I thought I had a good handle on the foods that work for me, but within the last couple of weeks I discovered a big blind spot.
As I mentioned, I’ve had hypoglycemia for a long time and now I have IBS. I’d worked out a way to manage the hypoglycemia — basically eat more frequent meals and prefer protein and fat over carbohydrates. If my blood sugar starts to get too low, I’ve relied on chocolate, candy or soft drinks (fizzy or fruit juice) like a carbohydrate jerry can to bump my sugar up briefly to relieve symptoms and give me some time to get some real food (i.e. containing protein and fat, as well as a moderate amount of carbs) in me.
The IBS is much more complicated as there are five different categories of carbohydrates that may cause a reaction, so if you have IBS, your food sensitivities may well be different from mine even if they cause similar digestive issues.
I’ve been following a FODMAP diet for a year now, though not religiously. In the elimination and reintroduction phase, I discovered I can eat:
lactose — Hooray! I can have ordinary milk, sour cream, cottage cheese (the creamed kind or dry curd), cheese (aged or not). The lactose in yogurt and ice cream is also not a problem, though the sugar is.
mannitol — The only food in this category that matters much to me is mushrooms, but cauliflower, snow peas and celery are also likely OK.
sorbitol — Most often used as a sugar substitute, sorbitol natural occurs in certain foods, like avocado (which I eat in quantity regularly) as well as corn, green bell pepper, broccoli, green beans, and green cabbage.
The problems start when I eat:
fructose — This means that lots of fruits are out, the ‘safe’ fruits are safe only in limited quantities (usually ½ cup), and I have to be careful with sugar in general. The sugar part is something I’m still figuring out.
oligosaccharides (aka oligos) — My number one problem food is wheat, though that’s mostly down to its ubiquity. Other foods in the same category are onions and garlic (which I’m limiting), nuts and legumes (limiting or avoiding depending on the details), and strong black tea (currently avoiding).
This is… a lot.
So what can I eat?
I learned from hypoglycemia to start any meal plan with protein. Meat, poultry and fish are all reliable since they contain no carbohydrates at all. Eggs are good. As noted above, lactose isn’t a problem for me so I can get my fill of any (unsweetened) dairy products, and thus milk and cheese make good snacks. Legumes (pulses), nuts and seeds all contain at least some FODMAPs, so going vegetarian or vegan would be exceedingly difficult; I try to eat these in small doses when I can but I’m not able to rely on them e.g. for snacks like I was doing with peanuts and other nuts. Avocados don’t have a lot of protein but they do have a lot of fat and seem to work for me to centre a meal around.
Next up in my usual analysis is ‘green’, by which I mean veg and fruit of any colour. Tomatoes, cucumbers, coloured bell peppers, carrots, parsnips, lettuce, and spinach are all definitely fine. The sorbitol and mannitol containing foods are also probably fine for me (but not necessarily for other folks with IBS).
Fruit is tricky because of the fructose. I need to limit some fruits and avoid others. There are none that are 100% ‘safe’ for me. I can have ½ cup servings of citrus, most berries, banana, grapes, kiwi, pineapple, cantaloupe, honeydew, rhubarb. And because my other problem foods in other categories all contribute to the irritation, I have to be careful how I combine things.
And then there’s what I usually think of as carbs — starches and sweets. I can have potatoes; rice, rice noodles, rice crackers; corn, corn chips and corn tortillas; quinoa. There are other grains and starches that wouldn’t cause IBS flare-ups (millet, sorghum, teff; plantain, yam) but I’m not huge on starch anyway due to the hypoglycemia so it doesn’t help much. ‘Gluten-free’ might be OK; basically it’s a flag that an item is worth a look, but since my issue with wheat isn’t actually the gluten, GF is hit or miss.
I’d been having IBS reactions recently and not understanding why so I went back to my book (The IBS Elimination Diet and Cookbook by Patsy Catsos), which reminded me that I need to be careful with oatmeal, sugar and nuts, which I wasn’t especially.
As with fruit, I need to limit oatmeal to ½ cup servings (cooked volume). And I also need to limit sweet foods the same way, even if they’re otherwise FODMAP-free: ½ cup max. So, ½ cup of sweetened yogurt or ice cream, and no sweet extras like fruit or chocolate sauce. Sigh. The cornstarch and tapioca puddings that set me off before would probably be safe in ½ cup servings too. Chocolate is OK up to a maximum of 1 ounce (30 g). [Theoretically I can have two such servings per meal/every 4-5 hours, but I’m being more cautious than that until I get a better handle on it.]
I tend to have snacks in later afternoon and before bed — often milk or hot chocolate, peanuts or sometimes almonds, chocolate, sweetened yogurt, fruit and/or ice cream. Of these, only the plain milk is entirely ‘safe’, and I was eating too much of the others, especially in combination.
For beverages, water, milk and green tea are all ‘safe’. I’ve never been big into green tea, despite having lived in Japan and visited a number of times, but I’ve also received a lot of green tea as gifts and I had amassed quite a stash. I probably have at least 6 months’ worth of green tea in the cupboard, and I’m enjoying it. (Weak black tea is just not worth the bother.)
I’ve never eaten a whole lot of carbs due to the hypoglycemia (though always more than permitted on a keto diet), but I do have a bit of a sweet tooth. After a meal I often find that I want something sweet and I’m not sure how much of that is behaviour and how much is more physiological. But I’m trying to focus on more substantial foods so I’m just not hungry so often. That way I can have a little sugar, as a treat.
In some ways my self-control is usually very good or even overdeveloped. But I wonder if sometimes my apparent self-control is less an issue of self-regulation and more habitually ignoring or denying desires. If you don’t desire, you don’t crave. For instance, I’m tremendously frugal, and when that aligns with my environmental concerns I think it’s clearly a virtue (e.g. deciding not to buy an item because contains or is packaged in plastic, or mending clothes rather than pitching them). But I also am in the habit of not going to movies, concerts or the theatre, and I’m not sure if that’s because I’m not interested or I’m just in the habit of denying myself things.
I’m finding the food issue to be a bit of a struggle. I would really like to be able to eat a piece of cake now and then, or a sandwich, or some nice fresh bread, or a chocolate croissant. There aren’t a lot of foods that I really enjoy, so it feels like a loss of pleasure to deny myself these things. But it’s just not worth three days of fatigue and brain fog for a bowl of ice cream with fruit and chocolate sauce. I hope I’m able to find new foods to enjoy rather than just deny myself yummy things out of pure tedious duty.
My current routine goes something like this:
- breakfast: 2 eggs (3 if lunch is a ways away), other savoury leftovers, no more than 1/2 cup fruit, green tea
- lunch: dry curd cottage cheese with sour cream, corn chips, green tea, and a wee bit of chocolate
- afternoon snack: hot chocolate or 1 serving of some other sweet with plain milk
- supper: usually chicken or beef with veg and starch per above — I make Mexican food a lot because of the corn tortillas and corn chips; Indian is also good for the rice (though I can’t have naan *cries*) but my only trick so far is butter chicken; nachos with guacamole and sour cream once a week
- dessert or bedtime snack: 1 serving of a sweet or cheese and corn chips
On the whole, this should serve to calm my hypoglycemia, since excess sugar or starch tends to upset my blood sugar levels. However it undermines my strategy of relying on sweets in case of blood sugar emergency (well, I could — in a pinch I’d take the IBS reaction over a blood sugar crash), so I’m going to look for some glucose tablets to act as my jerry can.
Notes on terminology
monosaccharide — a carbohydrate comprising one sugar molecule, such as fructose, glucose, and galactose (aka simple sugar)
disaccharide — a carbohydrate comprising two monosaccharides, such as sucrose (aka table sugar, fructose + glucose), lactose (galactose + glucose)
simple carbohydrates — mono- and disaccharides
oligosaccharide — a carbohydrate comprising three to nine monosaccharides, such as fructo-oligosaccharides (FOS) which are fructose chains and are a type of soluble dietary fibre, and galacto-oligosaccharides (GOS) which are galactose chains and are a type of prebiotic, found in legumes/pulses
polysaccharide — a carbohydrate comprising ten or more monosaccharides, such as fructans and inulin, which are also soluble dietary fibres
complex carbohydrates — oligosaccharides and polysaccharides