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.

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.