Meal Replacements and Oral Nutrition Supplements

Sometimes eating sucks. When my body hurts, I'm tired, and my gut is bloated, the last thing I usually want to do is add fuel to the fire by eating a meal. This is an unfortunate situation to be in because eating is one of those things we kind of have to do to survive. Luckily, there is a way to meet our needs without really eating. Enter the oral nutrition supplement. Calorie dense nutrition shakes designed to give you all the vitamins and minerals you need for livin’ in as little volume as possible. You can down one of these bad boys in under a minute and not have to worry about figuring out how you might fit an entire meal in your distended abdomen.

There are a lot of different nutrition supplements on the market, and it can be difficult to try to figure out which to buy. There are so many factors to consider, it can almost be overwhelming. In this article, I have tackled a few of the more common factors people consider when looking for supplements. Hopefully I have been able to provide some clarification on the differences between some of the common choices for meal replacement shakes.

Calories

The amount of calories I look for in one of these supplements depends on why I am using it in the first place. Am I trying to replace a meal? Then I would probably reach for something with a higher amount of calories. I usually try for at least 250 calories per shake, but closer to 500 calories is probably better. If I am using the shake to replace a snack, maybe 200-300 calories would be more desirable. 

Some nutrition supplements come as a powder that you can mix with water or another liquid. The benefit of these supplements is that you can add as much powder as you want and customize the amount of calories to the situation. Products like Modulen IBD, Huel, Garden of Life Raw Organic Meal Shake, and Super Fuel all come as mixable powders. Garden of Life is one of the lowest calorie options I have seen, coming in at 120 calories per serving. 

Most ready to drink supplements also have higher calorie options available. Ensure and Boost both make higher calorie versions of their regular nutrition shakes. You can usually tell a higher calorie shake because it will have the word “plus” in the name, i.e. Ensure Plus or Boost Plus. The big downside of these higher calorie versions is that a lot of the extra calories come in the form of sugar.

Fat

Fat is a tricky one. Often demonized, fat plays an important role as a source of energy, absorption of certain fat soluble vitamins, and managing inflammation. Certain fats are even essential, which means that we must get them from our diet. The type of fat in nutrition supplements matters. In most supplements, the fat content will be from vegetable oils. Animal fats are unusual or minimally used due to their tendency to be solid at room temperature.

Certain fats in vegetable oil, such as the Omega 6 fatty acids, are sometimes mis-labeled as pro-inflammatory. While these fats can be used by the body to create inflammatory molecules, research has shown that omega-6 fats are associated with lower or unchanged markers of inflammation. If you are somebody who is concerned about these fats, choose a supplement higher in monounsaturated fats such as Orgain or Huel. Looking for the words “high oleic” in the ingredients list is a good way to know that the oil used is high in monounsaturated fats. One supplement, Super Fuel, actually lets you add the fat to your shake yourself, so you can choose the exact type of fat you want!

Carbohydrates

There are a lot of considerations when looking at the carbohydrates in nutrition supplements. Some of the important things in my opinion are the sugar content, presence of artificial sweeteners, presence of maltodextrin, and fiber.

Sugar is an interesting one. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) says in their guidelines that there is insufficient evidence to recommend any specific change of intake of complex carbohydrates or refined carbohydrates or refined sugars and fructose. Therefore, any reason to limit sugar would have to be based on the known effects of high sugar consumption on heart health, gut health, weight gain, and other markers of health. Many of these supplements are high in added sugars, so it might be prudent to look for some of the lower sugar options such as Super Fuel, Huel, Orgain, or Garden of Life.

Some supplements contain ingredients that might be harmful in IBD patients. Specifically, maltodextrin and artificial sweeteners. Some of the low sugar supplements, such as Premier Protein, use artificial sweeteners like sucralose to replace sugar as a source of sweetness. Most supplements found in stores, including Ensure, Boost, and store brands such as Equate contain maltodextrin as a source of carbohydrates. In the IOIBD guidelines, the researchers note that it may be prudent to limit intake of both maltodextrin and artificial sweeteners. The authors also note, however, that the evidence for maltodextrin is theoretical and mostly based on animal models. Nutritional therapies that involve consuming nutrition supplements with maltodextrin have been found to be effective in IBD, so the jury is still out on maltodextrin.

Fiber is also a hot topic in IBD. Many foods considered healthy contain fiber, but many IBD patients who are flaring consider fiber to be something that aggravates their disease. Many of these supplements contain very small amounts of fiber, usually between 1-2 grams per serving. Some supplements, such as Huel, Kate Farms, and Super Fuel contain a higher amount of fiber. The general consensus from what I have researched appears to be that if you tolerate fiber, more is better. Like many other factors in IBD, fiber seems to be something to consider on an individual basis. Of note, Walmart’s brand Equate was the only supplement I looked at that had 0 grams of fiber per serving.

One thing to note is that some supplements include blends of fruits, vegetables, and other plant compounds. Orgain, Garden of Life, and Kate Farms all include these special blends, likely to try to mimic the benefits of eating whole foods. Other supplements, such as Huel and Super Fuel are made primarily from whole foods.

Protein

The protein needs of an IBD patient are increased during a flare. Protein is needed to help repair damaged tissue and maintain muscle mass, among many other functions. I think it is important to make sure that the nutrition supplement you choose has the protein your body needs to function optimally.

Most supplements have enough protein to meet your body's needs. A little trick I use is to try to shoot for 20% of calories from protein. You might need to whip up your phone calculator in the store, but the math isn’t too hard. First you would take the grams of protein and multiply it by 4, because there are 4 calories in every gram of protein. Then, all you need to do is divide the number of calories of protein by the total calories and multiply by 100 to get the percent!

Let's do an example with Orgain’s Nutritional Shake:

Looking at the bottom, we see Orgain has 16 grams of protein per serving.
Step one would be to multiply 16g by 4 to get the number of calories, which would be 64 calories of protein.

Step two, would be to divide the number of protein calories by the number of calories in a serving, which can be seen at the top of the nutrition facts label.

We would do 64 calories divided by 250 calories and get 0.256.

The final step, to get a percentage, would be to multiply by 100 to make that number a percentage. So, .256 multiplied by 100 is 25.6%. 

25.6% is more than 20%, so Orgain would pass my little test!

Some of the higher protein supplements out there are Huel, Ensure Enlive, and Premier Protein, and Garden of Life. It is important to note that if you aren’t in a flare, your protein needs are likely no higher than the rest of the population. 

Carrageenan

Carrageenan is an emulsifier used to help the ingredients in shakes mix smoothly. It has also been shown to cause a variety of negative effects in animal models, such as increased blood in stool, increased inflammatory markers, and lesions in the bowel. For these reasons, and some small scale human research, IOIBD also states that it may be prudent to reduce intake of processed foods that contain carrageenan in both UC and Crohn’s Disease. Most of the supplements found in stores, such as Ensure, Boost, and store brands such as Equate use carrageenan in their nutrition supplements. If carrageenan is something you wish to avoid, you can usually locate it at the bottom of the ingredients list. You can see it is the last ingredient in Ensure Plus.

To Conclude

I wish I could add more detail, but I don’t want to break your scroll wheel. The most important thing to do when looking for an oral nutrition supplement is to take a look at the nutrition facts label and make sure you are comfortable with the nutrition content and ingredients in your shake. I usually try to look for higher protein and fiber, and lower added sugars while avoiding sucralose, maltodextrin, and carrageenan. Oh and the shake has to taste good too. Could you imagine not wanting to eat anything and reaching for a shake that didn’t even taste good? Neither could I. Considering all that, I usually go for Orgain nutritional shakes. They fit my goals as far as cost, taste, and nutritional content are concerned. 

Another option is to try to make your own shake in a blender. It can be pretty easy to toss some oats, a banana, and a few scoops of peanut butter together and have a tasty, nutritionally dense smoothie to sip on. You even save some money that way too! At the end of the day, store bought shakes or homemade, oral nutrition supplements can be a great way to give your body the fuel it needs to function when you don’t feel like making or eating a meal.

Digestive Disease Week: Role of Diet, Lifestyle, and Environment in IBD

I thoroughly enjoyed attending Digestive Disease Week’s session on Role of Diet, Lifestyle, and Environment in Inflammatory Bowel Disease. Let's start from the beginning and understand why studies surrounding diet, lifestyle, and environment are so important in understanding IBD. 

IBD affects nearly 3 million Americans and over 200,000 Canadians. IBD is an immune-mediated disease that occurs due to certain, unknown environmental exposures in those with underlying genetic predispositions. Research on environmental exposures is needed to discover what environmental factors may contribute to an individual receiving an IBD diagnosis. This research will not only create an overall improved understanding of IBD, but also contribute to reducing the onset of IBD as well as cures for IBD. 

Ultra-Processed Foods and Risk of Crohn’s Disease and Ulcerative Colitis 

Two speakers in this session I found extremely interesting, the first being Dr. Chun-Han Lo. Dr. Lo reviewed his study on ultra-processed foods and risk of Crohn’s Disease and ulcerative colitis. The Western diet is thought to increase the risk of IBD through changes in the gut microbiome which can trigger immune function when compared to the Mediterranean diet. 

Foods were separated into four categories from least to most processed:

1. Unprocessed 

2. Processed culinary ingredients 

3. Processed foods

4. Ultra-processed food products

Dr Lo explains that right now, it is widely known that higher consumption of ultra processed food products is associated with all-cause mortality, cardiovascular disease, metabolic syndrome, obesity, and cancer. Agents and thickeners, that are often added to ultra-processed food products, were also examined. The study aimed to examine the associations between ultra-processed food products and the risk of incident of Crohn’s Disease and ulcerative colitis. 

The results indicated that higher consumption of ultra processed food products, specifically ultra processed grain foods and fat and sauces, was associated with an increased risk of Crohn’s Disease. Additionally, emulsifiers and thickener containing foods increased the risk of Crohn’s Disease. No subgroups had an association with risk of ulcerative colitis. This differentiates the impact food may have on Crohn’s Disease versus ulcerative colitis, furthering complexifying IBD. Further studies are needed on the effect of ultra processed food products in patients with established IBD may be warranted.  

Although you may not be surprised by the results, studies like these are so important to allow room for more niche research and continue to allow researchers and doctors to understand the WHY behind IBD. As a Crohn’s Disease patient with many food intolerances, I am excited to see research surrounding diet and quality of food. There is little research backing the quality of food, and many suggest following a specific diet such as low FOD-map, gluten free, dairy free, among many others. It’s extremely exciting to see additional research surrounding foods, specifically processed versus unprocessed foods. My hopes are that this study can contribute to encouraging people to eat better quality foods and, in turn, reduce Crohn’s Disease diagnoses. Further, my mind jumps to future research covering whether reducing ultra processed food products after an IBD diagnosis could help treatment and management of disease. 

Development of a Composite Environmental Score to Predict Age of Onset and Outcomes in IBD

Dr. Nidah Shabbir Khakoo spoke on the development of a composite environmental score to predict age of onset and outcomes in IBD. Specifically, Dr. Khakoo focuses on the fact that many environmental exposures associated with IBD are increasingly seen with Westernization. The study aimed to explore the relationship between individual environmental exposures and the age of onset of IBD. This study is extremely important in order to come to the understanding of what can cause a person to be diagnosed with IBD earlier in life, rather than later. 

As someone with IBD, I have frequently wondered what environmental exposures in my life have caused my IBD to have an earlier onset? Why did I receive my IBD diagnosis in my early twenties compared to others that are diagnosed in their fifties? These studies are crucial to understand potential causes for earlier disease onset and overall understanding of IBD. 

This study was administered on adult patients previously diagnosed with IBD. An environmental survey that queried age-dependent and lifetime exposures to various environmental factors were given among the participants to identify the environmental exposures each subject has had throughout their lifetime while looking at the age of their diagnosis. It is important to note that this study had a large number of hispanics, an underrepresented group in IBD research. The study looked at the age of disease onset, specifically comparing hispanics vs non-hispanics and Crohn’s disease vs ulcerative colitis patients. 

Earlier Ulcerative Colitis Onset: 

• US Born 

• C-section Delivery

• Fewer bathrooms 

• Decreased housing density 

• Ex-smokers

• No farm contact 

Earlier Crohn’s Disease Onset:

• US Born

• Water source - plastics 

• Fewer bathrooms 

• Decreased housing density 

• Smokers 

Dr. Khakoo shares that the environmental score presented explains a greater amount of the variation in the age of UC onset than Crohn’s Disease onset. Additionally, weighted and not-weighted scores did not predict disease location, presence of extraintestinal manifestations, likelihood of surgery or hospitalization, or number of biologics needed. Certain environmental exposures, such as bottle feeding, showed opposing effects in ethnic groups with IBD, leading to assume that cultural and socioeconomic factors may influence disease onset. 

These results give a baseline that other research needs to build off of. It is becoming increasingly evident that ethnicity differentiates environmental factors contributing to IBD and more research is needed to understand these differences. I’m looking forward to hearing of future studies regarding this subject and am hopeful more nuances regarding environmental exposures and the timing of IBD onset will be discovered.

It was great to hear from multiple experts about diet and environmental factors relating to IBD. I think that the data so far shows that there is a lot of work to do to understand what environmental factors contribute to IBD. I am looking forward to seeing future studies dive more in-depth to discover the causes of IBD. I am incredibly grateful to have heard from Dr. Chun-Han Lo and Dr. Nidah Shabbir Khakoo, and am confident these studies will have a large influence on future research on Inflammatory Bowel Disease. 

Tribute to Khichdi - A South Asian IBD Comfort Food

Note: While Khichdi is regarded by many as a nutritious, can-do-no-harm food, and has existed in ancient ayurvedic literature (ancient Indian medicinal journals) as a food that cleanses and heals the digestive system, the food is not a one-stop solution to IBD, and there is always the chance that it does not suit everyone’s bodies. My views are not medically backed, as I am not a nutritionist, dietician or doctor; I talk about my journey of IBD with a food that has become dear to my heart (and tract).

Khichdi has a soft spot in the hearts of many South Asian people, not limited to just the IBD folks. It’s appeal to such a diverse diaspora over a varied amount of time is amazing but not surprising, due to its flexibility in becoming anything it’s fans desire. In India, a country with many inequalities, khichdi is a dish that can both dress up fancily as a wholesome comfort food for some, and strip down to a humble meal that provides a day of nutrition for others, becoming a unique thread that ties the polar opposite lifestyles of the rich and poor of India. It simultaneously also acts as a thread connecting the ill and healthy, with Ayurveda texts prescribing it as a staple meal as part of a larger lifestyle free from illness and pain, but is also a very popular meal outside of Ayurveda. It has its place in popular literature1, journals of travellers2, was chosen to be the main showcased food for World Food India 20173, has a dedicated restaurant to capture its varieties4, and is used widely as holy offerings in Hindu temples5. The meal has countless variations in all the states across the country, retaining its quality of being a trusty comfort food at its core, a pretty big feat considering all the various ways the states of India differ so widely.

When I first started showing symptoms of Ulcerative Colitis, among my many concerns, one big one was how my diet was going to be constricted to only khichdi. For a lot of the South Asian community, this restriction to their diet as they were diagnosed/even now when they show symptoms, is very relatable. I had observed a few years of my brother’s diet with UC before I started showing symptoms myself, and I cringed at how disciplined he was expected to be in eating bland khichdi, oftentimes for multiple meals, for days, weeks, even months at a time. My first few years of having UC, I followed the same path for the first couple of years, following treatment only in the Ayurvedic realm, which required many bland bowls of the rice meal. It’s safe to say I was sick (not the IBD way) and tired of it. It wasn’t until I was out on my own, in rural India for the first time, that I realized my need and dependence on the food I had come to rely on so much after learning to listen to my body. During my first few weeks of being in a remote village managing my flare ups, I was uncomfortable on many levels, and yet my memories shine with gratitude for the few times I was able to successfully find and/or be invited for a warm and simple meal of khichdi. It had effectively found a place in my heart as the one and only food that I could rely on, even in the remotest of places. 

Below are my recipes for a flare-up version a and normal version I like to enjoy as my go-to comfort food:

Plain Khichdi (Flare-Up Version)

Ingredients:

1 cup rice (any, preferably broken)

¾ cup lentils (yellow mung split)

7-8 cups water

1-2 Tbsp ghee (clarified butter)

½ tsp turmeric

Salt to taste

Steps:

1. Wash rice and lentils in a bowl, and add to a pot on a stove.

2. Add salt and turmeric and bring to a boil.

3. Cover and put in on a medium-high heat. It will take 15-20 minutes to cook. It’s best to keep stirring occasionally and checking to get a porridge-like consistency.

4. When cooked, pour into a bowl and add ghee on top. Enjoy!

Khichdi with Vegetables (Normal Version)

Prepare Khichdi same as above.

For the Vegetables:

Ingredients:

2 inches bottlegourd, peeled and diced

1 carrot, peeled and diced

1 green bell pepper, diced

1 tomato, medium sized, diced

1 onion, medium sized, diced

1-2 Tbsp ghee

¼ tsp garam masala

¼ tsp paprika

Salt to taste

Steps:

1. While khichdi cooks, heat up a frypan with ghee.

2. Add the onion. When the onion turns translucent, add the tomato.

3. Add salt so the tomato mushes up quicker.

4. Add the carrot and cover the pan. Keep stirring occasionally. If needed, add water to fasten the cooking.

5. When the carrot is soft, add the bottlegourd. Cover the pan and let it cook, checking from time to time.

6. After the bottlegourd is cooked as well, add the bell pepper.

7. Depending on how mushy you like you bell pepper, add your spices (garam masala and paprika) and remove from heat. Keep the pan covered for some time.

8. Plate on top of the bowl of khichdi. You can add more ghee on top as per your liking. Enjoy!

9. Khichdi is generally paired with plain yogurt in India, as well as pickles and papadum (crispy lentil chip).

1 https://www.moralstories.org/birbals-khichririce/

2 https://www.thebetterindia.com/119823/khichdi-history-brand-india-food/

3 https://seachef.com/khichdi-gets-ultimate-boost-to-be-promoted-as-brand-india-food/

4 https://khichditgf.com/

5 https://metrosaga.com/indian-temples-and-their-prasadams/

What is a Healthy Diet?

Back when I was in college, I had a professor who hated the word “healthy”. She argued that the word had no real definition. At first, I am not sure if I agreed with her. Surely it was safe to say that something like spinach was a healthy food, right? It has fiber, loads of vitamins and minerals, and is low in calories - perfect health food! As time went on, and I thought about it more and more, I discovered she was right. There really is no one definition for the word healthy, because it applies differently to each of us.

Every person has their own goals as far as their health. For a bodybuilder, gaining muscle might be considered healthy. For a sprinter, something healthy might improve their times on the track. For others, healthy is eating in a way that will help extend their life. You can see that it isn’t as simple as slapping the label “healthy” on a food and calling it a day. 

One of my favorite examples is birthdays. It doesn’t take a nutrition expert to know that birthday cake doesn’t improve physical health, but what about mental health? The goal on birthdays has never been to help you sculpt that hot summer body, but rather to celebrate with friends and family. It is a time to feel joy that we have made it another year on this Earth. If taking the birthday cake away harms that goal, well then the only conclusion I come to is that birthday cake is health food. Don’t tell anybody at the hospital I work at I just wrote that.

What about for people with IBD? What does a “healthy” diet look like for us? Having an interest in nutrition as well as IBD, I wrestle with this question a lot. I know that for the general population, foods like broccoli and brussel sprouts have been shown to reduce cancer risk, among other benefits. Therefore, they would generally be considered “health food”. But for somebody in an IBD flare, you might be better off roasting a package of nails at 350 in the oven for dinner. All that roughage is just going to result in pain and irritation as it passes through the inflamed intestine. For an individual with IBD who is in a flare, broccoli and brussel sprouts might be the furthest thing from healthy food they can eat.

That is why I think it is so important that we all understand the temporary and individual nature of the word healthy. It is not set in stone, what is healthy for you to eat today might not be healthy for you tomorrow. You should never be ashamed because you are not eating what the average person would call a “healthy” diet with this disease. That isn’t to say that you shouldn’t pay attention to diet at all. Your definition of a healthy diet will depend on your goals, which will most likely be very different from the friends, family, and coworkers you interact with on a day to day basis. Don’t compare apples to oranges. Take the time to define your health goals, and then determine what foods will help you reach those goals. Find your healthy diet.

IBD, Mental Health, and Diet

Have you ever had a gut feeling before? Maybe you’ve had butterflies in your stomach when taking a risk, or felt something in the pit of your stomach when receiving bad news. Are these just idioms, or is there something else there? On my journey to become a registered dietitian, the connection between food and physical health is a common theme. Something we talk about much less is the connection between food and mental health. While Inflammatory Bowel Disease (IBD) is often thought of as a physical disease, the mental impact cannot be ignored. In my opinion, we don’t talk enough about the IBD and mental health connection, and we certainly don’t talk enough about how food can play a role in this aspect of our disease.

Mental Health and Gut Health

What does gut health have to do with mental health? Strap on your helmet, it's time for a crash course in the connection between gut health and the brain. The gut has over 500 million nerves, which serve as a two way communication system with the brain. If your gut isn’t happy, you better believe it is going to let its good friend the brain know about it. Our guts are also responsible for producing neurotransmitters, which help to regulate physical and mental functions of the body. One important neurotransmitter that regulates mood, serotonin, is produced 95% in the intestines! Another one, GABA, can be produced by the friendly bacteria in the gut, and can help reduce feelings of anxiety, depression, and fear.

Mental Health and IBD

As you can see, the gut and the brain are basically best buds. But what does that mean for people whose guts are broken more frequently than the McDonalds ice cream machine? Unfortunately, IBD patients are at an increased risk for developing anxiety and depression, and frankly, can you blame us? We are forced to bear the burden of a lifelong chronic disease, often being diagnosed during some of the most mentally vulnerable stages of our lives. High school is hard enough without explaining why you spend half of every class in the bathroom. It might seem like the connection between intestinal health and brain health is bad news, but there is a silver lining. If we can change the health of our gut, we can change the health of our brain.

Diet and Mental Health in Healthy Individuals

In healthy individuals, certain diets have been shown to increase feelings of wellbeing, reduce feelings of depression, and improve psychological health. Both individual foods such as fruits and vegetables, as well as dietary patterns such as the mediterranean diet, have been linked to these benefits. Some foods are also associated with worse mental health. Sugar has been linked with mood disorders and depression. Excess sugar consumption is also associated with dysbiosis, a shift in the composition of the gut bacteria from helpful to harmful species.

Diet and Mental Health in IBD

In a study presented at Digestive Disease Week 2020, researchers categorized IBD patients into two groups, a high sugar group (>100 grams per day) and a low sugar group (<100 grams per day). They found that those in the high sugar group had increased feelings of fatigue, trouble with social engagement, feelings of depression, and trouble relaxing compared to IBD patients in the low sugar group.

It is important to note that sugar containing whole foods such as fruit have been strongly linked to positive health outcomes, and should be considered differently than sugars from processed foods. Added sugars from processed foods such as soda or candy are associated with an unhealthy gut, and worse overall health.

I think this is such an important study, not only because it has practical implications for IBD patients, but also because it opens doors for patients to take control of their own mental health. I don’t think I've ever had a conversation with any GI doctor about mental health, despite the increased risk we carry with IBD. Until that changes, it is reassuring to know that we have the option to eat in a way that is associated with good gut health, and therefore good mental health.

References

Choi K, Chun J, Han K, et al. Risk of Anxiety and Depression in Patients with Inflammatory Bowel Disease: A Nationwide, Population-Based Study. J Clin Med. 2019;8(5):654. Published 2019 May 10. doi:10.3390/jcm8050654

Knüppel, A., Shipley, M.J., Llewellyn, C.H. et al. Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study. Sci Rep 7, 6287 (2017). https://doi.org/10.1038/s41598-017-05649-7

Stranges S, Samaraweera PC, Taggart F, Kandala NB, Stewart-Brown S. Major health-related behaviours and mental well-being in the general population: the Health Survey for England. BMJ Open. 2014;4(9):e005878. Published 2014 Sep 19. doi:10.1136/bmjopen-2014-005878

Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutr Neurosci. 2019;22(7):474-487. doi:10.1080/1028415X.2017.1411320

Brown K, DeCoffe D, Molcan E, Gibson DL. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease [published correction appears in Nutrients. 2012 Oct;4(11)1552-3]. Nutrients. 2012;4(8):1095-1119. doi:10.3390/nu4081095

How to Start a Food Diary

Dear Diary,

Sometimes when I eat it feels like a herd of angry buffalo have taken up residence in my gut. The rumbling, the pain, and the regret are all too familiar at this point. Maybe I just shouldn’t eat at all. Maybe that would be best. I wish it could just stop…

Okay, I might not be talking about that type of diary, but I’ve had many days in my Crohn’s journey where that could have described me. Like many people with Inflammatory Bowel Disease (IBD), I have a frustrating mix of good days and bad days. It always baffled me how I could feel good one day, but terrible the next. I wanted to know why. This started my journey of paying closer attention to what I eat, and in turn, keeping a food diary.

Why a food diary?

Our environment is everything we come in contact with on a daily basis that isn’t us. The air we breath, the things we touch, and the food we eat all make up our outside environment. If nothing in our environment impacts a disease, it should feel the same every single day. For me, and many others with IBD, this just isn’t true. In this case, we must start looking at our environment as a source of triggers for our disease.

One of the largest parts about how we interact with our outside environment is what we eat. Every day we eat a variety of different foods, from a variety of different places, that have a variety of different health effects. For me, food was an easy place to start to try to figure out some of my disease triggers. I know what I am eating every day, so why not try to see if there is any connection between what I eat, and how I feel. This led me to food journaling, and it has been an invaluable resource in helping me navigate and manage my own disease. It has given me power.

Research also backs up this idea. In one study done in 2016, one group of Crohn's patients was told to exclude either the four food types they had the highest antibodies to, while the other excluded the four food types they had the lowest antibody to. The group that excluded the foods types to which they had the highest antibodies had significantly lower disease activity and significantly higher quality of life.1 We might not have access to antibody testing, but we can certainly try to figure out what foods are worsening our disease and quality of life.

How to write a food journal

There are three main things to consider when writing a food journal: what you eat, the time you eat, and how much you eat. With these three written down, you will be able to better make connections between foods and symptoms. Let's do an example: For breakfast this morning, you ate a bowl of oatmeal with blueberries, some bacon, and a cup of coffee (I know, I know, coffee isn’t exactly known for its stellar track record in collaborating well with IBD, but it's a made up example!) How would that look?

Tracking Symptoms

Symptoms are a little trickier. Say you have some pain in your lower right abdomen, how do you know what meal might have triggered you? Was it the meal you ate 5 minutes ago? 4 hours ago? The day before? For this we need to know a little bit about how long food takes to get to each different part of the intestines, also called the intestinal transit time. In a normal, healthy adult the following is accurate:

But what if you’re flaring? Diarrhea, inflammation, stricturing, and other aspects of a flare can all impact the amount of time it takes for food to get to the finish line. Some studies have been done on intestinal transit time in IBD patients, with most finding that the intestinal transit time is longer in IBD than in normal healthy subjects.2,3,4 In one patient with Crohn's disease, it took 156.2 hours for one meal to pass through. Talk about taking the scenic route! Like many other things with IBD, you are going to have to take an individual approach and problem solve to figure out how to best match symptoms and meals. 

Resources

Tracking food can be done in something as simple as a spiral notebook, but there are also other options available. Here is a list of some apps you could use instead of a physical journal:

• mySymptoms Food Diary & Symptom Tracker (Lite) by SkyGazer Labs LTD

• Food Diary by WeCode Team

• Cara Care by HiDoc Technologies

References

1. Gunasekeera V, Mendall MA, Chan D, Kumar D. Treatment of Crohn’s Disease with an IgG4-Guided Exclusion Diet: A Randomized Controlled Trial. Digestive Diseases and Sciences. 2016/04/01 2016;61(4):1148-1157.

2. Andersen K, Haase A, Agnholt J, et al. P-113 Gastrointestinal Transit Times and Abdominal Pain in Crohn's Disease. Inflammatory Bowel Diseases. 2017;23(suppl_1):S40-S41.

3. Fischer M, Siva S, Wo JM, Fadda HM. Assessment of Small Intestinal Transit Times in Ulcerative Colitis and Crohn's Disease Patients with Different Disease Activity Using Video Capsule Endoscopy. AAPS PharmSciTech. 2017;18(2):404-409. doi:10.1208/s12249-016-0521-3

4. Haase AM, Gregersen T, Christensen LA, et al. Regional gastrointestinal transit times in severe ulcerative colitis. Neurogastroenterology & Motility. 2016;28(2):217-224.

Navigating Diet Culture with IBD

By Amy Weider

Growing up food was always a celebration for my family. Food was how and why we would come together and build traditions. We would eat lobsters for every New Years to signify good luck and we'd come together to break the claws and soak them in butter. I remember watching my mother make us a classic midwestern casserole on a weeknight and the Food Network was never not on in the background. Food has always been such a critical part of my life. It brings me joy and memories. So when I started getting sick around 9 years old my relationship with it was forced to change. I began to have severe stomach pains and was unable to hold any food down. The first instinct when someone is having intestinal issues is to always investigate diet. My loving mother quickly made the switch to all-organic everything, bland food, and no more sugary drinks. At 10, I very quickly had to change what I ate and go on intense diets. It was hard for me, as food is such an important part of my life and a means of joy. But nevertheless, my family supported me through it and we went through the motions. Gluten-free for a bit, dairy-free, liquid-based only, we tried it all. 

Alas, nothing worked. I was still, if not more, sick and constantly exhausted. Once the diets failed, I was given a colonoscopy and ultimately I was diagnosed with Crohn’s Disease. My Crohn's Disease was not fixed by a diet. In fact, no Inflammatory Bowel Disease (IBD)is caused or cured by food. Diet can help with inflammation or regulation of the disease, but diet also affects every IBD patient extremely differently. Most often, this is not how it’s portrayed and it’s hard for folks with IBD to carry the weight of the assumption that there is a one-size-fits-all cure. Ever since I first became sick, I have had people tell me constantly that if I ate a certain way I'd be fixed and that it is my fault I developed such nasty health problems. Hearing these things as a kid made me aware of diet culture very early on. 

Diet culture is the world we live in. It is everywhere. Diet culture can be defined as the patrolling of people’s weight under the guise of health, while it is really about control, shame, and reinforcing eurocentric skinny body standards and eating trends. Concrete examples of diet culture are folks labeling certain foods as “good” or “bad”, or the shaming of others for not eating the “right things.” Diet culture and the weight-loss marketplace is a $70 billion industry. There is no way of avoiding these harmful tactics of major companies marketing off of your body’s imperfections and longing to achieve the societal standard of a femme body. It becomes very difficult to balance the thin line between diet culture and a change in your nutrition for your health’s sake. Specific diets that are used to help manage IBD are often glamorized as the “new, hot trend that will make you drop ten pounds quickly!” There needs to be a greater understanding of how privileged it is to merely treat these diets as fads. They are often highly inaccessible, expensive, and fail for those who are just casually attempting them. But for others, for example those who have Celiac, this isn’t an option for them. There is so much nuance that is frequently overlooked when prescribing diets and there needs to be more attention given to diet vs. health and nutrition. The mask that is diet culture can very quickly take over one’s life.

When you Google “Crohn’s Disease” you cannot miss the slew of diet suggestions for anti-inflammatory foods or titles like “Gluten-free Fixed My Life!” Hearing people make statements like “you could cure that by eating ‘blank’,” has become a huge trigger for me. My relationship with food has had its rocky times, but it’s still a place I find deep comfort. Comments like these stem directly from diet culture and the invalidation of lived experiences. There is no right way to have Crohn’s Disease. Everyone’s life experiences differ greatly and the main lessons I’ve taken away from mine are to be open, ask questions, and not push assumptions onto others. Open a space for folks to guide a conversation about their dietary restrictions and needs if that’s what they want. NEVER suggest a new diet to an IBD patient unless you are their medical provider. Trust me, we have heard everything.

Starting a Healthy Relationship with Food

By Erin Ard

What should I eat during a flare-up? What should I eat to stay trim? What should I eat to be healthy? What even CAN I eat? Every day I'm plagued with these questions. Even more aggravating, none of which have an easy, clear-cut answer. But having had experience fumbling over meal-planning and studying nutrition, I've learned how to better navigate my eating habits.

Planning and preparing healthy meals for yourself can be an exhausting, time-consuming, and sometimes expensive, process - especially for college students. Now if you throw in food allergies, intolerance, or chronic illness this process can get MORE complicated! Having inflammatory bowel disease (IBD), myself, I know how challenging it is to eat healthy within your own food restrictions; especially if you don't have a good understanding of nutrition, gastrointestinal disease, or what your restrictions are! My disease has been in remission for several years now, so my food limitations aren't as strict as someone having a flare-up, and I still have trouble. For those who are new to the game, IBD is a class of autoimmune diseases that causes inflammation along the GI tract when the disease is active, and can hinder nutrient absorption. With Crohn's disease, a common form of IBD, there is no specific diet to follow to control symptoms. This is probably the most annoying thing you've read today, but I better let you know now.. According to the Academy of Nutrition and Dietetics, we only know of foods to avoid - foods like dairy, high fiber grains, alcohol and certain spices, since these tend to aggravate an inflamed bowel.

Being the nutrition major I am, I get to learn about the Dietary Guidelines for Americans (DGAs). These are a great resource for curious readers wanting to eat healthy and live an active lifestyle. They lay out simple and easy recommendations to help prevent chronic illness, e.g. diabetes or obesity. These illnesses have become more and more prominent in the U.S. and have direct ties with diet. But what about the many other nutrition-related diseases with not-so straightforward ties? Unfortunately, the DGAs aren't designed for all bodies. The research used to develop the recommendations use “healthy” test subjects, of course, not those with chronic illness already. If you have a chronic illness, you’ll need to take extra care to find your ideal, health promoting diet. Better start doing some research yourself or see a registered dietitian! Or try out this idea you've probably never heard before, a food diary! …

Taking extra care in regards to your diet is especially important with IBD. In Crohn's disease specifically, inflammation along the digestive tract can cause nutrient deficiency. Inflammation hinders absorption of important nutrients, vitamins, and minerals; putting you at a higher risk of malnutrition than your healthy roommate. Eating the right nutrient-rich foods and eating enough of these foods can make-or-break living healthy with IBD. All of this in mind, the DGAs are still an easy “go-to” to help you learn about what makes up a balanced meal and why. In the rest of this article, I want to help you navigate the DGAs and share my own troubles with forming healthy eating habits.

Navigating the Dietary Guidelines for Americans with IBD

When comparing the DGAs and what is good or bad for a person with the common IBD form of Crohn’s disease, there are a few noteworthy similarities. For instance, limiting saturated or trans fats, simple or added sugars, sodium and alcohol are wise choices for everyone. They also seem to focus on getting a variety of vegetable and protein choices, emphasize fiber, and recommend lower fat options for dairy. Here you need to be careful. As noted before, certain sources of fiber can hurt a person with active disease. In other cases, fiber can be very beneficial for a person with Crohn’s to add fecal bulk, when the disease is in remission (i.e. under control or without symptoms). It's important for you to understand what foods are necessary for a well-balanced diet and what foods impact your disease management. The DGAs give a great outline, but your personal nutrition plan should have the final say in deciding what to make for dinner.

Dietary Guidelines for Americans 2015-2020

1. Follow a healthy eating pattern across the lifespan.

2. Focus on variety, nutrient density, and amount.

3. Limit calories from added sugars and saturated fats and reduce sodium intake.

4. Shift to healthier food and beverage choices.

5. Support healthy eating patterns for all.

My Relationship with Food

All of this information I have outlined is great and all, but I haven't touched on the emotional aspects of eating yet. Eating is heavily tied to the emotions I experience in a day. My mind bounces back and forth so much in a day when I think about food, eating, how I feel, how my gut feels, how much time I have before my next class, and whether I even have the energy to fix a meal up.

I eat when I’m sad and eat when I'm happy. I'll make a great meal to celebrate an accomplishment or make comfort food if my gut hurts. If I have an important event to attend, I will forego eating entirely to prevent symptoms. If I’m sad or stressed enough, I will also not eat, and wallow in my own pity. It’s confusing and raw, and I don’t understand my eating habits most of the time. Like I said, eating is a heavily influenced by my emotions, so how I feel about my Crohn's or about myself will impact what and if I eat anything. Unfortunately, I've discovered that a majority of emotions I experience will have me make bad decisions about food. But pausing to understand why I make these decisions and what fuels these emotions, has helped me to better understand myself. All of this aside, I love making food.

Striving for Progress

I used to have so many misconceptions about food. The biggest misconception I had to overcome was what I needed to eat to be healthy and what I should eat to look good. As a teen and throughout college, I was more absorbed in looking good, being thin, and keeping belly small. Not maximizing my nutrient intake by eating whole foods and managing my disease resurgence.

I used to be influenced by fads and testimonials - "stay away from dairy for clear skin", "stay away from breads and pasta and sugars to shrink your belly", etc. Everything affected me. Every headline I saw or piece of information I was told. Any advice I was given. Everything I interacted with tried to influence my thoughts, opinions, actions, and lifestyle. Here I thought I was being educated. I never realized I was depriving myself more than helping.

What I’ve been learning is that nutrition is not black and white. The world will try to convince you that there are foods you should not eat for X and foods you absolutely need for Y health benefits. Sadly, this isn’t true. There isn’t one perfect diet plan out there for everyone or for XYZ benefits. Nutrition is much more complicated than that.

With all of this in mind, I would say that right now, I have the healthiest relationship with food I've had in a long time. Studying nutrition was a major player, but I also must give credit to being mindful every day. Being mindful of my cravings and urges has helped me stay away from flare-triggering foods. And I make progress each day deconstructing any false beliefs on what I see as a "healthy" food for me.

My message to you is to educate yourself, learn about food, learn what foods you tolerate, and strive for a healthy relationship with food.

Bone Broth: Nature's Multivitamin

It seems that #guthealth has become popular in the wellness space over the past year or so. With more awareness of IBS, Leaky Gut, SIBO, and many other bacteria imbalances in the gut being displayed through the media, there has been an increase in remedies that are bound to “fix” all gut issues. I am an advocate for taking preventive, healing measures to get to the root cause and work towards better overall health - not necessarily relying only on medication. However, these so-called remedies are not a “cure-all.” While diet plays SUCH a significant role in gut health, but there are far too many factors that contribute to overall gut health that are often overlooked. In terms of IBD, chronic inflammation is exactly what it sounds like – chronic. Those who are facing this issue often try several things to help tame inflammation and improve their health, but there is not one “cure” that will work for everyone. Many things can trigger inflammation, and those are different for each person. Common examples include: food sensitivities / intolerance, stress, hormone imbalances, and mental strain. All of which can cause added irritation and stress to our system which results in inflammation and often the inability to turn off our “fight” mode.

While stress is a main component of a suppressed immune system there are plenty of other factors that influence the lining of the gut itself - factors such as prolonged exposure to antibiotics, inflammatory foods, toxins, etc. Eventually, if the impact of these factors pile up, the lining of the gut can suffer and result in permeability issues that may cause excessive inflammation due to malabsorption of food and minerals.

One thing I am currently working on in terms of my Crohn’s Disease is repairing the lining of the gut. Due to years of antibiotic treatment, inflammatory foods, and chronic stress, the lining of my gut has taken a toll and is not as impermeable as it should be. I am planning on writing a separate post about my current protocol, as well as the lifestyle changes I am implementing, but for now, I would like to talk about two things I have added into my routine and their role in digestive healing.

There is a chance that either in your research, scrolling through social media wellness accounts, or talking with your doctors, you have heard about bone broth. Many healing diets such as GAPS and the Specific Carbohydrate include this as part of the beginning protocol, and for a great reason! Nutrients and minerals in bone broth are essential to improve and heal the lining of the gut. These nutrients help decrease inflammation, balance good / bad bacteria ratios, and increase the immune response. Bone broth is nutrient-dense, easy to digest, rich in flavor and boosts healing within the entire body – what’s not to love!

What exactly is Bone broth?

You may think of broth that your mom used to have you sip when you were sick as a kid, typically what is used in homemade soups. However, bone broth is much different – it is nutrient-dense, thicker, and in my opinion, SO much better. Bone broth is the result of steeping the entire bone remains of the animal (beef, lamb, pork, chicken, etc.); including the bone, marrow, tendons, ligaments, etc. By including all of these components, the amount of nutrients found in this broth is significantly high compared to regular broths. Simmering using the “nose to tail” method of the animal protein source enables the bones and ligaments to release healing compounds like collagen, proline, glycine, and glutamine that are transformative for your health (1). Bone broths contain minerals and essential amino acids in forms that are easy for our body to absorb. Some of the minerals included are; calcium, magnesium, phosphorus, sulfate – all of which are often sold as pricey supplements and used to reduce inflammation, joint pain, and arthritis.

It is important to be mindful of the kind of bone broth you are consuming. Meaning, not all store-bought broth is created equal. If you’re not going to make your bone broth at home (from scratch), it is crucial to check the ingredients of what you are purchasing in the store! Like many other products, manufacturers like to sneak in monosodium glutamate (MSG), which is recognized as a meat flavor but is actually a neurotoxin – and as mentioned earlier, toxins affect the gut! When looking at the ingredients list, you should seek out whole, organic ingredients such as the bone broth (filtered water and animal bones), organic vegetables, and minimal spices. Try to stay away from added preservatives because to reap the full benefits of bone broth it is best to consume it in its most natural form – as our ancestors would have prepared it!

Overall, bone broth is a great place to find all of the valuable amino acids, collagen, gelatin, and trace minerals. There are dozens of different nutrients found within bone broth, many of which can’t be obtained easily from other commonly eaten foods! I am a firm believer in using food as medicine and consuming as much nutrient-dense food as possible. Broth is one of the easiest ways to check those nutrient boxes off without having to consume a massive pile of veggies in one sitting! By regularly drinking bone broth, or using it in recipes, you can promote healthy gut integrity while reducing inflammation and permeability. Now let’s dive into some other benefits from regularly consuming bone broth, shall we?

1. Protects Joints

I’ve already mentioned the anti-inflammatory properties that broth has due to the nutrients. But one of the BEST components found in this broth? Collagen. Bone broth is one of the world’s best sources of natural collagen – a protein found in vertebrae animals; in their bones, skin, cartilage, ligaments, tendons, and bone marrow. Collagen is very beneficial for the growth of hair, skin, nails, and bone health (2).

As we get older, our joints naturally experience depletion resulting in loss of flexibility. Supplementing with collagen matters because as we age, cartilage diminishes. As the broth simmers, animal parts release collagen and it becomes readily absorbable to help restore cartilage.

Another valuable component in the stock is gelatin. Gelatin acts like a soft cushion between bones that helps them move smoothly without friction. It provides the building blocks that are necessary to form and maintain strong bones. Significant amounts of both collagen and gelatin form and reform connective tissue to help take the pressure off of aging joints and supports healthy bone mineral density. It’s never too early to start taking preventive measures to make joint pain less problematic as you get older!

2. Boosts Detoxification

As I have previously mentioned, in our Western World, the average person is exposed to a variety of environmental toxins, pesticides, artificial ingredients and chemicals. The human body is amazing in terms of having its own means of detoxification from heaving metals and other toxins. However, it has a hard time keeping up when it is flooded with large amounts of chemicals. Much like if you were to procrastinate and become swamped with homework, you’re suddenly overwhelmed and may not perform your best on the task at hand. Bone broth is considered a powerful agent in detoxification because it helps the digestive system expel waste and promotes the liver’s ability to remove toxins. It also helps to maintain tissue integrity and improves the body’s use of antioxidants.

Stock contains potassium and glycine – both of which support cellular and liver detoxification. By supplying sulfur (especially with added vegetables, garlic, and herbs) and glutathione, an agent that lowers oxidative stress, detoxification is boosted. Glutathione helps with the elimination of fat-soluble compounds, especially heavy metals such as mercury and lead. It also aids in the use of antioxidants, the absorption of various nutrients, and with liver-cleansing functions! With the increased intake of essential minerals that bone broth stimulates, the minerals act to remove toxins by stopping heavy metals from attaching to mineral receptor sites. If they can’t bind, they can’t mess with our systems!

 3. Supports Immune System Function

I have briefly mentioned at various times the permeability of the gut lining, inflammation, and a suppressed immune system. All of which contribute to multiple issues with what would generally be a healthy inflammation response.

Leaky gut syndrome occurs when undigested particles from foods seep through tiny openings in the weakened intestinal lining and enter the bloodstream. The immune system detects these invaders and becomes hyperactive to regulate the body. The hyperactivity increases inflammation and leads to dysfunctions all over, not just in the gut where the primary issue lies. The immune system releases high levels of antibodies that cause an autoimmune–like response and begins to attack healthy tissue. Individuals that already have a compromised autoimmune system, such as IBD patients, may suffer considerably more damage from a response because the system believes the particles in the bloodstream to be much more of an invader than a conventional system may.

Bone broth is observed to be one of the most beneficial foods to consume to restore gut health and therefore support immune system function and healthy inflammatory response. Collagen, gelatin, and the amino acids proline, glutamine, and arginine help seal the openings in the lining and support what is known as “gut integrity” – the intactness of the lining of the intestine to maintain its structure and function.

The amino acids and anti-inflammatory benefits create a perfect atmosphere for powerful immune-boosting to occur!

4. Good for the Gut

Bone broth stock is easily digested and soothing to the digestive system, unlike many other foods, which can be challenging to break down. Those with food sensitivities and intolerance (such as wheat or dairy) already have a hard time consuming many foods that may be considered “inflammatory.” Therefore, it is essential to look after the integrity of the gut, so vital nutrients are absorbed to support other bodily functions and overall health. After all, food is only useful if we have the means of absorbing its nutrients.

Bone broth has also been found to help heal the lining of the gastrointestinal tract. Critical components for digestion support that are found in bone broth include - collagen (proline / glycine), gelatin, and glutamine. Although there are many other beneficial minerals contained, these are most helpful to many IBD patients that have difficulty successfully digesting and passing bowel movements.

A healthy digestive tract consists of a single, tight layer of epithelial cells, a thick mucus layer, and a diverse group of microbes (bacteria in the gut). Gelatin is a significant component when it comes to the lining of the digestive tract because it supports a healthy lining of mucus within the system. The water is absorbed within to help maintain the layer of mucus that blocks gut microbes from the intestinal barriers. By drawing fluid into the intestine, the motility of the gut is improved, and healthy bowel movements are supported.

Collagen is another important component because it contains two essential amino acids: proline and glycine. Proline is necessary for the formation of collagen, and glycine works to improve digestion by increasing gastric acid secretion. Studies are currently being conducted and have shown that individuals with IBD, mainly Crohn's, are more likely to suffer from low stomach acid (3). Because the proper pH of the stomach signals the continuum of the digestive cascade, many people with low stomach acid face difficulty processing meals efficiently.

Summary

I know that was a lot of information, some of which may not have processed the first time reading it through - but that’s perfectly okay! Luckily you don’t need to know the names of all the essential amino acids found in bone broth to reap the benefits. I included this information because I know when I am learning about a new “supplement” that can improve my health, I’d like to know exactly how it works and why it is good. Many others like me enjoy doing their research to learn more, but others enjoy knowing the benefits, plain and simple!

So, another run down. When taken consistently, bone broth is exceptionally nutritious and works diligently to repair multiple components of your digestive tract. In addition to this, benefits are often seen through support in joint and bone health, hair / skin / nails, and detoxification processes of other organs within the body. It truly is impressive how functional this food is - hence, the nickname “nature’s multivitamin!”

I highly recommend giving this a try, whether you buy it from the store or experiment with making your own. I believe it’s wonderful! I drink mine first thing every morning, and it’s become something I look forward to - some people drink coffee, I drink bone broth (with an added scoop of collagen)! I hope you found this article informative and it piqued your interest to try something new, or reintroduce something back into your routine!

Stay Lovely,

Erin

Cooking with Crohn's - Gluten Free Strawberry Shortcake

With the summer heat, comes the summer treats! Watch this video of CCYAN Fellow, Leah, makes a delicious gluten free strawberry shortcake following the two recipes down below. It's important to stick to your own dietary needs to feel free to accommodate the recipe to your liking!

Recipe for Shortcake

• 1 1/2 cups gluten free all purpose flour

• 2 3/4 teaspoons baking powder

• 1/4 teaspoon salt

• 2 tablespoons sugar

• 3/4 cup heavy or whipping cream

• 1 large egg

Instructions

• Preheat the oven to 450°F. Line a baking sheet with parchment paper and set it aside.

• Mix the flour, baking powder, salt, and sugar together in a large bowl.

• In a separate bowl, beat together the cream and egg. Pour the wet ingredients into the dry ingredients and mix to form a cohesive dough.

• Scoop the dough in 1 1/2-ounce balls onto the baking sheet; use the palm of your hand to gently flatten each to about 2" to 2 1/2" diameter.

• Brush the tops of the shortcakes with cream, and sprinkle with coarse white sparkling sugar.

• Bake the shortcakes for 10 to 12 minutes, until they're risen and baked all the way through; break one open to make sure.

• Remove the shortcakes from the oven, split, and top with berries and whipped cream. Store, well-wrapped, at room temperature for several days; freeze for longer storage.

https://www.kingarthurflour.com/recipes/easy-gluten-free-shortcakes-recipe

Recipe for Whipped Topping

• 1 cup (8 fluid ounces) heavy whipping cream, chilled

• 1/2 cup (58 g) confectioners’ sugar

• 8 ounces cream cheese, at room temperature

• 1 teaspoon pure vanilla extract

• 1/8 teaspoon kosher salt

Instructions

• Transfer 2 tablespoons of the cream to a small bowl and set it aside. In the bowl of a stand mixer fitted with the whisk attachment or a large bowl with a handheld mixer.

• Place the remaining cream and beat on medium-high speed until soft peaks form.

• Add the confectioners’ sugar, and continue to beat until stiff, glossy peaks form.

• Transfer the whipped cream to a separate, large bowl and place in the refrigerator to chill.

• In the same bowl, place the cream cheese, vanilla, salt and reserved 2 tablespoons cream.

• With the whisk attachment, whip the cream cheese mixture on medium-high speed until light and fluffy.

• Remove the whipped cream from the refrigerator and add half of the whipped cream mixture to the cream cheese mixture, and whisk to combine.

• Add the remaining whipped cream, and fold it into the filling carefully until combined.

https://glutenfreeonashoestring.com/gluten-free-fruit-pizza/