How eating Low Carb helped me

As you know from previous posts, I suffered a great deal from painful digestion which started about a year ago. It got so bad I was scared of eating and thought I’d be miserable for the rest of my life. I tried so many OTC (over-the-counter) digestive “aids” I could have opened my own pharmacy! When not even my GI doctor could help me, I felt completely hopeless.

After months of research, I came across an eating plan created for people with diverticulitis, ulcerative colitis, chronic diarrhea, etc. and thought, hey, if this works for them - people with “real” painful gut conditions - why couldn’t it work for me? So I started following the advice of a book I came across called "Breaking the Vicious Cycle" by Elaine Gottschall. The eating plan is called the Specific Carbohydrate Diet.  When the book said: if the diet does nothing for you, you can always go back to eating the way you used to, what would it hurt to at least try it?

The Specific Carbohydrate Diet (SCD), as the name suggests, is specific because of the limited carbs that are permitted. The basic premise is this: in our gut there is an ever-constant battle being waged between good bacteria and bad bacteria, and this is normal. But when bad bacteria take over, the good ones have no chance and this causes an imbalance in the gut flora. I felt strongly that this was my problem.

For those with digestive issues it’s a vicious cycle where the wrong carbohydrates create a hostile environment and the hostile environment creates gasses and bloating and pain. Usually we end up craving that which is causing the problem in the first place: more sugar. I used to have food cravings for bread and sweets like nobody’s business! Eliminating sugar, basically what all carbs turn into, seems to starve bad bacteria of food for them to multiply. So, in essence, it stops the vicious cycle.

When I first read this, I thought “sugar” meant sugar, but I learned it isn’t just about sugar. Sugar comes in a variety of forms and molecular structures that can impact digestion. There are monosaccharides, disaccharides, and polysaccharides. As you probably already know, mono means 1, di- means 2, and poly- means 2 or more. The culprits to feeding bad bacteria and slowing down the digestive process seem to be the di- and polysaccharides. The book said that monosaccharides on the other hand are much more easily digested, going through the digestive tract virtually unchanged, seeming to therefore cause few people problems. Examples of monosaccharides are honey, dates, and lactose-free yogurt, and tend to be fine for most people (proceed with caution as your results may vary). 

The stuff you REALLY want to stay away from are all the other starchy things that feed bad bacteria, such as rice, corn, spelt, wheat, barley.....really grains of all kinds; cornstarch, thickeners, and emulsifying agents usually found in processed foods (guar gum, xanthan gum, carageenan and things like that); and all the usual starchy foods like potatoes, sweet potatoes and even regular dairy products. While many critics of the SCD site the difficulty in following it (because it does require “fanatical adherence” as it says in the book) I found that if you are motivated enough (pain is a great motivator) and have some cooking ability, it is not at all difficult once you understand the foods that contribute to your digestive distress. How long to stay on the diet probably depends on how bad things were when you started. I’ve been on it since right after Christmas (9 months) and feel I have a good handle now on what I can and can’t get away with, having only started experimenting in the last few months with reintroducing things that had been removed. What makes this process challenging is figuring out what YOUR particular trigger or problem foods are.

To say that this low carb way of eating has been a godsend would be the understatement of the century. Not to be too melodramatic, but it has given me the chance to return to normal and I am so glad I came across Elaine’s book.

It has become evident to me that there is something to this "low carb diet" thing. For many years, I was very skeptical of it, as many people still are. Who wants to give up eating bread, cookies, pasta and rice? I hear ya! But low carb seems to be working for a lot of people with digestive issues, not to mention a whole host of inflammatory conditions. People battling non-alcoholic fatty liver, diabetes and arthritis have managed their diseases with a low carb (LC) diet. And cancer research is discovering that starches feed cancer cells. In the absence of excessive carbohydrates, cancer cells don’t have much chance of reproducing. We hear a lot about inflammation and how we should be reducing it in our bodies. Well, come to find out, inflammation is a well-established driver of early tumorigenesis (the “genesis” or creation of tumors) and accompanies most, if not all, cancers. Wow! 

If that isn't a reason to cut your carbs I don't know what is!!!

Unfortunately, being "low carb" is still considered somewhat fringe and radical, although you hear about it more and more in mainstream media. Everybody thinks of the Atkins Diet right away. It’s really not the same. I certainly think this low carb thing is something worth checking into if you have health issues, or want to avoid any in the future.

P.S. Additionally, something I have found that works great in controlling symptoms when they flare up is a product called Iberogast (check out this link as it explains how it, as well as other natural remedies, can help those with any sort of digestive ailment, from IBS to heartburn). Iberogast is made in Germany and is very popular over there but fortunately you can buy it in the U.S. as well. I bought mine on amazon. Another thing that helps me is enteric-coated peppermint oil capsules and a digestive enzyme called Digest Gold from Enzymedica. This trio of products, along with the occasional activated charcoal for when bad gas pains hit, are my arsenal in fighting digestive distress. I carry them with me everywhere I go and am fortunately using them less and less as the months pass. In fact, I’m at the point where I don’t need them regularly any more. Success!

Mexican Chicken Soup

The weather is going to be a bit nasty this weekend. Rain is forecast for the next 4 days - unheard of in Southern California! Could it be El Niño (gasp)? We’ve been expecting it for months now, and we’re still waiting. Regardless, you know me - at the very mention of rain and the inevitable cooling of the temperature (however slight it may be) I’m off making soup! And in honor of El Niño, this time we’re making it Mexican.

I’ve made this soup several times now and love it more each time I have it. It’s a great combination of flavors. The addition of the roasted tomatillo salsa makes it "the bomb!" The traditional version of this soup is “chicken tortilla soup” but as I’m avoiding grains right now, there are none in this version. It’s from Danielle Walker’s cookbook, “Against All Grain”, a cookbook geared towards those with digestive trouble. It’s very digestion-friendly.

The recipe calls for it to be prepared stove top but I recently made it in my slow cooker because I was leaving the house and wanted it ready when I got back. So please note that I  only cooked it this way for a few hours. All day would be too long for the chicken, which would overcook and become dry.

The soup is very simple to make but do make sure you use homemade (chicken) bone broth for best flavor and superior nutrition. A simple soup needs a boldly flavored broth to lend backbone to it. Don’t use a wimpy stock from the grocery store unless you absolutely have to.

You can either choose, at the end of the cooking, to puree half the soup in a blender and return it to the pot to thicken it somewhat, or you can just leave it as it is.

Mexican Chicken Chowder

Ingredients

2 pounds chicken thighs, boneless, skinless, trimmed of fat
2 cups roasted tomatillo salsa
4 cups Chicken Broth
3 cups peeled and cubed sweet potatoes or butternut squash
2 cups peeled and sliced carrots
2 tsp. fresh lime juice
1 tsp. minced garlic
1/2 tsp. sea salt (or more to taste)
2 cups chopped pre-washed spinach
Garnish: chopped fresh cilantro and avocado slices


Directions

Place the chicken, salsa, broth, sweet potatoes, carrots, lime juice, garlic and salt in a stockpot over medium-high heat.

Bring to a boil, then cover and simmer 1 hour over medium-low heat.

Remove chicken, and using 2 forks, shred the chicken and set it aside.

Scoop 2 cups of cooked vegetables from the soup and puree in a blender. Make sure there is at least 1/4 cup of broth with it. Puree for 15 seconds or so and return to the soup pot.

Add the chicken back in and then the spinach and simmer 10 minutes until the spinach is slightly wilted.

Serve hot, garnished with the cilantro and avocado.

Playing Doctor

It’s horrible having digestive trouble.

You learn to not take anything for granted any more. When you have a “good day”, you are so ecstatic you don’t know where to begin to make up for lost time. Time that’s lost on the “bad days” when you have no energy, feel sick to your stomach, are on the toilet ½ the day, or are doubled over with cramps and pain. On the bad days, which usually outnumber the good days unfortunately, you question “why go on”? It can be so utterly depressing and feel so hopeless.

For those of us with debilitating digestive issues, what’s especially depressing about this situation is that the medical “experts” we consult are often of no use to us if they cannot find something “wrong” with us after performing all the usual tests. It’s important to understand why. Doctors are not required to take any nutrition classes throughout their entire medical education.

Why don’t doctors, especially gastroenterologists, even think to link diet with digestive issues? After all, Hippocrates, the Father of Medicine, said eons ago, “Let food be thy medicine and medicine be thy food”. What went wrong?

We veered away from the knowledge that older generations had about the medicinal properties of chicken soup, how ginger helps with nausea, that chamomile soothes. The medical community unfortunately developed a drug-based bias and tossed the conventional wisdom that people knew all along because there was no money in it. We started worshipping doctors and believed everything they told us. People never question doctors. Hey, people say, my doctor never told me I needed to stop eating _____ to ward off _____ (fill in the blanks). So why would we link food to health if even our doctors aren’t telling us to?

What floors me in this Internet age is that there is a tremendous amount of information available to each and every single one of us. You’d think your doctor would do some research, but alas, he’s too busy golfing or buying a Tesla. So what are you to do? Wait for your doctor to come around and start caring about you? Why waste even more time having “bad days”? Start doing your own research.

Google is your friend. And as we all know, it’s a rabbit hole. Once you Google something, you suddenly find yourself off on a tangent, reading about something else. That’s ok when you’re doing research. That’s exactly what happened to me. While investigating one thing I ended up on a different path. I think I learned a lot that way, just going with the flow, allowing myself to venture off course a little. I did start to see patterns in what I was reading and a lot of overlap, so I figured I was on the right path because all roads eventually led to Rome. That’s when you know you’re on to something.

Just now I googled “Let food be thy medicine” and found an interesting article from Johns Hopkins University that I think is worth reading. It gives me some hope that even mainstream medical communities are finally waking up to this reality:  http://www.hopkinsmedicine.org/hmn/w10/feature2.cfm

If you are suffering from any digestive ailment, I encourage you to start reading, exploring, and researching on your own. Read quality stuff though. Visit the NIH (National Institute of Health) website. Read medical papers if you can find something written in layman’s terms. Don’t trust the drivel written on quack websites and Better Homes and Garden. 

If you are not getting the answers you should be getting from your doctor, fire him and find another one. Do not feel badly that you are dumping him. He works for YOU and if he is stubborn and adamant that your lingering problems are not in any way related to food, or won’t approve a test that could conclusively diagnose a problem, he is not helping you. Find someone else.

My hope is that you have a doctor that you trust and respect and that trusts and respects you. Tell her what you’ve learned in your research and that you want certain tests done and why. Be prepared to support your requests with what you’ve read has worked for others.  On many forums I’ve read about people that end up teaching their doctors something new! The best doctors, in my opinion, are those without an ego, who want to learn because they truly want to be of help to their patients. They are open to expanding their knowledge, so that they in turn can help others.

I believe that we need to collaborate with our medical providers. We are in this together. And we should be solving our digestive problems together, looking for new methods and treatments, exploring both allopathic and alternative options, being open-minded to all possibilities.

Sometimes you have to play doctor yourself.

Update on the IBS Food Challenge

I was recently reminded that I never really continued with my story about what I had learned, and how I had fared, on the IBS diet I had initiated last year.

If you recall, I had done some homework on digestive problems and found something called the FODMAP Diet. FODMAP is an acronym for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols”. Quite a mouthful, but basically: components found in many foods that commonly trigger IBS (Irritable Bowel Syndrome) in a lot of people. Here’s a link to the article I wrote on the subject last April.

So what happened after Week 1 on the FODMAP Diet? 

I continued with weeks 2 through 6 and found that I felt better than I had in very long time. Clearly there was something behind this eating plan! Eating out was nearly non-existent because I had to maintain strict oversight of everything I was eating. I was preparing most of my own food and reading labels on the rest like never before.

I discovered early on that I was lactose-intolerant and cut out dairy entirely. This was perhaps the single toughest thing to deal with because I love dairy. But I did it for a while to give my gut a rest. It made a huge difference. Eventually though I would learn through more reading which dairy contained the highest amounts of lactose and just avoided those. Things like milk and soft cheeses (ricotta and cottage cheese, for example) were completely avoided. Hard cheeses like parmesan, pecorino, swiss and cheddar contain very low levels of lactose and I seemed to do alright eating these as long as I ate them in small quantities. Over time, if I wanted to eat or drink something that had higher levels of lactose, I’d take a Lact-Aid tablet which contains the enzyme my body lacks to digest lactose. Problem basically solved. That one was pretty easy to figure out. I still do all that to this day.

What was also a sort of no-brainer was that the usual suspects like beans and hard to digest vegetables were out.

What I also discovered, which took a little more detective work, were a variety of other vegetables and fruits I found I had trouble with. When I reintroduced them into my eating plan after the initial avoidance period, it became clear that things like broccoli, all members of the onion/leek family and asparagus created problems. Apples and stone fruit sat heavily in my stomach, while berries and bananas were much easier. Now I do the best I can to avoid the things I learned trigger IBS symptoms. Eating out makes this more difficult, especially because there are onions in just about everything! 

A list of the common IBS trigger foods can be found here.

This list was compiled directly by the creators of the FODMAP Diet but you can find other lists on different sites. If you just Google “FODMAP Diet Food List”, you’ll get lots of hits.

For you, if you’re suffering from IBS, the foods that cause you problems might be different from mine, but it’s a safe bet to start with "The List" and go from there. The important thing is to start and begin feeling better right away! 

After the initial avoidance phase comes the experimentation phase, where you start reintroducing a different common trigger food each week, and yes, this step takes discipline and commitment. But there is no other way for you to learn what makes you feel bad unless you tackle it like this. Your doctor cannot tell you what foods are doing this to you. Only you can find this out on your own by experimenting. Sorry, there are no shortcuts to doing the work.

Downing Pepto-Bismol, TUMS (or whatever else you’re taking) every day for the rest of your life is no solution. You are masking the underlining problem and ultimately you still have IBS. While there is no evidence that unresolved IBS will lead to colon cancer, stomach cancer, or anything like that, why tempt fate, and why be miserable? If it hurts, something is wrong and needs to be addressed.

Even if you don’t have IBS but you find that sometimes you have “tummy” problems, do an elimination diet like this one to uncover the culprit.

If you need help creating a customized food plan for yourself, seek out the assistance of a nutrition professional who specializes in FODMAP Diets. It will be money well spent to get back to feeling good. One dietician I’ve found whose site is easy to navigate and fun to read is Kate Scarlata’s, found here.

Homemade Sauerkraut

I realize not all of you are going to try this at home, but I wanted to share how super easy it is to make your own sauerkraut. I made it a few weeks ago and have been wanting to tell you about it!

Sauerkraut directly translated from the German is “sour cabbage” and consists of finely cut cabbage that has been fermented by various lactic acid bacteria. It has a long shelf life and distinct sour flavor, both of which result from the lactic acid that forms when the bacteria ferment the sugars in the cabbage.

As I’ve previously written, fermented foods have a long history in many cultures with sauerkraut being one of the most well-known. The Romans mentioned preserving cabbages and turnips with salt but it is believed to have been introduced to Europe in its present form 1,000 years later by Genghis Khan after invading China. The Tatars took it in their saddlebags to Europe. There it took root mostly in Eastern Europe and Germanic cuisines, but also in countries like France.

Ok, that worked for people back then, but why eat it now?

The health benefits of sauerkraut are numerous. It is a source of vitamins B, C and K. Get this: the fermentation process increases the bioavailability of nutrients, rendering sauerkraut even more nutritious than the original cabbage! It is also low in calories and high in calcium and magnesium and is a very good source of dietary fiber, folate, iron, potassium, copper and manganese.

Sauerkraut contains live lactobacilli and beneficial microbes and is rich in enzymes. The fiber and probiotics improve digestion and promote the growth of healthy bowel flora, protecting against many diseases of the digestive tract. It soothes the digestive tract and is effective against stomach ulcers.

Sauerkraut can even save your eyesight! That’s because it is high in lutein and zeaxanthin, both associated with preserving ocular health.

And perhaps most important of all, for this affects everyone, not just those of us with digestive issues: fermented foods, including sauerkraut, bolster the immune system.  Dr. Oz tells us how and why this is so important.

Anyway, now that I’ve (hopefully) sold you on the importance of eating this stuff not just once a year at Oktoberfest, let’s discuss how to make it. Here’s what I gathered to make mine:

1 head of green cabbage
4 peeled carrots
1 peeled daikon radish
1/2 bunch cilantro
a rather large wide mouth glass canning jar with a gasket and hinged lid (see photo below)

A Note:
While sauerkraut can and usually is as basic as just cabbage and salt for the brine, you can experiment as I did with adding additional vegetables such as carrots or cucumbers, raw ginger or daikon, herbs, and spices such as caraway seeds (very yummy - they will appear in my next batch). Makes things a little more interesting.

Directions:
Pulse everything in batches in your food processor using the shredding disk. As the processing bowl fills, dump its contents into another larger bowl. Keep working until everything is shredded. When everything is in the larger bowl, sprinkle 6-7 tsp of good quality sea salt over it all and then get your hands into the kraut and start squeezing it.

Really work the salt into the veggies. Do this for about 10 minutes until you extract a good amount of liquid from the vegetables. This is an important step because by doing so you are creating the all-important brine that will begin the fermentation process. Now, spoon the kraut mix into a container large enough to fit it all in there and cover. You’ll want a container that looks something like this:

Ok, so you’re done......for now. Let it do its thing.

The fermentation process:
Every day you’ll need to open the lid and let it burp. Gasses will be forming that need to escape. I let mine sit on the counter like this for 10 days, burping it daily (there was less gas on those final days), until the 10th day when I moved the container to the refrigerator. I didn’t get around to eating it right away because I was going out of town for the weekend, so it sat in the fridge another 3-4 days resting. Sauerkraut, believe it or not, actually improves the longer it sits, so don’t be afraid you have to eat it right away.

The tasting:
So the day finally came about 2 weeks after having started the process when I actually got around to opening up the sauerkraut and trying some. I was pleasantly surprised to find, like the cauliflower I had previously made, that the vegetables were not mushy at all but crunchy even, and that tangy flavor from the fermentation was there, but not overly so. My husband was leery about eating my “science experiment” as he called it, but was also surprised at how good it was.

Sauerkraut, as long as it remains raw and uncooked such as this one, is a tremendous addition to anyone’s health. Make some and enjoy it for lunch, alongside a sandwich or some lovely gourmet sausages with mustard.

Chicken Noodle Soup

Most of you know by now that I just love soup. I inherited this gene from my mother. And this week the temperatures here in Southern California provided the ideal conditions for “soup weather”. So I looked for something new to try out. New to me, but certainly not new to most. The humble, but ever popular, Chicken Noodle Soup sounded good.

This recipe contains digestive-friendly ingredients that soothe the digestive tract. There is nothing in it that could irritate, so just like when you have a cold and aren’t well, a bowl of chicken soup is perfect for when you need a little something soothing for your insides.

Just like in my post a few years ago on that wonderfully fragrant Vietnamese soup called Pho, this soup, as nearly all of them, calls for a rich bone broth to start. If you’re short on time, you can certainly use a prepared chicken or vegetable broth, but as I stated in that article, making your own homemade bone broth is not difficult and because of the rich nutrients that a bone broth contains, it’s definitely worth making.

Here’s the recipe I made this week.

Chicken Noodle and Vegetable Soup

Ingredients:
2 Tbsp olive or coconut oil
3 carrots, peeled and finely chopped
2 large stalks celery, finely chopped
1 bay leaf
1/2 tsp. turmeric
5 thyme sprigs, plus 1 Tbsp. finely chopped
3 marjoram sprigs, plus 2 tsp. chopped, or 1-2 tsp. dried
8-10 cups of homemade chicken bone broth
10 oz. boneless skinless chicken thighs, thinly sliced
1 cup corn kernels (frozen is fine)
1 cup rice vermicelli, broken into short lengths
salt and pepper
2 Tbsp. finely chopped flat-leaf parsley

Instructions:
1. Heat the oil in a large saucepan over medium-high heat. Add the carrot, celery, bay leaf and turmeric, and cook, stirring regularly, for 10 minutes, or until the vegetables have softened.
2. Add the chicken and brown a little with the vegetables. Add the herbs sprigs, broth and corn kernels and simmer over medium heat for 10-15 minutes (10 minutes if you’re using fresh or canned corn, 15 minutes if you’re using frozen).
3. Meanwhile, pour boiling water over the vermicelli noodles and let them soak in a bowl until they soften. Drain.
4. Remove the bay leaf and herb sprigs from the soup, add the noodles (*see note below) and cook an additional 2 minutes. Stir in the chopped thyme and marjoram, season to taste with salt and pepper, and serve with a sprinkling of parsley.

*You will surely have leftovers. In that case, I have found that the noodles soak up too much of the broth and get mushy the next day. What I do in Step 4 is leave the noodles out and instead, when the soup is ready, I take my bowl, put some noodles in the bottom and pour some soup over the top, and then sprinkle with parsley. I keep the noodles separate when storing them in the fridge overnight as well. So I would just add the herbs in Step 4, and leave out that bit about adding the noodles, and proceed with the rest of the directions.

A Book Review and the Four R's

When your digestion isn't functioning well, a comprehensive approach is needed to put it right. I have a wonderful book called "Optimal Digestive Health - A Complete Guide" that is packed with great information about digestion. It is a collaborative effort on the part of many experts in the field of nutrition and digestion and is over 550 pages long. You might want to look into getting it at your local bookstore on online at amazon. 

Explaining first How the Body Works, then providing a list of Tools for Evaluating Your Health, Finding New Strategies for Inner Health, Therapies for Mind-Body Medicine, to providing a List of Treatment Options for Specific Conditions, it is a great resource for anyone interested in improving their digestion. I wanted to share a section from the book written by Jeffrey Bland, Ph.D. that I find to be the core of not only the book, but of improving digestion. Something called "The 4R Support Program".

Here's what Dr. Bland writes:

"A comprehensive approach to normalizing gastrointestinal function, referred to as the "4 R's", involves four basic steps: Remove, Replace, Restore, and Repair. 

"Remove" focuses on eliminating pathogenic bacteria, viruses, fungi, parasites, allergens, and toxins from the GI tract. This is a crucial beginning step on the path to digestive wellness.

The second step is "Replace", replenishing enzymes and other digestive factors that may be lacking, such as pancreatic enzymes, hydrochloric acid (HCI), or intrinsic factor. 

The third step, "Restore", refers to restoring the beneficial bacteria that are commonly found in a normal digestive system, but may be missing from a dysfunctional one. It is an important step in restoring healthy function to the gut. A variety of supplemental resources may be considered helpful in this phase, including cultured and fermented foods and supplements containing live beneficial bacteria.

The fourth step in a 4R approach, "Repair", addresses intestinal permeability through the use of nutritional supplements known to be critical in intestinal function.

Step 1: Remove

• Common food allergies or sensitivities
• Bad bugs - candida (yeast) or bacterial overgrowth or parasites
• Problems from viruses
• Minimize environmental and digestive toxins

Step 2: Replace

• Betaine hydrochloride (hydrochloric acid)
• Enzymes (animal or plant-based)
• Bicarbonate (which enables the enzymes to work)
• Intrinsic factor

Step 3: Restore

• Probiotics - L. acidophilus and other probiotics
• Provide prebiotics if starches and sugars are tolerated. Nourishment for the beneficial microflora such as FOS (fructo-oligo-saccharides) and inulin
• Increase fiber and monitor the response. Soluble fiber such as oat bran increases butyrate and other essential fatty acids. Nonsoluble fiber such as cellulose is best tolerated by some people, but not others
• Increase resistant starch in the diet to reduce acidity, and raise fatty acids
• Monitor level of starches and sugars (carbohydrates are a common source of digestive upset)

Step 4: Repair

• Provide nutrients to heal the GI mucosa: vitamins A and C, B5 (pantothenic acid), B6 (pyrodoxine), the amino acid L-glutamine, and the mineral zinc
• Support the immune functions of the GI tract: vitamin A to nourish antibody production
• Continue to avoid allergens and irritants: certain drugs (such as NSAIDs), alcohol, and foods that trigger allergies."

In Step 1, finding out if you have these "bad bugs" requires testing, and usually not by a regular doctor. You might have to request these tests from a specialist. Some can even be performed by a specialized lab via mail. The book has a great list of resources throughout on where to go for help.

How to go about doing all these steps is outlined in the book, of course. Each section gets a well-researched and extensive list of suggestions to get well. Of course no one thing works for everybody, and it might take trial and error to find out what's really going on with your own digestion, but it helps to have a place to start from. I highly recommend this book. It has helped me immensely.

Regarding my own digestion, I have had much success avoiding lactose and doing the FODMAP Diet. While I sometimes still have low-lactose-containing foods, they still cause some discomfort and therefore must remain an occasional treat nad be eaten in small quantities. Onions and garlic are back in, and while eating them raw causes the most trouble, cooking them very well or adding them to foods during the cooking process and then removing them (and not eating them) helps tremendously.

Just like life, it seems, getting to know one's ever-changing body is a journey and a learning process. Learn by reading good books such as this one.

Frittering away the evening

I am approaching Week 6 on the Low-FODMAP Diet and I must say it has been successful overall. I've had setbacks, but as it says in the book I've been reading, this is normal. "Life happens" and you eat things accidentally, or out of habit and forgetfulness, and have a setback. You get the bloating, the gas, the diarrhea or the constipation, the cramping, the whatever, and you don't feel so good. And it reminds you, like when you fall, to get back on your feet and continue. More than anything, you want to feel good again.

It has been such an enormous relief to now have the tools with which to take back control of my health. I felt so out of control, and for me, that is a very difficult thing. I don't like feeling helpless and weak and don't want life to just blow me around like a leaf in the wind. I can honestly say that this way of eating has changed me, and to those two doctors in Australia who created it, I will be eternally grateful. 

I'm not done yet. I'm to now start adding things in again and test the results. This may take several more weeks of patient experimentation.

I'm sorry to report that my sourdough experiment failed. Nothing happened to my starter. It just sat there, staring at me. I found myself talking to it (I know!) encouraging it: "come on, you can do it...". Crazy. Finally after about 10 days (hey, I gave it a chance, didn't I?) I tossed the lot down the sink. Dejected, I haven't started a new batch yet. My friend Ken, who is anxiously awaiting some starter from me when this takes off, encouraged me to try again. So I will. Sometime this week.

In the meantime, I had a menu to plan for the upcoming week, and decided that I wanted something I hadn't had in while. I don't eat fried food very much at all. Don't care for it usually, but sometimes I get a hankering for vegetable fritters. As I paged through one of my vegetarian cookbooks to find some inspiration, I found vegetable fritters with tzatziki. If you know me, you'll know that I ADORE tzatziki. And I already had everything I needed on hand, including some homemade lactose-free plain yogurt. I just needed some vegetables and some oil to fry them in.

After my visit to the market, I got started.

Vegetable Fritters with Tzatziki

The dip:
1/2 cucumber, coarsely grated
1 cup plain yogurt
1 Tbsp. extra virgin olive oil
2 tsp fresh lemon juice
2 Tbsp chopped fresh dill
1 Tbsp chopped fresh mint (optional)
1 garlic clove, crushed
salt and freshly ground black pepper

For the fritters:
1 large eggplant, peeled and thickly sliced
2 zucchinis, thickly sliced
1 egg, beaten
4 Tbsp all-purpose flour (to be gluten free, I used tapioca flour but I think rice flour would work just as well)
2 tsp. ground coriander
1 1/2 tsp. ground cumin
salt and pepper

For the dip, mix the cucumber through salt and pepper together in a bowl and set aside.

Layer the eggplant and zucchini in a colander and sprinkle with salt. Leave for 30 minutes. The salt will pull out the bitterness in these veggies. Rinse in cold water, then pat dry very well.

Beat the egg in one bowl. Put the flour and remaining seasonings into another bowl. Dip the vegetables first into the egg, then into the seasoned flour and set aside.

Heat about an inch of oil in a deep frying pan until quite hot, then fry the vegetables a few at a time until they are golden and crisp. 

Drain and keep warm while you fry the remainder. Serve warm on a platter with a bowl of the tzatziki dip lightly sprinkled with paprika.

I served these as a first course before we had prosciutto-wrapped chicken for the main course. This is a super-simple recipe. You can get very fancy with this dish and add a sage leaf or rosemary twig before wrapping, you can make a slit in the chicken and stuff it with fontina cheese before sealing it back up and wrapping in the prosciutto, you can stuff it with spinach and feta before wrapping...........the possibilities are endless. But this is a simple, fast, straight-forward dish that takes less effort and still tastes great.

Prosciutto-wrapped chicken

Chicken breasts (1 per person)
Prosciutto slices (1-2 per breast, depending on the size of the chicken)
Ground sage
Garlic powder
Salt and freshly ground black pepper

Rinse and pat dry your chicken breasts.
Sprinkle with salt and pepper and rub 1/4 tsp ground sage and a bit of garlic powder on to both sides.
Wrap each chicken breast with a slice or two of prosciutto. Place on an oiled baking sheet, and bake in a preheated 350 degree F oven for 40 minutes or until done. Allow to sit 5-10 minutes before serving, to allow the juices to be reabsorbed into the chicken so they stay juicy.

I like to drizzle a little bit of balsamic glaze around my chicken breast on the plate for a little sweetness. Prosciutto-wrapped chicken is also delicious with roasted asparagus or roasted potatoes with rosemary. Either way, everything is excellent with a glass of French Rhone wine.

Salud!

Eating out when your gut is touchy

Adhering to a new way of eating is difficult enough when you're cooking for yourself, let alone when you find yourself away from home.

Let's face it - dining out while on a special diet is tough. And I don't mean a diet to lose weight. I mean a diet that is sometimes imposed on you, like when you're allergic to some kind of food or trying to heal an inflamed gut. 

But sometimes there's no way around it. Maybe you're travelling for business or are on vacation. Or you've been invited to a birthday party or a holiday event. What are you going to do - stay home because of the foods that might be there?

Eventually when you're on a special diet long enough, you become familiar with and more confident making it work for you. Eating out should be an enjoyable social experience. The trick is to look for friendly places to dine. Places that demonstrate an awareness of gluten-free or dairy-free eating, or are willing to make substitutions. I can't stand it when I see this written on a restaurant's menu: "NO substitutions". Run, don't walk!!

A good idea is really to telephone ahead to a restaurant or cafe and explain your special dietary needs to the chef. Chefs are becoming increasingly aware of food intolerances. Tell them what you can and can't eat. Ask about the ingredients in specific dishes. They are intimitely familiar with what's on their menu and what would be suitable, or how they can modify a dish to work for you. If they want your business, they'll make it happen.

If you're following a low-FODMAP diet such as myself, there are several cuisines where you can assuredly find something that will work:

Middle Eastern and Indian

Kebabs (skewered meats), tikka dishes, tandoori dishes, plain cooked rice

Southeast Asian
Fried rice (without scallion), steamed or sticky rice, rice paper rolls, sushi (check the fillings), omelets (check fillings), steamed fish, chili, ginger or peppered shrimp, meat, fish or poultry; roasted meats, steamed and stir-fried vegetables, rice noodle soup (pho), sorbets

Italian
In my opinion this is one of the toughest, although not impossible. You're just going to have to ask a LOT of questions.

Risotto (no onion, no garlic), gluten free pasta with pesto (check for garlic), carbonara or many marinara sauces without onion and garlic (good luck); steamed mussels, grilled chicken or veal, shrimp cocktail, mozzarella salad (if not dairy intolerant), antipasto, polenta, steamed vegetables, gelato, granita, and zabaglione (if not dairy intolerant)

Mexican
Another tough one because of the beans and salsa. But, you can try.

Plain corn chips, tacos (no salsa), tamales (without onions or garlic), tostadas, fajitas (without the onion and ask for corn tortillas), arroz (rice), and some of the desserts like flan or arroz con leche (rice pudding) depending on your level of dairy tolerance

Pub Food
plain grilled or roasted meat with vegetables (check gravies for onions, garlic), grilled fish, risotto, salads, flourless cakes, sorbets, meringues.

Another option is to "take your own"

Take your own salad dressing, to make sure it doesn't contain garlic or onion or any other high-FODMAP ingredient
Take your own wheat-free bread or roll to a sandwich bar and ask them to fill it
Take your own wheat-free bread or roll to a hamburger place where they provide the patty and fillings
Take your own gluten-free pasta to have it topped with low-FODMAP sauces, etc.
Take your own pizza base to a restaurant and ask them to top it with onion-free sauces and low-FODMAP ingredients.

Eating at a friend's or family's house

Ask politely what they intend to serve and then decide if you'd like to ask them to make alterations or if you'd rather bring some of your own food. This way you won't starve while everyone else is eating. If necessary, eat something before you go. Then just nibble on appropriate snacks during the event. Don't let the food (or lack of it) spoil your good time or anyone else's.

Travelling

The key to successful vacationing is planning, planning, planning!

Bring your own food on board the airline. That stuff they serve is crappy anyway, even if you didn't have a special diet to follow! Take snacks and easy-to-transport foods with you so that in a pinch, you won't be stuck with nothing and starve. Nonperishable foods such as breakfast cereal, crackers, appropriate trail mixes and nuts are always easy to take with you.

Overseas Travel

You may have to check with US Customs anad Border Protection and inquire about food restrictions in the country to which you are travelling. But once you're there, especially in many countries, such as the UK, Ireland, Italy, Germany and Australia, gluten-free products are relativey easy to purchase. While in other countries, especially in Eastern Europe and across the Middle East, it can be more difficult. In many Asian countries, much of the local food is rice, tapioca or potato based so it's a lot less challenging to find foods that will work for us.

Travel within North America is undoubtedly easier without the language barrier to deal with when trying to make oneself understood abroad. But I say, never pass up an opportunity to get out of your own country and see another part of the world.  Even if you slip up a little and end up not feeling well the next day, you make note of what didn't work and move on.

The easiest solution to eating while travelling is camping...I can pre-cook food at home, put it in plastic storage containers and bring it along with me to reheat. Easy, peasy and no gut-wrenching stomachaches to deal with.

Where to begin with IBS

Week 1 is behind me and I feel loads better being on this new eating plan!

If you have IBS or think you do, there are several things you can do right now to start feeling better right away.

Probably one of the first places to begin improving digestion is to minimize, or remove entirely, common stomach irritants such as coffee, alcohol, pepper, spicy foods and anything you already know you're sensitive to. At least for a little while. After some time you may be able to bring these foods back.

The FODMAP diet removes the other common gastric system upsetters that many people have trouble with: cabbage, broccoli, cauliflower, onions, leeks, shallots, and garlic, unfortunately, as well as other less commonly known irritants: carbohydrates / sugars from fruit, lactose, and gluten, to name a few. 

Another way to minimize discomfort is to eat more frequent but smaller meals. Eating too much at one sitting causes stress on the digestive system, having a lot to suddenly handle.

Avoid carbonated beverages, especially if you have excess gas.

Engage in non-strenuous exercise - walking, easy cycling, tai chi or yoga - until you feel better and can do more strenuous exercise. A hard workout just isn't good when you're feeling weak and don't want to rattle your stomach. But not exercising at all just isn't wise, especially when you have had IBS for months or years. I find that gentle forms of exercise can usually be well-tolerated. When I'm not feeling up to par, I go for a long walk and do some stretching. Something is better than nothing.

Getting proper sleep and learning to relax are also key to calming the digestive tract. I will go to bed a little earlier than usual and just read to relax.

So in addition to the above, here's what I've done: I have adhered strictly to the FODMAP eating plan except for one thing. I ate some non-dairy cherry "ice cream" forgetting that cherries are currently out. Can't say I can report any specific symptoms from that. 

What did me in though is the cream I put in my coffee the last 2 mornings. (Yes, I'm occasionally still drinking coffee. It's a hard one to give up). Anyway, I digress. FODMAP says that cream is a better additive than the milk in half and half (the milk contains a ton of lactose). On Wednesday I did ok with it but not yesterday. Two days in a row is apparently too much for me. Back to tea for a few days. Then I don't know what I'm going to do about my morning coffee. All those non-dairy creamers taste horrible, especially soy creamer, and they have such terrible ingredients. This is such a total bummer. 

But I can report that overall, this FODMAP thing is working. Part of this process is learning what I can tolerate and what I can't. It's looking a lot like lactose is a problem.

For the elimination portion of this eating plan, I have 5 weeks to go. Then comes the "food challenge" part. But more on that in future posts.

On to the recipe.

If you've followed me for some time, you know that on the weekends I sometimes like to whip up a batch of muffins for breakfast. They are quick to make - you can usually pop one into your mouth inside an hour. I don't usually eat a lot of pineapple but I just happened to have a can in my pantry and since pineapple is on the FODMAP list of acceptable fruits and contains digestive enzymes which I figured couldn't hurt, I decided to make these. They are also gluten-free. Best eaten the day they are made.

Pineapple Muffins

1 cup fine rice flour
1/2 cup cornstarch
1/2 cup potato flour (I didn't have any so I used tapioca flour)
1 tsp. baking soda
2 tsp. baking powder
1 tsp. xanthan gum
1/2 cup superfine sugar
2 eggs
6 Tbsp. unsalted butter, melted
One can crushed pineapple, drained (reserve liquid)
3/4 cup suitable yogurt
1 cup confectioner's sugar, sifted

Preheat oven to 350F. Line a 12-cup muffin pan with paper baking liners. Sift the rice flour, cornstarch, potato flour, baking soda, baking powder, and xanthan gum three times in a medium bowl (or mix with a whisk to ensure they are well combined). Add the sugar and mix until well combined.

Break the eggs into a second bowl and whisk. Using a large spoon, stir in the melted butter, pineapple and yogurt. Fold into the flour mixture.

Spoon the batter into the muffin liners. Bake for 15-20 min until a toothpick inserted into the center of the muffins comes out clean. Remove from oven and let cool in the pan for 5 min before transferring to a wire rack to cool completely.

Combine the confectioners' sugar with enough of the reserved pineapple liquid to form a smooth spreadable icing. Drizzle over the cooled muffins and serve.

Makes 12. Each has about 270 calories, and 49g carbs. To cut the carbs and calories, I didn't glaze mine.

What is IBS, and what am I gonna do about it?

Last week I shared with you that this blog would be headed in a slightly different direction and that I would be focusing on improving my digestion. This week I want to share a little more about IBS and my plan for tackling it. 

Years ago my gastroenterologist had indicated that I had a "functional" problem, because none of the tests (endoscopy and colonoscopy) showed any physical signs of damage or inflammation. I strongly suspect that, after all these years of dealing with a variety of symptoms, I have Irritable Bowel Syndrome.

So what is IBS exactly? According to the NIH (National Institute of Health):

"Irritable bowel syndrome is a functional gastrointestinal (GI) disorder, meaning symptoms are caused by changes in how the GI tract works. People with a functional GI disorder have frequent symptoms; however, the GI tract does not become damaged. IBS is a group of symptoms that occur together, not a disease. In the past, IBS was called colitis, mucous colitis, spastic colon, nervous colon, and spastic bowel. The name was changed to reflect the understanding that the disorder has both physical and mental causes and is not a product of a person's imagination."

Rather than quote the entire website, which by the way does an excellent job of describing the condition, I would simply direct you there, if you're interested in knowing more. Click here for more information.

Estimates show that anywhere from 10-15 million Americans suffer from unexplained digestive problems that could be considered Irritable Bowel Syndrome.

So what can one do about it? The NIH recommends the following:

• making changes to one's eating, diet, and nutrition
• taking medications (if needed)
• taking probiotics
• exploring therapies for mental health

Hippocrates said, "let food be thy medicine and medicine be thy food", and I have always believed this. I also realized that just "eating healthy" wasn't going to be enough, because I was doing that and things weren't improving. I knew that I'd have to make some changes to my diet, so following the first NIH recommendation was a given. 

My internet research on diets for IBS led me to a variety of sites that kept talking about FODMAPs. WebMD covered it, as did the Irritable Bowel Syndrome Group Forum, the IBS Information Page on About.com, and of course, there's even "an app for that".  But what in the world are FODMAP's? 

FODMAP stands for:

"Short-chain carbohydrates (oligosaccharides), disaccharides, monosaccharides and related alcohols that are poorly absorbed in the small intestine. These include short-chain (oligo-) saccharide polymers of fructose (fructans) and galactose (galactans), disaccharides (lactose), monosaccharides (fructose), and sugar alcohols (polyols) such as sorbitol, mannitol, xylitol and maltitol.

The term FODMAP is an acronym, deriving from "fermentable, oligo-, di-, mono-, saccharides and polyols". The restriction of these FODMAPs from the diet has been found to have a beneficial effect for sufferers of irritable bowel syndrome and other functional gastrointestinal disorders (FGID). The low FODMAP diet was developed at Monash University in Melbourne, Australia by Dr. Peter Gibson and Susan Shepherd, PhD."

I promptly went on Amazon and bought this book by the creators of the diet. Though there are many books on IBS out there, I wanted to hear this news directly from the people who developed it. I read their well-written and detailed explanation of the diet, how it works and why, and it convinced me to give it a try. 

In short, this pdf provides a quick and dirty list of what to eat and not to eat. But I would advise you to read the book, or any book on the subject, to better understand how and why this might work for you.

So I started the other day. The hardest thing for me, believe it or not, is giving up onions and garlic. I cook everything in onions and garlic. You know - I love FLAVOR! The second hardest is giving up the high-lactose dairy products I count on for protein (like cottage cheese and yogurt) and half and half in my coffee. Gluten is no big sacrifice, since I'd already more or less given that up anyway. But, I want to feel better, so I'm ready to do whatever it takes.

The book also has recipes. The very first recipe sounded really good to me and it was. (I violated another rule of IBS sufferers: don't eat too much at one meal as this puts strain on the digestive system. I couldn't help myself - they were just too good)! This recipe serves 3-4. 

Pumpkin, Chive and Feta Fritters

10 oz. fresh pumpkin or other winter squash, cut into 3/4 inch cubes
(or use a can of pumpkin. See note below)*
1/3 cup fine rice flour
2 Tbsp. cornstarch
1/2 tsp. xanthan gum 
1/4 cup chopped chives
1/2 cup crumbled feta
2 eggs, lightly beaten
1/2 to 1 tsp. ground cumin
salt and freshly ground black pepper
2 Tbsp. oil
3 Tbsp. light sour cream if you're not lactose-intolerant
Garden Salad 

Cook the pumpkin in a medium saucepan of boiling water for 8-10 minutes until soft, then drain and mash*. Allow to cool.

Sift the rice flour, cornstarch, and xanthan gum into a large bowl, whisking to ensure they are well combined. Add 2 Tbsp. chives, the feta, mashed pumpkin, eggs and cumin and mix well. Season with salt and pepper.

Heat 1 Tbsp. of the oil in a medium skillet over medium heat until good and hot. Add a heaping tablespoon of batter per fritter and cook 3-5 minutes. Flip over and flatten with the back of a spatula cooking for another 3-4 minutes until golden brown and cooked through.

Transfer the fritters to a plate and and keep warm while cooking the rest with the remaining oil. Mix together the sour cream and remaining tablespoon of chives. Serve the fritters with a nice big garden salad and a dollop of the sour cream. I skipped the sour cream because I am avoiding nearly all dairy at the moment.

* If you're short on time, you can always open a can of pumpkin, which is what I did. If you do this, you may need to add a little more starch. Make sure your batter isn't too wet after mixing everything together. I added a little sorghum flour that I had on hand.

A blog with a new focus

Nearly four years ago I started this blog called A Passion for Flavor. I imagined it would be fun to do - that I would tinker with for a while but eventually grow tired of it - but here I am, still typing away! 

Obviously, it's been a lot more fun than I had originally realized. Finding things to write about has been at times difficult, yet at other times the ideas just rolled out of me. The inspiration for subject matter was usually just about whatever I fancied at the moment or had talked about with a friend or family member, or an idea I had seen on a cooking show.

But now I'm going to switch things up a bit and take this blog in a new direction, mostly because I can no longer put off addressing an issue that urgently needs my attention. 

It's not an easy thing to talk about, but for nearly the past decade, if not longer, I've had digestive trouble. And unfortunately, things haven't improved much over the years. In fact, they have worsened. Years ago a gastroenterologist took me through the usual battery of tests and found nothing visibly wrong. I heard "you have a "functional" problem." This basically left me without any explanation for my suffering. I left his office thinking perhaps it was all in my head.

But my problems remained and over time I tried all sorts of things on my own: eating this or that thing that was recommended, omitting other things that could aggravate problems but never entirely, drinking peppermint tea (good for an upset stomach), then not drinking peppermint tea (bad for heartburn), drinking fennel tea and ginger tea for digestion, and black tea instead of coffee, cutting carbohydrates, taking apple cider vinegar, probiotics, drinking kefir and eating plain yogurt, drinking bone broth for more minerals, taking hydrochloric acid, pepsin, bromelain, papaya enzymes, digestive enzymes, digestive bitters, homeopathic remedies prescribed by a naturopath, and eventually just taking Pepto-Bismol and Alka Seltzer Gold when flare-ups reared their ugly head and I was frustrated and in a lot of pain. My medicine cabinet is chock full of bottles. And yet, despite all the reading, consulting, pill-popping and witches brews concocted, I suffer more now than ever before.

I had always tried to just ignore my symptoms in the hope that they would just one day go away on their own. This hasn't worked very well for me and clearly a different approach was becoming necessary. We've all heard the saying about the definition of insanity: "doing the same thing over and over again and expecting a different result." 

I started tackling the issue again. Reading, reading and doing ever more reading. And one day I found something that spoke to me. When a doctor tells you it's "functional", more often than not you have IBS (Irritable Bowel Syndrome). As I read about this, the symptoms totally described me. The gas, the bloating, the distention, the worrying about making it to the bathroom in time, the stomach cramping. Sometimes I feel ok, but I have no idea why. What did I leave out to create a friendlier digestive environment?

While not as debilitating as Crohn's disease or ulcerative colitis or IBD (Irritable Bowel Disease) that all can cause lasting and permanent damage to the digestive system, IBS can still negatively impact your day-to-day life and cause a lot of discomfort.

So, how will this affect the Blog, you ask? I am adopting a new eating plan, one developed for people suffering from IBS. I'll go into more of that next week, but for now, know that while there will still be fruits and vegetables and meats and fish and nuts discussed here, some of all of those things will not appear in my recipes.

The reason why is because this eating plan eliminates the foods that have been shown to cause IBS symptoms. After a period of time in which the digestive system is allowed time to calm down (about 6-8 weeks), one reintroduces one of the eliminated foods per week and logs the results. It makes sense to me that only in this way can I begin to learn what's causing the problem. Unfortunately, no doctor knows what my system can handle and what it can't. No one, despite their best intentions, can tell me what to do to save me the time and effort required. It is really a matter of self-experimentation.

So, will you want to stick around and go with me in this new direction? I'm not sure. But I certainly hope so because I will still be eating, and cooking, and making recipes and wanting to share them with you. And if you suffer from any digestive discomfort, either occasionally, or daily like me, I hope you'll possibly get something out of what I write about. Perhaps you'll learn something new, or reconsider something you're doing that might not be ideal for your digestive health. 

Not much really will change, except that the focus won't just be having a passion for flavor, but having a passion for digestive wellness. Maybe this is what I'm meant to do with this blog: to share my experience. 

So, my hope is you'll hang out with me a little longer. Or maybe because of this, discover me for the first time, or perhaps share me with someone you know who is also suffering from unexplained digestive trouble.

Thanks for reading.