figuring out what foods work for me

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

 

Food Matters

hypoglycemia

At least, I’m going to call it hypoglycemia for convenience. You’ll see why later.

Background

The first time I spontaneously got dizzy I was 12 when I tipped my head sideways to see into my desk. Although I don’t remember circumstances, I do recall having very occasional dizzy spells from that time and into university, at which point they became a little more frequent. I’d usually go home and have a rest, which sometimes helped and sometimes didn’t. Someone suggested it was low blood sugar but it didn’t seem likely because I was sometimes dizzy after a meal.

When I eventually went to the doctor, he diagnosed vertigo, meaning “I spontaneously get dizzy sometimes” and advised me not to move my head around too much. Uh, thanks. He was wrong, but in fairness it took me years of experience and a few other doctors and finally a particularly knowledgeable and helpful school nurse to figure it all out.

A couple of years after this most unhelpful of diagnoses, and after I’d graduated and moved to a different city, I’d been struggling with diet generally. I’d moved away from home with my boyfriend and neither of us were very interested in cooking. I generally ate food cooked from scratch rather than convenience food, so I was having trouble figuring out what the problem was. There had been dizziness, one occasion of an inexplicable sensation of nervousness, feelings of nausea, and no doubt other symptoms I’m forgetting. I went to the doctor, who said it sounded like hypoglycemia, though he didn’t order any tests. Just as well because the test is a glucose tolerance test in which you consume a sickly sweet glucose drink and then have blood tests every half hour for 2, 4 or 6 hours. As a needle-phobic, I was happy to give that a miss. His advice was to eat more meat and drink more milk to increase protein intake, but I found this challenging because I preferred to go more vegetarian and I was off milk at the time. So I attempted to manage my blood sugar through diet, albeit with limited success.

A few years later, when I was teaching English in Japan, I often struggled with low energy, low mood and difficulty focusing. One morning I was having a tough time. I’d made friends with the school nurse and her assistant; both of them had pretty good English but mostly they were nice, and I enjoyed being around them. So feeling unable to focus on work, I retreated to the nurse’s room and as we were chatting I told her I wasn’t feeling all that well, so she asked some questions. The main thing was dizziness and feeling generally blah. What kind of dizziness? This was the first time anyone had asked that question and I wasn’t sure how to explain it. Was it a sensation of going up and down like on an elevator, or was the room spinning horizontally? It was the up-and-down type.

This concerned her because up-and-down signifies high blood sugar, while horizontal spinning is typical of low blood sugar. It was very troubling to her, a nurse whose supervising doctor specialised in diabetes, that I should be having high blood sugar in the morning. Ah, I said. I ate something very sweet for breakfast. But from then on I paid attention to the type of dizziness and it was always pointed to low blood sugar.

I continued to struggle with blood sugar issues in Japan, so when I got back I consulted a nutritionist. Doctors don’t really get any instruction on nutrition, but some nutritionists aren’t much better. When this person encouraged me to eat things like Cheez Whiz and diet soft drinks, I knew I was unlikely to going to get any useful information out of her.

Anyway, since then I’ve just continued to treat it as hypoglycemia and try to figure out what works for me through trial and error.

Reactive hypoglycemia

If you consume sugar and a short while later your blood sugar is actually lower than it was to start with, that’s reactive hypoglycemia. The science is still somewhat unsettled on the precise mechanism, but one theory is that when the sugar is consumed, the body overproduces insulin. Insulin’s function is to lower blood sugar but here it kind of freaks out, and then you crave sugar. If you succumb to that craving, your blood sugar bounces up and down, and generally wreaks havoc.

Because I haven’t had the test, I’m not certain that this applies to me, but my current doctor says they don’t really do the glucose tolerance test for this anymore. And I know from experience that if I were to have a coke or even orange juice without eating some real food at the same time, it would fuck me up, so I probably do have reactive hypoglycemia.

But this isn’t the only issue for me.

Low blood sugar before meals

I also get low blood sugar before a meal, but since this isn’t provoked by consuming sugar, it can’t be reactive hypoglycemia. I suppose it’s just a normal low caused by my body burning off whatever I ate last. In other words (though I hate the term), it includes being ‘hangry’.

There’s another issue at play — I don’t really feel hunger and instead I eventually get low blood sugar symptoms. At first I thought this was an inconvenient coincidence, but now I wonder if I’ve actually learned (or was taught) to ignore hunger and if so this would be part of the cause of my blood sugar woes.

Even so, my low blood sugar symptoms seem to be more sudden and intense than what most people experience.

Symptoms of low blood sugar

Low blood sugar can cause a variety of symptoms. These are the ones I’ve experienced:

  • mood: from irritability, through grumpiness and foul temper, to full-on meltdown (crying etc.)
  • cognition: brain fog; my natural indecisiveness gets worse to the point of complete inability to make a decision (including, inconveniently, what I want to eat or where); inattentiveness; sensation of nervousness
  • dizziness
  • stomach: I’ll get a sudden feeling not of hunger but of void, which quickly turns to nausea (though I’ve never thrown up)

How I try to avoid low blood sugar

Avoiding reactive hypoglycemia is pretty straightforward: no sweets outside of mealtime, and especially no sweets as a meal. This includes sweet drinks such as soft drinks or fruit juice.

Avoiding low blood sugar at other times is more complicated because of my largely absent sense of hunger.

In general, I need to eat proportionately less carbs and more protein and fat than other people seem to need. If I eat carbs, I opt for complex carbs (e.g. rolled oats, brown rice, potatoes) instead of refined starches or sugars, but some carb-centric meals are best avoided (e.g. pizza, pasta). (You can get an idea of the effect of a given food on blood sugar by checking its glycemic index, but in general the less processed the better.) I eat meat, and dairy is a big part of my diet (full-fat everything). I eat on a schedule and frequently (breakfast, lunch, afternoon snack, supper, bedtime snack).

All of this becomes more complicated when I’m travelling because I don’t necessarily have access to a fridge, I can’t cook for myself, and I may be stuck with someone else’s schedule (especially on planes!). You can get carbs in any vending machine but protein is much harder to source. New restaurants are mostly a source of worry: will I be able to find something to eat here and will it be served before I have a crash? Do I have the language skills to figure out the menu and advise of my dietary issues? If I’m travelling, I don’t go anywhere without emergency rations.

As a result, travelling (or even going out to a new restaurant, or having a social event that centres food) causes me some low-grade worry. Will I get what I need when I need it? Dipping into my emergency rations around people is awkward because sometimes I sense they think I should share.

How I deal with low blood sugar when it happens

If I sense that my blood sugar is just a bit low and I can’t eat real food immediately, I’ll go for protein and fat (e.g. nuts). If it’s a little lower, then I’ll add something sweet (e.g. nuts plus chocolate, chocolate almonds). If it’s more of an emergency situation and my blood sugar has fully crashed, then I go for something sweet, preferably liquid because the sugar starts being absorbed into the bloodstream directly from the mouth (e.g. soft drink, fruit juice).

If my blood sugar is low enough that I feel I need some sugar right now, then sugar is the first step and real food is the next step. Real food doesn’t work as a first step in an emergency because it takes too long to be digested — I’ll end up having a full on blood sugar crash while I wait for the food to kick in. Not fun.

Conclusion

Blood sugar issues are inconvenient and become more of a hassle the farther away from home I get. I get anxious about it when I travel but I’m more relaxed if I have a travelling companion who understands my issues and can problem solve when I’m not able to. It’s not all negative though: it forces me to eat healthy food on a regular schedule, which is not the worst outcome. Uncontrolled hypoglycemia can encourage development of diabetes, so managing the issue through good diet is long-term self-care.

 

Notes on dizziness

The nature of the dizziness can be diagnostic (too bad my doctors didn’t know that). I’ve experienced the following:

  • low blood sugar: feels like the room is spinning, a horizontal feeling
  • high blood sugar: feels like you’re on an elevator, a vertical feeling
  • benign paroxysmal positional vertigo (BPPV): sudden and rather violent dizziness, provoked by changing the position of your head, can be calmed by moving your head back; results from crystals spontaneously forming in the semicircular canals of your ears and then interfering with the messages that the liquid and cilia in the canal send to the brain about position and movement (I’m certain that this is the first dizziness I experienced at age 12, and as of fairly recently it has become chronic)
  • extreme tiredness: to me feels like non-directional wobbliness; confusingly, the dizziness can happen even after I’ve slept, if the tiredness was bad enough (in university, I think I had both this and low blood sugar dizziness – the doctor’s mistake was thinking that there was only one kind of dizziness and thus one cause)

Notes on fatigue

In Japan I struggled with fatigue, at any time of day. At the time I assumed that my fatigue was all blood-sugar related, but I underestimated how exhausting it was for me to be surrounded by a different language and culture all day. I should have been eating a different balance of food, more of it, and having more naps. Fatigue is a difficult symptom to work with because a huge number of issues can cause it.

Food Matters

what I learned from FODMAP elimination and reintroduction

As I mentioned recently, I’ve had IBS (Irritable Bowel Syndrome) for three years now and have struggled to get the symptoms under control. My number one issue is bloating, and although it doesn’t interfere with my life the way, say, unpredictable diarrhea would, it’s still a significant annoyance. (Diarrhea and constipation are very common IBS symptoms but not ones that trouble me.) My belly puffs up easily so my clothes need to have a bit of stretch or they don’t fit. It’s a bit of a blow to body image and it makes me not want to take photos. I’m sure part of that is vanity and subscribing to society’s notion of what is or isn’t attractive, but I also I don’t feel like I look like myself.

I did some research online and found a book that looked promising (Patsy Catsos, IBS — Free at Last!, 2nd ed. (Portland, ME: Pond Cove Press, 2012). It looks at the role that FODMAPs (fermentable oligo-, di- and monosaccharides, and polyols) may play in IBS symptoms. FODMAPs are basically fermentable simple carbs. (FYI Monash University in Melbourne is the leader in FODMAP research, so their resources are the most reliable. The Catsos book is based exclusively on Monash research but it’s getting a little out of date now.)

There are five categories of FODMAP carbs:

  • lactose, found in milk and some milk/dairy products (a simple carb [disaccharide/two sugar molecules, in this case galactose + glucose])
  • fructose, found mostly in fruit (a simple sugar [monosaccharide/one molecule])
  • fructans, wheat and onions are top sources (a simple carb [oligosaccharide/three or more fructose molecules, up to a maximum of 10)
  • galactans, legumes/pulses are a top source (a simple carb [aka galacto-oligosaccharide/three or more galactose molecules, up to a maximum of 10)
  • polyols, none of which I’d heard of other than sorbitol, but they’re naturally occurring in some fruits and vegetables like prunes, mushrooms, dates and avocados (aka “sugar alcohols” though they’re neither a sugar nor an alcohol)

In the first phase, you eliminate (the majority of) FODMAPs for two weeks with the goal of getting things settled down. It only took about a week before the bloating pretty much stopped, hooray! I don’t ordinarily weigh myself often but I’ve now gotten into a routine of weighing daily, which revealed I’d also been retaining water. I had almost resigned myself to having to buy new clothes to fit my different circumference, but it looks like that won’t be necessary now.

I’ve now done all five challenges. I found it difficult to get enough food containing the target carb in one day to give a good test and so I may retest a couple categories. That said, I observed that lactose and polyols didn’t cause a reaction, fructose and galactose caused a mild to medium reaction, and fructans caused a strong reaction. For me the usual reactions are bloating and gas, but it’s possible that the problem FODMAPs also affect my energy and mood.

(To be clear, none of these carbs are inherently “bad”. What the FODMAP testing shows is that each person’s metabolism is unique, and what results in optimum function for one person may be much less than optimum for someone else.)

My big takeaway so far is that I need to tread very cautiously with fructans. The North American diet gets about 70% of its fructans from wheat and about 25% from onions. My strategy is to start with cutting out wheat; onions will get scrapped only if necessary. And since my issue with wheat is not a gluten allergy (celiac disease), it’s not going to do me any harm if I get trace amounts of wheat in my diet from prepared foods. All the IBS does is cause inconvenience, and it’s up to me which inconvenience (bloating versus the hassle of avoiding certain common foods) I avoid and which I accept.

I’m getting a checkup next week and when I speak to the doctor I’ll ask him what testing, if any, is available here for these different categories of carbs. I’ve certainly learned something from trial and error, but I’d like more rigorous testing so I get clearer results.

This isn’t the only issue I have with carbs. I’ve also had difficulties with hypoglycemia over the years.

Food Matters