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COVID-2019 Alert

The latest information about the 2019 Novel Coronavirus, including vaccine clinics for 12-17 year-olds.

La información más reciente sobre el nuevo Coronavirus de 2019, incluidas las clínicas de vacunación para jóvenes de 12 a 17 años.

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Specific Carbohydrate Diet Curriculum – Patient and Caretaker’s Outlooks (SCRUMPTIOUS)

The goal of this study is to grow educational information for patients and families at Stanford Children’s Health and beyond. An assessment was developed by Stanford Children’s Health to determine what educational content patients needed the most. We found that families want reliable evidence-based education. Here, we provide an SCD curriculum, including a primer on the SCD and how we use it to manage IBD, the science behind the SCD, nutritional adequacy of SCD, cooking videos and written recipes, a few tips and tricks on cooking SCD, Q&A’s from patient families, to help educate families.

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SCRUMPTIOUS curriculum


Primer on SCD:

This video provides an introduction to the specifics of the SCD and how we apply it in clinical practice (11 min and 40 min video)

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Microbiota of SCD:

This video discusses the science behind the SCD and how food affects the gut microbiota and inflammatory response (15 min video)

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Nutritional adequacy of SCD:

This video presents the most common questions we receive from our patients who are starting the SCD and our responses to them (9 min video)

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Cooking videos

Written recipes (click on recipe name to view)

Anytime Meat Sausages

Yield: 25-30 patties (1 inch thick 2.5 inches in diameter)
Prep time: 10-15 minutes
Cook time: 7-10 minutes

Ingredients:

  • 2 pounds ground meat (all pork or 1:1 mix of pork and chicken, or pork and turkey)
  • 2 teaspoons dried sage
  • 2 teaspoons salt
  • 1 teaspoon ground black pepper
  • ¼ teaspoon dried marjoram
  • ¼ teaspoon dried thyme
  • Optional ½ teaspoon red pepper flakes or ⅛ tsp of cayenne pepper

Equipment: Food processor or blender

Directions:

  1. Mix dried sage, salt, black pepper, marjoram, thyme, and red pepper flakes or cayenne pepper (if using) in a small bowl.
  2. Place ground meat into food processor or blender and sprinkle spice mixture evenly over the meat. Add 3 ice cubes or 3 tablespoons of water.
  3. Pulse the food processor several times to mix (this is to make the texture finer, more similar to sausage than hamburger).
  4. Use your hands to form the finely ground meat into patties or sausages, about 1 inch thick.
  5. Cook in batches, do not overfill the pan. Leave some room between the patties for air circulation.
  6. Heat approximately 1 teaspoon of oil into a skillet over medium-high heat. May omit the oil if the meat has fat in it. Place the patties onto the skillet. Cover skillet for the first 1-2 minutes will help the insides cook before the outside becomes overly brown.
  7. Cook patties uncovered until they are no longer pink in the center and the juices run clear, about 3-4 minutes per side. An instant-read thermometer inserted into the center should read at least 165°F (74°C).
  8. Let cool and enjoy immediately.

Note: May wrap the sausages into individual servings and freeze for up to 3 months. Then re-fry or microwave from frozen to warm up.

Easy Cheesy Cracker Chips

Yield: 12-15 tostadas or 30-40 crackers
Prep time: 1-10 minutes (depending on how long it takes you to grate the cheese)
Cook time: 20-30 minutes

Equipment: Grater or food processor or your favorite tool to grate cheese

Ingredients:

  • ~2 cups of shredded SCD legal sharp cheddar (or other meltable block cheese)
  • ~¼—½ cup of unblanched almond flour (the brownish flecks from the almond skins add good color)
  • Optional: Pinch of cayenne pepper, black pepper or other spices as desired

Directions:

  1. In a large bowl, combine almond flour and cheddar cheese. Use your fingers and toss the almond flour and spices (if using) to lightly coat the cheddar cheese. Do this gingerly so the cheddar does not clump up too much.
  2. Heat up a nonstick or well-seasoned cast iron pan on medium, then turn down to medium-low once heated.
  3. Make single layer “mounds” of almond flour and cheese mixture on skillet (size will depend on the intended use of the crackers).
  4. As the cheese melts, use a flexible plastic spatula to spread it out a bit and make sure it’s a thin layer without holes. You may fill in the hole with more cheese-almond mixture.
  5. Once cheese gets lightly golden, use spatula to flip and cook the other side. If the cracker falls apart, then there is either too much almond flour or the cheese is not melted/cooked enough. Be patient and let cheese congeal a little longer or add more cheese to the mixture.
  6. Once the second side is lightly golden, take off the skillet and place on the cooling rack. Do not burn because it will taste bitter.
  7. Let cool to harden or shape while still warm and malleable.

Uses:

  • Taco Shell: Form into a taco shell while still warm and malleable.
  • Taquitos: While still warm and malleable: roll cooked pork or chicken into them, let cool to harden, then add sour cream and guacamole and top with cut lettuce to serve as taquitos.
  • Tostada: Make it a larger round to use as a tostada.
  • Crackers/Croutons/Chips: Make the crackers smaller (for example, quarter size) to use in salads as croutons, crumbles into soups, or as crackers or chips to munch on or eat with tuna or chicken salad, etc.

Nothing But Veggie Chips

Yield: Variable, depending on how many vegetables you have
Prep time: 2-3 hours (slicing and dehydrating time)
Cook time: 1-2 minutes

Ingredients:

  • At least 3-4 fresh carrots (May substitute carrots with 3-4 beets, 1 butternut squash, ½-1 kabocha squash or whatever you have on hand)
  • 3-4 cups of oil - Use a neutral oil with high smoke point like canola, avocado, or peanut
  • ¼ tsp Salt
  • Optional - other spices as desired

Equipment:

  • Vegetable peeler or mandolin or your favorite tool to thinly slice vegetables
  • Food Dehydrator or oven
  • Deep pot for frying

Directions:

  1. Peel and slice carrots (or other vegetable) very thinly using a vegetable peeler.
  2. Place slices in single layers in the food dehydrator for several hours until moisture dissipates.   If a food dehydrator is not available, may place slices on a cooling rack nested in a cookie sheet in the oven at 150-200°F for 1-2 hours to remove most of the moisture. Vegetable slices will shrink substantially after moisture is removed. It will feel like slightly damp leather.
  3. Once you have a good amount of dehydrated vegetables, heat oil to 350°F. Test readiness of oil using 1 piece of vegetable. When the vegetable touches the oil, there should be a soft sizzle and bubbles, and it should crunch up within 30-45 seconds without burning.
  4. Once oil is ready, gently place a handful of vegetables at a time into hot oil. The addition of too many vegetables at once will cool the oil and you will not get a crispy chip.
  5. The chips should be ready within 30 seconds or just before it browns. Swiftly remove chips from the oil using a slotted ladle. Place chips onto several layers of paper towel to soak up some of the oil.
  6. Immediately sprinkle with salt or spices.
  7. Let cool for several minutes until crunchy.
  8. Enjoy as chips or use as toppings to add texture to soups.

Everything Coconut Crêpes

Adapted from Vered DeLeeuw, CNC at healthyrecipesblogs.com

Yield: 4 large crepes
Prep time: 5 minutes
Cook time: 5 minutes

Ingredients:

  • 3 large eggs
  • ~½ cup of lactose-free whole milk (can substitute with heavy whipping cream diluted with water by 50% or SCD legal almond milk)
  • ¼ cup coconut flour
  • 1-2 tbsp any oil
  • Optional: Ingredients for toppings or fillings

Directions:

  1. Beat eggs in a bowl until well mixed but not frothy.
  2. Add milk and continue to whisk gently.
  3. Add coconut flour and whisk until the texture is smooth. Let sit for 2 minutes to thicken.
  4. Heat a skillet over medium heat. Add about 1 teaspoon of oil and spread to coat the skillet.
  5. Gently re-whisk batter prior to each pour to incorporate all the ingredients.
  6. Pour 1/3 cup of batter onto the skillet and quickly swirl the skillet to spread batter evenly into the shape of a circle.
  7. Cook for about 2-3 minutes until the top is bubbly and the bottom appears set.
  8. Use a wide flexible plastic spatula to carefully flip the crepe.
  9. Cook the second side briefly - 30 seconds to 1 minute, then slide the cooked crepe onto a plate.

Note: May enjoy while warm, at room temperature, or cooled. Once cooled, may stack, separated by wax or parchment paper, and store in the refrigerator for up to 1 week. This does not freeze well. Ingredients to fill crepe may include ham and cheese; whipped cream, fruit, date syrup, sprinkled with toasted almond, etc.

Uses:

  • Fold while warm, drizzle with honey to melt, then sprinkle with fresh lemon juice and enjoy at room temperature.
  • May fill with ingredients like scrambled eggs with veggies or bacon and enjoy warm.
  • May allow to cool, then fill with ingredients like fruit compote or yogurt.

SCD Banana Bread Muffins

Adapted from: https://www.everylastbite.com/2014/04/06/the-best-banana-bread-scd/

Yield: About 12 muffins
Prep time: 10-15 minutes
Cook time: 25-30 minutes

Ingredients

  • 3 very ripe bananas, peeled
  • 2 eggs
  • 3 cups almond flour
  • 3 tablespoon melted butter
  • ¼ cup honey
  • 2 teaspoon apple cider vinegar
  • 1 teaspoon vanilla extract
  • ⅛ teaspoon salt
  • 2 teaspoon baking soda

Directions:

  1. Preheat the oven to 350°F. Line a muffin tin with 12-14 muffin liners.
  2. In a large bowl, add the peeled bananas and mix either in a standing mixer or using a hand mixer until the bananas reach a smooth, liquid consistency.
  3. To the bananas, add the eggs, melted butter, honey, apple cider vinegar, vanilla extract, and salt. Mix.
  4. To the liquid mixture, add the almond flour. Mix.
  5. Lastly, add the baking soda to the mixture and quickly mix to incorporate.
  6. Moving quickly, scoop mixture into muffin tin until each muffin liner is ⅔ to ¾ of the way full.
  7. Place into the oven and bake for about 25-30 minutes.
  8. Let cool for 10-15 minutes.
  9. Enjoy!

Note: You can add cinnamon, nutmeg, allspice, dried fruit, chopped nuts, or shredded coconut.

SCD Dairy Yogurt

Yield: Variable, depending on how much milk you use
Prep time: 20 minutes
Cook time: 24 hours

Ingredients:

  • 2-4 cups or ½-1 litre of milk (cow’s or goat’s, full fat or low fat)
  • ½-1 sachet of Yogourmet Freeze Dried Yogurt Starter or ½-1 tbsp of SCD starter yogurt

Equipment:

  • Jar with lid, large enough to accommodate the milk
  • Pot or microwave
  • Yogurt maker (or any heat source)
  • Thermometer
  • Optional: Colander, cheese cloth, and bowl that is large enough to accommodate the colander

Directions:

  1. Heat milk to 180° F. (Milk can be heated directly in a pot; in a glass jar placed inside a pot with water; or in a glass container in the microwave)
  2. Cool milk to 105 - 110° F. (May leave milk in a gently covered container at room temperature for several hours or speed up the cooling time by placing jar/pot of milk in an ice bath for 10-15 minutes)
  3. Add yogurt culture (for strict SCD, avoid cultures that contain bifidus).
    1. 2-5% of milk volume (~ 1 tablespoon starter yogurt in ½ liter milk = 15 mL of starter yogurt in 500 mL milk)
    2. Yogourmet freeze dried starter: 1 sachet per liter or 4 cups of milk, 1/2 sachet in ½ liter or 2 cups of milk
  4. Maintain the mixture at 105 -110° F for 24 hours in the yogurt maker or other heat source. Cover loosely to prevent contamination of yogurt. By 4-6 hours, the yogurt should begin to firm up.
  5. After 24 hours, remove yogurt from heat and cool in the refrigerator.
  6. Optional: For thicker yogurt: Place a colander lined with a cheesecloth over a large bowl, assuring clearance at bottom for the liquid whey to drip into. Then pour the yogurt into the lined colander. Place the bowl with colander and yogurt inside the refrigerator overnight or for several days. The longer it is strained, the thicker the yogurt will become.
  7. The yogurt will last 6-8 weeks in the refrigerator. Always scoop out yogurt with a clean utensil and keep the yogurt container covered to prevent introduction of unwanted microbes.

Uses:

  • Eat plain, or topped with fruit, nuts or nut-based granola, and/or honey or date syrup
  • Use yogurt to make shakes
  • Use thickened yogurt as farmer’s cheese in baking
  • Turn yogurt into “sour cream” by squeezing some lemon or lime juice into it and mixing well
  • Make a dip by adding spices, fresh herbs, garlic, salt and acid for a ranch-like dressing or veggie dip

Cashew Milk Yogurt

Yield: About 16 oz of yogurt
Prep time: 2 minutes
Cook time: 4-6 hours

Ingredients:

  • 1-2 dates
  • 1 cup raw, skinned cashews
  • 1 cup warm water
  • 1 tbsp of your favorite brand of Cashew Yogurt or probiotic capsule to be used as the yogurt starter

Equipment:

  • 16 oz Jar with lid
  • Small strainer
  • Yogurt maker or heat source

Directions:

  1. Add dates into the cup of warm water and let them dissolve. May speed up this process by heating the dates and water in the microwave for 1 minute. Strain out the bits of dates and seed using the small strainer. Set date-infused water aside. The date-infused water provides a little sugar for the bacteria to consume and also gives the yogurt a nice fragrance.
  2. Puree cashews and ¾ of the warm date-infused water in a blender until smooth. Slowly add more date-infused water to mixture to thin out the cashew cream into the consistency of heavy cream. It is okay not to use all the date-infused water if your cashew cream has reached the desired consistency of heavy cream.
  3. Heat the cashew cream to 105-110° F in the microwave or place the jar of cashew cream in a pot of water on the stovetop. If it is already at this temperature because you used warm water to dissolve the dates, then no need to heat further.
  4. Add yogurt culture to warmed cashew cream (the culture is the pre-made cashew yogurt or the probiotic capsule)
    1. 1 tablespoon of pre-made cashew yogurt in 16 oz of cashew cream or 2 capsules of probiotic in 16 oz of cashew cream.
  5. Place mixture into a yogurt maker or other heat source and maintain at 105-110° F for 4-6 hours. Loosely cover jar to prevent introduction of unwanted microbes from the environment. The yogurt will get quite tart by 6 hours, but if you like it more tart, you may leave for 8 hours. If you like it less tart, then 4 hours of fermentation should be fine as long as the yogurt has thickened to your liking.
  6. Refrigerate for at least 4 hours to set and enjoy!

Note: The store-bought cashew yogurt may contain bifidus, thickeners like guar gum and other ingredients which are not “SCD legal.” But the quantity used is so miniscule that most people seem to tolerate it. Nevertheless, use only if you have tolerated SCD for a few months and doing well without symptoms.

Cashew cream: Don’t want to make cashew yogurt? Then just puree the raw skinned cashews with plain water; 1:1 ratio, until smooth. Add a pinch of salt to taste and you have yourself a delicious cashew cream that you can drizzle on things like butternut squash soup or use to make a salad dressing. Make the puree thicker by using less water to make a hummus or dip.

SCD cooking tips & tricks:

  • Sour cream for tacos: Strained SCD yogurt with a squeeze of lime or lemon.
  • Heavy whipping cream: Heavy whipping cream with vanilla with a dash of saccharin. Whip it up to make whipped cream.
  • Alternative flour recipe: Use pulp from making nut/coconut milk in place of store bought flours. This is often more pocket-friendly and helps reduce food waste.
  • Apple cinnamon muffin recipe
  • SCD french cream: Recipe found in BTVC is delicious! You can use double cream for an SCD-legal sour cream or crème fraiche recipe, by using heavy cream and an SCD-legal culture.
  • Ranch dressing: Cooled unstrained yogurt plus grated garlic, plus oregano or fresh parsley with salt and pepper- perfect dressing!

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Q&A’s from patient families


Staging:

Q: Just to clarify–you do not recommend an “intro stage” for SCD?

A: We recommend “intro stage” only for patients with active symptoms like diarrhea or severe abdominal pain. In some cases we do an intro stage, but this is often individualized. Some need longer intros, others, less so. We use the PecanBread intro stages or the PRODUCE intro stage in most cases, unless there are specific needs like allergies, FPIES, prior food sensitivities.

Q: Is it preferable to do strict SCD for 12 months if you can before you do modified SCD?

A: Yes, strict SCD for 12 months (at least) is preferred, however sometimes the family is really eager to liberalize. We try to assess how the child is doing in terms of mood, height, weight, and nutrition.

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Weight/Clinical response:

Q: When can weight gain be seen with the SCD?

A: There is usually some weight loss at the beginning when you are getting started on the diet. By 2-3 months, we expect weight gain along a child’s curve. If weight loss is >7% of baseline weight at anytime, we need to “liberalize” to increase calories and then allow more time to get strict over time. We have had kids gain back 30 pounds in a year after having lost 30 pounds before diagnosis.

Q: How long does it take to see results on SCD?

A: It can take 3-18 months to get the calprotectin totally normal.

Q: If symptoms improve but mucosal healing does not, does that translate into still needing medication?

A: That is a complicated question... We treat with the goal of mucosal healing, but it’s a balance between growth, symptoms, labs, calprotectin, and endoscopic changes.

Q: How can you tell the response to the diet if your child is also on medications?

A: If you start medications and SCD at the same times, sometimes it’s impossible to know which therapy did what.

Q: Is further testing such as food sensitivity testing, allergy testing or microbiome studies required to determine an individual’s response to the diet?

A: No, we typically do not do food sensitivity, allergy or microbiome studies at this point. Science does not support these tests at this point.

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Nutrient/Food specific:

Q: Can we use coconut water with no additives?

A: All coconut water comes from green coconuts and thus not allowed, even if it does not have added sugars.

Q: Is it ok to use coconut flour or other coconut items for baking/cooking?

A:Coconut flour, coconut butter, dried coconut, and mature (brown) coconut are allowed! Coconut water, young coconut, and coconut nectar or sugar are not allowed.

Q: For spices, if the only ingredient is the herb—is it still considered illegal?

A: If the spices are all dried and crushed and no decaking or sugars added, then the spice or herb is legal. It is generally advised to avoid spice mixes as they may contain non-SCD ingredients.

Q: Are bananas with brown spots always preferred or only when symptomatic?

A: They are always preferred as they contain less starch.

Q: Is date syrup or date paste legal?

A: YES! Date syrup, because it comes from dates (which are allowed), is also allowed on the SCD.

Q: What ingredients can be used for baking?

A: Try exploring almond flour, coconut flour, and flours from other nuts and seeds, and get creative.

Q: What kitchen tools do you recommend that are the most helpful?

A: A blender, a food processor (use for shredding), instant pot, and dedicated nut milk makers. Some families like having a second refrigerator to store SCD ingredients that they buy in bulk.

Q: How important is it to consume a variety of foods on the SCD, and how does it increase the microbiome diversity?

A: Very important! The fibers in fruits and veggies are the food for the beneficial bacteria that are in the gut and are also consumed via yogurt and fermented foods such as sauerkraut and kimchi. More dietary diversity means that you are consuming more of different kinds of fibers, nutrients, and antioxidants which all work together and in different ways to support gut health and reduce inflammation.

Q: Are canned fruits and vegetables allowed?

A: Most canned fruits and vegetables are allowed as long as there aren't any additives that are not allowed on the diet.

Q: Are adzuki beans legal?

A: Navy, white, haricot, kidney, lima, black, and adzuki beans are allowed. Pinto, cannellini, chickpeas, and mung beans are not allowed.

Q: Do you recommend SCD for vegetarians?

A: Vegetarians can absolutely do the SCD and we have lots of experience in our center with vegetarian SCD-ers. It is important to make sure that they are getting enough protein from eggs, SCD-legal dairy, and SCD-legal legumes, nuts, and seeds. Some patients with IBD may need additional iron supplementation just depending on their medical history and needs.

Q: Can you make the Easy Cheesy crackers with harder cheeses?

A: Yes, other hard cheese that melts well, like Swiss or colby jack or monterey jack can be used. Parmesan does not melt well. Avoid buying pre-grated cheeses as they often have added, illegal ingredients like potato starch or coloring, thus you will need to grate your own cheese.

Q: Are impossible meat or beyond meat legal?

A: Impossible meats and beyond meat unfortunately are not legal.

Q: What are easy snacks that can be given between meals?

A: SCD crepes are scrumptious, especially with added honey and coconut cream. Carrot and beet chips is an easy snack—we have a video that will be posted on the LPCH IBD center website after these series of webinars. Please look on the “favorite SCD snacks” hand-out on Nimbal.org—it lists things like olives, hard boiled eggs, fruit and nuts bars, ants on a log, and more.

Q: Which type of pickles are legal?

A: Any pickle is legal when it is only the veggie and salt. The souring occurs when the bacteria in the fruit and/or veggies ferment and create lactic acid. Pickles that are soaked in salt and vinegar for the sour taste will not have the probiotic properties of fermented pickles.

Q: Is kombucha or sparking water legal?

A: Kombucha is not legal technically though we have had people who add it on while in remission and seem to do okay... Sparkling water is SCD legal—just be mindful that there aren't added sugars or other non-SCD ingredients. Spindrift sparkling water is one SCD legal brands.

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Yogurt:

Q: Is non-dairy yogurt as nutritionally beneficial as dairy yogurt?

A: Non-dairy yogurt will offer probiotics, and a little bit of protein and fat, however it typically won’t be as rich in calcium and protein as dairy yogurt.

Q: What if my child has a milk allergy, can they have yogurt?

A: You can use almond milk or coconut milk to make a non-dairy SCD yogurt. Make sure to talk to your dietitian and IBD provider to make sure your child is getting enough calcium and vitamin D in the diet.

Q: Can we use lactose free yogurt from the store?

A: We have not found lactose free yogurt without thickeners like guar gum. Lactose free yogurts also may not have as much probiotics as the SCD yogurt.

Q: The BTVC book states there is an issue with certain bacteria strains in store bought yogurt, is it still legal?

A: For the first 6-12 months, it is recommended to make homemade SCD yogurt by using a yogurt culture that does not contain Bifidus (this can be found in the ingredients list of a store bought yogurt). Depending on your child and how they are doing, they may be able to liberalize to a plain, store-bought yogurt after 6-12+ months on the SCD—however this decision is very individual. There are some store bought yogurts that are SCD legal, but can be difficult to find. To learn more, read here.

Q: Does freezing SCD yogurt change the viability of bacteria?

A: Freezing SCD yogurt makes the probiotics dormant, meaning they are “sleepy” and less active. You can make yogurt with some heavy cream, then mix it with some SCD-legal sweetener or fruit and freeze to make a frozen yogurt. The yogurt will “wake up” once consumed and is warmed inside your body, but would not be as “active” or “viable” as non-frozen yogurt.

Q: Does the timing of fermentation affect the yogurt?

A: The longer the fermentation, the more beneficial bacteria are created. SCD yogurt is richer in probiotics than store bought yogurt because of the longer fermentation period.

Q: The Breaking the Vicious Cycle book states that high galactose levels in lactose free milk (with added lactase enzyme) might be a concern for the liver, and suggests avoiding it. Is this still true?

A: In general, we are not concerned about galactose being problematic for liver health. In general, galactose is well-tolerated by most individuals. There is plenty in the SCD yogurt as lactose is broken down into glucose and galactose via fermentation.

Q: How do I help my child gain extra weight with yogurt?

A: You can make the yogurt with half whole milk and half, half-and-half—it is very delicious and creamy.

Q: Are there any commercial yogurts without bifidus?

A: Dannon Whole milk yogurt and Nonfat Butterworks yogurt

Q: Does making smoothie with yogurt change the amount of probiotics in it?

A: It shouldn’t! The probiotic content should be preserved, even when blended.

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