Archive for ‘Dietary Compliance’

August 15, 2017

Travel Tip #18 Push the Limits?

Travel Tip #18 Push the Limits is written with you in mind if you suffer from IBS, IBD, Crohn’s Disease, Celiac Disease or other conditions that may lead to a sudden need for bathroom facilities. I just got back from LA. During Sunday brunch I had a sudden reminder of how uncomfortable it can be to travel with a gastrointestinal condition. This travel tip deals with a subject that’s difficult to discuss in public.
cypress
If your guts are constantly in a knot and you can’t predict when diarrhea, gas, or pain may suddenly hit, it can be hard to imagine taking a long trip on an airplane or even in a car full of people. A fear of embarrassment or discomfort can lead to a gradual withdrawal from family outings and vacations.

Reluctance to disclose the real reason for resistance to certain situations often leads family and friends to misinterpret what’s happening. I mean who really wants to say, “I just can’t face the chance that I’ll poop myself during a 3-hour plane ride?” I don’t. It really doesn’t matter how close we are, I just don’t want to discuss that with you.

So, what should I do?

Pretend to be too busy, too sick, or too angry with Aunt Jane to attend?
Insist on a different trip that no one else is excited about?
Wear adult diapers?

Sometimes saying no may be the best choice. If your only motive is to take care of yourself, you’ve explored all the options that might make the journey enjoyable for you, and you still can’t find a way to make peace with attending, then say no. It’s only when you have an ulterior motive or when continual refusals begin to limit your access to a full life that saying no becomes detrimental.

Say yes within limits. If it’s hard for you to take care of yourself, establishing certain parameters in advance can make it easier to decide in the moment when presented with an invitation. For instance, you may want to have a rule that you only agree to car trips in areas with ample facilities. You may want to limit flights to 1 hour at certain times of the day. You could have a rule that you will not stay at friends’ houses so that you have the privacy of your own space. Along those lines, you can have a rule that you don’t share hotel rooms. If you know you usually have fewer problems an hour after eating, join the family after the meal rather than for the meal.
breakfast
Make sure you eat properly and/or take your medication on time. When you’re willing to say yes, there’s no reason to tempt fate. Adhering to the regimen that works best for you while varying your activity can make all the difference. Investing a little time in research and advance planning can make it possible for you to have plenty of medication on hand even when you miss a connection.
It can also mean that you have plenty of tummy friendly snacks on hand when meal times or restaurant options unexpectedly change.
orange tree
Focus on the good stuff. A beautiful view, a warm hug from your favorite cousin, or the smile on your grandson’s face when he meets LeBron James can all mitigate a little discomfort. After all, you may not feel perfectly well at home. If you can feel equally good and add some great memories, it may be worth risking possible inconvenience or embarrassment. If things turn out badly, you can make a different choice next time. If you always stop yourself before you start, you’ll miss out on a lot of good stuff.

Bring the party to you. If you need to be in your own space to be comfortable, make your home the place everyone gathers. Let the travel be someone else’s problem. Instead of missing out on memories and contact with people you enjoy, develop your hosting skills.

That doesn’t mean you have to do a lot of work and throw a party. Just establish that you’d like to see everyone at a certain time and invite, invite, invite. When someone visits, relax and enjoy them. It may take some time to develop momentum, but eventually word will spread that your place is the place to be. Making your guests feel welcome is all it really takes to be a great host.

If you suffer from IBS, IBD, Crohn’s Disease, or Celiac Disease, should you push the limits and travel or should you stay home? There’s no right or wrong answer. What’s right for today may not be right for tomorrow.

The important thing is to always, always take very good care of yourself. For some of us that is in and of itself pushing the limits.

August 1, 2017

A Bite of Regret

Before you have a taste of that beautiful cake, remember you could be taking a bite of regret. One of my friends is in pain. She isn’t complaining too much because she knows why. A couple of months ago she went on vacation. There was cake. After three years of feeling good on a gluten-free diet, she thought it probably wouldn’t hurt to just take one tiny bite of cake.
cake
While we know the research says one bite of gluten is enough to trigger an immune response that causes damage which can take a year to repair in someone with celiac disease, we don’t really know if that one bite of cake caused my friend’s problem. Why? Because she didn’t stop with that bite.

A few days later, there was pizza. She had half a piece. A bite of fried chicken here and a taste of a dinner roll there, pretty soon she was a few weeks down the road of regret and couldn’t deny how bad she was feeling. Now she realizes she’s in for a long haul in getting back to where she was before that fateful first bite.

I know it’s tempting to think that reducing gluten does much the same as eliminating it. That’s seductive because it sounds like you can periodically reward yourself with a doughnut and not suffer any ill effects. If you have an autoimmune response to gluten, reducing gluten will not work effectively. You must eliminate it entirely and forever to avoid continuing damage to your body.

The message from the medical community is sometimes confusing. Without definitive test results, your doctor may put you on an elimination diet for a few weeks then have you add back gluten to see if it affects you. Unfortunately, the results can be misleading. If you have gluten-sensitive enteropathy, you may not feel worse from adding back gluten after a few weeks because your body has not had time to heal the damage that’s already done.

Just like the gradual regret my friend recently experienced, symptoms may compound incrementally in a way that causes us to normalize our gradually increasing discomfort. It may only be after months of living gluten-free that we suddenly realize we no longer feel tight in our skin or our shoulder doesn’t ache or we can again lift a large cast iron skillet without difficulty. Questionnaires are so often focused on gastrointestinal discomfort that symptomatic patients may report having no symptoms.

In general, there seems to be a reluctance to diagnose celiac disease so it still often takes years of symptoms to get a diagnosis. I don’t know why this reluctance exists. I am hoping it will lessen in light of new research that indicates diet may be effective in treating conditions not commonly associated with dietary risk such as multiple sclerosis and depression.

If you have been diagnosed with celiac disease and know gluten is harmful to you, it is important to consistently and continually eliminate it from your diet. Failing to do so puts you at a higher risk of death (1). That’s something to keep in mind before you take that tempting bite! Make sure it’s not a bite of regret.

http://emedicine.medscape.com/article/932104-clinical
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0791-y
http://www.cbsnews.com/news/multiple-sclerosis-mediterranean-diet-to-counter-effects-study/
https://www.medpagetoday.com/allergyimmunology/allergy/15972
https://www.medpagetoday.com/allergyimmunology/allergy/15972
(1)Though still modest in absolute terms, risk of mortality increased by 75% for patients with mild inflammation of the small intestine at a median follow-up of 7.2 years (95% CI 1.64 to 1.79), and by 35% for patients with latent celiac disease (defined as gluten sensitivity) at median follow-up of 6.7 years (95% CI 1.14 to 1.58), according to a report in the Sept. 16 Journal of the American Medical Association.

July 9, 2017

Five Easy Ways to Freshen Up Your Summer Menu!

teaHere are five ways to freshen up your summer menu! When it’s hot and humid, the last thing you want is to eat is a heavy meal. Fresh, cool, and light seems much more appealing. My preference is to live on gelato in the summer, but that’s not really practical. Of course, I’d be happy to add ice cream, fresh peach granita, or banana popsicles to the menu – again, not exactly practical.

So what are some easy ways to freshen up your summer menu?

Salads
Many of us default to salads as our lighter fare for the summer. Salads are a great place to showcase seasonal fruit and fresh herbs. Strawberries, blueberries, and peaches are all great additions to spring or bitter greens. It’s also a great time to use tomatoes as a base for Insalata Caprese! Mint and watermelon pair well with salty feta cheese while a salad of cucumber and dill will lighten up the meat off your grill.
caprese salad
Cold Soups
Cold soups can fill you up while cooling you off. I love gazpacho in the summer! The traditional version has a tomato base, but you can also begin with watermelon, cantaloupe, cherries, or strawberries. If you’d rather have a milder flavor, vichyssoise made of potatoes, leeks, cream, and broth may fill the bill. One of my favorite cold soups combines honeydew, cucumber, and jalapeño peppers.
honeydew soup
Chilled Condiments
In the winter, it’s comforting to add complimentary flavors to your dish by serving a warm, thick sauce or gravy. In the summer, pico de gallo, salsa, chimichurri, tzatziki, raita, or another cold condiment will add layers of flavor without the heaviness of gravy. I recently made chimichurri with baby arugula instead of parsley. It was delicious with grilled steak!
asparagus guac
Iced Drinks
Icing down anything when the thermometer hits 100º just seems reasonable – coffee, water, lemon water, juice, gin, and vodka are commonly served with ice. In the South, we also drink a lot of iced tea! Adding muddled mint or cilantro and leaving out the sugar makes the tea even more refreshing.

Cold Desserts
Summer is the perfect time to serve chilled banana, tapioca, or rice pudding. It’s also a great time for no-bake fresh fruit pies. My mom made a fresh peach pie that makes my mouth water every time I think about it. And really, there’s no need to cook – a bowl of fresh fruit topped with a tiny bit of plain yogurt sprinkled with cinnamon and nutmeg can easily satisfy your sweet tooth in the healthiest way possible.

Freshening up your summer menu with chilled food and fresh produce is practical, easy, and delicious! Give these 5 ways a try.

July 4, 2017

Being Gluten-Free Doesn’t Mean You Have to be a Wet Blanket

flagIt’s a holiday and nobody wants a wet blanket at the party! I am qualified to give Fourth of July advice because I once lived in a house with patriotically colored shag carpet. I’m not kidding, the house had red, white, and blue carpet. When I lived there, my family hosted a Fourth of July party at which invitees were asked to design a new flag or write a new national anthem.

Participation was enthusiastic. One couple extended a dog food bag between two poles and barked their national anthem. One couple displayed a Butter Side Down flag and read Dr. Seuss’s “The Butter Battle Book”. Two young men representing the Nation of Lost Children waved inflated condom flags on their heads. (I didn’t say the party was reverent.) No one took things too seriously and no one was afraid to participate.

It’s been a long time since I’ve been to a party like that. Cell phone cameras, social media derision, and an increasingly thin cultural skin has put a damper on lots of good-natured fun. With this new starting point, I feel even more responsibility to make sure I remain gluten-free without throwing a wet blanket on the party! You may feel the same way. My approach to gluten-free party fun is practical.

Family BBQ
Many Fourth of July celebrations include a family barbecue in the backyard, around the pool, at the lake, or on the beach. The key word here is family. You know your family dynamics. While I prefer to default to the direct approach, sometimes long-standing dysfunction means directness gets rewarded with punishment. If you believe that your requests will be ignored or your contribution unwelcome, you still have options to make a family gathering work for you. Let’s explore several possibilities.

Volunteer to bring an appetizer, side dish, or dessert.

I like this option because it’s a chance to change preconceived notions about gluten-free food. Ask if the host has specific dish in mind then, without mentioning it in advance, bring a gluten-free version that knocks their socks off. When you get a compliment and casually mention you made it gluten-free, you can see light bulbs go off. I love it when that happens!

Bring a favorite family recipe.

My Aunt Opal and my ex-husband take a slightly different approach. They arrive at parties bearing family favorites. While they hostess may not have been expecting it, the minute word spreads that Aunt Opal brought a cherry pie, excitement builds. If you make a mean GF version of your grandmother’s pound cake, just bring it and see what happens. Save a portion for yourself in a discreet separate container so you have a desert option available. If the hostess doesn’t want to serve the rest of the cake alongside her desserts, you can eat your portion and leave the rest as a hostess gift.
grill
Make it easy for the host.

If your sister-in-law begins to fret that she isn’t sure which hot dogs are gluten-free, offer to bring a package so she doesn’t have to read labels. If she doesn’t like that idea, ask if she’d mind saving the package until you have a chance to read it. Either option takes the burden off the host and puts it on you. Making it easier for the host means anticipating your presence at an event won’t put a damper on the party planning.

Don’t whine.

Whining is a definite wet blanket. Even if you believe that your sister was deliberate in failing to provide an option for you at the family bbq, don’t whine at the party. Feel however you want to feel and vent about it later if you’d like, but don’t let her see you sweat. This will take away her power to ignore, dismiss, or torment you and it will allow you to continue to receive invitations to extended family functions. Next year, you don’t have to be available for your sister’s party at all!

It’s much easier not to whine when you’re not hungry. If your family is unreliable, approach the family party as though it’s being hosted by a distant acquaintance. Be prepared by stashing a small cooler in the car filled with your food. You can excuse yourself to eat at the car, or fill your plate from the cooler depending on the circumstances.

No matter how difficult or uncomfortable a situation, it is absolutely okay to take care of yourself. If you do so in the most considerate way possible and a family member becomes irritable, rude, hateful, or cruel, it may be time to reexamine the health of your relationship with that person.

Sometimes it is difficult to see family members as they really are. It can be absolutely heartbreaking to recognize that those you most want to love, protect, and nurture you don’t have your best interest at heart. Unfortunately, the pertinent question may be whether you should sacrifice your well-being or limit your contact. I encourage you to protect your physical and emotional health even if a relationship doesn’t survive. Independence Day is the perfect time to become independently healthy!
food truck

Community Festival

Some towns have 4th-of-July festivals with concerts and fireworks. There’s a lot to enjoy even if you can’t have a funnel cake. A little preparation will allow you to relax and have as much fun as everyone else.

Investigate.

Many festival details will be available on community calendars, in the media, or from the local Chamber of Commerce. Knowing which food vendors or trucks are participating in an event gives you a chance to review menus or contact the vendors for information. There may be plenty of gluten-free options available on site.

Be prepared.

In the heat of summer a lightweight, easy to carry cooler bag is a great investment. With your potato salad on ice, you don’t have to worry about it spoiling. There are backpack styles, messenger bags, and rolling coolers. If your town frowns on outside food at an event, a baby food pack may be in order. If it prohibits outside food, try contacting the organizers for an exception.

Have a fallback plan.

In my family, too hungry comes along with shakiness, irritability, and confusion. If you don’t want a wet blanket squelching your fun, it’s best to never reach that point. That’s why we always have a fallback plan. When it’s impossible to determine what will be offered and bringing food is prevented, we pre-eat.

At one time pre-eating was the standard plan for gluten-free party participants. It’s slightly less necessary now than five years ago, but sometimes it’s still the best option.

Bring a positive attitude!

Of course the real key to having fun whether or not there are gluten-free options is choosing a positive attitude. Many times the only difference between having a fun time or an awful time is making the decision to see all the positive and ignore most of the negative.

Alternative Plans
At other times, you may not be able to wrestle a positive attitude. That’s okay. If you are in too much pain, are exhausted, or simply don’t have enough support in your life at any given time, an event may feel like an additional burden rather than a fun escape. An alternative plan can help keep you connected, but lessen the burden of investigating and planning.

If eating leftovers and taking a long hot bath while everyone else is at the festival makes you feel renewed, that may be a better choice. Offer your friends or family a compromise. After some renewal time, you will plan to join everyone later for drinks and fireworks.

Have fun!

You’ll always have more fun when you can relax and be present in the moment. Planning just enough to make sure your basic needs will be provided for can alleviate anxiety and allow you to focus on the fun of seeing how far you can spit a watermelon seed, spray water with the hose, or shoot a bottle rocket.

Happy 4th! Have fun!