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.