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digestion web
March 20, 2016 | by  | in Features |
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Gutted.

Most of us like food, yeah? We need it to survive, and sometimes it’s just too hard to not Instagram a meal out. It’s easy to spend a lot of time talking about nice restaurants and cafés, that great new recipe we just tried, or how damn expensive food can be. But what about what happens once we’ve eaten? We don’t spend much time thinking about the inner workings of our intestines, and poo jokes are for 12 year-old boys, right? Approximately 25% of people suffer from some kind of diagnosed chronic stomach illness, which is a lot of us! So let’s stop pretending that nothing happens after we’ve eaten. Bodies do a lot for us, and can also cause us a lot of trouble. In particular, stomachs can be a right nuisance. They’re big, confusing, and do a lot of work. This means that when they stop working properly, shit goes down. It can be really hard to identify a stomach illness, let alone address it. One of the more medically confusing chronic stomach illnesses is Irritable Bowel Syndrome (IBS). Most of us have heard about it at some point or another, but still it tends to be a mystery for the most part.

Late last year I was woken up at 4am with an excruciating pain in my stomach, I thought that I had a ruptured appendix. The next day I got on a bus and shipped myself off to the emergency department. I was discharged with the all-clear on my appendix, a script for tramadol, and no diagnosis. I spent the next month or so traipsing down to Student Health at least once a week. Eventually my doctor gave me an IBS diagnosis, adding me to the 10-20% of people in New Zealand who suffer from IBS—according to the Health Navigator NZ website—which is pretty high! No-one likes to talk about it, because who the fuck wants to hear about the details of someone else’s large intestine? Well, tough shit, I’ve had enough of pretending it doesn’t exist. IBS is a functional gastrointestinal disorder with no known cure. It is identified by chronic abdominal pain, discomfort, bloating, and altered bowel habits. The cherry on top of an already bleak outlook is that there are no current tests that allow doctors to identify the syndrome; it’s more of a case-by-case kind of thing.

According to my doctor, IBS has baffled medical professionals for years as it has been really difficult to find a cause for it. That was, until the University of Monash came along and got everyone really excited about FODMAPs; a collection of short chain carbohydrates and sugar alcohol. FODMAP is an acronym that stands for some crazy unpronounceable words: Fermentable, Oligo-Saccharides, Disaccharides, Mono-saccharide & Polyols. What are they and how do they relate to IBS, you ask? What the Monash researchers found, essentially, was that people with IBS seem to have trouble digesting foods with high FODMAP content. Being an arts student, I’m not great at explaining the science behind it. FODMAPs are, in my understanding, different types of sugars in foods that people with some stomach problems have issues digesting.

***

The researchers tested various foods for their FODMAP content, and created the low-FODMAP diet. They have a comprehensive list of foods that people with IBS should avoid, and suggest that for a month or so, patients strictly follow the diet to see if it makes a difference. The idea is that after a few weeks, you’ll start to feel better. When this happens, you can start slowly re-introducing foods back into your diet to see which ones trigger stomach problems. The cool thing about it is that scientists across the globe are still testing new foods and every so often the list of stuff you can eat will be updated. I definitely appreciate having the chance to shove new foods in my mouth, so I like to periodically check the blog that Monash set up to keep people updated about the diet. They also have an app that helps people adjust to the diet, but it’s like $20.00, and being a broke student I cannot justify that. I’ve heard it’s great though!

While the low-FODMAP diet is a great advance for gastrointestinal science, it’s pretty fucking restrictive. I nearly cried when I looked at the endless list of food it says to avoid. The main things you have to go without are gluten, high-lactose foods, anything from the onion and garlic families, most legumes, and a heap of fruit and veg. That’s going to be difficult for anyone to adjust to, but when you’re a broke student it adds another level of difficulty. Gluten and lactose free food alternatives are so fucking expensive. When I started the low-FODMAP diet, I could barely eat without getting queasy, so I began living off rice, peanut butter, and banana. It was a shit time. I lost well over five kilos in about four weeks. It fucked up my relationship with food for a while. I struggled to eat (who wants to cook when you can’t eat any of the delicious food you love), and whenever I broke the FODMAP diet I felt both physically unwell, but also guilty for knowingly putting myself in pain. It took a while, but I eventually started feeling better.

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I’ve gotten a lot better at figuring out how to cook meals I like that still have flavour. I can eat things that have small amounts of onion and garlic in them without getting violently ill. But, it’s a lot of trial and error. I go through periods where I get really bummed out about all the delicious food I’m missing out on. I get sick of trying to make food taste nice, and the bungled attempts at cooking can be deflating. During these periods I live off porridge and/or muesli. I still go through periods where I feel that the IBS diagnosis is a bullshit label they give you when they don’t know what’s going on. Stomachs are both amazing and mysterious, who knows what’s going on in that gurgling mess.  

A low-FODMAP diet can be absolute misery, but if it helps your pain and digestion then it is worth it. It takes a while to adjust, but if you stick with it it gets easier. The University of Monash website is a trove of free and useful resources. I find that blogs have too many contradictory lists of things you can and can’t eat. Most recipe books are full of expensive foods and red meat (which I don’t eat). I’m keeping track of all the cheap meals that I’ve successfully made low-FODMAP friendly, and when I have enough I’m going to make meal plans for two to three weeks so I can rotate between them. Some tips for a fail-proof cooking method: use dried herbs in every meal, hing powder (an Indian spice) can be used as an onion and garlic substitute, and, if all else fails, smother your meal in cheese as it is blessedly low-FODMAP  (soft cheeses like ricotta & cream cheese are a no-go, but if it’s hard or ripened you should be okay).

I still struggle with going out to eat. I’ve worked in hospo since I was 15 and I know what a pain in the ass it is when customers are finicky with their order. “Can I have a large, decaf flat white, as weak as you can make it, with ten sugars in it?” No you cannot, leave me alone. So because I don’t want to be a nuisance to underpaid and underappreciated hospo staff, I don’t get too fussy with my meals out. I know that I’ll be miserable that night and the next morning, but most of the time I prefer to just get something that only has one or two foods I can’t eat, and simply enjoy the meal out and the company I’m with.

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Chronic illnesses aren’t just about the physical, they also affect you mentally. It can be tough to work through a diagnosis, and to try to accept that your illness is going to hang around for an indefinite amount of time. There are suggestions that 60% of people with IBS have a psychological illness, usually anxiety or depression. IBS is an illness that tends to flare up during periods of high stress, anxiety, and/or depression. I think this is due to the fact that it is a disorder of the gut-brain axis. What this means is that IBS is intrinsically linked to your mental health, and that your puku and brain are having secret conversations about what’s going on—just to make you miserable. I find this a total pain in the ass. When I’m stressed I get ill, which in turn stresses me out, a seemingly never ending cycle. When my anxiety was at its peak I suffered IBS too, but the IBS I experience now is worse and triggered by food and stress rather than by adrenaline coursing through my body. It’s also a different form of the illness, and manifests itself in different ways. No two people suffer IBS in the exact same way. This can be in relation to the foods and events that trigger it, or the ways in which it manifests itself. My doctor likes to remind me every so often that there’s a lot that happens in our stomach region (after all, there’s quite a few organs chilling out in that area), let alone all the different things that can happen to our puku.  

The main thing to take away from this is that it’s important to do your best to take care of yourself. The spoon theory is used by a lot of people with chronic illnesses to help describe what it’s like living with them. Essentially, the spoon theory says ‘spoonies’ (people with chronic illnesses) only have a certain amount of spoons each day, and that everyday tasks require us to use up spoons. Thus we have to prioritise what we do with our energy, or else we will run out of spoons. Some days our illnesses will be bad, meaning we start out with fewer spoons than normal. Other days our illness will treat us well and give us more spoons than normal. These are great days! The idea of the Spoon Theory is to show non-spoonies that we have to carefully consider all that we do. To deal with this, we find ways to protect our spoons, and cope when we’re running low. This can mean finding ways to de-stress, spending your free time making meals to freeze, and utilising Student Health Services. Student Health make it easy to see a number of health professionals in one place, and have them all communicate with each other. Managing IBS is much easier when you have a doctor and therapist communicating with each other so that they can tailor your treatment together. Also, it makes you feel like you have a cute team of people cheering you on and making sure that your body runs as smoothly as possible! Chronic illnesses can be difficult to live with, but it’s totally do-able. You learn a lot about yourself, and become a bit of a magician at figuring out why you’re feeling a particular way.

 

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