Bad Bellies and Different Cuisines

This past weekend, my partner and I met some friends for lunch at a Chinese Yumcha restaurant, and it made me think about my experiences with FM and other cuisines. In some ways, different cuisines can be better for my belly, and others can cause problems. 

This week, I would therefore like to share my experience with FM and different types of foods.

ADVANTAGES OF DIFFERENT FOODS

I have found so far that the main advantage of different cuisines, particularly Asian-based cuisines, is that there is very little reliance on wheat products. For example, rice flour is used in noodles, such as in vermicelli, which is particularly common with Chinese and Vietnamese food. Additionally, rice flour is used in batter with Japanese tempura. In Middle Eastern or South American cuisines, it is also more common to find other types of grains with meals, such as quinoa.

I have also found that although they still tend to contain wheat flour, French and Turkish breads seem to be made differently to other “regular” bread, and are often slightly better for my belly.

CHALLENGES WITH DIFFERENT FOODS

On the other hand, one of the main challenges with other cuisines is that in comparison to in “Western” cultures, there is less acceptance, or perhaps awareness, of different dietary needs. In fact, I have been told that in some Asian cultures, having a bowel condition is seen as “embarrassing” and “troublesome.” This means that it is often harder in these types of restaurants to find gluten free or fructose friendly meal options. Additionally, I have found that menus in these restaurants seem to have less complete ingredient lists for their dishes, which can make it hard to determine whether they are fructose friendly.

Along with this, I have found that across most cuisines, onion and garlic tend to be very popular, and this of course makes things difficult with FM. In particular, lots of different sauces use both of these ingredients. Onion is also very common in dishes such as Chinese stir fry, and Koren bulgogi, or in fillings for different types of dumplings.

One of my weaknesses when it comes to Asian food is Thai green curry, and as I’m sure you can imagine, this can be problematic – curry can be a problem for people with “regular” bellies, and the effect can be much worse with a belly like mine!

MANAGING CHALLENGES WITH DIFFERENT FOODS

While it can be challenging for people with FM to eat foods, I have found some methods that can help to manage this when eating out:

Ask questions – If you are unsure about the dish, ask for clarification on the ingredients. I find in this situation that rather than trying to explain my FM, I just ask whether the dish contains onion, for example.

Request for problem ingredients to be removed – Sometimes, if you make a special request, the restaurant may be able to accommodate you. I have previously had some success with asking for onion to be removed, and simply explaining that I am not able to eat it.

Before going to a new restaurant, particularly if you are not very familiar with the food, do some research – I often look up the menu online if it is available, or ask around about the food served there. This can sometimes just help me to prepare for what I can expect in terms of the food, and what to look for that will be more suitable for my belly.

Do you have any tips for FM and foods from different cuisines?

Bad Bellies and Stress

It’s been a bit of a tough one this week. :(

Things have still been very busy and stressful at work, which was not helped by the fact that it was a short week, due to a public holiday on Tuesday. As a result, my health has also been affected - I have had difficulties sleeping, low appetite, and my belly has felt off all week. Yesterday, work was busier than usual, and I was really struggling - by the time of my lunch break, I was feeling overwhelmed and drained. I am generally quite introverted, so I found that having some quiet time by myself, and playing Candy Crush Saga for a few minutes to give my mind a break, seemed to help. However, by the end of the day, I was exhausted. At that point, relaxing in front of the TV also seemed to help, but I was also very glad to crawl into bed later that night!

Today was a little better, but still stressful. My appetite has improved slightly, but I am still very tired and my belly has been a bit shaky. Again, having some quiet time at home tonight has helped, and I am also very glad for the weekend!

Do you have any tips for managing stress? Please share below.

Bad Bellies and Appetite

This week I have experienced some loss of appetite, which is not usually something I have trouble with. Therefore, this week I would like to explore the causes of loss of appetite, particularly with a bad belly like mine, and share my thoughts on how to manage this symptom.

COMMON CAUSES OF LOSS OF APPETITE

There are many possible causes of loss of appetite, and I have listed the most common ones below (summarised from here, here and here):

• Bacterial or viral infection
• Stress
• PMS
• Hypothyroidism
• Pregnancy
• Irritable bowel syndrome
• Inflammatory bowel disease
• Side effect from medication
• Depression
• Kidney, liver or heart disease
• Colon cancer
• Eating disorders

When looking at this list, I think that my problems with loss of appetite this week have been mainly caused by stress from work, as I have taken on a new role at work recently, and it has been very tiring. I am pretty sure that I do not have an infection or cancer, am not pregnant or suffering from an eating disorder, and do not have kidney, liver or heart disease. Also, I am generally excited about my new role, so I don’t think depression is a factor.

As previously discussed, stress can also exacerbate the symptoms of IBS and IBD, and I did also have quite a bad belly week in general. Additionally, loss of appetite is also common with both IBS and IBD. In particular, loss of appetite can be caused by many of the other symptoms or complications of these two conditions – bloating, nausea, pain, diarrhea, fatigue, and even mouth ulcers. You can read more about the relationship between appetite and IBS here, and with IBD here.

MANAGING APPETITE

Although some people might say it can be useful to lose weight, and look for appetite suppressants when on a diet, loss of appetite is generally not a good thing. It is especially problematic for people with bowel conditions, as the body may already be missing out on some nutrients.

Therefore, I believe it is important to find ways to increase appetite when experiencing loss of appetite. Here is a list of possible ways to treat loss of appetite (summarised from here, here and here):

• Treating the underlying condition, usually with medication
• Eating smaller meals, to help avoid bloating
• Eating food you enjoy
• Eating bitter foods, which can stimulate digestion
• Eating foods that can help settle the stomach
• Maintaining a regular meal schedule
• Creating a relaxing environment when eating

In my situation, I found that my appetite improved when I was more relaxed, and also when I was eating foods I liked. Stress relief activities also helped, such as dancing to my favourite music, or talking things out with people close to me.

Additionally, there are ways to prevent loss of appetite from occurring, as discussed here and here. In particular, these methods include changing your eating habits, avoiding stress, exercising, keeping hydrated, changing your routine, or adjusting medications.

Do you have any tips for managing your appetite? Share below.

FM and Going Gluten Free

When I was diagnosed with FM, my dietician suggested that “going gluten free” may help, as this would also help to decrease my intake of fructans. This is because wheat contains high amounts of fructans, as discussed in this previous post, as well as gluten. However, gluten free is not always fructose friendly, and this is something that I often struggle with, particularly with the current popularity of gluten free foods. This week, I will discuss the possible connections and differences between gluten free and fructose friendly foods, and my personal experiences with this.  

GLUTEN FREE FOODS

It is very common today to find gluten free variations of many foods which are typically made with wheat flour – bread, pasta, wraps, pizza bases, cakes, biscuits, and even Weet-Bix! I have to say that in my experience, these gluten free foods are sometimes unpleasant – they can be dry, heavy, and even tasteless. Additionally, I find that gluten free pasta does not fare well as leftovers, as they often lost their consistency. However, there are also some things that are very well made – flourless cakes, for example.

Here are my favourite gluten free products so far:

Peckish Rice Crackers

Butterfingers Gluten Free Shortbread 

Table of Plenty Rice Cakes

San Remo Gluten Free Pasta

Buon Appetito Gluten Free Pasta

DIFFERENT TYPES OF FLOUR

In order to make things gluten free, i.e. wheat free, there are many different flours that are used. This website gives a comprehensive list of possible alternative flours, but the most common ones in my experience are as follows:

• Maize/corn flour

• Potato flour

• Rice starch

• Spelt flour

• Tapioca flour

These flours are often made in combination to help get a good balance of textures, like in the recipes listed here. If you are mixing your own gluten free flour, the basic formula to follow is 40% whole grain flours, and 60% white starches.

The problem for those with FM is that some alternative flours are high in fructose or fructans. As previously discussed, I am very sensitive to corn flour. This can also be a problem when different flours are used as thickeners in sauces or stocks.

POSSIBLE ALTERNATIVES TO GOING GLUTEN FREE

In my experience so far, it is sometimes better to find other alternatives to gluten free foods. For example, I find that sourdough bread is a good alternative to gluten free bread, as it does not contain problematic ingredients like corn flour, and still tastes good. On the other hand, when ready-made gluten free foods are not suitable, a good option is to make your own flours, stocks or sauces.

What are your experiences with FM and gluten free foods? Please share below.

Recipes for Bad Bellies: Fructose Friendly Mason Jar Fruit Salad

Following on from last week’s post, this week I decided to try making a Mason Jar Fruit Salad.

I adapted this recipe for Triple Berry Nut Salad. In order to make the salad more fructose friendly, I substituted maple syrup for the honey. And, just because I like them, I added in some kiwi fruit, swapped the whole almonds for shaved almonds, and had some Greek yoghurt on the side. Greek yoghurt can also be generally better for bad bellies than other yoghurts, as it is less likely to contain thickeners made from wheat or other ingredients with high amounts of fructose or fructans, and tends to contain less lactose than other yoghurt.

Here is my recipe:

Ingredients

For the dressing:

Juice from half an orange

Juice from half a lemon

2 tsp of olive oil

1 tsp of maple syrup

For the salad:

1 punnet of strawberries, quartered

½ cup of blackberries

½ cup of raspberries

1 kiwi fruit, sliced

½ cup blueberries

Approx. 2 tsp of shaved almonds

Greek yoghurt

Instructions

• Combine the orange juice, lemon juice, olive oil and maple syrup for the dressing, and mix well. Add this to the bottom of the jar.
• Add the blackberries and raspberries.
• Add the strawberries.
• Add the kiwi fruit.
• Add the blueberries.
• Because the shaved almonds will quickly become soggy from touching the fruit, put them in a zip-lock bag. Then, fold up the bag, and put it in the top of the jar.

• During your lunch break at work, tip out the salad onto a plate, add the yoghurt to the side, and enjoy.

Note, however, that this recipe does not work with frozen berries! I learned this the hard way when the time came to eat the salad, and I discovered that there was now a lot more juice in the jar than before. Below is a photo what happened when I tipped the salad out onto a plate. It was a little difficult to eat like this, but still tasted okay. I realised that the frozen berries must have released more liquid as they defrosted overnight. Additionally, the fruit had compacted down quite significantly since the day before when I had prepared the salad, and I believe this is because the fruit had also softened during the night, possibly also due to the berries defrosting. I have therefore also concluded that this salad must be eaten quickly, and can only be made with fresh fruit!

Recipes for Bad Bellies: Fructose Friendly Mason Jar Salad

Last week, I discovered a new phenomenon – the Mason Jar Salad. By layering ingredients into a Mason Jar (or something similar), this is a very clever way to make a salad, especially to have for lunch at work.

ABOUT THE MASON JAR SALAD

The basic principle of a Mason Jar Salad is the way you layer the ingredients in the jar, particularly to keep wet and dry ingredients separated, to ensure that the salad stays fresh. Additionally, after you then tip the salad out onto a plate or into a bowl, the ingredients should mix together well, i.e. with the dressing on top, and leafy greens on the bottom. Here is a summary of the basic formula:

• First layer (bottom of the jar): salad dressing
• Second layer: “hearty” vegetables (e.g. tomatoes, cucumbers, carrots, capsicum, broccoli, celery)
• Third layer: other vegetables (e.g. beans, mushrooms, corn, avocado)
• Fourth layer: grain layer (e.g. pasta, rice, couscous, quinoa)
• Fifth layer: protein (e.g. chicken, fish, eggs, other meat) and cheese
• Final layer (top of the jar): leafy greens (e.g. lettuce, spinach, cabbage), nuts and seeds

As long as you keep to this basic formula, even if you are not using ingredients from all the layers, the salad should keep fresh in transport to work, and fall out of the jar correctly.

MASON JAR SALADS FOR BAD BELLIES

There are many websites that provide a good range of recipes for Mason Jar Salads, such as this one, or this one. Just by doing a search on Google, you can find even more. However, most of these recipes are not completely suitable for those with fructose malabsorption, or IBS in general – but they are easily adaptable.

This week, I chose to adapt this recipe for a Greek Chicken Mason Jar Salad. Most of the ingredients in this recipe are on the low-fructose content list, but I still made a few small changes. First, I did not put in any salad dressing, because pre-made ones tend to contain ingredients that affect my belly, such as garlic. Additionally, I am not a big fan of olives, so I substituted them for carrot. And finally, I added in parmesan cheese, for a little extra flavour, and pine nuts, for a bit of crunch.

Therefore, here is my recipe:

Ingredients

1 small-sized chicken breast fillet, cooked and sliced into small cubes

5-6 mini Roma tomatoes, chopped into halves

½ half of a cucumber, sliced and chopped into halves

1 medium-sized carrot, sliced and chopped into halves

1 small piece of feta cheese, chopped into small cubes

Approx. 1 tablespoon of parmesan cheese, shaved

Approx. ½ tablespoon of pine nuts, roasted

1-2 handfuls of lettuce leaves, chopped into medium-sized pieces

1-2 handfuls of spinach leaves

Instructions

• Add tomatoes, cucumber and carrot to the bottom of a small- or medium-sized Mason Jar (or similar - must be a glass jar with an airtight screw lid).

• Add the feta cheese and parmesan cheese.
• Add the chicken.
• Add the pine nuts, lettuce and spinach.
• Ensure that the ingredients are packed into the jar tightly, and then put on the lid.

• During your lunch break at work, tip out the salad on a plate or in a bowl (you may need a fork or spoon to help), and enjoy!

I was very happy with the result - the salad was still very fresh, and tasted really good! And my belly was completely fine. This is something I will definitely try often.

Have you tried making a Mason Jar Salad? Please share below.

Planning Meals for Bad Bellies

One of the things that I find most difficult about having two digestive disorders is planning my meals within the constraints of both, while also keeping to my budget. Some days, the question “What am I going to eat?” can therefore be very difficult to answer.

This week, I would therefore like to share my progress in this, and what I have learned so far.

MY GENERAL EATING PLAN

For several years, through school, university and now work, I have typically kept to the following daily meal structure: a small breakfast (usually some yoghurt), medium-sized lunch (like a sandwich or some fruit), and then my largest meal in the evening. This has been largely influenced by my general lifestyle – something quick as I leave in the morning, a slightly bigger meal in the middle of the day to keep me going at work, and then a good dinner when I get home and can relax. In particular, having yoghurt for breakfast seems to settle my stomach in the morning, which I believe is due to the probiotics in the yoghurt. Occasionally, I will also have some small snacks during the day, such as some biscuits or nut clusters, and try to keep hydrated as much as possible. This is the general pattern on weekdays, as I work full time during the week.

On the weekends, things are generally a bit more relaxed – I might have a larger brunch after sleeping in, rather than two separate meals for breakfast and lunch. Additionally, it is more common for me to eat out on the weekends, either with friends or my partner, whereas during the week I tend to prepare my own meals at home.

As discussed in this previous post, there are several different diets that could be useful for managing IBD or IBS, and I generally follow a combination of two or three different diets, depending on the situation. Similarly, you can find several suggested meal plans for IBD and IBS, such as this one, this one, or this one. However, I have found that neither of these are completely suitable for my situation, and thus I continue to rely on my own process of trial and error.

DIFFICULTIES WITH MY MEAL PLAN

I do try to be strict with my meal schedule during the week at least, as it is recommended to have regular meal times to help with digestion, both with IBD and IBS. There are a few factors that can make this difficult for me however, as summarised below:

• I am not the best cook. – Because I don’t seem to have much of either a talent or instinct for cooking, I find that cooking can take a lot of effort, and as a result, I often end up cooking very basic meals. Sometimes this can be good for avoiding trigger foods, but at the same time it means that I often lack variety in my meals.

• Specialty foods or ingredients are often expensive, or difficult to find. – While I try to be strict about avoiding my trigger foods, this can sometimes be quite costly, as specialty foods, often found in the health food aisle of the supermarket or in specialty supermarkets, are often more expensive than other “regular” foods. Additionally, although this it is becoming more common in Australia due to products by GlutenFree4U and Dr. Sue Shepherd’s Low-FODMAP range (see image below), it is often quite rare to find foods that are suitable for people with FM.

• It is easy to be lazy after a long day at work. – As discussed above, I am not the best cook, and when you add feeling tired after a long day, cooking can be the last thing I want to do!
• Sometimes I lose my appetite during a flare. – On days where I am feeling bloated or have a stomach ache, eating and cooking are often the last things on my mind.
• It is more difficult to avoid trigger foods when eating out. - As previously discussed, eating out can add an additional layer of complexity for avoiding trigger foods, as you often have less control over what you eat, and restaurants are not often able to cater for food intolerances – but this is becoming more common.

I am slowly working on my cooking skills and learning new recipes, but this has been a slow process. To help with this, I make sure to have leftovers to put in the freezer at much as possible when cooking, and when eating out, I look for restaurants or cafes that can cater to dietary requirements.

Do you have other suggestions for planning meals for IBS and/or IBD? Please share below. 

Bellies and Fruit

When I first tell someone that I have FM, they often ask, “So, that means you can’t eat fruit, right?” The idea that fructose is only in fruit seems to be a common misperception among the general public. For this reason, it is common for those who are newly diagnosed with FM, including myself, to avoid fruit completely at first. This can become a bit of a paradox, however, as we are often told that fruit is important for a healthy diet – as the saying goes, “An apple a day keeps the doctor away.”

So, how do I find the right balance between avoiding trigger foods, some of which are fruits, and having enough fruit in my diet to get the nutrients my body needs?

FRUIT AND FRUCTOSE

As previously discussed, fructose is a type of monosaccharide, and is generally difficult for the body to digest, especially in its fructans form. For this reason, many people believe that fructose is bad for the body, and can lead to weight gain and discomfort. Because most fruits commonly contain higher amounts of fructose, they are often avoided, particularly by those that are following a sugar-free diet. This is not entirely true, however – yes, fructose can be a problem, but avoiding fruit entirely is not the answer.

In fact, this 2013 US study concluded that eating fruit does not cause weight gain, and because the fibre in fruit can help slow down the body’s digestive processes, the effect that the fructose has on the body is often decreased when eating fruit. Additionally, as discussed in this article, fruits and vegetables contain relatively low levels of fructose, and can usually be handled reasonably well by the body – that is, for those without FM. Instead, foods that contain high fructose corn syrup, which is often used as a sweetening agent, can be more problematic for the body. Also, as previously discussed in this post, there are many other types of food that also contain high amounts of fructose or fructans.

HEALTH BENEFITS OF EATING FRUIT

Apart from not causing weight gain, there are also many benefits of eating fruit. For this reason, the “5 a Day” campaigns around the world advocate having five portions of fruits and vegetables every day, which was developed from the World Health Organisation’s recommendation that the minimum daily intake of fruit and vegetables should be 400g. and therefore I believe that despite having FM, it is important to have some fruit in my diet. Here is a summary of the main health benefits of eating fruit:

• Fruit is a good source of soluble fibre, and therefore helps lower cholesterol and relieve constipation.
• Some fruits contain vitamin C, which can help boost the immune system.
• “Blue fruits” such as blueberries, blackberries, and purple grapes contain anthocyanins, which have anti-oxidant properties, and can help prevent some cancers and aging.
• Fruit is naturally low in calories and fat, but are still filling, so they help to prevent weight gain.
• In general, fruit can help reduce the risk of heart disease and stroke.
• Some fruits contain high amounts of potassium, which can help lower blood pressure, and reduce the risk of kidney stones or bone loss.
• Many fruits also contain folic acid, which helps the body form red blood cells, and is particularly beneficial for reducing birth defects during pregnancy.

The below infographic gives a good summary of some of these benefits, however for more information on the health benefits of specific fruits, please follow the links on this website.

MANAGING FRUIT IN MY DIET

Growing up, I often loved eating fruit. My favourites were apples, pears, bananas, berries, watermelon, grapes, kiwi fruit, and mango. However, after my FM diagnosis, I found out that many of these contained high amounts of fructose, which meant that my choices were much more limited. I have now narrowed this list down to the fruits with lower amounts of fructose, which are bananas, berries, and kiwi fruit, and I have added mandarins as well. This way, I hope that I am still having a good mixture of nutrients – potassium from the bananas, anti-oxidants from berries such as strawberries (my top favourite fruit!), vitamin C from the mandarins, and omega-3 fatty acids from kiwi fruit. The fruits are also all good sources of fibre and other vitamins.

Most days I take one or two pieces of fruit to work to have with my lunch, and this seems to work well for my belly. After I first started doing this about 6 months ago, I have noticed a small difference in my energy levels and overall health. Additionally, I try to have extra little bits of fruit through eating fruit yoghurt in the mornings, and I occasionally have berry smoothies – but without apple juice or honey in them.

Note: Some suggest that there are certain ways to eat fruit in order to get the most benefit from them. For example, this website recommends eating fruit on an empty stomach, and separate to other types of foods. However, this is a myth, and has not been scientifically proven.

Do you have any suggestions for adding fruit to the diet for those with FM? Please share below.

Bad Belly Aches

For sufferers of IBD and/or IBS, stomach aches and abdominal pain are an extremely common phenomenon, and very often taken as a given. For many, including myself, there is often a silent struggle to manage the pain, while also not letting it take over our lives. However, not all belly aches are the same.

This week, I would therefore like to share the different types of belly aches I have experienced.

TYPES OF BELLY ACHES

As the below image shows, there are numerous causes of abdominal pain. For our purposes, however, I am just going to discuss the ones that are directly related to the digestive tract.

According to this 2012 article, there are two main types of abdominal pain that occur with IBD: visceral, and somatic. Visceral pain is categorised as occurring within internal organs, and the exact cause is often difficult to identify as it is often a dull and inconsistent sensation. Somatic pain, on the other hand, usually has musculoskeletal sources, and tends to be a much more intense pain.

I feel, though, that these two categories are insufficient to cover all of the types of abdominal pain I have experienced, particularly because they are very general categories. Instead, I prefer to identify my types of abdominal pain based on what I believe has caused them, and how they feel:

Indigestion pain – This pain often occurs if I eat foods that contain too much fructose or fructans, and often starts very quickly after eating. It is a quite intense pain, and is located in the area of my stomach, directly below my ribs. Depending on what I have eaten, it can last between 30 minutes and 2 hours.

Bloating pain – This type of pain often follows indigestion, and is localised lower down in my abdomen, in the area of my intestines. When I am bloated, I often find that the pain quickly increases if I am wearing form-fitting pants, due to the pressure on my belly, so I have to switch to tracksuit pants if possible. Sometimes the bloating can be improved through passing wind, but it can often take some time before it settles down completely, perhaps 2-3 hours on average. Additionally, the pain can ebb and flow as the gas moves through the bowel, so it is not a constant pain.

Hunger pain (1) – This type of pain is a strange one, and appears to be less common among those with IBD and IBS, but I have noticed happening to me a few times over the last 2-3 months. I believe I have experienced two different types of hunger pain: hunger pain that happens before meals, and hunger pain that happens after meals. The first type of hunger pain seems to happen because I have not eaten quickly enough after starting to feel hungry. This is often because I am meeting others for a meal, and have to wait for them to arrive and for our food to be prepared. This type of hunger pain feels similar to indigestion, but seems to be caused by hunger instead, as my stomach was always empty when it happened. It can sometimes last for 1-2 hours, and is not immediately helped by eating. Therefore, I am now very careful to have a precise eating schedule as much as possible.

Hunger pain (2) - The second type of hunger pain I have experienced was much more intense, and occurred with other symptoms. The first (and so far, only) time I noticed this pain was late one night when returning home after dinner, and although I had tried to be careful with what I was eating earlier that night, I started feeling very bloated while driving, and also slightly light-headed. Thankfully, I was able to get home safely, but by that point I was also feeling nauseous and unsteady on my feet. I had thought that it would be fixed by sitting on the toilet, but if anything, this made the pain and dizziness worse. The pain was very intense, and it felt like my stomach was being squeezed and twisted like a wet towel. I went to bed, and when I woke up 3-4 hours later, it was as if nothing had happened! I now believe that perhaps I had not eaten enough for dinner earlier that night, hence I quickly became very hungry again. To avoid this, I try to have little snacks with me to eat during the day if I start to feel hungry, and am also very conscious of eating enough at meal times.

Diarrhea pain – This pain often happens when I feel diarrhea coming on, and sometimes happens with nausea as well. The pain is felt lower in the abdomen, in the area of the colon, and bowel movements can be very uncomfortable. Depending on what has caused the diarrhea, it can last for 30 minutes or 24 hours.

Constipation pain – This type of pain occurs when constipated, and usually happens when I am attempting to have a bowel movement. There are usually be short, stabbing pains in the anal region as the pressure builds, and there is also some residual pain in the area following the bowel movement (if successful).

MANAGING AND TREATING ABDOMINAL PAIN

There are many methods to manage and treat abdominal pain, which mainly fall under three categories: pharmacological, behavioural, and procedural. Firstly, pharmacological methods include anti-inflammatory medications, such as those commonly taken by people with IBD, and general painkillers. Behavioural methods are largely focused on promoting relaxation and reducing stress, so as to help reduce symptoms. Finally, procedural methods involve treatments such as acupuncture and nerve blockers, which aims to directly treat the pain. If these methods are insufficient, however, surgery may be also necessary, such as a colectomy.

In my experience, my IBD medication seems to somewhat lessen the abdominal pain, but does not completely prevent it. Therefore, I manage my pain in two stages: prevention, and treatment. In other words, I do the best I can to avoid being in situations that will cause abdominal pain or make it worse, such as being careful with my diet and avoiding stressful situations. Additionally, as previously discussed, it is recommended that people with IBD have smaller meals and snacks throughout the day, as this can make it easier for the body to digest the food. If the pain still occurs, however, I then do what is necessary to treat it, and thereby help it to alleviate quickly. This can include sitting on the toilet, passing wind, or using a heat pack. My favourite type of heat pack is a wheat bag, like the one in the photo below:

Do you have any tips for managing abdominal pain? Please share below.

Bad Bellies and Diet

In my opinion, the most frustrating thing about having FM is its sheer complexity, as fructose is in almost every food. Additionally, having UC adds an extra layer of complexity for me. From what I understand, this is a common problem in general for people with IBS and/or IBD. Many people, including myself, have therefore tried to simplify things by creating special types of diets, hoping to make things easier to manage on a daily basis.

This week, I am therefore going to share some of my research into these types of diets, as well as how I have adapted them for my own needs.

COMMON DIETS FOR BAD BELLIES

In my research and so on, I have often come across discussions about different types of diets that are suitable for IBS and/or IBD. Here is a summary of the ones that I have read about most:

The Gluten-Free Diet – This diet is mainly designed for people with Coeliac Disease, and focuses on eliminating all foods containing gluten (wheat, rye, triticale and barley). This diet can also be useful for people with FM, as many foods that contain gluten also contain high amounts of fructans. Here is a good summary of this diet. For those with FM, however, this diet can still be risky, as mainly gluten free products use corn flour as a substitute for wheat flour. Additionally, specialty gluten-free products can be expensive, so some people can find it difficult to maintain this diet.

The Low FODMAP Diet – The Low FODMAP Diet was developed by Dr. Sue Shepherd in 1999, as a form of treatment for people with IBS, and has two phases – first, restricting all high FODMAP foods for 6-8 weeks, and then developing the diet to suit the individual’s condition. FODMAP stands for Fermentable Oligosaccharides (includes fructans), Disaccharides (includes lactose), Monosaccharides (includes fructose) and Polyols (includes sorbital and xylitol). Dr. Shepherd has now began developing her own range of "FODMAP Friendly" foods, as well as encouraging other companies to make their foods "FODMAP Friendly." Foods identified as "FODMAP Friendly" carry the below logo. While this is a very good diet to help with identifying trigger foods and tolerance levels, in some cases it may not be appropriate, as some people only have problems with one or two types of foods, or their problem foods may not be fully covered by the FODMAP categories.

The Paleo (Paleolithic) Diet – Reportedly the most popular diet in the world in 2013, the Paleo Diet is based on the premise that we should only eat the same sorts of foods as our ancestors did, and keep to the types of foods that our bodies are built to digest. In essence, this means no processed foods. Here is a good resource for understanding this diet. This diet is said to be very healthy and this has been supported by several studies. Some are still sceptical however, arguing that this diet is not necessarily sustainable, as the life expectancy of our ancestors was much lower than it is today.

Going Organic – This diet focuses on consuming only foods grown naturally, in order to avoid consuming harmful chemicals and environmental damage. This includes avoiding plants grown using pesticides or fertlisers, avoiding meat from animals given growth hormones or other drugs, and only using products from animals raised in a “free range” environment. Here is a useful summary of the main arguments for going organic. This diet can also be problematic however, as it can be difficult to determine whether foods are definitely organic, and organic foods are often more expensive.

The High-Fibre Diet – The High-Fibre Diet is often recommended for people with IBS-C, as previously discussed in this post, as it can help to reduce constipation. The most fibre-rich foods are often fruits, vegetables, and whole grains. However, this diet is not suitable for people with IBS-D, as too much fibre can cause diarrhea. Here is a good list of fibre-rich foods. Additionally, it can be difficult for people with FM to maintain this diet, as many high-fibre foods also contain high amounts of fructose or fructans.

The Low-Fibre (Low-Residue) Diet – The Low-Fibre Diet is therefore recommended for people with IBS-D, as it can help to reduce diarrhea. It is also recommended for people who have had bowel surgery. Rather than completely eliminating all fibre, this diet focuses on consuming only soluble fibre. Here is a useful summary of high- and low-fibre foods.

The Low-Fat Diet – This is of course a very common diet for weight loss, however it is also recommended for people with IBS because high-fat foods usually have lower levels of fibre, and can therefore cause constipation. Here is a good guide for following the Low-Fat Diet. When following this diet though, it is important to remember that not all fats are unhealthy, as discussed here.

The above diets are generally more appropriate for managing IBS, however some aspects of them are also applicable for those with IBD. As discussed in this article, people with IBD should avoid high-fibre and high-fat foods. In addition to this, it is important to keep hydrated, foods with prebiotics or probiotics may be helpful, and vitamin supplements may be necessary (as discussed in this previous post).

Have you found a diet that works best for you? Please comment below.

MY DIET

While all of the above diets have their benefits, in my own experimentation so far, I have found that neither of them are quite right for my situation. This is because none of them are specifically tailored for people with FM or UC. Therefore, through a combination of trial and error, elimination and substitution, I am slowly developing my own diet.

I have previously discussed my main trigger foods and tolerance levels, and these elements have helped guide me when I am thinking about what to eat each day. Additionally, I have found that different types of diets can be useful for certain situations. For example, when I am going to a function or event, it is sometimes easier to just list “gluten-free” for my dietary requirements. When cooking for myself, however, I will usually aim for something closer to the Low FODMAP diet - selecting the aspects applicable to my FM - as I am able to have more control over the ingredients used. Additionally, if I am having trouble with my bowel movements, I may try to either reduce or increase my fibre intake.

In my experience, and also in my general opinion, there is no such thing as a perfect diet, and it is neither healthy nor sustainable to be too restrictive in what you eat. As I mentioned in my first post, restricting my diet too much following my FM diagnosis just resulted in weight gain and fatigue. I am therefore focusing on what my version of healthy is, both because of, and in spite of, my FM and UC.

Have you had similar experiences with your diet? Please comment below.

Bad Bellies and Sleep

I have previously touched on the affect that sleep patterns have on the digestive system, but what about the effect that the digestive system has on your ability to get a good night's sleep?

For the last 2-3 years, I have struggled to get a full night's sleep. I did actually get a full night's sleep on one night last week, but I don't remember the last time I slept through the night before that, and it has not happened since. I have experienced two main types of sleeping difficulties: tossing and turning all night, and waking up two or three times during the night. While I have gotten used to it over time, and can cope on only a few hours of sleep most days, I have noticed that it can have a negative effect on my energy levels. I believe this has actually been a factor in the fact that I have had two car crashes in the last 18 months – thankfully, I am fine, but I can’t say the same for the cars! Additionally, I have found that if I have several nights in a row where I have slept very badly, I will inevitably get sick, usually with some form of cold or the flu.

However, for a long time I have struggled to figure out why I have had difficulties with sleeping for so long. Of course there are some nights where it is obviously due to things like stress from work, a bad stomach ache from a flare-up, or as a result of other symptoms from having a cold, but on other nights there doesn't seem to be a logical explanation.

So, I have been doing some research. As it turns out, I am not alone - difficulty sleeping and insomnia are common complaints among people with fructose malabsorption. As discussed on this blog for example, people have trouble waking up during the night, and being unable to fall asleep. Although it focused on the link between fructose malabsorption and depression, and not the link with sleep, this study concluded that there is a tendency for those with fructose malabsorption to digest L-tryptophan. This is because high levels of fructose in the body can interfere with the absorption of L-tryptophan in the digestive tract. L-tryptophan is an amino acid that is responsible for producing hormones such as serotonin and melatonin, among other things.  Melatonin helps control the body’s sleep cycle, and therefore with less L-tryptophan and as a result less melatonin, this means that those with fructose malabsorption can experience disruptions in their sleep patterns.

After reading this information, I have noticed in retrospect that when I have had a particularly bad belly day, I do seem to have more trouble with sleeping compared to other days. Additionally, the time when I started having sleep difficulties seems to correspond with when I first experienced symptoms to do with my fructose malabsorption. This is something I am going to focus on more moving forward, and perhaps through experimenting with my diet, I will be able to sleep through the night more often! I will share what I work out later on :)

Have you noticed that your sleeping patterns are connected to your diet and IBS? Please comment below.

My Belly and Food

One of the most common questions that people ask when I talk about my UC and FM is: “So, what can you actually eat?” Similarly, in support groups on social media, I have often seen people asking whether they can eat this food, or that food. However, these questions are not easy to answer, because as much food lists can be a guideline, everyone’s body is different, and can react to certain foods in very different ways.

For this reason, I thought that this week I would write about my belly’s reactions to certain foods, based on my experimentation so far. 

MY TOP TRIGGER FOODS

Whenever people ask me about my dietary requirements, I always say that first and foremost, I need to avoid apple, pear, onion, garlic, and wheat, as these three appear to be my top trigger foods. The other main food that I have a lot of trouble with is corn flour, which is where my belly seems to have a very individual reaction compared to most people with FM.

As previously discussed, there are some foods that contain higher amounts of fructose and/or fructans than others, and the amount of glucose in the same food can also make a difference. Not only do these foods all have quite high levels of fructose or fructans, they also have a very high fructose/glucose ratio, meaning that they are harder to digest. This table gives a good list of the fructose content and fructose/glucose ratios in common foods. When looking at the fructose/glucose ratio, if the ratio is lower than 1, the food should be easier for the body to digest. For example, you will see that fresh apple contains 6g/100g of fructose, and the ratio is 2.8 – the highest ratio on the table. In comparison, pumpkin only contains 1g/100g of fructose, and the ratio is 0.9. Interestingly, honey has a very high fructose content at 39g/100g, however it must also have a high glucose content, as the ratio is 1.1. According to this more extensive table, the fructose content of pear is also very high, at 6.2g/100g.

There is therefore little wonder that apple and pear cause a lot of problems for my belly! I first realised that apple was particularly problematic for my belly following my diagnosis with FM, as I realised that the reason I was feeling so sick was that I had been drinking apple juice all the time – apart from water, it was my main beverage throughout the day. Once I stopped drinking apple juice, my belly immediately felt much better. Now, if I eat more than one or two pieces of apple or pear, I start to have a stomach ache, and this can often lead to diarrhoea.

Onion and wheat also give me stomach aches and diarrhoea, which seems to be due to their high fructans content. According to this table, white onions contain 1.1-7.5g/100g of fructans and brown onions contain 2.1g/100g, whereas wheat contains 0.4-1.3g/100g. I have had problems with bread for many years, and initially thought I may have been gluten intolerant. Again, once I stopped eating bread, I noticed a significant difference. Garlic also contains a very high amount of fructans, at 9.8-17.4g/100g. I later realised that garlic and onion were major culprits, because they are cooked in almost every sauce you can think of, regardless of the cuisine! Now, I notice a significant difference in my belly’s reaction when I eat something with a sauce made with onion and garlic, compared to when I make my own sauces with just some herbs instead.

Finally, let me tell you about my belly and corn flour. After my FM diagnosis, I looked at several different lists of foods, all of which said that corn was fine to eat, as it has a very low amount of fructose – only 1.5g/100g according to this table. Therefore, one of the first things I bought to try was gluten free pasta made with corn flour, thinking that it would be a great alternative to regular pasta – one of my favourite foods. So, I joyfully made myself a large bowel of pasta with Bolognese sauce and sat down to eat it, only to unfortunately discover a few mouthfuls in that my stomach was starting to hurt, and I was also having significant trouble with acid reflux. Needless to say, my night was ruined, and I felt miserable.

I was confused about what had happened, so a few weeks later I saw a dietician, and asked her why my belly had reacted in that way to a supposedly “safe” food. She explained to me that everyone’s belly has a different threshold for certain foods, and that while eating the pasta made with corn flour, I must have passed my stomach’s threshold for corn. I have now discovered as well that corn flour, also known as maize starch or maize thickener, is used in many foods as a thickening agent, and to replace wheat flour in gluten free products, so this has complicated my grocery shopping even further!

Does your belly have a different reaction to certain foods? Please share below.

THE BEST FOODS FOR MY BELLY

Despite the fact that there are several foods that cause strong reactions in my belly, I have also discovered along the way that there are still lot of my favourite foods that I can eat without too much trouble – and I am very glad that I don’t have to give them up! 

Here is a list of the main ones:

• Mandarins and oranges
• Bananas
• Berries – In small doses. For example, I can only eat half a regular punnet of strawberries at a time.
• Kiwi fruit
• Tomatoes
• Leafy greens (i.e. lettuce, spinach)
• Cucumber
• Sourdough bread – I can eat 2-4 slices without too many problems. My favourite sourdough breads in Melbourne are the ones made by Noisette bakery, and Irrewarra Sourdough.
• Chocolate (phew!)
• Peanut butter
• Potato gnocchi – Though not completely wheat-free, this is still a good alternative to regular pasta.
• Fruit and nut clusters – Another great snack and a good alternative to muesli bars, I like the ones made by Mrs. May’s Naturals and Wallaby Bites.
• Dairy products – I am mildly lactose intolerant, so only one thing at a time. For example, some plain yoghurt with breakfast or a glass of milk is fine, but not if I have them together.

Are there any of your favourite foods that you can still eat? Please comment below.