Our Challenge List

After going through the cleanse process and starting to reintroduce new foods I found myself sitting down and looking at all the various lists that I had regarding what was okay and not okay to eat when one has FM.  I needed to go through those lists to get a better grip of what was commonly considered okay.  It took some time to gather the various lists and go over them and over them and try to determine which was the most consistent information.  I remember being quite baffled and frustrated at the time.  Finally I developed a list that I thought was pretty consistent with what I had read.  I wanted my own list so I wasn’t always flipping through the various lists trying to determine what to try next or what was sort of okay.  I’m glad I took the time to do this as after that I could just look at my list and stick with it.

This does not mean that the items on this list are all safe for those with FM.  What it means is that they are the mostly commonly tolerated foods or non-tolerated foods.  Each person is very different when it comes to FM, so it becomes an individual trial of the most commonly tolerated foods to determine what you can or cannot eat.  Remember to only introduce one new food every 5-7 days and not to overeat on the trail food.  Eat a small portion of the new food (e.g. 1/4-1/2 a banana, 2 strawberries) and then wait for 3-4 days to see if there is any reaction.  Consider trying it a second time before moving on to a new food … this would mean it would actually be  8 days before you introduce a new food.

At the time of making the list we already had added a few veggies back into our diet.  So the list below is a copy of what I compiled at that point in our diet. 

 

Currently Can Eat	Currently Can Eat	NOT ALLOWED	**TRYPTOPHAN
Fruits	Vegetables
*Pumpkin	*Lettuce	Apples	Bananas
*Rhubarb	Gr. Peppers	Pears (P)	Chicken
	*Zucchini	Watermelon (F/P)	Milk – cheese, yogurt, etc
	*Potato	Mango	Spinach
	Chives	Peach (F)	Turkey
	Borecole/kale	Honey	Nuts
	Corn	Onion (F)	Peanut butter
		Garlic (F)	Pumpkin seeds
Future Possibilities/Trials	Future Possiblities/Trials	Nectarine (P)	Sesame Seeds
Orange	Cucumber	Cherries (P)	Soy
*Grapefruit	*celery	Plums (P)	Eggs
Kiwi	Green beans		Cauliflower
Pineapple	Spinach		Kale
	Swiss chard		Green beans
#Strawberries	Carrot		Fish
#Raspberries	Tomato
Cantaloupe	*Mushrooms (P)
Blueberries	*Cauliflower (P)
Banana	*Broccoli (F?)
Cranberry	*Peas (F/P)
Grapes	Beets (F)
	Cabbage (F)

* low overall fructose

# medium overall fructose

(P) Polyols

(F) Fructans

**Tolerated tryptophan foods are good for those with FM as they help the body to process seretonin which is often hindered from being produced as it should in the intestines of those with FM. Eating extra tryptophan can help to reduce mood/emotional struggles

Elimination Diet Meal Ideas

It’s bland and boring, but it’s low in fructose and fructans

Breakfast:

• eggs – fried, boiled, scrambled
• bacon (look at ingredients find something sweetened with sugar or maple syrup),
• hashbrowns (check ingredients for type of oil used)
• ham mixed into a scrambled egg or on the side (again check ingredients on ham that it’s sweetened with sugar)
• fried potatoes (a safer option then hashbrowns)
• # oatmeal/porridge– can use oats or oat bran, cooked in water, add a small amount of lactose-free milk when eating
• GF pancakes with margarine or butter or topped with an egg
• #oat crepes/wraps* – filled with egg, bacon and/or ham
• GF bread* or toast
• plain cheerios # (this is if gluten intolerance is not suspected as cheerios are made with oats and have wheat starch added)

Lunch:

• GF bread* or toast
• oat wrap* with:
  • okay lunch meat
  • mayonnaise and chicken/turkey
  • egg salad (mayonnaise, egg, salt)
  • tuna salad (mayonnaise, tuna, salt)
• rice paper wraps (usually found in the Asian food section of the grocery store) with same as above – we often put two “papers” together to make a firmer, easier to hold wrap
• soup
• fry ground beef, chicken, turkey, add salt and water, bring to boil, add rice or white rice noodles
• cook chicken pieces in water with salt for a couple hours, remove meat and add to broth, add bit more salt, bring to boil, add white rice noodles
• pasta salad
• use white rice noodles, cook until done, add tuna, mayonnaise, salt

Supper:
This list may seem short, but you can make potatoes in a variety of ways as well as use a variety of meats to keep things a bit more interesting

• white potatoes
  • cooked, mashed, baked, french fries (watch ingredients if getting store-bought)
• white rice
• white rice noodles – check ingredients carefully, most gluten free rice noodles are made with brown rice.  Look for rice sticks or vermicelle in the Asian food section, these are white rice AND much cheaper then rice pasta, these also come in various size that can be used in soup or like spagetti
• non-processed meat seasoned with salt and pepper
  • steak,  unseasoned roast, ham (check ingredients as these are usually seasoned but often with okay ingredients), pork chops, whole chicken, chicken legs/thighs, unseasoned chicken breasts (usually you have to buy the fresh kind to get it unseasoned), turkey, venison, ground beef, chicken, turkey, pork, etc., fish, seafood ….etc, etc.
  • meatloaf – mix together 1lb ground beef, 3/4 cup oatmeal, 1 egg, 1/2 cup lactose-free milk or water and salt – bake in oven at 350 for 45 minutes
• fried rice
  • fry ground beef/chicken/turkey, add salt, add cooked cold white rice, fry together until warm, can also add scrambled eggs to rice mixture  (later you can fry in some tolerated vegetables)
• Confetti Rice
  • mix 1 cup instant white rice, 1 can of canned ham, chicken or turkey, salt, with 1 cup water, microwave for 10 minutes, sprinkle with grated cheddar cheese if desired, microwave another 1-2 minutes  (later if able to tolerate peas and/or green pepper you can also add some of these)

Snacks:

• boiled egg
• plain potatoe chips
• toast with margarine or occasionally cheddar or cream cheese
• GF pancakes – make small cookie size pancakes, add some margarine for extra flavour  or a sprinkle of sugar
• GF cookies – store bought ones are hard to find that are not made with brown rice or unsuitable sugars
• meringue cookies
• GF crackers – Glutino makes crackers with white rice

Drinks:

• water!!!  Drink lots!!
• kool-aid made with 1/2 amount of sugar
• green (decaf) tea or rooibos tea
• ice tea (homemade, not storebought)
• powder Gatorade - (some premade kinds can be okay, but it is not always clear if they are made with HFCS, whereas the powder form is made from sugar and dextrose)
• limited amounts of lactose-free milk

Desserts:

• egg whites/meringues*
• pavlova*
• jello (not sugar-free, use regular) in small servings
• homemade popsicles – made with kool-aid or mix kool-aid and jello
• ice pops (check ingredients – in Canada these are made with sugar and dextrose)

*recipe to follow in future posting
# avoid if you suspect gluten intolerance

High Fructose Foods

So we talked about safe foods, but it’s probably good to also list the high fructose foods … the ones you want to avoid completely and not even take in small amounts … at least not until you are confident in your diet

• Pears
• Apples
• Watermelon
• Mango
• Honey
• High Fructose Corn Syrup (HFCS) also called glucose/fructose
• Fructose
• Onion*
• Garlic*
• Asparagus*
• Wheat*
• Brown rice*
• Canned fruits sweetened with pear juice
• Fruit juices

*fructans

These are the foods you will pretty much always find on the various “To Avoid” lists.  The foods that have the most amount of fructose (in relation to glucose) or fructans.  There are more foods to avoid, and more foods can be divided by what’s usually safe and what’s often bad, but those foods are often very different from one individual to the next, whereas the above listed foods usually will cause problems and it is just best to stay away from them.

What to Eat During the Elimination Diet

What can you eat on the elimination diet?  This is million dollar question.  What is truly safe for those with FM is always a pondering question.  The answer that many foods are out for the first bit and the diet is very basic because FM is so individual that you need to stick to the very basic most safe low/no-fructose foods.

One thing I want to stress is the necessity to take wheat and brown rice out of your diet.  Wheat and brown rice, as well as onions and garlic, contains fructans (which I’ll get into in another post).  I also recommend that you keep these out of your diet for at LEAST one month, the longer the better.  For myself and many others they have found wheat to be a problem, but because it is a fructan it seems to sometimes cause a different reaction then fructose and so we are often fooled into thinking that it is okay.  For myself, fructose causes gas and bloating as the most obvious symptoms.  Fructans give me brain fog and make me extremely tired.

Another thing that would be wise to do is to eliminate as much dairy as possible and use lactose-free products if you are using dairy.  Many (dare I say the majority) of people with FM also have Lactose Intolerance. 

Below is an idea of the safe foods to eat.  As you can see this is very limited and you will find yourself eating a lot of protein … remember the goal is to feel better and relieve your pain and heal your gut so that it can better absorb the foods that it does get.

 

PROTEIN	VEGETABLES	FRUITS	GRAINS	OTHERS
Eggs	WHITE potatoes		WHITE rice	100% cane sugar in moderation
Beef			WHITE rice noodles	Salt
Pork			Oats*
Chicken	Zucchini #	Rhubarb #	Amaranth	Canola margarine
Turkey	Spinach #	Pumpkin #	Millet	Canola oil
Fish			Sorghum	Lactose-free milk in moderation
Seafood			Quinoa	Low lactose items in moderation **
Venison			Tapioca	White vinegar
Lamb			Buckwheat	Mayonnaise – look for a natural mayonnaise without the added garlic and lemon etc. or make your own

• *If you suspect gluten intolerance then it is best to avoid these
• **Butter, sour cream, cream cheese, cottage cheese, hard cheeses (cheddar, parmesan)
• # Most people can tolerate these items. If you can avoid them for the first part of the elimination diet this would be best, but realizing that you may find you need some fruit and veggies these would be the best options in very small amounts

The Elimination Diet

So you feel relieved that you now have a diagnosis and you know that you have FM, but then you turn to the computer to get a list of foods you can and cannot eat and you discover that every list says something different.  Talk about confusing and discouraging.  If you’re lactose intolerant you remove milk from your diet and after a time slowly reintroduce foods on the list that are low in lactose, if you’re gluten intolerant you look at the list of grains/flours that have gluten in them and remove them from you diet.  If you’re fructose intolerant (malabsorbant) you can’t find a list … or you can find lots of lists, but they’re all different and you have no idea what you can and cannot eat. 

It’s a bit overwhelming at first, overwhelming and frustrating.  It is a constant battle of evaluating everything you eat and every symptom you have, small or big, to try piece together what may have cause that, what did you miss or what did you accidently eat when you thought you were doing so good.  This is usually one of the biggest challenges of FM, trying to understand the diet and what works for you.  And in the end, even if you’re with a support group that can help to guide you, it all comes down to trial and error and what works for you.  There is no magic list, you have to trial the foods yourself to figure out what you can handle and what you cannot, you have to stay focused on the long task of reintroducing foods.  Depending on your level of sensitivity you may find this a challenging process or it may go okay if you are not extremely sensitive. 

One of the purposes of the Elimination Diet is to help you determine how sensitive you are and to give yourself a clear indication of what foods are okay, but the main purpose of the elimination diet is to get yourself to a point of feeling well again, to rid yourself of those symptoms that sent you searching for an answer in the first place.  This process usually takes about 5-7 days.  It is recommended to stay on the elimination diet for at least one week, preferably two weeks, this gives you system a chance to clean out as well as some time to recuperate, the more recuperation time the better the reintroduction of foods will go.  Some people have spent more time on the very basics because they just feel better that way.  The problem I encountered with the elimination diet is the lack of variety.  The lack of variety makes it hard to stick to, but it also means lack of nutrition.  I suffer from IBS-C and was left wondering if the constipation was still there because of the lack of fiber, fruits and veggies in the diet.  Unfortunately I was unable to reach a stage of feeling well as I could not get rid of the constipation (later I discovered this was a side-effect from my medication) but after a couple weeks on the elimination diet I decided I had to move forward to try and get more food into the diet.  There is no clear cut answer on how to go about it, you have to go on how you feel and what you think is best for your body, but it is definitely recommended to aim for at least one week on the very basics to get your system cleaned out.

After you have given your system a chance to clean out and hopefully feel better then it’s time to start trialing food.  This is where it almost gets more difficult.  You feel like you made it through those first days of eating nothing and now you’re ready to go, but the battle has only begun.  It is recommended to only introduce ONE new food every 4-5 days.  Reactions times can vary from immediately to up to 3 or 4 days after you have eaten a offensive food.  With time you will learn what your reaction time usually is and you may be able to adjust your reintroduction times, but as much as you want to rush things it is best to take it slow.  The next big battle is against cheating … oh it’s so tempting to just have a little bit of something bad … but that means you’ve messed up your system and have to clean it out again.  That means you have to go back to the basics for 5 days or so to give your body a chance to be recuperate otherwise you will not truly know if it’s the new food you introduce that is the problem or the food you ate when you cheated.   As you can imagine adding one new food every 5 days means it takes a LONG time to build up your food list … and that’s if things go well.  If you introduce a food that you react to you need to make sure you give 4-5 days of healing time before you try something new. 

I give credit to anyone who is able to stick out the elimination diet without cheating or getting sidetracked.  It is a difficult journey and I will admit that there were many times where I just “had to have” that “bad snack”.  Only to regret it shortly after I ate it, realizing that I was never going to get ahead if I kept picking at those things I missed so much.  It’s hard, and it’s frustrating, but it does get better.  It is also very much a mental battle.  You have to WANT to get better and WANT to go through the process.   There will be discouraging times where you can’t figure out what’s effecting you or you feel like you will never feel better, but you need to keep at it.  You need to also come to a point of accepting that this is a permanent change.  I think that was one of my biggest problems, I thought our FM issues were mild enough that we could get away with just removing the worst items and still being “normal”.  I had to come to terms with the fact that if we truly wanted to feel better then we had to change how we eat.  Many people find it useful to keep a record of the foods they eat and any symptoms they have each day so that they can better evaluation what is happening and be able to look back over time to see if there is a consistent pattern.

I know what the next question is … “what can I eat on the elimination diet?”