Elimination diet to indicate FM
Oct 21, 2013 19:52:19 GMT
Post by Charlie Arnold on Oct 21, 2013 19:52:19 GMT
Elimination diet for Fructose Malabsorption.
If you have no access to the Hydrogen Breath Test as a means of diagnosing FM, or your child is too young to do the breath test you can do an Elimination Diet to give you a good indication of whether you or they may have FM. However it takes quite a lot of time to carry out and is quite tedious but sometimes it can give you a clear idea of what you may be reacting to. This Elimination Diet is solely to indicate FM, or a sugar intolerance of some kind, if you have other intolerances too then you may find you have to keep restarting on different food groups. The diet below is what I carried out on my daughter aged 3 so she coped on little portions but you can modify the order of meals if you want to.
Sometimes you have no choice as to when you carry this out as you may be so poorly you just need to get started. However if you can pick a time carry it out when you don’t have too much going on as you may feel a lot worse before you start to feel better. This is because you may be eliminating food groups that your body has been festering on for years and it will let you know in no uncertain terms that it is not happy! However, once you get past that you should start to feel considerably better. So start by clearing your diary for a good few weeks, clear out the rubbish from your fridge or larder and spend a few weeks cutting back on sugars, fruits, vegetables and caffeine drinks rather that just stopping them altogether straight away.
Start by making yourself a chart as you will find you soon lose track of what you have and haven’t tried and keep a note of exactly what you eat, quantities and time that you ate it. Then how you felt through the day, how your bowels are and how you sleep. This will then give you a clear picture as the weeks build up of what you may be reacting to. The quantities are important, although tedious, as you may find 1 gram is ok but 5 grams aren’t. The main symptoms are likely to be stomach pains, diarrhea, gassy and bloated stomach or nausea and vomiting depending on the severity.
Try to buy as pure and fresh as you can to avoid the risk of contaminated foods. You will also then find you can use the meat juices as stock and drinks.
Don’t add in too many new ingredients at once, wait a day to allow for delayed reactions and if you get a bad one go back to a day of just chicken and rice before taking the next step. Add the new ingredient in either mid morning or lunch time rather than in the evening.
If you have any other medical conditions or are on medication then check with your doctor first before starting.
Days 1 to 4: These are the hardest. You literally just have white rice and a meat. I would advise chicken or turkey is your best option as it doesn’t get too fatty; a lot of these diets suggest lamb but I have tried that one and it gets really greasy by the end of day 2. Buy free range roasting chicken for ease and then you can use the juice from the roast for stock, all the meat then boil the carcass for stock and soup. Once you have roasted your meat, slice it up so you can just keep nibbling as you need to, as by day 2 you won’t really have a lot of energy to do much else as your body starts to detox. Boil your rice in water and rinse it through thoroughly once cooked in boiling water too to rinse off all the excess starch.
Breakfast: boiled white rice
Lunch: roast chicken slices in chicken stock gravy ( chicken stock thickened with rice flour.) If you want to use boiled rice too.
Supper: Chicken soup made with liquidized chicken, rice and boiled water.
To thicken with rice flour you will need about 2 heaped teaspoons to half a pint of water then bring to the boil.
Don’t be tempted to add salt, pepper or herbs at this stage.
If you get the nibbles in between meals just have a slice of meat.
Only drink pure water at this stage too.
Day 5: Milk. To open up your options for energy providers I would now try milk. Just a small drink of half a cup mid morning. If this is ok then this will open up options for sauces and drinks quickly. If you react then leave milk out and maybe try it again further down the line. If you are fine on it then you can continue to drink milk and gradually increase the amount as the diet goes on.
Day 7. Potato. This will then give you variety for carbohydrate. Replace the rice with a couple of boiled old white potatoes, with your lunch. If these are fine then you can use rice with one meal then potato with the other. This also then gives you the option of using potato flour as a thickener with your milk to add a sauce.
Day 9. Fish. Use a good quality source of fresh white fish if possible to limit contamination.
Day 11. Beef or pork. As usually meats and fish should be fine for FM you can start using more variety for protein. You can then alternate protein sources with each meal.
Time to start testing vegetables: those listed in the low FODMAP diet are as follows
Bok Choy
Carrots
Celery
Corn
Eggplant
Lettuce
Parsnip
Scallions (green part only)
Tomato
I would suggest starting with Celery, Bok Choy or lettuce first. Spinach is another option as it is low fructose. Again only try a new one every other day, if you start to react then you may be very reactive to fructose and need to think along the lines of HFI rather than FM.
Day 17. Gluten free flour, try to get a reputable make to avoid contamination, You could make yourself some flatbread (see recipe) to have with some soup using safe tested ingredients so far. Just start with a small amount and then you can build it up over several days.
Day 19. Yeast. This should be fine for FM unless you have a bacterial problem so now time to test it out. Make some gluten free bread using water, gluten free flour and yeast. Don’t worry about sugar as the starch will feed the yeast enough.
Day 21: To open up sandwich options try a butter or margarine spread on your bread.
Day 23: Cheese. Use a good quality plain cheddar that will not have been contaminated or treated with other things. Have some slices with your bread for lunch.
Day 25. Time to test some fruit: The safe fruits are supposed to be as follows:
Banana
Blueberry
Grapefruit
Grapes
Honeydew melon
Kiwi
Lemon
Lime
Mandarin Oranges
Orange
Raspberry
Strawberry
Again pick 3 and try them over the next six days. Try them as they are and separate from other foods as fruits only take about 20 minutes to digest and if you eat them with foods that take longer to digest then they may end up sitting and fermenting in the bowels causing a confusion of symptoms. Now some very reactive FM may not tolerate fruits so if you react then don’t eat fruits still for a few months then maybe retest.
If you react then I would go back to the chicken and rice for 4 days to allow the system to settle.
Day 27. Sugar. Supposedly on FM you can tolerate sugar. Again it varies from individual to individual so if you have been fine so far on everything you have tried you should be fine on sugar as in table sugar. If however you have been reacting here and there then try glucose powder first as a sweetener and maybe hold off sugar for some months. Or you could test table sugar to use it as a diagnosis and if you react then you know you are very reactive and avoid it for a good few months like fruit. Then once your system is feeling stronger you could try testing it again.
Day 30. Egg. Yes I know I have skipped a day, just to allow the sugar to kick in or not. I have left this till quite late as a lot of people can react to eggs as a separate intolerance. Just have a plain boiled egg for lunch with a safe carbohydrate source.
Day 32. Wheat. Obviously if you have reacted to fruits or sugar then you will be to nearly day 40 as you need to go back to chicken and rice to settle the system. Right, time to test wheat. Due to the fructans wheat may not be tolerated by FM sufferers but it is worth testing now as some can have it. Use plain white flour in your cooking, maybe a simple flatbread again at lunch time to see what happens. If you react then you know to avoid wheat, if you don’t then use it sparingly over the next few months to build up to a tolerated level.
So do you have FM? Well, if you had bad days after dairy then you are looking at a lactose problem. If you had bad days as soon as vegetables were added then you should consider HFI (Hereditary Fructose Intolerance) or very severe FM and need to stay off all fruit and veg for at least 4 months before retrying. If you stumbled even on the rice or potatoes then you may have a starch intolerance too so need to look more into disaccharide defiency. If you have been fine on everything so far then it may just be your body needed a detox, or try adding in an unsuitable fruit eg apple, or vegetable eg broccoli and see what happens, if you are still fine that just gradually work back towards a normal diet, if you start reacting then you have proved FM to be the problem and stick to the low FODMAP diet as set out in the safe ingredients section for a good few years before retesting your tolerance levels.
You may find every so often as life goes on you have to repeat this process, either to detox your body or to retest sensitivity.
Good luck. Try not to give up half way through as you won’t get a clear answer and you will be forever guessing.
If you have no access to the Hydrogen Breath Test as a means of diagnosing FM, or your child is too young to do the breath test you can do an Elimination Diet to give you a good indication of whether you or they may have FM. However it takes quite a lot of time to carry out and is quite tedious but sometimes it can give you a clear idea of what you may be reacting to. This Elimination Diet is solely to indicate FM, or a sugar intolerance of some kind, if you have other intolerances too then you may find you have to keep restarting on different food groups. The diet below is what I carried out on my daughter aged 3 so she coped on little portions but you can modify the order of meals if you want to.
Sometimes you have no choice as to when you carry this out as you may be so poorly you just need to get started. However if you can pick a time carry it out when you don’t have too much going on as you may feel a lot worse before you start to feel better. This is because you may be eliminating food groups that your body has been festering on for years and it will let you know in no uncertain terms that it is not happy! However, once you get past that you should start to feel considerably better. So start by clearing your diary for a good few weeks, clear out the rubbish from your fridge or larder and spend a few weeks cutting back on sugars, fruits, vegetables and caffeine drinks rather that just stopping them altogether straight away.
Start by making yourself a chart as you will find you soon lose track of what you have and haven’t tried and keep a note of exactly what you eat, quantities and time that you ate it. Then how you felt through the day, how your bowels are and how you sleep. This will then give you a clear picture as the weeks build up of what you may be reacting to. The quantities are important, although tedious, as you may find 1 gram is ok but 5 grams aren’t. The main symptoms are likely to be stomach pains, diarrhea, gassy and bloated stomach or nausea and vomiting depending on the severity.
Try to buy as pure and fresh as you can to avoid the risk of contaminated foods. You will also then find you can use the meat juices as stock and drinks.
Don’t add in too many new ingredients at once, wait a day to allow for delayed reactions and if you get a bad one go back to a day of just chicken and rice before taking the next step. Add the new ingredient in either mid morning or lunch time rather than in the evening.
If you have any other medical conditions or are on medication then check with your doctor first before starting.
Days 1 to 4: These are the hardest. You literally just have white rice and a meat. I would advise chicken or turkey is your best option as it doesn’t get too fatty; a lot of these diets suggest lamb but I have tried that one and it gets really greasy by the end of day 2. Buy free range roasting chicken for ease and then you can use the juice from the roast for stock, all the meat then boil the carcass for stock and soup. Once you have roasted your meat, slice it up so you can just keep nibbling as you need to, as by day 2 you won’t really have a lot of energy to do much else as your body starts to detox. Boil your rice in water and rinse it through thoroughly once cooked in boiling water too to rinse off all the excess starch.
Breakfast: boiled white rice
Lunch: roast chicken slices in chicken stock gravy ( chicken stock thickened with rice flour.) If you want to use boiled rice too.
Supper: Chicken soup made with liquidized chicken, rice and boiled water.
To thicken with rice flour you will need about 2 heaped teaspoons to half a pint of water then bring to the boil.
Don’t be tempted to add salt, pepper or herbs at this stage.
If you get the nibbles in between meals just have a slice of meat.
Only drink pure water at this stage too.
Day 5: Milk. To open up your options for energy providers I would now try milk. Just a small drink of half a cup mid morning. If this is ok then this will open up options for sauces and drinks quickly. If you react then leave milk out and maybe try it again further down the line. If you are fine on it then you can continue to drink milk and gradually increase the amount as the diet goes on.
Day 7. Potato. This will then give you variety for carbohydrate. Replace the rice with a couple of boiled old white potatoes, with your lunch. If these are fine then you can use rice with one meal then potato with the other. This also then gives you the option of using potato flour as a thickener with your milk to add a sauce.
Day 9. Fish. Use a good quality source of fresh white fish if possible to limit contamination.
Day 11. Beef or pork. As usually meats and fish should be fine for FM you can start using more variety for protein. You can then alternate protein sources with each meal.
Time to start testing vegetables: those listed in the low FODMAP diet are as follows
Bok Choy
Carrots
Celery
Corn
Eggplant
Lettuce
Parsnip
Scallions (green part only)
Tomato
I would suggest starting with Celery, Bok Choy or lettuce first. Spinach is another option as it is low fructose. Again only try a new one every other day, if you start to react then you may be very reactive to fructose and need to think along the lines of HFI rather than FM.
Day 17. Gluten free flour, try to get a reputable make to avoid contamination, You could make yourself some flatbread (see recipe) to have with some soup using safe tested ingredients so far. Just start with a small amount and then you can build it up over several days.
Day 19. Yeast. This should be fine for FM unless you have a bacterial problem so now time to test it out. Make some gluten free bread using water, gluten free flour and yeast. Don’t worry about sugar as the starch will feed the yeast enough.
Day 21: To open up sandwich options try a butter or margarine spread on your bread.
Day 23: Cheese. Use a good quality plain cheddar that will not have been contaminated or treated with other things. Have some slices with your bread for lunch.
Day 25. Time to test some fruit: The safe fruits are supposed to be as follows:
Banana
Blueberry
Grapefruit
Grapes
Honeydew melon
Kiwi
Lemon
Lime
Mandarin Oranges
Orange
Raspberry
Strawberry
Again pick 3 and try them over the next six days. Try them as they are and separate from other foods as fruits only take about 20 minutes to digest and if you eat them with foods that take longer to digest then they may end up sitting and fermenting in the bowels causing a confusion of symptoms. Now some very reactive FM may not tolerate fruits so if you react then don’t eat fruits still for a few months then maybe retest.
If you react then I would go back to the chicken and rice for 4 days to allow the system to settle.
Day 27. Sugar. Supposedly on FM you can tolerate sugar. Again it varies from individual to individual so if you have been fine so far on everything you have tried you should be fine on sugar as in table sugar. If however you have been reacting here and there then try glucose powder first as a sweetener and maybe hold off sugar for some months. Or you could test table sugar to use it as a diagnosis and if you react then you know you are very reactive and avoid it for a good few months like fruit. Then once your system is feeling stronger you could try testing it again.
Day 30. Egg. Yes I know I have skipped a day, just to allow the sugar to kick in or not. I have left this till quite late as a lot of people can react to eggs as a separate intolerance. Just have a plain boiled egg for lunch with a safe carbohydrate source.
Day 32. Wheat. Obviously if you have reacted to fruits or sugar then you will be to nearly day 40 as you need to go back to chicken and rice to settle the system. Right, time to test wheat. Due to the fructans wheat may not be tolerated by FM sufferers but it is worth testing now as some can have it. Use plain white flour in your cooking, maybe a simple flatbread again at lunch time to see what happens. If you react then you know to avoid wheat, if you don’t then use it sparingly over the next few months to build up to a tolerated level.
So do you have FM? Well, if you had bad days after dairy then you are looking at a lactose problem. If you had bad days as soon as vegetables were added then you should consider HFI (Hereditary Fructose Intolerance) or very severe FM and need to stay off all fruit and veg for at least 4 months before retrying. If you stumbled even on the rice or potatoes then you may have a starch intolerance too so need to look more into disaccharide defiency. If you have been fine on everything so far then it may just be your body needed a detox, or try adding in an unsuitable fruit eg apple, or vegetable eg broccoli and see what happens, if you are still fine that just gradually work back towards a normal diet, if you start reacting then you have proved FM to be the problem and stick to the low FODMAP diet as set out in the safe ingredients section for a good few years before retesting your tolerance levels.
You may find every so often as life goes on you have to repeat this process, either to detox your body or to retest sensitivity.
Good luck. Try not to give up half way through as you won’t get a clear answer and you will be forever guessing.