5/17/2017 Dose Dose 7AM 300 kcal ED 9AM 300kcal ED 11AM 300 kcal ED RX=1800 kcal/day 1PM 450 kcal LUNCH 5PM 450 kcal DINNER } 50% } 50% Kcal Elemental Diet AM Kcal Whole Food PM Limited evidence for greater efficacy at 1200+ kcal/day Remaining calories from whole food ”Half or “Partial” Elemental Diet 8AM 450 kcal BREAKFAST 12PM 450 kcal LUNCH } 2PM 300 kcal ED 4PM 300 kcal ED 6PM 300 kcal ED 5PM 450 kcal ED } RX=1800 kcal/day 50% Kcal Whole Food PM 50% Kcal Elemental Diet AM Limited evidence for greater efficacy at 1200+ kcal/day Remaining calories from whole food ”Half or “Partial” Elemental Diet Duration PARQ* Published recommended duration has not been established. Continuous, intermittent, periodic, or pulsed use can be considered in each case. Remaining calories from whole food ”Half or “Partial” Elemental Diet Exclusive Elemental Diet Strengths and limitations Slow Feeding Hydration Cautions and warnings about typical problems Remaining calories from whole food ”Half or “Partial” Elemental Diet *Procedures, Alternatives, Risks, Questions The Six Elemental Steps Weekly Follow-ups ✓ ✓✓✓ • Weekly follow-up for at least four weeks, or until stability achieved. • Track progress symptomatically and run periodic labs to monitor nutritional stability, and inflammation (SED, CRP, CALPROTECTIN, LACTOFERRIN) • Prepare patient for transition to whole food strategy • Manage medications, coordinate care, and address elemental obstacles. © 2017 Gary Weiner, N.D., L.Ac. 36 11
5/17/2017 Address elemental obstacles The Six Elemental Steps TIP: find flavored products with Natural, hypoallergenic ingredients TIP: dilute TIP: blend with ice Taste TIP: Plan on weight loss first week pf EED Weight Loss TIP: Avoid EED with very low BMI’s Weight Loss TIP: Adequate hydration and slow Hunger feeding ✓ ✓✓✓✓ TIP: lemon, lime, sat, vanilla TIP: Treat with prior or concomitant anti-fungals Fungal Ailments Elemental Obstacles Osmotic Diarrhea Fatigue TIP: Additional blood sugar and adrenal support TIP: monitor/treat anemia TIP: monitor deficiencies; Supplement IV and IM prn © 2017 Gary Weiner, N.D., L.Ac. TIP: Adequate hydration and sow feeding © 2017 Gary Weiner, N.D., L.Ac. Step 5 – Reintroduction of Whole Food Step 5 – Reintroduction of Whole Food Elemental diet is as effective in producing [E}xclusion diet allowed 51 out of 77 patients to remission of Crohn’s disease (CD) as is remain well on diet alone for periods of up to corticosteroid treatment, but most patients 55 months, and with an anual relapse rate of relapse soon after resumption of a normal less than 10% ( Lancet. 1985 Jul 27;2(8448):177-80) diet. (Lancet. 1985 Jul 27;2(8448):177-80) Dynamic & Flexible Specific Carbohydrates Hypoallergenic Antiinflammatory Fats Specific Exclusion Fiber & Residue Techniques Considerations Texture Modifications © 2017 Gary Weiner, N.D., L.Ac. © 2017 Gary Weiner, N.D., L.Ac. Specific Carbohydrate Diet (SCD) Sidney Haas, MD Used it to treat celiac Disease in 1930s Elaine Gotshall Popularized SCD in popular book Removes all grains milk products except for yoghurt fermented greater than 24 hours Sugars except honey d Fruits Dairy/Beans Meat, Vegetables Fish Legal Juice or Gelatin Only Grape Juice (100%) Apple Ciider 100% Peeled, deseeded & well cooked Carrot(cooked for 4 hours and pureed for moderate to severe symptoms) ` Roasted, Boiled or Broiled: Fish, chicken, beef, turkey, lean pork, lean game meats (no ham or bacon), Eggs INTRO PHASE 1 PHASE 2 PHASE 3 PHASE 4 any style (keep fats to minimum because hard to digest) Peeled, deseeded, well cooked, pureed homemade applesauce, homemade pear sauce. Raw Banana (very ripe) Peeled, deseeded & well cooked (pureed) Acorn squash, butternut squash, spinach, zucchini (and other summer squash) Roasted, Boiled, or Broiled Eggs any style (keep fats to minimum because hard to digest) 24-hour : yoghurt SCD, homemade yoghurt Peeled, deseeded, Peeled & cooked Raw & Peeled Raw Apple, apricot, avocado, Blueberry, boysenberry, Apple, blueberry, blackberry, well cooked cantaloupe, cherry, date, blackberry, cantaloupe, cherry, date, elderberry, fig, Apricot, avocado (cooked), elderberry, fig, gooseberry, cherry, cranberry, date, gooseberry, grapes, olive, peach, pineapple, plum, grapefruit, grapes, kiwi fruit, elderberry, fig, gooseberry, peach, pear, persimmon, plum, tomato kumquat, lemon, lime, mango, grapefruit, kiwi, kumquat, raisin, raspberry, strawberry, orange, papaya, passion fruit, tomato lemon, lime, loganberry, Raw peach, pear, persimmon, mango, orange, papaya, pineapple, pomegranate, plum, Dried passion fruit, rhubarb, tangerine, tomato, watermelon Avocado raspberry, strawberry, Sparingly, with caution tangerine, watermelon Peeled, Cooked Raw deseeded, well Beet., cauliflower, celeriac, celery, Chinese cabbage, Beet., cauliflower, celeriac, celery, Chinese cabbage, collard, cooked pureed collard, cucum Bok choy, cucum Bok choy, broccoli, cabbage, carrober, daikon radish, broccoli, cabbage, carrober, kale, leek, lettuce, mushroom, olive, onion, peppers, radish, daikon radish, kale, leek, rhubarb, shallots, snow peas, sugar snaps peas, spinach, Swiss Artichoke, asparagus, cucumber, lettuce, mushroom, olive, onion, chard, watercress garlic, green beans, mushrooms, peppers, radish, rhubarb, peppers, pumpkin and other shallots, snow peas, sugar snaps winter squash (no spagetti squash) peas, spinach, Swiss chard, watercress watercress Pan Fried: crisp-fried Battered/Deep-fried Baked Dried Jerky pork or “legal” bacon can be added Nut Milk Blanched cashew, hazelnut, macadamia nut Nut Butter Pecan, blanched almond Eggs any style (keep fats to minimum because hard to digest) Nut Flour Pecan, blanched almond, hazelnut Nut Butter Blanched cashew, hazelnut, macadamia Eggs any style (keep fats to minimum because hard to digest) Nut Flour Blanched hazelnut, cashew, macadamia nut, walnut, , Nut Pieces Blanched almond, pecan, shredded coconut No peanuts! Beans Cooked (prepared according toBTVC): Haricot beans, Lentils, Lima beans, Navy beans, Split peas PHASE 5 Whole Nuts (chew well!) Blanched hazelnut, cashew, macadamia nut, walnut, , Beans Cooked (prepared according to BTVC): Black beans, Kidney beans , , , , 37 12
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