain dietary changes we usually only get a small number of patients to participate in these type of studies. And the fewer patients in a study, the lower quality the study is thought to be. 

When it comes to the paleo diet I have reviewed the literature and as far as I can find, there are only two randomized control trials looking at this diet, plus one other non-randomized trial. One of these studies looked at patients with diabetes and the others looked at "healthy" people and observed the changes. All the studies showed positive results - better diabetes control, weight loss, improvement in cholesterol levels and blood pressure, decreased waist circumference. I have included the links to the study abstracts below if you are interested in learning more. 


So as you can see the scientific evidence for a paleo type diet is very limited. And since it is considered such an "extreme" diet physicians feel very uncomfortable recommending it without more studies to back their claims. So even though there is a lot of anecdotal reports and patients who swear their symptoms or conditions have improved by eating this way that is not enough for the medical community as a whole to get behind this way of eating. 

I would like to say that this will change in the near future but I highly doubt it. So the next time you ask your doctor for dietary advice please keep these things in mind. I still recommend talking to your doctor before making drastic changes to your diet because there are certain foods that can be very dangerous for people with certain medical conditions, and as you know there is no "one size fits all diet" for everyone. 



I hope this was useful! Let me know if you have any feedback or questions. 

January 25, 2014

Paleo Chocolate Fudge Haystacks (Paleo, Dessert, No added sweetener)



So when I started this recipe I actually intended to make fudge. Like real fudge. Not fudge haystacks… but to be honest I got impatient. Making real fudge would have required me to make cashew butter and well I didn't want to wait that long for my food processor to blend all those cashews. So I quit early and came up with this recipe instead. I blame my impatience on being sick (because I am normally such a patient person…). Regardless I have to say I am pretty happy with the results. I have been trying to come up with more dessert recipes that don't use any added sweeteners and this one fits the bill. These are only sweetened with dates. I took these to my birthday dinner over the weekend since the gluten containing cake that my Grandma made would just not do for me and my "special needs diet". Most of my family does not understand why I eat the way that I do so I often end up bringing some of my own food to family functions. It's kind of funny. I really don't mind it since a few years ago I would have been totally overwhelmed by the thought of making food without gluten, soy, dairy, sugar etc etc. It's amazing how you adjust over time. Anyways everyone (except for my sister) really liked these so hopefully you do to. And if you know my sister you also know that she doesn't like a lot of foods so I don't take her dislike personally.

Have a good weekend everyone!

Ingredients

2 cups raw cashews (preferably soaked and dehydrated)
2 cups dates (soaked for 20-30 minutes first) 
1 package coconut cream concentrate (you can buy this here or use coconut butter)
1 TBSP organic vanilla extract (I use this brand
1/4 cup grassfed butter or ghee (this brand is what I use) 
1/8 cup cacao butter (you can buy this here
4 TBSP organic cocoa powder
pinch sea salt
1 1/2 cups finely shredded coconut (I recommend this brand


Directions

1. In your food processor combine the dates, cashews and coconut cream (I had to do this in 2 batches given the amount) and blend until dates are smooth and cashews in are fine pieces
2. Place a medium sized pot on the stove on low heat and transfer your cashew-date-coconut mixture to the pot
3. Add the vanilla extract, butter/ghee, cacao butter, cocoa powder and sea salt to the pot
4. Allow the butters to melt and stir to combine the ingredients
5. Once well combined turn off the heat and add the finely shredded coconut to the mix
6. Place a sheet of parchment paper on a baking tray/sheet
7. Form 1-1.5" balls with your hands and place on the parchment lined baking tray (see images)
8. Place the tray in the fridge and allow to cool for approximately 2 hours

Again, like most of my desserts I actually like these better cold. You will just have to see what you think!
Let me know if you have any questions!




January 18, 2014

Weekly Recipe Wrap Up

It's my birthday today. Those who know me know that I am not much of a birthday celebrator and this year I have managed to catch the cold/flu from hell. Yep happy birthday to me! Sorry for the whining it's just that I never get sick. I probably haven't been sick for 2-3 years. And being a resident constantly exposed to nasty germs and infections I think this is pretty impressive. Apparently I am not invincible though. Dam. I wish I was. I have been watching lots of Suits the last few days to help me feel better (at least I tell myself it will make me feel better). I bet Harvey Spector doesn't ever get sick. Now that is a guy that seems invincible. Just saying. If you haven't seen the show you should check it out. It's a good one.

I have pinned a lot of recipes the last few weeks so it was hard choosing just a few for this weeks post but I hope you like the ones I picked. And if you are ever interested you can check out my Pinterest account to see the ones that didn't make the cut. There are some good ones there too I promise.

1. Gluten Free Hamburger Bun from the Tropical Traditions Website


It is always challenging finding bun or bread substitutes on a paleo style diet so I am pretty excited by the look of these buns. They are made with coconut flour, almond flour and eggs so the ingredients are all pretty safe and the results look great! 

2. Kabocha Squash Tacos From Fast Paleo


This is an interesting twist on a taco recipe made using my favourite type of squash. Kabocha's! These are also sometimes called buttercups depending on where you buy them so just be aware of that. If I were to make these I would add some delicious grassed beef to make this a complete meal. Yummy. Maybe I will make these tonight… hmm… 

3. Banana Chai Granola from GI365


I have yet to try making paleo style granola but when I do this will be the recipe I go to! There is no added sweetener in this one and the granola is sweetened with bananas and dates only. Genius! It's no secret that I love the blog GI365 and this is yet another recipe that I am dying to try! Kari is brilliant in the kitchen let me tell you. And her photos are gorgeous too. I might be slightly jealous. Only slightly. 

4. Gluten Free ABC Brownies from the Tropical Traditions Website 


I love it when people think of genius ways to use real food in recipes. This is a brownie recipe that incorporates both avocados and bananas. That may sound strange but avocados seem to lend themselves well to anything chocolately. You will just have to take my word on that and try these little treats. They do look pretty delicious if I do say so myself. 


Well everyone that's all I have for you for now. I hope you like these recipes! Let me know if you make any of them. I am going to go make some tea and curl up on the couch. Yep I do know how to have fun on a Saturday! I hope everyone has a good weekend! 

January 11, 2014

Sweet and Savoury Apple Cheddar Biscuits (SCD, Coconut flour, Nut free)


If you don't eat dairy I suggest you stop reading now! These little biscuits contain cheddar cheese, and I know that some of you strictly avoid dairy products so unfortunately these aren't for you. But for those of you who do occasionally include dairy in your diet please keep reading!

I for one only rarely have dairy. Before making these it had probably been 6 months since I had had any (so yes when I say rarely I really mean it!). And when I do eat dairy, it is in the form of organic, unpasteurized, lactose free cheese. If we could get raw dairy here in Calgary I would be all over that… but for now this is as good as it gets! I know some of you in other places have an easier time getting access to raw dairy products so if you do take full advantage and use some for this recipe!

I taste tested these little guys on the boyfriend and I think his direct quote was "I don't think any gluten free biscuits could get better than these." So hopefully you agree! The texture is definitely different that a traditional gluten containing biscuit so if that is what you are used to it may take a few biscuits before you adjust. But the health benefits are worth it! Trust me. And for those of you that don't tolerate nuts or are trying to limit nut flours you will be happy that these are made solely with coconut flour. Yay! 

Sweet and Savoury Apple Cheddar Biscuits (SCD, Nut free, Coconut flour) 

Ingredients

2 cups shredded apples (I used 4 small Pink Lady apples but any sweet apple should do) 
1/4 cup coconut oil
1/4 cup grassfed butter or ghee
1 cup grated cheddar cheese (raw, unpasteurized and lactose free preferably) 
2 TBSP pureed onion
1 cup coconut flour 
1 tsp organic vanilla extract
1/2 tsp aluminum free baking soda
1 tsp dried basil
pinch sea salt
Optional: 4 pieces of bacon, broken into pieces (highly recommended!)
Optional: 1 egg (I don't tolerate eggs but this will help the dough stick a little better) 

Directions

1. Peel and core apples. Then grate them or place in a food processor to shred
2. Transfer shredded apples to large microwave proof bowl and add coconut oil and butter/ghee
3. Heat apples and fat on high for 1-2 minutes (until oil is melted) and stir well
4. Puree enough onion in your food processor to yield 2 TBSP and transfer to bowl
5. Add the rest of your ingredients and mix well with a pastry blender
6. Preheat your oven to 350F
7. Place a sheet of wax paper on a baking sheet or tray
8. Form 2 inch sized biscuits with your hands and place on baking sheet (see photos below).
** HINT: wet your hands between each biscuit to form them easier and add a bit more moisture
9. Place your baking sheet in the oven and bake for 17- 18 minutes (until edges just start to turn brown)
10. Remove from oven and allow the biscuits to cool. Use a metal spatula to remove from wax paper
** NOTE: Let these cool completely before eating. They retain the moisture better as they sit so if you try eating them right away you will end up with a crumbly mess!

Recipe yields: 13 biscuits
These keep really well in the fridge. I actually like them better after they have sat for a day in the fridge. I feel like the flavours are brought out by sitting longer…but maybe thats just me!





Enjoy everyone! And have a good weekend! Let me know what you think of these if you try them!
And as always please feel free to contact me with any questions!

Oh and I created a Facebook page just for my blog. You can find it here:
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January 08, 2014

If You're Struggling Part 2

It's been a while since I wrote an "If you're struggling" post and I decided that after the holidays was a great time for another one of these. If you haven't seen my first post with this title you can find it here:
If you're struggling part 1

Did you overdo it over the holidays? Did you cheat on your normal dietary routine? Are you now paying the price? Don't worry there are things you can do to get back on track! We have all been there so don't lose hope! You are not alone!



Those of you who suffer from GI problems, whether it be Crohn's, ulcerative colitis, irritable bowel syndrome, small bowel overgrowth etc etc. are probably used to having "flares" or periods of time when your GI system seems to be so upset no matter what you do. And identifying triggers can be a very challenging task. Over the years I have been able to gradually identify some of my triggers and I now am cognizant to avoid them if I can. Regardless, whatever your triggers I have one general rule for getting your system back on track:

SIMPLIFY


What do I mean by that? Let me explain

1. Simplify your diet

Whether you know your specific dietary triggers or not, one easy thing you can do is go back to a very simple, easy to digest diet for a few days to allow your GI tract time to rest and recover. What do I mean by this specifically? Well I can only speak for what works for me but these are the foods I rely on when my body needs a break:

1. Bone broth: you have all heard me sing praises for bone broth before but it is especially important during a flare. I would drink 3 cups of this a day when you are suffering. This can be chicken, beef, turkey or any other grassfed, free-range animal. Remember DO NOT use bones from animals raised on hormones, antibiotics, artificial feed or other "modern methods" as this will actually be harmful rather than helpful for you. Bones and fat are where animals store the majority of their nutrients, fat soluble vitamins and minerals so if you are eating animal bones raised on antibiotics, soy supplemented feed and hormones, this is what is being incorporated into the bones and fat. Not what you want!

2. Meat from reliable sources: I eat a lot of ground grassfed beef when I am flaring. I simply fry it in a bit of coconut oil, butter or ghee and season with sea salt and pepper. You could also use any other type of ethically raised meat as long as you prepare it in a fairly simple way without a lot of additional ingredients. Not only is this easy to digest but is packed with omega 3 fatty acids (anti-inflammatory), essential vitamins and minerals.

3. Vegetables: Now vegis can be a bit tricky. You want to stick to vegetables with minimal fibre when you are flaring. I rely on roasted squash and well cooked carrots when I am suffering. I have found that these are the easiest for me to digest. And the more they are cooked the better.

4. Fruit: I do not suggest eating a lot of fruit when you are flaring. The extra sugar only helps feed the strains of bacteria in your gut that you are trying to settle down. BUT, if you really need a sweet fix I would only recommend trying very ripe bananas (think lots of black spots). These are the easiest to digest, with minimal fibre, although they are high on the glycemic index so some of you may not be able to tolerate them at all.

5. Eggs: If you tolerate eggs this is a great time to load up. I, unfortunately do not do well with eggs so I don't eat these when I am flaring but they are so versatile that they make a great addition to your diet. These can be prepared in almost any manner, just try not to overdo it with the fats when you are preparing them. And as with all your other products make sure you are getting these from a reliable, local source.

6. Beverages: During a flare I suggest you drink only water, herbal tea and bone broth. I add lemon to my water to give it a bit of flavour and coconut water is also a great option if you are looking for some extra electrolytes (which you may need if your diarrhea is severe). If you are drinking herbal teas make sure they contain only SCD legal ingredients and no artificial or natural flavours (these likely contain soy). My go to herbal tea is peppermint or spearmint or a combination of both. Very soothing to the digestive tract!


2. Simplify your life

This one is definitely easier said than done. And for those of you, like me, who are the classic Type A personality, it may not be possible to give up all of your commitments, but if you can eliminate certain stressors it will help immensely.  The mind is extremely powerful, and stress can manifest with all sorts of physical symptoms, and if you are like me, the gut is the first place that stress hits. There is a ton of evidence linking stress to IBS and IBD symptoms, so if you are skeptical I have included links to a few abstracts addressing this very issue below. Even small changes can make a difference. Cutting out intense exercise for a couple days, having a relaxing bath before bed, attending a yoga class to help clear your mind. Anything you can think of that will help you relax or de-stress will be beneficial. 

Some of the literature linking stress and GI symptoms:


I hope you find this to be helpful! Let me know if you have any questions! I hope you start feeling better soon!

January 04, 2014

Weekly Recipe Wrap-up

Has anyone else noticed that there have been some especially good recipes being shared in the blog world recently? Is it the holiday season? I don't know what it is but I am not complaining! I have some delicious looking recipes to share with you this week.

Is everyone back at work now? I sure am. I am mentally still in the holiday mode so it has been tough to focus on work but the hospital has been insanely busy lately with the flu outbreak so the time definitely flies by that's for sure!

Do any of you make new years resolutions? Have you broken any of them yet? It is January 4th after all..
I have never been a resolution making person… sometimes I come up with goals for the year or things I would like to accomplish but they have never revolved around January 1st. I know a lot of people resolve to get in shape and eat better every year so if you are one of those people hopefully you will find some helpful recipes and tips on my blog! And speaking of eating well I have another weekly recipe wrap up to share with you this week. I hope you are inspired by some of these! Simply click on the title and the link will take you to each recipe.

Weekly Recipe Wrap-up

1. No Bake Sticky Berry Bars from Paleomg


Those of you who have followed my blog for a while know how much a fan I am of the blog Paleomg. Here is yet another recipe that Juli put together. That berry topping looks delicious! I pretty much love any dessert recipe that involves fruit so to me this looks amazing! To make this SCD legal simply sub the maple syrup for honey. And coconut butter can be used in place of coconut concentrate depending on what you have on hand. 

2. Sweet Potato and Herb Meatloaf from Paleo Fondue 


Now I know that people have mixed feelings about meatloaf. I for one have always liked it so hopefully those reading do too! This is an interesting twist on the traditional recipe using sweet potato. This recipe comes from the blog Paleo Fondue which I recently discovered. To make this one SCD legal I would replace the sweet potato with butternut squash. I think the taste should be similar, although I have not tried it so don't quote me!

3. Creamy Tomato Soup from Paleo Girl's Kitchen


It has definitely been soup weather here in Calgary! We have had so much snow and cold weather this year it is ridiculous! So to satisfy all those cold weather food cravings I am sharing this soup recipe with you. This one comes from Paleo Girl's Kitchen. If I were to make this I would use fresh tomatoes instead of canned and homemade chicken broth to make it SCD legal. I would also use full fat coconut milk instead of light (you all know how I feel about fat by now!). 

4. Chestnut and Drunken Raisin Muffins from The Saffron Girl 


"Drunken raisins." Did that title catch your attention? I have to say that it did mine! I was very curious to see what these muffins contained. I must admit that chestnuts are not an ingredient I have ever cooked with so I would really like to try making these. This recipe comes from the Saffron Girl whose blog is dedicated to travel and food. What a great combo! Maybe in my future life I could come back as someone who only has to travel and cook. What a dream that would be! Yes a girl can dream. 

Well everyone that is this weeks recipe wrap-up. What do you think of these? Will you try making any of them? Which one will you try first? 
I hope you are all staying safe and warm! I plan to hibernate as much as possible this weekend. That's what winter does to me. It also "forces" me to cook more with all that time indoors. Yes it's a big sacrifice I know. 

I hope you have a good weekend! Please feel free to send me any comments or questions!