My Weird Diet

Monday, November 14th, 2016 12:35 am
flwyd: (spam lite)
[personal profile] flwyd
I sent the following message to folks who are coming to Thanksgiving to (attempt to) let them know what I can and can't eat. This is the first time I've written this all down, so it seems worth documenting for posterity. Hopefully I won't have to refer people to it for too many more months.

Most importantly: I don't have to eat every dish you bring! Feel free to make something delicious even if I won't be able to have it. There will be enough food on the table that I can eat.

Executive summary: texture and thickness are key; spices are limited; strong acids are suspect; fats, sugars, and salts are fine. The simple version is "No dairy, no eggs, no to most spices; either very soft or very crunchy."

The details follow. I realize this is long; feel free to send me a recipe and let me call out anything that will cause me trouble.

The most probable explanation for my eating challenges is that the sphincter at the bottom of my esophagus has trouble opening. This manifests in food restrictions based more on consistency and texture than on ingredients. For instance, I can drink a smoothie with blended peanuts, wheat germ, and barley malt but I have trouble with peanut butter on bread.

The texture spectrum:
  • SAFE: Foods that can be sucked through a straw (broth, smoothies…)
  • SAFE: Foods that dissolve in your mouth or otherwise can be eaten without teeth (ice cream, banana, pumpkin puree, mashed potatoes, hummus, halva…)
  • SAFE: Soft blocks of protein (lunch meat, ham, tofu…)
  • SAFE: Firm foods that chew into small pieces (nuts, carrots, some chips and crackers…)
  • PRETTY SAFE: Foods softened in water (boiled or canned vegetables, noodles, cooked legumes, cooked grains…)
  • POTENTIALLY DANGEROUS: Soft but sticky foods (bready substances, nut butter, french fries, lettuce…)
  • DANGEROUS: Foods with gristle or fibrous bits that are difficult to fully masticate (steak, ground beef, kale, spaghetti squash, many fresh vegetables…)


Additionally, there are some ingredients which my body has painfully rejected in the past few months and I now avoid. Aside from dairy, most of these are foods I've loved eating regularly over the last twenty years, so I really hope I can eat them again by next Thanksgiving.

Individual sensitivities:
  • Dairy (milk, cheese, cream, butter… anything derived from a mammal's udders)
  • Eggs (this prohibition adds a lot of challenge to my diet)
  • Extra-virgin olive oil
  • Red wine
  • Capsicum peppers (both spicy and bell)
  • Peppercorn/black pepper (basically anything with the word "pepper" in it)
  • Turmeric
  • Dill
  • Lemongrass
  • Clove


Since several spices have led me to have absolutely miserable days, I'm taking a very cautious approach to spice. I'm able to handle cinnamon, cumin, ginger, and garlic. If a product lists "spices" as an ingredient, I don't eat it. For individual herbs and spices not explicitly listed I decide on a case-by-case basis. If there's a spice you'd really like to bring to Thanksgiving (particularly in the savory category), let me know and I can do a trial in advance–I'd love to collect some more data.

I'm also taking a cautious approach to highly acidic foods like tomatoes, many fresh fruits, and alcohol. I might accept these if offered or I might decline.

Macronutrients:
Fat, sugar, and salt are all good. I'm currently dramatically underweight, so the standard dietary advice given to Americans doesn't apply to me–I'm finishing a whole pint of non-dairy ice cream as I write this and I eat plenty of bacon. I can eat plenty of fat as long as it doesn't make food stick to the throat like salad with dressing (and as long as it's not butter). High sugar is fine too; my morning smoothies feature honey, molasses, or syrup. My dietitian also recommended I have 50% more sodium than the max recommended level, so salt is fine. (I'm currently trying to keep dietary fiber low, but I don't worry much about fiber content at social events, so don't sweat it.)

Common food restrictions:
Other than dairy and eggs, I seem to be okay with all the common allergens (nuts, legumes, gluten, soy, shellfish…). I don't follow any preparation-based restrictions (kosher, halal, raw, fair trade…). For the most part, if I can easily swallow it then I want its calories in my belly.

Dietary advice:
I know you mean well, but whatever diet or food you've heard is good for something or other is probably not applicable to me. Most diets have weight loss as a goal, but losing more weight would significantly compromise my health. It's hard to sell diet books if weight gain is a side effect, so if you've heard of a diet, it's probably not right for me (unless you've got a good recipe for chanko nabe). Similarly, I'm actually trying to avoid anti-inflammatory foods for a while. When I was diagnosed with an autoimmune disorder I went full haul on anti-inflammatories. Unfortunately, I think the COX-blocking effects may have negatively impacted my gut, so I cut them out of my diet (with the exception of omega-3 fatty acids and ginger). If you saw an article about some wonder food or supplement, I'm probably avoiding it.

Date: 2016-11-14 04:16 pm (UTC)
From: [identity profile] willow-red.livejournal.com
Having been through my own food weirdness (thankfully not as bad as yours sounds), I sympathize.

I have one of those weird opposite recommendations--feel free to try this or ignore it as you see fit. Peppermint tea is sometimes used as a remedy for upset stomach. However, a while back, I saw a caveat that people who have acid reflux should avoid peppermint because--wait for it--it can cause the sphincter between the esophagus and the stomach to temporarily weaken and/or not close fully. Since you have the opposite problem, this effect might be desirable.

Either way, I wish you the best of luck.

Date: 2016-11-15 05:54 am (UTC)
From: [identity profile] flwyd.livejournal.com
Yeah, I've read that about peppermint.

I've taken to sucking on a peppermint candy when I'm having a hard time swallowing. It seems to help a little.

Date: 2016-11-14 07:21 pm (UTC)
From: [identity profile] dr-tectonic.livejournal.com
I would argue that the standard dietary advice given to Americans doesn't apply to anybody, because it's terrible advice. :)

I have also been eating plenty of bacon (but not ice cream) because I'm on a low-carb high-fat (ketogenic) diet, and I'm losing weight for the first time, like, ever. It runs counter to conventional nutritional dogma, but it seems to me that it matches up with your plan, and I'm curious to know how things look coming at it from the other side.

So, as I understand it, by default your body burns glucose derived from carbohydrates for energy, but if they're not readily available, it will happily switch over to burning ketones derived from fats. Now, it's sort of the case that "a calorie is a calorie" and that your body stores excess calories as bodyfat, but there's an added complication in how different foods modulate hunger. Carbohydrates tend to amplify it, while fats damp it down. So trying to restrict your calorie intake by avoiding fat is self-sabotaging, because you end up feeling hungry all the time, and those hunger signals also lead to your body deciding it's in starvation mode and needs to store everything it can. Whereas if you avoid carbs, not only are you less hungry, you also bring all the fat-metabolizing systems online.

So going by that model, in your situation, you would want to make sure you've got plenty of both carbs and fats available in your system, and that sugars are good because they'll help signal your body to hold onto all the extra. Probably you want a mix of simple and complex carbs, so that you're not sugar-crashing all the time, but keeping it balanced with fats and proteins will help smooth things out, too. So yeah, non-dairy ice cream and bacon. And maybe some raw carrots and squash soups.

How well does that explanation fit with the recommendations from your dietitian?

Date: 2016-11-15 06:41 am (UTC)
From: [identity profile] flwyd.livejournal.com
As I recall, my dietitian said that getting fat into cells requires glucose, sodium, and water, so yeah. I suppose that's why a diet of potato chips and soda is an easy path to weight gain. (I haven't tried this approach because most sodas have a low calorie count, they may exacerbate acid issues, and potato chips tend to get stuck in my throat if I'm not careful.)

I also read this year that the speed at which someone eats can influence their glycemic levels which in turn influence whether or not they retain or burn the calories. That source said something like "The same food, eaten more slowly, might lead to less weight gain." Unfortunately for me, having restricted swallowing capability means that eating a meal quickly isn't an option.

I spent a lot of this year focusing my intake on protein and fat, the former because amino acids are crucial and the latter on the principle that it's easy to blend and carries 9 calories per gram instead of 4. On this scheme my body kept functioning for the most part but I didn't make any headway on weight. There were also several days when it seemed like my stomach had to work really hard to process the input. I suppose one way to lose weight is to eat foods that require a lot of work to break down, like whole grains, fibrous vegetables, and steak.

My friends run ketotic.org, a site focused on science behind a ketogenic diet, so I've heard a fair amount about the idea.

I don't buy the claim that carbohydrates (as an entire class) cause weight gain, diabetes, heart disease, etc. because almost every large society over the last five thousand years[1] has had grain as a key dietary staple[2], most without wide incidence of those problems. I do accept the observation that not eating carbohydrates can lead to wait loss and reduce incidence of many health problems, though it may in part be the elimination of some specific food type that a person has trouble with, so cutting all carbs is throwing the wheat away with the chaff, so to speak.

Until this year, I ate a lot of carbs and remained at my high school weight. Most of these carbs were from high-fiber sources[3] and my intake of refined sugar was pretty low.

[1] Which is all of history that had large societies, because it's really hard for a society to get big without agriculture.
[2] I think this is in large part because it's a lot cheaper to grow grains than it is to grow livestock (or carbs vs. protein more generally). Global or even nation-wide adoption of a ketogenic diet, short of major engineering advances in in-vitro meat, would be an utter ecological disaster.
[3] Reading the low-fiber-diet instructions for a colonoscopy was pretty surreal. The intersection of "things on the recommended list," "things I normally eat," and "things I'm currently able to swallow" was very small indeed. Fortunately I spent the weekend in the Midwest, home of low-fiber diets.
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