Getting (A Little Too) Intimate with Doctors

I realise I've not posted on my encounters with the medical profession during my pre-glutenfree days.

Let me say right off the bat I have tremendous respect for doctors. I know how difficult the course is, how long it is, and how demanding the job is after you graduate. And yet, I do wish the doctors I'd consulted about my digestive problems (prior to discovering that it was gluten to blame) had been a bit more curious about my symptoms (that might have led to further investigation and a diagnosis) and a bit more understanding too.

I've been for a total of 3 colonoscopies, each after having consulted a doctor with a description of my symptoms. Each procedure was uncomfortable, embarrassing and left me none the wiser about what was assailing my digestive tract (other than the doctor and his prodding colonoscope from Hell).

At the end of each, the doc would look resignedly at me and declare that since there was not visible damage, he would make the call for Irritable Bowel Syndrome, and for some reason I would feel guilty that it was not some other momentous discovery or announcement.

The first doctor was actually kind enough to tell me that IBS really is just a convenient catch-all for when they haven't discovered the root cause of all the symptoms -- a "Syndrome" is a collection of symptoms. And then he said to avoid things that might be causing irritation to the system, like chilli, tea, coffee, spices... Gluten was not on the list.

I suppose there isn't very much awareness in the medical fraternity about gluten intolerance in adults -- no one I consulted ever told me to check for it. And yet IBS is on the rise in Singapore -- won't somebody connect the dots please?

At best, you get uncaring uncomprehension from your medical professional. At worst, you can get dismissed for malingering or hypochondria (a nasty doctor in Toa Payoh did that to me once, belittling my suffering. Guess who's not getting any repeat custom, and who's getting instead recommendations not to visit his clinic...)

One doc even told me "Oh IBS patients really just need to get on with life and not think about it." He really seemed to suggest that it was all in my mind -- Doctor, the problem's at the other end; are you sure you passed medical school?

All of which troubles me more that just a wee bit. If the trained medical professionals don't seem to recognise gluten intolerance as a real problem, if they don't have it on their diagnostic radar, what hope is there for all the silent sufferers among us? Statistics in the U.S. show that about one person in 132 is afflicted with gluten intolerance. In Singapore that works out to a whopping 37,800 people! But how many do you know? Most of us just carry on suffering quietly, consulting unknowing doctors, and living painfully with the condition. But you don't have to! I feel like shouting from a rooftop whenever I hear someone complain of IBS -- "You ought to try giving up gluten!" It may not work for everyone, but boy did it work for me.

Lessons Learnt: of Gluten, Rice, Dairy, Chocolate and IBS...

Yes, I just popped in again. For most of the previous months it was much the same old, same old, and I didn't feel that much of it was worth posting in bits and bobs. But all the little discoveries I've made since my last post have been accumulating, and have been particularly enlightening to me. I think another post is now in order...

I'd gotten used to living life gluten-free, but I still got bothered every now and again but episodes in the toilet with symptoms consistent with being glutenized. The only problem was -- each time I had no idea what the offending item was that I had eaten and triggered the symptoms. All I knew was, it was most likely gluten lurking in some innocent-looking ingredient, but most times it was difficult to zero in exactly on what it was.

But after some investigation, I hit on something. One of these offending ingredients is... (insert drumroll/spooky music here)... unfortunately the humble rice noodle. I'm not going to carpet bomb and relegate all rice noodles to the "Cannot Eat" bin, but did you read Christopher Tan's recipe for chee cheong fun in the Sunday Times recently? One of his ingredients (small in quantity, but it struck fear in my heart nonetheless) was WHEAT STARCH. Not the most pleasant news to read on a lazy Sunday morning, but even though I sorta knew this kind of non-purist rice noodle creativity was going on in kitchens everywhere, it still wasn't nice to see it advocated in print. Incidentally, I also caught a repeat of Rick Stein's Far Eastern Odyssey, in which he profiled the traditional method of making rice noodles (wholly gluten-free) in Vietnam. It was a long and laborious process, which he explained was necessary to encourage the weak proteins in the gluten-free rice grain to bind together. It seems only logical for non GI cooks to want to add some gluten to their rice noodles, as it'll give them immediate stretch and elasticity. So gentle reader, proceed with caution when it comes to rice noodles outside your home (whose fabrication you did not supervise). If you're not hyper-sensitive to gluten, then perhaps this isn't such bad news, and you can down your chee cheong fun, koay teow, tanghoon and mifen AYOR. If you are, maybe you should stick to cooking your own, after checking the ingredients on the label religiously. I think I'm going to take the middle road. Once in a while I'll test a rice noodle dish at a new stall, and if I don't get a reaction, it should be OK to keep going back.

Now what I've learnt about dairy... As I explained to the first commenter on my first post, many of those stricken with advanced GI have their intestines in such a damaged state that they can no longer digest lactose efficiently, leading to many concomitant symptoms. But give the gut time to heal after going gluten-free, and you may find the lactose intolerance disappearing. It did for me! Hallelujah...:)

And now some bad news about dairy. A certain percentage of GI sufferers also develop a sensitivity to EGGS, and unfortunately I think I may be among them. I don't experience crashingly bad symptoms after having a dish with eggs in it, but it is enough to be a bit of a bother in the toilet. I first noticed reactions after eating some gluten-free cake, and thought there had been gluten contamination of the ingredients in the factory. And mysteriously, I seemed to have reactions a day or two after the weekend, even scrupulously gluten-free ones. And also after Nasi Padang dinners.

Turns out the eggs in the cake, the scrambled eggs I would frequently have on weekends, and the egg-dipped Nasi Padang bergedils were to blame. After avoiding eggs, I no longer have the frequent tummy grumblings. However, I will eat them on special occasions (the symptoms aren't as severe as those provoked by gluten anyhow, so I can tolerate an episode now and then).

And for this blog, I'm going to continue treating eggs as pretty much neutral, since I am blogging about going gluten (not egg) free.

One of the difficulties in pinpointing offending items is knowing when an offending item might have been ingested. To know that, you have to link time of output back to time of input, and who really knows for sure? Well, happily enough, I think I have an idea. For me, it takes about 36 hours from the time I eat something to the time it makes its graceful plopping exit. And how do I know this? Quite by chance, actually. Once, after having had a delicious squid ink paella at Don Quijote in Dempsey, I discovered that the body DOES NOT DIGEST SQUID INK. You pass out the black stuff as hitam as it went in, and for me this happened about 36 hours later. So if you ever want to know for yourself -- book yourself a sumptuous (and very black) Spanish dinner (I get no commission for this plug, by the way).

A bit about chocolate. It's gluten-free, so it shouldn't cause any problems for us GI sufferers. But back in the day, I noticed things would turn all Kafkaesque in the toilet after I'd eaten goodies like chocolate cake and brownies, much more so than usual. Today, I think this was because chocolate in larger quantities can cause constipation. Mixed in with my intolerance to eggs and milk (sometimes in the cake) at the time, plus the GI, and things could (and did) get like a battlezone in the loo. I believe chocolate worsens the symptoms of GI. But on its own, without gluten, it causes me no problems and I eat lots of it everyday, because it gives me Pleasure. I am an absolute chocolate fiend.

And finally -- all my posts aren't just for a bit of self-centred catharsis at the computer. I do hope my little discoveries help others out there who are still trying to find the answers to why their own digestive systems seem to have gone all Alexis Carrington on them. One of the secretaries where I work once told me she'd been "diagnosed" with Irritable Bowel Syndrome, or IBS (I use inverted commas for the word "diagnosed" because IBS is really just a label for a set of symptoms, not a specific disease with a known cure). I immediately told her that what worked for me after my IBS "diagnosis" was going gluten-free. She tried it -- and it worked for her magically too! That left me feeling positively energised, knowing that spreading the awareness of GI can make a tremendous difference to other sufferers. I hope you find your cure too.

Local Foods We CAN Eat (They Aren't That Many, sob, sigh!)

Finally back to blogging after a long long LONG break…

Truth is, sometimes living with gluten intolerance can get more than a little discouraging. The past few months I’ve been battling gluten episodes on and off, and it took me a while to figure out what was causing the problems.

I realise now that it must have been the creatine supplement I’ve been taking. Creatine on its own is gluten-free (usually creatine monohydrate) and I take it because it helps with my gym workouts (higher energy, more muscle pump, faster recovery are among its benefits). However, the latest one I’ve been taking, on the recommendation of my trainer, likely has some gluten in it (probably the ‘starch’ listed on the ingredients list). It’s annoying, but it took me quite a while to figure out it was this, because I’d tried an earlier batch (different flavour) and it didn’t seem to affect me. Maybe it’s the flavour formulation, or maybe they changed the ingredients slightly for this batch. Whatever it is, I’m going to have to dump the lot.

And that kind of underlines the problem with gluten intolerance… most times you get hit with an episode, you just don’t know where the gluten snuck in. And by the slow process of elimination, you finally get to identify which the offending item was.

Anyway, after my last post, I thought I’d move on from listing foods we can’t eat, to foods we can.

Easier said than done. It got a little depressing, when I started listing common dishes in Singapore and realised that there aren’t really all that many that you can safely eat without having that nagging feeling that you might have to pay for it the day after (or the day after that). Mostly it’s due to the presence of soy sauce, but there are other reasons too. Anyway, I’ve come to the sad realisation that the GI diner still needs to tread carefully around our famed hawker centres, and that even the so-called ‘safe’ foods are only so after you give special instructions to the hawker to omit certain items.

But anyway, here goes:
1. Number one on my list is chicken rice – this is safe if you take the white-cooked chicken (don't eat the skin -- sometimes rubbed with soy), and omit the dark soy dipping sauce. If you like the roasted version (actually it’s deep-fried), be aware the marinade has soy, so it should be avoided if you’re especially sensitive. I’m not, so I get the roasted breast all the time. And I find if you ladle soup over the rice, you don’t miss the dark soy as much, especially if the soup and the chilli sauce are good (they usually are). As it is, chicken rice is probably my staple go-to dish at hawker centres, as I don’t get any gluten reactions from it. And as far as cholesterol worries are concerned, my last two medical check-ups showed I had low cholesterol, so it doesn’t seem to be that much of a risk. It probably helps that I like my red wine, and also like chicken breast more than the other fattier parts. Oh but be aware that not all chicken that’s brown is the roasted variety. Some stalls do a soy-sauced chicken, which should be avoided for obvious reasons.
2. Char siew and shao rou rice – once again, the marinade probably has wheat in it (soy and other sauces), but it depends from stall to stall. Generally I find if you rinse off the char siew in the accompanying bowl of soup, it doesn’t affect me. However, avoid the thick brown gravy that they usually smother the meat and rice with. That will likely set you back.
3. Fried carrot cake – but only the white one. The dark one is of course loaded with soy. And be aware that if they fry other noodles on the same griddle, some stray strands may end up in your order rendering it contaminated with gluten.
4. Nasi padang – oh so delicious, but be careful what you choose. Many items are battered (especially the fried chicken) so avoid those. Not only will you be avoiding gluten, all that deep-fried splendour can’t be good for the heart anyway. The curries should be OK, as is also the potato patty bergedil, surprisingly. But proceed with caution, as some places may add flour to the potato mix (I think this is rare though). The veggies are usually OK.
5. I love Love LOVE thosai, especially with dhal curry and that divine green chilli-coconut chutney. I’m not a die-hard vegetarian by any means – must have meat most days to feel satisfied – but this is one vegetarian dish that completely bowls me over. Unfortunately, there is a cloud blocking my rainbow. I have had gluten reactions from thosai before, even though the traditional recipe is supposed to use only rice flour. I can only surmise it’s because the rice was milled in the same facility that mills wheat (and getting contaminated in the process), as it wouldn’t make sense for flour factories in India to specialise in just one or the other. Or maybe the cook just dipped his spatula into the wheat flour before the rice flour. So once again, proceed with caution.
6. Chinese economy rice – not my favourite (most times too oily for my taste) but as long as you avoid the battered items, and the darkly-sauced ones, most dishes should be OK.
7. Yong tow foo – this is up there on my list for the sheer dazzling choice of bright fresh veggies, but once again do be careful. Avoid the items stuffed with the fish paste (usually a mix of fish and flour – and it may be wheat flour) if you can. Actually, I just remove the stuffing at the table and don’t eat it. And watch where they cook the noodles – the rice noodles (koay teow or mifen) should be OK on their own, but if they’re cooked in the communal pot they cook the wheat noodles in, whoops, more contamination in the mix.
8. Chinese rojak – avoid the dough fritters please! Indian rojak – just about everything is battered and deep-fried, so generally to be avoided.
9. Fish soup – hawkers tend to cook these individually these days, and that’s perfect since the cooking medium should be free from contamination by wheat noodles. Just don’t ever order the mee sua – that’s wheat. Oh and I’ve asked about the fried fish – it’s not battered, even though it looks that way. So it should be safe to eat (and I do eat it, often, although the sliced plain fish is my favourite).
10. Porridge – generally OK. Avoid fish cake and fishballs if they serve it.  And of course never have it with the you tiao (wheat crullers) or soy sauce.
11. Beef and beef ball noodles. The Hainanese version has tons of soy in the soup and thick gravy, so it’s best avoided. The clear version (Hakka, I’m told) should be OK. The beef balls don’t contain flour traditionally and so should be gluten-free. Most stalls only serve mifen and koay teow so no worries from cross-contamination with other (wheat) noodles.
12. Zi char – fried rice is usually made without soy, so most versions should be OK. However, some places add fish cake or crab stick, which should be avoided as they do contain flour. Unfortunately, it’s difficult to tell if they add the offending items until after you get your order. Hor fun with sliced fish is usually OK, but the seafood hor fun and mui fun may have some soy in them.
Hmph. It often seems to me that the only 100% safe food in a hawker centre or food court would be white rice and a plate of fruit. That’s an exaggeration, but still it’s clear you can’t just go in and order something right off and expect it to be wholly gluten-free.

Foods to Avoid When You're Gluten Intolerant

Top of the list, of course: wheat, barley, oats and rye, and anything made from them.

The problem is these cereals can hide innocuously in other foods, and they're not always easy to spot. It's a fact of life for the gluten-intolerant: sooner or later (the sooner the better) we all turn into rampant ingredient label readers.

The list of forbidden foods with gluten includes:

• Bread and buns (thus ruling out sandwiches and burgers, unless you forgo the bread and buns)
• Cake
• Pancakes
• Biscuits
• Cookies
• Crackers
• Wafers
• Pizza
• Pasta
• Wheat noodles (mee, mee sua/mian xian, meen)
• Fish cake, fish balls, fish paste, crabstick (if made/mixed with wheat flour)
• Soy sauce (contains wheat)
• Dumplings (like char siew pao/cha shao bao, sui jiao, wantan – there’s wheat in the skin)
• Dim sum (usually encased in wheat skins, but ask – the soybean skin ones are generally OK unless they use wheat flour paste to seal)
• Wheat-based wraps (tortillas, popiah skin if made with wheat)
• Roti prata (roti canai to Malaysians)
• Chapati
• Most breakfast cereals
• Beer (it's made from barley)
• Boiled barley drinks
• Horlicks, Milo, Ovaltine (anything with malt)
• Teriyaki/barbecue sauce (if thickened with wheat or flavoured with malt – read the label)
• Batter-fried items (e.g., sweet and sour fish/chicken/meat, KFC chicken). Tempura items, if made to the traditional recipe, should be coated in a rice flour batter, not wheat flour. But it is always wise to check with the kitchen, since chefs like to get creative with recipes.
• Bread-crumbed items (e.g., chicken cutlets or fish cutlets, that are coated with breadcrumbs)
• Sauces and gravies thickened with wheat flour (especially if you see the word roux, but check with the chef even if you don’t see this)
• Sausages and ham (if wheat is used as a filler – it usually is)
• Western meatballs and burger patties (usually contain breadcrumbs).
  

Soy sauce is usually OK in small amounts for me – apparently the production process breaks down the amount of gluten. Obviously this will vary on the brand of soy sauce, so venture at your own risk.

Rice and rice noodles – like meehoon or mifen – are great, as are rice-only crackers and breakfast cereals.

Beware of pan-fried meats, even if not coated with batter or breadcrumbs. Sometimes these get dusted with flour before they go into the pan, to prevent sticking. A case in point: foie gras may sometimes be flour-dusted before cooking.

Thosai, or dosa, that delicious South Indian thin crêpe of slightly soured batter, is traditionally made with rice and lentil flour only. I love thosai. But as with all items made with a batter, proceed with caution. Most places are fine, but some kitchens may face gluten contamination as all places serving thosai also serve the more popular roti prata as well. All it would take is for the cook to stir the two different batters back and forth using the same spoon without washing in between, and the thosai would turn bad for us GI sufferers.

And do note that noodles in the food stalls tend to be cooked in the same pot of boiling water or stock. So even if you order rice noodles, they may be rendered unsafe if cooked in the same pot of water previously used to cook wheat noodles. Proceed with caution once more.

One more thing. Most chicken rice meals should be safe, especially if you avoid the dark soy sauce it comes with. But I just noticed my favourite stall also chops its lemon chicken on the same board as the regular chicken, and as lemon chicken is always bread-crumbed, there may be residual gluten on the board that gets transferred to your order. Generally, they scrape the board with the cleaver fairly clean between orders, so most times my chicken comes to me free of the offending crumbs. But if the preceding order is for that dastardly lemon bird, stray crumbs may escape the cleaver and adhere to yours, so it's good to be observant and ask that they wipe the board clean if the order before yours is for the crumbed version.

Paranoid? Maybe a little. But I'll take a little obsessive watchfulness over intestinal pain and suffering any day.

And It's Going to Take Some Time...

Back again from another work-related trip, also to Malaysia. It wasn't the easiest time for me. One reason I do hope awareness of gluten intolerance increases in this part of the world, is because people in Southeast Asia don't seem to take it seriously when you say you can't eat gluten.

This time, I thought I took the necessary precautions in order to ensure gluten-free meals the whole trip. But they weren't enough to overcome the sheer ignorance and apathy I had to face.

I remembered well enough to alert the trip planners ahead of time. My colleague in charge of the meals answered brightly "Sure thing! We'll make sure you won't be served wheat or barley!", as though anyone eats just wheat or barley like some kind of a dish on their own. When I pressed on and clarified that that included not just the usual suspects like bread and cake, but also things like soy sauce, beer, batter-fried or bread-crumbed foods, and even imitation crabstick, his reaction on the other end of the line seemed suspiciously like a stunned silence. Yes, young Paduwan, you have much to learn.

As does almost everybody else out there, or so it seems. My meals, as long as they were buffet-style, were OK, as I could just avoid the foods with gluten. Chinese meals, with several courses, were tolerable, as I could avoid the courses with wheat, barley or oats. But catered, fixed meals and communal dinners where I had no control over the menu were a positive nightmare. There was one meal where we were all supposed to cook our dinner ingredients in a Chinese steamboat, that fun communal stockpot in the centre of the table. It's great for social bonding. But it's only fun for me if there's no gluten in it. Going in to dinner, I took one look at the piles of raw wheat noodles laid out all around the steamboat and knew immediately I would have to back out, as any gluten-free ingredient cooked in that same swirling soup as the noodles would mean hours of cramping and pain a couple of days after, not forgetting the accompanying gory output.

With a pained smile, I apologised and excused myself. I went back up to my hotel room and ordered from the room service menu instead. And here's the thing: I shouldn't have had to apologise. I'd made my dietary needs clear only to have them ignored -- if anything they should have apologised to me. And yet just two days later, on a team-building trip outside, I got my pre-packaged meal and had to throw away the accompanying chicken because it was breaded. (No one accepted my offer to take it off my hands.) That kind of waste just makes me feel wretched. There are people starving in the world, and to dump food uneaten is beyond disrespectful.

What really sucks is that the trip organisers went out of their way to ensure the vegetarians in our group had meat-free options all the way, the Muslims had everything halal, and the Hindus had it all beef-free. But my meals were spent dodging dishes and wasting food. Were they ignorant? Or did they just not care?

I heard that one of the planners commented later -- referring to me -- that all Singaporeans are fussy eaters. How snide that sounded, as though they thought I was being pernickety just because I didn't like this or that, that it was just a taste thing, or that it was some kind of new-fangled diet. Listen up people: I don't choose to be fussy about food. I eat this way because to do otherwise would damage my body. Can you knuckleheads comprehend that? If an alcoholic refuses alcohol, or a diabetic sugar, are they just being fussy, or are they doing what they do so their bodies don't break down? It's the same thing for the gluten intolerant. Keep whacking the system with gluten and possible outcomes include severe malnutrition, osteoporosis, even cancer. So keep your comments to yourself and try some common sense please. A little respect for a person in need wouldn't hurt either.

All in all I think I managed to avoid most of the gluten on this trip. Some of the offending substance might have sneaked in during a multi-course Chinese dinner on the first night, but my enzyme pills weakened the impact a bit. They're not a cure, and your intestines still suffer damage, but the symptoms soften from killingly painful to just barely tolerable. So two days after (it seems like the symptoms take two days to reach their peak) I had the painful toilet runs again. But after that, things seemed to settle down a bit.

I missed being away from my regular foods. One food I have noticed that helps out a bit, surprisingly, is cheese. This isn't a cure either, but if you've been hit with only a tiny bit of gluten, I think the casein helps to hold things together somewhat as food passes through your digestive canal, so you have an easier time when the waste emerges. In plainer terms: your gloopy diarrhea turns more solid and easier to evacuate. So if you've had a tiny bit of gluten (say, in some soy), I find some cheese at night seems to help the next day. Do note that it doesn't help if you've had more than just a smidgen of gluten. And no I don't believe it offers any protection. But that there's another tip for coping with gluten in the world.

Oh to have had a slab of cheddar on this trip up north!

Back Again, with a Golden Tip

Yes, I know I've been highly remiss. A month without posting! How time does fly when you're not having fun.

You see, the past few weeks I've been recovering from being glutenized. Yes, it still does happen from time to time, and it seems like the past four weeks have been like a triple whammy of being hit unexpectedly with gluten from sides unseen.

About four weeks ago, I went out to dinner with some friends. As per the usual, I checked with the wait staff and the chef regarding wheat, barley, oats and rye in all that I ordered. All seemed safe, and I exited the restaurant feeling very happy.

Dinner was on a Saturday. Sunday brought with it some tummy rumblings, bloatedness and the beginnings of that grim, "plugged-up" feeling. And on Monday -- there they were again, the sticky, unmoving stools. And it lasted for a few days, before beginning to clear up by the weekend. I realise now that despite my best efforts, people in the dining scene, waiters especially, don't quite know what to look out for when you announce you have to eat wheat-free. I suspect it was not the dishes I ordered, but rather the amuse-bouche that arrived under the radar, as it was the only item whose wheat-free status I hadn't insisted the waiter check with the chef. As it was, when it arrived, and upon my asking, he answered hurriedly "Yes, it doesn't contain wheat... umm, except for this slice of accompanying toast..." It was a small cup of thick soup; I had thought it was thickened with a vegetable puree of sorts, but now...

And then on the following weekend, another dinner with friends. This time it was Chinese food, and I foolishly let a friend order. Among the dishes -- an ominous-looking beef stew, and prawns deep-fried in cereal. (If you don't already know, most western stews are thickened with wheat flour. Chinese ones are less likely to be so, but they do have generous lashings of soy sauce, which does contain gluten. And cereal prawns are usually crumb-coated with oats. Delicious, but deadly for the gluten intolerant.)

I should have known better, but I ate some of the beef, shaken dry of the sauce. And just one of the prawns, scraped as free of the oats they were coated in as much as I could. You see, not eating any of it at all would have been a tremendous loss of face to my friend who had ordered. My fault, for not being clearer about what was off limits for me.

I really should have known better. That dinner was also on a Saturday. Sunday and Monday were spent in bloated, cramping gassiness, stricken again with unmoving constipation.

Then on Tuesday, I had a normal bowel movement. I had a temporary sense of relief, thinking the worst was over, that I hadn't actually ingested that much gluten. How wrong I was!

I know now that it was just my body getting the normal stools, laid down before my gluten attack, out of the way before the main event. Before that Tuesday was over, I had run to the toilet five times, holding my cramping tummy, to sit on the bowl for hours in total. And washing and wiping, washing and wiping after each session, trying in vain to wipe away that which will not be fully wiped away. (Picture the inside of a pipe covered in a sticky sludge, and you'll get the idea why there was always some residue stubbornly overstaying its welcome.)

The next day I had to fly to Kuala Lumpur for business. And if waiters in Singapore are bad, those in KL really are much worse, insofar as understanding of dietary needs are concerned.

"I can't eat wheat."

"You can't eat meat?"

"No, wheat."

"Wit? What?"

"WHEAT. Gandum. Terigu. Mian fen. Gothumai. Atta. Does this contain wheat? Or flour?"

"Er, yes, this has potatoes/rice/liver/vanilla/[add any old gluten-free ingredient here]... so I think you can't eat this right?"

And so on.

So this past week, my diet has been a little erratic. You quiz the restaurant staff, you order food in the food courts and ask that they hold the soy, but really if it's all new terrain you just never know. I just got back to Singapore, and my symptoms over the past few days haven't been that bad, but things aren't really back to normal yet. It could be that an ingestion of gluten takes time to totally clear out from the body, and the length of time depends on the quantity ingested, or the severity of the reaction -- what I mean to say is, what I'm experiencing right now could also be the after effects of my two glutenized weekends previously. But while I really don't know if there was any accidental ingestion of gluten while I was in KL, my gut feeling, ha ha, is that yes there was.

One thing I have noticed -- and here's a tip worth its weight in gold -- the digestive enzyme pills I've been taking really do seem to help. I always have on me my trusty bottle of pills, after reading this tip in Dr. Shari Lieberman's Is Gluten Making Me Ill? You need to take a couple of these, in preparation for any meal that you suspect might sneak a little gluten into your system. Not so effective if taken after said meal, but still better than doing nothing at all.

I took the little green suckers (the brand I buy is "Enzyplex", available at all good pharmacies -- if you know of any other brands do let me know) before that first dinner about four weeks ago. Symptoms after were relatively mild. Relatively. No cramps, but my digestive system was far from normal.

The second weekend, I forgot the pills. And boy did I suffer, cramps and gas and diarrhea and constipation, et al.

This past week, been taking them off and on. And the symptoms are there but milder.

They're not a cure, and you still suffer if you're glutenized, but they do help. A million thanks to Dr. Lieberman. This is one tip I really do treasure.

More tips later...

What's Normal Feel Like to You?

Hi there. Googled this blog and actually found it last night! That means chances of other readers finding it are higher now. So I'm inspired to keep posting.

I've written at length about the sludge and the diarrhea, and the creepy floaties, and the wind and the rain and the sound and the fury, all assailing you as part of your GI experience...

But there's no amount of verbiage that can accurately capture the immense sense of relief you get when, after years of suffering toilet carnage, you actually have a normal bowel movement. It was like rediscovering a sweet memory of childhood (actually, for me who developed GI as an adult, a normal bowel movement during my GI years was but a sweet memory of childhood).

For the majority without GI, a visit to the toilet is supposed to be relief for the body. You're relieving your body of waste: you do feel a real physical relief. I thought I'd never feel that way again.

Then came Christmas about two odd years ago. December for me is usually a time of parties and feasting, both for Christmas and New Year's. I'm a bit of a gym nut, and am always fussing over my physique (or lack of it). So while I look forward to the company and food around the festive season (and people in Singapore love food), I dread the accompanying weight gain (especially the thickening at the waist, that seems to creep up on you so easily after 40). You're not talking loads of extra poundage, maybe just a pound or two, but it shows on your waist when you're lanky as I am.

Enter the brilliant idea: I decided to try going carb-free, in preparation for the calorie-laden end of year. (Except for the carbs in my veggies -- you mustn't cut them out totally, or the brain can't function at optimum. Thanks to Oprah for that tip!) No rice, but also no bread, pasta, pizza, cake, cookies, noodles... in short, I was going wheatless, in addition to other things.

After a week or two, I began noticing a HUGE difference in my life. No more cramps or bloating. No more diarrhea. No more straining for hours on the toilet bowl trying to move a load of gluey poo. I still remember exiting the toilet one day, with a broad smile on my face and this thought in my head: A NORMAL BOWEL MOVEMENT! Who'da thunk something as mundane as that could bring such joy?

Let's get a little bit into the details. A normal bowel movement for me is one with stools that aren't too hard, but aren't too soft either. And banish the thought of stickiness! The poo's gotta hold together, so that when you push it gently on its way, it slides along nicely keeping its shape. And upon exit, you get the nice C-shaped sausage (thanks Dr. Oz for that advice!).

You know, even if it comes out in solid blobs I'd be happy. The thing is, when it's hard or semi-hard, it doesn't just hold its shape, it holds in its smell too. The poop's pretty odourless, unlike the stinky soft and semi-soft stools.

And then when Christmas and the associated feasting came around, I had a bout of diarrhea. And after New Year's, I bought a loaf of my favourite chocolate chocolate chip bread to celebrate my full return to carbo-land. Yikes! The ensuing sludge was the stuff of nightmares.

So that's when I realised it was probably something in the carbs that was affecting my digestive system. It wasn't all carbs to blame, as I hadn't cut them out totally, but something in the bread, pasta, pizza, cake, cookies, noodles DING *lightbulb moment*....

And so that discovery marked the beginning of my gluten-free journey. I was so overcome with joy and relief, not just at the return to bowel movement normalcy, but also at finding out it was something external that was the cause of my travails, and not actually my own body breaking down. That had been a constant nagging fear -- what's wrong with my body? Why's it behaving like this? Turns out my body was fine; it was just reacting under attack like a normal body would, only this time the attacker was gluten.

Oops. I'd been thinking it was time I shifted away from postings on poo, but I guess it's not time yet. Maybe later.