Tuesday, July 23, 2013

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.


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