The royal treatment

It's really important to celebrate. 

On Thursday night, Ross and I went to our favourite haunt to celebrate a busy but successful week of work - along with my rekindled relationship with garlic and onions.

Royal Thai is our favourite restaurant if we have something to celebrate. We often go there for anniversaries, work successes, birthdays - anything of significance. 

It's our favourite because it's sentimental to us - and delicious. The food is full of fresh, sensational flavours. Just the right amount of spice without being greasy or heavy. 

There's plenty of variety, too. We love the Pad Thai, Pad Phrik King, and Kaeng Mussaman Nau. But everything we have tried has been excellent. We usually have two dishes, a rice each, and share.

Chicken Pad Thai.

Pork Pad Phrik King.

Royal Thai isn't expensive; it's just special.

A meal will only set you back $20 a head, meaning you can splash out on a special bottle of BYO wine to match the occasion - we recommend a riesling or gewurztraminer to complement the vibrant Thai flavours. 

Plus the service is great. And they cater for gluten-free diets - just ask. I can even eat there on my low-FODMAP diet by avoiding high-FODMAP vegetables, altough you may need to be careful if you are sensitive to onions and garlic. 

The only downside is that Royal Thai is a bit of a walk from us. But I suppose that is probably a good thing. If it was any closer, we would probably go there every week. 

And that wouldn't be quite so special, would it? 

Living the dream.

Time to explain myself

On Friday, I had an appointment with Sarah, my dietitian, to discuss my low-FODMAP diet now that we know what foods trigger my irritable bowel symptoms. 

I am now at a point where I can gradually start re-introducing or increasing my intake of certain foods. And the thought of trying some of my favourites again is pretty exhilarating, which might seem a tad dramatic, but after two months without aioli, trying it again is pretty big deal. 

The point is, I can now find my 'new normal'. (Of course, I use the term 'normal' here very loosely.)

And as it turns out, the hardest thing about this new normal - because eating aioli certainly isn't difficult - has been explaining exactly what that new normal is. 

Talking about low-FODMAPs is one thing. But explaining my version of low-FODMAPs is even harder. People have been extremely supportive during my journey and it's nice to have opportunities to explain myself to those who are interested. But finding the right words is another matter entirely.

"It's changed my life", while accurate, doesn't convey enough information. But "here's a monologue on gastroenterology..." doesn't quite work either. 

  

It's a balance between having a simple explanation - so that I don't put people to sleep or, worse, put them off their dinner - and making sure that I don't shy away from the reality of my digestive problems. 

Because my reality might resonate with someone else. 

Irritable bowel syndrome (or IBS) affects about one in every six people (yes, really), which means that every person I talk to either knows someone with IBS or is struggling with it themselves. 

So, while explaining my diet might be (ok, definitely is) embarrassing, it's a conversation that might be needed. (Of course, a conversation can only get you so far - treatment of IBS should always be overseen by a doctor and / or a dietitian. See the Monash University app for more information about the low FODMAP diet.) 

Through trial and error, I've got my new normal summarised down to three sentences. Here are those three sentences explained. 

I am gluten intolerant, but I am also on a low FODMAP diet to manage the symptoms of IBS.

Irritable bowel syndrome is very common, but the symptoms and their severity can very a lot between individuals. For me, IBS means excruciating stomach pains. The low-FODMAP diet helps me to alleviate these pains and encourage normal bowel function. In fact, the low-FODMAP diet has been shown to improve symptoms in 76 percent of people with IBS. 

FODMAPs - or Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides and Polyols - are a group of sugars. For many people with IBS, some or all of these sugars are malabsorbed in the small intestine, leading to digestive discomfort. 

The low-FODMAP diet limits the intake of these sugars (the 'elimination phase'). Then, if symptoms are alleviated, the sugars are then re-introduced one by one to identify individual triggers (the 're-introduction phase'). Once these triggers are known, the diet is customised to achieve symptom control (the 'normalisation phase').  

This means that I can't digest certain foods properly (for example, apricots, milk and honey). 

FODMAPs are in a wide range of foods that fall under six broad categories. Here are some examples of foods that are high in FODMAPs.

Fructose (in excess of glucose) - honey, fruit, especially dried fruit or juice, and some vegetables 

Lactose - milk products (but not all dairy products - cheese and butter are ok)

Sorbitol - some fruit (e.g. apples, pears, blackberries, apricots, nectarines, plums), vegetables (e.g. avocado) and artificial sweetener  

Mannitol - some fruit (e.g. watermelon), vegetables (e.g. cauliflower, mushrooms, snow peas) and artificial sweetener  

Fructans - garlic, onions, wheat, rye and barley (and some other fruits and vegetables)

GOS (galacto-oli-saccharides) - legumes, such as chickpeas (and some other fruits and vegetables)

The elimination and re-introduction phases that I have been through have revealed which of these six broad categories are my triggers. 

It turns out that I malabsorb sorbitol, lactose, and fructose, especially sorbitol. Apricots are NOT my friend.  

On the plus side, I can tolerate mannitol, fructans and GOS pretty well. This means that, among other things, I do not have to live without aioli. 

Interestingly, I can absorb the sugars in gluten-containing foods (i.e. fructans) fine, which means that I am intolerant to gluten itself (the protein) rather than the FODMAPs in these foods. This confirms that my gluten intolerance is a very separate issue. 

But while I have to strictly avoid gluten, I just need to limit my intake of FODMAPs. 

Due to the potentially-damaging effects of my gluten intolerance, I have to be very strict in avoiding gluten. But that is not the case with FODMAPs - I'm not trying to cut them out entirely.

Foods that are high in FODMAPs are good for you nutritionally and eating them is not damaging. The diet is about symptom management, not exclusion. Tolerance for the different sugars can also change over time, so it's important to be continually re-testing tolerance levels to get the most enjoyment and nutritional value out of the diet.  

Mindfulness is important when it comes to managing symptoms. The effects of eating FODMAPs are cumulative, so it is important to be aware of how much of each FODMAP you are eating - even the ones that don't tend to cause you problems - and how they might interact. 

Non-dietary factors are important too - on one hand, stress and hormonal fluctuations can exacerbate symptoms. On the other hand, dietary supplements can help.  Probiotics and lactase enzymes can help enhance tolerance, and peppermint capsules can help with symptom management. 

Burger Fuel gluten-free C N cheese burger with aioli (but no onions).

So this is where my version of the low-FODMAP journey starts. 

I'll be sticking to my rice porridge, back to eating aioli sometimes, and avoiding apricots like the plague - with lots of other food groups in between. 

I'll be cutting back on lactose, except on the odd occasion (as in, I'll be eating a whole packet of lactase tablets at Christmas to enjoy our delicious family traditions). 

When I'm eating out, I won't be as strict as I have been, so some of my blog posts won't be relevant for everyone's version of the low-FODMAP journey (but I'll give you information where I can). 

Most of all, I'll be feeling my way as I go - discovering my limits and eating lots of delicious treats on the way.

I hope you'll join me on the next phase of my journey. 

Chow down on this

Despite my obsession with eating - and, in particular, eating out - I actually don't think it's necessary for all restaurants and cafes to cater for my dietary requirements. 

Some requirements are difficult to cater for and the market just isn't big enough for everyone in the hospitality industry to be able to do it economically. 

Of course, I think it's important that some businesses cater (I wouldn't be able to eat otherwise). And I also think it's important that those who do cater make that known to their patrons and completely understand what is required (dealing with a waitress who doesn't really understand what gluten free means is always fun. "Oh, but I know someone who is gluten free and they would eat that" or "but I was told couscous is fine so it must be". You get the picture.).  

But if a business doesn't cater, then that I understand. Genuinely, I do. And if they do cater, well, then that's a bonus. 

What I don't understand is outlets that do not engage with their customers. 

If a person asks whether a restaurant or cafe can cater for them, it's important for the business to respond - regardless of whether they can cater or not. It helps the business understand customer demand, it might attract a new customer, and - perhaps, most importantly - it is courteous customer service. 

Which is why I don't understand why Chow hasn't responded to a query I sent them well over a week ago. 

I wanted to visit Chow and I was trying to help them by asking ahead, rather than nagging waitresses and kitchen staff when they are really busy and the information might not always be on hand. 

But the fact that they didn't reply tells me they don't actually care about my health. It tells me that they only offer gluten-free and dairy-free options to cater for what's trendy, not because they are actually conscious of dietary concerns. 

Maybe I am expecting too much and blogging has turned me ranty (please tell me if that is the case). But the difference between this experience and the superb service I have received elsewhere is so stark. 

At the same time that I emailed Chow, I emailed Dragons who replied to me in less than 12 hours with a very helpful, informed response. And - bonus - they can cater for me!

The contrast makes my eyes hurt.  

I certainly know which restaurant I will be visiting this weekend. 

In the meantime, Ross and I have decided we don't need Chow anyway. We've been making our own Asian fusion food and it's pretty damn good!

Update: Chow have been in touch. They intended to get back to me but due to an error on their part the email never came through. It's great to know they do care (and can cater) after all! The options sound pretty tasty, too. 

Beef sticks with low FODMAP spicy satay sauce.

Juicy duck breast with Asian glaze, polenta fries (cooked in duck fat), and bok choy.

Thai coconut sticky rice with passionfruit curd. 

Low FODMAP lattes (and why catering for special diets is only the beginning)

Update: Rice milk has now been found to be high in oligosaccharides, despite rice itself being low in FODMAPs. Personally, I cope alright with this type of FODMAP (I'm not too sensitive to oligos) but if you're on the exclusion phase, rice milk is no longer suitable. Instead, I recommend So Good soy milk (made with soy protein, not the bean) or almond milk.

Looking for a low-FODMAP latte? Have found the cafe for you!

I like coffee. I mean I really like coffee. And since I started my low-FODMAP diet, I have been drinking it black (lactose is not my friend, cafes use high-FODMAP soy milk, and almond milk hasn't yet been tested).  

I love my morning Americanos. And I happen to drink the best coffee in town. But black coffee is a very no-nonsense way to drink your coffee. 

A flat white will wake you up by gently nudging your brain into action. Black coffee pulls you out of bed, throws you against the wall, and shakes you violently into frantic alertness. 

This is exactly what I want - ok, need - on a Monday morning. But it isn't quite what I'm after on a quiet Saturday. 

Which is why it is so exciting that we discovered Deluxe today during our morning stroll to Moore Wilson's. 

Deluxe is a small, hipster cafe that serves Havana coffee. And, you guessed it, they offer rice milk (!!). 

Now, other cafes in Wellington may also serve rice milk (if you know of any, I'd love to hear about them). But Deluxe is the only one I have ever seen advertise it. 

Asking for special ingredients can be annoying and embarrassing. Especially rice milk. It is a level of coffee-fussiness that doesn't even make the what-your-coffee-order-says-about-you list.

Cafes - if you cater for dietary requirements, you have to make it known. It is not enough to cater to us. Seriously, it isn't. If people on special diets don't even get a mention on your blackboard, it isn't inclusive. It just reinforces stigma around alternative diets, which are often related to very serious health issues. It is really important to remember that many of us who are on special diets don't have a choice about it. 

I care much more about feeling welcome than I do about having rice milk in my coffee. 

And for that reason, Deluxe has won my heart. And my weekend patronage. 

Me and my rice milk flat white.

Update: Apparently Coffee Culture in Timaru offers rice milk (I'm not sure about the other Coffee Culture stores).