Sigh ...

This week has not been a good one ~ I pushed the boundaries a bit too much ... but I did enjoy those 8 green beans! LOL Felt quite sick for 3 days in a row, so now it's back onto the much stricter regime/diet designed for when the hydrogen breath tests are done. I plan to stick to this rigorously for a week, then maybe see what happens. I have quite a food phobia atm but the good thing is that my weight loss continues. I've now said 'good riddance' to almost 9 kgs.
Found this excellent weblog yesterday. While it is from 2008/2009, the info is still very relevant & written with an amazing sense of humour. There are 140 responses which I highly recommend you also read ... loads of helpful comments.
http://avthompson.wordpress.com/what-is-fructose-malabsorption-disorder/

White Rice with Roasted Vegetables

Cut mushrooms, zuchinni and pumpkin into chunks, then toss in olive oil to just glaze each piece. Sprinkle the pumpkin with ground nutmeg and cardamom. Bake in a hot oven til soft and caramelised. Use your preferred method to cook some white rice. While the rice cools, chop the roasted vegs into bite-size pieces. Pile rice on plate & top with the vegs. This is a very tasty combo which can be eaten by itself or as a side for various types of meat. Tried and tested by myself without any symptoms, but I only used 2 mushrooms cut into quarters to lower the polyol (mannitol) dose. Of course, don't include them if you are sensitive.

Fructose Friendly Pancakes with Blueberries and Maple Syrup

OK, so maybe they're not as good as the ones made with white SR wheat flour but they were still yummy. I used Aldi's own brand 'Has no ...' Pancake Mix and made up as per directions on the packet - with eggs & milk, so this is not lactose free. The mix contains buckwheat, rice flour, tapioca starch and it did smell a little strange to me. I'll get used to it. LOL

The pancakes were light, fluffy and golden.

Taste was unfamiliar, but I still enjoyed eating them for lunch. Mouth feel was good.

So .... add 1/2 cup of frozen blueberries, 1/2 teasp white sugar and 1/2 dessertsp butter to a small pan over low heat. Stir until warmed and sticky, while you make the pancakes in a second, larger pan. Stack your pancakes on a plate, spoon the blueberries over them and then pour some Pure Maple Syrup on them as well. What a treat. BTW - I didn't eat all the ones in the pic above!

Be mindful of dose overload and what your individual threshold is :)

Phew! It's on the nose

About 2 years ago I started to develop some really strong, adverse reactions to the smells of many foods. For example, tinned fish ~ any sort of fish really, chilli, deli meats, the horrible packaged soups etc which DH likes. I also hated the smells of chemicals, which made me feel sick ... but it wasn't new. I'd had that for about 20 years. I was having difficulty cooking too - I'd get part way through preparing a meal & have to stop due to nausea. I'd even dry retch on occasion. To my peril, I ignored these warning alerts from my body. If I forced myself to eat the meal that was making me feel like this I would end up with severe FructMal symptoms, sometimes within only 45 minutes! In the end DH & I just accepted it was part of the "new me". He was very considerate and set up a cooking area for himself in his shed where he could cook & eat all the things I hated.

Then, only a few days ago, I was re-reading info at the RPAH Allergy Unit website: http://www.sswahs.nsw.gov.au/rpa/allergy/

where I found this: Your nose may become more sensitive on the elimination diet, and strong odours and fumes may cause you to feel ill. This usually subsides after the diet is liberalized.

Read the full text here: http://www.sswahs.nsw.gov.au/rpa/allergy/

and this ...... Some people with food intolerances find that their sense of smell gets more acute on a restricted diet. Strong perfume, car exhaust, petrol fumes, fresh paint, cigarette smoke and other irritant smells and fumes may make you feel ill or give you a headache.

Read the full text here: http://www.sswahs.nsw.gov.au/rpa/allergy/

I can't wait to get all the resources I've ordered from RPAH.

Seems my snozz was right on the money!

A day from my food diary

When I first started a Low FODMAP diet, I struggled a bit to develop a daily meal plan which was tasty but didn't cause any symptoms. In the hope of helping out other newly diagnosed FructMals, here's a sample of what I can eat. Please remember that each of us need to find our individual levels of tolerance. I am very sensitive, so it's been a lot of trial and error - mostly error! What works for me, may not work for you ~ but at least this could be a starting point. I'm still trying to cut white sugar out completely, not 'quite' there yet. LOL I'm not lactose intolerant, but I mostly use LF milk ... just in! To make the small serves of tea or coffee extra special, I always use one of my beautiful eggshell china cups.

BREAKFAST: Traditional rolled oats cooked with 50-50 water & lactose free milk, sweetened with 1 tablesp maple syrup. Sprinkle 2 tablesp of Freedom Foods brand GF (Fructose Free) Fruit Free Clusters on top of porridge. (Available from Coles/Bi-Lo). Cup of Earl Grey tea with 1 tsp white sugar, no milk

MID MORNING: Original Corn Thins X 3 with a scrape of Nuttelex & Vegemite (or Nutella for an Easter treat!). 1/2 banana. Black coffee with 1 tsp white sugar or some coffee granules

LUNCH: Gluten Free wrap with cos lettuce, grated carrot, shaved cucumber, 1/2 cheese slice (shredded), 3 cherry tomatoes (sliced), 1 small mushroom (finely sliced), sliced smoked chicken breast. 8 raspberries with 2 tablesp homemade yoghurt. Cup of tea with 1 tsp sugar and milk.

AFTERNOON: 1/2 banana mashed on 1/2 gluten free bread roll. Small latte, no sugar

DINNER: Tuna Mornay (recipe below) served with steamed silver beet or spinach and white rice. Small cup of Earl Grey tea with 1 tsp sugar, no milk

SUPPER: I rarely have supper, but sometimes sneak in a cup of Early Grey tea (black, no sugar).

Alternate Breakfast: 1) GF toasted cheese or tomato sandwich 2) GF toast with Nuttelex and a scrape of jam, vegemite or peanut butter. Add a 1/2 cup serve of fruit from the safe list ... I usually have a small slice of cantaloupe.

Alternate lunch: Poached egg on GF toast + small salad.

Alternate dinner: 1) small serve of meat (dry pan fried) with vegetables from the 'safe' list (1/2 cup serves). For eg, I like mashed potato, pumpkin and steamed zuchinni or carrot. 2) GF pasta tossed with pumpkin, capsicum, tomato and mushroom chunks roasted together with a little olive oil, sprinkled with dessertsp grated parmesan cheese (or layered GF lasagna with the same ingredients). Limit the mushroom, which contains polyols, until you know your tolerance level. Be careful with capsicum & tomato too.

TREATS: 1) Patties brand GF fructose friendly lamingtons ... in the freezer section of most supermarkets. 2) D'Lush GF Double Choc & Peppermint biscuits ... Coles and Bi-Lo health foods section. 3) I also quite like Patties brand GF fructose friendly Pizza Rolls.

FructMal Tuna Mornay

After the Smoked Cod recipe disaster, I was very careful before posting this one for Tuna Mornay. I have now eaten this three times without any symptoms at all, so I believe it's safe. It does have flour used as a thickener, however the amount eaten is minimal. I am very sensitive to fructans in wheat, but I was fine. If it concerns you, use corn flour. The following amounts made 4 entree size portions. The leftovers stored and re-heated well.

30g butter

1 stalk celery, chopped fine

1 tablespoon plain flour (if preferred, use spelt flour or similar substitute)

1 cup milk (reduced fat or lactose free works well)

1/3 cup grated hard cheese (cheddar or tasty)

130g canned corn kernels

2 X 185g canned tuna in springwater, drained

3/4 cup Orgran brand GF corn crispy crumbs

1/4 cup grated parmesan cheese

Pre-heat oven to 180C. Melt butter in medium saucepan. Sweat celery til soft. Add flour & cook, stirring, for 1 minute. Gradually stir in milk. Cook, stirring, until mixture boils and thickens. Remove from heat, add tasty or cheddar cheese, corn and tuna. Stir until cheese melts. Spoon mixture into small ovenproof dishes; or a medium sized single dish. Sprinkle with combined corn crumbs and parmesan cheese. Bake for 15 mins or until heated through & top is golden.

I served it with steamed silver beet, but a salad of choice would be nice too. Add a GF roll or fresh GF bread and you have an easy-to-prepare tasty meal which won't cause you any tears. This recipe will become a permanent one for me.

Reading, reading, reading

First I want to say that I deleted the post with the recipe which I had thought was FructMal safe - it possibly was - but I had a reaction to it the next day, so thought it best to remove it. I think I probably reacted to the smoked fish ... who knows what chemicals were used???

Edited to add: After speaking with a dietician at Diet Solutions, I now think I was reacting to the amines in the fish.

This past weekend was wet & cold, so I spent quite a lot of hours doing further reading.

There's a great Fructose Malabsorption Group at Yahoo. It requires registration & approval to join from the group owner/moderators, but worth the wait to access the wide knowledge and support from the other members. It was started by people in the U.S. but many Australians are very active members. There's excellent info available:

http://health.groups.yahoo.com/group/fructose_malabsorption_australia/

I also found a website headed by Jaci Barrett, a recognised expert in GI issues/conditions.

Diet Solutions is in Surrey Hills, Melbourne. They conduct their research through Monash University, auspiced by Box Hill Hospital. Lots of excellent info here:

http://dietsolutions.net.au/

You can order their Low FODMAP Diet Booklet, but not using a CC phone order unfortunately.

The order form is here:

http://www.med.monash.edu.au/ehcs/research/docs/booklet-final-order-form.pdf

I believe there are some inconsistencies in the Shepherd Works Low FODMAP Diet booklet. For example, brown rice is listed as 'safe' ... my most recent research indicates that white rice only is suitable for people with FructMal. Capsicum (bell pepper) is also listed as safe ... be wary! Check your sensitivity to cabbage, broccoli & cauliflower ... fructans are the enemy here. Perhaps I don't have the most recent version of the booklet. It certainly does pay to be very up-to-date.

The other important thing I learned during the past 24 hours is that so-called 'onion stock' is not safe ... be wary of Silly Yaks products. Some people are reporting reactions to these products. The very most recent research has proven that onion and garlic fructans are water soluble, so removing the flesh after cooking does nothing because the fructans will still be in the liquid. However, they are not fat soluble so it is apparently safe to infuse oil with onion and/or garlic using heat; then use that oil for cooking to add flavour. Store in the fridge and use within 2 weeks. Be absolutely sure that no flesh gets into your cooking accidently.

Personally, I intend to remain well clear of those two nasties!

My new best friend

Suffering at times from acute indigestion, bloating and wind I had been looking for something to alleviate the discomfort. Then I remembered that, immediately before a gastroscopy, the GI asked me to swallow some Infacol to break up any bubbles in my stomach. Why not I thought? It works for babies. The medicos obviously think it has a place in the management of GI procedures ... I'll give it a try. It works! I take 1/2 a syringe every time I feel that all-too-familiar painful wind trying to escape. No wonder babies cry so hard when they have colic. My GI told me that I can take as much as I need to; for as long as I need to. It's not addictive, it's safe to use. The active ingredient is surfactant, which breaks up the bubbles and helps to disperse them. It will make you 'burp' quite loudly ... but who cares? Better out, than in ... right? Infacol is sold by chemists, but I have also seen it in the baby products on supermarket shelves. It's around $AUD10 per 30mls bottle and lasts me 5-6 days.

If it's sweet, be careful what you eat

Yeah, yeah I know ... a bit obsessed, but I want to share my new knowledge & hope someone who needs the info actually finds it. If you are a FructMal, let your taste buds help guide your food choices. If it's fruit, veg or processed food & it tastes or smells sweet it probably contains fructose or fructans. Think about it. Are pears & apples sweet? Onions? Are tomatoes sweet? Asparagus? Cabbage? What about pre-packaged foods? Biscuits? Muesli bars? Processed cereals? Breads? On the other hand, Traditional Oats (porridge) smell and taste a bit, well ... bland. So does rice. Most FructMals can eat a normal sized helping of these; and foods which are made from them but without HFCS added ... be vigilant! Food manufacturers are very sneaky. Use your nose too. Your sense of smell can be a great ally. If it smells sweet ... think mango ... it's probably going to give you grief.

Seven years of hell...my Fructose Malabsorption Journey

In 2003, just before I went to the US for the first time with DH, I had a sudden onset of Irritable Bowel Syndrome (IBS) without any warning at all. It made the trip I'd been looking forward to for so long, very difficult. Over the next few years I was able to manage it, but this condition really should be called "Unpredictable Bowel Syndrome". It's painful and embarrassing. It made going to work difficult. It meant eating out was almost impossible. It made driving long distances, or any sort of travel, just about impossible. However, I was still able to visit my elder daughter to spend time with her and my grandchildren. I managed a second trip to the US with my husband; and a third with my younger daughter ... but neither of those trips was a whole lot of fun. Then in October 2009 all hell broke loose when I had to have my gall bladder removed in an emergency operation after several unbelievably painful attacks. This was followed by further surgery in December 2009 to repair an enterocoele which was caused by the violent vomiting during that final gall bladder attack. The surgeons told me my IBS symptoms might become worse, but nobody could have prepared me for what followed. Over the next 2 years my symptoms became so bad that I was housebound. Thankfully I had retired - which was just as well as there is no way I could have been working during this time. I couldn't even make it to a supermarket to do the shopping. I wasn't able to do heavy housework. I couldn't walk 200m out the back to check my animals. I couldn't confidently meet the man who delivered stock feed to our property. I literally couldn't leave the house! The very worst thing for me was that I didn't get to see my family or grandchildren very often. My daughter & I organised get togethers in Melbourne which were always fun, but to be able to manage the long drive etc I had to take Imodium and the side effects of taking that rotten stuff were not at all pleasant. In October 2010 I'd had enough!! I was severely depressed, even suicidal. It was time to find some courage, make an appointment with a gastro enterologist and try to find out what was wrong with me. I'd put it off for a long time because I was terrified about the invasive procedures I knew would need to be done, but I was now in a dark place with no quality of life. I had to wait nine weeks for that first appointment and the GI man said those two words I'd been dreading ... 'gastroscopy' and 'colonoscopy'. It was another 5-week wait for the procedures to be done. They were both negative and I was devastated. Plunged again into a reactive depression, I'd been hoping for a diagnosis of Coeliac Disease - or even bowel cancer would have been a relief. At least there would have been a diagnosis, I could have been getting some sort of treatment, there would have been some hope in my life ~ instead I was still undiagnosed, still terribly sick. My symptoms were profound. Then my daughter told me about a lady she'd spoken with who had told her about Fructose Malabsorption ... you can read about it here: http://shepherdworks.com.au/disease-information/fructose-malabsorption I spent hours & hours: weeks & weeks researching this condition, learning as much about it as I could. Trying to understand it. Finally, a small window of hope. The more I read, the more I was convinced that this was what was wrong with me. Frustrated by the long timeframes waiting for medical appointments, I decided to be pro-active and organised for myself to have a hydrogen breath test done; and in the meantime put myself on the very strict diet required prior to performing the test. The first 7-10 days on this diet were hard. I almost gave up hope again, thinking that I was completely on the wrong track but now I know that, during those first days, I was in detox melt down! Thankfully, I persevered with the diet and the fructose malabsorption test was positive. Outwardly, I was cautiously optimistic - but inside I was ecstatic!!! I was totally convinced that I'd finally got an answer - one which Dr. Natalya & I had worked out for ourselves (NOT the medical people I'd spent months and weeks and hundreds & hundreds of dollars on). It's now been seven weeks since I began the Low FODMAP diet and the worst of my symptoms are gone! I have a life again! I've spent almost a whole day in the car driving to see my daughter, son-in-law and grandchildren! I can do most things I want to do. I am still not 100% well - I have nausea, bloating and other intestinal symptoms, but it's early days still. I don't have a lot of energy ... but I AM getting better! If this is as good as it gets, I don't mind. I have a life again. Low FODMAP diet info here: http://shepherdworks.com.au/disease-information/low-fodmap-diet Australia is a leader in Fructose Malabsorption research. We also utilise hydrogen breath testing far in advance of most other countries. Shepherd Works is recognised as a leading world expert in the treatment and management of a group of conditions (which include Coeliac Disease and Fructose Malabsorption) more widely known under the Irritable Bowel Syndrome spectrum. IBS is now more clearly defined. It's better understood. There is a lot of information available about Fructose Malabsorption. It can be hard to understand, confusing and inconsistent. It takes some sorting through - don't give up. There are food lists to help you out, but remember that individuals will have different symptoms and different levels of tolerance to different fructose/fructan containing foods. Fructans are chains of fructose molecules that terminate in a glucose molecule. They are the nasties in many veggies and wheat, spelt, kamut and brown rice (not white rice). It's a matter of working out what's best for you. What you can (but even more importantly!) what you can't eat. A specialist dietician can help you sort through it all. I see one at Shepherd Works and she has been fantastic. As a general rule, corn (NOT high fructose corn syrup ~ HFCS) and white rice are well tolerated. Wheat products are not, because wheat contains fructans. Oats are also OK. Make sure their content is 100% ... learn to read labels :) Many processed foods contain onion, apple and/or pear juice additives (for flavour). These are a huge no-no! Most fruits and many vegetables contain fructose/fructans, but there are others which don't. If you search for low fructose foods you'll find enough to keep you from starving. LOL Finally, I blogged my experience in the hope of helping at least one other person ... but please remember that I have no formal training ... so contact someone who does and I'm sure they will be able to help even further.