Coaching and Meal Prep Case Study #3

Specific Carbohydrate Diet

38-year-old woman with ulcerative colitis who has been nine months on the Specific Carbohydrate Diet but was still experiencing severe symptoms related to her condition. She didn’t have a lot of variety in her meals, mostly ground meats and steamed vegetables that had been deseeded and peeled. She ate a lot of nut butter and honey as she felt this was her, "only remaining joy to eating." In spite of the limited diet, her efforts had not yet resulted in the cease of a flare which had now lasted 10 months. She had been taking the medication, Prednisone for nine months (starting out at 60 mg and tapering down to 10-15 mg)., but was unable to get any lower in dosage without the symptoms of the flare worsening. She no longer felt dining out was an option due to several bad experiences where in spite of best efforts received food off-diet or her needs were poorly received by the waitstaff.  

Health Through Diet called in to assist with diet coaching and meal preparation:

  • We first focused on the client's belief that she could only have a limited number of foods. Upon further discussion, it was discovered that the eliminated foods were based more on a hunch than documented findings. Educated the client on the benefits of maintaining a detailed food log, at least initially to help fine-tune the diet protocol. She was not aware that, based on an individual's gut motility and overall makeup, some reactions could be immediate while others could be delayed reactions (two to three days later). Helped the client set up a detailed food log, (broken into 1/2 hour increments on an Excel spreadsheet) so that we could more thoroughly test her food intolerances.

  • Had client read the book, "Living Well with Diet Restrictions" to learn added strategies for dining out and grocery shopping. While the client had read, "Breaking the Vicious Cycle," she did not have a copy with which to refer back to. Both books were purchased.

  • Educated client about nut butters as being an advance food on the diet. Based on existing symptoms, the client had not moved passed the initial stages. Nut butter was removed from the diet for the intial stages. Advised the client that at most, 2 tablespoons of honey was the maximum amount she should be consuming per day. 

  • With help and support, the client agreed to go back to the intro part of the diet, maintain food log and monitor progress week by week to start. 

  • Assisted client on-site several times with meal prep, to field questions and to add variety in cooking techniques. 

  • After three months, the client was ready to try dining out. Helped the client set up a network of 12, local restaurants that would accommodate her dietary restrictions. Created a list of procedures, requested by each restaurant e.g. how much advanced notice was needed, specific times of day to dine, knowing which individuals she would need to speak with for reservations and/or once at the establishment etc.

  • Weekly 1/2 hour to hour phone check-ins with client to field questions and offer moral support as well as email check-ins throughout the week for questions that came up in between calls. 

  • Encouraged client to meditate to daily to help with stress which is known to exasperate her condition. Suggested the phone application Head Space.


  • After maintaining the food log for several weeks, it was quickly determined that some of the main issues with food evolved around her eating late into the night, right before bed. Once she omitted foods three to four hours prior to bedtime her symptoms started to improve drastically.

  • The detailed food log helped her discover that nut butters, vegetables not thoroughly cooked and carbonated water were causing additional issues. Elimination of these three items was, as she described, a "game changer."

  • After four and a half months of coaching, she had tapered off of Prednisone completely and was enjoying a more varied set of foods. 

  • At eight months, the client had finally come out of her flare and was enjoying more social activities with friend and family that including dining out at one of her twelve restaurants. At last check-in, the client was planning a trip to Costa Rica as a reward for her dietary success.

  • Client continues to find value in the occasional check-in with her diet coach.