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?”

What is Fructose Malabsorption?

The simple answer would be that FM is when the intestines are unable to properly digest fructose, leaving a person with various health problems.

More complex?

Our intestines are only able to digest so much fructose per sitting.  When one has fructose malabsorption that means that they are not able to digest as much as the average person can.  If a person is not able to digest 25 grams of fructose per sitting they are considered to have FM.  25 grams of fructose is a lot of sugar in a sitting.  There are varying degrees of FM sensitivity, some can only absorb about 1 gram of sugar per serving and others can absorb closer to 20-25g. 

Fructose is a simple sugar called a monosaccharide (from the greek meaning single sugar) found in many plants and often called fruit sugar.  The body uses monosaccharide for energy.  Pure, dry fructose is a very sweet, white, odorless, crystalline solid and is the most water-soluble of all the sugars.  Fructose occurs naturally in fruits, some vegetables, honey, sugar cane, sugar beets, wheat, and some other plants.  Fructose is found commercially in sucrose (table/white sugar) and high fructose corn syrup (knows as fructose/glucose in Canada), as well as crystalline fructose.

A person with FM has an inability of the small intestines to break down fructose into smaller molecular fragments for digestion.  The fructose ends up progressing down to the large intestines where bacteria breaks it down into methane gas, hydrogen gas, carbon dioxide and fatty acids.    This results in bloating, diarrhea, flatulence, abdominal pain, nausea and lethargy.  Symptoms generally appear two to 24 hours after ingesting fructose-containing food.  Because this usually causes diarrhea this also results in important vitamins and minerals being lost and over time a person can develop nutritional deficiencies,  commonly calcium and iron, but long term can lead to anemia and osteoprosis.

It should be mentioned that Fructose Malabsorption was previously called Dietary Fructose Intolerance and is still sometimes referred to as this.  Fructose Malabsorption is different then Heriditary Fructose Intolerance (HFI).    In HFI a person lacks the enzyme to break down fructose, thus it can cause liver and kidney problems, as well as be fatal. Fructose Malabsoprtion (FM) although not always pleasant it is not life-threatening and is easily manage by diet. In HFI you must adhere to a very strict fructose-free diet whereas with FM you can learn to adjust your diet according to what you can tolerate.

Links to further reading:

• http://en.wikipedia.org/wiki/Fructose_malabsorption
• http://en.wikipedia.org/wiki/Fructose
• http://www.healthhype.com/fructose-malabsorption-cause-symptoms-and-diagnosis.html
• http://www.livestrong.com/article/285512-what-is-fructose-malabsorption/
• http://www.foodintolerances.com.au/food-intolerances-fructose.aspx
• http://glampress.glam.com/blogs/healthhypecom/fructose_malabsorption_cause_symptoms_and_diagnosis
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001399/
• http://en.wikipedia.org/wiki/Hereditary_fructose_intolerance

Symptoms of Fructose Malabsorption?

The symptoms of FM are very widespread, but the most common ones are:

• bloating
• (smelly)  flatulence
• diarrhea
• constipation
• stomach pains/cramps
• acid reflux/indigestion/heartburn

The other common symptoms that people will complain about are:

• vomiting
• brain fog/fuzzy head/difficulty concentrating
• aching eyes
• fatigue 
• headaches
• mood disturbances
• depression
• trouble sleeping
• joint pains

(*italics denotes symptoms that I get)

If you look at this list you can see that it would be rather hard to come to the conclusion that FM is what is ailing a person by these symptoms. Those with FM are usually diagnosed with IBS, and unfortunately that's as far as the doctors go.  I’m not sure why they find it acceptable to just diagnose a person as having IBS.  That to me is like saying “you have cancer” and leaving it at that.  Cancer is a broad term used to explain a larger variety of illnesses, but to tell someone they have cancer does not tell them anything about the cancer they have, what form they have, how they got it, how to treat it, etc.  IBS is just a broad term that tells a person they have something going on with their intestines/bowels.  But what is causing the irritation?  How do you treat this irritation?  IBS classifies the symptoms but does nothing to help a person fix the cause of the symptoms.  I don’t need a doctor to tell me I have IBS, I know that, but what I need to know is what caused this syndrome and how am I going to treat it. 

Many people with FM are left undiagnosed for years before they finally stumble across FM, often after having tried many different medications,  diet changes, and evaluated what they are eating for quite some time.  Some people are fortunate enough to have a doctor who is aware of FM and will send them for the test, but many doctors are not aware of FM or that there is a test for it.  There are also many doctors who believe that there is no such things a FM (leaving patients extremely frustrated and “lost”).  There is slowly becoming more awareness of FM, but it is still widely unheard of.  While there is a test for FM the ultimate test is the diet, as this is what will truly tell you the severity of your FM, and if you couldn’t have the FM test done, then it will help you to determine if FM is what is ailing you.

Managing your low-fructose diet is done by managing your symptoms.  When the symptoms are under control the diet is under control (that is if there aren’t other things to factor in also, which there often is).

Where to Start?

It’s hard to even know where to begin.  I remember the excitement of getting a diagnosis for Rebecca, and then the discouraging feeling when I began to read and research and couldn’t come up with any very consistent information.  I remember reading and reading and trying to put it all together … even now I have to keep reading and trying to understand since it’s a disorder that continues to change as more research is being done.  What we thought was okay at one point is no longer considered okay (e.g. rye) and what we were told to avoid before might be said to be allowed now (e.g. green beans).  But in the end they can say all that they want but it it still comes down to your individual sensitivity which can just leave you thoroughly  confused as so many things can factor into that sensitivity (sensitivity to other foods, medications, other illnesses, etc).  It’s been over a year of seriously trying to figure out my diet and I’m still very confused at times.  I know this sounds discouraging, but I also know that if I were a bit stricter I might be able to put a better finger on things.  At the same time I also realize that I have Wacko Steph Syndrome (which simply means nothing with me ever makes sense or follows the books) so I’m not a very good example.  Everytime I think I have it figured out something else changes things making me feel discouraged and lost (e.g. a recent change in medication).  I just *sigh* and keep trudging along reminding myself that while I don’t have it all figured out I’m a long ways ahead of where I used to be and this means I feel better then I used to.  Focus on the positive and deal with the negative.

That all being said I have to say that I do not have an extreme case of fructose malabsorption (FM).  I would say that in our house we are moderately sensitive.  We would be most sensitive then those who are mild and just have to avoid the worse fructose foods, but we are not so extreme as some who have a very very limited diet.  We are able to eat a good variety of food, especially since we removed wheat from our diet.  We found that wheat (fructans) was our biggest issue and once we removed that we were better able tolerate more fruits and vegetables.  So while we’re not the mildest case we are definitely not severe.  People who know us may think our diet is difficult and we have some severe sensitivity, in comparison to the many other FM people I have heard from, communicated with, I know that we have it pretty easy.

As I write my blog I want to remind people that I am not a doctor, I have no medical background and am not very good at understanding biology … although I have certainly had my abilities tested and trained in this area in the past years.  I am simply a FM sufferer and mother who wants to enjoy eating while keeping unwanted symptoms away so that we can feel healthy and enjoy our life.  My goal is to simply have a place where I can store information, for myself to go back to and for others to learn from.  A place where the information is gathered.  I realize that it is always best for one to do their own research, but this will provide a starting base and as much as possible I will try to provide links so others can read and learn from what I have read.  This will help me to remember where I found information as well.  So often I read something and keep it in mind when trying to figure things out, but then can’t remember where I read it to refer back to it. 

Welcome to my blog.  I am going to assume that since you are here you, or someone you know, has FM.  I am sorry that you have to deal with this, but with time you will better understand how to eat healthy and what your body can tolerate and this will help you to feel better.  It may seem overwhelming at first, but with time you will get a grip of it and feel more confident in determining what you can and cannot eat, what you can tolerate, how much you can tolerate, etc.  While FM sucks … it is manageable and treatable.