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Inflammatory Bowel Disease, Charles A. Sninsky, M.D.,
--------------------------  Gastroenterologist, Associate Chief,
Section of Gastroenterology, Vanderbilt University, Nashville, TN

Inflammatory Bowel Disease (IBD) can present a diagnostic dilemma.
There is an "Indeterminate Colitis" which may have features of both
ulcerative colitis, a superficial condition of the large bowel, and
Crohn's disease, an inflammation and scarring in the small and/or
large bowel.  These are the two diseases in the category of IBD.
Other conditions may mimic IBD.  Listening to the patient's symptoms
is helpful in arriving at a correct resolution.

The age of onset for IBD is anywhere from 2 to 70 years with the peak
at 20 years of age.  Considering IBD as an altered immune state, some
of the etiological factors that could affect the immune system include
infections, environmental influences, drugs, smoking, diet, genetics
or psychogenics.

The systemic complications of IBD can include the eyes, liver, kidney
stones, joints, skin lesions and short stature in children.  But the
reason why ulcerative colitis can present strictly locally at the
rectum or encompass half the large bowel or all of it is still not
known.

The goals of the treatment of IBD are:
  * control of the patient's symptoms
  * support of good patient nutrition and growth
  * emotional support
  * treatment of any external manifestations
  * prevention of occurrence or recurrence of the condition

IBD is an immune system disregulation.  The treatment is to slow down
the immune system with medications.  Unfortunately, 12% of patients
don't even fill their prescriptions because of cost, side effects or
how often drugs are prescribed.

Stress does not cause IBD.  It can, however, aggravate the condition.

There is a Crohn's and Colitis Foundation (CFFA) to help patients
cope.

Surgery is may be required if there are complications of IBD or if the
IBD is refractory to medical management (i.e., doesn't respond to
treatment).


Q: Are there a large number of patients with CD and IBD?

A: No.


Q: What about iritis?  Is the link with colitis or CD?

A: Iritis is an inflammation of the eye.  It is another immune system
   response.


Q: Is there any connection between IBD and colon cancer?

A: YES!  The longer period of time one has Crohn's or ulcerative
   colitis the more chance for cancer.  The odds increase 1-2% per
   year for each year over 10 that one has the disease.


One Loaf, Many Breads, Beth Hillson and Elizabeth Reed, The
---------------------  Gluten-Free Pantry, Glastonbury, CT

Beth and Elizabeth demonstrated how many tasty treats could be created
from a basic bread mix (e.g., their own French Bread Mix):  pizza,
baguettes, hamburger rolls, and pigs-in-blankets.  [author's note:  We
got to eat them.  Yummy!]

The recipe for pigs-in-blankets is:

Mix together the following ingredients:
   3-1/2 or 3-3/4 cups baking mix
   1-3/4 cups water
   4 Tbsp. butter

Then beat 4 Tbsp. more of water into the mix to thin it.

Spear a half-inch piece of GF hot dog, cheese, or ham on a toothpick.
Smear the thinned mix on the speared food to coat it.  Bake the coated
food in the oven at 400 degrees F until browned and cooked through.


Taking the Guesswork Out of Making Breads, Bette Hagman, Celiac and
-----------------------------------------  Author of _The Gluten-Free
Gourmet Bakes Bread_, Henry Holt & Co., New York, NY, 1999

[Author's note:  This article is severely constrained by the copyright
laws applying to Bette's books and the materials used in her
presentation.  I was, however, impressed by the amount of information
and the clarity and simplicity of the presentation.  I consider the
book an excellent reference.--Carolyn Sullivan]

Bette began by saying that the companies keep changing models of bread
machines to keep sales up.  Probably the biggest change that celiacs
need to make is to eliminate the stirdown and second rise as our
breads do not need it.

She has come to believe that if the protein content of GF
(Gluten-Free) bread can be made similar to bread with wheat, then
similar results can be obtained and cup for cup substitution in wheat
recipes can be used.  She finds that using her new formula she does
not get hungry as quickly and the nutrient value goes up.  The new
formula (number 4 on page 40, with some xanthan gum added) is:

   Garfava bean flour   2/3 part (from Authentic Foods)
   Sorghum flour        1/3 part (from Jowar)
   Cornstarch           1 part
   Tapioca flour        1 part

The new book explains flours.  Bette has added nutritional information
and dietary exchanges for each recipe (very helpful for diabetics).
She has not abandoned the old formulas and refers to previous recipes
at the end of each chapter.  [Author's note:  I have noticed the trend
toward the use of bean flour in other GF recipes including those of
Sandra Leonard.--Carolyn Sullivan]

All of Bette's recipes are tested by members of the celiac community.
[Author's note:  Vicki Lyles of our group was one of the testers for
her latest cookbook.]


Using the Mind/Body Connection to Reduce Stress, Kay H. Coker, LCSW,
-----------------------------------------------  MSW, Clinical Social
Worker, The Emory Clinic, Emory Health Care, Emory University,
Atlanta, GA

There is a total interrelation between the mind and the body with
neuropeptides providing communication between them at the cellular
level.  What is required is techniques to access this communication.

Feelings are stress.  Chronic illness provides an additional stress
over the usual catastrophes of life.  The number and kind of stressful
events is not the problem.  Rather, our perception of them is.  We can
usually manage the big events.  It is the small ones that trigger us
into overload.

Mindfulness Based Stress Reduction is discussed online at
<http://www.MBSR.com>.


Substitution Solutions, Jay Berger, Tech Support and General Manager,
----------------------  Miss Robens, Frederick, MD

First, you have to know WHY a recipe calls for a given ingredient to
ensure that your substitution will contribute the same characteristic.
The same ingredient may be used for different reasons in different
recipes.

Second, does your substitution differ in water content from the
original (e.g., butter vs margarine or whole milk vs skim milk)?

Third, make and evaluate only one substitution in a recipe at a time.

Fourth, because GF baking is unforgiving, keep in mind these general
rules:

  * Measure accurately
  * Use all ingredients at room temperature
  * Use the right equipment (e.g., a powerful mixer)

[Author's note:  The Fall 1999 issue of _Sully's Living Without_
contains an article by Ms. Berger on "Substitution Solutions".  To
subscribe, call (630) 415-3378 or visit their website at
<http://www.livingwithout.com>.]


Nutritional Concerns in the Gluten-Free Diet, Lee G. Jimenez, MA, RD,
--------------------------------------------  Nutrition Support
Dietitian, Medical College of Georgia, Augusta, GA

The absorption of nutrients can be affected by active CD.  Mr.
Jimenez pointed out that GF products are NOT required to be vitamin
fortified.  He had four recommendations for all celiacs:

  * Educate yourselves
  * Continue close medical nutrition follow-up
  * Comply strictly with the diet
  * Take a vitamin-mineral supplement daily  [Individual nutrient
    deficiencies should be determined and treated.--Dorothy Vaughan,
    TCCSSG Dietitian Advisor]