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.

All About UC

As discussed briefly in this previous post, Ulcerative Colitis (UC) is the less severe form of IBD, and generally affects only the inner lining of the large intestine, i.e. the colon and rectum. Essentially, UC causes the lining of the large bowel to become inflamed and develop small sores or ulcers, as discussed here. The main symptoms of UC include diarrhoea, abdominal pain, blood in the stool, loss of appetite, and fatigue.

This week, I would like to discuss UC in more detail and draw comparisons to Crohn’s Disease, and in turn share some of what I have recently learned myself about both of these conditions.

DIFFERENT TYPES OF UC

In my research, I have recently come across some information that surprised me: there are actually four different types of UC. These are ulcerative proctitis, proctosigmoiditis, left-sided colitis, and pan-ulcerative or total colitis. Ulcerative proctitis affects only the lining of the rectum, and is milder than the other types. Ulcerative proctitis is the most common form of UC, as approximately 30% of people with UC have this type. Proctosigmoiditis involves inflammation of the rectum and sigmoid colon, and symptoms include bloody diarrhoea, cramps (particularly on the lower left side of the abdomen) and a sense of urgency with bowel movements.

Similarly, left-sided colitis also includes pain in the left side of the abdomen, and this is because with this type of UC, the inflammation extends from the rectum and up the left side of the colon, up to the spenic fixture. Left-sided colitis is the next severe form of UC, with additional symptoms such as loss of appetite and weight loss. Finally, pan-ulcerative or total colitis is the most severe form of UC, as it affects the entire colon. This type is also the most dangerous, as it can lead to massive bleeding and a condition called toxic megacolon. With pan-ulcerative colitis, people can experience severe abdominal pain and extensive weight loss, and may require surgery.

From the descriptions I have read, I believe that I have ulcerative proctitis, as my symptoms are generally quite mild, and I have not had any pain in my left side.

Do you know which type of UC you have? Comment below.

SOME OTHER FACTS ABOUT UC

Here is a list of other interesting facts about UC that I have read about recently:

• Diagnosis of UC: Apart from a colonoscopy, UC can also be diagnosed using a barium enema, but this method is less accurate.
• UC and sleep: Studies have shown that it is important to have the right amount of sleep and a good sleep schedule to prevent flares. According to an April 2014 study, women who have less than six hours or more than nine hours of sleep are more at risk of having UC flares.
• UC and pregnancy: Although fertility rates may be reduced after having a colectomy, pregnancy is still possible after surgery, and the pregnancy can actually help improve symptoms. This is something that I was very glad to read about, as it is something I worry about occasionally, especially as children could be a reality for me in the next 5 years. However, if you have had a colectomy, it is suggested that you wait a year before conceiving, as this will help avoid post-surgery complications.
• UC and genetics: Studies have shown that there are genetic links with UC: It can run in families, and is more common in certain ethnic groups. I have tried to work out if there are links to IBD in my family, and may have found some tenuous links in my father’s side of the family.
• UC and food: Although some foods can make UC worse, diet does not cause UC. Instead, researchers believe that UC can be caused by a combination of genetics and environmental triggers, but this is still uncertain.
• Other symptoms of UC: UC can also manifest in other areas of the body, with symptoms including eye inflammation, inflammation of the liver, bone thinning, kidney stones, joint pain, skin rashes and mouth ulcers. You can read more about these symptoms here and here. This was interesting for me, as I do have trouble with mouth ulcers quite regularly, despite increasing my vitamin C intake, and I now wonder if my life-long struggle with dermatitis could also be connected to my UC in some way.
• UC and smoking: Studies have shown that in fact UC is more common in non-smokers, suggesting that there may be something in cigarettes that can prevent the development of UC. Disclaimer: Please do not take this as an endorsement for smoking.
• UC and colon cancer: There is a greater risk of contracting colon cancer after 8-10 years of living with UC, particularly in those that have pan-ulcerative colitis. However, less than 10% of people with IBD develop colon cancer, so there is still a very low risk – phew!
• UC and anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen sodium can cause inflammation and intestinal bleeding, so it is recommended that people with IBD avoid these medications. I have actually found that ibuprofen is most effective for me when I have headaches, and have not noticed any effect on my bowel, but I will try to be more careful of this in future.
• UC and stress: Researchers in the past believed that there was a psychological component to the development of IBD, however these studies have not been confirmed. Stress can exacerbate UC symptoms, but is clearly not a cause of UC.

COMPARISON TO CROHN’S DISEASE

Based on my research, I have put together the following table to compare UC and Crohn’s Disease. I have used information from here, here and here. Note that while the causes and symptoms can be similar, there are also some very significant differences between UC and Crohn’s Disease, so it is important not to confuse the two or treat them as one condition.

Also, it is possible to have a combination of both UC and Crohn’s Disease, which is called indeterminate colitis. You can read more about this here. About 10% of cases are found to be indeterminate colitis.

*More information here: granulomas, 5-ASA medications, corticosteroids, Cimzia, Humira.

Keeping up the Nutrients

One of the things that worried me the most when I was diagnosed with FM was how to avoid high fructose foods while still having a balanced and healthy diet, and this is something that I still struggle with. As previously mentioned, since my FM diagnosis, I have struggled to maintain a healthy diet. Within in a year of the diagnosis, I had gained quite a bit of weight, and I am still struggling to keep my weight under control. While I am by no means obese, I am nevertheless heavier than I have ever been and have had trouble fitting into some of my clothes, so I am not happy about this! I have heard that some medications taken for IBD such as Prednisone can cause weight gain, however this is not the case for me, as I do not take this medication.

I have therefore concluded that the reason for my weight gain must have been the changes in my diet. After my FM diagnosis, I changed to a very simple diet, avoiding as many high fructose foods as possible. Because wheat is a significant problem food for me, but was also a large part of my diet previously, I was eating a lot of pasta and bread made with rice flour and potato flour, which meant that my diet was very high in carbohydrates, hence my weight gain. My diet was clearly very unhealthy, and I felt horrible. I have decided that to help with the weight issue, I need to work on having a more balanced diet and do more exercise, but I still worry that I am not getting the nutrients I need, as I still need to avoid a lot of foods.

MY STRUGGLES WITH IRON

Since I was about 8 years old, I have struggled to keep up my iron levels - although thankfully never quite bad enough to be classified as anaemic. Because of this, I have often struggled in the past with fatigue and dizzy spells. I was initially told that the best way to manage this was through my diet, for example eating more red meat. However, I found out when doing a routine blood test a couple of months ago that my iron levels have decreased since my FM diagnosis. As a result, for the first time, I am now taking iron supplements. I was initially concerned that the supplements would have a negative effect on my bowel, as this can be a common side effect, but this does not seem to be a problem, and I am now taking the supplements three times a week.

MY STRUGGLES WITH VITAMIN D

About three years ago, also through having a routine blood test, I found out that my Vitamin D levels were quite low, and was told by my GP to start taking vitamin D supplements. For the first six months or so, I took the supplements three times a day, and then reduced my dosage to once a day. I have now been told that my vitamin D levels are slightly over the average recommended level, so I have reduced my dosage further to three times a week (I usually take them with my iron supplements). I was initially told that my vitamin D levels were likely low due to not enough sun exposure, which made sense because I do consciously avoid being in the sun for too long, as I have very fair skin and some history of skin cancer in my family.

NUTRIENT DEFICIENCIES AND IBD

Disclaimer: I am not a nutritionist or doctor. The below comments are based on my own research, and are only meant to be used as a guide. Consult your doctor or nutritionist to help identify the best treatment options for you.

According to several studies, it is very common for people with IBD to have problems with nutrient deficiency. There are three main reasons for this: decreased intake of nutrients due to dietary limitations, difficulties absorbing nutrients due to inflammation of the bowel, and nutrient loss due to diarrhoea and bleeding. You can read more about these causes here and here. As a result, I am starting to wonder whether my iron and vitamin D deficiencies are also related to my IBD.

Vitamin D deficiency is quite common in people with IBD according to this recent study. The main reasons for this are that dietary fat, which is necessary for the body to absorb vitamin D, is poorly absorbed when the bowel is inflamed. Additionally, some medications can interfere with the body’s ability to absorb calcium, which is necessary for the body’s ability to use vitamin D. Studies have also shown that there is a link between the development and treatment of IBD, as vitamin D can impact the body’s digestive processes and immune system, in that symptoms often improve with increased vitamin D intake.

Iron deficiency and anaemia are also very common in people with IBD – around 36-76% more common than those without IBD according to this 2013 study. The main reasons for this are decreased dietary intake of iron, blood loss and malabsorption. Iron deficiency can of course make things more difficult for people with IBD, as common symptoms of iron deficiency and anaemia include dizziness, fatigue, headaches, loss of appetite and disrupted sleep.

For similar reasons, it is also common for people with IBD to have deficiencies in calcium, folic acid, vitamin B-12, and magnesium. You can read more about these here and here.

Apart from generally keeping healthy, there are some nutrients that can help to improve IBD symptoms. For UC in particular, the following nutrients can help with symptoms: iron and B vitamins can help with fatigue and memory, potassium can reduce stomach cramps, and magnesium can reduce diarrhoea. 

Do you have any tips for managing nutrient deficiencies and a healthy diet? Please comment below.