… On Sugar and IBS

sugar-on-black-web

If you know me, you know that what I’m about to tell you is seemingly out of left field. Since I was very little I was the child that always loved the extra cookie, who would cheat and take dibs out of the cookie bowl while mom was making chocolate chipped wonders. I love cheesecake and given the opportunity I would happily eat dessert rather than a real meal any day of the week and twice on Sunday. But besides the obvious nutritional issues, there’s one glaring problem with all of this. And that is that I have IBS.

For those that don’t know, IBS (or Irritable Bowel Syndrome as you can whip out at cocktail parties) is a disorder afflicting 1 out of every 10 people according to the International Foundation for Functional Gastrointestinal Disorders. Those with IBS can’t have certain foods, or can only some of the time, without getting a stomach ache usually resulting in constipation, diarrhea, a combination of both, or their less popular but no less effective cousin, vomiting. While I’d love to tell you exactly what IBS is, if we’re gonna get down to brass tacks I’ll keep it real- no doctor will be able to completely define what it is because it is an amalgamation of symptoms based on the location of impact. I stand by that statement. The general understanding is the nervous system, the brain, the stomach and the colon don’t fully comprehend each others’ role in the operation of a healthy body and in various ways seek to undermine one another. Just kidding. But in all seriousness, those components just don’t jive to different, individualized effects. Take the following excerpts, and let me tell you that these are also from the IFFGD, which is no slouch:

“The exact cause of IBS is not known. Symptoms may result from a disturbance in the way the gut, brain, and nervous system interact. This can cause changes in normal bowel movement and sensation.”

“IBS is unpredictable. Symptoms vary and are sometimes contradictory.”

“Treatments are available for IBS to help manage symptoms. Not all treatments work for all people. Through research, better treatments may be found.”

I’m going to be totally blunt with you (and then back myself up, of course)- while I’m not a doctor, I am a person that has IBS and has seen numerous doctors since I was little, and none of them- not one- has been able to control my symptoms. I’ve been prescribed a host of oral medications including fiber supplements, antacids, probiotics (for the gut health component), and rather unnecessarily antidepressants (for the neurological component). They weren’t effective. The reason, I firmly believe, is that there is a profound lack of understanding regarding what this disorder is, and I personally feel that a number of symptoms have been lumped together even though the causes vary wildly and the results drastically.

I’ve read medical journals, I’ve read cookbooks, I’ve listened to doctors and in every case the approach is problematic. Cookbooks are problematic because as any IBS sufferer knows, though we may both be categorized under the same symptoms we may have drastically different reactions to the same foods. I love apples but I know friends with IBS that cannot touch them. Some of those friends will be fine with milk and for me, that’s the equivalent of “Bye Ingrid, see you next Tuesday”.

I’d become so frustrated with the consistent “You can’t have this, you can’t have that, you can’t you can’t you can’t” approach, that combining that with an eventual total confusion over what I could and couldn’t eat, I began to not eat anything. One summer several years ago, I became literally a bit gaunt. If you know these cheeks, you know that’s serious. But I couldn’t seem to have anything without feeling sick, so I just didn’t really eat. All I could keep down was a  particular smoothie from Starbucks (What’s up Starbucks!)

So the reason this topic is so important to me is because I understand what it is to go through life thinking that you can’t eat anything. That you’ll always feel sick, and because of which it’s just not worth having anything. And I want to share with you something that changed my life, that across the board for IBS sufferers I swear holds water regardless of what foods you are ok with. And that is the damage that sugar does to a tummy that has IBS.

I really did just say that.

I will be the first one to tell you that I love cupcakes. I love love love sweets. But they were making me extremely sick, I’m not kidding. The final straw came when I developed a migraine. I know a lot of people get these, but I don’t. And then I started to get really bad ones, all the while having stomach aches as well. I was basically a hot mess. But one day I had a migraine so horrible and fast I had to lie on the floor at work and take a cab 5 minutes to get to my apartment, where I promptly threw up. I knew I was just wrecking my body and I didn’t know what to do. I felt completely confused and helpless and while I knew I wasn’t eating healthy, I had developed a defeatist attitude because nothing had been helpful. And one day my friend said “Have you ever tried to just knock sugar out of your diet?”.

I found that ludicrous. That was what extreme health nuts did, and there was no way I could do that. I was the queen of cakes, for crying out loud. And for a time I pushed it aside. But as the headaches continued I thought… well, what do I have to lose, a stomach ache? I mean good grief, I already was versed in those. So I decided that just for one week, I would try making a salad I had copied from SWEET GREEN (the Harvest Bowl) and I’d pack that for my lunch and have a light breakfast. I chose foods that I generally had ok luck with, and also cut out pop (or soda… I’ll throw you that bone). And something kind of amazing happened. I went 4 whole days without feeling sick.

FOUR. WHOLE. DAYS.

To some reading this that’s not a big deal, but keep in mind that on a bad day I can get 4-5 stomach aches that, no offense, would kill a lesser person. As an added bonus, I lost 2 pounds in under a week. So feeling encouraged, I decided to keep moving forward with it. I tested out drinking seltzer water and after 7 more days of reflexively gagging on it, got myself to drink that rather than pop. I started feeling a lot better. Then came a meeting that literally changed my whole approach. I joined Women’s HealthWorks and met with a nutritionist. I was pretty brutally honest and said that I have a lot of trouble eating breakfast without getting sick (as many IBS sufferers know) and that I was wary of eating consistent meals since I had to be on the go a lot. And she then said something that literally no one had ever said prior:

“Well, what foods do you have success with?”

And I know that sounds like the simplest question, but it was an entirely different approach than anyone I’d ever met. I told her that my salad seemed to be doing pretty well, and taking that into account she asked me about other foods I could generally have based on different food groups. We came up with another salad I could make and a breakfast plan involving waking up early enough to trick my stomach into thinking it was awake. I know it sounds like my stomach is another person and that this was some covert operation, and to a degree it was, but I decided I could give it a shot.

Some will try to explain that natural sugars are not a GI (gastrointestinal) irritant, and that it’s sweeteners, heavier in fructose rather than sucrose that are irritants. I disagree for myself, personally. They are both hard on the tum. And for me, cutting down on both has been really astounding. I’m not going to say that I never get sick, because every so often I just do and that is what it is. But by cutting out most really processed sugar, I’ve found that my IBS symptoms have calmed down exponentially. Foods that I never thought I could have before, let’s take coffee, I can have in moderation if I’m smarter about getting for example unsweetened iced coffee rather than my former love, a mocha. And while it may sound bland to you digestive pros out there, I’m excited because my menu, while much lower in sugar, still tastes good. I’ve lost 10 pounds in one month, not even thinking I was really heavy prior, and I feel much, much better. I don’t get headaches now unless I eat too many sweets, and my stomach aches are at an all-time low. At the end of this post, I’ll share with you what I’ve been eating day-to-day, knowing full well that if you’re reading this with IBS you may not be able to have the same exact thing, obviously.

But in the meantime, I’m also super excited to include contributions from two really great people. First is Ashley Abbott, the amazing dietitian who dealt with yours truly from the first utterance of “I can’t have breakfast” to the next “I think this may cause gas, are we sure about this?”. She is fabulous, has really wonderful insight and I’m so happy to share her words with you!

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Photo Courtesy of Healthworks Fitness Centers for Women

ASHLEY ABBOTT MS, RD
Healthworks Fitness Centers for Women
Registered Dietitian, Cambridge Location

When Ingrid emailed and asked me to write a piece for her blog, I was stunned. I remember our appointment being full of laughs (Ingrid has some great stories) and also quite tricky. I remember when she left, I hoped I had helped her.

I am a Registered Dietitian at HEALTHWORKS FITNESS CENTERS FOR WOMEN. My job is a lot of fun, and it is also very challenging. Very few people want to talk about food, and nobody wants to be judged for the food that they eat. Let’s be honest- when I said dietitian, you heard food police. I hope to change this perception. I do not want to judge the food that you eat. My job is to make sure that the food that you eat is nourishing you, keeping you energized, helping you sustain a healthy weight, and, most importantly, delicious! I do not want you to feel deprived, and if you do, I have failed at my job. I am not judging you, and in fact, I am probably more afraid that you are judging me and my ability to help you.

Ingrid walked in for her appointment and had me laughing from minute one. Then she uttered the five words that give dietitians nightmares, “I have Irritable Bowel Syndrome”. IBS triggers and symptoms vary significantly from person to person. There is no quick fix, no magic pill, no perfect diet. I cannot give you concrete guidelines, or a list of foods to avoid. What we can do, what Ingrid and I did, is work together to manage your symptoms and focus on the foods you can eat to help you feel your best.

I was very impressed and thankful that Ingrid had already done her research in regards to her IBS triggers and symptoms. She had tracked her food, tracked her symptoms, and had a very good idea of what foods she needed to limit vs. what foods she could enjoy in abundance. This is my first recommendation to all those who come to me with digestive issues. Track your food, track your symptoms, and let’s find the pattern. I need this data to give you nutrition advice that will best suit you. Keeping a detailed journal may seem tedious and (let’s just be honest here) downright annoying. But, knowledge is power. I have met many people suffering from IBS who had been fed the line, “there is not much you can do”. This is a silly statement. There is ALWAYS something you can do! Do not be discouraged or feel like you are doomed to a life of zero food variety.

One of the most important parts of my job is dispelling food myths and relieving food fears. Food is not meant to hurt you or work against you; food should be fueling you and making you feel good! It is our source of energy throughout the day. All my low carb folks out there- carbohydrate is your brain’s preferred source of energy. Feeling irritable? Let’s share a piece of whole grain bread and get your blood sugar back up.

One thing I have noticed is how little we think about our food. We go for what is convenient, eat if we remember, and chow down on something small while staring at a computer screen. We go many hours without eating, and then wonder why we can’t control portions at night, or why we lack energy midday and head to the office candy bowl. You do not have willpower; your blood sugar is taking a nosedive, and your body is craving sugar to get it back up. Let’s stop this pattern. Taking the time to think about your food and even (dare I say it?) do a little food prep is KEY! This goes for anyone trying to manage IBS symptoms, lose weight, stay healthy, or just function like a human being without needing 10 cups of coffee throughout the day.

I want you to think balance. I know, how cliché of me. I am not very fancy but I promise balance really does work. What do I mean by that? I mean regular meals and snacks (think every 4 hours or so) that contain whole grains, lean protein, healthy fat, fruit and veggies. The amount you need of each food group is based on your individual goals, but everyone would benefit from a healthy balance of foods from each group. Please stop being afraid of fruit; fruit is fabulous.

If you do have IBS, you may feel like it is impossible to include all of the food groups. Maybe you have identified fruit as a trigger to your symptoms, or green leafy veggies, or carbohydrates. You do not have to give up an entire food group. Instead, I propose that we look at different options when consuming these foods. Certain veggies, such as broccoli, can be particularly difficult to digest and may promote bloating or gassiness. Cooking veggies can make them easier on your system, and there are plenty of veggies, such as carrots, mushrooms, pumpkin, and zucchini, that are easy to digest. Eating small, frequent meals is another trick to easy digesting. There are lots of tips and tricks we can explore to help improve your symptoms! Again, there is no quick fix but there is always a solution!

Finally, before I leave you, I do want to touch on the sugar topic. Are we addicted to this stuff? Can that happen? Studies say yes. Food manufacturers rely on a team of chemists, biologists, mathematicians (I am not kidding here!) and marketers in order to make a product you can’t help but overeat. Using the perfect combination of sugar, fat, and salt, they create a food-like substance that begs to be overeaten. Too much added sugar- I am not talking the naturally occurring sugar in fruit, veggies, and dairy- can spike your blood sugar and send you on a whirlwind of cravings when it comes crashing down. Added sugar provides no nutrients to your body, just calories. Naturally occurring sugars in fruits and veggies are packed together with fiber and disease-fighting phytochemicals. The absolute best thing you can do for your body is enjoy a diet packed with whole foods and limit the processed stuff. Forget the calories and think NUTRIENTS. Read ingredient lists. If the ingredient list looks like a lab experiment, skip it.

Ok, time for me to get to the point. I want you to enjoy food. I want you to think about food and put effort into your meals. If you have a sensitive digestive system, I want you to take the time to track your food and symptoms so that you can manage them without giving up an entire food group. I want you to know exactly how good your body can feel with proper nutrition and exercise. You are worth it!

Ashley is a registered dietitian at Healthworks Fitness Centers for Women, Cambridge, MA. Please visit the center’s WEBSITE for more information or to schedule a consultation!

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I also reached out to my good friend and all around great person, Ann Mazur. Ann is an elite runner and also one of the people I always think of who stays fit while also not being (I’m gonna go there) “crazy” about it. She always has really great advice for getting back on the wagon, but also if she really wants the donut, she has the donut. And I’m stoked that she’s here to tell us why that’s ok, while also keeping us motivated to keep moving!

Ann Mazur
Lecturer of English, University of Virginia
Ph.D., English literature, UVa

200hr. RYT, Elite Runner
Founder of RUNNERS LOVE YOGA

Photo Courtesy of Runners Love Yoga

I think sometimes people (especially other female runners) think that you have to have ZERO dessert in order to be an elite runner.  However, this is definitely not the case. I myself quite enjoy how Shalane Flanagan (Olympic medalist in the 10k)  is very upfront about her love for donuts–she once tweeted something to the effect of “massively regretting having 5 donuts today; should’ve just had 4.” I think if you’re speaking of categories of people and what they eat, and we’ve got “regular people who eat too much sugar” (the large majority of America), “IBS and how sugar really doesn’t help that,” then you also need “endurance athletes” as a separate category. Of course, this LARGELY depends upon the volume of mileage/workouts that one is doing, but at a certain point an endurance athlete just needs some calories, and it frankly is probably better/healthier to just have the large calories per volume of a treat (alongside healthy things), than to eat a bunch of fruits alone (tons of volume) to try to get to the appropriate caloric intake.  This is definitely not even the case for all runners, since I think people tend to overestimate the amount that they actually burn off while running. This would be the case for most triathletes and I would say probably all swimmers.  I’m sure most people probably remember the report about what Michael Phelps ate for BREAKFAST — if Michael Phelps was trying to do just protein powder and salad, that would seriously not work out so well. Granted, most people are not Michael Phelps, but they could learn to just chill out a little from his diet.

I firmly believe in just trusting my body — if I really want a donut, ice cream, etc., I have it because I probably need it for some reason or another.  (In college, I would get low on iron, and would always crave this one cereal that I figured out at some point was coated in reduced iron.)  Too many people are afraid to trust their bodies, and way too many people have far too much guilt over particular foods. I was very lucky to grow up with a mom who would say how ice cream was a good source of dairy and that peanut butter cups were a good source of protein — of course we knew that these were treats, but the point is that there’s absolutely no reason to regret eating a pack of Reese’s if that’s what you want. I was perfectly oblivious to how most adult women are a little nuts over having donuts, etc. until I read my grandma’s copy of Redbook at around age 8 and saw how much of it revolved around weight loss– I remember thinking something to the effect of, “do these people really think about nothing else?  What a waste of energy!  Just go for a walk and don’t eat the whole cake!”

While I’m defending donuts, I’d also like to point out that people tend to think of bagels as being super healthy, but you really might as well just have the donut!  To me, donuts seem way more exciting than a bagel!!

Where there’s a will, there’s a way in terms of fitting exercise into one’s schedule.  If you really want to find a way to do it, you’ll do it.  If you want to find an excuse, you’ll find an excuse.  Along those same lines, having a structured time schedule that you stick with is absolutely essential. Maybe you’re meeting someone at the gym or a trail, or maybe this is just your own solo workout. Whatever it is, you have to be consistent and you also have to love it.  I actually love working out; my advice is find something that you really like to do.  I’d also say that for a beginner, maybe running is really not so fun for the first couple weeks–give each exercise a chance and make sure you’re setting yourself up for success with appropriate footwear, safe conditions, and a plan for progression in terms of volume.

I love donuts, but I genuinely love salad!!  I feel like people think I’m lying when I say this, but it’s true.  The analogous advice to “find a workout you love” is “find healthy foods you enjoy.” Life is short; eating and staying fit should be fun and not a chore.

You can find more of Ann’s philosophy on the benefits of yoga on running as well as general health on her RUNNERS LOVE YOGA homepage as well as TWITTER,  FACEBOOK and her fabulous INSTAGRAM page.

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And now for the moment we’ve all been waiting for, the section I’d like to call EATING LIKE INGRID! Just kidding. But I am going to list a typical day for me that seems to keep stomach aches reasonably calm, and just for us I will make it a day that I have a treat, also. I find that sometimes if I have something little and sweet it helps me not feel totally deprived but it’s small enough not to do any damage and prevent all willpower from slipping away. Another key element I found is to include a grain at every meal. I went for a long time thinking grains make you heavy, but the reality is it’s not true and for those with IBS, grains can be a crucial element to your meal as they absorb acid. Also, if you’d like to keep dairy try some Greek Yogurt or Goat Cheese. Goat Cheese lacks lactose which can be brutal and Greek Yogurt’s additional straining rids it of most of the whey as well as lactose. So here we go!

BREAKFAST
*2 slices of toasted whole grain bread topped with an egg-white omelet containing tomato, onions and asparagus. Canola Oil Cooking Spray (NOT Olive Oil)
*About a half cup of sliced up strawberries

SNACK
*Cold Brew with a little bit of Soy Milk, unsweetened
*Coconut Macaroon (!!)

LUNCH
*Homemade Harvest Bowl Salad
-Kale, sweet potatoes, goat cheese, onions, apple slices, chicken, wild rice, balsamic vinaigrette

SNACK
*1/2 cup Greek Yogurt with 1/2 cup Strawberries

DINNER:
*Kale/Bean salad
-Kale, Chickpeas, Black Beans, Quinoa, Chicken, 1/2 Avacado, 2 Tblsp Red Pepper Hummus, Hard Boiled Egg, Onion

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And there you have it. I can’t believe I ever wrote a post about eating well, but I did and I hope that it helps someone! Do I fall off the wagon sometimes? Yeah. And then I get a stomach ache and it helps get me motivated to get back on!

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