The mind is willing but the flesh... not so much
February 6, 2015 1:38 PM   Subscribe

How do I eat healthier and exercise more while struggling with chronic GI/fatigue issues?

I was recently diagnosed with IBS-D after struggling with diarrhea, gas, and stomach pain over the last few years. I am seeing a GI doctor and had a colonoscopy, which ruled out more serious conditions like Crohn's or IBD. I also tested negative for celiac disease. In addition I have struggled with chronic tiredness and fatigue related to a sleep disorder of unknown origin currently diagnosed as restless leg syndrome/periodic leg movement disorder. I have been tested over and over for every condition my doctors could think of but so far there has been little progress in terms of figuring out what exactly is wrong or how to treat it.

At this point I desperately want to make changes to improve my health but feel so overwhelmed that I have no idea where to start improving things. I am familiar with what foods are good/bad for IBS but draw blanks when it comes to coming up with new ideas for meals to prepare. I am somewhat picky, don't really enjoy cooking, and usually eat the same thing for each meal for long stretches of time. At this point I am totally burnt out on most of my preferred healthy food choices (hummus and carrots, tabbouleh and chips, edamame, salad). Half of my groceries go uneaten while I default to ordering out or snacking on comfort foods which are not so great for me.

In the same vein, I want to exercise more but have trouble motivating myself when I'm always tired. I have never really enjoyed working out and hate going to the gym, but these days I have a lot of anxiety around doing my preferred workout activities (walking, yoga and dance class) during IBS flare ups.

Things that have been helpful: taking psyllium husks daily, cutting down on FODMAP vegetables, switching to sheep/goat/aged cheese to cut down on lactose, eating more raspberries, doing the squat challenge (liked that it could be done at home and showed results relatively quickly)
Things that have not worked: Probiotics (have tried many different kinds at this point and overall they tend to make the diarrhea worse), eating more oatmeal (can't stand the texture but love baking with oats)

I am looking for recipe ideas for both meals and snacks, especially ones without a ton of ingredients and/or with minimal prep, as well as exercises that can be done at home. The more specific the better-- I have been floundering when it comes to putting general advice into practice. As far as food goes, I strongly dislike most nuts and seeds (ok with cashews and pistachios), most beans (ok with chickpeas and lentils), dried fruits, and yogurt that isn't plain vanilla. I love cheese, seafood, soups, thai curry, korean food, avocado, chocolate, and most veggies.
posted by fox problems to Health & Fitness (13 answers total) 11 users marked this as a favorite
 
This is not a food or exercise suggestion (sorry), but I highly suggest you look into magnesium supplementation, as it can help with digestive issues, fatigue, AND restless leg. The catch is that too much magnesium too quickly will worsen diarrhea. You can try epsom salt baths (the magnesium is absorbed through your skin), magnesium oil, or a powdered supplement called Natural Calm.
posted by raspberrE at 1:59 PM on February 6, 2015 [2 favorites]


I'mma tackle the food - let's see how I do with this.

I love cheese, seafood, soups, thai curry, korean food, avocado, chocolate, and most veggies.

I can work with this.

TIP 1 - get as many kinds of frozen veggies as you can. That way all you have to do is drop them into boiling water to make soup.

TIP 2 - if you have some extra time on a weekend or something, pre-cook some veggies so they're all in your fridge ready to go. If you want to be really ambitious, you can also pre-cook some dried beans and then dole them out into smaller containers and either freeze or refrigerate them; one good tip I learned about cooking beans, too, is that instead of just soaking them, try boiling the shit out of them for a couple minutes first and THEN soak them. You can soak them for a shorter amount of time, and it also seems to be better and making beans more digestible (a Greek playwright I knew said that doing it this way "gets rid of the farts").

And you can use your precooked beans and veggies thusly:

GUAZETTA:

Take some precooked chopped-up green leafy vegetable - kale or spinach are perfect - and drop it into a pot with a chopped-up tomato, a cup of beans (either white beans or chick peas are good), and a can of chopped clams. Pour in enough seafood broth just to cover, and let that simmer until it's heated through.

MINESTRONE:

Beans, whatever vegetables you want, and broth. Seriously, WHATEVER VEGETABLES YOU WANT. I can't tell from your list whether pasta would be okay, but a handful of tiny pasta also thrown in would work too. Dump it all in, heat it up. Sprinkle some grated parmaesan cheese on top before you eat it.

COLCANNON:

This is a serious standby for me - take a potato, drop it in a pot, cover it with water, and boil until the potato is soft. Meanwhile, either heat up a handful of chopped kale (if it's already in the fridge) or chop up a good handful of kale and boil that in a separate pot. Drain it and run it under cold water just so you can handle it, then peel the skin off and mash up the potato in a bowl; if it's too dry you can add a little plain yogurt, maybe (not VANILLA yogurt, just plain yogurt); the regular recipe calls for a tiny bit of milk, but I don't know if your system would react to that, but non-flavored plain yogurt might be okay instead.

Then - mix the chopped kale and mashed potato together and spread that into a baking dish. Top that with some grated cheese, and throw that under the broiler until the cheese melts. Done.
posted by EmpressCallipygos at 2:01 PM on February 6, 2015 [4 favorites]


On the exercise front, I would try to translate the two activities you like to do (dance and yoga - this is harder for walking) into things you can do at home when you're not feeling up for attending a class. If you have cable, there are lots of free exercise classes on "On Demand" (if your service offers something like this). There are also some on Hulu and Netflix. And, of course, you can always get DVDs from the library or purchase them.

Unfortunately I'm more of a Pilates person than a Yoga person, so I don't have great suggestions for Yoga videos. In the Pilates world, I love Ana Caban's DVDs, and I also really like Robin Long, who has a great You Tube channels with short videos. If you like Pilates or want to try it, she might be a great option since she has a few different series on You Tube with 5-10 minutes videos for each day...could be a good way to ease back into exercising since at least for me it is way easier to commit to 5 minutes of exercise than an hour of exercise. :)
posted by rainbowbrite at 2:19 PM on February 6, 2015 [1 favorite]


I would gently suggest also discussing the diagnosis with a psychiatrist, perhaps one recommended by your GI specialist. TCAs or tricyclic antidepressants in low dosages can slow down the gut, treat neuropathic pain of the kind you report, and cause mild drowsiness, which might help you with getting a good night's sleep. TCA-induced mild constipation is useful for treating IBS-D, which is why GI specialists can also prescribe loperamide (the generic name for the OTC drug Imodium).

I suggest this option as an adjunct that could potentially help gradual diet and exercise changes be more successful, as it was helpful for me. Good luck!
posted by a lungful of dragon at 2:23 PM on February 6, 2015 [2 favorites]


I'm not sure how the basic ingredients of Korean cuisine mesh with cutting out FODMAP foods or your own specific dietary needs, but I think the basic idea of it is something you could use to your advantage. In Korean home cooking people generally keep a bunch of side dishes made at any given time (pickles, salads, little bites of things) and then they'll make rice, and one main dish and/or soup, and that will be any given meal. So instead of cooking for every meal, cook a few side dishes to store and prepare some simpler things in portions/combinations whenever you have time and motivation, and eat them with rice and soup for a meal, or just by themselves. You might also find that for you having more and smaller meals throughout the day helps keep your systems running properly, so having lots of various side dishes to snack on is the ticket, instead of chips or cookies or whatever. Don't feel constrained to only Korean foods for your side dishes, and you could also count premade things that you buy at the store, too, if you can afford it.

I am not Korean but I love the food and have tried rather successfully to make a lot of it at home. I use Maangchi as a jumping off point more often than anything else. All her recipes are easy to modify and she gives lots of alternatives to hard-to-find ingredients, although hot pepper flakes and sesame oil are vital. Her website has a pretty active forum where you could talk about different modifications or suggested combinations. Some things I make regularly: vegetable pancakes, gimbap, bok choy, broccoli pickles, radish kimchi, eggplant (though I normally don't make this one spicy, sometimes I put a dollop of miso instead). All of these are things I make a big batch of and keep around for up to a week, nibbling at here and there, except the gimbap which is lunch.

For exercise at home, can you do yoga at home? I do yoga at home. There are tons of videos on youtube for various skill levels. I have a space in my living room (which has an interesting ceiling, maybe you could put something interesting on your ceiling in your yoga spot for the positions where you're looking up?) and a yoga mat and a few thin, sturdy pillows and a chair for support, and another chair where I put my tablet running the videos I like. For me, since I'm definitely at a beginner's level, it's more about finding a person whose voice I find centering and makes videos that I find challenging enough but not demoralizing. Maybe you're at a higher level than me, but maybe doing simpler yoga at home more regularly will get you to a place where you can find a class or instructor again. I think it's more about continuing to just do something, rather than doing it better and better or perfectly.
posted by Mizu at 2:29 PM on February 6, 2015 [3 favorites]


I have ulcerative colitis, and I've struggled as you describe. I'm currently in remission (mostly), and although in most regards I don't have a lot to offer you wrt your question, I did just want to mention that if psyllium helps you, you might consider using Konsyl. It was recommended to me by one of my doctors and I have found that it really make a much bigger and better difference than the pills do. I was taking about 12 capsules daily when I switched over. The balance of soluble and insoluble fiber seems to be perfect for me and really slowed down the urgency & frequency of my diarrhea.
posted by janey47 at 2:42 PM on February 6, 2015 [1 favorite]


Soooooo I pretty much could have written this. I'll write a brief summary below, but before that:

Have you kept an actual food diary or just tried IBS diets? I found that even though I was negative (genetic and blood test) for celiac, gluten still made me feel totally sick. I also had issues with milk. I would suggest a food journal first and possibly an elimination diet. It sucks but it can get you feeling better.

Do you have a GP you trust? Someone who actually listens to your problems? It took me a bit of doctor-shopping before I found my GP and she's amazing. Took a full history and full symptom review. There's tons of bloodwork to check for the issues like fatigue, blood counts, vitamin levels, checking for things like rheumatoid problems and the like.

Food: After exploring food intollerances...

Do you have a slow cooker? Soups can be made in a slow cooker overnight and that means less prep and less sitting around. In general a food processor might be helpful to reduce the food-prep annoyance.

I also have a very limited diet and hate food prep. One thing that helps is watching TV while cooking. There's also tons of Paleo blogs and recipes that are actually simple. Try to look for one-pot recipes. Quinoa is a good one-pot solutions and you can throw veggies, broth, quinoa, and more in a pot and let it cook.

I've also become a fan of pre-cooked ham at the grocery store. It's super easy to add pre-cooked ham (or even deli meats) into recipes. Just chop it up! Rotisserie chicken is good for that too, less cooking!

Memail me if you want, but I literally had probably the same tests as you. My "IBS" kept getting worse, my stomach was in constant pain, but all my tests were normal. Then I started to get gallbladder pain. Has yours been ruled out? Well all my gallbladder tests were normal, until they yanked that sucker out about 3 weeks ago and sent it to pathology. It wasn't normal! I still feel like crud from recovery - nausea and stuff - and I have no idea how I'll end up feeling -but my stomach no longer burns and I barely have any cramping and no more diarrhea. Just saying -although you may not have the same problem - that there's hope for gut problems you just have to push a little more.
posted by Crystalinne at 5:26 PM on February 6, 2015


Look into a Ketogenic diet. There's stuff all over the interwebs about how it's really good for people suffering from IBS. Your energy will skyrocket because in ketosis your body is forced to burn fat for energy instead of glucose which means that you don't have insulin spikes and your blood sugar is more regulated (the downside of this is that you don't get to have sweets….except for some dark chocolate every now and then). But you will have WAY more energy to work out. Seriously. Like manic energy.

It does require some meal planning and food prep, but once you get into the routine (and have more energy) it's not so bad. And it sounds like this kind of diet could incorporate a lot of the foods you already like to eat - veggies, thai food (coconut oil is a staple in this diet. you can cook meat in it and it's really good. or make coconut chicken soup. You can eat avocados galore, and definitely lots of cheese and butter and seafood.

My last selling point is that any extra weight you might be carrying around will most likely end up just melt off. Srsly. Give it a shot!
posted by lettuce dance at 10:08 PM on February 6, 2015


Have you tried any elimination diets? I would at least eliminate gluten and eliminate dairy completely for 1-2 weeks (not at the same time) to see if you feel any better. I'm very lactose-intolerant and I notice digestive side effects if I eat even butter or goat cheese without taking a lactase pill. If you find that entirely eliminating dairy helps, you can then reintroduce in small quantities and perhaps try out lactase pills in case that's contributing to the gut problems. I typically eat small to moderate amounts of dairy (always taking a pill) for 2-3 meals a week, and dairy-free the rest of the time. I don't love dairy as much as many people raised on a typical Western diet, but I'll never give up my fancy French cheese either.
posted by serelliya at 10:59 PM on February 6, 2015


I could have written this, but I find it difficult to articulate through the pain!

If you like oatmeal, try these: http://minimalistbaker.com/healthy-5-ingredient-granola-bars/ Pretty tasty and dead easy - don't forget to process the dates, though.
posted by mibo at 7:22 AM on February 7, 2015


On the food front, I just looked at a list of FODMAP no-nos and only cabbage and onions and garlic are really central to Korean food. (I once had a Chinese medicine herbalist tell me that I had to abstain from onions and peppers and garlic for a month and after I glared at him, he said "I know, you are Korean, but you can do this."

From what I understand, each individual will have their own specific list of FODMAPs that are problematic, so it would be worth figuring out if cabbage and onions are problematic for you or if they can go back on the okay to eat list of foods. Rice seems to be a-okay and chili pepper seems to be a-okay and I saw no mentions of soy sauce, ginger, or sesame oil. I would think dduk guk (rice cake soup) would be a safe bet, and it's incredibly easy (I just do an anchovy broth by boiling 8 anchovies for like 30 minutes, fishing out the fishies, and then putting in rice cakes, soy sauce for saltiness, and egg whisked in. If zucchini, mushrooms are okay, then put those in too. I usually put in frozen dumplings but you should see how those affect your GI since they have some of the verboten ingredients). As someone with a mysterious bloating issue, I have been flirting with the idea of doing a low FODMAP diet, so I'm happy to ponder this more. Doing a Korean stew rotation (soondubu, doenjang) with modifications for low FODMAPs seems not that difficult and if you have a rice cooker (it can be an old school not fuzzy logic one) then you have a meal! I'm too lazy to even mess with the banchan (side dishes) but the shigeumchi (blanched spinach) is pretty quick and myeolchi bokkeum (stir fried little anchovies) will keep a long time.

I also second the suggestion to use Youtube as a home yoga class. I've been watching Adriene and Esther Eckhart videos (I like their vibe).
posted by spamandkimchi at 11:52 AM on February 8, 2015


If you can afford it, I highly recommend a treadmill desk. I wanted one for a long time--I kept putting it off due to the cost. But I finally decided that pinching my pennies is better than pinching my blood vessels. For the past 3 months or so I've been walking about ~50 miles per week without having to change my routine very much. It's easier to operate a computer in this configuration than you may think, and you barely even notice you're exercising.
posted by Hot Pastrami! at 1:30 PM on February 8, 2015


(coconut oil is a staple in this diet

Coconut oil does good things for the gut, even if you don't go so far as to follow a ketogenic diet.

About 15-17 years ago, I read an article about RLS that suggested that B vitamins and iron might help. So, when my legs were driving me crazy in the evening and making it impossible to sleep, I would take a B vitamin supplement. I would give it about 30 to 45 minutes to see if that worked. If it did not, I would then also take an iron supplement. About nine years ago, at the age of 40, I finally began having regular, non-anemic periods. I had been severely anemic all my life before that. I had also been hypoglycemic for years.

Anemia, hypoglycemia and diabetes are all known to worsen the condition. These are all blood disorders. The feet are farther from the heart than any other body part. Between that and gravity, they take circulatory problems the hardest. I have come to believe RLS is not neurological, but is, instead, caused by a combination of factors like nutritional deficiency and circulatory problems. I still sometimes get RLS. It no longer takes me 30 to 90 minutes a night to resolve it. It usually takes me about five minutes. These days, it responds well to caffeine and hydration (and sometimes to going pee -- urine dumps toxins from the blood).

I have known other people who were able to treat their RLS with other nutritional supplements, including magnesium and potassium. So I will suggest you try to figure out what nutrients are things you are probably deficient in. Try things one at a time, at least a week apart, so you can have some idea which thing does what. Keep a journal. It is really, really common for there to be a delayed reaction. For me, doing something often has an effect 48 hours later. It's hard to spot patterns like that if you aren't tracking it somehow.

The gut is lined with mucus which is mostly made up of salt and water. My gut issues benefited tremendously from switching to a good quality sea salt to support healthy mucus production. These days, I do okay with table salt occasionally, but for a long time I did not tolerate regular table salt well. It caused me problems.

Sea salt plus either organic butter or coconut oil and the right kind of carbs did a whole lot of good stuff for my gut. One year, I made mashed potatoes from scratch basically every single day, sometimes twice a day. I cooked the potatoes in filtered tap water with good quality sea salt. I poured off most but not all of the water, leaving behind a lot of the starch and a little liquid. I added organic butter and sometimes also a bit of coconut oil. Then I hand mixed it with a bamboo spoon. Serve with whatever proteins or veggies you like. It was common for me and my oldest son to have just mashed potatoes for one meal and mashed potatoes with steak for a second meal.

A lot of natural things that help gut issues will cause diarrhea. Basically, bad stuff needs to come out somehow. The diarrhea from supplements that are healing the gut is typically not miserable like diarrhea from antibiotics or illness. Coconut oil does promote diarrhea. So does aloe vera, another thing I took for a time that helped my gut get better. I worked on consuming such things at a slow enough rate to keep the diarrhea from being bad and I also consumed constipating things to counter it, like rice and dark chocolate. Rice is still my go-to for dealing with certain issues.

IIRC, the gut is the source of a high percentage of serotonin. Serotonin is important for sleep. It's possible that the gut issues are part of why you aren't sleeping well, due to the impact that can have on the brain chemistry. Co-q-10 in the morning, about 12-14 hours before you want to sleep, might help treat the brain chemistry angle of this so you can sleep better.

Walking has been hugely important to my recovery process. My practice is to know where all the public and store bathrooms are and make sure I can get to a bathroom fairly quickly. Could you do something like go to a local mall and walk around the interior of the mall so you have ready access to the bathroom? Walking promotes gut motility. It also does good things for lung function and I have serious respiratory problems. So walking is my primary source of exercise. My understanding is that it is the best/easiest exercise for the human body.

Best of luck.
posted by Michele in California at 1:56 PM on February 8, 2015


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