Ding dong

Up from the computer chair to let in the nutritionist recommended by a family friend, here for a house call. We shook hands at the door and then sat down on the living room couch. I grabbed paper and pen to take notes, new curriculum.

“So, I have a handful of patients with bad stomachs, IBS, IBD, celiac, et cetera, so I understand what you’re dealing with. From what your father said, it sounds like your ulcerative colitis has been flaring pretty bad recently?”

“Yeah, I had to drop out of college, but now I’m back home with healthier habits and diet and I still can’t seem to get it under control.”

“Mhm, how many bowel movements per day?”

“Five or six, sometimes more.”

“Do you notice any food that coincides with more movements?”
“Haven’t been paying attention to that, but I have been trying to eat less late at night so that there isn’t so much in my system in the morning which is the worst time.”

Beware midnight munchies.

“Okay, that makes sense. Your father mentioned that your latest blood test showed hemoglobin in the anemic range…”  

“That’s right.”

“Do you feel fatigued often?”

“Yes, sleeping like ten hours a night on average.”

“Have you tried iron supplements from the pharmacy?”

“Yeah, but they hurt my stomach.”

“I see, are they slow release?”

“Yeah, they’re a little better but they still feel like rocks going down.”

“Well, we can find ways to incorporate more iron into your diet,” She went into her bag and pulled out a red folder which she put on the coffee table, “I printed out some of the material that we’re going to go over so you don’t have to take too many notes. There’s a sheet with iron-rich foods that are low fiber, so they should be easy to digest: oatmeal, tofu, red meat, especially if it’s prepared in a cast-iron pan. Also having vitamin C with iron-rich foods helps your body absorb the iron.”

Gotta be strong to fight them.

“So, like a glass of orange juice with oatmeal in the morning?”

“Exactly, or tomato and ketchup on your hamburger. Have there been any changes in your diet recently?”

“Yeah, I was eating at the dining hall food at college and then had chips and snacks in my room, didn’t have a kitchen, you know?”

“Yes, mass-produced cafeteria food is usually highly processed, now that you’re home, you can take more control. So, what have you been eating on a day-to-day basis? Starting with breakfast.” She took out a pad and paper to note my responses.

“The first thing I eat is always really bland, like toast, oatmeal, or cereal.”

“If oatmeal goes down okay, it’s a great source of fiber and iron, and is much better than one of the sweet breakfast cereals. Do you have milk?”

“Yeah, with cereal, or sometimes in tea.”

“Does it bother you? Lactose causes digestive problems for lots of people.”

“It seems to be okay, maybe gurgles a bit going down.”

“How about yogurt?”

“Yeah, mom usually has yogurt in the fridge, so sometimes with granola.”

“Does the yogurt gurgle?”

“I don’t know, it seems to be okay.”

“That’s good, yogurt gets rid of lactose while fermenting, so it’s easier to digest and great for a lot of reasons, which we’ll come back to. How about coffee?”

“No, my doctor said the caffeine can stress my stomach, so I usually just have tea.”

“That’s good. How about for lunch?”

“For lunch I usually eat a bigger breakfast, pancakes, an omelet, eggs and toast…”

“Mhm, those all sound good. Any fruits and vegetables?”

“Sometimes blueberries with granola, usually some veggies with dinner.”

“What’s dinner like?”

“Well, sometimes I skip dinner if my stomach’s bad, but if I’m hungry I’ll have some of whatever’s left in the fridge, or whatever mom makes, she’s been trying to keep things pretty soft for me. Cooked veggies like carrots or broccoli, a starch like pasta or potatoes, and then usually some kind of meat, burgers, pork chops, meatloaf, or shepherd’s pie with sweet potato which I really like. Though my dad got me this book “Self Healing Colitis and Crohn’s,” which pretty much says that eating vegan will cure me.”

“Well that sounds a little too simple, I think there are factors beyond your diet, but we can focus on getting you the nutrients you need while minimizing the stress on your system. We can try cutting things out of your diet like meat, dairy and gluten, monitoring your symptoms, and then reincorporating them to see if they are causing problems. Does eating a lot of food all at once, like a big dinner, bother you?”

“Yeah, everything bothers me on the way out.”

“I see. Have you tried doing smaller intermittent meals, like six times a day, or snacking?”

“Yeah, that helps, less going through all at once.”

“What kind of snacks do you have?”
“Bananas, creamy peanut butter, cheese and crackers, potato chips… some other stuff. If  I didn’t eat enough during the day, then sometimes I snack before I go to bed, but that always makes it hard to sleep.”

“Yeah, limiting yourself before bedtime is good practice. Your stomach does not digest well when you’re horizontal and sleeping. What about sugar?”

“Yeah in juice and stuff. I try to avoid candy. Sometimes there are treats around the house after holidays.” Bought a Reese’s at the deli yesterday.

“Well it sounds like you keep a pretty good diet for what you’re dealing with. How about liquids?”

“Pot of tea in the morning, and then mostly water throughout the day, but sometimes I have juice or soda.”

“Okay, you should be drinking a lot of water to keep yourself hydrated if you’re having diarrhea, two liters a day minimum, tea counts.”

I nodded and scribbled down: 2 l/d liquid

“So what I would like you to start doing if you can, is to keep a food journal,” homework assignment, “mark down everything that you eat and drink and how much on an Excel spreadsheet or word document with four columns: catalog of what you ate, time of day, the quantity, and any notes on how you felt in the next six to eight hours if there was anything unpleasant or irregular. So, at the end of the week, you can send me your journal, and then we can talk through what’s working and what isn’t. Sound good?”

 “Yeah, I think I can do that if I can estimate the amount.”

“Yeah, ‘one bowl of cereal’ instead of ‘30 grams of cereal’ is fine. It’ll be hard to remember to write everything down at first, but it should also help you become more aware of exactly what you’re putting through your digestive system, and then we can try to isolate certain problem foods.”

“Okay, yeah. That sounds like a good strategy.”

“The other thing that I want you to try is building up healthy bacteria in your gut.”

“How do I do that?”

“Mostly by consuming fruits, vegetables, and fermented foods like yogurt. You can also pick up probiotic supplements at the health food store, which mix nicely into yogurt. You can start by trying Primadophilus Optima, and you’ll want to get one within the range of 35 Billion CFU, which stands for Colony Forming Unit, which is basically a count of the active microorganisms in each serving.”

Jot: 35 bil CFU.

“Also eating organic foods helps, though I know that can get expensive,” can’t forage in the city, “do you have a juicer?”

“Yeah, we have an old one, but it takes a lot of fruit and veggies to yield anything.”

“That’s true, but it gets rid of the fiber and lets you get most of the nutrients and bacteria, so it would be useful even if you only make half a cup. Think of it as your medicine.”

“Okay, we can do that.”

 “If you’re feeling ambitious, another thing you could do is try to make your own yogurt.”

“That sounds difficult.”

“It is the first time, but then you get the hang of it and it’s easy. You have to buy a starter culture, and milk, and basically you just warm up the milk to 180 degrees Fahrenheit to kill the bad bacteria and then bring it back down to 120, add the good bacteria, keep it warm for a few hours, and then refrigerate.”

“Okay, cool, I could try that. The homemade yogurt is different from store-bought?”

“Yep, there are more live probiotic cultures in the ones you make at home, because they don’t need any preservatives to survive packaging and shipping and all that.”

“And the probiotics in the yogurt are supposed to help with the inflammation?”

“Yes, they help balance the bacterial community in your stomach. One of the developing hypotheses about autoimmune diseases is that us humans have changed our bacterial profiles dramatically from our ancestors,” moldy bread serendipity, “and now our immune systems are overactive because they’re not used to navigating this new bacterial landscape. For example, almost everyone has been prescribed antibiotics at some point, which is essentially like a nuclear bomb for the bacteria in your stomach, killing bad and good bacteria. Some people have even started trying ‘human probiotic infusions,’ also known as fecal transplants, have you heard of those?”

“Yeah, I read about that online, poop in a turkey baster.”

“Haha, that’s right, I’m sure in the future they will seem very crude, but they’re basically a probiotic injection, and since they haven’t figured out how to isolate the good from bad bacteria yet, they just use the whole thing. There are even some studies being done about the autoimmune benefits of being infected with certain parasites, like hookworm, which may actually have evolved symbiotically with humans. Our understanding of the bacterial world is just beginning in many ways, and we are just starting to realize that we’re composites of many other living things, which essentially makes us superorganisms.” A part.

“And how about your psychological health? Do you feel okay?”

“Yeah, I’m usually tired, and sad that I’m not at college, but I’ve been getting along okay.”

“That’s good. You know about the gut-brain axis? Your stomach and brain are connected by your vagus nerve as well as your immune system, so just remember that if you ever feel anxious or depressed, the root of the problem could very well be your stomach. For example, you’re feeling tired and that will go away when your stomach absorbs more iron.”

“I’ll keep that in mind.”

“Okay, so, at the end of the week, I want you to send me that food journal, and then we can figure out our next steps, okay?”

“Sounds good.”
She gathered her stuff, and I walked her to the door.

“It was very nice to meet you.”

“You too, thanks a lot for stopping by, I really appreciate it.”

“It was easy for me to get here, so I can come again, we’ll talk soon.”

“Great.”

Smile and a wave, done interacting today.

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