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Elimination Diet Questions - Fructose And More
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I have not been diagnosed celiac; in fact I've been tested twice with negative results. However, I've been dealing with food sensitivity and gastric issues for several years now and I am currently on an elimination diet. I have suspected fructose intolerance for a while now, considering the things that I know I cannot eat - legumes, fruits, juices, and corn.

My main symptoms are all gastro-related, (one non-stomach issue, recurrent bone pain in the legs, has actually been reduced during this diet - go figure.) My daily problem is bloating and distention after eating. I can gain so much abdominal girth that I bust zippers. Non daily, but persistent issues include gas, abdominal pain, burning and cramping, and alternating diarrhea and constipation.

For two weeks now, guided by my nutritionist, I have eaten leafy greens, jasmati and texmati rice, yellow and green squash and spaghetti squash and avocado. Halfway through the two weeks my nutritionist did allow some whole dairy foods; I stuck with goat cheese and natural yogurt. The reason that dairy even came up is that I am a vegetarian, and at the onset of my health problems back in spring of 2006, I was a strict vegan (completely dairy-free) going on five years. When I finally added dairy back in February of 2007, I noticed absolutely no change in my symptoms. Bloating and distention were the same, no pains when eating dairy, no worsened diarrhea or constipation. So when I couldn't stomach meat on this diet (due to ethical reasons) my nutritionist suggested soy. This didn't sit right with me, considering that I used to practically live off soy, and so we tried dairy.

My main concern is this: Its day 13. I must admit that overall I feel better since going on the diet. My gas has been reduced dramatically. I also have no pain. Bloating and belching, however are still going strong; I only see moderate differences here. Notably, however, I decided that with the lacklustre results I should eliminate dairy, so yesterday I said farewell to it by polishing off two servings of plain organic kefir. Of course, I reacted right away - massive bloating and pain stretching into today. I assume this is due to the inulin, which is a fructan, and I feel that this gives a lot of weight to my assumptions about fructose.

My main concern is that I'm at the point where I'm supposed to start adding foods back into my diet. How do you add foods when you don't feel well? I feel like the diet "didn't take." Today I switched out the dairy for eggs - I didn't suspect dairy but if it's not dairy then I'm supposed to believe its vegetables that are bothering me? Can anyone give me an explanation of how dairy could be the culprit given the situation that I described? Can the symptoms of different intolerances be so interchangeable that it is impossible to notice when one is adding an untolerated food?

Lastly, I do realize that the bloating could also be 1. I just need time to heal or 2. rice - which I have not eaten in large quantities before this diet. Given that either of these is the case, however, I'm just as concerned about my questions above - how in the world can I know what works when adding foods back into my diet if my main symptom just needs time before it will go away?

Thanks to any who tackle this question. I hope it is not too difficult to read. At this point I am incredibly frustrated and terribly hungry.

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Goat's milk has very little of the type of casein people usually react to. I don't know why you didn't react to yogurt, although some have reported that they do better with fermented products.

I didn't always react to dairy. It was a problem that increased over time.

I am surprised that avocado is on your list. I thought it was a fairly common allergen/intolerance.

At the bottom of this link, there is a beginning list for one elimination diet. You might try adding items on this list:

http://www.drmcdougall.com/med_allergic.html

And skipping the avocado ... (I'm not allergic or intolerant to avocado, but much of anything this high fat makes me pretty bloated and gassy.)

But I don't think it a great idea to be adding items if you are still having symptoms, though.

Do you happen to have anything with your meals you haven't mentioned? For instance, what do you drink? And how have you been seasoning what you have been eating? Are you eating brown or white rice (people sometimes have trouble with one kind, but not the other ... it seems to go both ways). Supplements or medicines you take? Sugarfree gum (artificial sweeteners are another thing that blow me up like a balloon)?

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Goat's milk has very little of the type of casein people usually react to. I don't know why you didn't react to yogurt, although some have reported that they do better with fermented products.

I didn't always react to dairy. It was a problem that increased over time.

I am surprised that avocado is on your list. I thought it was a fairly common allergen/intolerance.

At the bottom of this link, there is a beginning list for one elimination diet. You might try adding items on this list:

http://www.drmcdougall.com/med_allergic.html

And skipping the avocado ... (I'm not allergic or intolerant to avocado, but much of anything this high fat makes me pretty bloated and gassy.)

But I don't think it a great idea to be adding items if you are still having symptoms, though.

Do you happen to have anything with your meals you haven't mentioned? For instance, what do you drink? And how have you been seasoning what you have been eating? Are you eating brown or white rice (people sometimes have trouble with one kind, but not the other ... it seems to go both ways). Supplements or medicines you take? Sugarfree gum (artificial sweeteners are another thing that blow me up like a balloon)?

Thank you for your reply. It's strange that you mention McDougall - I was McDougalling for the 2nd time ever when I started getting all the bloating and distention. The first time I loved it, lost tons of weight, had lots of energy. The second, not a pound came off and I got sick. Not necessarily sick from the diet, but clearly there was something changed about my body by then. The list on that site is chock full of some of the most sugary vegetables around, not at all what a person with a fructose intolerance/malabsorption can eat. Brown rice too, just like wheat, has fructose in the germ. None of these foods are okay for me except spinach and chard, and I am already eating those. Avocado is on all the lists for elimination that I have seen; its the only fruit besides maybe lemon or rhubarb that doesn't have a lot of fructose.

As for having things on the side of my meals, my only condiment was sea salt. I haven't been able to chew gum without a stomach ache in years. I did taper off of coffee per my nutritionist's directions rather than come off cold turkey. That took about the first week.

I have given up the diet temporarily until I see my nutritionist tomorrow. I can't live off of leafy greens and salt. I just thought that some people here might have experience with elimination diets and have some advice to offer about what to do when your symptoms don't disappear.

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can someone at least answer two questions as i embark on this gruesome quest a second time?

1. i have been vegetarian for 10 years and the thought of eating meat makes me sick. Obviously I need to however as my list of "safe foods" (I dont even know what is a safe food for me) grows smaller and smaller. Can anyone suggest a good source of meat given the fact that I live in New York City and have access to Whole Foods, Trader Joe's etc. and would like to have to spend the least amount of prep time on meat as possible. Given all the info i've been given about the "brain-gut connection" I don't think its a good idea to cry through my meals while I'm trying to get better. I don't want to eat meat but I realize that I now have to, so any suggestions on clean meats that I won't have to spend a lot of time preparing myself will help.

2. some of you must have gone on elimination diets to determine your sensitivities. If any of you experienced your symptoms for a while after going on your diets (say your guts just needed time to heal) I would love to hear about it as it would be encouragement to me. Today I got sick and I didn't eat any suspect foods (gluten, wheat, soy, milk, fructose) so I would love to know about delayed healing times, otherwise I am not feeling very optimistic. I have been diagnosed with gastroparesis in the past, which can lead to death by malnourishment/starvation; I don't want to settle for this diagnosis. I think I'm dealing with food allergies but its discouraging when the elimination diet doesn't clear things up in the alloted two weeks.

Thank you and namaste.

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I'm not dx'd either, but I've had intermittent stomach pain with eating apples and drinking a glass of milk. I get terrible migraines with diarrhea if I get an ice cream at Dairy Queen.

I haven't been on an elimination diet. When my bloating got bad, I went on a juice fast. It helped me so much because the bloating was killing me. Eating was really not an option at that point. I also thought at one point that I had gastroparesis.

Anywaaay, there's a book on Amazon called, Self Help way to heal colitis and IBS, and I don't have the book, but in one of the reviews, it says the gist of the book is to remove Milk, Fruit, and Sugar from your diet. So for me, removing sugar could be the missing link. I did go on a "no sugar diet" a couple of years back, and I remembering having LOTS of energy and feeling great. My bloating was not as bad then, so I didn't do it to get rid of the bloating. I don't eat a lot of sugar either but maybe it doesn't take much. And that's the point of this long post, maybe it's the sugar. :)

I am currently trying Pancreatin enzymes and lactaid because I feel like my stomach does need to heal and the enzymes will help it along. My stomach pain/bloating is gone. It's too early to tell right now if this will last.

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Thank you for your reply. I agree that it is probably the sugar too. At least the sugar is probably the worst offender. I did cut sugar in all of its forms out completely for the first round of the elimination diet and I did feel quite a bit better, even the bloating was reduced, but it was still there. I just wasn't sure if it was supposed to go away completely or if I was supposed to assume that I needed time before that sort of thing would stop happening and take the results to mean that I had identified the culprit.

I do have the book you mention - I'm really torn between giving that diet a shot and going for the very spartan elimination diet again. He makes quite a few allowances that I cannot eat at all, such as tomato juice and yogurt. I wish I could eat yogurt but even goat and sheep yogurt bloats me. I would probably explode if I drank a glass of tomato juice.

I was also considering a juice fast; but I am always scared of that as I was juicing a LOT when I first got sick. I was juicing fruits and veggies though and I was juicing on top of eating, so I realize that a real juice fast excluding fruits and sugary veggies would be a different thing.

Best of luck to you. Pancreatin can really help some people. I hope that your bloating and pain stay gone.

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I was assuming that the sugar, milk sugar and fructose messed up the pancreas and then the enzymes that helps to digest the food and then you get the bloating and pain. Pancreas problems do run in my family.

Have you tried taking lactaid when you eat yogurt?

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No, I haven't tried Lactaid. This dairy thing is new to me. I really still can't tell that it bothers me except for the bloating. There isn't any pain or anything, not like there is with sugar or fruits, just bloating. Fish is the ONLY food that doesn't bloat me though. Although today I bloated a little during yoga and all that I had eaten all day is fish. Is there any way that the gut is just so damaged that all food will bloat me? I'm just curious - what is your theory on the sugar having an effect on the pancreas?

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According to this web page about digestion, http://users.rcn.com/jkimball.ma.ultranet/.../G/GITract.html

the pancreas secrete digestive juices for digestion-Amylase for sugars, etc. I read somewhere that eventually the pancreas quits functioning because it starts wearing out or becomes inflamed. Since blood sugar affects the pancreas, and you read everywhere that sugar causes inflammation.

Anyway, I know I felt better when I gave it up. I just need to do it again. :o

I've got tons of books on health. It gets confusing sometimes trying to figure it out.

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