Five months

Today marks five months on the Specific Carbohydrate Diet.

I haven’t written much lately because there hasn’t been much of interest happening with my gut lately.  I’m still on a roller coaster, but it’s a very gentle roller coaster these days.  A few weeks ago things were less than ideal, but for the past week or so my gut has been functioning more or less normally.  I keep waiting for a shoe to drop!  I’m sure that I’ll have another setback at some point, but as long as I keep moving two steps forward and one step back — instead of one step forward and two steps back — I’ll be happy.

I’ve added in a few foods recently.  Foods that I added previously and wasn’t sure whether I was reacting to badly or not: oranges and pecans.  This time, I’m adding them in a bit more slowly: for example, instead of snacking on a random amount of pecans every night, I’m eating 1/4 cup every other day.  If I don’t seem to be having any problems after a week, I’ll try almonds, and maybe bake something with almond flour again.

I also bought a jar of Bubbie’s pickles.  I love pickles, and Bubbie’s have no sugar added and have probiotics in the brine.  As an added plus, they’re delicious!

I’ve had a few cravings lately.  We stopped in at Safeway to get some Halloween candy, and I really wanted some M&Ms.  But I could tell it was almost entirely a psychological reaction: I wasn’t really thinking about the taste, it was all about the ability to buy the bag and the act of eating them.  Fortunately, the cravings that I’ve had have been very easy to ignore.  As far as I know, I’ve been strictly SCD-legal for several months — and the only times I may have eaten something that’s not legal in the first couple of months were accidental.

I grill-roasted a turkey breast last week, and it came out well.  With that under my belt, and several SCD-legal recipes for cranberry sauce and mashed butternut squash and a few other traditional-esque Thanksgiving recipes, I think I’ll survive the upcoming Thanksgiving holiday.  I fully expect to be giving thanks that my gut is on the mend!

Transplant what?

On the day after my four-month SCD anniversary, I thought I'd share some news on the latest possible treatment for IBS that's getting a lot of buzz these days.

It's known by several names.  Fecal Bacteriotherapy.  Fecal Microbiota Therapy.  Stool transplant.  Yep, you read right, stool transplant: you take someone else's poop and transplant it into your colon.

Although it might sound absurd at first, once you think about it, it makes a lot of sense: there's a very diverse little village of bacteria in your gut, and if some parts of the population overgrow and others are suppressed or removed altogether, the entire system can start malfunctioning.  Badly.  But if you repopulate the village with a bunch of happy bacteria from the well-functioning village down the road, everything starts working properly again.

So how is this accomplished?  Well, it's been done in a few doctor's offices as a treatment for stubborn c. diff. infections.  But because it's still a fairly new procedure and hasn't received FDA approval, it's more commonly done as a DIY project.  You get a blender, some poop from a sympathetic donor, a turkey baster, and... well, you get the picture.  There are several threads going right now in the forums at http://www.ibsgroup.org that were started by people who decided to give it a try; a couple appear to be unqualified successes for people who have suffered from IBS for years.

Recently, a doctor in Canada came up with a way to extract the bacteria from someone's poop and pack them into pills that can be swallowed, rather than having to insert them via the other end of the pipe.  The whole process is described in this article.  It's not much different than taking any of the bazillion commercial probiotics that are out there, these capsules simply contain a much more diverse population of bacteria.

Both approaches -- the procedure done by a doctor and pills created for a specific patient -- have given a lot of people some new hope.  It may be somewhat gross to think about, but most people who suffer from serious IBS symptoms for years or decades would be willing to try just about anything.  Unfortunately, regulatory approval takes a long time, so it's unlikely that either approach is going to be widespread anytime soon.  But there's always the DIY approach.

And what do I think about it?  Since the Specific Carbohydrate Diet has helped me a lot so far, I'm going to continue on this path for the time being.  My biggest concern isn't the "gross factor," it's the lack of data about which bacterial families/strains are necessary for proper gut function, and in what ratio.  And which of those families/strains I'm low on, or are missing from my gut completely.  I mean, if the bacteria that I'm missing are the members of the community who are in the book club, and my donor happens to have an overabundance of bacteria that belong to a motorcycle gang, well... I just don't want to accidentally make things worse, that's all.

But it will definitely be in the back of my mind as an option down the road.

The Nonsense That Is Homeopathy

A few days ago I ended up in a contentious exchange about homeopathy in a Yahoo! group that I belong to. This group is dedicated to the Specific Carbohydrate Diet, and I've gotten a lot of good information and ideas from several of the long-time members. Sometimes discussions veer a bit from SCD-specific questions and comments to more general health-related topics; in this case, someone had posted a question about whether or not anyone was planning on getting a flu shot. Someone responded that she didn't get a flu shot, and if she came down with the flu she'd take a homeopathic remedy named Oscillococcinum, and that prompted me to get on my homeopathy-is-nonsense soapbox.

I don't remember when I first became aware of homeopathy, though I'm guessing it was sometime in the 1990s: I became a vegetarian around 1990, and vegetarianism and veganism seem to go hand-in-hand with "alternative medicine" (sort of funny that I'm now following a diet that almost no vegetarians follow, yet many of the followers are very into alternative medicine!). In the late 1990s or early 2000s, I wrote this article for the Straight Dope website mailbag column on something called "color therapy." Towards the end of the article, I write, "It shouldn't take much research, however, to find treatments that are similar in that they a) look or sound as though they might have a beneficial effect, and b) are not supported by one piece of scientific evidence. Try typing 'homeopathy' into your favorite web search engine." That last sentence started a flame-filled thread in the Straight Dope forum dedicated to mailbag pieces that went on for a long time. But the article isn't dated, and I can't remember whether I wrote it before or after Cecil's main article on homeopathy, located here. In any case, by that time I'd read enough to be a firm non-believer in homeopathy.

Homeopathy was created by a German physician named Samuel Hahnemann back around 1800. The hypothesis behind it is "like cures like": the same substance that produces symptoms of disease in healthy people will cure similar symptoms in people who are ill. We're already starting off on shaky ground -- I mean, how many people who find out from a throat culture that they have strep throat are going to be willing to swallow a capsule full of streptococcus bacteria? -- but it gets better: the substance is diluted to make the remedy, and the more diluted the substance is, the more effective it will be. With that, I believe the whole concept moves into the realm of fantasy. In his article, Cecil mentions "one cold remedy with a dilution of 200C, which mathematically is less than one molecule per all the known matter in the universe." Far less, in fact: a 200C solution means that the substance has supposedly been diluted to one part in 10 raised to the power of 400 (that's a 1 followed by 400 zeros), and it's estimated that the number of atoms in the known universe is 10 raised to the power of 80. Now, to me, that estimate seems awfully low: the universe is a big place, right? But even if you simply think of it as one part per all the known matter on earth, the concept is still pretty absurd. It's generally understood that once something has been diluted past a point far below this, there's not much chance that even a single atom of the original substance is contained in the remedy dose. And guess what? Oscillococcinum is a 200C remedy.

It's my belief that Hahnemann's ideas were (somewhat) reasonable at the time. This is over 200 years ago, and the concepts of atoms and molecules were apparently just gaining ground. But given the problems with the genesis of Hahnemann's hypothesis when he ate some cinchona bark (described in the Wikipedia article on homeopathy), and given what we now know about the properties of matter and the mechanisms of disease, the system defies logic and, more importantly, the laws of physics.

So when the subject came up in this group, a group of people who are very concerned about their health and who I've gained some great insight from, I felt compelled to explain what I know about homeopathy in the hopes that these good people would not waste time, energy, and money on something so worthless. Because I've found that most people who take homeopathic remedies know virtually nothing about homeopathy, they simply know that it's "alternative" so it must be better than what the doctor would give you, and a friend told them, "it works." As they say, no good deed goes unpunished.

I concluded a post where I described the basic concepts of homeopathy with this: "I know that people will believe what they like about homeopathy, as well as other forms of treatment and other concepts. But I will continue to rail against homeopathy anywhere it's mentioned, because I find it unconscionable that homeopathic remedies continue to be marketed to good people, like the people who belong to this group, who are trying desperately to regain their health. I urge anyone who has used homeopathic remedies in the past to read up on the subject; the Wikipedia article is a good start, and there is a lot more material out there."

That garnered this response from the poster who brought up Oscillococcinum: "You may want to think twice before railing against something you have no experience with." But that's poor advice: I don't need to experience a car crash to know that it would be bad for me; I don't need to experience self-trepanation to know that it would be a bad idea.  My response was, "One needn't experience something in order to apply critical thinking skills and come to a negative conclusion."

Another group member went on a long rant about why the people of the group are sick and tired of traditional doctors.  I understand that, and to a certain extent I can say that describes me pretty well.  But he writes, "we really don't have time to decide whether homeopathic remedies work or not, we don't have time to wait for researcher's answers."  This is the attitude I find most disturbing, the "don't bother me with the facts, I'm on a mission" approach.  I get the frustration, I really do.  But ignoring well-established laws of the physical world won't get you closer to realizing your goal; it may even send you down the wrong path if you get what you think is a positive response.  Not to mention the fact that, in the case of homeopathy, you don't have to wait for researcher's answers: homeopathic remedies have never been shown more effective than placebo in all of the numerous well-designed, peer-reviewed trials that have been performed.

The Oscillococcinum poster had this to say about her experience (just before advising me to "think twice"): "It is impossible for me to believe that a 6 month old baby who is so sick that he cannot raise his head and who is suddenly transformed to a happy child playing merrily with his toys on the floor 10 minutes after being prescribed the correct homeopathic remedy is experiencing a placebo effect. This happened time and again with my children. If not for that, I might question it too. But I have seen it with my own eyes too many times to not know there is something there."  I responded that without knowing any of the variables in play at the time, I couldn't offer any explanation.  But of course, there are many possibilities: the flu wasn't the cause; the child was going to start playing with his toys in 10 minutes regardless; the remedy had inactive ingredients (as if it had any active ingredients!) like sugar that gave the child energy; the child had been fed 30 minutes earlier and the food was just kicking in; etc.  I didn't bring any of that up, because I didn't want to get into a long drawn out discussion of what caused a child I didn't know to perk up five or ten years ago after taking a homeopathic remedy with an ingredient list that I didn't have access to.  She wants to believe it was the homeopathic remedy, and I'm sure there's nothing I can say to change that; I'll never believe that something that has no trace of a substance that supposedly reduces flu symptoms could actually accomplish that (in ten minutes, no less), and there's nothing she can say to change that.  I simply explained that my intention in discussing the subject is never to offend or belittle, just to educate, and if sending my thoughts through the ether sounded like an attack at any point, I was sorry.  Then I said I'd get off my soapbox, and hoped she wouldn't be surprised if I got back on it in six months if the subject came up again.  And added a smiley.  You just can't tell how people will read things when their sacred cow is involved.

She got the last word with this bit of condescension: "Well you know, we all have our own little box from which we view the world. Some people, through experience, have expanded their box and it's a bit bigger in some areas than other people's so they have a more expanded view. This is fine. It's when someone tries to force others who have a gained a larger view through experience into their own more limited box because they cannot see anything else - that's when things become annoying."  At least I've got the laws of physics and good critical thinking skills in my box, little though it may be.  And "forcing" someone into my little box?  Really?  People get so wound up.  I've never tried to force someone to believe anything about homeopathy in all the times I've discussed it, verbally and with written text.  How would I even do that?  "You'll stop believing in homeopathic remedies or I'll come down this ethernet cable and MAKE you stop believing!"  Sheesh.

And finally, this: "if you cannot see the purpose of something, by all means you have a right to your view, don't use it. I ask that you give the same respect to others who have a different experience."  Respect?  Gee, I'm not sure I've got room for that in my little box.  I'm guessing that "respect" to this person means "not explaining the premise behind homeopathy to someone who mentions it," whereas I prefer to think of respect as "trying to educate someone about something that is a waste of their time and money."  But to each his or her own.  You just might want to give some respect if you expect some in return, and here's a hint, telling someone that their worldview box is smaller than yours doesn't carry any respect points.

I've already learned quite a few things from this poster about the Specific Carbohydrate Diet, both in response to questions from me and in response to questions from many others.  She posts frequently, and I'm sure I'll learn more, and I'm sure we can be civil.  I imagine if I ever met her in person I'd find her perfectly likable, and we'd have a perfectly friendly conversation.  The whole exchange was just really disappointing.

At least I got the homeopathy-is-nonsense word out there again.  I'd offer the same advice to anyone reading this: if you've taken homeopathic remedies in the past, do yourself a favor and read up on the whole system.  Or I might just have to come down this ethernet line and make you disbelieve.

What I Miss - And What I Don't

Sorry I haven't been posting.  I've been quite busy with house projects and other activities.

A brief update: I'm still doing quite well, though my symptoms have come back to a small degree.  I believe this was due to the introduction of peanut butter and nuts, but it's difficult to say for sure; I discontinued the use of both last week, and I'm giving my body a week or two to re-adjust.  Some SCDers have reported developing sensitivities to foods while on the diet, most notably dairy products.  I hope that's not the case with me, as I really think the homemade SCD yogurt has helped a lot, but if it is, I'll deal with it; when my current batch of yogurt is gone, I'm going to take a break from making yogurt for a week or two and see how my body responds.

I still believe that I'm better off than I was before starting the SCD, and I hope to continue improving.

A couple of weeks ago, Jenny and I went to see a movie.  We enjoyed the movie, but the movie theater experience isn't quite what it used to be for me.  I almost always had some popcorn at the theater, and usually some candy too: M&Ms were a favorite of mine, as were Reese's Pieces.  Looking at the options in the concession case, I realized that there is nothing that I can eat in movie theaters any more.  Popcorn is a complex carbohydrate, and as far as I know all of the candy that's available is sucrose-based.  When we went to a movie a couple of months ago I took some dates with me, and it was nice to be able to have a snack in the theater; but it's just not quite the same.

So that got me thinking about things I miss, now that I'm on the Specific Carbohydrate Diet.  Here are a few:

• Chips and hummus.  For some who know me well, this goes without saying, as I used to have some chips and hummus once or twice a day before the SCD.  Usually Mission brand corn chips, and just about any brand and flavor of hummus.
• Chips and salsa.  Who can resist Chevy's salsa?
• Subway Veggie Delite sandwiches.
• Dark chocolate.  Surprisingly, I don't think of this one very often; I thought every evening would be torture, since I used to have chocolate while watching TV on most evenings.  Still, every once in a while, I do crave it.
• Being able to go out to eat whenever I want.  It's not so much that I love restaurant food, it's just the ability to decide at the last minute that it would be nice to go out.

And thinking about things that I miss got me thinking about things that I don't miss:

• Pretty serious morning attacks of diarrhea.
• Not being able to eat breakfast, lest the morning attack continue all the way until lunch or later.
• Occasional worrying about whether or not I remembered my morning or evening dose of Loperamide.

I'm sure there are other things that fit into both categories, but those are what have been on my mind lately.

Three months

Yesterday was my three month anniversary on the Specific Carbohydrate Diet.  I'm still very happy with the outcome so far, although the past several days haven't been ideal.  I tried a peanut butter experiment last week, and kept the rest of my diet neutral in terms of foods, but I was eating a bit more fruit mixed in with my yogurt and had an occasional additional piece of fruit, and I was eating a bit more cheese than previously.  So I'm still not sure whether it was the peanut butter (a small amount each day over three days), or the additional fruit, or just random timing that has seen my gut slightly unhappy.  Still, "slightly unhappy" is substantially better than it used to be, so I'm not worrying about it.

My body has seen substantial changes over the past few months.  I've lost enough weight to go from a 33" waist to a 30" waist; I'm not sure how many pounds that represents, because we don't have a scale in the house, but I imagine it's around 15.  I look really thin, but I've always had a pretty slight frame, and I feel fine, so I'm not concerned about the weight loss at all.  I've read that substantial weight loss is very common in the first few months of the SCD, and that it's not hard to gain it back after your body adjusts.

My back is smooth, so my dietary change seems to have had a positive impact on my mild eczema.

Most importantly, my gut seems to be functioning much more normally.  I hope to see continued improvement over the next few months, since I plan to continue on this path for the foreseeable future.

Since I still think that sugars are more of a problem for me than anything else, my plan is to continue to introduce more vegetables over the next month and not experiment much with fruits (fruits right now amount to an over-ripe banana in the afternoon, and a small bowl of homemade applesauce at night followed by some dates stuffed with dry-curd cottage cheese).  Spinach seemed to be a problem early on, so I've left it out of my diet.  I'm going to try it again soon, as well as other leafy greens, like bok choy and kale.

I'm also very eager to try nuts again, although I've read that introducing nuts and peanuts too soon is a common mistake.  It didn't go well a couple of months ago, so I'm going to hold off on whole nuts a little longer, and simply add in something made with almond flour occasionally and see how that goes.

As I was eating breakfast the other day, Jenny said, "Another very colorful breakfast.  I think you get more vitamins than anyone else I know!"  I think that's true: I think I'm eating more vegetables now than I was when I was a vegetarian!  Usually two different kinds at every meal, sometimes three, and fairly large servings at that.  I'm trying to be very conscious of the amount of meat that I'm eating: while I think that it has helped me, I'm still not altogether happy about it, and I think that 1/4lb. to 1/2lb. of meat or fish at each meal is more than enough.  I hope to decrease my meat consumption to 1/4lb. per serving over time.

There have been other changes related to this diet as well.  Having one meat-eater and one vegetarian in the house has been a challenging transition.  Our food bill is much higher than it used to be, as my taste in meat is rather high-end: I recently bought a tuna steak at $25/lb. (fresh ahi was so much better than canned albacore!), and my favorite cut of beef is a NY steak, recently on sale at $16/lb. (however, the food bill is at least partially offset by the fact that we don't go out to eat nearly as often as we used to).  I'm sure it would be cheaper at Safeway, but I think the quality is much higher at Whole Foods.  Of course, I buy cheaper cuts as well: I've become much more cognizant of the cost of different cuts, and look carefully before buying.  But having been disappointed by a few cheaper purchases, I'm still willing to pony up for something I know I prefer.

So there have definitely been challenges.  But overall, I'm pleased with the progress.  So on I go.

Recent developments

I haven't posted anything recently because not much of note has been happening.  I thought I'd take a moment to share a few minor changes and insights as I near my three-month mark.

I'm continuing to do very well, with only occasional, very mild, IBS-D symptoms.  I think my gut is behaving very similarly to how it was behaving for most of my life prior to the appendectomy, or slightly better (less gas).

There's not much new in the meat area, although I've been experimenting with marinating chicken before grilling it, and I've been really happy with the results.  I'll definitely try some more of the marinades that are in the Weber's Real Grilling book that I recently picked up at a used book store.

I've added some vegetables back in, making sure that I kept the rest of my diet stable while adding them one at a time, and adding them for four or five days before adding the next one.  My vegetable rotation now includes carrots, butternut squash, zucchini, green beans, broccoli, cauliflower, and asparagus; less often, it also includes other squashes like yellow crooknecks, and bell peppers.  On the fruit side, I'm regularly eating tomatoes and avocados at meals (still weird to think of them as fruits!), and for sweeter fruit snacks I'm having a banana a day, homemade applesauce several times a day, and dates.  I also recently got some oranges and had some fresh-squeezed orange juice (it was heaven), and I've had a couple of plums recently.  Olives, one of my favorite foods, are also back on the menu.  Infrequent items have been cucumber and homemade pear sauce, and neither seems to have been a problem.

I've been eating much more cheese than I thought I would ever eat.  Several types of cheese actually have little or no lactose, and are permitted on the SCD: swiss (I've been eating Emmentaler and I like it, I'm going to buy some Jarlsberg next), gruyere (which I love!), and cheddar (since this one has a more variable amount of lactose, I've stayed away so far, but plan to research which types/brands would be most suitable).  I've also been buying dry-curd cottage cheese, which is similar in flavor to regular cottage cheese, but is made in such a way that it is free of lactose.  Jenny suggested stuffing some dates with dry-curd cottage cheese, and I loved it, so it's now part of my nightly dessert: a small bowl of homemade applesauce followed by 5 stuffed dates.

I continue to believe that the one item that has had the most profound impact has been homemade yogurt.  The first few batches I made I used the YoGourmet lactobacillus acidophilus starter; the yogurt is quite tart (which I like), and seemed to help a great deal.  Then I bought a bottle of starter from GI Pro Health -- without noticing before I ordered that it uses lactobacillus casei, not lactobacillus acidophilus.  The l. casei yogurt isn't nearly as tart, and it has seemed to me that I'm just very slightly more susceptible to old familiar symptoms than I had been, so for the batch that I just finished this morning, I went back to the l. acidophilus starter. I'll see how things are working over the next few days before deciding whether or not to stick to the l. acidophilus variety.  At some point, I'll also stop eating yogurt and take one or two l. acidophilus capsules a day to see if the benefit is the same: I bought them to test so that I'd know whether or not it would be something I could use instead of homemade yogurt while traveling.  I realize I need to do this test for future traveling reference, but it's hard to get excited about it when I know what the outcome will be if the test is a failure!

Most recently, it seems that a few symptoms were triggered by wine.  I'm not happy about this, as a glass of wine with dinner was a pretty regular thing for me.  But I have to be honest with myself about what caused the problems, and make decisions accordingly.  It doesn't mean I'll never drink wine, it just might be a much more infrequent activity than I'd like.

In a few days I'll hit the three-month mark.  Transitioning to this diet was not easy, but I can't argue with the results.  I'm posting about it frequently at ibsgroup.org: if I can help even one person decrease their symptoms from any sort of gut dysfunction, I'll be happy!

Taking stock

I've been on the Specific Carbohydrate Diet for almost two and a half months now.  I thought I'd take stock of how things are going, and what I've learned.

For the past 12 days, I've been almost symptom-free.  Only two very brief episodes leaning towards diarrhea, but not quite there.  A friend recently asked how much better I thought I was, and I replied, "Right now, this minute, I'd say 95%."  I think this is huge.  Unfortunately, I realize that it's unlikely that this will continue indefinitely: 3-month and 6-month "flares" are common in people who commit to the SCD, and even people who do not suffer from IBS or other gut dysfunctions have occasional bouts of diarrhea and constipation.  But for now, I'm very happy with how things are going, and I will definitely continue with the diet for the foreseeable future, adding things in slowly so that I can try to keep track of what doesn't work for me.

I have far less gas than I used to.  I remember listening to Dr. Dean Edell in the car one afternoon, and he threw out the statistic that the average person passes gas 17 times a day.  I think I laughed out loud, thinking to myself that if I went an HOUR without passing gas 17 times it would be a record!

I'm now eating breakfast every day, something I couldn't do without triggering an episode of diarrhea for almost 2 years.  I believe that my diet is quite healthy, with fairly lean protein and generous portions of one or two vegetables at every meal.  I eat virtually no processed foods, and only have small afternoon and evening fruit snacks (I look forward to being able to eat more fruit, but high-sugar foods like fruit seem to still be somewhat problematic, so I'm keeping the quantity small for now).  I just bought some shorts with a 30-inch waist, something I haven't done in probably 30 years or more, and although losing weight wasn't my goal when I started this diet, I can't say losing those 15 or 20 pounds is a bad thing, I've been wondering how to get rid of 5 or 10 for many years.

The Specific Carbohydrate Diet has also apparently affected my body in another, non-gut-related way: for years I've had very, very mild eczema all over my back (not a big problem, it simply made my back itchy from time to time) and an acne-like rash (or rash-like acne, either way probably just another form of eczema) in a small area on my torso from my sternum to my belly button.  Both are now much less prominent, and I haven't made any changes other than my diet.  I've read that for people with compromised gut function, healing the gut can cause many non-gut-related changes in the body, and that seems to be the case here.

I've learned that many things I thought I knew about my body were either incorrect or at least questionable.  Years ago, I often had difficulty in the morning before school, either having diarrhea or feeling like it was coming.  I hypothesized it was because of a milk allergy, or lactose intolerance, or the fat content of the bacon I'd eaten; now I'm virtually certain that there was an element of lactose-intolerance, but it wasn't because the lactose was lactose, it was because the lactose was a complex carbohydrate of any kind -- and I have to wonder if the high sugar content of the daily glass of orange juice I drank didn't play a part as well.  If anyone had told me back then that I'd be eating a half-gallon of homemade yogurt a week, not knowing that you could incubate your own yogurt in such a way that the lactose is all eaten up by bacteria, I would have laughed out loud.

One of the most important lessons I've learned on this journey is that Every Body Is Different.  Many of the generous and knowledgeable folks on the BTVC-SCD Yahoo group that I joined a few weeks ago have said many times that SCD must be individualized for anyone who attempts it.  It's not just a matter of what's legal and what's not.  It's a matter of understanding why things are legal or illegal, and then including only those things on the legal list that don't cause symptoms.  Some people can eat only small amounts of fruit; some people can eat all the fruit they like.  Some people can eat a whole jar of peanut butter but can't tolerate tree nuts at all; others are just the opposite.  For me, so far, it seems that I can tolerate cruciferous vegetables (for which I'm thankful, since broccoli is one of my favorite vegetables); others are never able to.

My thoughts about diet in general have changed fairly dramatically.  As a vegetarian for over 20 years, I can't tell you how many times I heard the "evolution" argument against vegetarianism: humans evolved as meat-eaters, so excluding meat from the human diet is a mistake.  My (usually non-verbalized) response to that argument was that looking at the evolution of man over those many eons way back when fails to take into account many changes that are very, very recent, e.g., instead of working by hunting and gathering and carrying water from a river a mile away, we now work by sitting in a cubicle staring at a monitor.  But what I've come to believe is that, in essence, man's intellectual evolution has far out-stripped his physical evolution, and the physical attributes of the species are still virtually unchanged from thousands of years ago.  So the diet from thousands of years ago, though it should be modified somewhat due to different activity levels and different activities, is, by and large, still reasonable.  One thing I'm going to attempt to learn more about in the near future is when cultivation of grains became so prevalent.

I now think that living for so long on a vegetarian diet did not serve me nearly as well as I thought it was.  For years, I believe I was slowly damaging my body internally by relying heavily on grains and legumes and other complex carbohydrates that my body was not able to process well.  That led to inflammation, and I'm sure I wasn't getting nearly the nutrition that I thought I was.  This doesn't mean that a vegetarian diet can't work for someone, since Every Body Is Different.  I just don't think it was working for me, even though I thought it was.  I'm still not happy about eating meat in terms of being responsible or partially responsible for the death of another creature so that I can eat.  And if it was just a matter of longevity -- if someone could say to me with certainty, "You'll live 4 years longer if you eat meat, but otherwise your life will be the same" -- I would probably switch back to a vegetarian diet.  But it's not about longevity in my case, it's about quality of life.  And quality of life goes up, way up, in the absence of IBS symptoms.

So, the journey continues.  I have no doubt that it will not be a straight path to being completely healed.  But I think I'll be able to handle the twists and turns ahead.

Minor milestone

Today marks seven days without any diarrhea.  Things haven't been perfect, but it's probably the most symptom-free seven days I've had since starting the SCD.

It's a small victory, but I'm happy to claim it.

Two month checkpoint

I've been on the Specific Carbohydrate Diet for just over two months now.  It has not been easy, and there have been times -- like during my recent trip out of town -- that I've almost abandoned it, even if just temporarily.  But I feel like I've made considerable progress in healing my gut.

For the past week, things have been good -- almost too good, making me wonder when a shoe was going to drop.  But so far, no shoe, just relatively normal gut activity.

Although I'm not certain, I believe this turn for the better is due to SCD yogurt.  The day after we got back from our trip I made another batch of yogurt, which was ready to eat on Tuesday.  Tuesday morning was bad, but that was half-expected: traveling in general has always messed with my gut, sending it one way and then the other for a couple of days after a trip.  So when everything seemed completely normal on Monday, I knew it wasn't that simple, and wasn't surprised when I blew up on Tuesday.  I went ahead and started eating yogurt that afternoon, one large spoonful after each meal.  On Wednesday night or Thursday morning, I upped it to two large spoonfuls after each meal.

Since Tuesday, gut activity has been pretty normal, even a slight shift in the other direction (though there are many who suffer from IBS-C, a slight shift in that direction is usually a welcome change for those of us with IBS-D!).  I've kept my diet very simple, adding back in a couple of things, but mostly keeping it to eggs, meat, and a simple rotation of well-cooked vegetables, so the yogurt is the only thing that seems to make sense as the positive influence.

Of course, this could just be a random shift.  Not only have I had the "roller coaster" experience on this diet, but I've read that it's extremely common for gut activity to be highly variable when starting out on the SCD.  And yet, you get to know your body after a while, and sometimes one explanation seems more likely than another.  Just a gut reaction, if you will.  :)  To me, right now, the yogurt seems the most likely explanation.

It also fits the pattern from a couple of weeks ago.  I made my first batch and started eating it a couple of days before our trip.  I kept eating it up through the morning of the trip, and my gut activity was minimal.  I stopped eating it during the trip, and things didn't go so well.  So perhaps with a steady stream of incoming good bacteria via a delivery method that gets most of it where it needs to go intact, I do okay, and without it, I don't.

Time will tell.  I'm making another batch right now, a full half-gallon instead of a quart, and I'll be upping my intake to a few large spoonfuls after each meal tomorrow.  Even if there are setbacks, if the overall trend continues positive, I'll keep up with the yogurt.

Traveling on the SCD

Jenny and I got back from a short trip a couple of nights ago.  I turned 50 on August 1st, so we flew out to California to have a little party with my family and a close friend.  We stayed in Santa Cruz, in a small motel on Beach St., right across from the Boardwalk; when we lived in Ben Lomond and Santa Cruz, we used to go to the Santa Cruz Boardwalk every year or two on my birthday, so it seemed like a fitting location for the big 5-0 this year.

I knew that staying on the Specific Carbohydrate Diet while traveling would be twice as difficult as it is at home, since we weren't going to be staying in a condo or other accommodations that have a kitchen.  I wasn't disappointed.

The Tucson airport is relatively small, so the restaurant options in the gate area are limited.  Our flight left at 11:15 and arrived in San Jose at 2:25, and with times like those the smart choice is to buy a portable lunch and eat it in the air (or on the ground in between, as there are no non-stop flights from Tucson to any of the three Bay Area airports).  But as far as I could tell, there were no viable "traditional" lunch options available.  Fortunately (or unfortunately, I'm not sure at this point), while Jenny looked for a sandwich, I found a cheese-and-fruit container at one shop; it had sharp cheddar and swiss cheeses and a bunch of grapes, and since all of those are permitted on the SCD (many hard cheeses have a negligible amount of lactose), I bought it.  I ate it in the plane on the ground during our brief stop in Los Angeles.

Whether there was a problem with either of the cheeses or the grapes, or the fact that I'd started the SCD yogurt a few days earlier, or some other reason, it was a bad afternoon.  Fortunately, the episode didn't last long, but it was unpleasant.

Feeling better that night, we walked out on the Santa Cruz wharf and found a restaurant where I figured I could ask for something grilled plain.  I had a steak, which was good -- but I'm not sure it was completely plain: it tasted slightly like it had been marinated in soy sauce, and soy sauce is not SCD-legal due to the wheat and soy content.  But that could have been my imagination, it might have just been salt.  It came with vegetables, all of which were SCD-legal (I skipped the potato), but they weren't cooked nearly as thoroughly as I'm used to at this point.  So the entire meal, while tasty, was minimally SCD-compliant, if that.

The next morning we went to a cafe on the beach and I got two eggs, over hard, with crispy bacon; I'm not sure why bacon is legal if it's crispy, maybe cooking it a long time breaks down the added sugars.  In any case, it was not quite as crispy as I would have made it at home, so another iffy meal.

It was a late breakfast so we skipped lunch.  I stopped in at a local market to get some kiwi fruit and blueberries, the two fruits that were still on my menu.  They're both SCD-legal and on the low-FODMAP diet, so I'd been having one kiwi fruit in the morning and a handful of blueberries at night.  Then, before leaving for dinner, another brief episode of diarrhea.  Frustrating and aggravating.

For dinner, we went down to Carmel, another favorite destination.  Fortunately, at nicer restaurants, ordering things made to order is usually not a problem: when I started describing what I was looking for, the waiter just smiled and said, "Just tell me what you need, I'll get it for you."  So I asked for the swordfish, grilled plain with no sauces, and that's what I got.  Skipped the potato and tomato (I asked if it was stuffed, and he just said, "Um... no, you can't have that," based on what I'd already told him), and just had steamed vegetables; again, not steamed as thoroughly as I would have, but pretty close.  So far, the best meal, both in terms of taste and in terms of SCD compliance.  I had some blueberries for dessert.

The next morning I went back down to the beachside cafe after my kiwi and had a couple more eggs, this time with some sliced tomato, so this meal was completely legal.  Then for lunch I had grilled chicken with green beans.  The waiter was also one of the cooks, so I felt confident that his description of the marinade was accurate, and since all of the ingredients were legal, I believe it was fine.  Still, shortly after... another episode.  By this point, I was getting pretty dejected, and had many thoughts about just bailing on the diet altogether.  But I decided to keep at it.  Dinner was a steak and enough broccoli to choke a horse.  The steak tasted fine, so again, asking for something grilled plainly seemed to work; I only ate half the broccoli, if that.  Blueberries for dessert in the room again.

Saturday was my birthday party!  I had a kiwi in the morning, and my sister was kind enough to steam some carrots and zucchini for me to go along with the burger that my brother-in-law grilled for me -- I think it was the first hamburger, and not veggie burger, that he'd ever grilled for me!  With some tomato slices and avocado, it made a fine burger, even if it didn't have a bun.  I wasn't able to have any cake -- I figured any dessert at all would be a bad idea at this point, so I didn't try to do any SCD-legal cakes -- but everyone else enjoyed some.  Yet again, that afternoon, boom.

I should note that the episodes I was having were brief, and in between there was some semi-normal activity.  Still, those episodes were taking a mental toll. And while it seemed like SCD compliance was actually going pretty well, having to plan ahead for each and every meal was also taking a toll.  It's one thing to know what you have to cook and how you have to cook it; it's another to have to throw that ball into someone else's court every meal.

For dinner I walked back down to the wharf and ordered salmon at a different restaurant, grilled plain, butter on the side.  The waitress actually told me that's the way she gets it as well, which made me feel better about asking.  That and some steamed vegetables, and again I think I got a fully legal meal, though again, the vegetables weren't steamed as fully as I would have.  I really don't fault restaurants for that: mushy vegetables aren't all that popular!  Some more blueberries back in the room later that night.

Sunday was travel day again.  At this point, I was starting to suspect that the fruit might be a problem -- perhaps I moved from cooked fruit to raw fruit too quickly -- so I skipped my morning kiwi, went down to the beachside cafe, and had a couple of eggs, nothing extra.  San Jose airport is quite a bit bigger and busier than the airport in Tucson, so there are more restaurants, and I found that Una Mas now does bowls made-to-order, so I got a bowl with nothing but chicken and quacamole.  I don't know if this was legal or not: the chicken looked like it had spices on it, and I doubt if even the employees would know whether or not the spices they use have added anti-caking agents or other SCD-illegal substances, and while my homemade guacamole is legal, who knows what they put in theirs.  Still, I figured it was the best I was going to do, short of ordering a steak at one of the slightly bigger restaurants, and I wasn't in the mood for that much food, especially since I didn't want to trigger any negative reaction just before getting on a plane -- although at that point, "just before" was a couple of hours, as our flight was delayed.  Little did I know that it would end up being several hours, as our flight was eventually delayed almost four hours.  So my Una Mas chicken ended up having to last me until we got home at 9:30 that night.  I've never cooked pork chops and carrots as quickly as I did that night, I was starving!

The next day?  Virtually perfect gastrointestinal activity.  Go figure.

So traveling while on the Specific Carbohydrate diet is definitely challenging.  You have to be very specific when making requests, and even then, it's difficult to know if you got what you were expecting.  But for my first trip on this diet, I think this one went pretty well.

Yogurt

I made my first batch of SCD yogurt yesterday.

"Eat yogurt" is a common refrain from doctors and friends to anyone who has IBS.  The reason is that yogurt (generally) contains a lot of bacteria that is good for your gut, specifically lactobacillus acidophilus.

As someone who has believed for the past 30 years that he's lactose-intolerant, it's a bit strange to be eating yogurt.  However, because of the process for making SCD yogurt, lactose isn't a problem: it's cooked (or "incubated") for much longer than regular yogurt.  The idea is to give the good bacteria a much longer time to eat the lactose in the milk.  The yogurt maker I bought indicates that you can make yogurt in 4 to 4 1/2 hours, but SCD yogurt is cooked for 24 hours.  Apparently this is enough time for the bacteria to eat all the lactose.

The yogurt maker that I bought is the YoGourmet Multi.  I bought it on the recommendation of several SCD sites.  Fortunately, several of those sites go into detail about how the maker is fine for the standard 4-4.5 hour time, but that it runs too hot to use for an entire 24 hours: long before the 24 hours are up, it will have heated up to 125F or hotter, most likely killing off the majority of the bacteria that you're interested in.  That will mean not enough good bacteria, and too much lactose, a double-whammy negative.

The solution that someone came up with is to use a plug-in dimmer switch.  You let it get up to the optimal temperature of 100F - 110F, then turn the dimmer down to about halfway (depending on the switch), which should keep the temperature in range.  Since I had read all this, I went ahead and got a switch before my first batch.  Without knowing how much power the switch lets through, it's a bit of a guessing game at first: it's still a bit hot, turn it down; turn it down some more; oops, seems a bit cool now; etc.  Hopefully I kept the temperature close enough that the bacteria thrived, and the lactose is gone.  And now that I'm familiar with the switch, it shouldn't be so hard next time (if there is a next time!).

The yogurt came out well.  I'm definitely not a yogurt connoisseur, so I asked Jenny to try it, and she thought it was very good.  I had a spoonful on some blueberries this afternoon, and I liked it.  If I'm doing okay tomorrow, I'll try two spoonfuls.

Unfortunately, water intake still seems to be a problem.  For some reason, it seems as though too much water is getting to my colon, and my colon isn't efficient enough at absorbing it, and bingo, diarrhea.  My current hypothesis is that a) my gut motility has always been on the high side, meaning everything moves a bit too quickly; and b) the appendectomy either negatively impacted my ileo-cecal valve operation, allowing it to open too easily, or it damaged the nerve structure in my lower gut in a way that decreased its ability to absorb liquid, or both (there's also the possibility in this scenario that the surface area of my appendix was just enough to keep things in line most of the time, and not having that surface area available is just enough to tip the scales toward diarrhea; not having any nerve damage down there would be nice, although the end result is the same).

This problem is much more pronounced on days when I take on strenuous physical activity in the morning: I sweat a lot, and get thirsty, and drink a lot of water.  Later in the day, boom.  I try to limit the amount I drink without getting dehydrated, but it's a delicate balance.  If only my body was like the World Book Encyclopedia illustrations under "Human Body" that I so loved as a kid: layers of plastic pages, each one revealing a deeper layer of the body.  If I could just see what the hell was going on in there I'd be so much closer to a solution!

But I can't.  So I'll continue to muddle through the best I can.

Backward momentum

About a week ago, I started feeling like I'd reached a plateau, as my symptoms didn't seem to be improving.  For the past few days, I've felt as if I've actually started moving backwards.

Although there are a few things that I think could be having an impact, I think the most likely candidate at this point is an increased intake of sugar in the forms of fruit and honey.  Many different types of fruit are allowed on the SCD, as is honey, but different people tolerate them differently.  At this point, I'm almost convinced that I don't tolerate many sugars well.

So I've been reading up on the low FODMAP diet.  FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols.  There's a brief Wikipedia article about it here.  Basically, the point of the low FODMAP diet is to limit the intake of substances that contain sugars that are most difficult for people to digest.  It's not quite as restrictive as "don't eat foods containing fructose," because unless one is actually intolerant of a specific sugar due to a lack of the enzyme that breaks down that sugar, in certain forms the body will tolerate that sugar well.  Rather, it's more about restricting the combined forms of sugars that are most difficult for people to digest; in some cases these are sugars that are combined molecularly, in some cases it's simply the presence of multiple types of sugar in the same food.

On the Specific Carbohydrate Diet, no complex carbohydrates are allowed, so the oligosaccharides and disaccharides that are restricted on the low FODMAP diet are already off the table.  But there are quite a few fruits and vegetables that are allowed on the SCD that are restricted on the low FODMAP diet.  One of the bigger categories is foods that have a higher-than-1:1 ratio of fructose to glucose, since glucose apparently enhances the absorption of fructose.  So, for example, apples have a high fructose-to-glucose ratio, so they are not allowed on the low FODMAP diet, but bananas have a low fructose-to-glucose ratio, so they are allowed.

Another concern is fructans, chains of fructose molecules; these are similar to starches, which are chains of glucose molecules.  Fortunately, it doesn't appear that anything I've been eating is high in fructans (which is not surprising, as I would think they would be restricted on the SCD as well due to the fact that they are complex carbohydrates).

And another concern is polyols, sugar alcohols.  These include malitol, sorbitol, and xylitol; they are added to chewing gum and some processed foods, including diet soft drinks, but they also occur naturally in many fruits.  Learning about these gave me another "Aha!" moment: my gut has always reacted badly to diet drinks.

It turns out that several of the fruits that I've been eating are restricted on the low FODMAP diet: apples (I've been cooking them for applesauce, which might break down any chained sugars, but would presumably not have any effect on the fructose-to-glucose ratio), avocados, peaches, pears, and plums.  And several vegetables that I've been eating are restricted on the low FODMAP diet as well: asparagus, brussel sprouts, cauliflower, garlic, and onions.  Unfortunately, the one sweetener I'm allowed on the SCD (besides saccharine, which I'm just not going to buy), honey, is restricted on the low FODMAP diet (honey gets its sweetness from fructose and glucose, so I'm guessing it's a high fructose-to-glucose ratio issue).

Fortunately, there are plenty of fruits and vegetables that are allowed on both the Specific Carbohydrate Diet and the low FODMAP diet, and several of the vegetables are already in my rotation: bananas, blueberries, cantaloupe, kiwi, pineapple, citrus fruits, green beans, broccoli, carrots, peppers, olives, tomatoes, and zucchini.

So I'm going to change things up a bit for the next week by limiting my diet to an intersection of the SCD and the low FODMAP diets.  I will have to eliminate a few things that I've been eating, but I might also add in a few things (e.g., cantaloupe).  I'm not all that happy about being even more restrictive with my diet, but if it helps reduce symptoms I'll gladly continue.

Pancakes!

After a month and a half, I've gotten to the point where I've eaten all of the basics several times, and it's getting a bit boring.  So I bought a cookbook a couple of weeks ago:

I thought I'd give one of the breakfast recipes a try today, so I made Vanilla-Hazelnut Pancakes.

Now, I'm not the world's biggest pancake fan.  I'm sure there are people out there who could eat pancakes every day and not get tired of them, but I'm not one of them -- sometimes I get tired of eating pancakes before I'm done with one plate!  But for a change of pace, I do like a few flapjacks every once in a while, and it's probably been a year or two since I've had any (mostly because I didn't eat breakfast for a year or a year and a half), so I thought I'd give this recipe a try.

I was very pleasantly surprised.  I recently baked a carrot "cake" from Elaine's book, and while it was tasty, it wasn't really a cake, it was more like a loaf-shaped pudding.  So I was apprehensive that these pancakes were going to be gritty, or rubbery, or hockey puckish, or something other than good ol' fashioned griddle cakes.  But they were relatively light and fluffy, and had good flavor.  They may have been sub-par to a pancake aficionado, but they worked just fine for me.

The main ingredients are almond flour and eggs, with filberts and vanilla added for flavor (the recipe specifies hazelnuts, but filbert is just so much more fun to say).  The batter seemed a bit thin, so I added a little more almond flour than the recipe called for; I might try it as written next time, just to see if the extra flour is really necessary.

Of course, maple syrup is the standard topping for pancakes, but it's not allowed on the SCD.  The recipe includes a recipe for Vanilla-Infused Honey Syrup, but I opted for some fresh blueberries instead.  A little drier than traditional pancakes, but still tasty.

All in all, a positive first try from this cookbook!  I look forward to trying some of the other recipes soon.

Slow But Steady

I haven't posted lately because there's not really much to write about.  I believe that my gut function is continuing to improve, although at this point it seems to be improving very slowly.  I'd love some more rapid improvement to "normal," but I'll take gradual improvement over no improvement, no question.

Whereas before I felt like I was on quite a roller coaster, I now feel like I'm on more of a kiddie roller coaster: there are still some good days and some bad days, but the bad days aren't all that bad.

The main point of the SCD is to remove complex carbohydrates from the diet and only allow monosaccharides.  But I think even monosaccharides (e.g., glucose and fructose) have an effect on me.  So while I'm going to continue to eat fruit, I'm going to cut back a bit.  Cutting back on the amount of juice I'm drinking seems to have had a slightly positive impact.

I've found some good recipes on the internet that have added a little interest to the meat I've been eating.  I figure if I'm going to eat meat, I might as well try to make it as tasty as possible.  A little butter-lemon sauce with minced onions adds a lot of flavor to baked chicken or fish!

I've got a fairly decent rotation of vegetables that seem to sit well with me, so I feel like I'm eating a healthy diet.  I do miss my chips and hummus, and desserts, but I've been remarkably good about staying on track.  Hopefully I can keep it up in a couple of weeks when I'll be traveling for five days.

Speaking of desserts, I tried a carrot cake recipe in Elaine's book.  While it was tasty, it wasn't really a cake.  :)  It was more like a vaguely loaf-shaped pudding.  I'm trying to find a decent cake for my upcoming birthday, if anyone has any SCD cake recipes that they like, I'm all ears!

One Month!

This is the final day of my first month on the Specific Carbohydrate Diet.

If you've read my previous posts, you know that this has not been an easy month.  The extreme change in diet from long-term vegetarianism to a meat-centric diet; the initial week of mostly boring fare that took a lot of time to cook; the roller coaster of feeling better and then having a setback (which, unfortunately, is continuing, but -- fortunately -- to a much lesser degree); all of these things have made the past month quite challenging.

But I continue to believe that, in terms of IBS symptoms, I'm now doing as well or better than I was before I started, and without taking Immodium on a daily basis.  I'm virtually convinced that a long-standing Small Intestinal Bacterial Overgrowth situation was going on, and that this radical change in diet is almost entirely responsible for mostly or completely eliminating it.

My diet is now fairly diverse, as I've added many vegetables back in, and I'm usually eating two at lunch and two at dinner along with whatever the meat course is.  I've also been enjoying some great summer fruit, and will be adding berries and other fruits in soon (the peaches and nectarines at Whole Foods are great right now!).

I'm definitely going to continue with the diet, and I hope that my gut function will continue to improve.

There will certainly continue to be challenges.  Jenny and I are now both basically cooking for one, since our diets are so different.  And our eating schedules are different, mostly because the kitchen is small enough that both of us cooking at the same time is difficult.  There are still times when I seriously long for a bag of Mission tortilla chips and a tub of hummus, any variety, but I can't eat either corn or chickpeas on this diet.  We've also only been out to eat once in the past month -- yesterday -- and I've only had wine once in the past month, also yesterday (and yesterday evening was one of those "setback" evenings, which is sort of depressing, though I can't really tell whether either of those things had anything to do with it).  So there have been challenges, and there will continue to be challenges.

But since I seem to be heading in the right direction, I'm sticking with it.  If things continue to seem better, I'll probably put together some sort of challenge to my system to see if my gut has healed enough to tolerate a small amount of complex carbohydrates (and you can bet that chips and hummus will be part of that challenge!).  But I probably won't attempt that until I hit the three- or six-month mark, even if I'm feeling pretty normal before then.

Tomorrow marks the two year anniversary of my appendectomy.  It's hard to believe I've put up with the awful aftermath of that operation for this long, but I'm glad I tried this approach to change things, and I'm glad it seems to be working!

Feeling Good

It's been over three weeks, and I'm happy to report that I'm feeling good.  Today I added in tomatoes, onions, garlic, and bell peppers.  I've also eaten some plums and a nectarine in the past few days.

In terms of gut activity, I feel like there are four major periods in my life:

1. Before my appendectomy in July, 2011.  I had a wonky gut, to be sure, but I learned how to manage it early in life, and it really didn't have an enormous effect on my life, it was just a relatively minor annoyance.
2. The first six months after my appendectomy.  This was the period of time when I was learning that things weren't working properly, and trying to understand what was wrong.  I took several different kinds of probiotics, a couple of different kinds of antibiotics, and a few various other prescription and non-prescription items to try to get things working normally, but nothing had more than a marginal effect.
3. The next year and a half.  I started taking Immodium, and within a month or two I had zeroed in on one milligram (half a pill) twice a day as the best approach.  I estimate that this reduced my symptoms by about 80%.  The worst part was that it seemed much more unpredictable than it had been before the operation.
4. On the Specific Carbohydrate Diet.  Just over three weeks now of no complex carbohydrates, and no Immodium.  I'm also taking a probiotic called "Ultimate Flora" on most mornings (the ones where I don't forget).

I'm going to go out on a limb here and say that I think I'm now doing as well or better than I was when I was taking Immodium twice a day.  No explosions in the past several days, and things generally seem to be working pretty normally.  I know there's a good chance that there are setbacks still to come, but I'll try to keep a positive attitude if that happens.

In the meantime, I'll enjoy feeling better!

The Roller Coaster Ride

Step right up, folks!  Only one thin change in diet to board!

Yes, the last several days have been a bit of a roller coaster.  Gut seems fine... gut explodes... gut seems fine... gut explodes...

The diarrhea episodes are generally short, and completely different than what I was experiencing after the appendectomy but before I started taking Immodium.  And I don't know if they're being caused by the switch to a meat-based diet, or by one or more of the foods that I'm eating, or by something else.

One possible culprit is spinach.  Spinach -- and leafy greens in general -- is sort of a mixed bag: lots of nutrients and fiber, but also a high quantity of oxalic acid, which binds with some of the nutrients and decreases their bioavailability. And the oxalic acid itself might be a problem.  Some people have problems with leafy greens, so, for a while, I'm going to lay off the spinach.  I may re-introduce it in a week if things have settled down to see if problems recur.

Another possible culprit seems to be water.  Yes, water.  I made a joke about it in an earlier post, but honestly, drinking a lot of water -- something that happens out here in the desert quite frequently, especially when I'm riding my bike or knocking down walls -- really seems to play havoc with my intestinal tract.  I'm feeling like I have to be just as careful with how much water I drink and when I drink it as I do with what foods I'm eating.  If the quantity of water that I'm drinking really is having a negative impact, it seems as though there are a number of different possibilities as to why, based on things I've read over the past few days.

If what I've read is accurate, 80%-90% of ingested fluids are absorbed in the small intestine.  Whatever's left is supposed to be absorbed by the colon.  Based on the results of last year's colonoscopy, I'm not inclined to believe that there's anything wrong with my colon's ability to absorb liquids in general.  So could it be that my small intestine isn't doing a good enough job of absorbing fluids, thereby sending too much to my colon, and that's causing a problem because it does fine absorbing a normal amount of fluid but it can't handle the excess volume?

Well, maybe so.  I found a celiac site where members were discussing a decreased ability of the small intestine to absorb water because the villi and microvilli in the small intestine had been damaged by celiac disease.  While I don't have celiac disease according to a blood test from a year or two ago, I do think it's likely that the villi and/or microvilli in my small intestine have been damaged by decades of SIBO.  So at this point I'm hoping that continuing on the Specific Carbohydrate Diet will allow my small intestine to heal, which will presumably decrease any symptoms I may have due to water intake.

There is another road that this search took me down that I found very interesting, though, at the moment, I'm still thinking it's an unlikely explanation for my water woes.  The other day I decided to try to limit my water intake (not to dangerous levels, just to maybe 40 or 50 ounces) to see if it would help my gut.  I was thirsty all day, yet my pee continued to be clear or near-clear.  So I Googled a bunch of different phrases related to thirst.  Most of my searches resulted in many pages discussing diabetes; this was no surprise to me, as I've known since my mother was diagnosed with Type II Diabetes Mellitus that excessive thirst is a common symptom of this disease.  I've had a glucose tolerance test and the results were completely normal, but that was some years ago, so it would probably be wise to get re-tested given genetics and all that.  Still, I'm not overly concerned about the likelihood that I have diabetes mellitus.

What I learned after browsing a few pages, however, is that that there is another type of diabetes that is virtually unrelated to diabetes mellitus: diabetes insipidus.  The main symptom?  Excessive thirst despite drinking fluids, and the excretion of excessive amounts of diluted urine.  This sounded intriguing.  So I read up on it on the Mayo Clinic's website.

As I was reading, I was thinking (and I still think) that this is a stretch.  I'm not always extremely thirsty, and it's not so much that I'm excreting a large amount of urine, it's just that it never seems to darken up much even when I'm exerting myself and not drinking much.  But then I got to the "causes" page, and got suddenly alert when I read this:

"Certain drugs, such as lithium and demeclocycline (a tetracycline antibiotic), also can cause nephrogenic diabetes insipidus."

So I looked up democlocycline and found that it's marketed as... Declomycin.

Declomycin.  That sweet, drinkable antibiotic that has become the bane of my existence.  It turned my teeth gray.  It most likely damaged my gut.  And now I find out it may have damaged my kidneys, making them unable to respond properly to anti-diuretic hormone (ADH), also known as vasopressin.

Now, I still think this is a stretch.  Given the results of my SIBO test combined with the results so far of eliminating all complex carbohydrates from my diet, I'm inclined to believe that a) I did, indeed, have SIBO, and b) a long-standing, low-grade SIBO situation damaged the structure of my small intestine, and c) that damage is what's responsible for any difficulty I may currently have absorbing water.  But given my body's slightly weird response to water -- not just lately, but for many, many years -- and given the fact that Declomycin, a drug that I took a lot of way back when, may be implicated in a disease that alters your body's ability to deal with water normally, I have to raise an eyebrow.

I'm planning on finding a family practice or internal medicine doctor here in Tucson soon, just to establish a relationship with a local doctor.  I'll probably schedule a full physical exam since I'm turning 50 this year, and I'll request a glucose tolerance test as well as one or more of the tests for diabetes insipidus.  I don't expect positive results, but it won't hurt to check.

If nothing else, I learned some interesting stuff!

As far as the diet goes, a couple of new additions today: green beans and avocado.  And in addition, I found a mustard that doesn't have any added sugar.  So mustard is back on the menu!  I found that mustard and avocado on my hamburger patty at lunch today made it about 300% better than the plain one I had last night.

Two weeks down

I've made it through two weeks of the Specific Carbohydrate Diet.  It hasn't been easy -- what I wouldn't give for a bag of chips right now -- but I think it's been helpful.

It's not all positive.  Another internal melt-down today, after several days of fairly normal activity.  It could have been due to one of the new foods I've added, or to some sort of bacteria making its way into something that was in the fridge too long, or to sunspot activity.  Who knows?

But still, it's mostly positive.

The latest vegetables are zucchini, summer squash, and spinach, and the latest fruit is apple (in the form of applesauce).  The latest meat is ground turkey, made into sausage-patty size portions for breakfast.  The guys at scdlifestyle.com have a recipe for this "turkey sausage" which calls for 4 lbs. of ground turkey and just a few pinches of spices; I halved the meat amount and doubled (at least) the spice amount, and it was still way too bland, the next time I make it I'll double the spice amount again.  Upcoming vegetable additions will be green beans and asparagus; while several fruits are allowed in phase II of the scdlifestyle.com plan, I'm probably going to hold off on adding too much in the way of fruit, because I think the sugar -- even though it's simple -- might be a problem.  I'll be adding cod to the fish list, and probably turkey (not ground) to the meat list.

One slightly surprising outcome is that I've lost some weight: I'm almost back down to the 32" waist that I had 25 years ago.  I don't think I've lost so much that it's something I need to be concerned about, but I'll be keeping an eye on it.

Generally speaking, I think I still have the same amount of energy that I had before.  I'm often feeling snoozy in the afternoon, but that's nothing new, and I think it's actually worse here in Tucson than it was in the Bay Area just because of the weather: who wants to do anything when it's 105 degrees out?

So I'm going to continue on this path for the time being.  Someone mentioned that it takes 4-6 weeks for the body to adjust to a carnivorous diet after a long time as a vegetarian, but I don't know if that's an opinion, or something based on a study, or just some random numbers they thought sounded good.  I will almost definitely give this at least a month.  Hopefully all the internal stuff will continue to improve.

Respect and Frustration

I've been on the Specific Carbohydrate Diet for 10 days now, and I'm still encouraged by the results so far.  I'm proceeding a little faster than the meal plan approach that I got from scdlifestyle.com, because the foods I've introduced so far don't seem to have been a problem, and because I'm fairly certain that none of the foods available in this phase will be a problem.

One thing that this process has done for me is give me a newfound respect for what many (maybe most) homemakers did back in the 40s and 50s.  The amount of time that I've spent in the past week prepping food and cooking food and washing dishes has surprised me, and I was expecting to have to do a lot of work.

Now I know that there are a lot of people out there who still do a lot of this.  But with the prevalence of convenience foods of all kinds, I think that cooking three meals a day from scratch is more the exception than the rule.  Pouring out a bowl of cereal doesn't take much time or thought, and neither does building a sandwich from lunchmeat out of a package.  I'm not trying to put these things down: everyone does whatever they think is best for themselves and/or family members, and if heating up a frozen meal is acceptable and all there's time for, it's not up to me to say that's good or bad.  I'm just saying that I now have a greater sense of the amount of time and effort that went into the process of cooking meals, day after day, before convenience foods became so popular.

I went to the market last night to pick up some more supplies (spinach and applesauce will be the next new menu items).  As usual, there were several sample tables with chips and salsa, and cheese, and various other goodies to try to tempt you into buying the products.  I have to admit, seeing them was pretty frustrating.  I'd usually stab a little cheese cube with a toothpick, or try whatever salsa they had out, just to see if I liked it -- and occasionally the marketing trick would work, and I'd buy the product.  But now I can't try the samples, or buy the products, or even think about any other similar products.  Unless they start setting out bowls of pureed vegetables with no added ingredients, samples are a thing of the past, at least for the time being.  It was a little disheartening.

But I know it's worth it if I can get my gut back on track, which is the direction things seem to be heading.

One Week Down

Well, I've made it through one week of the Specific Carbohydrate Diet, which, if I do say so myself, is quite an accomplishment.

Results so far are mixed, but I see them as positive overall.  I'll definitely be continuing.

I haven't advertised this blog very widely, but for the few who are reading, thanks for your support!

Something's Fishy

Today's new food:  salmon.  I used to grill halibut on my hibachi on the patio of my apartment in San Leandro 23 years ago, but I don't remember ever cooking salmon; I don't even remember eating it, but I'm pretty sure I have.  I broiled it, since that's one of the approved cooking methods at this point; thank goodness for the internet, I found step-by-step directions for broiling salmon on wikihow.com.  Jenny was on Febreze patrol after my dinner, but I didn't find the smell overpowering, and the salmon was pretty good.

So here's what's on the meat portion of the menu at this point:

• Broiled hamburgers (not a fan, I'm skipping ground beef for the time being)
• Boiled chicken (in SCD chicken soup; quite bland)
• Broiled chicken (not bad)
• Broiled pork loin (quite good)
• Broiled salmon (quite good)

I've been buying the meat at Whole Foods, and our food bill has increased substantially.  I know that I could get cheaper meat at Safeway, but without any information about where the meat came from.  If I'm going to have to do this, I'm willing to pay a premium to feel better about the purchase.  And I feel better about the purchase at Whole Foods, since they have a rating system for the conditions in which the animals were kept.  While I still think that killing, by definition, isn't humane, I'd still prefer that treatment up until that point be humane, and I think that's more likely (though not guaranteed, since I can't actually go to the companies they buy from and inspect the conditions myself) with Whole Foods meats.

And the vegetable portion of the menu:

• Carrots -- boiled (to death) and pureed
• Butternut squash -- boiled (to death) and pureed

Basically, when it comes to vegetables, I'm eating baby food: bland and extremely easy to digest.  Fortunately, salt and pepper are allowed, and at this point I can start adding other spices.  I can stop pureeing pretty soon as well: the scdlifestyle.com guys recommend 14 days, so I'll probably puree my next vegetable (zucchini), which I'll probably add this weekend or just after, and then start cooking them in other ways.

Tomorrow I'll be cooking up a batch of pearsauce, and it will be nice to have something sweet.  So far the only things that I've had that have been sweet are grape juice and apple juice, each diluted 50/50 with water -- and not much of either.  These are allowed because they only have simple sugars.  I believe the same is true with pears, and the cooking makes them easy to digest (back to the baby food idea).

So, you might ask, is this working?

Hard to say.  I've still had several episodes of diarrhea, but I've also had relatively long stretches without, and I've had far less gas.  I still think that any gut explosions may be attributable to a sudden change to a meat-centric diet, but at this point the whole die-off thing might be in play.  A friend read my two-steps-forward-one-step-back description and said that he thought it sounded more like two steps forward and one step left.  I like that way of looking at it better: the diarrhea is different than it was, so it doesn't exactly feel like a step back.  It's still frustrating, but I'm doing the best I can to stay positive and to continue to view this as a reasonable approach.