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Post by dryope on Feb 8, 2013 22:41:50 GMT -5
Hi Everyone -- Like a lot of folks who post here, I've been reading through a lot of posts here to try to figure out what is causing my problems. I wanted to thank everyone here for being so kind to talk about what you're going through so the rest of the world can be better informed about this condition. I'm going to the Mayo Clinic in late March for follow-ups for my newly diagnosed celiac disease. I was diagnosed at a US base in Japan, so they can't do much here and referred me over there. I only suspected celiac while I was doing an elimination diet for DFI. But now that I'm on a celiac diet, I find I still feel awful after eating. I eliminated all but foods on the DFI safe list, and I found I was reacting to even just 100 mg of fructose (a small glass of homemade lemonade with NOW dextrose). So that made me suspect HFI, although I know DFI is still possible. It goes without saying that this has all been a life-long problem. As a child, I ate almost exclusively rice and chicken and didn't touch fruit or vegetables. It was only as an adult that I got myself into this mess by trying to be healthy and a more adventurous eater. Here is the tricky part: I don't get severe GI symptoms. I get headaches, brain fog, and muscle tension after eating. Nausea comes and goes, but no history of vomiting. The only thing I get apart from that is bloating and hard stool. Again, the lack of more severe GI stuff made me think DFI might not be the cause. As a child, I got diarrhea on and off as well, but with the celiac I can't tell what caused it. Don't get me wrong -- I would love to have DFI instead of HFI (if I got to pick). I already have genetic hemochromatosis, so my liver is taking all it can. But here are my questions -- 1. Is there a way to get the Mayo Clinic to test for HFI? As a 35-year-old, I'm worried about convincing them to try it out. I'm leery of the breath test for DFI based on what I've read here, which is what, I suspect, they'll offer me. 2. Without dairy (cow/goat casein seems to make me dizzy for days and I'm still lactose-intolerant from the celiac, though that may go away), gluten, or fructose, I'm worried about nutrition. Do you all take a safe multivitamin or other supplements from reliable companies to keep yourselves from being deficient in nutrients? 3. I've always been underweight, and since starting the elimination diet for DFI 6 months ago, I lost even more weight. I need to gain 10 lbs to be healthy and the dietitians I've seen have been rubbish. I had thought I could eat a bunch of peanut butter to get it back, but that turned out to be a terrible idea. Does anyone have any advice for weight gain? I can only eat so much rice in a day, and meat is icky so I have a hard time forcing myself to eat more the the minimum I need for protein. Anyway, thanks very much and sorry to be so long-winded! I'm sure I'll sort more of this out with doctors, but it would be nice to get some thoughts from the real experts.
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Post by charlie on Feb 9, 2013 5:40:48 GMT -5
Hi. Welcome to the board, hopefully we can help to point you in the right direction. I will leave the testing info to the Americans on here as I don't know how the system works but I can maybe answer other questions. Which problem is it? Certainly your symptoms after eating suggest a metabolic problem where when the "toxin" is in the system it affects the pH balance of your blood causing headaches and nausea. My daughter gets this within half an hour of having sugars and I can see it coming on now by the colour change in her face. She then gets hypoglycemic as a follow on and then yo-yo's. but which metabolic problem is it. Have you been absolutely diagnosed celiac or its suspected. It may mean the problem is your absorption through the small intestines which is where alot of the sugar malabsorptions originate. If celiac is suspected but is negative to the absolute test then you may be looking at sucrase-isomaltase deficiency as the starch in wheat is the problem not the gluten and then sucrose is in so many foods that also contain fructose. Also for some the lactose is a problem so you have multiple sugar malabsorptions in one condition. The good news on this is that you can replace the missing enzymes to open up the diet. Usually you get bad diarrhea with this but not always and often depending on how much of the enzyme is missing. With DFI or fructose malabsorption then wheat again can be a problem due to the fructans it contains so you do have to eliminate it. But usually lactose is not a problem. Your safest route is to try to get the genetic HFI test done first as it is non-invasive but it doesn't necessarily pick up all the mutations so isn't absolutely negative. If you already have liver problems then that is your safest first step. If they insist on doing the breath test then try to get them to do bloods too as they may show more what is going on as the breath testing is rather random (in my opinion). Otherwise your best option is the elimination diet and take out absolutely everything with sucrose, fructose, wheat and dairy which I think you have done already then slowly add things back but only low fructose, sucrose first. If you go over to the malabsoption link in my signature it shows how to do this. Use things like the www.nutritiondata.com to check values. Until you have eliminated all toxins for a few months you will find your body over-reacts to foods and therefore weight gain is hard as your body will just be throwing stuff out. Peanut butter (contrary to popular opinion) has high fructose in it so thats no good. Your best base diet (unless it is starch related too so look up www.csidinfo.com for that incase) is white rice and plain meats or fish and eggs. Avoid potatoes for now as they do have low fructose but maybe add these in first. My daughter has safe sausage and bacon for breakfast every day and does really well all morning on that. As for vitamins, to avoid setting Bill off again there is a recent thread on peoples ideas on that subject if you click on new topics in the top bar it will come up as recently discussed and then you can make up your own mind. Colormist has posted about cron-o-meter which you may find helpful to use to help you decide. Any way, hopefully that has given you some ideas to consider. Good luck and please feel free to ask anything you want. Charlie
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Post by dryope on Feb 10, 2013 1:02:27 GMT -5
Thanks very much for the warm welcome. I've been confirmed celiac. And leaky gut and SIBO symptoms are definitely a possibility that I'm also investigating (the SIBO diets involve a ton of fructose, though). But it's just too strange that I only get this reaction when fructose is involved. Here's an example -- Last Friday I drank homemade lemonade with dextrose. The amount of fructose in the small dose of lemonade was 0.1 g according to the Finnish site. There were about 50 calories of dextrose in the same glass. (I drank it slowly over the course of an hour.) I began experiencing headache and losing focus pretty soon after starting to drink it, so I ate some (very washed) white rice with ghee and salt. And the headache went away and I felt better. Then I ate a full serving of almonds and had some potato chips and I crashed hard the rest of the day (I had run out of rice and was away from home). In practice, I get symptoms that put me out of commission after I eat every day, every meal, all my life. Unless it's just dextrose or plain white rice and meat or eggs. I plan my life around this, but it's been hard. It should have occurred to me that something was up when I realized I'm more alert around 6pm if I *do* have a glass of red wine on an empty stomach than if I don't! I only recently discovered that fructose may be connected. I had had no idea it was in non-sweet stuff to such a degree. I had just avoided fruit and sweet things and thought I should be fine. I think there's no way I could have the main form of HFI -- my symptoms just aren't severe enough. But perhaps one of the milder mutations. I'll get a 23andme test just in case, though. I also think I've gone in and out of ketosis as a result of all this throughout my life, hence the inability to gain weight. Thanks for the tips! I've used cron-o-meter in the past, and nutritiondata is basically my homepage. It's not possible to get what I need from my diet, so I guess I'll keep my current vitamin plan as is. I'm on the trolley with the plain diet. I asked the folks on the US fructose malabsorption boards what I should eat on a long flight for my medical visit (I live in Japan), and they told me to eat french fries and bananas. But I'm taking homemade beef jerky and rice cakes. Anyway, thanks very much again for your help.
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Post by ukbill on Feb 10, 2013 12:13:18 GMT -5
Welcome to the site Dryope, Hopeful we can help or at least off some assistance. You say "It goes without saying that this has all been a life-long problem. As a child, I ate almost exclusively rice and chicken and didn't touch fruit or vegetables. It was only as an adult that I got myself into this mess by trying to be healthy and a more adventurous eater. " Well that is as good an indication that HFI is possibly the root cause of you condition as anything else. Been as its been life long that usually rules out DFI, FM et all You sound to me to be classic HFI and the fructose contamination in the Dextrose has been doing you no favors at all! You are lucky not to have been taking Glucose all these years that has more Fructose in it than Dextrose (we think). I am not a medical professional so I do not know if the Celiac problem is related to your (probable) HFI or not. However when the liver is damaged or having a hard time of it, particularly after years of Fructose damage, it may well then have problems dealing with everyday difficult to digest things like Gluten.. so maybe a strict HFI Fructose free diet might solve all your problems (eventually your liver is likely to take months to years to recover fully). I have seen similar problems with friends who became alcoholic, as their livers get more damaged, they can not eat many of the things they used to be able to eat. Unfortunately the sort of damage Alcoholism cause's to a liver is not repairable often. IF I can be of any help with a healthy HFI diet please let me know .. Colormist and Sheree have HFI food blogs also. You can find them from links on the site and from the Facebook page Sheree runs. Take care.
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Post by ukbill on Feb 10, 2013 15:58:41 GMT -5
Regarding weight loss I suggest eating loads more meat ,rice and eggs! Cheese omelets are good for loading the calories on! Also eat some Liver pate if not Liver itself because that contains nearly all the minerals and vitamins (except for vitamin C) you really need, and its far healthier than chemical vitamins. A none digestible fiber will sort your stool problem out. Only start taking it in very small amounts and build up to the full 2 x teaspoons a day in plenty of fluid. Can you please post the link to the Finnish site? I have suspected Dextrose will contain Fructose as well as Glucose but not been able to prove it until now thanks for that! Keep smiling
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Post by dryope on Feb 10, 2013 16:35:25 GMT -5
Thanks, UKBill!
The celiac is totally separate. It also means dairy is out for the next two years or until my insides heal from the celiac damage. So sad -- everything is bearable with cheese. Liver is delicious but out from my hemochromatosis. I successfully ate a Hebrew National hot dog with fried rice and some light spices and caraway seeds, though! So I'm trying to get creative. Reading up on what is safe for people on this board has been a godsend.
The weird thing is that eggs seem on the fence -- sometimes they affect me and sometimes not. I know the yolks have fructose in them, and when I cook them it's usually OK but raw in homemade mayo they put me right out. So I'm a little suspicious of them, even when cooked.
Anyway, what gives me pause is my liver panels have always been just fine. But then I know my celiac was protecting me from my hemochromatosis and vice versa, so it's possible that there is more going on here than I realize. Since going gluten-free my iron has shot up (celiac causes anemia). Anyway, I may just have one of those 30% mutations or something if HFI is even a possibility.
Anyway, thanks again!
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Post by serene on Feb 12, 2013 17:07:28 GMT -5
Hi and welcome,
Did they do the blood test for celiac which is what was positive? I am assuming you are going to Mayo to get the endoscopy done to confirm then? That is the definitive diagnosis for celiac.
It can be very hard to figure out exactly what is going on. I relate to what you are writing. For years I thought that I had multiple food problems, and in the end it turns out that it is only Fructose that is causing the problem.
My gut has started to heal after a short time on the HFI diet and I am now able to tolerate wheat, corn and dairy, all of which I had not been able to tolerate before.
Certainly, follow the celiac diet until you get the confirmation from the test. Are you able to have dairy if you use a dairy enzyme, or is it totally out? Are you able to tolerate any other meats aside from the hot dog? I agree with Bill that protein is your mainstay. Also, check out gluten free grains as a way to add weight back on.
Best, Serene
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Post by dryope on Feb 12, 2013 17:26:47 GMT -5
Thanks, Serene. Yes, celiac confirmed by blood test and I had a biopsy already, but going to Mayo for some follow-up. A few recovering celiacs have severe reactions to fructose several months after going gluten-free, but they have much worse damage than I do and different reactions. I just bought a blood sugar monitor, so I'll start testing my patterns to see if it's HFI or a really severe DFI. And I sent away for 23andme.
Glad to hear you healed up after some time without fructose! I hear it takes a while to clear your system. I wonder if there is intestinal damage along with HFI? If so, there should be some blood markers like tTg or something, I imagine. Did you fail the celiac panel altogether then? I only had the tTg positive and failed all others and the biopsy. TTg shows damage and is 90% specific for celiac, but could also indicate other intestinal damage, such as from autoimmune liver disease. But my liver panels have always been just fine (though I am slightly yellow and always have been). HFI has so little research, I wonder if it could also cause this blood work. The biopsy showed no damage. Then again, it often misses it.
I react to cow and goat casein, so no dairy for me. Any lean meats are fine. I just don't like meat. Sigh.
Anyway, having second thoughts about aggressive diagnosis after reading colormist's blog post about insurance. Yikes!
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Post by serene on Feb 12, 2013 18:22:58 GMT -5
Interesting, so the blood test was positive for celiac but the biopsy was inconclusive? Did I get that right? So, it sounds like you are a carrier for celiac, but may not be manifesting symptoms at this time. Of course, given that you could become symptomatic with intestinal damage in the future, it is best to follow doctor's recommendations to stay on gluten free diet.
I had already been gluten free for about 4 years before I did a workup for celiac unfortunately. I had a doctor that did an allergy test that was positive for wheat, so I experimented with removing it at the time. However, years later I wondered if I may have celiac. At that point, it wasn't possible to do a blood test for it because there was no wheat in my system so it wouldn't be accurate. They did a genetic test and I am a carrier for it. So, they put me on a gluten challenge for a few months. They did the biopsy. Like yours, mine was negative, but it did show some irritation. In hindsight, my system may have been aggravated more from fructose.
My symptoms to fructose are very similar to yours. I also have an instant headache with throbbing eye pain when I have too much fructose. I also have the feelings of nausea that come and go as well as the constipation, ugh.
I should clarify that I had thought that I was having a problem with wheat and dairy, but now I realize I probably never did. I think that it was fructose all along. I just had never suspected fructose as a problem, as no one had ever said anything about it to me. Now that the fructose is out of my system, I am eating these other foods without a problem.
I hope that you are able to get some answers soon! I found that the doctor's office I am working with is not able to send the blood work out to an outside lab so I am pursuing the genetic testing on my own with 23and me. It sounds like you are also considering this.
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Post by dryope on Feb 12, 2013 23:40:31 GMT -5
Thanks--please update on the forum with your genetic test. I do wonder about the lesser mutations, though, which 23andme doesn't check for and I hear Dr Tolan does. Btw, tTg is a marker of intestinal damage from an autoimmune disease, almost always from celiac. I haven't had the genetic test yet. 30% of the population is a carrier, but only 1% develop the autoimmune condition (or so they say). It's almost certain I have celiac. But since HFI is so unresearched, I suppose intestinal damage from that could maybe also cause it. I confess my scientific abilities are mostly aspirational. HFI isn't autoimmune, so maybe that can't be. I'm glad to hear you don't have gluten issues, though! But HFI or severe DFI is worse. It sure sucks to read Living Without or any of the other celiac magazines . They want me to eat what?! The DFI forums are equally ridiculous with their half a banana a day and salads at every meal and whatnot.
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Post by charlie on Feb 13, 2013 4:41:52 GMT -5
Hi Dryope,
sounds like you have been getting well checked out which is great and also knowledgeable on the subject.
One thing though, by all means get a blood sugar monitor and test your glucose levels but don't use it as a definitive. It may explain symptoms if it shows low blood sugar as in hypoglycemia and teach you why you are feeling how you are feeling but it isn't a good indicator of HFI. The problem with alot of these sugar malabsorptions which is still what you may have is that they vary considerably from person to person and can cover several types of disaccharide (sucrose, fructose and lactose and possibly maltose) therefore if the small intestines cannot break these down for whatever reason then the glucose released will be considerably diminished and therefore hypoglycemia builds up. Also alot of people find with fructose malabsorption (FM) that they can use spare glucose in the system to pull the fructose through the intestines therefore again all glucose gets blocked.
Yes, one of the symptoms of HFI can be hypoglycemia after ingestion but it is NOT the only reason. Just don't want you getting confused.
It may well be that at the end of the day you have a problem with disaccharide absorption and this is why you have to eliminate so much. It makes for a hellishly organised diet for a while to clear the system and you are looking at several months to do it then carefully add a few things in but not bananas, I left the DFI forums and started my own as I got very worried about the obsessive advise on them. Many FM sufferer can tolerate more levels of fructose, others can't (especially if it started in childhood) and I do believe there is a middle ground fructose absorption problem that is hereditary but hasn't been identified yet and needs the HFI diet but also limited wheat too and possibly dairy.
But follow the track of HFI for now as you have clearly identified (both of you) that fructose is a serious issue and the safest first step is the gene test as you never know, you may have a common mutation and being in America where it seems to be better detected then it may well be one.
But for now, keep fructose free and experiment with new meals, there are lots posted on here and on the FM board to try. Just off to post another one that is really easy............
Charlie
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Post by dryope on Feb 13, 2013 6:13:26 GMT -5
Thanks, Charlie! That's excellent advice. I'm doing great with the rice and meat/fish/egg diet, and I sort of don't care why, as long as there's no liver damage.
Thanks again, everyone. I didn't want to say it, but this forum is MUCH more informed and helpful than the DFI one I was on. I've spent hours reading through the posts here and there's so much knowledge and experience here.
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