By NMajik at en.wikipedia (Own work (Original caption: “Source: Self”)) [Public domain], via Wikimedia Commons
This is the last post in my little Specific Carbohydrate Diet series. The Specific Carbohydrate Diet (SCD) is just a real food diet, with some added food tweaks that good observers throughout history have discovered reverse disease and promote healing. It is not the holy grail of diets, although for some patients, it is the cure they were looking for. (You may prefer the word “control” instead of the word “cure,” since these patients will probably never be able to go back to DiGiorno pizza.) I definitely suggest the SCD for Crohn’s and ulcerative colitis as a starting point diet because there is research behind it. (See here for a short summary of the evolution of the SCD diet with references.)
When I used a form of SCD for my gastrointestinal issues (not inflammatory bowel disease), I ran into a few issues and the diet stalled for me, even regressed. I don’t give up easily when I think there’s a way to accomplish something, and so I played around with the diet and I read what other people trying the diet were saying. I’ve compiled a little list of things to try if SCD is not working for you.
Remember, nothing here on my site is medical advice and should always be investigated and explored. Talk with your doctor and maybe get a referral to a dietitian for help. This is the internet. Believe nothing. Question everything.
Eliminate “pesky” foods that are allowed on the diet: nuts, peanut butter, eggs, dairy. Foods that we know cause life-threatening allergies can also cause other immune reactions in the body that aren’t nearly so serious. Even though they aren’t life threatening like true allergy, they still can cause bad, uncomfortable immune reactions, especially at the interface of the gut lining (but not limited to the gut lining).
Common food allergens like nuts, peanuts, dairy, and eggs are notorious for more than just anaphylaxis and hives! If you read research studies, you’ll see them coming up again and again for things like migraines, eosinophilic esophagitis, and eczema! I feel like medical doctors only communicate the life-threatening aspect of these foods (which is super important, of course), and ignore their involvement in so many other disease states. So people walk around treating their problems with creams, puffers, and pills, when they could be investigating their diet.
The Specific Carbohydrate Diet allows eggs, almonds, nuts, peanut butter, homemade yogurt, cheeses and butter. All good foods! But also all known top allergens that can perpetuate illness in susceptible people.
(Coconut is not necessarily a top 8 common allergen, but I’ve read of many SCD’ers having trouble with it, particularly the flour. I’d add it to the “pesky” list.)
How do you know which “pesky” to take out? Well, you can start with the one you have a sneaky suspicion about. Or you can see if your doctor will order you an IgG blood panel (which has such variable results for people), although you need to know up front that many conventional medical doctors disapprove of them. Or you can eliminate them all, and slowly bring them back in one at a time.
Whatever you do, be smart and make sure you’re getting any nutritional deficits accounted for!
Cut down on baked goods. When people switch to the SCD, they often, understandably, try to recreate the diet they had been eating: muffins, breads, pancakes, and cookies. ALL of these things can be made on the SCD and are super tasty! However, the ingredients for them come from the “pesky” category (almond flour, eggs, butter, and so on), so they really shouldn’t be routine food fare. They also come with a big whop of sugar; yes, I know it’s honey, but fructose in excess has its own negative effects. Baked goods are great as a transition to ease families into eating more real, wholesome foods. If my kids hadn’t had a baked good, I would have had some runaways.
In any area of the diet you may be lapsing and skimping in, get strict again. Get back to eating only the legal foods with “no exceptions.” It’s so easy to let products back into our kitchens. A little guar gum here. A little BHT there. Some maltodextrin there. Some modified food starch. And then you’ve walked down the slippery slope and fallen. Crash and burn for a few little ingredients that really weren’t even that important to you!
Studies indicate that emulsifiers may cause problems for inflammatory bowel disease, so if you’re struggling, get the “small stuff” back out!
Alternatively, perhaps the idea of “being strict” is sabotaging adhering to the diet well, and adding in a few select real, whole, foods, like rice and/or potato may be helpful in overall adherence to the diet.
Even though certain foods are not allowed on the diet, that doesn’t mean that a person’s body and disease will not tolerate them. Yes, it’s best to adhere to the diet as it is written, but it is VERY likely that adjustments will have to be made. Remember, the diet is not magic. It can’t prophesy exactly what your body will and will not tolerate. If adding in a food that may not be problematic anyhow is the price to pay for keeping on the diet instead of giving up completely, it’s worth a trial! Make sense? (But do talk with your healthcare provider who is overseeing your diet. They might have some other tips they’d like you to try first.)
Elaine Gottschall, the author of the diet, did not intend for The Specific Carbohydrate Diet to be a forever diet. She advocated moving off the diet once symptoms were well-controlled.
Read about FODMAP foods. Foods have natural sugars and molecules that we don’t absorb and that feed our gut bacteria. It’s actually a good thing. But sometimes, guts that are compromised need a break from these too, or else they’ll have painful bloating, gas, diarrhea, and/or constipation. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAP foods can cause pain outside of actual inflammatory disease and would be worth exploring. I have noticed that many people suggest cutting down on fruit if the SCD isn’t working well for you, and I can see where certain fruits will exacerbate a FODMAP condition. Here’s a good site with FODMAP information. Just click on the symbol, and it brings up a nice handout.
Take away the power struggle. When it comes to kids, they MUST understand the diet and their bodies. Kids usually make good decisions when they’re given good information and see the impact of certain foods on their bodies. Make it a point to understand the diet and read the book, then paraphrase it and explain it to your child. Kids need empowered, not controlled. Sometimes our fears lead to a strong need to control, but kids will buck this. Well, at least mine do!
The mind-body idea. We KNOW that there is a BIDIRECTIONAL process between the brain and the gut and conversely, the gut and the brain. It works from the bottom up. And the top down. If you’re ready to take it beyond diet and supplements, maybe it’s time to move inward. Google things like mindfulness and IBD. Or hypnotherapy and IBD. See what you think. This area has definitely piqued my interest. It takes me months and years to write, so you’ll definitely want to read in this area before I get any posts up on it!
Well, that’s it for today. I’m sure there are other tweaks. I think the best tweak is to know you’re going to be okay. Know that nothing can get you, because you’re bigger inside than anything you can comprehend. If you’re on the religious side, know that you’re a spiritual being forever with a human body but fleetingly.
Feel welcome to post any tweaks you’ve found beneficial.
When I used to work as a physician, I wondered what it’d be like to stay home with the kids full-time. Some moms would say, “I HAVE to work. My kids drive me crazy.” I always thought to myself that I’d still like to try it and see. Maybe crazy is a state of bliss that I’d like quite a lot.
I did get to stay home, and to my chagrin, I did fall into crazy. Crazy nutrition. At first, I honestly did wonder if I had taken neurotic to its pinnacle, but I kept reading and reading. And over the short four years since I began having any interest in nutrition at all, other than having the best chocolate chip cookie recipe, there have been some major upheavals in medicine regarding nutrition, particularly regarding fat and cholesterol. But I know there will be more.
One upheaval that intrigues me, because I swear real food is pixie dust, is doctors using a realfood diet to throw inflammatory bowel disease into remission without medicine. At Seattle Children’s Hospital, researchers are reversing serious cases of ulcerative colitis and Crohn’s disease using the exact same voodoo, or pixie dust (if you prefer), diet that Elaine Gottschall, a stay-at-home mother of two, used in the 1950s to save her 8 year-old daughter’s life from near-terminal ulcerative colitis. The diet, called the Specific Carbohydrate Diet (SCD), was the last hope that Elaine had for possibly saving her child’s colon, maybe even the child’s life itself. Permanent poop collection bag? Death? How about we try this weird diet.
Dr. Sidney Valentine Haas’s Stodgy, Misinformed Diet
The SCD is not a new diet. It has been around in some form since approximately the 1920s, when Sidney Valentine Haas, MD was using it on his celiac and severely afflicted gastrointestinal patients. At this time, there was no known celiac disease and gluten connection. Dr. Haas, using close observation skills and taking good patient histories (all things falling into disfavor in today’s medical climate), felt that starchy carbohydrates and table sugar were bad for his patients. So he developed a diet which removed starchy foods and sugar, making it inherently gluten-free and grain free. He found that his patients did fine with fruit, and he strongly encouraged bananas, and he even thought there was something special about the banana.
His “banana” diet was pretty popular and was used to manage celiac disease until the gluten connection was verified. Then, Haas and banana diets fell into disfavor, ridicule even. However, Dr. Haas, a reportedly kindly man who lived into his 90s, never acquiesced that gluten elimination should be the sole treatment of celiac disease. He remained adamantly suspicious that most starchy carbohydrates were problematic and needed removed for a time (not a lifetime). He genuinely believed in his diet, and if you read closely, he is scorned for never succumbing completely to the hypotheses that gluten is the sole problem for celiac patients.
(Now, I don’t know whether he was right or wrong about gluten. I DO KNOW that there are celiacs who follow a STRICT gluten-free diet, never eating away from home, and I know they still have abdominal issues. So, perhaps his intuition is not as laughable as it seems. Perhaps, as time passes and we learn more, we will find facts that make him more right than wrong. I don’t know. History repeatedly shows genius in ridicule, and maybe there’s more to treating celiac than just taking away gluten.)
The SCD would have probably stopped right there if it hadn’t been for Big Magic (you really should read the book by this title, very good). Elaine Gottschall (now deceased, 1921-2005) called herself an ordinary, happy, stay-at-home, 1950s’ mom. She had two young daughters. One of her daughters, Judy, began experiencing incapacitating gut issues and was diagnosed with ulcerative colitis at the tender age of four years old. Little Judy was so sick and malnourished by the time she was 8, she had stunted growth and even her neurological system was shutting down. Elaine and Herb were told their daughter had two options: colon removal or death. Elaine wouldn’t hear it and refused to take death or colectomy (colon removal) as an answer for her daughter if she could do anything about it.
So she did what all desperate patients do (or parents of patients), she doctor shopped. After much doctor shopping and no hope in sight except surgery, an acquaintance of a friend pointed her to an outdated, nearly ancient physician. She finally landed in the arms (figuratively) of our now 92-year-old Dr. Sydney Valentine Haas. He started her daughter Judy on his version of what is now the Specific Carbohydrate Diet. Her daughter improved dramatically within days and even more in the months that followed, living a full life, even being able to eat a very diverse diet eventually.
Dr. Haas died within two years of meeting the Gottschall family. Would his diet die with him? No. Elaine Gottschall made it her mission to understand that man’s diet, even going back to schooland earning degrees in biology, nutritional biochemistry, and cellular biology. If this diet helped Judy live and get her life back, she wanted to know why and share it with the others who were sick. Many times she wanted to give up, but her husband was convicted that the world needed this information that would be lost without Dr. Haas, and he knew Elaine was just the woman to do it.
Herb encouraged Elaine to write a book eventually called Breaking the Vicious Cycle, do health consults, and speak. She functioned at a grassroots level, and she touched thousands of lives, helping people turn their health around with the SCD. But, sadly, she could never break through to medical circles. Her daughter said: “She also wanted the acceptance from–if not approval of–the medical mainstream, which she never got. She was told stories by mothers who said their doctors would refuse to treat their children if they followed her diet…”
Doctors refusing to treat patients if they tried this diet? A diet that has now entered the halls of medical research with initial success? Elaine’s diet brought success to many suffering patients, but the patients’ doctors wouldn’t have it. How could a simple diet help? How could a stay-at-home mom know what she’s talking about? Who was she to challenge medical management?
Because of Elaine’s tenacity and courage (and ability to persist despite medical contempt), people today may have an opportunity to try diet over drugs. Some doctors are listening to patients and trying the SCD in clinical research. (See my last post.)
Elaine, Herb, and Judy (their daughter), thank you.
The SCD studies are small and sparse, but they’re pretty remarkable, especially in kids, whose healing capacities are always amazing. IF diet makes a difference, then I think Elaine Gottschall is right, the only way it’s going to get to medical doctors is if patients keep showing them. Dr. Suskind’s studies from Seattle are shedding some light, but they’re so small. With just a snap or a new successful medical discovery, his work will be trampled over forever, as Dr. Haas’s almost was.
Did Dr. Haas have it ALL right? No. Did Elaine Gottschall? No. Does the doctor named Natasha Campbell-McBride (who has taken Elaine Gottschall’s work further in her clinical practice, renaming her diet GAPS)? No. Does Dr. Suskind, a researcher using SCD in his studies? No. But continuing to cut out colons and continuing to prescribe immunosuppressants without ever trying significant dietary modification such as the SCD is irresponsible and, to me, unethical. Medical doctors maliciously, scornfully, and condescendingly name-call and ridicule diet theories they don’t agree with like pompous elitists. And guess what! When we do that, nurses, dietitians, pharmacists, and the public follow along. Then, we end up in a big mess. Like Days of Our Lives. Please stop the division.
You are never too small. You are never too insignificant. You are always enough. Your experience is for you. Your experience is for others. Live boldly with love and compassion.
Even your cooking can change someone’s life.
Sites and links I followed for information, which should always be verified before you even think about trusting anything…
Imagine having diarrhea 15 times a day, every day. Add some blood to that. While you try to walk across a university campus. Or coach basketball. Or serve on a Navy ship in the middle of the vast ocean. Or learn to add, subtract, and multiply.
This is life with Crohn’s disease or ulcerative colitis, collectively called inflammatory bowel disease (IBD). And when I was a medical student on general surgery, I swear it seems like we were digging around every day in some poor patient’s intestines due to his or her inflammatory bowel disease. Many emerged from surgery with bags to collect their liquid bowel movements.
I feel like I’ve heard it a thousand times. “My doctor says it doesn’t matter what I eat for my Crohn’s disease.” Have you heard that? Do you believe that? That’s 100% false. Research since the 1970s shows that patients can go into remission with special “nutritional shakes.”
Patients are often convinced that food impacts their disease, but they can’t always pinpoint how or which foods. Medical studies weren’t very helpful in the past; they looked at things like fats, amino acids, and vitamin D, finding some correlations, but nothing to hang their hats on. So hard-working doctors just shrugged their shoulders and said, “It doesn’t really matter, dear patient. Just eat.” [Scram. I’ve got 8 patients waiting to see me. I don’t have time to listen to you speculate about whether or not milk gives you diarrhea.]
But fascinatingly, studies have shown for forty years now, plus or minus, that IBD can be controlled with nutrition! Well, more accurately put, researchers and patients controlled IBD with exclusive enteral nutrition. Exclusive enteral nutrition, EEN for short, is basically just a “nutrition” shake kind of like Ensure or PediaSure, only it tastes much worse. The ingredients in the shake have been pre-digested so they can be absorbed completely in the small intestine.
Studies have repeatedly and reproducibly shown great results for IBD patients and EEN, particularly Crohn’s disease. How great? Well how does upward of 100% sound to you for a remission rate? Would you even settle for a 70% rate? Yeah. That good. I’m cherry picking a little; some studies didn’t have such high success rates, but most did. And some studies that didn’t look all that good to begin with looked better after the study results were adjusted for patients who just couldn’t tolerate the special liquids (often quite a few). Also, results were consistently better for pediatric patients [who often heal more quickly and have to be compliant whether they like it or not—and sometimes choose to be compliant because they feel so much better!]. (Kansal, 2013)
But patients and doctors, I guess, weren’t having that. Too yucky. Too restrictive. (Just for interest, I notice that Nestle seems to make many of these nutritional EENs.)
What’s in that shake?
Great minds pontificated about what it was in the EEN drink which could cause these patients to do so well. They played around with the liquid formulas with good success, trying to make them less repulsive and less expensive. Then they pondered, “Well, can we let our patients eat [cake] and take some of this EEN stuff?”
So researchers let patients drink the liquid EEN formula and have free access to table food at the same time. Yum! With free access to table food, despite the nutritional “shake,” the remission rates weren’t as good as when a patient ate only EEN liquid—but they were better than the patients who received no EEN at all. Aha! So it’s starting to look like something in table food perpetuates increased inflammation in inflammatory bowel disease patients. (Triantafillidis, 2015)
Okay. All Mama’s good table food really threw a wrench in the great effects of the EEN shakes. What next?
Well, allowing table food was a step backward, and researchers thought, “We need another twist. What can we do? This is fun.”
So researchers gave patients nutritional “shakes” and they let them eat only certain allowed foods. (NO CAKE this time. Sorry.) Bingo. Success rates held at about 70% of patients showing improvement and or sustained remission. (I know a lot of doctors who made just 70% in class and are successfully practicing. Pass equals MD, baby. Seventy percent is pretty good.) That’s awesome. How happy would you be to be symptom-free and able to eat some real food? (Sigall-Boneh, 2014)
It’s 2017. Can we ditch the EEN altogether and just eat real food?
Now, we have to cap it off. Could patients get off of the disgusting “shakes” altogether? (Good-bye, Nestle…) Well, the Journal of Clinical Gastroenterology is about to publish a study done by a Dr. Suskind (and his team, of course!) from Seattle Children’s Hospital. Ten pediatric patients followed a diet called the Specific Carbohydrate Diet for three months, and 80% of them had symptoms improve significantly and even resolve and lab markers normalize. Eighty-stinking-percent! Let me repeat: eighty percent success. WITH FOOD.
Way to go Dr. Suskind and team. Way to take medicine back to truly patient-centered, do-no-harm care! And most importantly: WAY TO GO PATIENTS AND PARENTS WHO PARTICIPATED IN THIS STUDY! Changing how you eat is hard work, and most people balk, standing in the corner cowering with too much fear to leave their pizza and bread behind. Not you. Not you. (Suskind, 2017)
[Click here for a readable summary of Suskind’s report and here for an abstract of it.]
Meh. Study needs to be bigger.
Now, I showed someone Suskind’s research summary, and she replied, “But there’s only ten patients. I wish it was bigger.”
Sigh. So do I. But it’s what we’ve got. And it’s so promising. I’m ebullient. Diet alone! Eighty percent remission! With real food. No diarrhea! No bleeding! No stomach cramps! Virtually 100% safe. No injections! No risk of white blood cell counts crashing. Why won’t people try this?
Reminds me of a verse I learned from a big book, although I’ve adapted it. “The fiddle plays and you won’t dance. The singer wails a mournful tune, and you will not cry.” We are hard to please. Impossible nearly. What do we want? A magic bullet pill with no side effects?
I must close now. But you will not want to miss my next post about the amazing stay-at-home mom who made it her life mission to show the world that inflammatory bowel disease can be controlled most of the times with real, whole food. And I’ll explain a little about the diet that saved her 8-year-old daughter’s life and which she spent her life studying and evangelizing.
Welcome back to my self-interview about this voodoo diet called GAPS–
Wait–why do you call it a voodoo diet? Ha! I took to calling all this alternative stuff “voodoo” because, as a conventional medical doctor, I didn’t believe in it. It seemed like tricks and magic without real, tangible evidence and results. (Snake oil. Voodoo. Quack, quack. $Ching, ching, ching. All these people seemed in cahoots together.)
The GAPS diet especially seemed like spooky voodoo because it repeatedly talks about making and drinking broth from bones–bone broth– and eating animal organs. If that ain’t “voodoo” sounding to a refined, civilized girl who eats cereal for breakfast and a sandwich for lunch…
Do you still think it’s spooky? Nah. Now I realize it’s just a traditional way to recoup the needed minerals, proteins, and vitamins that are stored in bone and the organs of animals. It’s basically just using the whole animal, as cultures historically did before us.
I mean, it seems even a generation or two before us, kids were still forced to eat their liver. Not “their” liver, but the cow liver on their plate. They didn’t all run to the store to pop some vitamin D, folic acid, calcium, magnesium, and vitamin C pills. And ask the grandparents! You’ll find some of them who have an affinity for an organ they haven’t eaten in years!
My dad loves liver. My father-in-law heart. I remember eating the tongue with my own farming grandparents when I was a kid. Each meat cut and organ has its own vitamin, mineral, and amino acid profile! So by only eating white meat or steak, we are completely missing the gamut of beneficial nutrients, due to our snobbery and “advancement.” It’s a sad misuse of an animal. I’m so sorry to be perturbing my vegetarian friends’ sensibilities. I know it sounds yucky.
Well, it does sound a little gross, I have to say. Anyhow, I have read some bad things about the GAPS diet? Can you mention some of those concerns?
Yes, well, there’s the concern of lead toxicity in the daily broth requirement. If the animal is raised on a bucolic, yet lead-laden farm, then the animal can have a higher concentration of lead in its bones, seeping into your broth. I’ve read you can’t really predict which land will be high in lead levels because the lead can permeate the air, travel, and settle in a different area, remaining for years and years. Remember, we used to use lead in gas for our cars. So I’m not sure you could predict without testing, which farms will have higher lead than others. But I’m no expert. So, sure, there may be an unpredictable risk of lead.
Another concern is the effect of a sudden carbohydrate drop on the body. GAPS doesn’t have to be a low carb diet, but the introduction diet is way too easy to be almost no carbs at all! Most people just enter ketosis with uncomfortable symptoms, like headaches, fatigue, and a little nausea.
Other people, and kids are pretty sensitive, react violently to the ketosis transition, with horrible nausea and persistent vomiting. This really puts them at risk for electrolyte disturbances, which could land them up in the hospital! Most likely, and I’m not a GAPS provider or expert and you shouldn’t use my blog for medical advice, this could be avoided by making sure to eat carrots, winter squashes, pumpkin, and honey in the recommended tea. I personally think a slower transition to a low carb diet is much safer. When I transitioned, when I felt that low-carb feeling, I eased it with some cooked carrots and honey in my tea. I’m a weenie. But a safe weenie.
Food obsession is a definite concern too. The GAPS food list becomes a Bible. I remember my husband coming home when I was doing GAPS and showing me an article about orthorexia. This is an eating disorder where people obsess about eating healthy, judge themselves and others by how they eat, develop anxiety due to food choices, and basically, their whole life simply become wrapped up in food. I was glad he showed me this article. We talked about it together, decided no, that’s not where I was at, and then I proceeded with a new awareness of something that can easily afflict health-conscious people–myself included—if awareness is not high.
And then we get into raw eggs and raw milk and raw fish…
Oh, uh, yummy…by the way, what do you eat on GAPS? Well, the book has a whole list of do’s and don’ts. But, basically you eat lots of vegetables, like broccoli, cauliflower, zucchini, carrots, squash. Meats, trying to incorporate grazing animals that roam pretty freely outside–and not just eating one cut of meat, but the whole animal, including organ meats.
Eggs, seafood. Fruits. lentils and specific beans, soaked. Nuts. Honey. Peanuts are okay, too. And then daily consumption of fermented foods for probiotics and homemade broths (using leftover scraps and bones) for the minerals and amino acid profile.
But what shocks most people is that there are no grains or potatoes allowed. Not even sweet potatoes. GAPS’ carb foods are things like carrots, squashes, lentils, honey, navy beans, fruits, peas.
Did GAPS “cure” you? No. It did improve me, though to the point that my GI symptoms were very tolerable. It also showed me that the many headaches I was getting wasn’t just my kids. (Love you, girls!) Ha! I had some sensitivities to particular foods, like eggs, which give me headaches. But I had to carefully do and re-do the introduction, elimination type part of the diet to figure that all out.
What do you mean? Sensitivities? Geesh! You had to take out MORE foods? Yes! A full GAPS diet would have been disastrous for me, but because I went through the introduction and followed the author’s suggestions on watching for food intolerances, I was able to identify problem foods I had: dairy, nuts, eggs, chicken, coconut. After 18 months on GAPS, those foods still bothered me (and still do). GAPS helped me but did not cure me.
But the GAPS diet is laden with foods that will bother many autoimmune-ish people, like dairy, nuts, eggs, and legumes. All very “healthy” foods that I think should be in a person’s diet if they are tolerated.
WAIT a minute. Are you kidding me? Some people have to take it further than GAPS or Paleo?
Well, nobody has to do anything! Right!? It’s important to remember that! This is always a choice! But, yes. Some people will find much relief in taking their diets down to whole food and then further eliminating nightshades, legumes (beans and lentils), all nuts and seeds, all dairy, eggs, all grains (wheat, soy, corn, even rice and quinoa). Also, watching out for reactions that are very individual, like avocados or shellfish or coconut, etc.
But remember, the goal is not to be a martyr or to be “cool,” the goal is to feel better, to feel like yourself. And your own diet tailoring will take you there, not somebody elses.
Are you sure this stuff, it’s not all in your head? Or those people’s heads?Could be. But my head really wants it to be okay to eat pizza. I’d love me some pizza. My head wants pizza. It’s my favorite food. But when my head starts eating pizza, my body gets mad. My head is like, “Ah, see! That wasn’t so bad, and it was delicious.” And my belly is like, “What did you just do to me?”
Would the “you now” recommend the diet to the “you back then”?
When I started this nutrition stuff, I needed an extremist to bring me to my eating knees. All my food came from a box. It all had dairy and wheat. And I didn’t really see anything wrong with that. Mostly, I’m not extremist in anything. I always thought that a really good diet (and life) allowed absolutely anything in moderation. But my gut and headaches didn’t agree, and food definitely played a role. I haven’t read a better book at explaining how to eat 100% unprocessed food than Dr. Natasha Campbell-McBride’s Gut and Psychology Syndrome (GAPS) book.
I mean, she taught me that even tea bags were processed and that “whole food” tea would be the loose leaf tea, or even better, the mint you grow in your garden. However, the GAPS book is not really written in a scientific manner, it is more evangelical–and maybe even fanatical?
It is written to drive things home and to allow for no exceptions. I needed Dr. Natasha Campbell-McBride’s unique, rigid approach. There’s no looking for GAPS-legal processed foods because honestly, none exist. (Heck, even nuts are supposed to be soaked!) If I had a loophole, I would have wriggled my logic right through it.
Dr. Campbell-McBride’s GAPS diet book breaks things down in a simple, general way for pretty accurate reading–but could definitely be considered reductionisic or “fruity” by anyone with a medical or scientific background.
I would recommend to myself back then that I not be afraid of any real, whole food, and that I introduce it slowly, seeing how I do. Not just follow the GAPS list of foods. Start with those, and then not be afraid to journey forward.
Do you believe everything in the book?
No. Not as stated. But yes, I do see now with my research that the gut and its bacteria play a huge role in the body’s pathology. I see where soaking nuts and beans helps. And where eating organ meats and bone broth supplies needed nutrients.
I do not find her “allergy testing” on the skin to be useful or practical. It may even be dangerous. Someone with a severe food allergy may think, because their skin doesn’t have any changes after putting some of that food on their skin overnight, it’s okay to eat a known allergenic food.
I’m still not a fan of raw milk. Sure, if it’s my cow, I wash the teats, and I milk the animal.
Mostly, I know that one plan will NOT fit all. Ever.
Well, let’s stop talking and see if anyone wants to comment. Okay. Good. I hope people remember that this blog is a place of sounding ideas, sharing ideas, not one of guidance. Ha! “Like the blind leading the blind, shan’t they both fall in the ditch…”
Listen, you’ve heard the term hypoallergenic as it relates to your jewelry, your skin care products, and your laundry detergent, but have you ever thought about the food you eat? Have you ever thought about if what you eat is hypoallergenic? No, no. NOT sterile. Hypoallergenic doesn’t mean sterile!
You don’t blink an eye when a friend says, “Oh, I can’t wear cheap earrings. My ears get sore.” You get that! We can all relate to people needing hypoallergenic jewelry or skin products. But have you ever thought about the food you eat and whether or not it’s hypoallergenic to your system?
Yes, indeed! Just like these external substances can lead to immune reactions, so can the food you eat! However, the food you eat leads to a chain reaction of internal immune system activation that doesn’t just sit right there at the gastrointestinal (GI) tract.
You have immune cells lining the intestines which sample the foods you eat and decide whether or not they like it. Whether you like the food doesn’t matter. Whether the food you eat is healthy or not doesn’t matter. If the immune cells sample it and don’t like it, they are going to send out signals (histamines, prostaglandins, interleukins, interferons, and other cytokine signals) in the blood stream which can affect any organ system in your body: you stomach, your brain, your skin, your reproductive system, your lungs, your connective tissue (joints, as an example), your thyroid.
My Oligoantigenic (What!?!?) Diet
When I first started down this fascinating nutrition avenue a little over four years ago (from a classic diet of cereal for breakfast, a sandwich for lunch, and pizza or pasta for supper), one of the first things I learned about and tried was an “oligoantigenic diet.” I had read that some people with the same gastrointestinal malady that I suffered from had been treated in a medical research study with an oligoantigenic diet!
What in tarnation is an oligoantigenic diet? I’d never heard of that! Basically, it is a strict, hypoallergenic diet that allows only foods which are accepted to be very mild on the body’s immune system. Once I figured out that I could think of an oligoantigenic diet as a type of “hypoallergenic” diet, I got it! Choose foods which cause the least known reactions! For those of you familiar with a strict elimination diet, you know what I’m talking about here too.
So I started on a (miserable) diet consisting of three foods which don’t seem to rile up people’s immune systems too much: lamb (I didn’t even like lamb), plain sweet potato (I had only ever eaten those as fries), and white rice (which I had never eaten plain). Did I mention it tasted miserable? But persistence led me on a food journey of a lifetime (for a lifetime). And as I’ve heard it said, “I didn’t know I was feeling so bad till I started feeling so good!”
An oligoantigenic diet (or hypoallergenic diet) is NOT meant to be a long-term diet. A person starts with a small group of 3-5 foods and builds from there, learning to observe signs and symptoms that tell him or her that a particular food category raises immune reactions (by observing for headaches, GI changes, spikes in fatigue, skin rashes, and other clues).
The Pesky Foods
Never once going through pharmacy school, medical school, residency, and hundreds of hours of continuing education did I ever hear about a hypoallergenic, oligoantigenic diet or even an anti-inflammatory diet. (I was served plenty of donuts, bagels with cream cheese, and pizza, though.) It took me going after my own health to learn about nutrition.
Since my oligoantigenic diet, I’ve done a lot more reading. What I’ve found is that the same foods that doctors KNOW are immune provoking because they cause true, life- threatening food allergies, are the same foods that can be removed to lighten the load of a body stressed by health problems. By removing known immune-provoking, inflammmatory-producing foods, the body gets a rest from the prostaglandins, histamine, interleukins, interferons, and other cytokines that it makes in response to something it thinks is harmful.
Although any food can cause allergic and sensitivity issues, there are eight foods that are medically known to cause the majority of the reactions. Why? These foods have what I call “pesky proteins.” They have proteins in them that have very, very strong bonds, making them difficult for our digestive tracts to break down. The better food is broken down into its smallest parts in our intestinal tracts, the less inflammatory it is to us.
The pesky eight foods are:
These are the common drop-dead if you eat them allergenic foods. But I’m not talking about drop-dead allergies here. I’m talking about you and me and Mr. Smith walking around with headaches, bloating, fussy guts, allergies, asthma, psoriasis, eczema, depression, fatigue, puffy eyelids, puffy faces, coronary artery disease, increasing forgetfulness, dry and itchy eyes, chronic sinus problems, joint pain–do I HAVE to keep going? I sure can. Sometimes by simply eliminating the above food categories (with NO cheating), a person can gauge how much food is affecting their health.
Enter Anti-Inflammatory Diets
Since trying my three ingredient, hypoallergenic diet, I’ve discovered a whole world of anti-inflammatory type diets, which aren’t as strict as an oligoantigenic (hypoallergenic) diet. I find it fascinating that these diets often eliminate the Pesky Eight foods, capitalizing on what we know about the immune system and health! However, anti-inflammatory type diets incorporate and expand further on the idea of the immune system and inflammation in the role of health problems.
Each named anti-inflammatory diet (sometimes called autoimmune diets) has its own unique quirks. In general, though, these diets do three things.
Eliminate most of the Pesky Eight foods (although seafood is usually encouraged if a person knows they are not truly allergic) and a few other problematic foods which don’t make the top eight. (Things like corn, any gluten grains, beef, chocolate, citrus, tomato, and beans)
Eliminate processed foods, refined foods, including sugars.
Include abundant vegetables and fruits.
Anti-inflammatory diets (autoimmune diets) seek to eliminate the most common food problem causers and also try to bring in food problem solvers.
Diets in general can be overwhelming, and when they talk about restricting food groups, diets can be downright terror-provoking. As I’ve journeyed away from an oligoantigenic elimination diet, my own diet landed very similarly to many of these anti-inflammatory type diets. It wasn’t by choice and planning. That’s just how it fell. I can’t eat many of the Pesky Eight foods and feel good doing so. My body likes hypoallergenic food best.
I hear a lot of people say that no good diet restricts food groups. I really, really understand what they’re saying. However, LOOK AT THE PESKY EIGHT! They are good, healthy foods!!!!! But if the GI tract immune system triggers a cascade that sets the rest of the body on edge, you’re not going to feel good.
So please, when someone says they can’t eat dairy or wheat, give them a break. When they say they can’t eat eggs or beef, give them a nod. It’s just as frustrating for them as it is you. And if you have any nagging health problems, talk with your doctor about a dietary referral to see if an oligoantigenic food trial helps you gain control of any of your issues.
Don’t use anything on my site as medical guidance or instruction. I hope it sparks curiosity to help you want to learn more. And, oh yes, I like to think that for most people, autoimmune type diets can be expanded with a whole health approach.
It’s so easy to let jealousy torment you when your husband loses 30 pounds eating very low carb (while sneaking in Snicker bars)–and you only lose 5 and swear it makes you manic. Why does it work this way?
It’s so easy to cry and wallow in yourself when you try everything for your multiple sclerosis (MS) and nothing seems to make it budge–well, not like it did for Terry Wahls, who changed her diet and lifestyle and went from a zero-gravity recline wheelchair to riding a bike. What does she have that you don’t?
And how about these people with cancer? The people who go to Mexico and get coffee enemas? Why does one come back glowing and cured and the other one we remember with love and frustration, saying, “Tsk, tsk. She wouldn’t take chemotherapy and look what happened to her. Goes to show. . . ”
I could go on and on. He dropped gluten and his arthritis went away. She started coconut oil and frankincense for her dementia and now she recognizes her family again. He gave up dairy, started some aloe, and his constipation is gone for good. Going raw, vegan cured her chronic fatigue and fibromyalgia. Dropping all grains and all dairy and all sugar and starting physiologic folate helped his autism. Fish oil cured her depression.
Can I stop? Do you get the idea? Is this you?
Shocker. Spoil alert.
Stop reading if you’re completely sold on a new diet or have just spent big money on a new supplement because I have some bad news.
It may not work for you. (Gasp. Shocker.)
But I have some good news too! It MAY work!
Today I want to help you understand maybe why you’re not getting better doing the good things you’re doing. Why each person’s health plan (diet, supplement, exercise, sleep, etc.) must be tailored individually. It sounds overwhelming to think you actually have to formulate your own health plan, that it’s not written out there for you in some book, but isn’t that really the journey of our whole life? Finding out what makes us tick? What brings us peace? Coming to terms with our limitations and expanding our strengths?
“I Don’t Have MS, Terri.”
Medical doctors group symptoms and tests together to arrive at a diagnosis. A label. A name. The name helps us to know what to expect for a patient’s outcome. What we’ve tried before that has helped or not helped.
Dementia. Psoriasis. Ulcerative colitis. Multiple sclerosis. Migraines. Crohn’s Disease. These are labels. They are necessary labels! For example, we know that the group of people who have ulcerative colitis symptoms and tests will need monitored for colon cancer, and that many celiac patients can be symptom-free following gluten-free diets. Having a label helps!
But there are tough cases. Cases which don’t fit, and sadly, they’re more common than medical doctors want to admit or even know about. These patients doctor shop, so often a doctor isn’t given the chance to even know that refractory cases are as rampant as they are. There are diagnoses that don’t have good treatments, like irritable bowel syndrome and fibromyalgia.
These patients, these refractory cases, are like a nebulous cloud which floats around looking for answers. Why can’t they get their answers?
I have a friend (actually I have many friends with MS, sad to say) with classic multiple sclerosis (MS) symptoms and diagnostic tests. She repeatedly tells me, “Terri, I don’t have MS. I’ve never believed I have MS.”
You’d think as a medical doctor, I’d laugh my head off silly.
Maybe you, as a vociferous alternative health proponent are thinking, “She must not be doing it right. She needs to do this [insert your desired diet or supplement]. She needs to try harder. She needs to try longer. . .”
Now, my friend is a little frustrated. She has had MS for years, and sometimes it’s better. Sometimes it’s worse. She has tried nearly everything.
What I want you to think about for people–is the possibility that our labels group similar health cases together which may stem from different causes. And when that is the case, when the underlying cause of presentations which LOOK the same is NOT the same, a person can bang her head into a wall (this is one of my favorite images because I’m so prone to doing this if I’m not careful) wondering, “Why not me? Why can’t I? Why did it work for her?” Except in a highly motivated individual who says, “I’m moving on. I can do this. That failure taught me something,” this can be counterproductive and harmful.
One Leukemia: 11 Diseases
And now I get to the crux of my post. When I was in medical school, I learned about acute myelogenous leukemia (AML). I learned it as ONE disease entity. ONE (a bad disease entity at that). New research shows that this AML that I learned about as one disease, is actually 11 diseases, with 11 different causes–which show up looking the same! This helped explain why some people responded so well to treatment and some people tragically did not. We weren’t treating ONE disease, we were treating ELEVEN!
I think that most of our clinically diagnosed diseases will ultimately be found to be caused and/or impacted in different ways. Until that day that you know exactly what the cause of your illness is–your obesity, your thyroid problem, your irritable bowel, your IBD, your arthritis, your insomnia, your depression, your constipation, your MS, and so on–until that day, you’re just going to have to take a flat-out comprehensive approach to have the best outcome.
Should you eat low carb?
Should you eat high fat?
Should you eat dairy?
Should you eat meat?
Should you eat grains?
Should you take calcium?
Should you supplement with CoQ?
Should you take iodine?
And so on and so forth. Whether you should or shouldn’t may depend on your genes, how they are expressed, your gut microorganisms (bacteria, fungi, viruses), and how your environment (sun, exercise, sleep, diet, daily doses of inadvertent toxins) interacts with those.
There is no ONE diet. There is no ONE lifestyle. In fact, there’s probably no one dementia. No one MS. No one IBS. There may be 11. So find a platform which resonates with you. Try it. Be willing to modify it. Don’t abandon what works. Keep what works and build your plan. Don’t despair. Don’t give up. Start with absolutely real food if you have a problem you really need to tackle. And move forward, tweaking as your body tells you.
(And, of course, seek medical advice and always be safe.)
Photo credit: By An unknown Chinese artist [Public domain], via Wikimedia Commons
I have one more post on folate to share before I leave it behind. It is a recipe I use to help my family eat more greens, including the folate-powerhouse spinach.
Eat more folate-rich foods, including greens.
Some people–maybe you–can’t metabolize the form of folate called folic acid very well. Folic acid is what is added to most grain-based processed foods and used in most vitamins. These people do much better with folates found naturally in foods. Since they don’t metabolize folic acid very well, their bodies are basically functioning on a “folate deficiency” despite adequate intake of folic acid.
I don’t know. Which reason do you want? Folate deficiency may play a role in depression? Bipolar disorder? Birth defects? Anemia? Atherosclerosis? Alzheimer’s? Chronic fatigue syndrome? Gout? Hearing loss? Blood clots?
Although the research on folate’s connection to many of these conditions is not clear-cut, there are some suggestions. On something as simple as eating real, folate-rich food, I don’t see a need to wait around for the million dollar research study.
When it comes to folate, spinach leads the pack. I use this simple dressing which the kids enjoy to deliver folate-rich greens, including spinach, to my family.
Folate Delivery Dressing
1/3 cup of bacon drippings
1/4 cup of maple syrup (or honey or sweetener of choice)
1/4 cup of apple cider vinegar
Diced onion (may omit)
Salt and pepper to taste
Spinach (or greens of choice)
Heat bacon drippings in skillet over medium-high heat until melted and hot. Add onions and saute until golden brown. Add the maple syrup and whisk. Allow to thicken and bubble. Add apple cider vinegar and whisk again. Allow it to reduce and thicken a little. Salt and pepper to taste.
Use the dressing to pour over fresh spinach, tossing to wilt. Use just enough to coat as desired. Alternatively, the greens may be added to the pan and cooked a little.
Nutrient deficiencies abound. Not huge deficiencies that can be pointed at directly. But little micronutrient deficiencies. Feed yourself and your families fresh vegetables, fruits, and foods to overcome these deficits. You’ll feel the difference! It is important. I just wish I could emphasize this enough!
Thank you to my lovely, young daughters for the graphics on this post.
Vegetable Series: When we changed our eating two years ago, I resolved to be afraid of no vegetable. Not knowing how to cut it or cook it was NOT going to keep it out of my cart. For a long time I’ve wanted to do a series of posts on all the different vegetables we have tried and what we do to the poor things. May you, too, vow to try any and all vegetables in your supermarket! Go get ’em, tiger.
“I LOVE those French fries!”
Have you tried parsnips? Have your kids tried parsnips? Do you or your family like parsnips? Do you have a great parsnip recipe? Do you know what parsnips are?
For my kids, I often find keeping dishes simple and flavors not too complex suits their taste buds more at this young age. Plus, when you’re eating a whole, real foods lifestyle, faster and easier is much better for the cook, too! We made parsnip “fries” to prepare for this post. When my husband and kids came into the kitchen, I was frantically grabbing fries to stash and hide behind the coffeemaker so I wouldn’t have to make more to photograph! I was glad the “fries” were a gastronomical success! M5 year-old daughter said, “I love those French fries, Mom.”
This wasn’t always the case.
If you can do it with a potato…
As I’ve pointed out, we’ve only been eating this way for about two years now. The word out there is: If you can do it with a potato…you can do it with a parsnip. So I tried parsnips in soups, roasts, mashes, and casseroles. (“What is this, Mom?” As in, they didn’t approve.) I even made parsnip fries, which you could tell they didn’t mind, but they didn’t really eat many. My kids were just too close to their potatoes. Near removal of the potato and addition of parsnips on occasion, and my kids can now tally parsnips to the growing list of vegetables they’ll eat!
What am I saying? If at first you don’t succeed, try, try again! Kids need repetitive exposure and a great example. Persist in a vegetable-rich diet for your family. Understand it may take years. Accept it and don’t give up. In the meantime, just be prepared to eat a lot of vegetables yourself…
What is a Parsnip?
It is a root vegetable which looks like a fat, white carrot (one of its relatives).
Commonly cultivated and eaten in Europe before the potato was introduced. (Do you know where potatoes originated from? The mountains of Peru.)
Usually thought of as a fall and winter vegetable, but since it stores so well, it is available year round.
It is a starchy vegetable and has a sweet, nutty taste and a potato-like texture when cooked.
Frost and refrigeration bring about a sweeter taste.
Neck to neck, there’s not much nutritional difference between a parsnip and potato. Parsnips have a little more calcium and a little more fiber. Parsnips are a little (not much) lower on the “net carb” ladder than a potato. The only real difference I can think of is that a potato belongs to the family called a “nightshade” and a parsnip doesn’t. (Nightshades are excluded for people who follow an anti-inflammatory diet because some minor research indicates they may be detrimental to the lining of the GI tract, may increase the body’s production of inflammation-producing chemicals, and increase arthritis and achiness in people. So someone on an anti-inflammatory diet could easily replace the potato with the parsnip.)
Parsnips are nice because they keep in your refrigerator forever. I choose them and store them like I do carrots. Often they come coated in a waxy material, so I always peel my parsnips with a potato peeler before using them to get this strange stuff off.
Then, do what you’d do to a potato! Here’s one to try, but don’t stop here!
Parsnips, washed and peeled
Salt as desired
Garlic powder and onion powder if desired
Preheat oven to 375-400 degrees Fahrenheit (191-204 degrees Celsius). Cut the parsnips so that they resemble French fries. Toss in just enough olive oil to lightly coat. Sprinkle with salt and other seasonings. Lay each cut fry on a baking sheet so that the fries have space between them. You may need to use two baking sheets if you’re making a lot. (If you get them too close together, they steam each other and get soggy rather than crispy. Uck.)
Baking times seem to vary immensely. The best idea is to just watch. I start by baking in the preheated oven for about 10-15 minutes (but still watching them), and then I take them out and flip the fries. I bake for another 10-15 minutes or so. The goal is a fairly golden brown fry that isn’t burnt and isn’t soggy. Sometimes I remove the ones that look done before the rest.Taste before serving and add more seasoning as desired. Serve hot. Nobody likes cold fries of any kind. Do they?
Family “gustar” report: 5/5 ate these fries all gone. Will definitely try to include these more in our repertoire.
Note: Parsnips are discouraged for the GAPS/SCD diets.
One of the most serious effects of iodine deficiency is damage to a fetus. (Echo: Damage to a fetus…damage to a fetus…damage to a fetus.) Iodine deficiency wasn’t on my radar when I conceived last fall! I had had no dairy, no eggs, and no iodized salt for at least a year and a half, and I was taking no iodine supplementation, prenatal vitamin or otherwise. So I have to wonder about my iodine status prior to pregnancy and in early pregnancy. Early in pregnancy, I was too sick to tolerate a prenatal vitamin, and both my doc and I agreed that all I probably really needed to be sure to choke down was a folic acid supplement to prevent neural tube defects. (Strangely enough with the food and smell aversions, in my first trimester, I could not get over the urge to eat any and all kinds of seafood, which is a good source of iodine: sardines, oysters, mussels, clams, mahi mahi, tuna, shrimp, scallops, soft-shelled crabs, Nori, and dulse–you name it. I threw seafood cautions to the wind and gobbled that stuff down, since nothing else sounded good! Anecdotal but interesting.)
I wish someone would have told me that my best sources of iodine had all been removed from my diet, and even with them included, I would still have been at risk for iodine deficiency. So if you’re dairy-free, skipping iodized salt, vegan, intolerant or allergic to eggs, autoimmune Paleo, or follow a crazy diet (I can say that because I follow a crazy diet.), please just make it a point to make sure you’re getting sufficient iodine. And as always, don’t use anything on my blog as medical advice.
Not good. Statistics show that pregnant women’s iodine intake and levels are not sufficient and are continuing to decrease.
In the United States, there is a periodic survey which evaluates how our iodine intake is doing, the National Health and Nutrition Examination Survey (NHANES). NHANES has revealed that urinary iodine levels for pregnant and non-pregnant women in the United States have dropped significantly since the early 1970s. Adequate urinary iodine levels for pregnant women should be 150-249 micrograms/L (based on the World Health Organization standards). The United States has hovered around and then dropped below this point:
1971-1974: 327 micrograms/L
1988-1998: 141 micrograms/L
2001-2006: 153 micrograms/L
2005-2010: 129 micrograms/L (Goal is greater than 150 micrograms/L) (1, 2)
In the most recent survey, some regions such as California and Pennsylvania were alarmingly low, 105 and 125, respectively. And this doesn’t even take into account the interfering factors of halides in our food and environment which interfere despite levels of iodine!
So what does low iodine mean for pregnant women and their babies? (Not good.)
Iodine deficiency can lead to what is called “reproductive failure” in the female, which simply refers to repeated miscarriages and increased stillbirths. The more severe the iodine deficiency, the more the risk increases. One study showed that the frequency of reproductive failure was directly proportional to the severity of the iodine deficiency. Women who had iodine deficiency had twice the risk of reproductive failure. (There are many causes of “reproductive failure” besides iodine deficiency. Other nutritional factors such as selenium deficiency could also be responsible for reproductive failure. And aside from nutritional factors, there are many other causes, as well. So I am not saying, “Iodine is it.” Please don’t think that.) (3)
Known iodine deficiency effects on the fetus are numerous and include:
Increased miscarriages (loss before 28 weeks of pregnancy)
Increased stillbirths (loss after 28 weeks of pregnancy)
Increased premature births
Congenital anomalies (birth defects)
Increased perinatal morbidity and mortality (increased bad outcomes and death occurring shortly before or after delivery)
Cretinism (mental retardation with changes in stature, hearing–often a high tone defect, and sometimes the inability to use arms/legs due to severe rigidity)
Goiters in newborns
Hypothyroidism in newborns
Lower IQ (3, 4, 5)
Medical literature supporting iodine’s role in producing a healthy, in utero fetus and subsequent neonate is NOT hard to find!
All degrees of iodine deficiency…affect thyroid function of the mother and the neonate as well as the mental development of the child. The damage increases with the degree of the deficiency…
Iodine deficiency results in a global loss of 10–15 IQ points at a population level and constitutes the world’s greatest single cause of preventable brain damage and mental retardation. (5)
When a mom is iodine deficient, iodine deficiency is passed on to the developing fetus who has NO way of getting iodine or thyroid hormone except through the mom. You are it, Mama.
When a woman becomes pregnant, her baby absolutely relies on the mom’s thyroid hormone, which requires iodine to be made. The baby cannot make its own thyroid hormone until later in the pregnancy, and even then, it still needs iodine provided by mom as the raw material for its own thyroid hormone production.
Iodine is 100% necessary for the production of thyroid hormone, and if it is not sufficient, then the mother and baby will be exposed to hypothyroidism (lack of thyroid hormone). Thyroid hormone is necessary for the function of all cellsand is critically important for brain development, especially in a fetus and newborn. Thyroid hormone helps to make sure that the fetus’s cells grow, develop, differentiate, and express the right genes.
Most health organizations recommend about 150 micrograms of iodine daily for non-pregnant adults, but iodine needs increase when a woman becomes pregnant. To make more thyroid hormone to cover the baby’s needs, the woman needs more iodine. She also needs more iodine because during pregnancy, the blood filtration through the kidneys increases and extra iodine is lost in the urine during pregnancy.
It doesn’t end with pregnancy, either. Nursing mothers need more iodine because the iodine is transferred to the baby by her milk. The baby still needs iodine. (6)
The developing brain of the fetus is probably the most vulnerable target organ for iodine deficiency.
First Growth Spurt of the Brain
The developing baby’s brain has two major “growth spurts.” The first one is at 12-20 weeks (months 3-5). During this first one, the brain cells (neurons) are rapidly multiplying, moving to their correct places, and organizing themselves appropriately. Studies indicate that iodine repletion should occur by three months of pregnancy to prevent cretinism (severe mental retardation, deaf/mute, and effects on the arms and legs). Most of us in developed countries probably won’t fall into iodine deficiency enough that cretinism would develop, but I think it may be revealing in other neurological conditions as well, that getting the iodine levels back up in the first trimester is probably optimal. However, even if the first trimester is missed, iodine supplementation still shows beneficial effects in pregnant women and their fetuses.
The second spurt of brain growth occurs in the third trimester and doesn’t finish until the child is 2-3 years old! This spurt allows the cells that support the brain’s neurons (knows as “glial cells”) to multiply, move to their appropriate places, and to become coated with myelin. By the time of the second spurt, the baby has a functioning thyroid, so it doesn’t rely on mom for thyroid hormone anymore, per se, but it relies on mom for its source of iodine. If mom is not eating enough iodine, baby still can’t make thyroid hormone for itself and its brain. If mom didn’t get enough iodine in the first trimester, damages can still be minimized.
“Correction of iodine deficiency during the second trimester reduced neurological abnormalities, increased head growth, and improved the development quotient in a severely iodine-deficient area of western China. Correction at a later period did not improve neurological development, although there was a trend toward slightly larger mean head circumference and higher development quotients than in untreated individuals. ” (6)
There is a spectrum of how insufficient iodine levels affects the fetus.
“Mental retardation from iodine deficiency is not limited to the extreme form of cretinism, but instead extends over a broad continuum to mild intellectual blunting that may go unrecognized unless carefully investigated. Thus, iodine deficiency puts virtually everyone in the affected population at some risk for brain damage. Many studies have compared performance of iodine-deficient children with that of iodine-sufficient peers on standardized intelligence tests…iodine deficiency lowered a mean intelligence quotient by 13.5 points. In view of the many people living in iodine-deficient areas and their vulnerability to its effects on the developing brain, these numbers indicate a staggering public health problem. This and neonatal mortality, rather than goiter, have become the main reasons for advocating urgent correction of iodine deficiency.” (6)
Severe iodine deficiency and cretinism: The most notable and sad outcome of iodine deficiency, as it is completely preventable, is cretinism. I have read that early Alpine explorers would come across entire villages of “cretins” isolated in the mountains. These local pockets of population lived off of iodine deficient land, and it wasn’t until food started coming in from elsewhere and iodine supplementation was implemented in the 1900s that the incidence of cretinism was reversed. At the time, doctors and people in general felt it was something “in the air” or “in the water” of the valleys or perhaps a “genetic fault.” Cretinism presents with:
Deaf and mute
Spasticity of limbs (the arms and legs can draw up tight and not extend properly)
Mild iodine deficiency: Mild iodine deficiency effects are more pervasive and not as concrete to pinpoint. Children from low iodine pregnancies have been found to have:
Elevated hearing thresholds/ hearing loss (4, 7, 8)
Dr. Jerome Paulson, chairman of the American Academy of Pediatrics council on environmental health says this in May, 2014 for NBC News:
“The brain development issues are very subtle and are not likely to be noticed in an individual child. It’s an issue for society as a whole when you have a large number of children who are not reaching their full potential.” (9)
If iodine deficiency is increasing in our pregnant women, wouldn’t congenital hypothyroidism in the newborn be increasing?
So as I typed this post up, I thought, well–if iodine deficiency is creeping up among our pregnant patients, then our babies should have a higher risk of hypothyroidism (low functioning thyroid). In fact, a month ago, my hairdresser was telling me about her good friend whose baby just wasn’t very active. They checked, and it was hypothyroidism. I’ve never really looked at or been notified about increases in newborn hypothyroidism (congenital hypothyroidism) in any of the journals I subscribe to, so I Googled it. (Because low thyroid function is SO detrimental to a newborn’s health and brain function, one of the tests mandated by every state in the newborn screening poke includes a test for congenital hypothyroidism.) Sure enough, there is a rise of congenital hypothyroidism. I cannot and will not say it is due to maternal iodine insufficiency because I think most health problems are usually caused by a combination of factors, but I certainly am suspicious about iodine deficiency’s role in this. In Krakow, Poland, before the introduction of iodized salt, 1 in 3920 newborns had transient hypothyroidism, and after the introduction of iodized salt, the rate dropped to 1 in 48,474. (2) Experts are also considering the roles of perchlorate (a toxic byproduct of rocket fuel and fireworks production) exposure, as these seem to be contaminating our environment and entering our bodies, interfering with thyroid use of iodine, and whether use of iodine-containing disinfectants at the time of birth could contribute. (2, 10)
So why don’t we just put our pregnant women on iodine and crank her up good?
Case studies show reports of hypothyroidism in significantly iodine supplementing moms: So you’re a natural person. You’re not afraid of supplements. You’re pregnant, and you think you’re going to run out and start loading up on iodine. Not so fast. There have been cases of congenital transient hypothyroidism in newborns from maternal iodine supplementations, at doses of about 12.5 mg. Whoa. I would never want a baby to have hypothyroidism from over-supplementation! On the other hand, I think this area should be explored better. Was the mom supplementing other important nutrients needed along with iodine? How transient would the hypothyroidism have been in the baby? If the mom had kept supplementing, would the thyroid disorder have stabilized naturally? But we don’t know the answers to these nebulous questions, and so I accept that too high of a dose of iodine in pregnancy may be dangerous to the baby as well! On iodine deficiency in pregnancy, it is probably best for the iodine naïve woman to err on the side of recommended amounts. (11)
Prenatal vitamins: Slowly, recommendations are moving toward making sure women get iodine in their prenatal vitamins, and word is getting out there. NBC News had a little blurb on their site about it in May 2014. But, in my opinion, the information still is not out there to women OR their obstetricians. I just don’t think obstetricians are aware of iodine deficiency numbers in pregnant women, and I would venture to say many (most?) obstetricians don’t look at the prenatal vitamins their patients take! Only about 50% of prenatal vitamins in the United States contain iodine! And if they do contain iodine, the iodine content may vary by up to 50% of what is on the label.(1, 12) The American Thyroid Association recommends that all prenatal vitamins contain iodine, 150 micrograms. (13)
Best to get iodine optimized BEFORE pregnancy: This is good, but I feel iodine sufficiency needs to be in place WELL BEFORE pregnancy! If our pregnant women are low, that must mean that our child-bearing population is riding completely on the edge. In addition, it may be that some of the ill effects seen with iodine supplementation have to do with the iodine status of a person in the long-run! So the more iodine sufficient a person is their whole life, the more they tolerate extra supplementation without conversion to hypothyroidism. Dr. Elizabeth Pearce et al report on a study from Sicily which shows that moms who re-introduce iodized salt in the first trimester after having been off of it for two years have markedly increased risk of mom being hypothyroid! However, in patients who had used iodized salt routinely prior to pregnancy for two years, the risk of hypothyroidism in mom was much less (although not absent). (14)
Iodine deficiency is absolutely a problem in many pregnant women. Iodine should optimally be sufficient in the first trimester, and unfortunately this is often a period when women are not aware that they are pregnant or they are too ill to take a prenatal vitamin with iodine or eat iodine containing foods. I think that brings us back to the idea that we are functioning, many of us as a population, on a near empty tank of iodine to begin with. Adequate iodine intake should occur BEFORE pregnancy. I hope you are taking note and continue to take inventory of you and your family members’ sources of iodine. Eventually, after I summarize why in the heck we need iodine, I will do a more detailed post on iodine content of foods. You can see some basic summaries of this in my previous iodine posts.
I would like to tell you that your doctor, especially your obstetrician, is up on this. And maybe they are. But I have a sinking feeling most are not. If getting pregnant is possible for you, it is best to start thinking about iodine intake today.
Sorry for the long post. Hope those interested found some tidbits to ponder.
1. Kathleen L. Caldwell, Yi Pan, Mary E. Mortensen, Amir Makhmudov, Lori Merrill, and John Moye. Iodine Status in Pregnant Women in the National Children’s Study and in U.S. Women (15–44 Years), National Health and Nutrition Examination Survey 2005–2010. Thyroid. Volume 23, Number 8, 2013. (Link to full text)
2. John S Parks, Michelle Linn, et al. The Impact of Transient Hypothyroidism on the Increasing Rate of Congenital Hypothyroidism in the United States. PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010. pp. S54 -S63. (Link to full text)
3. Dillon, J. C. and Milliez, J. (2000), Reproductive failure in women living in iodine deficient areas of West Africa. BJOG: An International Journal of Obstetrics & Gynaecology, 107: 631–636. doi: 10.1111/j.1471-0528.2000.tb13305.x. (Link to full text)
4. Cresswell Eastman and Michael Zimmerman. Chapter 20: The Iodine Deficiency Disorders. Thyroid Disease Manager. Online. Updated February 12, 2014. (Link to online text.)
5. F Delange. Editorial: Iodine deficiency as a cause of brain damage. Postgrad Med J 2001;77:217-220 doi:10.1136/pmj.77.906.217 (Link to full text)
6. John Dunn and Francoise Delange. Damaged Reproduction: The Most Important Consequence of Iodine Deficiency. The Journal of Clinical Endocrinology & Metabolism. 2001 86:6, 2360-2363. (Link to full text)
7. DeLong GR, Stanbury JB, Fierro-Benitez R. Neurological signs in congenital iodine-deficiency disorder (endemic cretinism). Dev Med Child Neurol. 1985 Jun;27(3):317-24. (Link to abstract)
8. Alida Melse-Boonstra, Ian Mackenzie. Iodine deficiency, thyroid function and hearing deficit: a review. Nutrition Research Reviews. 2013 Dec;26(2):110-7. doi: 10.1017/S0954422413000061. Epub 2013 Jun 12. (Link to abstract)
10. Richard S. Olney, MD, MPHa, Scott D. Grosse, PhDa, Robert F. Vogt Jr, PhDb. Prevalence of Congenital Hypothyroidism—Current Trends and Future Directions: Workshop Summary. PEDIATRICS Vol. 125 No. Supplement 2 May 1, 2010
pp. S31 -S36 . (doi: 10.1542/peds.2009-1975C) (Link to full text)
11. Kara Connelly, MD, Bruce Boston, MD, Elizabeth Pearce, MD, David Sesser, David Snyder, MD, Lewis Braverman, MD, Sam Pino, Stephen LaFranchi, MD. Congenital Hypothyroidism Caused by Excess Prenatal Maternal Iodine Ingestion. The Journal of Pediatrics.
Volume 161, Issue 4 , Pages 760-762, October 2012. (Link to full text)
12. Angela M. Leung, M.D., Elizabeth N. Pearce, M.D., Lewis E. Braverman, M.D. CORRESPONDENCE: Iodine Content of Prenatal Multivitamins in the United States. N Engl J Med 2009; 360:939-940February 26, 2009DOI: 10.1056/NEJMc0807851. (Link to full text)
13. Public Health Committee of the American Thyroid Association, Becker DV, Braverman LE, Delange F, Dunn JT, Franklyn JA, Hollowell JG, Lamm SH, Mitchell ML, Pearce E, Robbins J, Rovet JF. Iodine supplementation for pregnancy and lactation-United States and Canada: recommendations of the American Thyroid Association. Thyroid. 2006 Oct;16(10):949-51.
14. Elizabeth N. Pearce. Iodine in Pregnancy: Is Salt Iodization Enough? J Clin Endocrinol Metab. Jul 2008; 93(7): 2466–2468. doi: 10.1210/jc.2008-1009. PMCID: PMC2453047 (Link to full text)
Great overview of hypothyroidism in pregnancy adn a section on iodine:
Today continues on in the long, arduous, controversial trek that is iodine. For this post, I had wanted to take a critical look at how iodine affects fertility, both male and female, and pregnancy. The post was too long, so I am splitting it into three parts.
More iodine introduction and review today because I want to stress again how iodine deficiency may be present despite the common medical community saying it isn’t in industrialized/developed countries.
Iodine and pre-conceptual/conceptual fertility tomorrow or so, as time allows me to get my citations in somewhat presentable documentation form.
Iodine and post-conceptual fertility/pregnancy the post or so after that. (Notice the “or so?” Moms always learn to be wishy-washy on timing of events, right?)
I spent a long time searching about fertility and iodine, and thus my absence in publishing blog posts lately. One article and question always leads to another and another. Despite looking high and low, I will make no great conclusions regarding iodine and fertility. Sorry. Hypothyroidism (low functioning thyroid gland) and hyperthyroidism (over-functioning thyroid gland) clearly do play a role in male and female fertility, but connecting the dots to iodine has not been performed much yet in research studies. However, we DO know that iodine deficiency is one cause of hypothyroidism.
My take, off the cuff, without sources and science, regarding iodine
Although we absolutely need iodine, our bodies seem to become adjusted to regulating our thyroids and bodily systems based on how much iodine we give them. Our bodies make do, down-regulating this pathway and up-regulating that pathway, until a critical iodine low point at which the system fails and you see the serious consequences of overt hypothyroidism and offspring with severe deficits, such as mental retardation. Before that severe iodine deficiency crisis hits, there are varying degrees of “normal” a body can manage to function at in different people with the iodine amount provided–which probably aren’t really “completely normal” functioning states but good enough to sustain life and reproduction with little noticeable compromise.
To significantly replace iodine at this point, when a person is “low in iodine” but functioning “okay” (where the body has managed to find a nice “homeostasis” regarding iodine use), can do one of three things. It can:
1) Benefit the body without negative thyroid side effects (the goal and the most common outcome).
2) Bring about a hypothyroidism.
3) Bring about a hyperthyroidism.
If a person is already hypothyroid from low iodine intake, even if mildly so, hopefully iodine replacement will allow the body to start optimizing its iodine use for improved thyroid function and the functioning of other tissues that use iodine, such as the ovaries, breasts and prostate without any ill effects. In fact, most people do fall under the umbrella of tolerating iodine supplementation just fine and benefitting from it, but doctors worry a lot about iodine bringing about hypothyroidism and hyperthyroidism in what were observably “normal” people. And this does happen. Cruise the internet for research studies and iodine supplementation anecdotes, and you’ll see good and bad outcomes. (To optimize replacement with the least amount of negative thyroid response, iodine supplementation needs to be taken along with some other important co-nutrients: selenium, vitamin C, and zinc. This is a topic for another post.) Iodine is a mixed, controversial medicine bag.
As an obvious reminder, don’t use anything in my posts as medical advice, only use it for introductory informational purposes. The internet is a not a doctor. And there can be huge risks from implementing what you find on internet health sites. Walk cautiously, and find a healthcare person you DO trust to talk things over with.
Let’s remind ourselves of why a person would be iodine deficient from the last Iodine Post and then eventually move on to what I could find regarding iodine on male and female pre-conceptual/conceptual fertility tomorrow…
Iodine deficiency erratically riddles the population of developed societies. Why? Who is at risk? Am I? Are you? Why do they say we are “iodine sufficient” if we are not?
Why would well-fed people be iodine deficient?
(I am omitting the discussion of goitrogenic foods and halides, which put people at risk for iodine deficiency disorders, despite adequate iodine intakes. I will discuss those in later posts. It is an important topic which needs its own post.)
Real food iodine sources primarily include dairy, eggs, ocean seafood, and seaweed. Iodine can be a dietary toughie to get because levels of iodine fluctuate greatly EVEN IN THESE REAL FOODS. I would like to contrast this with nutrients such as B vitamins and magnesium, which although they are diminished in our modern food sources, they are abundant in MANY, diverse food sources which people eat, especially real food advocates.
Milk iodine content will vary depending on if the grass cows eat has iodine (Are they grazing on coastal pastures or iodine-deficient Great Plains grass?), if cows are supplemented with iodine-containing feed, and if iodine containing washes are used prior to milking.
Egg iodine content will vary depending on if the chickens are fed iodine supplemented chicken feed or not.
Vegetables and plants have no need for iodine, although they will take it up from the soil, passing it graciously on to us. Most soils away from the ocean coasts are iodine deficient (iodine is most abundant in ocean water, which falls on the land in the form of the rain cycle, replenishing coastal soil and plants with iodine from the sea), so eating “locally grown” food from iodine deficient soils will provide less iodine content.
Meat iodine content will vary, again based on what animals are fed or where they are grazing.
Sea salt mostly has only trace amounts of iodine.
Bread productsuse bromine rather than iodine-type dough conditioners, like they used to. (Heck, homemade bread doesn’t use either!) I realize to some readers that bread is a processed food, but it is eaten by most people. And the replacement of iodine-based dough conditioners for bromine-based dough conditioners, which interfere with iodine utilization in the body, plays a significant role in iodine deficiency disorders and the decreasing amount of iodine intake in the United States.
Seafood and seaweed’s iodine content vary by the kind of seafood but is usually a lot more predictable than the foods listed above.
Who is at risk? Examples.
If you stop and think, you can easily identify why people would be iodine deficient:
Case 1: An American woman who is dairy-free, doesn’t like seafood, and who has switched over to non-iodized sea salt because she thinks it tastes better. She still eats bread, but her bread has no iodine, and in fact does use a bromine derivative for dough conditioning. Hopefully she eats eggs and lives on the coast.
Case 2: An American college student who eats only bagels, cereal bars, or Pop Tarts for breakfast, sandwiches with chips at Subway for lunch, and some freezer-kits for supper. All these processed foods may not provide enough iodine, since non-iodized salt is used. Hopefully, some iodine is sneaking in through the cheese and eggs used in the products chosen. But we don’t know.
Case 3: A family in Australia who eats strictly organic, without realizing that studies show that organic dairy has less iodine, organic bread in Australia has no iodine, and their fruits and vegetables are grown in an iodine depleted area. They worry about mercury and radiation in seafood, and one child has an egg intolerance/allergy, so they shy away from eggs. I’m not sure where this family gets enough iodine. Maybe they take a multivitamin.
Case 4: A 67-year-old man who has lactose intolerance, who shuns salt because of blood pressure issues, who only eats the egg whites (not high in iodine) due to cholesterol concerns, and whose wife doesn’t like fish at all.
Case 5: A vegan who eats no dairy, no eggs, no meats, and no seafood. She could eat seaweed but doesn’t like the taste. Iodine intake is not lookin’ good.
Why do they say we are “sufficient” if we are not?
(Emphasized phrases are bolded by me.)
From The Proceedings of the Nutrition Society, 2010:
The WHO [World Health Organization] prevalence data emphasise that iodine deficiency is not only a problem of developing countries; the highest prevalence of iodine deficiency is in Europe (52.0%), where the household coverage with iodised salt is the lowest (approximately 25%), and many of these countries have weak or nonexistent control programmes for iodine-deficiency disorders. (1)
and The American Journal of the Medical Sciences, 2009:
IDD [iodine deficiency disorder] can occur in iodine replete-environments.A high index of suspicion is needed to recognize these cases.It is pertinent that the correct diagnosis be made to avoid unwarranted life-long thyroxine therapy in patients presenting with goiter and hypothyroidism, which is easily treatable with iodized salt. These cases underscore the need for considering iodine deficiency in the etiologic diagnosis of goiter and hypothyroidism, even in iodine sufficient regions. (2)
From my research, I am concluding that iodine deficiency is insidiously surfacing in individuals and small subpopulations (for example, pregnant women, vegans, or those with multiple food intolerances) in many developed countries, probably riddling whole populations like a shot-gun due to unique dietary patterns and habits of individuals and their families. How is it that the medical community, chomping on their brominated office donuts, sipping their Coffee-Mate tainted coffee, and brushing their teeth with fluoridated Crest, may be slow to recognize this? (Yes. This was me.) Well, when the scientific community prudently checks to see if an area is getting enough iodine, they look at levels as a POPULATION, not in individuals. To determine the iodine sufficiency of an area, “on-the-spot” urines are checked for iodine in a sample of hopefully “representative” people.
Spot checks of urine for iodine content are known to be erratic and insensitive, so they can’t be used to determine true iodine status of an individual, but when they are collected and pooled together an overall snapshot of the area (or population) in question can be gained. The median (That’s the number that occurs in “the middle” when all the result values are lined up from smallest to greatest–it is not the average/mean.) is then used to determine if the tested population is iodine sufficient.
The median value determined can still “hide” a significant amount of the population who may be deficient. What values are on the low side of the median? How low do they go? If most people in the community who are checked use iodized salt and drink milk, well, those folks are probably iodine sufficient and pooled results tell the researchers that “all is well.” However, if you and your family don’t drink milk and skip iodized salt, plus you all hate seafood, your low urinary iodine spot check will be lost on the low side of the median. You’ll be told your community or population is iodine sufficient, and you won’t change a thing you eat. Iodine deficiency affects us as individuals, but unfortunately, iodine evaluations are made based on populations. True, accurate testing in individuals is pretty intensive. It requires a 24-hour urine collection, and so just getting “eyeball” spot urine results and pooling them together makes the most sense for determining a society’s iodine status. (3)
So as I did in the last post, I encourage you to take inventory of your family’s commonly eaten foods to see if you may be at risk for mild iodine deficiency despite your government and medical societies saying: “There is no concern of iodine deficiency in the United States (or Australia, France, etc.).” I’ll bring a wealth of information eventually on iodine to the blog, but it takes me time. Meanwhile, just explore your diets, and make sure you’re getting some foods which usually have decent sources of iodine.
Remember, food counts. It really matters. It matters for you and your family and their families to come. Let’s move on to iodine and fertility tomorrow-ish…
1. Iodine deficiency in industrialized countries. Zimmerman M. Proceedings of the Nutrition Society: Conference on ‘Over-and undernutrition: challenges and approaches. 2010; 69: 133-143. (Full text link.)
2. Iodine Deficiency Disorders in the Iodine-Replete Environment. Nyenwe EA and Dagogo-Jack S. The American Journal of the Medical Sciences. Jan 2009; 337 (1): 37-40. (Full text link.)
3. Estimation of iodine intake from various urinary iodine measurements in population studies. Vejbjerg P, Knudsen N, et al. Thyroid. Nov 2009; 19(11):1281-6. (Abstract link.)