2011 Resovolutions, Part 2: The FODMAP Not Taken

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.