TPV Episode 33 Show Notes: Breastfeeding and First Foods

April 5, 2013 in Practical Tips, Show Notes

Our thirty-third show!
Ep. 33: Breastfeeding and First Foods

In this episode, Stacy and Sarah welcome Arsy from Rubies and Radishes, author of The Paleo Slow Cooker, to talk about breastfeeding and first foods. Discussed are such topics as handling food sensitivities in babies, how to deal with issues with milk supply, and why Stacy knows so much about this stuff.

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The Paleo View (TPV), Episode 33: Breastfeeding and First Foods

 

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TPV Episode 30 Show Notes: Basic Paleo FAQ

March 15, 2013 in Show Notes

Our thirtieth show!
Ep. 30: Basic Paleo FAQ

In this episode, Stacy and Sarah tackle a variety of questions that seem to come up all the time and definitively answer them for you. Can you eat quinoa? Can you do paleo as a vegetarian, or without grass fed meat? And what about pork? Is it inherently unhealthy like the Weston A. Price Foundation claims? Find out these answers and more this week!

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The Paleo View (TPV), Episode 30: Basic Paleo FAQ

 

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A New Study Has the Media Buzzing About Gluten. Again.

February 25, 2013 in For Babies, Paleo Philosophy, Practical Tips, Topics for Paleo Families

A new study in the journal Pediatrics has the gluten-free/celiac disease world buzzing (this article has been published on dozens of websites).  The study concludes that early introduction of small amounts of gluten while still breastfeeding reduces the risk of celiac disease.

The study looked at two cohorts of Swedish 12-year olds, the first were a group born in 1993 during an epidemic of celiac disease (during the epidemic, the incidence of celiac disease increased from 1 in 100 to 3.3 in 100, believed attributable to changes in government recommendations for the age of gluten introduction to 6 months old, combined with a concurrent increase in the gluten content of baby foods) and the second were a group born in 1997 after the epidemic (after the government revised their guidelines to lower the age of gluten introduction to 4 months and the amount of gluten in baby foods was reduced).  The study sought to determine the impact of breastfeeding in relation to gluten introduction on the future development of celiac disease.

The hypothesis of the study is well summarized in this statement from the discussion section.

“Oral tolerance to an antigen develops early in life, and celiac disease can be viewed as a failure to develop oral tolerance to gluten, or a later loss of this tolerance.  The development of oral tolerance is a complex immunologic process involving interactions between genetic factors and environmental and lifestyle exposures, such as bacterial gut colonization and infant feeding.”

And this idea is what has my inbox flooded with questions.  If oral tolerance for gluten develops early in life and breastfeeding helps with the development of oral tolerance, is it better to give our paleo babies some gluten now?  Will that help prevent celiac disease and other autoimmune diseases?

To answer this question, let me first summarize exactly what this paper shows about the relation between breastfeeding, gluten introduction and celiac disease.  Over 13000 children were enrolled in the study.  The incidence of celiac disease was 2.8 in 100 in the 1993 cohort versus 2.2 in 100 in the 1997 cohort.  The median age of gluten introduction was the same (5 months old) between both cohorts.  But, the infants in the 1997 cohort were breastfed an average of 2 months longer than the 1993 cohort (age of weaning increased from an average of 7 months to an average of 9 months between 1993 and 1997).  What this means is that the number of babies who were breastfed during and beyond gluten introduction was significantly larger in the 1997 cohort (number of babies breastfed beyond gluten introduction was 70% vs 78% in the 1993 and 1997 cohorts, respectively).  From this, the authors conclude that introducing gluten before weaning reduces the risk of celiac disease.

24GLUTEN-articleInlineThis is an interesting observation and I think that this Op Ed piece in the NY Times provides a possible explanation for the result that is not thoroughly discussed in the original paper:  it’s all about the gut microbiota.

The most current understanding of celiac disease (well summarized in this paper, which sadly requires a subscription to view) is that the development of celiac disease (and indeed all autoimmune diseases) relies on three factors:

  1. Genetic predisposition
  2. Environmental trigger (in the case of celiac disease, that trigger is gluten)
  3. A leaky gut and/or gut dysbiosis

All three of these factors work together to develop autoimmune disease.  In terms of celiac disease, the genetic predisposition is at least partially understood: 90% of celiacs have one of two variants of the HLA gene (either DQ8 or DQ2).  What you need to know about the HLA gene is that it (or more specifically the protein in encodes) is involved in antigen presentation to the adaptive immune system, and defects in this process seem to be permissive for autoantibody formation.  But, approximately 30% of us have one of these gene variants and only 1% of us develop celiac disease (it should be noted that these gene variants are linked to other autoimmune diseases as well as non-celiac gluten sensitivity, so it’s not like the other 29% of us are getting off easy).  The environmental trigger for celiac disease is dietary gluten (or more specifically the protein fraction of gluten, called gliadin).  So, what’s the wild card?  A leaky gut.  And the development of a leaky gut may be what determines the age of disease onset, which is highly variable.  Chance (or maybe previous infections or maybe gut dysbiosis, i.e., the wrong types of bacteria growing in the wrong numbers in the wrong part of the gut) may be what determines whether a person develops celiac disease versus another autoimmune disease versus other health problems linked to gluten.

A leaky gut can be caused by a wide variety of factors, including: diets rich in some types of lectin (like gluten) and saponins (especially glycoalkaloids), stress, and gut dysbiosis (especially bacterial overgrowths).  Gut dysbiosis itself can be caused by diets rich in processed foods, refined carbohydrates, some types of lectins (especially prolamins like gluten and agglutinins like wheat germ agglutinin) and saponins (especially glycoalkaloids), by some medications (such as PPIs and antibiotics) and by stress.  A leaky gut and gut dysbiosis go hand in hand and it is not known which comes first.

So, what is the link between breastfeeding and a leaky gut?  The link is really to gut dysbiosis (or lack thereof).  Studies show that breastfeeding is important for the establishment and growth of normal gut microorganisms.  In particular, breastmilk contains probiotics (from strains shown to be deficient in the guts of those with celiac disease) and for the duration of breastfeeding, the guts of babies are being constantly inoculated with these beneficial bacteria.  It is becoming increasingly recognized that the healthy diversity and relative amounts of gut microorganisms are intricately linked your health.  So, it’s no surprise that whatever factors contribute to healthy gut microorganisms in babies will protect them from disease.

So, let’s get back to the study.  It has one very big limitation relevant to this discussion.  It cannot separate whether the exact age of gluten introduction in babies who were breastfed longer has any effect on celiac risk.  This study definitely shows that breastfeeding longer decreases celiac risk.  But, the idea that this is because breastfeeding occurred during and beyond gluten introduction is speculative.  It certainly makes sense given other research on the link between gut microorganisms and disease risk that a healthy gut is important in celiac disease risk and that breastfeeding longer improves the health of the gut microorganisms.  But, this study just can’t tell you whether introduction of gluten early (and before weaning) is important.  If the reason breastfeeding is protective is because of its probiotic effects (it’s nutrient value would be another good reason), then it could be that it doesn’t matter when gluten is introduced (if ever) as long as the gut is healthy when you do.

From birth through adulthood, diet has a profound effect on the composition and relative quantities of your gut microorganisms (I explain this is detail in my book).  And healthy gut microorganisms have a profound protective effect on the integrity of the gut barrier and are essential modulators of the immune system (yes, I explain this in detail in my book as well).  The optimal diet in terms of gut and gut microorganism health seems to be a hunter/gatherer/gardener type diet, rich in plants (but not grains or legumes and nothing processed or refined) and wild or pastured meat and/or wild-caught fish (no surprise to us in the paleo community).   What is healthy nutrient-dense food for you just happens to be healthy food for your gut microorganisms.  And, while this is an oversimplification, if you feed your gut bacteria good food, they are healthy, and therefore you are healthy.

So, getting back to the question that is flooding my inbox:  does this paper mean you should feed your paleo babies a little gluten now so that they will develop immune tolerance?  This study does not allow us to conclusively say yes or no.  Certainly, this study does not prove its assertion that introducing small amounts of gluten into the diet very early and prior to weaning will increase immune tolerance and therefore protect your baby against ever developing celiac disease (although you can add this study to the bounty of scientific studies showing that breastfeeding is beneficial for your baby). It should also be noted that the health of the mother greatly affects the probiotic and nutrient content of the breastmilk.  It is unknown whether breastmilk is still protective in the context of obese mothers or mothers with chronic health conditions.

I believe that the best thing that you can do for your baby’s long term health (besides love and cherish them) is feed them nutrient-dense, nourishing foods that will help them have healthy guts and healthy gut microorganisms.  I do not believe that gluten consumption promotes a healthy gut or healthy gut microorganisms (and the science backs me up on this one—I reference a few hundred studies on this topic in my book).  But, I also don’t know whether, if you wait “too long” to introduce gluten, if some magical window of opportunity to develop immune tolerance against gluten will be missed (or how much gluten you would need to keep in the diet to maintain immune tolerance).  I also don’t know whether having immune tolerance against gluten is even a good thing in terms of overall long term health.  Science does not yet provide a clear answer.  So, with all of these ideas in mind, the decision will have to be yours and will have to be based on your own risk assessment.

Bengmark S. Gut microbiota, immune development and function. Pharmacol Res. 2013 Mar;69(1):87-113. doi: 10.1016/j.phrs.2012.09.002. Epub 2012 Sep 16.

Fasano A. Leaky gut and autoimmune diseases. Clin Rev Allergy Immunol. 2012 Feb;42(1):71-8. doi: 10.1007/s12016-011-8291-x.

Groschwitz KR and Hogan SP. Intestinal barrier function: molecular regulation and disease pathogenesis. J Allergy Clin Immunol. 2009 Jul;124(1):3-20; quiz 21-2. doi: 10.1016/j.jaci.2009.05.038.

Hascoët JM et al. Effect of formula composition on the development of infant gut microbiota. J Pediatr Gastroenterol Nutr. 2011 Jun;52(6):756-62. doi: 10.1097/MPG.0b013e3182105850.

Ivarsson A et al Epidemic of coeliac disease in Swedish children. Acta Paediatr. 2000 Feb;89(2):165-71.

Ivarsson A, Prevalence of Childhood Celiac Disease and Changes in Infant Feeding. Pediatrics. 2013 Feb 18. [Epub ahead of print] http://pediatrics.aappublications.org/content/early/2013/02/13/peds.2012-1015.long

The Science and Art of Paleofying—Part 3 Leavening and Fats

November 29, 2012 in Baking Ingredients, Cooking Tips

Creating paleo adaptations of our favorite recipes (a.k.a. paleofying) helps us stay on board with paleo through the holidays (and many other times of the year), help us feel like we can still celebrate and partake in all of the fun and food luxury of the season.  I know that many of you are pulling out your old favorite recipes and wondering what to do with them (I’ve had many questions lately about rules of thumb for flour substitutions, and alternatives for those with nut or egg allergies).  I am too.  I have several family favorite recipes that I am tackling this year.

Paleofying is as much an art as it is a science.  I vaguely remember a time when I did not have extremely well-honed cooking instincts (I think that was back in middle school).  But even starting out as a fairly good cook, there was still a learning curve to all of these new ingredients and to baking without gluten.  After a year of paleo baking (and blogging!), I have a much better understanding of how to adapt conventional recipes now and thought it was high time I share some of this knowledge and experience with you, in addition to my perfected recipes.

This is the third in a 6-part post series to help you start the process of adapting your recipes (did I call this a 4-part series before?  Yes, I just realized I needed two extra parts and I reserve the right to expand this to a 7-part series if needed!).  In the first post, I discussed paleo flours and other ingredients that add bulk to a recipe.  In the second post, I discussed binders (ingredients that hold baking together).  In this post, I will discuss leavening agents and fats.  In part 4, I will discuss sweeteners.  Part 5 will discuss liquid ingredients and wet-to-dry ratios.  Part 6 will discuss some strategies for doing iterations and troubleshooting your recipes.  You may also be interested in some of my posts that reference paleo baking ingredients:  Important Pantry Items for The Paleo Baker, Paleo Flour Substitutes, Sugar vs. Sweeteners, and Is Sugar Paleo?).

Leavening Agents

Let’s start with leavening agents.  Leavening means anything that puts little bubbles of air into your baking making it lighter, often “rising” while baking.  Classic leavening agents are baking soda, baking powder, yeast, butter (or more specifically the butter sugar combination), and eggs.

Baking soda is sodium bicarbonate.  It comes from a natural mineral that was originally mined, but is now made industrially using the miracles of chemistry.  Sodium bicarbonate is an alkali, so when it mixes with acid, it undergoes a chemical reaction and CO2 bubbles are released (woohoo for acid-base chemistry!).  Depending on how much acid it is mixed with, it either reacts slowly or very quickly (think homemade volcano science projects).  If your recipe calls for baking soda, then no substitution is necessary.

Baking powder is not paleo.  It contains corn starch (corn-free versions typically contain potato starch).  It’s actually one of my biggest pet peeves to see baking powder in paleo recipes because that little bit of corn starch can be a big problem for many people.  However, the active ingredients in baking powder, baking soda and potassium hydrogen tartrate (a.k.a. tartaric acid, a.k.a. cream of tartar), are paleo.

Tartaric acid is an acid naturally found in grapes and is a byproduct of wine making. You can buy cream of tartar in the spice or baking section of just about any grocery store.  Cream of tartar is an acidifying agent.  It provides the necessary acid for baking soda to react with to make its little CO2 bubbles.  Baking powder contains both baking soda and cream of tartar (and the aforementioned corn starch as a drying agent), so if you recipe calls for baking powder, here are some simple substitutions:

1 tsp baking powder=1/4 tsp baking soda + ½ tsp cream of tartar
or
1 tsp bakin powder=1/4 tsp baking soda + 1½ tsp vinegar or lemon juice
or
1 tsp baking powder=1/4 tsp baking soda + ¼ cup molasses
or
1 tsp baking powder=1/4 tsp baking soda + some other acidic ingredients like applesauce

I will only briefly mention here that baker’s yeast is a perfectly acceptable ingredient to use in paleo baking (see my post Is Yeast Paleo?).  However, you will have to pay close attention to binders in your recipe to hold in the air bubbles that yeast makes.  I have two yeast-based paleo bread recipes (almond flour and nut-free) and both took many, many iterations to get right.

Cookie recipes will often use the combination of butter creamed with granulated sugar to achieve some lightness.  You can still do this with paleo baking as long as you use a granulated sugar (there are unrefined options which I will talk about more in the next post of this series).  If you replace sugars with liquid sweeteners like honey or with fruit, then you might need to add a little extra baking soda to replace the leavening effects of the butter and sugar.  You won’t need much though, maybe as little as an extra 1/8-1/4 tsp.

Eggs provide leavening in addition to binding in many recipes, especially if the recipe calls for beating the eggs very well before adding in other ingredients or separating the eggs and beating the whites.  If you are struggling with dense baking (especially cakes and breads), then before changing anything, try beating your eggs for 3-5 minutes (this works best if the eggs are room temperature).  You can also try beating the egg whites and folding them in (see my recipes for Holiday Trifle, Paleo Styleand Cinnamon “French Toast” Flat-bread (Nut-Free)).

Fats

If your recipe calls for vegetable oil, then the typical paleo oil replacement is melted extra virgin coconut oil.  If you don’t want to coconut flavor that this brings to your baking, you can use a naturally refined coconut oil instead.  Olive oil or avocado oil are also acceptable substitutes for vegetable oil in baking.  While these oils have a higher mono- and polyunsaturated fat content, as long as you are baking at 350F or less, you really don’t need to worry about the fats oxidizing.

If your recipe calls for peanut butter, then Almond Butter or any other nut butter will work well.  Sometimes mixing a couple of different nut butters (like Almond Butter, Walnut Butter, and Pecan Butter) will provide a more neutral taste.  You can also substitute some of all of the fat in a recipe with nut butters (or even coconut cream concentrate), which works well for cookies but can also be used in breads and cakes.  Because of the fiber in nut butters, these can also help act as binders.

If your recipe calls for butter and you cannot tolerate any dairy, then palm shortening is the most similar ingredient in terms of chemistry.  Lard also works.  Often people get stuck on just using coconut oil for baking, but coconut oil can make baking heavy and chewy, which isn’t always desired.  I find palm shortening especially useful in cake recipes where butter contributes to the lightness of the cake.  It will also be helpful in cookie recipes to achieve a crispier, less chewy, cookie.  If you do want chewy cookies, then coconut oil is a great choice.

If your recipe calls for shortening or margarine, palm shortening is your go to substitute.  You could also use butter or lard.

When my paleo recipes call from palm shortening versus coconut oil, it is always extremely intentional.  They have very different properties in baking.  Palm shortening will help thicken a batter, keep baking lighter, provide a completely neutral flavor.  Coconut oil is healthier and can help hold a recipe that is short on binders together.  I love coconut oil for cookies because I tend to love chewy cookies.  It’s also great for use in brownie type recipe, anything where that chew is a good thing.

I will talk more about fatty liquids like heavy cream and buttermilk in the 5th post of this series, but I will mention here that if whipped heavy cream is an ingredient in your baking and you can not tolerate any dairy (many paleo enthusiasts still consume heavy cream, especially if grass-fed), then whipped coconut “cream” is a good substitute.  Chill a can of coconut milk in the fridge for 24 hours.  Carefully scoop out the solid half at the top of the can, whip and go.  You can also use Anoy-D brand coconut cream and then you don’t have to worry about what to do with your half can of coconut water when you’re done.  If your coconut cream isn’t holding together (sometimes happens if you get too much liquid from the bottom of the can mixed in), then try adding a little arrowroot powder to help it hold together.

One more quick note on fats.  Many recipes that we might want to adapt are “low fat” recipes from the last 30 years of fat-phobia.  I often find myself increasing the amount of fat in a recipe, either by straight up using more fat or by using nut flours that are higher in fat or replacing dry ingredients with fat (like using full fat coconut milk).  Increasing the fat too much in a recipe can cause baking to be quite heavy, but sometimes increasing it a little can work magic.  More fat often means it holds together better, and depending on what fat you use, you can have better control over the texture.  And the best part?  High fat baking tends to taste great even with less sugar.

I hope this will get you started on your paleofying adventures.  As you play more and more with these ingredients and get to understand their properties better, it will be easier to intuit what will work in any particular recipe.  But, I still have recipes that take me many iterations to get right.  And of course, if you adapt a recipe that is absolutely awesome, you are welcome to e-mail it to me to share on the blog:  thepaleomommy@gmail.com