Actually keeping a journal, as Gabes suggested, can be very helpful, because often it's things that are so well-established in our routine that we don't even think of them as a potential risk, that turn out to be the last piece of the puzzle. I had the same problem as you. I kept a journal of everything I ate and drank, plus symptoms, bowel movements, how I felt, medications, supplements, etc. for 3 and a half years. I kept my journal on a spreadsheet on a computer. But until I cut gluten out of my diet, I seemed to react to anything and everything, at random. And like you, I was a big fan of jalapeños and other chilis, and I thought that food wasn't interesting unless it was "hot".BearcatRx wrote:When the symptoms overpower the medication and I experience loose stool (not necessarily full on D), I try to go back over my food consumption over the last 24-48 hours to try to determine anything that may be the cause. Thusfar I have not been able to pinpoint anything in particular. At least, none of the common allergens seem to be the culprit. I've been able to consume dairy, gluten and even hot wings with no problems.
The problem is that anti-gliadin antibodies have a half-life of 120 days. By contrast, the half-life of antibodies to most other food sensitivities are approximately 6 days, more or less. That means that the decay rate of gluten antibodies is so slow that they tend to dominate the attention of the immune system (because they are "always" there).
A few months after I eliminated gluten from my diet, I was able to detect reactions to other foods, by studying my journal. But as long as gluten had remained in my diet, the journal seemed useless. Not everyone is affected this way. Some of us can see results of a GF diet within a matter of days. But for many of us, it takes months after we change our diet, before we can detect any significant improvement, because our immune system is almost entirely focused on gluten until after we have avoided it for a while.
And certain foods (corn, in my case, and casein) took roughly 3 days to cause me to react. We each have our own individual reaction pattern, and times tend to vary from the times that others take to react. After you have avoided gluten long enough to be able to sort of reset your immune system, you will see that a typical gluten reaction usually begins around 5 or 6 hours after ingestion, though some of us react in as few as 3 hours, and others may take 12. Those who react in only 10 or 15 minutes are experiencing an IgE reaction, due to a classic wheat allergy. Those reactions are triggered as soon as the food contacts the mucosal tissue in the mouth.
The reactions that occur in the gut are mostly IgA-based reactions (that result in the production of T cells), thus the reason for the longer time for development of symptoms after ingestion of food. It is possible to have IgE-based reactions in the intestines however, and this results in mast cell reactions (the release of histamine, cytokines, etc.). These mast cell reactions can cause symptoms similar to the IgA reactions. The difference is that they can often be stopped/prevented by the use of type 1 antihistamines. IgA-based reactions cannot be controlled by antihistamines.
I too was always looking for "the culprit". But that approach is doomed to failure, because the problem is typically caused by culprits (not 1 culprit). I would avoid one food, and when that didn't make a difference, I would add it back into my diet and exclude another. I managed to waste a year and a half experimenting with that approach before it dawned on me why it couldn't work — we have to eliminate all of our inflammatory foods at the same time, in order to achieve remission. Because obviously as long as a single inflammatory food remains in our diet, the inflammation will continue to be generated, and MC symptoms will continue. After I did that (reduced my diet down to a few simple, basic foods that I was sure I could tolerate), within 2 weeks I was in remission (but of course this was only possible because after I initially cut gluten out of my diet, I never reintroduced it — I continued to totally avoid it. The point is, if we fail to avoid even a single food that is a significant source of inflammation for us, then remission will remain elusive.
And that's why treating this disease is an individual effort. We have to work out our own custom diet that is safe for us. Neither our GI specialist nor a nutritionist or dietitian can tell us exactly what our safe diet will be — we have to determine that ourselves. We can certainly follow clues, based on what has worked for others, but I doubt that any 2 of us follows exactly the same diet.
For example, many people choose chicken as a "safe" meat to use in an elimination diet. But experience shows that more than a few of us react to chicken. Many of us react to pork or beef. By contrast, virtually no one here reacts to turkey or lamb. So those are typically very safe choices. Most wild meats are also usually safe (except for bison, because virtually all bison alive today share DNA material with domestic cattle, due to both unintentional and intentional crossbreeding during the last century and a half). And certain fish commonly cause reactions (especially tuna and salmon). Examples of vegetables that are usually safe include carrots, squash, green beans, broccoli, cauliflower, and sweet potatoes. Peeled, to minimize fiber, and overcooked, to make them easier to digest. But as Gabes pointed out, portions of vegetables should be relatively small, in order to minimize total fiber intake (fiber is very abrasive to an already hyper-inflamed gut, and too much fiber can delay or even prevent remission). A good elimination diet will allow your intestines to heal, and then you can experiment with adding foods back into your diet.
It's not easy, but it works, and it allows us to get our life back (usually, without any need for any meds).
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