YANMDietician, but...
December 25, 2016 2:47 PM   Subscribe

I'm a fairly healthy 32yo lady with a few issues that may be related to what I eat. I have some extra time in January and would like to use it to cook and eat a more healthy diet. We are also planning to TTC in January. What diet changes will give me the most bang for my buck, so to speak?

I'm an omnivore and I eat healthier than the average American diet (no fast food, reasonable levels of vegetables, etc.) but I certainly don't eat as well as I could (I average about two cookies a day, and probably eat more bread than I should).

I'd like to make a few straightforward changes to my diet to be nicer to my gut, prepare for (hopefully!) conceiving, and generally eat better.

I have a number of issues going on that may be related to what I eat:

* I was diagnosed with IBS about 14 years ago. My symptoms vary from diarrhea to constipation to bloating and gas to pain, sometimes severe enough to wake me up from sleep. It definitely doesn't affect me daily - maybe more like every other week? - and usually it's pretty good if I'm careful about certain things (no ice cream before exercising in the summer, etc.) but I've had more severe symptoms both last year and this year around the holidays. I suspect I'm eating richer foods and more sweets (and more food, in general) than normal this time of year, but I can't pinpoint exact triggers.

* I have a history of migraines. They've been well controlled for the last few years by lifestyle changes and eliminating caffeine, most alcohol, and most chocolate, but this is day two in a row of prodromey feelings (rare for me, thankfully!), so they're on my mind.

* I have an iron deficiency, with lowest ferritin of 4.6 and most recent ferritin (after iron infusions) of 53. I eat a relatively iron-rich diet (I eat red meat, I know to eat it with Vitamin C and eat calcium later, etc.) but even on oral iron supplements, I couldn't get my numbers up until I got IV infusions. This makes me wonder if I have some sort of absorption issue, though the iron loss itself could be from menstruating. (I tested negative for celiac disease.)

* I also have really, really low cholesterol (total cholesterol of 96 in March, LDL of 25, HDL of 58 - my doctor was happy, but I was actually denied health insurance on the first attempt because of this), which also makes me wonder if I have some sort of absorption issue.

My doctor knows about these issues and isn't too concerned. I'm not too concerned either, but I do like to optimize health/diet stuff when I can, and this seems like a good time to make some healthy changes.

I've thought about trying the Whole30, trying a low FODMAP diet, just cutting out sweets and trying to eat more veggies, etc., but when I do research online, I get overwhelmed by options.

(I also have OCD and can be triggered by "you must not or you are a bad person" reasoning when it comes to fitness and diet, which makes it more complicated.)

YANMD, YANMDietician, YANMTherapist but what two or three concrete things could I change about my diet in January that won't hurt and might help?

Thanks in advance, and happy holidays to all!
posted by bananacabana to Health & Fitness (17 answers total) 12 users marked this as a favorite
I am not your anything, of course. But I personally find adding more fiber and more probiotics (e.g. yogurt, kombucha) gives me a very high marginal value - 'bang for the buck'.
posted by SaltySalticid at 2:54 PM on December 25, 2016 [3 favorites]

W30 can be really great, but it is very black and white "you fucked up, START OVER." Based on what you've written about yourself, I'd really recommend against it for you. Or at least, I'd join their FB group this week and spend a few days browsing before January 1, when they will almost certainly kick off another community W30.

For the exact opposite approach to nutrition, I've worked with a RD who is also a yoga teacher and her approach is very mindfulness based. She's doing a free online challenge right now (FB and I think also email?)-- even though it's probably half over, you could certainly sign up right now and get a feel for how she works. I think she does one on one work, but she also has an online course that's very "develop a healthy relationship with food and your body" based. As an example, a recent challenge was "instead of counting calories, count colors of your food."
posted by instamatic at 3:43 PM on December 25, 2016 [3 favorites]

You say you want to do something straightforward, and the only thing you mention in a negative way is eating about 2 cookies a day and maybe more bread than you think should. So you could try cutting back on those things if you want.

I've heard of people with mystery food triggers trying Elimination diets. It sounds like a massive pain in the butt, and something you might want to do while working with a doctor, but it could help you determine your triggers and it sounds like that might be useful.
posted by bunderful at 4:30 PM on December 25, 2016 [1 favorite]

Iron: Parasitic infections scavenge iron and American doctors tend to not look for what they view as a third world problem. You could consider getting tested.

which also makes me wonder if I have some sort of absorption issue.
You could request a sweat chloride exam. IBS and malabsorption are common for people with atypical CF.

Start a food journal. Read labels, read labels, read labels. Track the kinds of oils in your food. I find this makes a big difference.

Some things that can help the gut include good quality sea salt, aloe vera and the right oils. I found organic butter and coconut oil helpful.

posted by Michele in California at 4:51 PM on December 25, 2016 [2 favorites]

W30 can be really great, but it is very black and white "you fucked up, START OVER." Based on what you've written about yourself, I'd really recommend against it for you. Or at least, I'd join their FB group this week and spend a few days browsing before January 1, when they will almost certainly kick off another community W30.

If this poster is referring to the "Whole30 First-Timers Support Group" on FB, they are a TOUGH, TOUGH crowd. I am not sure I would recommend that particular group. If the OP decides on W30, which is really an elimination diet with a strict paleo base, they can PM me for other W30 FB groups. Or maybe just join that group and lurk for a while.
posted by jgirl at 5:05 PM on December 25, 2016

I've done Whole30 before, and although I thought it was a very interesting experiment and had interesting results on my health, and I was originally going to say totally go for it given your other health issues (a lot of people anecdotally say it helped incredibly with migraines and IBS), but the other posters are right - there are so many rules it is extremely difficult to follow the program, and if you're the type that would psychologically struggle with that it makes sense to stay away and do something less restrictive.

It is basically the ultimate elimination diet. I think the real question is, will doing an elimination diet itself be a problem for you? I do very well with rules-based diets (with no limitations on portions), personally and that is why I did the Whole30. You just have to know yourself. I know that if I have a set of specific rules for a specific time period and certain things are off limits, I find that easy to follow and it works for me. It removes the psychological struggle for me - I don't have to agonize over whether I can eat something or how much, it's either yes or it's no.

On the other hand, any diet that I've ever tried that involved portion control has failed. I cannot eat one cookie without eating 20 cookies, generally speaking, and if I try it always ends in heartbreak and recrimination. So I feel like I cannot answer the question of how you should approach your diet, but I can tell you that for me, a "diet change" like "eat less sweets" would be doomed. However "no sugar" would be fine. Other people find that making rules like "no type X foods on certain days or at certain times" work for them - not for me. If I can eat anything I want on Sunday, I'll have macaroni and cheese for every meal and a carton of ice cream instead of a normal serving because I've got to get it while I'm "allowed" to!

Think about your emotional approach to eating and why certain things have worked out well or been challenging or upsetting to you in the past and that should help guide your choices.

There is no diet that can make you more fertile (although believe me, when I was TTC I read it all during my two years of infertility treatment, and tried it all too, no matter how farfetched). If you are overweight, then losing weight can help, but it doesn't have to be anything extreme. From the research I have heard, just 10 pounds makes a difference.

As for IBS and migraines, there are certainly a lot of people out there who have anecdotally improved their symptoms with eliminating grains/gluten or sugar - it sounds like you've identified that chocolate and sweets make your symptoms of both of these worse, so going no sugar for the month seems like it would be a simple and potentially good option. I like a challenge, personally, so I'd probably cut all sugar including artificial sweeteners and 'natural' sugars like honey and agave, but if that would get into triggering territory for you in terms of restrictions, you could be more relaxed.

Considering iron deficiency and low cholesterol, I don't think those issues need to figure into the decision, unless you were considering eliminating meat or animal products more generally, and I don't think you need to or should from a purely health-based standpoint.
posted by treehorn+bunny at 6:15 PM on December 25, 2016 [4 favorites]

I meant the Whole 30 Support FB group; I've never looked at the first timer's group.

Basically, W30 works really well for people who find it easier to make one set of decisions on January 1, instead of "should I have one cookie or two" every day. It's not as useful as you'd expect for an elimination diet, because you're eliminating everything at once. If you're serious about an elimination diet, I'd talk to your doctor and do a serious "one thing at a time" elimination. (My doctor also said that 30 days was not really enough for a proper elimination diet, fwiw.)

I dunno, I finished maybe three W30's (and failed out of at least that many), but at this point the restrictions feel really arbitrary (white potato? No white potato? 100 calories of dates, sure, but not 5 calories of sugar that is pretty much chemically identical?) and they started to make me orthorexic about my eating habits, so I knocked it off.
posted by instamatic at 8:16 PM on December 25, 2016 [3 favorites]

Cut out sugar. Two weeks later, cut out flour. Two weeks after that, cut out dairy. That leaves what is basically a Whole30 without the guilt. I think you will be really surprised at how much better you feel.
posted by raisingsand at 9:16 PM on December 25, 2016 [3 favorites]

Do an elimination diet. It's the only way to know your triggers for sure. These ones are pretty simple to follow (1, 2).

Monash University (IBS/FODMAPs central) has Android and iOS apps you could use to plan meals.

(Also, if your diagnosis was only established with your reporting of symptoms, you can ask to have tests to clarify whether it's IBS or celiac.)
posted by cotton dress sock at 10:39 PM on December 25, 2016 [2 favorites]

How's your B12 levels? If they are borderline (under 400) you may also have low stomach acid, which is often a result of either atrophic gastritis, which is an autoimmune thing, or H pylori. Sometimes it's from taking medication like proton pump inhibitors or metformin. Low iron absorption is another symptom as well as general inability to digest proteins. It's been linked with difficulty conceiving. There are a couple tests for it- endoscope or swallow a pill thing that measures your stomach acid production.
posted by fshgrl at 11:41 PM on December 25, 2016 [1 favorite]

Common migraine triggers include:

red wine - both from the red wine itself, and from the sulphites used as preservatives. You could try switching to a sulphite-free red wine, or to white wine.

sulphites used as preservatives in dried fruit, especially (but not limited to) dried apricots.

posted by Sockpuppets 'R' Us at 11:49 PM on December 25, 2016

How were you tested for celiac? The number of doctors I've known who had no idea how to diagnose it, and no understanding of its symptoms is part of the reason it often takes a good decade for diagnosis. There are dozens of symptoms, if not hundreds, in any array of combinations. You can get it any any time. You can also be completely asymptomatic. All that said, IBS-type symptoms plus severe anemia certainly ring a lot of alarm bells.

Were you simply given a blood test? Or were you given a biopsy? The blood tests seem to be extremely unreliable; neither test is any damned good if you're not eating gluten. If I were you, I'd start there and completely absolutely rule it out. I also wouldn't get any old doctor to diagnose me; I'd go to a specialized academic clinic. Off-hand, I know Columbia has a good one, but so do the University of Maryland, Chicago, and probably most major university-affiliated hospitals in big cities.

If in the end, you test negative, I'd get their advice on how to seek best practice treatment for your symptoms. If all of this is wrong, however, and you feel completely absolutely confident that you don't have celiac, I'd still ask a celiac center for a referral on how to proceed medically because chances are they'll have seen other people with your symptoms that didn't have celiac, and they may well be able to advise you best. The severe anemia you're describing isn't a do-it-yourself-diet situation; it calls for a specialist who can guide you. Be persistent. Get rid of doctors who don't analyze well or listen to you. It'll be worth it if you can kick, or at least control all the IBS stuff.
posted by Violet Blue at 11:50 PM on December 25, 2016 [1 favorite]

The blood tests seem to be extremely unreliable;

I don't know where you heard that but the blood tests are both sensitive and quite specific especially when run as a panel. The Mayo Clinic have a nice diagnostic flow chart you can look at too.
posted by fshgrl at 9:51 AM on December 26, 2016

even on oral iron supplements, I couldn't get my numbers up until I got IV infusions

How's your thyroid? If you have hypothyroidism, you may not produce enough stomach acid, which would explain why you have malabsorption issues. If you've had persistently low ferritin, there's some evidence that low ferritin levels impair thyroid function.
posted by blerghamot at 10:41 AM on December 26, 2016 [2 favorites]

I was diagnosed with IBS about eight years ago and personally, elimination diets (specifically gluten free and dairy free) were a waste of time and effort for me because I didn't have a true allergy. What really worked for me in terms of "bang for the buck" was $3 on a half gallon of organic milk and $20 on kefir grains, which will last for years. I cultured my own kefir as soon as I received the grains and was able to eat wheat and dairy within a week. After eight years of being on a strict GF/DF diet, I was shocked that the solution was so simple. I literally went from having to run to the bathroom after a teaspoon of cream in my coffee to drinking a whole milk latte with no problem whatsoever. In days. Yay probiotics!

I have nothing against elimination diets but I'd strongly suggest that, before you eliminate things from your diet, try what you can *add* to your diet to fix and maintain your gut. A lot of people go to refrigerated probiotics because they're afraid of butilism or something but they are so, so expensive and have less # of strains (10-ish?) compared to what you can culture yourself (30-ish). Also, there's lots of research right now that links the immune system to microbes in the gut, and some it shows that the gut microbe can change within days so it's important to continually feed your gut with good stuff like fiber-rich foods like vegetables, whole foods, and basically anything unprocessed. Sounds like you do that already, so it's not a huge change.

Some things I've read that have helped me:
The Good Gut
Some of My Best Friends Are Germs
NY Mag article by John Swansburt
Sonnenburg Lab

Edited to add in case it's not clear: IANAD. This was just my experience of adding fermented foods to my diet, where I went from having terrible gastrointestinal distress on a daily basis to absolutely no problems with food whatsoever. My experience isn't yours, though - proceed with caution, see your doctor if you need to.
posted by onecircleaday at 4:49 PM on December 26, 2016 [8 favorites]

Just wanted to clarify, in case of misunderstanding, that elimination diets for IBS are intended to be taken on for short periods, and have the purpose of identifying the specific foods that trigger symptoms. If you don't have symptoms with a specific food, there isn't a reason to cut it out.

Would do medical tests before doing an elimination diet, though. Might skew things otherwise.
posted by cotton dress sock at 10:54 PM on December 26, 2016 [1 favorite]

Response by poster: Thank you all for these awesome suggestions! I decided to avoid Whole30 for psychological reasons and just try to avoid sugar and eat more vegetables during the month of January and see how it goes. So far (1.5 days in...), so good!

Happy New Year!
posted by bananacabana at 11:23 AM on January 2, 2017

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