Bad Bellies in the New Year

I hope everyone has had a good holiday and New Year! :)

I don’t usually make New Year’s resolutions, but this year I thought I’d make an exception.

In 2015, I continued to slowly gain weight, and by November I discovered that I was now the heaviest I have ever been. I am not in danger, but I do not feel good about myself, and don’t feel healthy either. Therefore, I have decided that my New Year’s resolution for 2016 is to prioritise my health!

There are three parts to this resolution: more exercise, more cooking for myself, and more focus on understanding my belly.

EXERCISE

I have already started working on this part of my resolution. In November, I realised that while it was good for improving my fitness in the long term, swimming twice a week was not intensive enough to help me lose weight. I was very conscious of not pushing my body too hard, as this can put extra stress on the body as previously discussed, so I decided to add walking to my weekly routine.

I first started with a gentle 10 minute walk to and from my local public swimming pool on my swimming days, and after a few weeks, added a 30min walk on Monday evenings. After I was comfortable with this, I started trying to jog some parts of my walking route. At this point, I am now going for a walk/jog twice a week on top of swimming twice a week, and have already lost 3kg!

To help me with this, I have also invested in some good quality running shoes and comfortable clothing, and borrowed my partner’s old GPS watch (see photo below). My partner has been running regularly for a couple of years, and he has been very helpful and encouraging in this, which has really helped with my confidence and motivation! ♡

COOKING FOR MYSELF

As I have mentioned previously, I am not the best cook. I can cook basic things, but have no instinct or creativity for it, and often no energy either. However, last year I started living with my sister who is a very good cook, and she has helped motivate me to try cooking new things and experiment with making things that are more suitable for my belly. :) I have decided to put much more effort into learning how to cook more for myself this year, which will hopefully help me to both improve my health and decrease my symptoms.

I am also looking forward to trying out the below cookbook, which was a Christmas gift from my family. Sourdough bread (particularly when made with spelt flour) has been confirmed by Monash University to be better for those with fructose malabsorption and IBS in general, as the long fermentation process seems to use the FODMAPs in the flour, thus making it easier to digest.

UNDERSTANDING MY BELLY

I have also realised that while I now have a much better understanding of UC and fructose malabsorption, I still have a lot to learn about my belly and its trigger foods. Therefore, I have resolved to put more effort into testing my tolerance levels for different foods, and working on my diet in general.

The first step in this was creating a new food table card (see photo below), which has a more up to date list of good and bad foods based on fructose and fructan levels (using the Monash University Low FODMAP Diet and FODMAP Friendly apps as guides), and it is now colour coded – including putting the best and worst foods in bold, based on what I currently understand about my trigger foods. I have also given copies of this card to my family and others close to me, to help them better understand my situation with food, and work as a guide if they are cooking for me.

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.

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 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.

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.

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. :-)