Help me interpret my elimination(ish) diet results
March 18, 2013 2:30 PM   Subscribe

I suspect my diet is causing me chronic health problems. How can I confirm this and fix it without health insurance? Semi-elimination diet results inside - please help me interpret my observations.

In essence, I inadvertantly had great results with a month on a semi-elimination diet. I recently spent a month living and working in a place with shared meals prepared by cafeteria staff. This was in a Central American country, and the food provided included a ton of rice and beans, a few veggies, plenty of meat, not a lot of spices/onions/garlic, and a fair amount of dairy and gluten. There wasn't much salt in the food, but there was a decent amount of processed wheat flour & sugar (in desserts, daily PB&J's for lunch, crackers, cookies, etc). I didn't drink as much water as I should have, but I did drink a ton of beer, tea, and coffee.

After a month on this diet, I felt better than I've ever felt before, and a number of chronic health issues that had been plaguing me had suddenly vanished. I was also doing a ton of exercise during this time, but I have mostly continued the exercise after returning home and the symptoms have all come back after about 2 weeks. My diet at home is fairly terrible and I know that there are plenty of things I can change (lots of processed/salty foods, high-fat, too many carbs, not enough vegetables).

However, I will have a lot more energy to cook and overhaul my overall diet once I have eliminated the ongoing health issues, so I want to focus on the specific health problems that improved as a first step. Those issues are:
  • Lower abdominal pain, painful gas, and bloating 1/2-3 hours after eating, often such that I can't stand up for ~1/2 hour during an attack.
  • Gross distension of the lower abdomen during attacks - makes me look super pregnant.
  • Skin problems: excema on sides of nose, seborrheic dermatitis, breakouts on neck/chin
  • Water retention / water weight, which makes me look puffy all the time. It gets worse around my period but is pretty annoying all the time. The amount of water weight seems to fluctuate fairly quickly, too - one day my clothes will fit fine, the next day they're too tight all over, and a couple of days later things will fit again. Other people have even commented on how labile my weight seems.
  • Low energy, sleeping a lot
  • Brain fog
  • Depression & anxiety
For the first few symptoms, I think I've been eating too much fructose/sugar and that this is the cause of the serious post-prandial pain - I'm having fructose malabsorption problems. Since returning home, I've noticed that when I consume no fructose and try to limit my daily load of fructans (from tons of onion & garlic mostly), I don't have attacks and I feel generally fine, though the water weight has definitely still stuck around.

The water weight is still a mystery to me, though. Here are my hypotheses - could anybody help me narrow this list down based on my observations? Anything I can watch for to narrow it own further? Things I haven't thought of?
  • Sodium-potassium balance - at home, I tend to eat very salty foods and eat very few foods that are high in potassium. I ate a lot less salt and a lot more potassium on the good diet.
  • Dehydration - I know that I rarely drink enough water at home, and I've heard that this can cause your body to hold on to excess water. It's entirely possible that my increased intake of coffee and beer on the diet still shifted my fluid balance toward the positive, even with its diuretic tendencies - seriously, I drank a lot of coffee and beer. Does it make sense that water consumption could be making such a big difference?
  • Fructose malabsorption side effect - I've read that the high concentration of solutes in the small intestine caused fructose malabsorption can cause water retention because it changes the osmotic balance. I'm not sure how this would affect my entire body at once, though - does this seem plausible?
  • Carb overload - I'm not sure about this, because I actually ate a fair amount of carbs there. I had two PB&J's for breakfast/lunch and plenty of rice/beans/potatoes with dinner, often followed by a bready dessert. I also had plenty of carbs in the beer (though it was a fairly light beer). I have had decent results with low-carb diets in the past, though.
  • Some sort of exercise effect - while I've been keeping up most of the exercise, I haven't been working myself quite as hard or as regularly as I did down there. Would it make sense that exercise would have such an immediate and drastic effect on the amount of water weight I'm carrying?
Does anyone have any insight? Which of these hypotheses seems most plausible? Cheers and thanks.
posted by Vatican Cameos to Health & Fitness (20 answers total) 7 users marked this as a favorite
So, how much salt and sugar are you having? You say it is too much. But, that is a barometer that is frequently uncalibrated.

I would keep track of what you are eating using a website like FitDay or DailyPlate. Do it for an average week and then see just how poor your diet actually is.
posted by munchingzombie at 3:10 PM on March 18, 2013

I see no mention of what kind of fats or oils you normally consume versus what you consumed there. I would think that is a factor.

The bloating issues you have are a common side effect of my genetic disorder. One of the things we misprocess is oils. It is very well established that this is an issue. It is standard to prescribe ADEK vitamins -- in other words all the fat soluble ones. Supplementing MCT (medium chain triglyceride) oil is pretty well known as something helpful for my condition.

I saw big improvements in my condition when I eliminated oils I do not tolerate well. I did this by observation and trial and error. My experience is that hydration is impacted by a number of factors, including getting the right oils in my diet. Think about how desert plants are waxy to retain moisture. Minerals (salt, potassium, etc) and type of carbs also impact that.

I used to bloat pretty badly and I still have some bloating in my belly. But I don't bloat up like I used to. I used to get congratulated on my pregnancy because from one day to the next the bloating was so much worse. I used to have terrible problems with my feet swelling. I am not where I would like to be but I am dramatically better. Paying attention to which oils I tolerate well and which ones I don't is a big piece of that.

There are no doubt other things going on. But it looks to me like you are completely overlooking this piece of it, while admitting you eat a junky high fat diet normally. After being off peanut oil for a few years, lunch from Chik-fil-a left me in agony for days. So my experience is that the wrong oils can definitely cause gut pain as well.
posted by Michele in California at 3:16 PM on March 18, 2013

I had every single health problem you mentioned and they all went away when I was diagnosed with Celiac disease and I cut all gluten from my diet.

A simple blood test can tell. I'd see a doctor.
posted by kinetic at 3:23 PM on March 18, 2013 [3 favorites]

People react differently to things, so it's hard to tell. The best idea is to re-create the diet you were on in that country -- basically, do an elimination diet on purpose. You already know that you felt good on it, and it sounds simple enough to replicate without much effort.
posted by DoubleLune at 3:27 PM on March 18, 2013

Note to other commenters: OP said she doesn't have health insurance so presumably seeing a doctor right now is not what she wants to do first. And having been tested for celiac disease, the accurate tests are super expensive even if you have insurance.

One thing I would *highly* recommend is keeping a detailed food diary and also keep track of how you feel. You are trying to process a lot of information - make it easier on yourself and write it down!
posted by radioamy at 3:37 PM on March 18, 2013 [2 favorites]

Regarding the bread you ate in sandwiches while in the Central American countries, any idea where the wheat used in the bread was produced/manufactured? There are a lot of studies related to allergens in the fungal amylase used to process wheat flour in the US which may not be used in other countries. So, you may not actually have celiac disease, but could be allergic to something else in the bread--which I suspect is true for a lot of us!

Some relevant journal articles:

Allergy to flour and fungal amylase in bakery workers:

Is fungal alpha-amylase in bread an allergen?:

There are some other interesting items related to the phytic acid used in white bread processing leaching magnesium:

Magnesium deficiencies can wreak all kinds of havoc with the system--especially and including digestive issues.

Another thing to watch out for is Yellow #5: (found this by accident when researching why I got shortness of breath/heartburn when drinking Tang!)

If you've recently taken antibiotics, eating yogurt or kimchi or sauerkraut (live) or taking a probiotic can help with the digestive issues, too. (Fun little graphic about our microbiome:

Anecdotally, I've found that cutting wheat-based items (produced in the US), processed sugar (especially sodas with phosphoric acid, and anything in cans due to BPA content), avoiding yellow #5, methylparabens (now in lots of food, for some reason), and oils like cottonseed, plus taking a magnesium supplement helped me *immensely.* You can take too much magnesium, though, so if you supplement, don't overdo it. It is, of course, difficult to know which of the aforementioned really matter, though. I have a suspicion it's the magnesium.

Also, intermittent fasting has helped me a lot (but IANAD & IANYD); if I know I'm not going to be able to avoid eating bad stuff, fasting 16-18 hours beforehand (and before a "big week," 2 days) has kept the symptoms away (in my case, symptoms that are pretty evident after eating too much white bread include heartburn, peripheral neuropathy, brain fog). Also, with this diet, I can drink alcohol moderately without heartburn or other negative side-effects, which is a nice benefit!
posted by jenh at 3:50 PM on March 18, 2013 [3 favorites]

I had similar stomach problems that went away when I moved to an Asian neighborhood and ate almost entirely traditional Filipino and Thai food for a month. I theorized it was the rice and have continued to use rice as my main carb with good results. On the diet I had before (paleo) my health wasn't as bad as on a junk food diet, but adding rice to it made my stomach so much more stable. I also find it an easy diet since the rice-cooker/steamer combo makes good quick meals.
posted by melissam at 3:50 PM on March 18, 2013

To answer your question directly, yes, eating a diet with too much sodium can cause water/fluid retention.

I cannot answer whether that is what has caused your fluid retention specifically. But eating salty foods is bad for your health, so I can certainly encourage you to eat a lower sodium diet - most of us would benefit from such a dietary change.

Not exercising can also cause fluid retention, but even a minimal amount of exercise is usually enough to keep fluid from building up (like just walking or stretching your legs every so often). It sounds like you were eating plenty of carbs on that diet as well as your current one - rice has a pretty high glycemic load, typically.
posted by treehorn+bunny at 3:52 PM on March 18, 2013

I would make a list of what you eat here that you didn't eat there, the eliminate those things one at a time for a period of a few weeks and see when you start to feel better. Other than the onions/garlic, you don't specify how your diet is different.
posted by cecic at 4:00 PM on March 18, 2013 [1 favorite]

OP, you are describing me, EXACTLY, when you talk about your symptoms. The thing is I too improved dramatically when I went to South America. I spent two weeks on a small cruise ship traveling in Antarctica and then onward up the coast. It was a cruise so I ate like a pig, all my favorite foods, which do include a lot of veggies and fruits as well as meats, cheese, and desserts. Yet oddly, my bloating disappeared and I lost 5.lbs (something no amount of exercise and diet had been able to help me accomplish back home). When I got home my bloating and all the other symptoms returned within a week. I have been to 5 different doctors including a gastrointestinal specialist and have been tested for Celiac disease amongst many other things. I've been told I have IBS which is basically doctors telling you they don't know what is wrong. It's gotten so bad that sometimes my stomach bleeds and I have gained twenty pounds. The only things that have ever helped even the slightest bit is cutting back/out cheese and gluten and taking a probiotic ( I like Align, they are expensive but effective). These things by no means cure my problems they just alleviate the worst of it. In my unprofessional opinion the food in the US is made from so many additives and genetically modified ingredients something has gone wrong. I saw a study done in the Netherlands that showed feeding chickens feed made from *Round Up Ready * corn killed the good bacteria in their systems and left the bad bacteria to multiply out of control. I think something similar is going on for people in the US. If you find an answer to your problems I hope you will follow up here. I will crossing my fingers for you. I know how miserable it can be. Good luck!
posted by WalkerWestridge at 4:08 PM on March 18, 2013 [1 favorite]

Okay, I feel like a heel now for missing the part about not having health insurance.

All of the theories you listed are valid reasons for why you might be experiencing fluid retention. It kind of sounds like a perfect storm of little things all adding up resulting in monster fluid retention. I know it's hard to motivate yourself to make a BIG lifestyle change when you're feeling crappy, but just think about how much better you felt and push yourself over the hump. It really can take 60-90 days to see significant changes from a dietary modification so be persistent and don't get discouraged! Enlist a friend if you need help doing that initial round of grocery shopping/cooking lunches/etc. You can do it!
posted by telegraph at 4:28 PM on March 18, 2013

Aside from electrolyte balance, water retention can also be a side-effect of inflammation. Your symptoms sound like possible IBS to me. Increasing soluble fibre intake is one of the things recommended for IBS, and in eating more rice and beans, you were probably doing that in Central America.

The foods that people with IBS can or can't tolerate can be pretty individual. Some do okay with dairy, others don't. Same with fructose. Here's a little snippet from Practice-based Evidence in Nutrition:
· The foods most commonly identified as causing symptoms include fatty foods, gas-producing foods, alcohol, caffeine, lactose, wheat and [presumably insoluble] fibre.

· Restrictions of specific foods need to be individualized based on symptom management.

· Elimination diets are not recommended.
There's also this interesting little tidbit - no idea if it would help you or not, so not recommending it, just sharing:
Evidence from clinical trials suggests that adults who consume 187-225 mg of peppermint oil two to four times a day may experience a reduction in abdominal pain or discomfort that is related to their irritable bowel syndrome (IBS). Although additional trials are warranted to establish the effectiveness of peppermint oil, it may be considered as a treatment option for individuals with IBS.
Personally, I'd try to recreate the diet that worked for me as closely as possible to see if the symptoms subsided again.
posted by Ouisch at 5:03 PM on March 18, 2013

I'm a skeptic with (I like to think) an iron gut, but there was a period of about 2 weeks when I felt progressively more and more exhausted and depressed, to the point where my thyroid levels were checked.

During that two weeks, I was eating a new kind of pre-packaged/flavored instant oatmeal every day, bought in bulk by and then gifted to me by a friend who didn't find them to her liking. When the oatmeal ran out.....the fatigue and fogginess lifted. Dramatically. The culprit was sucrolose (aka Splenda)--which is supposed to be the "good" artificial sweetener (and I never use artificial sweeteners, and eat a pretty "whole foods" diet). Be merciless about cutting out additives, preservatives, and artificial anything--they're more common than you think, even in "good" packaged/prepared edibles/staples.
posted by availablelight at 5:51 PM on March 18, 2013

My morning brain fog disappeared after I went gluten-free for a while as a test. But it turned out not to be the gluten! It was that I was no longer eating pure carbs in the morning, but more protein-heavy items, and it seems that I require protein in the morning for my brain to work.

I also experience painful gut issues and tracking what I ate with one of those online diet-plan services showed me that I require at least 20 grams of fiber a day to not have problems. Fewer than that, bad news.
posted by telophase at 6:18 PM on March 18, 2013 [1 favorite]

You might also want to research the FODMAPs protocol which was developed in Australia by dietitians to treat IBS. But you seem to have tolerated a lot of foods on that protocol well in South American, which is why I didn't mention it before.
posted by melissam at 9:40 PM on March 18, 2013

Could it be not enough fibre? Beans have a lot.
posted by kjs4 at 10:11 PM on March 18, 2013

I had everything you have for years, minus the pain. For years, I thought I had some sort of sensitivity to salt. Nope.

1) I was diagnosed as hypothyroid, and after many trials and tribulations ended up on the right dose of meds.

2) More importantly, I was diagnosed as hypoglycemic, and counseled to maintain a high-protein + veggie diet.

3) Neither of these things really helped the bloating, barring an early period in my new diet when I was off all grains almost entirely. What DID help the bloating, finally, was discovering that some of what looks and feels like bloating is actually constipation. And then discovering that I'm slightly low potassium (for years, I'd thought I simply couldn't handle much salt), and slightly low iron, which can cause constipation!

4) At the suggestion of my doctor, I also gave up wheat, and when I've gone back to it, I've had some allergy symptoms from time to time, though I'm not sure I'm truly allergic. That said, I was always one who'd happily fill up on lazy wheaty things, and the prohibition forces me to put the effort into eating high protein meat.

Nowadays I don't bloat nearly at all. My skin is still too dry, but that's partly correlated with low thyroid. And the difference between a day with high protein and a day without continues to blow my mind. Try that first. My suspicion is a lot of women, in particular, undereat protein, and then wonder why they've no energy ... to wit, this was me for years. But I've seen it with countless roommates, too.

If you want to try to increase your potassium levels, the safe-food way to do it is with low-sodium V-8, or in a more moderate way (packing far less punch) by eating/drinking whole avocados/bananas. A V-8 4 or 5 times a week makes me feel much better, especially if I start to see signs of bloating. The avocado/banana thing simply doesn't provide me with enough. You can also take iron OTC if you think this might be useful. But as someone above advised, I'd do a few weeks on first, to see what that reveals.

In my case, my iron was coming in borderline (70%); and my potassium levels were closer to 50%. Foolishly, I ignored the potassium for a long time because I mentally coupled it with salt. So I think you're wise to have considered it.
posted by Puppetry for Privacy at 11:09 PM on March 18, 2013 [1 favorite]

i have most of your symptoms.when you get health insurance i'd suggest finding a really top endocrinologist who specializes in things like fatigue, etc. some of your symptoms sound like hypothyroidism and the water/sodium imbalance sounds similar to my renin/aldosterone problems.
posted by wildflower at 12:40 AM on March 19, 2013

I'd recommend actually DOING an elimination diet. I did just recently and I'm shocked by what I discovered.

I actually bought the book, The Virgin Diet, because it was very detailed about how exactly to do the elimination diet and how to reintroduce foods to determine if I was reacting to them.

So here's what I discovered, I react quite badly to wheat, eggs, peanuts and chocolate. When I eliminated these from my diet, I no longer had dibilitating diarrhea, gas or rashes. I also stopped feeling so fuzzy headed.

Do spend about $13, get the book, and see what you discover.

You're very lucky in that you don't need to see a doctor to do this, it's just common sense.
posted by Ruthless Bunny at 6:12 AM on March 19, 2013 [2 favorites]

I think doing an actual elimination diet is a good plan. But I strongly suspect that if you started by eliminating pre-packaged foods and focusing on vegetables, beans and other high fiber foods, that might go a long way toward replicating the results of when you were in Central America pretty well.

If you're eating frozen foods/pre-packaged foods, and what you describe as "very salty" foods, I'd bet you could actually be underestimating the quantity of sodium that you are ingesting.

I like the fitbit website (you don't have to have the device to use the site) for tracking, but there are tons out there. I think fitday actually had better nutrient tracking, but it's been some time since I've used it.

Good luck!
posted by pixiecrinkle at 7:50 AM on March 19, 2013 [1 favorite]

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