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!
Tuesday, September 3, 2013
Sunday, August 18, 2013
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.
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.
Tuesday, August 13, 2013
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.
It's a small victory, but I'm happy to claim it.
Sunday, August 11, 2013
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.
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.
Tuesday, August 6, 2013
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.
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.
Sunday, July 28, 2013
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.
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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