<<Disclaimer: Verify this information before applying it to your situation.>> 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]