Day 53: The problem with confounding variables

Question: What happens when you cheat on your elimination diet with a bunch of foods you shouldn’t be eating?

Answer: You don’t know which of them is causing the pain you’re now in. Dammit. 

The Autoimmune Protocol (AIP) diet is split into two phases for a reason. The first is elimination. In this phase, you basically cut out all the things that are the likely culprits for all your pain and discomfort. This includes: grains, legumes, dairy, and sugar (a la paleo), but also eggs, nuts, seeds, nightshades and all their associated spices. This leaves you with meat, fish, most vegetables, and fruit… although you are also supposed to limit your fruit intake to two portions per day. You’re also supposed to try and include a decent amount of organ meat and fermented foods in your diet as these are highly nutritious and probiotic.

The second phase is reintroduction and takes place once you are in full remission, i.e. your pain and discomfort has disappeared (preferably) completely. The reintroduction phase is really several mini phases as you introduce foods one at a time so you can monitor the effect they’re having on your body. The idea is that you can tick certain foods off your suspect list as you successfully reintroduce them with no negative side effects.

To most people, the initial phase sounds like the hardest. Cutting out all those foods all at once! That’s way tough. But actually, the reintroduction phase has been the hardest part for me. Specifically, stopping myself from getting overexcited and reintroducing things too quickly… and then getting so carried away and sure of myself that I end up cheating… badly. There was gluten and sugar and caffeine and all sorts. It was a real mess. If you’d like to read my full confession, please feel free.

So today, very unfortunately, I woke up with a tiny twinge that I’d already convinced myself last night that I might be able to feel. Now I know it’s definitely there. It’s very low level, but it’s back. And given my binge yesterday, there’s no denying that the food I eat has an effect on my condition.

On the one hand, this leads me back to the assumption that this condition is more than just a series of bladder infections and puts Interstitial Cystitis back on the radar. On the other hand, I have no idea out of all of the things I shouldn’t have been eating yesterday, which one of them is the culprit. I have some suspicions. Here are the suspects:

  • Chocolate
  • Gluten
  • Sugar
  • Coffee

Let’s break it down.

Chocolate – notorious for triggering IBS, allergies and, in an IC bladder, irritation and pain. If you’re desperate for chocolate, you should try a white chocolate or a very dark, semisweet chocolate. It’s the cheaper milk chocolates that seem to be the most irritating.
(IC Network)

Well, I did eat dark (semi-sweet) chocolate, but it probably still didn’t do me any favours (and definitely isn’t AIP).

Gluten – Foods with gluten can cause flares for some people with interstitial cystitis (IC). Reports from patients suggest an increased prevalence of celiac disease among people with IC. Not all IC patients with gluten sensitivity have celiac disease. If your test for celiac disease is negative, you may still notice that gluten worsens IC symptoms.
(IC Help)

Also, do we even need to be questioning gluten? I mean, it’s not even paleo friendly. I’m definitely not going to be officially reintroducing gluten into my diet.

Sugar – Simple sugars and coffee are strong irritants to the urinary tract and kidneys
(Ask a Naturopath)

Again, not even paleo friendly so won’t be reintroducing in its usual form. I have also noticed during the elimination stage that when I ate lots of dried fruit, especially dates, I had an increase in pain.

Coffee – (regular & decaf) are, by far, the most irritating to an IC bladder, not just for the caffeine but also for the very high acid level. We strongly suggest that you avoid all coffees if you are currently symptomatic.
(IC Network)

Pretty much anything you come across that mentions interstitial cystitis and food will tell you to steer clear of coffee. Admittedly, coffee has been one of the most difficult things for me to avoid. But when I’ve cheated during this AIP challenge, despite missing it so much, I didn’t cheat with coffee until yesterday. I think this is because I already know that coffee doesn’t do my bladder any favours.

Paleo Mocha

I guess I’ll just have to wait a little bit longer until I can treat myself to one of these again…

Given the links between all of these foods and flares of Interstitial Cystitis, I’m going to safely assume all of them are problematic and having them all at once in one day pushed my bladder back into the irritation zone. Based on gut instinct and the associations I’ve made over the last few months, I would wager that the ring-leaders yesterday were the sugar and the coffee. Even though I had just the one coffee (and sort of accidentally – I’d intended to order hot chocolate), it was basically mixed in with lots of sugar and dairy. Oh crap, I forgot dairy. Hang on…

Dairy – There doesn’t seem to be much of an established link between dairy and Interstitial Cystitis specifically, but it’s generally recommended to be avoided as it has high allergenic potential. My feeling is that in this case it got caught up as collateral damage amongst all the other naughty things I shouldn’t have been having. I imagine I’ll be able to reintroduce high quality dairy at some point, but for the moment, it’s out.

Lesson learned: this process only works if you do it properly! You can’t just stick your fingers in your ears and assume you’ll be better forever like magic. However tempting it is.

So anyway, I still think I’ll be able to eat chocolate and dairy at some point in the future. There’s no way of knowing whether they’re OK yet so they’ll have to be removed again for now. I really think my problems lie mainly with gluten, sugar, and coffee. And alcohol. But I haven’t had a drink since September, so it’s vindicated in the case of my current state.

And the search continues. The pain is mild and certainly not square one levels. Also, not where it should be for square 53 levels, i.e. remission. Maybe somewhere inbetween? Square 30? Lots of ground to make up in the last week then…

Food diary
Breakfast: Banana. 2 poached eggs, smoked salmon, spinach, pumpkin seeds, balsamic vinegar
Lunch: Leftover mustard and balsamic chicken with spinach, beetroot, baby salad leaves, pumpkin seeds and balsamic
Dinner: Cilantro meatballs with sweet potato mash
Snacks: nuts, dried figs, dark chocolate, paleo bar

Pain level (out of 10)


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