ugh.
not good. i do not feel good. double dose of promethazine and some tylenol and i am still head-achey and flagrantly nauseous.
admittedly, i did have a lot of sugar today... not smart. i do not feel smart.
this evening, i wanted nothing more than to eat my yukons scalloped in rice milk and read my book on Eve Ball. alas, i made some poor decisions today (like not running; eating three mini gluten-free cornbread muffins, a quarter of a chocolate waffle and four pieces of salt water taffy; not drinking any water until 2pm). not hungry. i do not feel hungry.
i was hoping to avoid a repeat of the last year, but this whole back-to-where-i-was-last-April business is not promising. not promising.
Showing posts with label gluten. Show all posts
Showing posts with label gluten. Show all posts
Tuesday, May 25, 2010
Friday, February 26, 2010
days like this
1. Apparently, I am still capable of working occasional 12 hour days.
2. Apparently, I am still capable of occasionally stopping at the store on the way home from said 12 hour work days.
3. Apparently, I am still capable of occasionally using said groceries after said 12 hour work days to cook delicious dinner.
4. I am not, however, anywhere near inclined to spend my 2 left over hours of awakeness on the aforementioned days to either work on the abstracts for my two papers, or to write a post in Hungry blog on the exquisite discussion that occurred during the morning's Journal Club.
5. It is 830 on a Friday night and I am planning to crash on my pillow. So. Maybe I'm not quite back yet... But I'm really, really happy.
2. Apparently, I am still capable of occasionally stopping at the store on the way home from said 12 hour work days.
3. Apparently, I am still capable of occasionally using said groceries after said 12 hour work days to cook delicious dinner.
4. I am not, however, anywhere near inclined to spend my 2 left over hours of awakeness on the aforementioned days to either work on the abstracts for my two papers, or to write a post in Hungry blog on the exquisite discussion that occurred during the morning's Journal Club.
5. It is 830 on a Friday night and I am planning to crash on my pillow. So. Maybe I'm not quite back yet... But I'm really, really happy.
Thursday, October 15, 2009
On the Evolution of Diet
My experience has always been that during the ebb of a Crohn's flare, carbohydrates pass with the least residual damage. In the long term, however, carbohydrates are increasingly the spotlighted culprit of havoc-wreaking; and not solely by way of Klebsiella.
I've flirted with the Paleolithic (or, SCD) diet before; before diving headlong into this most recent flare (2.5 mos, and counting), I was balancing quite nicely in a Me Friendly version of the Paleo diet. Because I had only been doing so for several days before The Fall, and because my gastrointestinal condition had been sloughing downhill for almost a year, I wasn't able to give the diet a legitimate chance.
Now that I'm working on climbing out of this crevice, however, I'm trying to shift my current selection of solid foods away from Carbo Loaded and into Paleocentric orbit. My Me Friendly version of this was additionally limiting the red meats (fats), nuts (fats and allergies) and very fibrous vegetables (obstruction).
What I aim to do nearly without:
dairy (no brainer)
sugar (no brainer)
salt (no brainer)
grains (categorically similar to dairy in terms of damage, but I don't seem to have a gluten problem so we'll keep those with low glycemic indices)
legumes (see above; I could never entirely eliminate legumes...)
red meat (fats)
nuts (fats and allergies)
berries (seeds)... These last three are part of the "Do Consume" stipulation of the Paleo/SCD diets; alas, knowing that they destroy me I cannot invite mucosal carnage.
What I aim to tolerate:
poultry and fish
eggs
fruit (without pulp or small seeds)
root vegetables (non-stringy)
fermented foods (this should be interesting)
other foods with low glycemic indices
I'm typically quite skeptical of the hardcore diet reversions that try to re-plant us in the days before preservatives and cooking. Most of the diets that come recommended with Crohn's are pre-processing, or Paleolithic era (Dr. Balzer summarizes this nicely). Atkin's, Raw Food, SCD-- they're all based on caveman diets. And that's fine, except that we haven't been Cro-Magnon for 20,000 years. Very, very few proponents of these diets take into consideration the evolution that has occurred in the human gut during the gap between then and now (not to mention the inherent shift in caloric intake). I'm truly at a loss as to why.
It's sort of like how Western culture touts that if we all ate three rice-based meals a day -- heavy on the salts and carbs, mind you -- we'd all sport Asian slender, low cholesterol and have beautiful creamy skin. This false-cause fallacy forgets that one can train the body to produce the proper enzymes to accommodate such an adjustment, but it's not all about enzymes... there are genes involved (Ley et al 2008; Bengmark 1998). The anthropologists argue that we currently evolve too rapidly for these genetic influences to accommodate (Kligler & Lee 2004); my position continues to be that epigenetics and post-translational modifications negate that stance. The microbes that inhabit our gut and help us process food have co-evolved with us, any may respond to a dynamic change in diet either positively or negatively depending on your physiology and genetic predisposition.
My bias is moderation. Unless you have a predictable or distinguishable allergy, it is usually not helpful to eliminate something from your diet entirely. Gluten, yes. Dairy, okay. Carbohydrates, not so much. Fruit, definitely not so much. I can't do a hardcore Paleolithic or SCD diet because I have never been able to limit my diet that strictly for an extended time without invoking a flare -- which is something else the caveman diet prognosticators tend to neglect; the importance of variety. Variety is why people on the Homeopathic route take Probiotics.
I also have a resistance to thoroughly processed foods heavy on the preservatives, sugars and salts; this resistance escalates to phobia when I am on PPR. The Ley group argues that the evolution of agriculture and cooking didn't have an appreciable effect on our Gut Flora -- that the preparation of otherwise inedible grains which are the primary sustenance of our microbiotic friends did not significantly encourage their co-evolution. Others suggest that these new tools were the paradigm shift that brought about an exponential predisposition to gastrointestinal disorders. My bias aside, there is more sufficient evidence for the latter case from genetic, microbiological, anthropological and other fields (Cordain et al 2005; Wrangham et al 1999).
So we'll see how this unfolds.
I've flirted with the Paleolithic (or, SCD) diet before; before diving headlong into this most recent flare (2.5 mos, and counting), I was balancing quite nicely in a Me Friendly version of the Paleo diet. Because I had only been doing so for several days before The Fall, and because my gastrointestinal condition had been sloughing downhill for almost a year, I wasn't able to give the diet a legitimate chance.
Now that I'm working on climbing out of this crevice, however, I'm trying to shift my current selection of solid foods away from Carbo Loaded and into Paleocentric orbit. My Me Friendly version of this was additionally limiting the red meats (fats), nuts (fats and allergies) and very fibrous vegetables (obstruction).
What I aim to do nearly without:
dairy (no brainer)
sugar (no brainer)
salt (no brainer)
grains (categorically similar to dairy in terms of damage, but I don't seem to have a gluten problem so we'll keep those with low glycemic indices)
legumes (see above; I could never entirely eliminate legumes...)
red meat (fats)
nuts (fats and allergies)
berries (seeds)... These last three are part of the "Do Consume" stipulation of the Paleo/SCD diets; alas, knowing that they destroy me I cannot invite mucosal carnage.
What I aim to tolerate:
poultry and fish
eggs
fruit (without pulp or small seeds)
root vegetables (non-stringy)
fermented foods (this should be interesting)
other foods with low glycemic indices
I'm typically quite skeptical of the hardcore diet reversions that try to re-plant us in the days before preservatives and cooking. Most of the diets that come recommended with Crohn's are pre-processing, or Paleolithic era (Dr. Balzer summarizes this nicely). Atkin's, Raw Food, SCD-- they're all based on caveman diets. And that's fine, except that we haven't been Cro-Magnon for 20,000 years. Very, very few proponents of these diets take into consideration the evolution that has occurred in the human gut during the gap between then and now (not to mention the inherent shift in caloric intake). I'm truly at a loss as to why.
It's sort of like how Western culture touts that if we all ate three rice-based meals a day -- heavy on the salts and carbs, mind you -- we'd all sport Asian slender, low cholesterol and have beautiful creamy skin. This false-cause fallacy forgets that one can train the body to produce the proper enzymes to accommodate such an adjustment, but it's not all about enzymes... there are genes involved (Ley et al 2008; Bengmark 1998). The anthropologists argue that we currently evolve too rapidly for these genetic influences to accommodate (Kligler & Lee 2004); my position continues to be that epigenetics and post-translational modifications negate that stance. The microbes that inhabit our gut and help us process food have co-evolved with us, any may respond to a dynamic change in diet either positively or negatively depending on your physiology and genetic predisposition.
My bias is moderation. Unless you have a predictable or distinguishable allergy, it is usually not helpful to eliminate something from your diet entirely. Gluten, yes. Dairy, okay. Carbohydrates, not so much. Fruit, definitely not so much. I can't do a hardcore Paleolithic or SCD diet because I have never been able to limit my diet that strictly for an extended time without invoking a flare -- which is something else the caveman diet prognosticators tend to neglect; the importance of variety. Variety is why people on the Homeopathic route take Probiotics.
I also have a resistance to thoroughly processed foods heavy on the preservatives, sugars and salts; this resistance escalates to phobia when I am on PPR. The Ley group argues that the evolution of agriculture and cooking didn't have an appreciable effect on our Gut Flora -- that the preparation of otherwise inedible grains which are the primary sustenance of our microbiotic friends did not significantly encourage their co-evolution. Others suggest that these new tools were the paradigm shift that brought about an exponential predisposition to gastrointestinal disorders. My bias aside, there is more sufficient evidence for the latter case from genetic, microbiological, anthropological and other fields (Cordain et al 2005; Wrangham et al 1999).
So we'll see how this unfolds.
Saturday, September 5, 2009
Food of the Day: Spaghetti Squash
Since I know you're all so anxious to hear how my contumacious tummeh dealt with spaghetti squash soup... no trouble! I can't emphasize enough how exciting it is to be able to eat something that is neither broth nor pure carbohydrate after two months. This is so thrilling, in fact, that I have resolved to make some of these tantalizing spaghetti squash hash browns when I get down to California (although I will have to substitute the onions and butter).
Our Food of the Day - you may have guessed - is spaghetti squash. It is a staple food in the SCD because it is fairly low in carbs and sugar. Additionally; low in saturated fat and cholesterol, excellent source of vitamin B6, vitamin C and folic acid. Most of the carbohydrate ratio comes from the sugar content, but these are simple vegetable sugars - the good kind of bad sugar. Spaghetti squash is also a good source of choline (also mentioned in the BEETS Food of the Day post). Although it is slightly inflammatory due to the fiber content, it seems to be a good introductory food for me (to be consumed moderately, of course).
For those who have asked, I believe that easing back into solid food with the Specific Carbohydrate and gluten-free diets is going to be ideal for this particular flare. I will not be holding steadfast to the guidelines of both, mind you, but combining the most helpful parameters of each (id est, absolutely no nuts/seeds and no meat/dairy for quite some time to come). The SCD is geared toward Crohnies and Coeliacs who have trouble gaining weight, and I have NEVER had trouble getting back to my normal weight. Therefore, I will be slowly tapering off the simple carbohydrate intake (grains, potatoes, rice) and easing into foods that result in less "residual throughput" breeding ground for unwanted flora, and that do not gibe inflammation. Complex carbohydrates (apples, plums, blueberries, fresh orange juice with no pulp) are supposed to be specifically IBD protective. Simple sugars (watermelon, dried fruit, pineapple, grapes), however, contribute to inflammation and so will be avoided. [Griel et al 2006, Art Thromb Vasc Biol; Gastrich et al 2008, Top Clin Nut]
Carbohydrate and sugar complexity is tough to negotiate because most foods have both simple and complex varieties. Low glycemic index is really going to be my best friend on this one.
Remicade Part Deux went well this morning, and I have finally been given permission to start up vitamin C and D (but no multivitamin yet, for a reason that I do not fully comprehend [yes, as a scientist I do not get this one... something about chelation that shouldn't actually be happening]).
Our Food of the Day - you may have guessed - is spaghetti squash. It is a staple food in the SCD because it is fairly low in carbs and sugar. Additionally; low in saturated fat and cholesterol, excellent source of vitamin B6, vitamin C and folic acid. Most of the carbohydrate ratio comes from the sugar content, but these are simple vegetable sugars - the good kind of bad sugar. Spaghetti squash is also a good source of choline (also mentioned in the BEETS Food of the Day post). Although it is slightly inflammatory due to the fiber content, it seems to be a good introductory food for me (to be consumed moderately, of course).
For those who have asked, I believe that easing back into solid food with the Specific Carbohydrate and gluten-free diets is going to be ideal for this particular flare. I will not be holding steadfast to the guidelines of both, mind you, but combining the most helpful parameters of each (id est, absolutely no nuts/seeds and no meat/dairy for quite some time to come). The SCD is geared toward Crohnies and Coeliacs who have trouble gaining weight, and I have NEVER had trouble getting back to my normal weight. Therefore, I will be slowly tapering off the simple carbohydrate intake (grains, potatoes, rice) and easing into foods that result in less "residual throughput" breeding ground for unwanted flora, and that do not gibe inflammation. Complex carbohydrates (apples, plums, blueberries, fresh orange juice with no pulp) are supposed to be specifically IBD protective. Simple sugars (watermelon, dried fruit, pineapple, grapes), however, contribute to inflammation and so will be avoided. [Griel et al 2006, Art Thromb Vasc Biol; Gastrich et al 2008, Top Clin Nut]
Carbohydrate and sugar complexity is tough to negotiate because most foods have both simple and complex varieties. Low glycemic index is really going to be my best friend on this one.
--
Remicade Part Deux went well this morning, and I have finally been given permission to start up vitamin C and D (but no multivitamin yet, for a reason that I do not fully comprehend [yes, as a scientist I do not get this one... something about chelation that shouldn't actually be happening]).
And now I must sleep, for I have an early flight.
Monday, August 24, 2009
crash and burn
Well then. I have used my scientific analytical skills and deductive reasoning to ascertain the culprit(s) of last night's relapse. Weighing in at 1.5x as painful as this flare's initial attack, striking an epic 9.9 on the richter scale and legitimately petrifying my boyfriend into thinking I had gone into labor... last night's attack was (drumroll...)
... due to two slices of gluten- and allergen-free tapioca bread?
Seriously? Really?
Since gastros always tell you to eliminate dairy and fiber from your diet when dealing with Crohn's flares of any magnitude, I'm introducing solids back into my diet by way of the gluten-free realm. Safe, right?...
That's right, folks. I was so impressed that six days of prednisone had allowed me to keep down Lipton Soup Secrets noodle soup and a few Nilla Wafers that I strode boldly into the land of gluten-free starches to put some taste back on my pallet. I am willing to suggest that this was one of the worst mistakes of my life. Well... this mistake was, perhaps, not the tapioca bread but the fact that I brilliantly decided to sample the other goodies I found - a few puffs of Veggie Pirate's Booty and a small cocoa-tasting cookie thing.
CLEARLY this was too much excitement for my Nilla Wafer- and broth-fed tummeh. Good god. Two+ hours of some of the most violent pain of my life. I opted for 15mg oxycodone as opposed to heading to the ER for a morphine/anti-nausea drip at 1am the day I was supposed to return to work.
Oddly enough, I had the energy to actually go in to work today. At 7am (courtesy of my stay-at-home-boyfriend and chauffer). I know - I was shocked, too. And now I'm studying... I have no idea how the stimulant perk of prednisone chose to kick in at 6am this morning, but shit am I happy about it.
The only problem with going to work and trying to study all day is that... well... I'm freaking hungry. icanhaz toasted onion bagel with vegan shmear, lox and capers??
Conclusions: 6 days of 40mg prednisone was not enough to quell this flare, and new foods no matter how disgustingly mild should be introduced one at a time!
Sunday, August 9, 2009
crohn's and coeliac
Sunday morning: 6mp, levisin, peppermint pill, ginger tea, probiotic and oatmeal.
Sunday afternoon: split pea soup.
Sunday evening: levisin, promethazine, peppermint pill, ginger tea... baked potato and spinach.
Now then. Way the hell back in 1984, the two most prevalent instigators of Crohn's were dairy and wheat (Workman et al). However, most Crohnies are told that wheat is the lesser of the two evils and end up embarking on a primarily bread-packed diet, especially when ill. A decade later, there is a notably high prevalence of Coeliac disease in Crohn's patients (Tursi et al 2005). Huh... I wonder how in the world this might have happened.
[note: I reserve the right to use the scientific spelling of coeliac disease, since celiac is meant to be called the disease of the coelem...]
I have two working theories.
1) Crohnies seek out the most mild diet possible, including wheat breads to try to give some kind of nutritional value to the meager gustatory regimen and subsequently develop Coeliac or gluten-sensitivity due to the overload of gliadin and transglutaminases that are the trademarks of gluten/wheat intolerance.
2) Coeliac and Crohn's are actually cohorts.
I like the Tursi study because, unlike many medical case studies, it actually has a pretty thorough methods protocol (yes, I am particularly scrupulous about scientific protocol). When they conclude that all patients should begin a gluten-free diet upon CD diagnosis, this recommendation is sound. Namely, all of their case study patients were diagnosed with CD for the first time immediately prior to being subject to this correlative Coeliac study.
What I would have liked to see is the prevalence of actual villous damage in CD patients with antibody markers of Coeliac. This study, however, looked only at biomarkers of Coeliac, and not at histological damage. If most CD patients with Coeliac disease do not have villous atrophy, it suggests that Coeliac evolved after the onset of Crohn's inflammation, is in early or benign stages, and is the result of an elevated wheat intake (likely inadvertent) in the quest for a "Crohn's friendly" diet.
I would also like to see a study in veterans of CD to see what symptoms of Coeliac they exhibit, which would confirm or reject my working theories. A girl can dream, eh?
--
The point of this post is that I'm now trying to modulate (but not eliminate) my gluten intake... just for the hell of it. Coeliac disease has been discarded from my list of contributing ailments by several blood tests, so I'm not really concerned, but it is interesting.
Subscribe to:
Posts (Atom)