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My Belly and Swimming

The usual rule is to wait one hour after eating before going swimming, right? Well, it appears that this rule doesn't apply when you have a sensitive and unstable stomach like mine.

About a year ago, I decided to start swimming a couple times a week. Because my local swimming pool is open late in the evenings on weekdays, I planned to go to the pool after work. At first, I tried going for a swim immediately after finishing work, but because I was often tired and hungry, I found that I didn't have the energy for swimming. Instead, I tried having dinner after getting home, then after waiting for an hour, going over to the pool for my swim. However, I quickly discovered that I would have trouble with my stomach while swimming, sometimes after only two or three laps. There have even been a few times when I have had hiccups while swimming, which, as I'm sure you can imagine, makes swimming very difficult! I have also quite often had problems with reflux, which would steadily get worse as I continued swimming.

After lots of trial and error, I worked out that my stomach needed closer to three hours' wait after eating - three times as long as the usual wait time needed for most people. I have also discovered that if I do start to have trouble with my stomach while swimming, it helps if I switch to swimming backstroke - I think this is because it takes the pressure off my stomach.

Have you had similar experiences while swimming? Please comment below.

RESEARCH ON EXERCISE WITH IBS AND IBD

We all know that in general, exercising is a good idea, and studies have found that this is consistent for those with IBS and IBD. In a 2011 study conducted at the University of Gothenburg in Sweden, 43% of the 102 participants with IBS experienced a significant level of improvement in their symptoms after increased levels of exercise. The researchers concluded that this was because the exercise helped to aid digestion, and to relieve stress, thereby stabilizing the body’s hormonal systems. A more recent study conducted in Poland earlier this year looked at the effects of exercise for those with IBD, and had similar results. As well as relieving stress and improving overall health, researchers found that symptoms improved because the exercise helped to boost the immune system.

However, exercise can also be quite difficult for those with IBS and IBD. For example, this article published in the Telegraph discussed how British Olympic rower Sir Steve Redgrave has had to pull out of races due to problems with his Ulcerative Colitis. From personal experience, I can attest that when I am having a flare up with my UC or a stomach ache after eating, exercising is the last thing that I want to do! Some suggest that people with IBS or IBD may have a limit to how much exercise their body can endure.

Please comment below if you have any tips to share for exercising with IBS and/or IBD.

What is Fructose?

Fructose is one of the two main naturally occurring sugars, the second being glucose. Glucose and fructose are both monosaccharides, meaning “one sugar”, as they only contain only one form of sugar molecule; as opposed to sucrose (also known as table sugar), which contains both fructose and glucose, and is therefore a disaccharide. Lactose is also a disaccharide, as it is made up of glucose and galactose.

FORMS OF FRUCTOSE

The body’s reaction to fructose, especially in those with fructose malabsorption, depends on the form that fructose takes in our foods. Fructose comes in two main forms: fructose, which is the single molecule, and fructans, which are chains of fructose molecules. Fructans are the more difficult form to digest, even for those who are not sensitive to fructose.

Fructans are most commonly found in wheat, which is why those with fructose malabsorption often find that bread is a very problematic food. For this reason, up until my diagnosis with fructose malabsorption, I believed for quite some time that I may have had Coeliac Disease.

FRUCTOSE AND GLUCOSE

As I mentioned above, fructose and glucose are both monosaccharides, however they are absorbed very differently in the body. The main reason that fructose can be problematic for many people is that is it not easily absorbed in the body – in fact, only liver cells can break down fructose. In contrast, the majority of the body’s cells can easily break down glucose and convert it into energy.

Fructose and glucose are often found together in foods, and because it is easier to digest, glucose can actually help the body to better absorb fructose. Foods that contain a higher proportion of glucose than fructose can also be easier to digest. My dietician suggested that one way to help reduce the symptoms of fructose malabsorption, particularly if you are in a situation where it is difficult to avoid foods with high fructose content, is to take a glucose tablet with your meal.

Food Intolerance Diagnostics has created a quite useful table showing the fructose/glucose ratios in many common foods here.

FOODS WITH HIGH FRUCTOSE CONTENT

Disclaimer: As I am living in Australia, the below table is accurate for foods produced in Australia, but may not be consistent for foods in other countries. For example, the use of high fructose corn syrup (HFCS) in soft drinks and sweets is much more prevalent in the US than in Australia, as it is commonly used as a substitute for sucrose. For readers based in countries other than Australia, please only use my table as a guide.

For your information, I have created the below table outlining the fructose and fructans content in common foods, which is based on information provided by Dr. Sue Shepherd, in her book Food Intolerance Management Plan.

GENERAL TIPS FOR MANAGING FRUCTOSE MALABSORPTION

I will go into more depth with different diets and so on in later posts, however to start with, here is a summary of the top 5 tips that I have been given for managing fructose malabsorption:

• Rather than always avoiding your favourite foods, look for ways that you can substitute different ingredients so that you can reduce the symptoms. Here is a very good website for information on ingredient substitution.
• Each person will be affected by different foods in different ways, and it is almost impossible to completely avoid fructose in your food. Over time, try to work out what your thresholds are for eating different foods, by slowly trying different amounts of the foods and concentrating on your body’s reaction.
• My dietician gave me some very good advice: for those foods classified as having low fructose or fructans content, use “handfuls” as a measure of your portion sizes for each food, as it can still be very easy to exceed your body’s tolerance threshold.
• For those who also have IBD or other problems, be very aware of the different ways that your body reacts to different foods and at different times, has there could be different reasons for your symptoms. More details on this here.
• Cooking for yourself is often a much better way to avoid problem foods compared to eating out or getting take away meals, as that way you have much more control over which ingredients are used.

Why am I so uncomfortable?

The technical term for digestive discomfort is "intestinal dysbiosis," which means that there is an imbalance of the "good" and "bad" bacteria in the bowel. There are several causes of intestinal dysbiosis, however for our purposes I am just going to give you a brief summary of the more "natural" causes: Inflammatory Bowel Disease, Irritable Bowel Syndrome, genetics, allergies, and hormonal imbalance. The reason for this is to clarify the differences between these causes, as there seems to be a common misconception that they can be the same thing - for example, I am quite often asked if my Fructose Malabsorption means that I am allergic to foods containing fructose, but this is not the case.

INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease (IBD) is an autoimmune response, causing inflammation of the intestines, however the root cause is unknown, and there is currently no known cure. IBD comes in two forms: Ulcerative Colitis, and Crohn’s Disease. Ulcerative Colitis is the less severe of the two forms, affecting only the inner lining of the large bowel, whereas Crohn’s Disease affects the full thickness of the intestinal wall, and can manifest in any part of the digestive tract. The symptoms of IBD include abdominal pain, diarrhea, nausea, weight loss, constipation, malnutrition and fatigue; and, if not properly managed and treated, can lead to bowel cancer. IBD is treated using daily medication, and sometimes dietary changes.

IRRITABLE BOWEL SYNDROME

Irritable Bowel Syndrome (IBS) is most commonly caused by the bowel being sensitive to certain foods. Common food sensitivities include lactose intolerance, fructose malabsorption, and non-Coeliac gluten sensitivity. However, the root cause is also unknown, and there is no known cure. The symptoms of IBS include bloating, flatulence, stomach aches, nausea, and diarrhea. IBS is usually treated through dietary changes.

GENETIC FORMS OF FOOD SENSITIVITY

While commonly thought of as a form of IBS, as the symptoms and treatments are very similar, Coeliac Disease does not fall under the umbrella of IBS. The root cause of Coeliac Disease is genetic, although environmental factors can also trigger the onset of the condition. Coeliac Disease is an autoimmune response to gluten, which causes the intestinal lining to become inflamed, but there is also no known cure.

There is also a genetic cause for sensitivities to fructose and lactose, called Hereditary Fructose Intolerance (HFI) and Congenital Lactase Deficiency. Both of these involve the body not being able to produce the enzymes necessary to break down fructose or lactose. Like Coeliac Disease, the symptoms and treatments are similar to for IBS, which also means that misdiagnosis as IBS is very common. There is no known cure for either of these, and the most effective treatment is to avoid all problematic foods. If not properly managed, these diseases can cause symptoms such as liver or kidney failure, and in extreme cases, may even be fatal. 

ALLERGIES

Allergies are caused by an immune response to what the body perceives as foreign substances, called “allergens.” Common allergens include nuts, shellfish, animal fur, dust mites, pollen, and so on. Allergies generally have genetic causes, and can range from being very mild to life threatening. Symptoms can include hay fever, skin rash, asthma, swelling, and vomiting, and in severe cases, anaphylaxis. Allergies are treated using antihistamine medications, and in some cases specific allergen immunotherapy, which can change the body’s immune response to certain allergens.

HORMONAL IMBALANCE

Hormones are used to regulate the body's chemical processes and functions, but sometimes they can become disrupted, and this can have a significant impact on the digestive tract. There are two main causes of hormonal imbalance: stress, and sex hormone cycles (i.e. cyclical changes in testoterone and oestrogen) - yes, hormonal imbalance can affect digestion for both men and women. The digestive symptoms of hormonal imbalance are very similar to the symptoms of IBS, which means that it can often be difficult to differentiate between the two. Hormonal imbalance can be treated through stress management, hormone therapy, or changes in diet.

My Story

Hi everyone, my name is Aimee, and welcome to my new blog! Belly Burdens is a lifestyle blog designed for people with Ulcerative Colitis and/or Fructose Malabsorption, or for people who know someone in a similar situation.

To start with, let me tell you my story.

Since my early teenage years, due to the increasingly unstable nature of my bowel, food and I have had an uneasy relationship. (I now believe this is part of the reason for my aversion to cooking, but that's another story.) My problems with food are largely due to a combination of two things: Ulcerative Colitis and Fructose Malabsorption. I am also mildly lactose intolerant. I have been told by my doctor that this kind of combination is quite common, as one often leads to the other.

PART ONE: ULCERATIVE COLITIS

I was diagnosed with Ulcerative Colitis (UC) when I was 17 years old. This was after I discovered blood when going to the toilet. (I won't go into too many details about that part, other than to say it was not menstrual blood, and I didn't have a urinary tract infection either - I think you can probably work it out for yourselves what happened right?) After my first (and as I would later find out, certainly not my last) colonoscopy, the diagnosis was confirmed. To say I was shocked was an understatement - my first thought was something like “Wow, I have a chronic disease, how is that possible?” I was told that I was lucky, as it was unusual to discover this kind of disease at such a young age. But I didn’t feel lucky - I just was worried enough about surviving high school, and now I had this to deal with as well?!

UC is the less severe form of Inflammatory Bowel Disease. As I was glad to find out, UC is reasonably easy to treat, and my case is a very mild one. In fact, I am happy to report that the last time I had a colonoscopy, my doctor said that they could hardly see any signs of the disease, so clearly the medication is doing its job! It does, however, still cause my digestive tract to be unstable most of the time, and my belly often makes funny gurgling noises - I hardly notice them anymore, but sometimes I can get funny looks from others! On bad days, I can also get incredibly painful stomach cramps, but fortunately this does not happen very often.

I am currently managing my UC by taking a medication called Pentasa, with a dosage of one 500mg tablet with food three times daily (NB: Pentasa must be taken with food as it can quickly cause nausea if taken on an empty stomach). Pentasa can affect your white blood cell count, so I must take regular blood tests (usually I aim for every 2-3 months), and because it is an Aspirin-based medication, I cannot take Aspirin for headaches - but of course there are plenty of other options. I also need to have a colonoscopy every 2-3 years to make sure that the disease is still under control.

PART TWO: FRUCTOSE MALABSORPTION

A few years later, mid-way through my university degree, I gradually started to notice that even with my UC medication, I was still experiencing significant discomfort after eating, including stomach aches, bloating, and reflux, and it was becoming increasingly severe and frequent. In fact, I have had problems with reflux since my early teenage years, however as I could never pin point the exact cause, I had learned to deal with it. At first I noticed that the effects seem to be worse after eating bread, so I avoided eating bread as much as I could. Doing this helped, but the symptoms still did not completely go away.

After a year or so of this, I went to see my doctor, and he booked me in for all of the tests – hydrogen breath tests for fructose and lactose sensitivity, and a bowel biopsy for Coeliac Disease. The test for Coeliac Disease was negative, and I had a very low reading for lactose, but my reading for fructose was through the roof, meaning that I had Fructose Malabsorption (FM). At first I was relieved, as I at least knew now what the problem was – and I was glad that I didn't have to give my beloved milk and cheese! However, when I then found out which foods contained fructose, my heart sank - it was in nearly everything. 

That was nearly two years ago. I now know that while it is not easy and takes a lot of time, money and effort, FM is manageable - but more about that later. At the time, the best piece of advice I was given was by a dietician, who told me to remember that despite how uncomfortable you are feeling, foods containing fructose does not hurt you, and are not life threatening. If you have just found out that you have FM, I hope this helps put things into perspective for you as well.

Have you had a similar experiences? Please comment below, I would love to hear your stories!

THE NEXT STEP

Up until recently, I really have just been doing the bare minimum to manage my UC and FM, just taking my medicine and trying to avoid consuming foods with high fructose, as I decided that I did not want to allow these things to disrupt my life too much. However, in the last year, I have gradually begun to gain weight, and have had issues with vitamin and nutrient deficiencies, and generally just feeling unhealthy, so clearly this approach is not working for me.

I have therefore decided that starting from now on, I am going to put more effort into properly managing my diet and focusing more on my health in general, and I am hoping that doing this blog will help to keep me motivated in this. I also hope that my accounts of this journey and the experiences I have had will help all of you, my readers. I would appreciate any and all feedback or input, so please do not hesitate to comment on my posts, or contact me via social media. :-)