Tuesday, March 26, 2013

Corn and Fructose Malabsorption

I'm no doctor, I'm just a girl collecting my findings of food allergies, intolerances, and malabsorptions. Of course, you should ALWAYS consult with a doctor or dietician before starting a new diet, especially if you suspect or know of an allergy.

I knew before I was even diagnosed with fructose malabsorption disorder that my body was reacting very badly to anything that had corn in it. So, I think that I must have a corn allergy (not a doctor's diagnosis!). Since being diagnosed with fructose malabsorption, I have been trying VERY hard to be as free of fructose, as well as corn, as possible... and still having terrible reactions to so many things that I thought were ok! So, I've become quite adept at trying to pinpoint where the actual problems are coming from. Lo and behold, the answer is usually CORN. Sneaky sneaky corn. It's in SO MUCH! I am definitely going to get myself tested to find out if I have a corn allergy, but let me tell you, when you are in chronic pain over food, you learn to listen to your body. Period. EVERY TIME I have corn, I am in pain. So, even if it turns out I don't have a corn allergy, I will still avoid it like the plague.

Anyway, I thought I'd share some of the products I recently found out have, or might have corn in them. I've been attempting to do some gluten free baking lately (an easy way to avoid wheat, which is a fructan- watch for other problematic ingredients, though!). Since gluten is the sticky part that helps breads and pastries stick together, the recipes will often call for something like guar gum, or xanthan gum. Xanthan gum is usually derived from corn! I hear there are some that aren't made from corn, but I haven't been able to find any. Baking powder has cornstarch, and most caramel is made with corn syrup. Also, I have been using dextrose instead of sugar to avoid the fructose part of the sugar, but I have found that anyone avoiding corn should be wary of food products that list dextrose as an ingredient. Dextrose used in food products is not chemically pure, and can contain remnants of what it was made from, which is usually corn. I did find that I was reacting to a certain brand of hashbrowns that listed dextrose, and have stayed away from anything listing dextrose ever since. (Apparently, chemically pure dextrose should be ok, because it isn't a protein and thus can't be an allergen- but I haven't been able to verify that quite yet.) Vegetable anything, and anything that lists "flavoring" or "natural flavor" I avoid, just in case. Some other ones I avoid are corn alcohols or alcohols that don't say what they are made from (could be corn-derived). I've personally reacted to vanilla, and vanillinCellulose and stearic acid are two that I have seen listed on medication- so I avoid those medications.

TONS of things that you would never think have corn in them... do.

IT'S NOT FAIRRRR!

But life goes on, right? The best I can do is try and avoid it as much as possible. I found two amazing sites that have been a tremendous help in figuring out what to avoid. You'll see that some of my information comes from these sites (like the part about the dextrose!) Check them out, if you are interested in an extensive list of items that (may) contain corn.

http://www.vishniac.com/ephraim/corn-bother.html
http://www.cornallergens.com/list/corn-allergen-list.php


*Again, I'm no doctor, I'm just a girl collecting my findings of food allergies, intolerances, and malabsorptions. Of course, you should ALWAYS consult with a doctor or dietician before starting a new diet, especially if you suspect or know of an allergy.


Monday, March 18, 2013

My Current Diet

Many people who are diagnosed with fructose malabsorption will do just fine on a low-fructose diet. Eating very small amounts of fructose, spread out throughout the day, is tolerable. If I remember correctly, my nutritionist said that most people consume about 60g of fructose per day. She recommended 20g per day, and not more than one serving of fruits or veggies (1 cup fresh, 1/2 cup canned in WATER) per meal. Most of her clients do very well on this diet, from what I understand!

This diet works for most fructmals, according to my nutritionist, and definitely confirmed through my own research:

Small amounts of lemon, lime, and fresh berries are favorable for fruits. Ripe bananas are ok for some people (not me!). Most fructmals will not be able to handle apples, pears, watermelon, dried fruit or fruit juices (because of the concentrated amounts of sugar).

Most fructmals cannot handle
wheat, barley, rye, onions, asparagus, leeks or garlic. Fructmals who are not too sensitive have found that they are able to cook with garlic or onions for flavor, as long as they don't eat the meaty part. 

Cruciferous vegetables like broccoli and cauliflower are ok for some, but everyone is different. I personally can't eat them. On the favorable list for most are zucchini ( can have in tiiiiiny amounts), avacado (no-can-do for me, but I'm super sensitive!), and spinach (seems to be ok so far). Carrots, beans and peas are tolerated by some, but generally don't sit well with most fructmals. 

Milk is generally tolerated, as long as there is not also a lactose intolerance. Avoid sweetened yogurts and milks high in sugars like soy milk and almond milk.

(My nutritionist said that plain yogurt or greek yogurt is ok, but some nutritionists believe it unwise to introduce bacteria into a fructmals body, as the bacteria are already going a little nutso.)


Oats, quinoa, buckwheat, and white rice are generally ok (my nutiritionist said that brown rice is ok, too, but I have found conflicting information on that, and know from personal experience that I don't handle it well). White potatoes are ok for MOST fructmals (I can only have them in small amounts).
Avoid sweet potatoes!

Meats and eggs are a GO, unless honey-cured or sweetened (like most ham and bacon). Unsweetened nuts should be ok for most people.

Avoid
all "itols," like sorbitol, mannitol, etc.

Avoid
agave syrup, molasses, honey, jam, jelly, high fructose corn syrup, fructose sweeteners, sugar alcohols. Sucrose (sugar) is ok for most people in small amounts, and is best tolerated with a meal. Glucose is ok, and dextrose is ok.

Some people can handle very small amounts of dark chocolate. Watch out for
chocolate liquors, because of the high amounts of sugar. 

The diet outlined above works for MANY people. Unfortunately, not for me. I'm super sensitive!! After further research I found this diet, which was VERY helpful. It suggests eliminating as much fructose as necessary, for 6 weeks, to "re-boot" your system.

AVOID (for at least 6 weeks):
ALL fruit and fructose
Wheat, spelt, kamut, brown rice
All of the onion family
Asparagus, artichoke, green and yellow beans
Anything probiotic (like yoghurt)
Anything prebiotic (like FOS, inulin, or chicory)
The “-itols” (like sorbital, mannitol, maltitol, xylitol, etc.)

Greatly reduce intake of sucrose, honey, molasses

If still have symptoms after 6 weeks, eliminate:
Corn and tomatoes
Rye and oats
All nuts
All honey (ratio of fructose to glucose is not consistent in honey, as it is in sucrose)

If, after several weeks you still have trouble, try eliminating all potatoes. Not a lot of fructmals have trouble with potatoes, but some do. Very few people have problems with oats and nuts.

When reintroducing foods, try only one food at a time, in one form (only raw, only cooked, only commercially frozen).

Unfortunately, I did end up having to eliminate, even before the 6 weeks, tomatoes and nuts. I'm too scared to try honey. Corn was a problem before I was diagnosed with fructose malabsorption, so corn has always been "out" for me. 

I have learned that I do need to avoid all the foods mentioned above (in red), except for white potatoes, which I can handle in very small amounts. I only eat them once a day. I also react strongly to broccoli, cauliflower, any type of bean, peas, chicory, and gums, like xanthan gum, carob bean gum, guar gum. I had a super strong reaction to almonds, so I am avoiding all nuts, for 6 weeks, just to be safe. I have eliminated all of those things from my diet (for at least 6 weeks). I changed my toothpaste to Arm and Hammer Peroxicare, bc most other toothpastes have sorbitol. I feel MUCH better after doing so. I avoid mouthwash with sorbitol. I avoid anything from the grocery store that says "spices," or "flavorings," bc they might have garlic or onion. THAT SNEAKY FRUCTOSE! I also have to watch out for garlic and onion in powder form.

The things I have been handling well are white rice, steel cut oats, butter, eggs, milk, cheese (check labels!), small amounts of potatoes- once a day, and all meats, except for pork (although I don't think that has to do with fructose, unless it is bc that is what the animal is being fed). I try my best to get grass-fed beef and chicken. 

It's tough following such a strict diet, but I'm feeling a little better some days. Some days I feel worse, but I think that once my body gets through this detox phase, I will feel much better. I am both looking forward to and dreading introducing new foods into my diet, to see how I tolerate them. I have a long way to go!!!

This is just what works for me. Everybody (every body) is different! We can all tolerate different things. It's important to listen to YOUR OWN body, and what it is telling you. Also,  remember that I am NOT a doctor! I'm just a girl relating my own experience to you all. It is always wise to seek the wisdom and advice of a doctor and/or nutritionist before starting any diet.

 

Saturday, March 16, 2013

What the heck IS Fructose Malabsorption Disorder? In fact, what the heck is fructose?

Fructose Malabsorption Disorder is the inability to absorb fructose. When we don't absorb fructose, it travels into the lower intestine, where bacteria eat it up. After eating the fructose, those nasty bacteria create hydrogen, or in some cases methane, in our bowels. It is my understanding that the fructose is basically being fermented in there. EW! This can cause (as in my case) a huge distended belly. According to my GI doctor, when a persons belly gets that big, it starts to spasm. The spasms are what cause the pain that comes with the distended belly. Other symptoms caused by having fructose in the lower instestine are diarrhea, cramping, constipation, chronic stomach pain, and headaches. 

Fructose also affects us in less immediate ways.When fructose travels to the lower intestine, where we store tryptophan, the fructose binds with the tryptophan- making us unable to absorb it either. Soooo... it all leaves the body. Since tryptophan is what makes us sleepy when it is dark- not having any can cause insomnia. Tryptophan also helps us make seratonin... and since seratonin is what makes us happy, a lack of seratonin causes depression. (Interestingly, one recent study shows that women who have fructose malabsorption disorder are much more likely to suffer from depression than men- likely because men create much higher levels of tryptophan than women do.)

Fructose is a single molecule sugar found in most fruits (with higher amounts in stone fruits, like apples, pears, and peaches). It can also be found in sweeteners, high fructose corn syrup, etc.


Some foods have molecules of fructose chained together- we call these food fructans.
Wheat, spelt, kamut, brown rice, onions (anything in the onion family), shallots, leeks, artichokes, asparagus, green beans, and tomato paste are some of the major fructans.

Table sugar-I believe in America, beet sugar and cane sugar-have equal parts fructose and glucose. Glucose is another type of sugar- a type of sugar that is easily absorbed, even by fructmals! Glucose also does the wonderful job of helping the fructose to get absorbed. So, if you have equal parts of glucose to fructose, or MORE glucose than fructose, chances are you will absorb it (again, unless you go overboard and freak out your system). Some people react to sucrose or regular table sugar (even it teeny tiny amounts) but many fructans can tolerate it without symptoms, as long as they don't go overboard with it.

 Sorbital, mannitol, xylitol, and other “itols" inhibit fructose absorption in everyone! Fructmals should stay far from these "itols," which can even be found in gum and toothpaste. We already have enough trouble without these "itols!" (It is my understanding that Arm and Hammer “Peroxicare” is one of the few toothpastes that does not have sorbital- but don't take my word for it. Always read your labels!)

Additionally, because fructmals already have issues with bacteria creating all sorts of chaos in the stomach, some doctors and nutritionists believe that fructmals should avoid probiotics (like yogurt), and prebiotics (like inulin, and chicory). These are also known as fructooligosaccharides (FOS). Apparently, these can make the bacteria crazier than they already are. I have also read, in contradiction, that some doctors and nutritionists believe it is important to have probiotics, to help balance the flora in our guts. One lady in my yahoo fructose malabsorbtion group has said that her doctor had her start with a tiiiiny 1/8 tsp of goat kefir, and now she is at 2 tablespoons. She says she able to tolerate much more fructose, having done this. I still stand in the "who knows?!?!" section on this one.

(Ok, I admit it. I'm standing in the "who knows?!?!?! section of all of it. But, I'm trying to learn!)


Things that some fructmals can handle, in small amounts, that I just can't seem to tolerate right now are carrots, tomatos, lemon/lime, berries, cauliflower, broccoli, and nuts. I am actually only tolerating spinach and zucchini, and only in tiny amounts. As for right now, I have decided to eliminate those foods during my elimination phase. For 6 whole weeks I will do my best to be not just low fructose, but fructose FREE. If I run into a food that gives me reactions- it lands in the elimination pile for now. After 6 weeks, I will start "testing" foods in very small amounts, one at a time. This is an approach I found on a couple VERY HELPFUL websites I happened to stumble upon! You will see that much of my information comes from there (I will post links below). Apparently, Canada is ahead of us, and Australia is ever further ahead of them as far as understanding fructose malabsorption. All of the research is still VERY new, everywhere, though, which is what makes it so difficult to understand and deal with. There is a lot of conflicting information out there! What I have stated here is my basic understanding, from my own personal research. Please, do your own research, and talk to your doctor and nutritionist about how to approach your diet.

http://avthompson.wordpress.com/what-is-fructose-malabsorption-disorder/

https://sites.google.com/site/fructmal/diet

http://health.groups.yahoo.com/group/fructose_malabsorption_australia/message/13644

Monday, March 11, 2013

My Path to Diagnosis: Fructose Malabsorption Disorder

For the last five years or so, I have been dealing with chronic stomach pain, which until recently, was undiagnosed.

At first, I was told "drink more water." That didn't seem to help. I was told "eat more fiber." That didn't help. One doctor frowned, and told me that if my boyfriend loved me, he would wait (although I was 26 at this point, and in a monogamous relationship). He sent me to a gynecologist to get tested for STDs, have a Pap Smear, and an ultrasound. Everything came back normal. I decided to sign up for Carelink. The doctor ran a blood test, checked for diabetes and whatever else, and everything came back normal. She told me to "drink more water," and also to "eat more fiber." I did, but still, my stomach hurt.

My allergies were spawn of the devil. I took Claritin D every day, and blamed it for my insomnia- but I had to have it, or my headache was out of this world. None of the many nasal sprays they gave me seemed to help. It seemed that the more my allergies bothered me, the more my stomach hurt. It hurt to sit for too long. It hurt if I ate. It hurt if I didn't eat. It ALWAYS hurt. It became my norm. I was always distended. I began to have acid reflux. GERD. Ear pain (which I now know can be caused by severe acid reflux). I tried Ranitidine, Prilosec, Prevacid, Nexium... nothing helped. 

I had a Celiac Screen. I tested negative. They did an abdominal ultrasound, and the medical student raved about how wonderful my organs were, how easy it was to get a good picture. She wished she could practice on me all the time. Everything was normal. The doctor recommended I see a gastroenterologist, but I didn't think I could afford it without insurance.

So I didn't go.

The Celiac screen got me thinking about food, though. I noticed that I was starting to get strange sickening smells in my nose around certain foods- I would always describe it as "rotten fruit and sawdust." No one else could smell these smells. Popcorn, our all-time family favorite, began to taste TERRIBLE. The smell made me sick. Chocolate smelled terrible. CHOCOLATE! The former best smell in the world! I couldn't drink Big Red without the smell. A friend sent me an article on the horrors of corn, and so I tried to pay close attention. The next time I had corn... there was the smell! My Mom sent home a turkey casserole made with corn tortillas... it was AWFUL! It stank. The smell was on my breath all the time. It was the same smell as my fecal matter. I was disgusted, scared, confused. My stomach hurt all the time. I stopped eating anything with corn in it. I knew it made me sick.

I thought that maybe that was it- corn was the answer- but the pain didn't go away.

We went on vacation, and on our road trip, I had what I though was an allergic reaction to something in the New Mexico air- since it started with a slightly stuffy nose. The stuffy nose quickly turned to the inability to get a deep breath. I started hyperventilating, and snot and tears poured from my face. I couldn't breathe. My hands tingled. My nose tingled. Luckily, I had packed some Benadryl along with other "just in case" medicines- and my husband tore through the bags to get me some. After laying on my back for awhile, and taking deep breaths, I began to normalize.

All through our trip, I laughed and joked that I was allergic to New Mexico, but when I had another attack on our way back into Texas, I began to wonder if I really was!

My stomach still hurt. My body was tired, but my mind was racing all the time. I worked a lot, did a lot of photoshoots, but it was so exhausting to pretend to feel good, when my stomach was in so much pain. My poor family suffered. I kept up appearance while working, and came home deflated and irritable. I was moody. I was impatient. I didn't sleep. Many times my stomach was so distended I had to unbutton my pants. I often looked as though I was four months pregnant. I never wanted to leave the house, because it was so much more comfortable to stay in my pajamas all day. I changed into them right away, every time I stepped foot into my home. When I did go out, I wore T-shirts, and didn't bother with makeup- because I was all bloated and ugly, anyway. Once, I told my Mom that I wanted to sit around the house all day without having to do anything, even take a shower or wash my hair. She said, "That's for depressed people," and I laughed and said I was joking. But I wasn't. My husband and I rarely had sex, because of the extreme pain it caused, and this was causing me a lot of guilt and anxiety (although he was quite understanding).

When I had another another attack after eating at a restaurant, I realized that each of the other two episodes also happened almost immediately after eating. I assumed I must have eaten some sort of corn. I though that maybe I was allergic to nuts, because I had almonds at or near two of the meals, and some fried food that could possibly have been cooked in peanut oil for the third. I popped some Benadryl, but I was scared, so this time I had my husband drive me to the hospital. The E.R. doctor told me I was having anxiety attacks, and prescribed me Xanax and said to take it three times a day. Of course, I didn't. I knew better. I KNEW that somehow, food was causing these attacks- but I didn't know what, or why. I experienced a few more attacks. I developed a light rash on my neck and chest, and when I had these attacks, the rash was angry. Avoiding corn, I created a frittata one night, with eggs, broccoli, cauliflower, red pepper, spinach (all healthy choices, right?), and had a severe attack, which in addition to the other symptoms caused my whole body to go cold, and my entire leg to feel like it had a "charlie horse" and jump around.

I was getting kind of scared, by this point. I was a google monster! I suspected pylori, candida overgrowth, diabetes, and a few other things, and considered getting my own tests done... but where do you start? Around this time I also began to discuss my symptoms with a friend, who I knew had a strict diet. She told me she couldn't eat gluten, and the sugar that comes from fruit. She described her symptoms before she was tested, and how she was finally diagnosed with fructose malabsorption through the "breath test" her GI gave her. I thought to myself "I have that!"I also thought that this breath test didn't sound nearly as daunting as an endoscopy, or one of those other scary procedures that my brain associated with the GI doctor.

 I decided to look one up. It didn't matter the cost. My symptoms were starting to freak me out, the pain was becoming unbearable, and maybe, just maybe, it was something as simple as this malabsorption thing.

So, I went to the GI. I drank a cup of fructose. The nurse informed me I might have diarrhea, and/or stomach pain. She said I'd blow into a tube every 30 minutes for up to three hours, or until I blew a 75 or higher (for a positive diagnosis). I went back to the waiting room, and very quickly had to run to the bathroom. I broke out in a bright red rash on my neck and chest. It felt like an elephant was sitting on me. When the nurse got me from the waiting room, so I could blow my first breath (not including the control), she exclaimed that she had never seen anyone break out in a rash before, that it was weird. Then, when I blew a 108 on the first breath, she said "That's because you're WAAAAAAAAAY positive!" Pause. "Hold on." She left the room and shut the door.

I was diagnosed with fructose malabsorption February 7th, 2013. I was also diagnosed with bacterial overgrowth a few days later (which I took some hard-core antibiotics for!) I was happy to know the cause of all of my discomfort. It was good to have a name for it. I was thankful that it wasn't something that could kill me. If my friend could live with it, then so could I! I was feeling very positive. Even when the nurse showed me the list of foods I could not have, I felt ok. I could do this. I could manage this. Dare I say I even had "fun" the first time I went shopping for new foods? I was learning to read labels. I was excited to cook at home, more.

 But, as religiously as I tried to follow the diet, I had another attack. My stomach kept hurting (keeps hurting!). Unfortunately, some days I feel worse than I did before. Some days I feel better! But many days, I feel worse. As with anything, there is a learning curve, and I'm trying my best to be patient. I saw a nutritionist, who definitely gave me some helpful information, but it seems that I am more sensitive to many things than other "fructmals" are. I am having to branch out on my own to figure this out. As I look for recipes and foods that I don't react to, I come up depressingly empty-handed.

But this is just the beginning of my journey! Sure, it's not a bowl of peaches, but it is what it is, right? And I have to deal with it, so I will. I have faith that one day I won't miss my old friend, Fructose. I have faith that one day I'll be a pro at all of this. I'll know what to eat, and what not to eat. I'll be a great cook, and share my recipes! I have faith that one day, Ill be able to eat out or go on vacation without fear, or have a drink with my friends, and not pay dearly for it.

I have faith that I will be a healthier, happier person.

Have faith with me.