Gluten, Paleo, and Pizza

Abstract

Gluten is the major storage protein found mainly in wheat. It is sticky, elastic, traps air and gives baked goods their sponginess. It is also used in countless processed foods as a stabilizer or thickener. The gluten-free food industry is a significant trend. More people buy gluten-free food than those diagnosed with celiac disease or gluten-related disorder (non-celiac gluten sensitivity or gluten allergy). Celiac disease, gluten sensitivity, and gluten allergy are described. Atypical celiac disease and difficulties in diagnosis are described. The need for research on gluten sensitivity is highlighted; it is poorly defined and there is not a validated biomarker for diagnosis; still, it is a recognized medical condition with symptoms overlapping many of that of celiac disease.

Introduction

Gluten-free nutrition is among the most engaging and debated topics in dietetics. Awareness on gluten and the gluten-free lifestyle is highly important to dietitians and other health practitioners in integrative and functional medicine. Celiac disease and gluten-related disorders are grossly misunderstood, even among highly-educated health practitioners. Those familiar with the gluten-free lifestyle are likely to encounter the Paleo diet, which is a call for return to eating the way humans did before the agricultural revolution 10,000 years ago. The Paleo diet reinforces the gluten-free lifestyle by placing restrictions on grains, among other things. The science on gluten, celiac disease and gluten-related disorders is briefly reviewed here. A gluten-free pizza recipe is provided. 

What is Gluten?

Gluten (Latin for “glue”) is the major storage protein in wheat and is also found in barley and rye. Its sticky and elastic properties trap air when leavened, which gives baked goods their sponginess and cohesion. Gluten is also used as a binding or thickening agent in countless processed foods (eg, salad dressing and deli meats). Gluten and its close relatives secalin and hordein, from barley and rye, are:

•        only partially broken down in the human digestive tract and yield protein fragments called gliadins, which trigger unfavorable immune responses in susceptible individuals¹.
•        theorized to be mistakenly interpreted by the gut-associated immune cells as a part of a dangerous microbe, which triggers an immune response in everyone, like that triggered by harmful bacteria. This is not exclusive to those with gluten-related disorders².
•        body’s fight against gluten is like its fight against bacteria: Everyone’s immune system fights potentially harmful bacteria every day; only rarely do we lose the fight against bacteria or gluten³.
•         present in higher amounts in and comprised of new antigens due to modern agriculture hybridization, which creates a greater chance for a susceptible individual’s immune system to mount a maladaptive immune response⁴.
•             relatively new to the human diet, being introduced about 10,000 years ago at the birth of agriculture¹. 

Gluten Freedom by Alessio Fasano, MD

Alessio Fasano, MD and author of Gluten Freedom¹, is an international expert on celiac disease and gluten-related disorders. He is the founder of the Center for Celiac Research, located in Boston at Mass General Hospital for Children. He and his team discovered zonulin, a protein produced by the small intestine cells, which regulates intercellular permeability by regulating tight junctions (gated channels between cells)⁵. Its evolutionary, homeostatic purpose may be to enable the immune system to mount attacks on potentially harmful microbes or substances⁶. In individuals with genetic susceptibility to gluten-related disorders, zonulin is produced in excess and leads to impaired intestinal barrier function⁶. The constant flux of undigested proteins and antigens from the intestine into the bloodstream can increases the work load of the immune system and may increase risk for autoimmunity: conditions in which the immune system loses the ability to distinguish potential threat from self-cells, resulting in damage to self-cells in effort to destroy perceived threats⁷.

Celiac Disease

        

Celiac disease (CD) is a “genetic disorder affecting children and adults. People with celiac disease are unable to eat foods that contain gluten…. In people with celiac disease, gluten sets off an autoimmune reaction that can eventually lead to complete destruction for the villi, the tiny fingerlike projections lining the small intestine”⁸. Healthy villi increase the surface area of the small intestine and allow nutrient absorption. In CD, production of antibodies and cytokines (inflammatory chemicals) lead to the destruction and flattening of villi, which causes nutrient malabsorption and impaired intestinal barrier function. Celiac disease affects one in 133 people in the United States⁹. Common symptoms are malabsorption, including diarrhea, bloating, enamel loss, nausea, vomiting, anemia, osteoporosis, and tooth enamel defects⁸. Celiac disease is not food allergy; an individual may outgrow a food allergy; celiac disease is an autoimmune disease that requires a gluten-free diet for life⁸. CD is now known as a clinical chameleon, which means that it is difficult to diagnose and often manifests in various and atypical signs and symptoms, as reported in the following excerpt from Sheila Dean, RD, in The Integrative RDN newsletter¹⁰:

In a 2005 paper by Sanders and colleagues in the British Medical Journal, the authors state, “CD used to be perceived as involving gastrointestinal symptoms suggestive of malabsorption, but this manner of presentation is now described as the classic (typical) form.” ⁵Furthermore, the authors suggest that patients with CD may have the “silent” or atypical form – that is, without gastrointestinal symptoms — where the condition affects organs other than the small intestine, with manifestations such as altered thyroid function, skin abnormalities, bone disease, iron-deficiency anemia, and even neurological disorders, including depression, mood changes, migraines and inability to focus.⁵ As a result, one could potentially have CD but be free of the classic GI symptoms for years. More recently, the term “potential” or “latent” CD has been used to describe patients with sub-clinical pathology and other subtle immunological abnormalities, such as celiac-like mucosal immunoglobulin pattern and increased density of intra-epithelial T cells, suggesting a significant risk of developing CD later in life.

Researchers have found that undiagnosed CD (often associated with atypical CD) seems to have increased greatly in the US in the last 50 years, and that it is associated with a nearly 4-fold increased risk of death¹¹.  

Diagnosing Celiac Disease

Fasano says that “blood test panels can screen for presence of specific antibodies; a biopsy of the intestine (before beginning a gluten-free diet) is usually needed to make a final diagnosis⁸.

According to NIH¹²:

Genetic tests may be used to detect the genes that turn on the body’s immune response to gluten. Such tests can help rule out celiac disease, but they can’t be used for diagnoses; many people who have the genes never develop celiac disease. Your doctor can use a blood test to look for signs of celiac disease. Before the test, continue eating foods with gluten. Otherwise, the results may be negative for celiac disease even if you have it. Eating a regular diet can also help your doctor determine if you have a form of gluten sensitivity that is not celiac disease. Gluten sensitivity is something you may grow out of over time, Fasano explains, whereas celiac disease is a lifelong condition.

Genetic predisposition markers HLA DQ2/8 are positive in about 97% of cases of CD¹³. Many of the symptoms of gluten sensitivity are like celiac disease. They include tiredness, stomachaches, muscle cramps, and leg numbness¹⁴. 

Non-Celiac Gluten Sensitivity and Non-Celiac Wheat Sensitivity:

Gluten sensitivity, the new kid on the block in gluten-related disorders, is¹⁵:

•           as the word sensitivity suggests, a reaction to ingesting gluten-containing grains.
•           a condition producing a myriad of symptoms like celiac disease, though less severe.
•           a cause for many gastrointestinal and non-specific symptoms like “foggy mind” and joint pain.
•           not linked to the intestinal inflammation and flattening villi characteristic of celiac disease. 
•           not linked to the presence of tissue transglutaminae (tTG) autoantibodies, which are used in celiac disease diagnosis.
•          linked to an innate immune response; whereas, celiac disease is linked to an adaptive immune response.

The estimated percent of the American population that may be affected by gluten sensitivity is 6 percent¹⁶. The Celiac Disease Foundation (linked with Medline Plus’s summary of NCGS) states the following on non-celiac gluten sensitivity and non-celiac wheat sensitivity (NCWS)¹⁷:

         There is new research stating that those with non-celiac gluten sensitivity or non-celiac wheat sensitivity are more numerous than those with celiac disease. Sufferers experience a systemic immune response and intestinal cell damage to the level of compromising intestinal barrier function, which is often referred to as “leaky gut.”¹⁸ Measurement of certain antibodies may be used to diagnose NCGS. Sufferers may experience up to 200 symptoms shared with celiac disease including “foggy mind’, depression, ADHD-like behavior, abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain, and chronic fatigue when they have gluten in their diet, yet do not test positive for celiac disease.”

Experts are “not quite sure what genetic or immune mechanisms trigger this condition. [They] do know that the number of individuals with gluten sensitivity is exploding.”¹⁹ Concerning gluten-related disorders, Fasano says that the real experts are those who have navigated their way back to health with the gluten-free lifestyle. Diagnosis is made by an elimination diet followed by a challenge, which is the monitored re-introduction of gluten-containing foods to evaluate whether health improves with the decrease or exclusion of gluten from the diet¹.  

Non-celiac gluten sensitivity (NCGS) was “originally described in the 1980s and [is a] recently ‘re-discovered’ disorder characterized by intestinal and extra-intestinal symptoms related to the ingestion of gluten-containing food, in subjects that are not affected with either celiac disease (CD) or wheat allergy (WA)”.²⁰

The discussion on gluten gets more complex with the identification of “other plant proteins contained in wheat, such as lectins, agglutinins and amylase-trypsin inhibitors, [which] may have a role in the development of symptoms after the ingestion of cereals by triggering the innate immune response^[72-74]. For these reasons, and given the scattered data regarding the pathogenesis of NCGS, it has been suggested that the “non-celiac wheat sensitivity” definition may be more appropriate^[75,76]”²¹.

Even from a conventional AND viewpoint, gluten sensitivity has been identified as a real health condition that requires sufferers to identify what agrees with their own body’s, and to diligently seek solutions²²:

Because we don't know if there are long-term health consequences to continuous exposure [to gluten in NCGS], individuals with gluten sensitivity make their own decisions about what kind of gluten-free diet they wish to follow. Some choose to completely avoid gluten, while others may be more lenient in their efforts to avoid risk of cross-contact.

Linking Gluten-Related Disorders and Other Health Conditions

The prescription of a gluten-free diet (at least a temporary one) for health complaints typically not associated with gluten-related disorders is very popular in integrative and functional medicine. With consideration of the importance of maintaining gut barrier function for overall health, the premise that humans cannot digest gluten completely and that it may temporarily increases intestinal permeability in everyone, a gluten-free diet is a common intervention point for any health complaint in integrative and functional medicine. More specifically, adverse reactions to gluten are considered a contributing factor to Hashimoto’s (autoimmune thyroiditis). Support for this idea follows²³:·       

•          People with Hashimoto’s often present with food sensitivities (including that for wheat or gluten), which are revealed in elevated levels of certain IgG antibodies (food sensitivity testing).
•          By decreasing intake of IgG-reactive foods, IgG levels may decrease; IgG antibodies are thought to be the same types of antibodies that attack the thyroid gland in autoimmune disease.
•          The incidence of Hashimoto’s is higher in those with CD.
•          Surveys suggest that many with Hashimoto’s experience improvement in symptoms on a gluten-free diet.

Sheila Dean, RD, shares startling links between CD and other autoimmune conditions, as well as important points on the broader topic of autoimmunity¹⁰:

•       Autoimmune disease is grossly underdiagnosed and misunderstood: 72 million people in the US have an autoimmune disease—only 24 million are diagnosed.
•       Celiac disease is now recognized as a common autoimmune condition that may develop at any age and affect many organ systems.
•       The prevalence of CD in people with T1DM is 10-30 times that found in the general population.
•       Hashimoto’s disease and T1DM are the most frequently reported CD-associated conditions.
•       Early detection of atypical CD is important in prevention of T1DM due to their common genetic base, which is human leukocyte antigen (HLA).
•          Screening for atypical CD includes salivary tests for anti-gliadin antibodies (AGA) and tTG-Abs, and antibody serological assays including anti-emdomysial and anti-tissue transglutaminase tests.    

Wheat Allergy

Wheat allergy is different from celiac disease and non-celiac gluten sensitivity in that²⁴:

•        It triggers a different and usually more immediate immune response.
•        It is linked to overproduction of IgE antibodies; whereas, celiac disease is linked mainly to IgA autoantibodies; there is no increase in IgE antibodies or autoantibodies with food sensitivity.
•        It is 10 times less common than CD, occurring in only 0.1 to 0.3% of the US general population; it’s prevalence rate is more frequent in children at 3 to 5 percent.
•        Its reactions can include baker’s asthma, GI distress, itchy skin and hives, and fatal anaphylaxis
•        Diagnostic tests include skin prick tests, blood tests for specific antibodies, and elimination diets (with a food diary) and food challenges to reintroduce the food being tested.
•        People with life threatening food allergy must carry an emergency kit with injectable epinephrine.

Paleo (“Caveman”) Nutrition

The Paleo diet (aka the Caveman or Stone Age diet) is centered on the idea that humans evolved on a hunter-gatherer lifestyle that includes fruits, vegetables, nuts, seeds, and meat-- excluding grains (especially gluten-containing grains), legumes, and milk²⁵.  These exclusions are of the purist persuasions of “Paleoism”. There are modified Paleo diets that include moderate amounts of gluten-free grains, legumes, and milk. A proponent of Paleo may emphasize traditional preparation of grains and legumes (soaking, sprouting, and fermenting) to increase digestibility, and to lower gluten and anti-nutritional factors like lectins and phytates²⁶. A2 milk is popular in modified Paleo, which is milk from cows (Guernsey or Jersey breeds), goats, and sheep, which produce A2 casein, which some consider in line with ancestral nutrition and more compatible with human physiology than A1 casein-containing milk produced by Holstein cows²⁷. Validating the practices of Paleo nutrition is beyond the scope of this article. The purpose here is to highlight significant ideas in the health food industry, those that are promoted by the Paleo and gluten-free lifestyle community, and those that are accepted by many in integrative and functional dietetics. Many integrative and functional dietetics practices are based on the “n of 1” concept, or self-based research, which is relies heavily on elimination diets, food challenges, and subjective reports on signs and symptoms. This is popular due to the expenses and limitations of diagnostic testing, especially with poorly understood conditions like gluten sensitivity. This may also be in line with patient-centered care and empowering people to take initiative and responsibility for their own health.       

Conclusions

There is sufficient research to state that the number of people who may benefit from a gluten-free diet is greater than that diagnosed with celiac disease. Gluten sensitivity is poorly understood and has recently become a recognized medical condition that may require strict exclusion of gluten-containing foods like CD. Recent research has linked gluten-related disorders to other health conditions and diseases including T1DM, autoimmune thyroiditis, and a variety of non-specific symptoms like joint pain, fatigue, and “foggy mind.” Gluten is a peculiar protein that humans cannot digest completely, and one that my increase intestinal permeability (“leaky gut”) in healthy, non-celiac individuals. According to Alessio Fasano, however, gluten is like bacteria we encounter everyday: The immune system fights it and most do not lose the fight to gluten. Citing his book, Gluten Freedom, is appropriate here due to his status as the leader in celiac research. RDs and doctors in integrative and functional medicine continue to prescribe gluten-free diets as having potential to reduce symptoms of nearly any disease. A gluten-free diet poses financial and food preparation challenges. That said, it is not necessary to use gluten in making a highly palatable pizza, as shown in the recipe below. 

Gluten-Free Pizza 

Yield: 12 3.75’’x 3.33’’ square pieces                             Oven: 400˚F (375˚F in convection)  

Ingredients:

• Almond flour- ½ cup
• Garbanzo bean flour- ½ cup
• Arrowroot flour- ½ cup
• Ground flax seed- 2 Tbsp.
• Baking powder- ½ tsp.
• Olive oil- 1 Tbsp. + 1 tsp.
• Eggs - 2 large
• Shredded mozzarella- 1 cup, packed (5 oz.); dairy-free cheese may be used. 
• Water- ¼ cup
• Pizza sauce- ½ cup
• Parchment paper 

Directions:

1)      Preheat oven to 400˚F.

2)      Mix all dry ingredients: flours, flax seed, and baking powder). Add 1 ounce or ¼ cup shredded mozzarella. Mix well.

3)      Whisk eggs briefly. Add eggs, water and 1 Tbsp. olive oil to flour mixture. Mix well with whisk.

4)      Spread dough on parchment paper. Make a 14’’x10’’ rectangle. Moisten hands to keep it from sticking to hands. Dough will be approx. ¼’’ thick. 

5)      Spread pizza sauce evenly on dough.

6)      Bake for 12 minutes. Remove from oven and sprinkle remainder of mozzarella on pizza. Optional: add oregano to taste. Bake for additional 5 minutes to melt cheese.

7)      Cut pizza 3x4 for 12 pieces.  

Note: Reduce baking times in convection oven, even at 375˚F (try 8 minutes plus 3 minutes).

References

1. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 5,23. 

2. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 24.

3. Wagner O. Grains, brains and bellies review. The Integrative RDN. 2015; 17(3): 57.

4. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 28.

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

6. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 51-64. Zonulin’s function. 

7. Foroutan R. Zonulin: the gateway to leaky gut. The Integrative RDN. 2013; 16(1):1-4. 

8. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 7-8. 

9. Fasano A, Berti I, Gerarduzzi T, et al. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study. Arch Intern Med. 2003; 163(3):286-92. https://www.ncbi.nlm.nih.gov/pubmed/12578508?log$=activity. Accessed 12/10/17.

10. Dean S. The gluten connection: The relationship between celiac disease and type 1 diabetes. The Integrative RDN. 2011; 14(2): 25-29.

11. Rubio-Tapia A, Kyle RA, Kaplan EL, Johnson DR, Page W, Erdtmann F, Brantner TL, Kim WR, Phelps TK, Lahr BD, et al. Increased prevalence and mortality in undiagnosed celiac disease. Gastroenterology. 2009 Jul;137(1):88-93. https://www.ncbi.nlm.nih.gov/pubmed/19362553. Accessed 12/10/17. 

12. NIH. Going gluten free: necessary for some, optional for others. News In Health. 2016. https://newsinhealth.nih.gov/2016/05/going-gluten-free. Accessed 12/7/17. 

13. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 38. 

14. Medline Plus. Gluten sensitivity (summary). https://medlineplus.gov/glutensensitivity.html. Accessed 12/10/17. 

15. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 18.

16. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 36. 

17. Celiac Disease Foundation. Non-celiac wheat sensitivity. https://celiac.org/celiac-disease/understanding-celiac-disease-2/non-celiac-gluten-sensitivity-2/. Accessed 12/10/17.

18. Uhde M, Ajamian M, Caio G, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut. 2016 ;65(12):1930-1937. https://www.ncbi.nlm.nih.gov/pubmed/?term=Intestinal+cell+damage+and+systemic+immune+activation+in+individuals+reporting+sensitivity+to+wheat+in+the+absence+of+coeliac+disease. Accessed 12/10/17. 

19. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: xxxvii.

20. Catassi C, Bai JC, Bonaz B, et al. Non-celiac gluten sensitivity: the new frontier of gluten related disorders. Nutrients. 2013;5(10):3839-3853. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820047/. Accessed 12/10/17.

21. Elli L, Branchi F, Tomba C, et al. Diagnosis of gluten related disorders: Celiac disease, wheat allergy and non-celiac gluten sensitivity. World Journal of Gastroenterology: WJG. 2015;21(23):7110-7119. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4476872/. Accesses 12/10/17. 

22. Begus R. Food allergies, celiac disease and gluten sensitivity. http://www.eatright.org/resource/homefoodsafety/four-steps/separate/food-allergies-celiac-disease-and-gluten-sensitivity. Accessed 12/9/17. 

23. Wentz I. Supporting a patient with hashimoto’s thyroiditis through nutrition. The Integrative RDN. 2015;18(2):29-38. 

24. Fasano A, Flaherty S. Gluten Freedom. Nashville, TN: Wiley; 2014: 44. 

25. Kohn J. Should we eat like our caveman ancestors? http://www.eatright.org/resource/health/weight-loss/fad-diets/should-we-eat-like-our-caveman-ancestors. Accessed 12/10/17. 

26. Zastawny J. The microbiome and fermented foods. Wholesome Joe (blog). http://wholesomejoe.blogspot.com/2016/12/the-microbiome-role-of-microorganismsin.html.

27. Brooke-Taylor S, Dwyer K, Woodford K, Kost N. Systematic Review of the Gastrointestinal Effects of A1 Compared with A2 β-Casein. Adv Nutr. 2017 Sep 15;8(5):739-748. https://www.ncbi.nlm.nih.gov/pubmed/28916574. Accessed 12/10/17. 

28. Brigid T. 5 reasons to try a paleo challenge. Being Brigid (blog).  https://beingbrigid.com/5-reasons-to-try-a-paleo-challenge.

Compost: Closing the gap between kitchen and farm

What is Compost?

Compost links what we eat at the table back to the farm and soil. Composting is basically recycling natural materials. I think composting makes the earth a better place, and that's the purpose of this post! Compost is decomposed plant and animal materials including leaves, grass clippings, kitchen waste, straw, wood chips, manure, etc. These things are also called organic matter. Compost is a great soil fixer because it makes soil fertile and absorbs water well. It revives the nutrient and microbial balance of soil. There's something like a million microorganisms on a pinhead of soil. In other words, soil is alive. Compost is essential for a garden, especially when starting out.

 

Bin of kitchen waste for composting
 and worm composting

It all starts with gathering compost ingredients. It's like any food recipe. The key to a good compost pile is having a variety of ingredients and a good balance between green materials and drier, brown materials. This keeps the balance between moisture and air. A pile that's too wet will be a stinky mess that can harm your garden. A pile that's too dry will take long to make compost. It's nice to gather enough material to make a pile that's at least 3 cubic feet. That means 3 feet high, 3 feet wide, and 3 feet tall. With a pile that big, hot composting will occur. That means that the activity of bacteria will be so great that the pile may reach 140°F in a few days, and then decrease gradually. This is the fastest composting method and takes about 3 months. 

In cold composting, piles are either made too gradually or are not large enough to keep heat produced by bacteria that break down organic matter. In this method, compost may take a year. You know you have compost when the materials are broken down to the point of being unrecognizable from their original state. Good compost has a pleasant, earthy aroma. It's actually invigorating. Composting is generally neglected in conventional farming and is a pillar of organic and natural farming. It's used to reduce soil compaction and improve water absorption and nutrient balance. It helps reduce pH issues too, which means that it makes extremes in acidity or alkalinity of your soil not matter as much. Here's some of my favorite things about composting: 

• Toxins including certain pesticides are broken down or made less harmful in composting.
• Pathogens (disease causing microbes) and weed seeds are destroyed in hot composting and worm composting .
• Compost supports variety and balance of soil organisms  (bacteria, fungi, insects and worms) and reduces need for pesticides.
• Seed starting mix with worm compost showed a dramatic increase in seed germination, plant growth and resistance to diseases and pests compared to mixes without. Worm compost tea has similar benefits.
• Compost helps reduce lead contamination, which is common in urban lots.

Compost Ingredients

Fresh grass clippings, dry clippings and wood chips

Gather compost ingredients including kitchen waste, grass clippings, leaves, straw, manure, etc.  Grass clippings from lawns treated with commercial weed or insect killers can impair plant growth. Certain chemicals in weed killers, such as clopyralid, persist in soil for years and resist break down in composting. Spreading fresh grass clippings out to dry in the sun  allows you to use them as brown matter. Layer fresh grass clippings and other moist matter thinly in your pile to maintain air flow. Chop leaves with a mower to decrease matting. Cooked food, meats, and oils may invite rats and raccoons. Kitchen waste for the pile includes banana peels, citrus peels, apple cores, coffee grounds and filters, egg shells, and any uncooked stalks, stems, etc. Breaking up tough things like broccoli stalks with the back of an axe or hammer helps them compost quicker. Cover food scraps with leaves or dry grass clippings to keep flies and smells down.  

Schwebel, my Shih Tzu, on dry grass clippings

Balance your pile by mixing moist green things and food scraps with dry, brown materials until moisture of your pile is like a wrung out sponge. Some recommend repeating 6 inches of brown material and 2 inches of green material until you reach 3 feet high. I really don't follow a recipe that closely. I just keep the wrung out sponge idea in mind. Just get out there and learn by doing.

Adding dog and cat waste isn't recommended because it may spread bad germs. Although turning a pile isn't absolutely needed, turning occasionally (every 3-6 weeks) will quicken the process. If the pile is dry while turning, water or add green matter. If it's wet and smells of ammonia or sulfur, add dry matter. Placing your pile under a tree will help keep it from getting too wet, or from drying out in the sun. I cover my pile with a tarp to keep it in the sweet spot.    


Finished Compost, Bins, and Use

Join your pallets with screws
and 2x4s or Cerro wire

Compost bins promote even decomposition and help block pests and dogs. Wooden pallets screwed together or tied with Cerro wire works for me. Applying a 3-inch layer of compost is good for initial garden establishment. Follow with 1-2 inches of compost annually or after each crop. More compost than this may lead to an excess in phosphorus. A 2-inch layer of compost is enough for the nutrient needs of most crops, though additional nitrogen may be needed. Yellow leaves are a sign of nitrogen lack. Natural, organic sources of nitrogen include alfalfa meal, blood meal, fish emulsion, poultry manure, and compost tea. When I transplant seedlings, I usually use a small handful of balanced organic fertilizer or a shot of fish emulsion for each plant. You can get them at garden centers.   

3ft x 3ft x 3ft and ready for hot composting

Take Home Message

Compost is a great soil conditioner. It's good for the environment, helps reduce what we send to landfills, and connects us with the land. It reduces need for synthetic farm chemicals and pesticides. It's a great learning activity for all ages. Do your part in promoting health by composting your kitchen and yard waste.





Be Wholesome!
Joe Zastawny 

Wholesome buckwheat black bean brownies

Finding ways to eat healthy

You've probably been bombarded with foods that don't support optimal health this holiday season. The purpose of this post is to share that you don't have to forfeit your healthy goals in order to connect and feast with people. These buckwheat black bean brownies are rich and moist, gluten- and casein free, and very rich in vitamins, minerals, fiber and plant chemicals that support overall health. I was careful to keep added sugars low and use to natural, minimally processed ingredients for sweetness. I also aimed to make this somewhat paleo-friendly. These brownies are low in sugar and low glycemic compared to a few other holistic and hip black bean brownie recipes out there.

Why these ingredients?

Black beans are high in fiber and antioxidants and lower in lectins than larger beans, which is appealing to the paleo-minded. Lectins have a reputation for irritating the gut and promoting digestive distress. Canned food is frowned upon by the health conscious, but in the case of beans, the high heat of the canning process my be beneficial in that it lowers lectins. Soaking, sprouting and fermenting are other ways to reduce the anti-nutritional and potentially gut irritating chemicals in beans and grains. I think sprouting deserves some attention.

Buckwheat is gluten free, promoted by some paleo doctors, and a real nutritional powerhouse. It's a good source of fiber, magnesium, manganese, copper, phosphorus, and antioxidants. The fiber in buckwheat supports healthy cholesterol levels and is prebiotic, which means that it stimulates the growth of health promoting bacteria in the colon. That means support for healthy metabolism and a multitude of benefits. Buckwheat contains the phytonutrients (plant nutrients) rutin and quercetin. Rutin protects cholesterol from damage, reduces inflammation, supports healthy blood pressure, and binds to heavy metals. Quercetin is known for its anti-inflammatory effect.

Cooked buckwheat. Good in
salads, soups, and stews too

Buckwheat is gluten free, not related to wheat, and is named a pseudograin, like quinoa. It's very easy to cook: Simmer 1 cup of buckwheat groats in 2 cups of water for 15 minutes. Eating carbs like buckwheat with protein and healthy fats helps lower their blood sugar and insulin spiking effect. The idea here is to keep your blood sugar and insulin levels moderate and steady for overall health. This recipe has that.

Honey contains antioxidants, vitamins, minerals, and prebiotic fiber. There's a whole DIFM webinar on the benefits of honey.  It's very sweet so "a little dab'll do ya". You could substitute dates, figs, organic sugar, maple syrup, or bananas for honey. I like the idea of using bananas instead of sugar to reduce empty calories.

Eggs bind these ingredients together. They are a cheap and good source of protein and very nutrient-rich. The science on whether the cholesterol you eat increases your risk for heart disease has changed recently and is debated. According to the 2015 Dietary Guidelines:

The Key Recommendation from the 2010 Dietary Guidelines to limit consumption of dietary cholesterol to 300 mg per day is not included in the 2015 edition, but this change does not suggest that dietary cholesterol is no longer important to consider when building healthy eating patterns. As recommended by the IOM,^[24] individuals should eat as little dietary cholesterol as possible while consuming a healthy eating pattern.

I'm of the persuasion that organic, pasture-raised eggs are wholesome and part of a balanced diet. Many holistic health experts say that heart health is more about reducing both sugar and high glycemic food and less about any restriction on cholesterol and saturated fat. There's a lot of bickering on this. Let's just eat real, natural food and get on with our lives. But this isn't medical advice.

Ghee is butter minus casein proteins and lactose, though some brands may have traces of casein. It adds the traditional richness of butter to baking recipes and is full of healthy fats when derived from pasture-raised cattle. It has a high smoke point, so it's tolerant to heat. It's even stable in medium to high heat pan frying. There are doctors and dietitians who say that saturated fats like ghee, butter, and coconut oil are wholesome, natural food and are good when balanced within a diet rich in vegetables, fruits, nuts, seeds, legumes, whole grains and pasture-raised meat. This info really goes against the vilification of saturated fat and cholesterol we've been taught for the past 50 years or so.

Puree buckwheat too

Ingredients

• black beans - 1 can rinsed and drained
• cooked buckwheat groats - 1 cup
• 3 eggs (I prefer organic, pasture-raised)
• organic ghee (clarified butter) or butter - 2 tbsp
• coconut oil - 2 tbsp
• cacao powder - 1/4 cup
• ground flax seed - 1 heaping tbsp (grind with whole flaxseeds in a coffee grinder)
• 1 banana
• honey, maple syrup or organic sugar - 2 tbsp
• sea salt - 1/2 tsp

Frosting (optional but allows you to add sweetness if necessary)

• coconut oil - 2 tbsp
• ground flaxseed - 2 tbsp
• vanilla extract - 1/4 tsp
• sweetened to taste with your choice of sweetener: stevia, sugar, honey, etc.
• water - 1 tbsp

Nice and dense. Even better when they cool.

Steps

1. Preheat oven to 325.
2. Puree all brownie ingredients in a food processor or blender.
3. Pour brownie batter into a 9x13 pan lined with parchment paper, or grease the pan with coconut oil, ghee or butter. I used a pyrex pan. Stainless is good.  
4. Bake for 40 minutes or until a toothpick comes out clean.
5. Let brownies rest at room temperature for 10 minutes. 
6. Frosting: cream all ingredients together with a fork and spread onto brownies with a rubber spatula. 

I think these are going to displace some of the 2.50-$3.00 nutrition bars I've been eating. They're great on the go.

Be wholesome!
Joe Zastawny

The microbiome and fermented foods

The microbiome

The role of microorganisms in supporting the health of humans, livestock and ecosystems is among the hottest health science topics. Special attention has been given to the human microbiome, which is the sum of the bacteria, yeasts and molds that live in and on the human body.¹ The microbiome is 100 trillion microbes, which is 10-times more than all human cells.² The gut microbiome is considered to have a profound influence on immunity, cognition, nutritional status, and general health. It influences health so much that it's best described as an "externalized organ".³

The purpose of this post is to explore the potential benefits of traditional fermented foods in supporting a healthy microbiome. This reflects a health approach that emphasizes harmony with nature and microbes as opposed to today's overly sanitized and germophobic society. Research states that modern, city lifestyles mean lower exposure to beneficial microbes, low microbiome diversity, greater immune dysregulation, and increases in inflammatory and allergic disorders.⁴ The idea is that a healthy microbiome makes a healthy gut and that a healthy gut makes you resistant to chronic and infectious disease. This perspective focuses on influences of food, medicine (especially antibiotics), toxicants, the environment, and even stress and psychological factors on the microbiome and overall health.   

$3 kraut with eggs, avocado, 
and cooled sweet potatoes

Benefits of fermentation

Culture, culinary art, biology and medicine intersect at traditional fermented food. Traditional fermentation employs bacteria, yeast and fungi in converting carbohydrates into acids and alcohols.² Also, a food that has been processed with bacteria, yeast, or mold (or their enzymes) for preservation, safety, palatability, appearance or nutrition is fermented.⁵ This is different from putrefaction, which involves protein breakdown and production of off odors.² Fermentation is the oldest food biotechnology.⁵ It is low-energy and essential where other food processing technologies such as canning and freezing are not available. The benefits of this time-tested technology include the following:^2,5,6 

• Reduction in anti-nutrients including protease inhibitors and lectins in legumes and phytates in cereal grains.
• Cruciferous vegetables are considered healthy, though they contain naturally occurring toxic compounds and goitrogens that may lower thyroid function when consumed in excess.  Crucifers include broccoli, cabbage, collard greens, kale, radishes, and watercress. In fermentation these potentially harmful chemicals are converted into cancer fighting  and liver detoxification supporting chemicals (i.e., isothiocyanates, indole-3-carbinol, and sulforaphane)
• Soybean isoflavones are changed into antioxidant glycones, which may help reduce hypertension, cardiovascular disease, and cancer.
• Increase of B vitamins (bioenrichment) and stabilization of vitamin C.

The buzz about fermented foods has a lot to do with the beneficial bacteria found in them. These bacteria are considered probiotic, which means "life promoting". Pasteurized and canned fermented foods are not probiotic because probiotics are killed in high heat processing. Fermented foods may be the best way to get probiotics considering that they can be made cheaply and provide vitamins, minerals, antioxidants, and fiber.⁷ Making them can be fun and educational too.

As with many nutrition topics, there is debate over the healthiness of fermented foods for certain health conditions. For example, some holistic health experts advise patients with gut candidiasis (yeast overgrowth) to avoid fermented foods.⁸ Still, others recommend at least a couple servings of fermented veggies daily, stating that they generally improve gut health and reduce inflammation. I say that you may have to start slow and pay attention to how your digestion responds. Whether increasing exercise, fiber, or fermented foods, you may experience temporary discomfort followed by a benefit. It's up to you. This isn't medical advice.

Fermented vegetables
 

Make kraut with onions, garlic, carrots,
 beets, curry, or peppers. Be creative. 

Sauerkraut is a German word for sour cabbage. Interestingly, history credits China as the birthplace of fermented cabbage-- and it took about 1000 years before it arrived in Europe with Mongolian ruler Genghis Khan.⁹ The fermentation method described here, the sauerkraut method, may be used with any suitable raw vegetable: carrots, radishes, cauliflower, turnips, onions, garlic, etc. The method utilizes lactic acid bacteria (LAB) found naturally on the surface of vegetables. LAB consume sugars and produce lactic acid to prevent growth of bad bacteria.¹⁰ Fermentation methods are as diverse as the world's cultures.

The sauerkraut method is simple, though you have to pay attention to salt concentration, temperature, moisture, and fermentation vessel. Rinse cabbage and remove outermost leaves. Use a knife, box grater, food processor or mandolin to cut into 1/4 inch strips. Place shredded cabbage in a container with salt and pound or massage to release sugars and nutrients essential to LAB.

A 2% by weight salt concentration is recommended in sauerkraut production.¹¹ That's about 2-3 teaspoons of sea salt per 1 quart jar of shredded vegetables, which is basically salt to taste. It is important to press out air pockets when packing vegetables into fermentation vessels and to keep them submerged to inhibit growth of aerobic (air-loving) spoilage microbes including mold. Leave a little head space for expansion. If using a plain mason jar, you'll have to open it to relieve pressure. Fermentation is complete in 1 to 4 weeks,¹¹ though there are recipes that call for only 3 to 7 days of fermentation.

Another salting method is dry salting. Use 2-3% salt by weight . A 1-inch layer of shredded vegetables and part of the salt is applied; this layering continues until the container is three quarters full.¹¹ The vegetables are covered with plastic and compressed with weights to promote brine (salt water) formation. Fermentation starts as soon as brine forms and is evidenced by bubbling, which is CO2. Most LAB work best at 64 to 72°F.¹¹ Lower temperatures slow fermentation and higher temperatures can cause spoilage. Room temperature is fine in my experience.

Sea salt, pickling salt, and kosher salt are recommended due to their purity and absence of additives. Impurities and additives including non-caking material, iodine, lime, iron and magnesium cause problems; don't use common table salt.²

Common fermentation vessels for the home scale include mason jars, ceramic crocks with moats, and proprietary anaerobic (no oxygen) fermentation vessels with air-locks. Crocks with moats or air-lock lids let CO2 out and don't let oxygen in. There are special mason jar lids that do this too.

Fermentation crock

There is debate on whether an anaerobic vessel is necessary. Some say you'll get a moldy product without an anaerobic vessel, even though the mold may not be apparent-- others say they aren't necessary and a plain mason jar is fine. I've made kraut with a plain mason jar and it was tasty, though I don't have lab testing to confirm it was optimal. Also, the lid I used might have contained the toxin BPA, which I aim to avoid. Good news is that probiotics in ferments may help us detoxify BPA. Mercola.com has an interesting mason jar lid. Ceramic crocks make sense if you're that committed.

Unfortunately, government and academic information on traditional fermentation is rare or zero. For example, the Michigan State University Extension says that "for many popular products there are not yet any science-based guidelines for safe production. For this reason ... [they recommend] trying recipes outlined by reliable sources such as the USDA, the National Center for Home Food Preservation and University of Wisconsin Extension".¹² But even these leads require high heat processing and canning, which destroy probiotics. So, the public must either search high and low to develop research-based recipes, or trust the safety of non-scholarly sources.

In conclusion, I think it's reasonable to (1) shred cabbage or other vegetables; (2) salt to taste and pound briefly with a potato masher or massage to expel juices;(3) seal in a glass jar, leave at room temperature for days or weeks, and relieve pressure as needed; (4) refrigerate and enjoy your fermented food for weeks or months. It's pretty simple. 

Be wholesome,
Joe Zastawny 


References

1. Blaser M. The microbiome revolution. Journal Of Clinical Investigation [serial online]. October 2014;124(10):4162-4165 4p. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed April 19, 2016.

2. Battcock M, Azam Ali S. Fermented Fruits and Vegetables: A Global Perspective. Rome, Italy: Food and Agriculture Organization of the United Nations; 1998:1-6.
3. Lu K, Mahbub R, Fox J. Xenobiotics: Interaction with the Intestinal Microflora. ILAR Journal /National Research Council, Institute Of Laboratory Animal Resources [serial online]. 2015;56(2):218-227. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed April 19, 2016.
4. Thornton C, Macfarlane T, Holt P. The Hygiene Hypothesis Revisited: Role of Materno-Fetal Interactions. Current Allergy & Asthma Reports [serial online]. November 2010;10(6):444-452. Available from: Food Science Source, Ipswich, MA. Accessed April 23, 2016.
5. Nout R, Sarkar P, Beuchat L. Indigenous fermented foods. In Doyle M, Beuchat L, eds. FoodMicrobiology: Fundamentals and Frontier. 3rd ed. Washington DC: ASM Press; 2007:817-835.
6. Tolonen M, Taipale M, Viander B, Pihlava J, Korhonen H, Ryhanen E. Plant-derived biomolecules in fermented cabbage. Journal Of Agricultural And Food Chemistry [serial online]. n.d.;50(23):6798-6803. Available from: Science.
7. Meyer M, Romotsky S. Going with your gut. The Integrative RDN. 2014;17(2):25-26.
8. Myers A. 10 signs you have candida overgrowth & how to eliminate it. Amy Myers MD website. http://www.amymyersmd.com/2015/11/10-signs-you-have-candida-overgrowth-and-what-to-doabout-it. November 6, 2015. Accessed April 30, 2016.  
9. Haas S. Fermented &flavorful Sauerkraut: Natural fermentation adds goof-for-you bacteria tosome of your favorite foods. Food & Nutrition; July/August, 2015:26-27.  
10. Breidt F, McFeeters, Diaz-Muniz I. Fermented vegetables. In Doyle M, Beuchat L, eds. Food Microbiology: Fundamentals and Frontier. 3rd ed. Washington DC: ASM Press; 2007:783-793.
11. Battcock M, Azam Ali S. Fermented Fruits and Vegetables: A Global Perspective. Rome, Italy:Food and Agriculture Organization of the United Nations; 1998:43-56. Cowan MK, Microbiology: A Systems Approach. 4th ed. New York, NY: McGraw-Hill; 2015:396,458.
12. Jarvie, M. Interested in making your own fermented foods? Michigan State University Extension.April 3, 2014. http://msue.anr.msu.edu/news/interested_in_making_your_own_home_fermented_foods. Accessed April 23, 2016.