Making sense of a food diary

[Rebecca85]

Since coming out of hospital a month ago I have been keeping a food diary to see if any foods in particular give me symptoms. But I can't make head nor tail of it! Today I bloated right up and got bad pains after eating grilled chicken and salad. Yet I have eaten chicken before with no problems, and I have had salad before with no problems! Has anyone else found what they can/can't eat changes, or does anyone have any advice at all for me???

I guess the only way to find out for sure which foods are going to cause problems is to do a proper exclusion diet, but I don't want to do this until I get an official diagnosis and speak to a doctor or dietician.

At the moment I just feel like I'm in limbo and I thought a food diary was something positive I could do while I wait for test results and for someone to tell me what is going on! But instead it's confusing the hell out of me!

Rebecca.

 

[dreamintwilight]

I understand your confusion. I still feel somewhat the same way. I keep a food diary and I try to be as specific as possible. I am in the middle of reading "The new Eating Right for a Bad Gut" by James Scala and it talks about how to keep a food diary. Perhaps you could check it out and see if you could improve on your diary to make it more specific.

I was also keeping a food diary right before I ended up in the hospital after my official diagnosis. I thought I had been pretty careful on what I was eating and I still ended up getting an obstruction.

I think it could also have to do with what, if any, medications you are on. For me, I was on Humira, but it wasn't a strong enough dose and now I'm on Imuran as well. I think my body was just extremely sensitive to any types of foods because my body was still out of whack and I have strictures. So, any little amount of inflammation was going to make my condition worse.

I have come across recently a link between charcoal-grilled food items and flares for me. I know some people are really sensitive to certain spices too. I read about one person on the forum here saying it took them forever to figure out they couldn't tolerate mustard or onion powder and sometimes you don't always know if those things arein your food when you go out to dinner.

It's a frustrating process for sure, but I think the medications your doc prescribes you will help make the process easier. For now, I'm sticking to a low residue/low fiber diet with not many spices. I'll try adding different foods back in once my current meds have had a chance to control my inflammation.

 

[Everlong]

I find it very tough also to pinpoint certain foods. I wouldn't attribute the bloating and pains to the chicken and salad, especially since it sounds like might only be the first time.

I have found other things become a factor when reacting to something. Just a few months ago I introduced almonds into my diet and had a negative reaction. It really surprised me. I decided it would be a good idea to just avoid them for a week or two, let myself get back on track, and then give it another try and see if I react again. I tried them again a few weeks later, ate about half the serving size as before, and I had no problems. I haven't had any issues with them since. The two things I think that may have set me off was that I was introducing a new food into my diet, and I ate a large serving. I probably should have eased the new food in more gradually.

Exclusion diets are a pain in the ass, but without consistency you won't be able to tell what is the cause and what is the effect. Its just like any kind of experiment, there must be constants. What I've done in the past is set up a meal plan that is consistent from day to day, but provides a fair amount of variety throughout the day so you don't get quite as bored. Make sure you eat at similar times from day to day (I've set up multiple alarms on my iPod throughout the day to tell me when its time to eat). If you notice a pattern developing where you keep getting sick at a certain time each day, you can be pretty sure that it is something you're eating and not that your body is just feeling a bit cranky. Try to figure out what is causing it and replace it with something else that you know is safe. When you're feeling better, try introducing it back into your diet and see if you start reacting to it again.

 

[Cat-a-Tonic]

Rebecca, when you say you're keeping a food diary, how specific are you being? For example, would you just write "salad" or would you write "iceberg lettuce, cherry tomatoes, cheddar cheese" etc? Do you include the amounts of each ingredient, like 4 oz lettuce or 5 cherry tomatoes? I haven't done a food diary yet but I think I'd like to start, and I'm not sure how much data to write down or how specific to be.

Although I haven't kept a food diary, I've definitely been paying attention to what foods seem to affect me. With regards to salad, I noticed that I can eat a small basic salad just fine - but one day when I added some garlic croutons to my salad, I felt horrible. So awhile later, I was making home-made spaghetti sauce, and I decided to add some garlic to the sauce. Again, felt horrible. So I was able to draw a conclusion that garlic is not my friend, since I can eat regular salad and I can eat spaghetti sauce without garlic. So it might just be, like Marisa said, that there's one little ingredient that you wouldn't even normally notice that's causing you problems. Try finding something "safe" that you can eat repeatedly, then add an ingredient each time and see how it affects you.

 

[Rebecca85]

At the moment I am trying to cook main meals from scratch so I know what goes into my food, and am writing down each individual ingredient or if I used a recipe I will just write down the recipe name. I don't write down serving sizes, but I do have a kind of 'standard' size in my head and will write if it's different e.g. 'chicken' means 1 medium chicken breast.

For work and out and about I have a selection of prepackaged snacks that I am pretty sure are safe since I have them every day, so the chicken salad is the only thing that was different today to yesterday.

The only thing I can think of that might be the problem is the quantity- before I had the salad as a side dish whereas this time as it was the meal I had double the amount. So maybe it was just too much 'difficult' food in one go.

Also I seem to have a cumulative effect throughout the day- it is very rare for breakfast or elevenses to have a bad reaction, in fact I have only been poorly in the am once and that was the day I went to hospital for the second time.

I think I will have to have a good look at my diary, start by eating the same as I did on my best days and go from there adding one thing at a time. And start with small amounts.

 

[dreamintwilight]

Yeah, definitely smaller meals are better. You will find a lot of literature and doctors recommending this. I tend to stick to 1 cup of pasta or rice in a serving. A half cup of veggies or fruit in one meal. Even things like skin on chicken make a difference for some people.

I agree with the cumulative thing as well. I am fine with spinach, but one time I made spinach lasagna and I ate a piece 3 days in a row for lunch and ended up in a huge flare.

That book I recommended says to pay particular attention to serving size, at least at first. Then you get used to what 3/4 cup of milk in cereal looks like and stuff. So, if it increases a bit you can pinpoint which thing was different.

I also write down the exact time I eat and take medications as well as when symptoms seem to occur. I read in that book that it takes about 4 hours for food to get to the ileum, so you can kind of estimate based on your symptoms what foods might be effecting you and where they might be in your digestive tract.

 

[Cat-a-Tonic]

I have a hard time telling where in my digestive tract I'm affected - I seem not to be bothered by what I eat until the next day. I recently tried to eat a turkey burger, but it was greasy and gross and I knew I'd end up paying for it. I had it at lunch, but didn't get ill from it until the next morning. Same thing with the croutons I mentioned earlier (although I didn't know I'd end up sick from those, but I did have the salad w/ croutons at lunch and didn't get sick until the following morning). I guess that's one of my quirks. So if I ever really feel like eating comfort food that I know I'll pay for later, I just have to make sure that I don't have anything going on the next day.

 

[dreamintwilight]

Yeah...well CT scans and scopes will tell you for sure which areas your disease is located in. Mine is in my terminal ileum, so I know 4 hours after I eat something if it bothers me or not because I'll get pain in my lower right side.

 

[Cat-a-Tonic]

I get pain in the lower-right side too, but my colonoscopy came back normal (I even checked to make sure that they were able to get the scope into the terminal ileum, and they said yes they had, and that looked normal too). So after that I don't know what to think. I have to pay my insurance deductible for the scope, then figure out which test to have next - CT scan or pill cam. I'm wondering if I should just induce a huge flare (garlic, anyone? ) and then have a CT scan.

 

[dreamintwilight]

Some scans are more helpful than others. Like my scope didn't show how bad the narrowing in my ileum was. The doc couldn't get to the ileum, but he said they took pictures of it and were able to see it. A couple weeks later I ended up in ER with bowel obstruction. Got a barium follow-through and they saw the narrowing a lot better. Surgeon and GI couldn't agree whether they saw fistulas or not. The barium enema I had the first time I went into the hospital when they were trying to diagnose me also picked up the fistulas and narrowing that the regular CT scans (with contrast and IV contrast) couldn't pick up very well. I guess barium is pretty effective in showing the tiny stuff often missed by scopes and regular scans.

 

[Rebecca85]

I found that before I was taking any medication symptoms would start 3 hours after eating. And the colonoscopy did find inflammation in the bit where the small intestine meets the large (is that the ileum?). So either I have a quick transit or the inflammation is also elsewhere in the small intestine. As I am eating smaller more frequent meals now, I have found it harder to pinpoint the exact time, but bloating can start within half an hour of eating and pains gradually develop from there. Luckily I don't have D as in "I have to
go now!" but do find that when I go it is a lot looser and if I eat something wrong it can be liquid the next day- but still with no urgency (which I put down to being very regular).

 

[dreamintwilight]

The ileum is the last part (terminal) of your small intestine. The ileocecal valve is the part that connects the small and the large intestines. My doc reached the valve, but couldn't get IN the ileum where the fistulas and strictures showed up on my scans. So, even though he said they took a picture I'm still not convinced they saw far enough into my ileum, which is why I ended up in the ER again for obstruction and got my medications increased.

Are you staying away from eating foods with skins and seeds? The skin on tomatoes, bell peppers, potatoes, apples, etc. are made up of insoluble fiber which is the stuff that doesn't digest well and irritates the gut. Just another idea if you haven't read/heard about that before.

 

[kenny]

I kind of gave up pinpointing foods for direct cause like that. Something I cant eat because I cramp up and well you all know how it goes.

But my surgeon told me that is a physiological issue with short bowel or with having to reacquaint my system with certain foods. Like when you change a dogs dinner it can give them runny poo too.

He told me Crohn's is a chronic condition and the real problem is damage from recurring long term inflammation. It is Eating Patterns and calorie count that I think the diaries can help with most.

I guess without having had surgery yet it is more frustrating. When I was in that spot I was on a strict liquid and soft food diet. It took me almost three months but I beat the flair without any steroids. However there was too much damage that had occurred over the past decade of two to avoid surgery.

 

[Rebecca85]

It took a while for the doctors to get through the valve and I had to move around to give them a hand. That was the worst part of the scope. They only went into the ileum enough to take a biopsy as they could see lots of inflammation and I think they mentioned ulcers. So I don't know how far up the inflammation goes.

I have been removing the skin on some veg like potatoes and carrots, but not on peppers or tomatoes. So I guess that could be part of the problem with the salad. I don't think it's the seeds because strawberry and kiwi are fine. Unless its a combination of skin and seeds. So many maybes and perhapses!

 

[dreamintwilight]

Yeah....there were too many maybes and perhapses for me, so I eliminated all seeds and skins no matter what, just for peace of mind We skin tomatoes when they're still hole, then cut them and scrape out seeds. You can roast bell peppers over an ope flame or in the oven with your broiler. It's super easy and fun and the skins come right off. Or you could always buy the jarred kind if you don't want to go through the hassle.