2011 Resovolutions, Part 2: The FODMAP Not Taken

meowser-48.jpg posted by meowser

I used to fantasize writing a universal cookbook for eating theorists. Each food would come complete with a citation from one system or authority claiming it the most divine edible ever created, and another, from an opposing view, damning it as the worst pestilence one human being ever fed to another.

Steven Bratman, MD, Original Orthorexia Essay

So for all the operetta involved in this dietary change, how much did it benefit me? Well, let’s just put it this way; it helped quiet down my noisy belleh, and I actually got a surprising brain boost out of it. I had thought all that stuff about leaky guts and opiate peptides was woo, and maybe it is, but the fact of the matter is that it made a difference in functionality for me. When I adhere to GFCF, I don’t feel like a totally uncoordinated stumbledrunk (most of the time), and I have markedly less agitation and anxiety and don’t stim as much as I used to. It could be that only a small percentage of autistic folks actually do get this benefit, but I do seem to be one, though a “cure” it ain’t.

As it were, though, I was just scratching the surface. Sure, I’m “sensitive” to food. I’m sensitive to air and water, why the hell wouldn’t I be sensitive to food? But the question nagging me was, was it really going to be every food that was going to give me problems? Do they even make diapers in my size? Yeah, I know a certain tiny percentage of post-chole patients do have issues with bile salts (warning: grody stuff in link) and have to go on something like Questran, but my patterns didn’t seem to fit that. Some foods really have been okay. But here’s the thing: When they diagnose you with IBS, what’s the first thing they tell you to do? Eat a high-fiber diet. Which usually means lots of things like whole wheat bread, brown rice, lots of veggies and fruit. And these are undoubtedly wonderful things for people without major intolerances to have a lot more of, if they can.

But after I ate an apple and a pear from that Zabar’s basket, I knew there had to be more going on than just gluten and dairy stuff. Apples! Apples are health food, right? Keep the doctor away, right? Yeah. I had a childhood that was more or less one long stomachache, and do you think anyone would have taken me seriously if I’d complained that apples made me feel yucky? But they do, and the shrink sez it’s a common thing for autistic folks to have problems digesting. Along with pears. And tomatoes. And onions, which I’ve never liked much anyway but are undeniably useful for cooking.

So then I did some poking around and discovered the mostly-unknown-in-the-U.S. disorder called fructose malabsorption. Apparently, about 30% of the population in Western nations has it to one degree or another. Thirty percent! With rare exceptions, that usually doesn’t mean we can’t eat any fruit sugars, but that we have to know what our limits and triggers are. This covers not just fruits or their derivatives (including everyone’s favorite chewtoy, HFCS), but also many veggies and beans. (Does Michael Pollan know about this?) And in some cases, it can lead to problems digesting wheat and dairy, too.

Meanwhile, I’ve discovered that small amounts of Gatorade (which changed its formula in 2010), along with SweeTarts and Smarties, can help me digest things like tomato sauce and carrots, because the dextrose in them helps balance out the slight overbalance of fructose to glucose in the veggies. (These are the hard-candy Smarties known as Rockets in Canada, not the chocolate-based candy by that name sold outside the U.S.) Doesn’t do squat for me with apples and pears, though, or with any savory veggies or grains…oh well. But Gatorade! It keeps the doctor away! For reals now!

And more poking around still uncovered a condition called salicylate sensitivity, which we auties (among others) can also be subject to, and which covers the triggers I have that aren’t accounted for above. Guess which foods are highest in salicylates? Yes, that’s right — pretty much every produce item that’s not on the FODMAP list. (And Donna Williams, an autistic author based in Australia, says documentation exists that veggies are being bred these days with extra salicylates, which are supposed to protect against cancer.) Not to mention tons of nonfood stuff like aspirin and ibuprofen, and most commercially available shampoos and soaps. Holy frigging gluten-free donut holes, Batman. Maybe there’s a good reason some people resist chowing down on ten-foot piles of produce — we don’t just get a little farty eating undercooked broccoli stems, we turn our tummies into skin-covered Cuisinarts doing it, no matter how many times we try over and over again to “get used to it.”

Oddly enough, though, beans don’t bother me at all. Not even if I eat them with pickled cabbage slaw. I’m weird, I know.

I’ll probably keep thumping away on this drum until I die or get a knuckle-ache, but one more time for old times’ sake: Insisting that everyone “eat healthy” (or be thin) is a form of ableism. All of us can’t fucking do it. Oh, they think they’re not talking about people who have Medically Documented Problems eating fiber by the yard, but when we’re potentially talking about almost a third of the population, most of whom have no idea why they can’t “learn to like” stuff that’s allegedly good for them, something is getting lost in the conversation.

Dr. Bratman published his orthorexia article in 1997, but most of what he wrote still applies. Like him, I can’t help but be flummoxed by the fact that, after all this time, after all this study, after billions of human volunteers happily and unhappily offering their bodies up for the cause, nobody can come up with a unifying theory of nutritional medicine. Instead, what we have are handfuls of theories about what’s “good for us,” all of which cancel each other out. Is it possible that some people thrive as veg*ns? Sure. Is it possible that some of us really do have metabolic issues requiring a relatively high consumption of animal proteins? Sure. (Remind me to go on for about six weeks about low-carbing sometime, but for now I’ll just say that going to the grocery store and seeing apples marked with skulls and crossbones would make me snortlaugh to the point of hiccups.) And is it possible that some people have to be every bit as careful consuming “healthy” food as they do eating “junk”? Sure. But that seems to be too much complexity for all the eat-like-I-do gasbags out there to process, just like they can’t process that being fat doesn’t cause diabetes any more than male-pattern baldness causes prostate cancer, and that as much as we might like to prevent prostate cancer, we’re not gonna cure it with hair transplants.

The dietary changes I’ve made pretty much require me to learn to cook all over again, learn to grocery-shop all over again, learn to eat out all over again — in other words, all the things they tell us we have to do if we want serious weight loss. (Fifteen pounds is not serious weight loss for someone my size.) So yeah, I’m capable of doing that, if there’s a clear and imminent benefit to doing so. But here’s why it usually doesn’t work (especially in people who don’t binge) for losing and keeping off any more than minor amounts of weight, if that: people get hungry. Very few people are capable of ignoring constant, gnawing hunger for decades, and very few people can endure the disorientation of forcing themselves into ketosis for years at a time, either. If I pass a pizza place, I might lament the fact that I can’t have a slice without giving myself a terrible tsura, but I don’t have to keep telling myself you’re not hungry you’re not hungry nobody your size can be hungry you just think you’re hungry don’t eat don’t eat don’t eat don’t you want to be liked? Instead, if I’m hungry, I can reach in my bag and pull out some almonds or GF crackers and a portable squeezy tube of hummus, and have something else.

And if I want the pizza bad enough that I’m willing to endure the attending asplodey, I’ll have it. This is where “intuitive eating” becomes a process that incorporates left-brain knowledge about what I can physically handle and what I can’t (as opposed to “demand feeding,” which basically means giving the right brain whatever it’s clamoring for and trusting that I can handle it, whether true or not). I can have what all of me wants (and can afford, of course). And so can you, whatever that is.

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23 Responses to “2011 Resovolutions, Part 2: The FODMAP Not Taken”

  1. Dee Says:

    This is such a great illustration of how eating the same way doesn’t work for everyone. So glad to hear that you were able to figure out how things work for you, and improve your quality of life.

  2. Fantine Says:

    “I’ll probably keep thumping away on this drum until I die or get a knuckle-ache, but one more time for old times’ sake: Insisting that everyone “eat healthy” (or be thin) is a form of ableism. All of us can’t fucking do it. ”

    Meowser, I don’t have the digestive problems you have, but I do have a serious problem with certain textures. I gag on raw vegetables, half-cooked fruit (like in fruit pies) or vegetables, mushrooms, fruits and veggies with skin (like peas), and certain other foods. If I’m going to eat vegetables, they need to cooked practically to mush. I am also a “supertaster” and have problems with bitter things (like certain salad greens) or foods with a strong flavor (like broccoli).

    From what I understand, this is related to a sensory processing disorder that I’ve had since birth. Until I heard a mention of this disorder and researched it, I thought I was just a picky eater and a horrible person who couldn’t learn to like veggies, and gee, that must be why I’m so fat. So add me to the list of fatasses who cannot “eat healthy” just because that’s what I “should” do.

    • Meowser Says:

      Oh gods, textures. You don’t even want to know how many onions I’ve picked out of my food over the years. People sure give me weird looks for doing that, but they don’t even want to know what the alternative is!

      • April D Says:

        I’m with you on the onions picking. My mother used to shake her head and ask how I could even tell they were THERE when I’d be pulling tiny flecks of the damn things out of meatloaf or something. Trust me. I knew where ever one of those damn things were…

  3. Dee Says:

    I’ve gotta say that I don’t have any of these issues with produce. When I was a kid, I liked all kinds of vegetables and was very, very picky about meat and fish. For years, I would have preferred to live on vegetables, pasta & rice, beans, nuts, and cheese. As I’ve gotten older, I’ve learned to eat more normally. I generally don’t have any digestive issues at all, and I like the foods that are considered healthy and always have. The texture of animal fat grosses me out and I avoid eating it when it’s not rude to do so, but “slimy” vegetables like cooked mushrooms and avocados are fine with me.

    This didn’t stopped me from getting fat as a kid and staying fat as an adult.

  4. AcceptanceWoman Says:

    You’ve illustrated so well the whole experimentation mindset which is so hard to achieve when we’re surrounded by nutritional “shoulds.”
    I’m glad you’re feeling better.
    I agree, there’s a world of difference between “nah, that’s going to make me feel crappy in an hour so I would rather not eat it even though it looks/sounds good” and “don’t eat don’t eat don’t eat don’t eat.”
    I had a gastroenterologist (who looked and sounded like John Malkovich) tell me that sugar works as an analgesic, which explained so much to me, including why some regular coke (when it was still made with sugar) generally helped me feel better before I figured out that I was lactose intolerant. So, how many people out there “self-medicate” with sugar? As in, it really makes them feel less sick to their stomach? Lots, I would guess. I’m pro-relief from pain, so that works for me.

    • Meowser Says:

      Yeah, I remember when “Coke syrup” (pre-HFCS) was a well-known upset stomach remedy. But it was just Coke syrup, not any other kind of soda syrup. Apparently, Pepsi wouldn’t cut it. Nobody was really able to explain why, especially since by that point, the formulas were more alike than different. And I think Pepsi actually had more sugar, IIRC.

      • MacNabb Says:

        Oh, that’s so interesting. When I’m feeling kind of off (usually hormonal), Coke works like magic to make me feel better. It has to be red-label Coca-Cola over lots of ice. Pepsi doesn’t seem to work, nor do any other colas I’ve tried. I generally avoid HFCS, so I think of my occasional intake of Coke as “strictly medicinal”.

        We also had a bottle of coke syrup in the house when I was a kid (early 70s), for upset stomachs.

        And in case these might be of interest: I discovered recently that homemade ginger syrup made into ginger ale with club soda (or seltzer), has phenomenal stomach-settling properties. I also sometimes use an old family remedy (Sicilian, I think, since it came from my grandmother): pour some boiling water over a bay leaf in a mug and let steep as for tea, 4-5 minutes. Add a bit of plain old white sugar– about a teaspoon, more or less, for an average-sized mug– and sip from a spoon as hot as you can stand it. It has a pleasant herbal taste and really does seem soothing to me, both for stomach and upset nerves.

      • Inquisitive Raven Says:

        The thing about Coke vs. Pepsi syrup is weird because Pepsi was originally marketed as “aiding digestion.” I believe that’s where the name comes from.

  5. the fat nutritionist Says:

    Very interesting post and links, meowser. This is such a fascinating topic for me, and only underscores what I’ve slowly learned about good nutrition over the years: that it looks different for everyone.

    And I think you are totally right in the ableism inherent in assuming that everyone can follow the “typical, healthy diet” recommended by the USDA/ADA/etc. and that those who can’t or don’t are somehow wrong.

    If you have strong food preferences or physical reactions to certain foods (even “healthy!” foods) there is a good reason why, and it’s worthwhile to find out what works for you. A healthy diet for one person can look much different from a healthy diet for another person.

    • Meowser Says:

      Right. And what gets me is that so many people, especially those of lower SES, aren’t even given a chance to find out what that means for them. I am by no means well-to-do, but I have enough of a food budget that if I buy something I find gross, or can’t tolerate, I can toss it in the trash with little compunction. That wasn’t always the case; a few years ago, I couldn’t afford to “experiment” at all.

  6. Chutti Says:

    Hey-

    Your words on the difference between can’t/shouldn’t and don’t want to are very helpful. There is such a lot of grey area between those two things.

    I am one of those lucky folks who can eat anything, and often do, within the realm of 25 yrs as a (fat!) vegetarian. My hubs, on the other hand, has struggled with his digestion and allergies forever. His autoimmune/arthritis spectrum stuff also manifests in his gut. We’ve been through Gluten Free, dairy free, nut free, soy free, and you name it. I try to eat what he does ( except meat) and at one point you could have made a Venn diagram of our common foods that only included….tacos. Which we still like, thank jeebus.

    He and I were both raised in very low-income households, but now have the financial means to eat whatever is best for us. And we are the total Jack Sprat couple-he has a hard time keeping up his weight. Anecdotally, we are a great answer to the ‘just eat local organic veggies and you’ll be healthy’ crowd. We do, we love them, but I agree with the ableist assumptions inherent in the Pollan crowd. Which is too bad, because I really like a lot of other stuff that he says.

    Thanks for some really good links and info. I wasn’t aware of the fructose malabsorption issue, which bears looking into for him. In our quest to maximize fiber beyond his daily supplelements, we drink a ton of smoothies fortified with apple. Hmmmmm. This may account for the IBS like symptoms not responding.

    Yep-what is good healthy eating for one, may not be for another. And all the shame and finger-wagging in the world is not going to help us find what we each need.

    Great story-you’ve really got me thinking!

  7. penguinlady Says:

    Thank you for posting this! I’ve had the hare-brained theory for a while that foods a person dislikes could also be a body’s way of telling you that you are “allergic” in some way. Maybe I dislike raw tomatoes for deeper reasons than “they’re gross”!

    I also wanted to thank you for talking about what you eat as greater than “a diet”. I’m doing a medical thing this month and to assist that, I’ve made some changes to what I eat. It’s been hard for me to explain to people that I’m not doing “a diet”, I’m changing “my diet”. The goal is not weight-loss, but a specific medical balance (even though, of course, one of the suggestions from my doctor was “lose weight”). Food affects our bodies in ways we don’t even know yet; what affects me may not affect anyone else!

  8. amandajane5 Says:

    I’ve always described myself as a “meatatarian” because I love to eat tons of red meat, and have since childhood. And can’t stand veggies unless they’re raw or only gently steamed – I have serious problems with mushy, and since I’m Southern, didn’t discover I could eat them at all until I started cooking for myself. Veggies in the South are traditionally cooked way past death, and usually with meat in them. But as a metatarian kid, my pediatrician always wondered over how I was a “picture of health” when my mom worried about how I wouldn’t eat veggies. One of the things I found out when I started having health problems as an adult is that I’m anemic – not horribly so, but I was probably eating lots of red meat for a reason! Figuring out your personal diet can be so hard.

    • Living 400lbs Says:

      I craved meat, eggs, and cheese for several years. Went to a new doc who did a bunch of general tests as an “intake”-type thing and discovered I was borderline anemic due to a vitamin b12 deficiency. Started on B12 supplements and suddenly I’m interested in things like “fruit” for breakfast. How strange!

  9. Lisa Says:

    Wow. This is incredibly timely (found this link via Shakesville). I’ve been miserable for months and finally visited my GP last month (a lovely lady who never gives me shit about my weight) about my rebellious innards. She twigged it as IBS and gave me a couple of prescriptions, suggested cutting out dairy and anything else I recognize as a trigger (um, yeah, right now that seems to be air molecules) and asked me to come back in a month to see if I was better. In a word, no. I’m off to a GI doc next week. Hopefully he can give me some insight in to what’s going on in the Southern Hemisphere. I’ve been trying to figure what I can (or am willing to suffer for) eat and what I just am going to have to give up completely (ice cream, I’m looking at you) in order to feel better. That’s all I want. A day without horrible abdominal cramps and associated unpleasantness. It’s not going to be easy by any means figuring out what works and what doesn’t, but you are absolutely right. Approaching my eating with a “what I can eat without horrible consequences” vs. “what I should or shouldn’t eat” is probably what will save my sanity.

  10. charliesdaughter Says:

    I am also so glad you’re feeling better, and this post reminded me of a food adventure I had last week. I’m forever trying to eat “healthier,” for vague guilt and body-image reasons I will not belabor here. So the other day I had to eat “on the run” and selected one of those macrobiotic, vegan pre-packaged meals that are available at delis all over New York City.

    I am not vegan. I am not even entirely sure what “macrobiotic” means, but boy did I feel virtuous when I slapped my six bucks down (not even joking, $6, wtf?).

    Two hours later I was at the pharmacy deciding whether I just needed the Pepcid, or if I should get some chewable Tums, too. Three hours after that I was sending SOSes to my BF pleading for him to bring home ginger ale.

    The ginger ale helped, but you know what really settled my stomach and sent me off to non-nauseous sleep? A big heaping bowl of Kraft Mac and Cheese, made with real butter and, my piece de resistance, half-and-half.

  11. The WellRounded Mama Says:

    Meowser, I can’t say it often enough….you ROCK. I love your way with words.

    I agree with the Fat Nutritionist: “This…only underscores what I’ve slowly learned about good nutrition over the years: that it looks different for everyone.” Amen to that.

    So Meowser, tell us what you CAN eat. Do your next post on what DOES seem to work for you now.

  12. Jackie Says:

    Check out this episode around 7:00. Do mean feeling asplodey like that?

    It’s so funny when Venemous Snaptrap (the rat) bloats up lol

  13. Rosa Says:

    Wait, you mean when it actually makes you healthier you can stick to a diet? That things that actually make you feel better are motivating?

    To me that’s one of the worst effects of the thin=healthy idea. People don’t stick to diet/exercise designed to make them thin because it’s not intrinsically rewarding (for most people). But I know a ton of people (including many who had yo-yo dieted for years) who stick to diets & exercise programs that are actually healthful for them, because being healthier actually feels better. You wouldn’t think that would be a point people would have to make more than once, but it’s amazingly sllippery in the brain.

    I’m so glad you’re finding some things that tame your guts, Meowser.


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