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!