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

reflecting and looking forward

“No peeking”, a Sinful Sunday photo from May 2016.

Well, 2019 was a year. Fortunately there was more positive than negative.

IBS-friendly diet and improved energy

In late 2018, I started managing my IBS using a FODMAP-based diet and by January 2019 I could tell that it was having a positive effect, and not only on my digestive symptoms.

The most unexpected — and utterly delightful — effect was that it largely resolved the fatigue that I’d struggled with for over seven years at that point, despite having undergone every relevant test my doctor could think of. As a result, instead of being constantly dragged down and only randomly experiencing the occasional unpredictable ‘on’ day, most days are now good days and if I get blindsided by some surprise fatigue, reverting to a conservative diet and waiting out my digestive process for a maximum of three days almost always resolves the issue.

For an accidental discovery, it’s had a huge effect on my day-to-day life. A few years ago, the combination of fatigue, poor sleep, depression and then antidepressants meant that I never knew for sure if I’d have the energy, cognition or focus to a given thing at a given time. (A few weeks after I tapered off the antidepressants in April 2018, the cognition and focus came back, but fatigue remained.) Eventually I got tired of disappointing myself so I just stopped planning anything and instead would decide on the day whether I was up for doing the thing. Which was me doing my best to cope, but it wasn’t very effective and it had exacerbated my inherent tendency not to make plans or have goals.

I now have the energy to plan and set goals, though I’m not actually very good at either of those things. So I’ll be working on that in all areas of my life, especially food (shopping, prepping, cooking), and sexuality (specifically exploring the factors that may be contribute to my low libido).

meditation

At the beginning of 2019 I started going to a weekly meditation class with a Buddhist group that meets conveniently near my place. I’d been thinking for some time that meditation would probably be good for my buzzy brain. And during my most recent meditation, I became aware that even though my brain is still far from quiet, it’s perceptibly quieter than it was when I started a year ago. It’s nice to feel that sense of progress.

I’m not practicing regularly at the moment but I’m working on making it part of my routine. And I’ll continue going to the classes because I find them helpful and I like the people: folks who are actively working on themselves to to decrease criticism and increase compassion are people I want to be around.

Wolf’s new job

Another significant change was that at the beginning of 2019 Wolf got a good contract job in a nearby city. For a change, we’re now both working at the same time, so things have suddenly gotten much easier financially, although he now has the expense of his own apartment and utilities. I’m in the process of paying out our mortgage early (we’re currently in payout limbo as the request has been made but the bank hasn’t withdrawn the money yet), so there’s a financial freedom on the horizon for us.

It’s not a secure enough job for me to consider upping stakes yet. But we’re making efforts to remain connected despite the distance, and he’s going to look for enjoyable things we can do when I come to visit to help with my project to have more pleasure in my life.

solitude

But with Wolf away, I’m once again alone here. It’s less than ideal but nowhere near as difficult as when he was overseas doing his doctorate: I tend not to get especially lonely; we talk on the phone every day and see each other every few weeks; neither of us are dealing with depression and/or anxiety the way we were before; and I still have support from Jaime.

Some time ago, I discovered that I couldn’t answer the questions “what do I like? what do I want?” in relation to sex. I now see that I struggle to answer these questions at all, for anything. I think this is largely because other people’s needs and wants seem much louder to me than my own. (It’s no coincidence that my epiphany occurred only after Wolf had been away for the better part of two years.)

But there is a mental quietness that comes from being by myself virtually all the time, enhanced by the fact that I keep the house literally quiet most of the time too. That literal and figurative quiet allows me to listen for my inner voice.

I’m going to make the most of my quiet time, keep trying to figure out my answers to those questions, and see what I can do to remain tuned in to my gut even when I’m not alone. I currently subject myself to a certain amount of mental chatter via social media, but I’m considering cutting down in order to be more deliberate with my energy; no decisions made yet on this point.

car theft

Our summer was marred by the theft and subsequent destruction of our car. Someone came in the back door of our house in the early evening and stole a handful of keys that were right there, including the car keys. I experienced a bunch of difficult emotions, chiefly anger, but in the end it didn’t hit me as hard as I (and others) expected. It was too much to process at once (similar to grief in that way) and I was concerned that perhaps I was at risk of burying the emotions rather than processing them. But I’m able to think about it now and while it’s still a bit sensitive, I don’t feel the need to avoid it, so I guess I’m OK.

Despite various anxieties I experienced that made it difficult to buy a new car, I did buy one, and I like it. Rather than getting a colour that would blend in, I got red because it’s my favourite colour, and despite the fact that some people judge drivers of red cars. Rather than getting a standard licence plate I got a personalised plate because it makes me happy to see it. It was an exercise in determining what I like and want, and prioritising my own pleasure.

I still have some anger, sadness and frustration about this episode, but I trust that it will ease over time and that giving it some attention today will help that process. We’ve taken some steps already for increased security and I’ll give some thought to some others, all with the goal of keeping my response reasonable and proportionate and not turning into an angry misanthropist in a walled compound.

looking forward

I’ve spent a lot of time over the holidays planning, which is unlike me. But I think I’m ready for planning and strategizing now in a way that I wasn’t before, thanks partly to the meditation I’ve been doing. (One of my common intrusive thoughts while meditating is my to-do list, so it would be helpful if I gave it its own dedicated time.)

This process of listening to my gut and planning has given me a clearer idea of what I want to do with this blog going forward. Having realised and accepted that I still have unresolved issues around sexuality, I want to work on those and I’m going to try harnessing the power of memes to give me a kick in the pants to get that stuff done 🙂

 

F4Thought

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