Questions about lab results and finding a safe diet

[ilsebb]

Hello,

I just got my Enterolab results and I have questions (no kidding!). Here is some background about me that might help.

I'm 85 and was diagnosed with MC in Nov 2024. I have been off of gluten and dairy since that time.  I am 5'2" and 100 lbs, but I was 160 lbs before MC wreaked havoc, so my weight loss has been pretty severe. My diet for the last several months has included these foods:

pumpkin, carrot, parsnip, peeled cucumber, white potatoes, fermented cucumber pickles
rice and rice cakes/pasta
banana, strawberries, melon
eggs, chicken, turkey, tuna, sometimes shrimp, salmon, trout, cod
chicken bone broth
almond milk and sometimes almond butter or almond flour
olive oil, avocado oil mayo, low salt (cut with potassium),
decaf coffee, chamomile tea (recently added), a half lime -not squeezed - in my water for flavour
small amounts of maple syrup
sometimes tomato sauce or ketchup
occasional ingredients in my cooking: black olives, apple cider vinegar, lemon juice, cinnamon, cumin, ginger, turmeric, baking powder or soda, arrowroot starch

I take 3500 IU vit D and I'm about to start using topical magnesium oil.
I take 6 mg budesonide and 4g pentasa for now but I am working with my GI to wean off slowly. Budesonide did not seem to help me, so the GI added pentasa while weaning budesonide.
Presently, I am fairly stable symptomatically, but still have the occasional flare day, so I feel like I have definitely made good progress but not yet in remission. I'm aware the meds could be covering up the real situation and that's why I went for the test, to see how my diet might improve.

So here are my test results:

Quantitative Microscopic Fecal Fat Score      3443 Units   (Normal Range is less than 300 Units)

Fecal Anti-gliadin IgA      26 Units   (Normal Range is less than 10 Units)

Fecal Anti-casein (cow’s milk) IgA      17 Units   (Normal Range is less than 10 Units)

Fecal Anti-ovalbumin (chicken egg) IgA      35 Units   (Normal Range is less than 10 Units)

Fecal Anti-soy IgA      24 Units   (Normal Range is less than 10 Units)

With respect to the mean value of the 11 foods tested, overall, there was only a modest amount of immunological reactivity detected to these antigenic foods in terms of fecal IgA production.

Mean Value 11 Antigenic Foods      22 Units   (Normal Range is less than 10 Units)

While all of the foods tested can be immune-stimulating, the hierarchy of reactions detected were as follows:

0 Rice, White potato
1 Oat
2 Corn, Tuna, Pork, Chicken, Almond, Cashew
3 Beef, Walnut

Meats:
Meat toward which you displayed the most immunologic reactivity: Beef
Meat toward which you were next most immunologically reactive: Tuna
Meat toward which you displayed intermediate immunologic reactivity: Pork
Meat toward which you displayed the least immunologic reactivity: Chicken

Nuts:
Nut toward which you displayed the most immunologic reactivity: Walnut
Nut toward which you displayed intermediate immunologic reactivity: Almond
Nut toward which you displayed the least immunologic reactivity: Cashew

Now for my questions:

1. The fecal fat score is crazy high indicating severe malabsorption. What does this mean?

2. Do I need to reduce fat in my diet?  Can I safely add organic coconut yogurt (tapioca starch in it) and avocado? Can I still eat avocado oil mayonnaise - I eat this every day.

3. Should I be taking pancreatic enzymes? I'm concerned now that I have serious absorption issues.  Pretty sure Dr. Fine will recommend it.  It says this on my test: Pancreatic insufficiency as the primary cause of fat malabsorption usually causes significant elevations of fecal fat values, usually into the moderate (600-1000 Units) or severe (>1000 Units) ranges.

4. How are my scores in general? To me they don't seem too bad, other than egg which I eat every day. Does "modest amount" of immune reaction mean that my inflammation is not so bad and recovery could be coming sooner than later if I get on a safe diet?

5. Can I still eat chicken? Can I add pork?  I don't like lamb, and I'm not sure how much wild game meat I could stomach either.  Don't like turkey much.

6. Can I include some cashew butter/flour in my safe diet plan?  I know chicken, pork, and cashew are in the 2 category, but they rank lower, and if I eliminate everything else maybe it could be safe?

7. Is it safe for me to add GF oats?  I have suspected that oats aren't great with me, but my score is a only a 1.

8. Is there any fish I can safely eat?  Wild caught salmon or cod?  Can I have wild caught shrimp?  Rainbow trout?

9. Can I still eat small amounts of raw strawberries and melon?  Can I add applesauce?

10. Is it okay to keep a little bit of tomato (occasional use of tomato paste or ketchup)?

12. Can I continue to use a little bit of the anti-inflammatory spices I listed (powdered form, or grated and cooked)?

13. Can I still use almond milk? Or should I switch to cashew?

14. It's obvious that eggs have to go (sob, what to do for breakfast?).  I honestly don't know if I can stomach eating dinner for breakfast. Is there a safe turkey bacon? Can I have uncured pork bacon? Can I have quinoa, or is it laxative?  I have also been diagnosed with diverticulosis, so not sure this is safe for me.

15.  Are there any other issues with my current diet that I should be aware of?

And finally, what do you make of this in the test notes:

"The results are delivered in such a way that you are not left with “nothing to eat,” but instead they should guide you in avoiding the foods to which the highest or most immunologic reaction was detected (and hence, are most stimulating to your immune system). We discourage dietary changes that involve removing too many foods at once. This can lead you to feel too hungry too often, especially if adequate healthful replacement foods are not readily available. Dietary elimination (beyond gluten-free, dairy-free, and soy-free) is best approached over a period of weeks to months and sometimes years, removing one or two additional foods at a time, rather than removing many foods at once."

Thanks in advance to anyone who is able to have a look at my situation and advise based on individual or group experience.

Ilse

[tex]

Hi Ilse,

I'll try to answer all your questions. Remember, these are just my opinions, and I'm not a doctor.

1. The fecal fat score is crazy high indicating severe malabsorption. What does this mean?

That score may be high because your diet contained a lot of fat when you sent the sample to the lab for analysis. All the olive oil, avocado oil, etc.Will show up in the test. But most of us have a malabsorption problem when our MC is active, because our food is incompletely digested when MC is active,due to the fact that it causes the production of digestive enzymes ro be compromised.

2. Do I need to reduce fat in my diet? Can I safely add organic coconut yogurt (tapioca starch in it) and avocado? Can I still eat avocado oil mayonnaise - I eat this every day.

Probably, though it's best not to overdo anything — moderation is the best policy.

3. Should I be taking pancreatic enzymes? I'm concerned now that I have serious absorption issues. Pretty sure Dr. Fine will recommend it. It says this on my test: Pancreatic insufficiency as the primary cause of fat malabsorption usually causes significant elevations of fecal fat values, usually into the moderate (600-1000 Units) or severe (>1000 Units) ranges.

Some people feel that it helps, but the key is to get the Inflammation level down so that the malabsorption stops, then our enzyme production will resume naturally.

4. How are my scores in general? To me they don't seem too bad, other than egg which I eat every day. Does "modest amount" of immune reaction mean that my inflammation is not so bad and recovery could be coming sooner than later if I get on a safe diet?

They're typical, though on the low side. But the test results are probably suppressed because you've been taking budesonide for so long.

5. Can I still eat chicken? Can I add pork? I don't like lamb, and I'm not sure how much wild game meat I could stomach either. Don't like turkey much.

If I were in your shoes, I wouldn't be eating those Proteins. I would be meeting turkey, lamb, goat, venison, and other wild (or wild type meats, raised on a farm or ranch). Our food is our medicine when were treating MC by making diet changes. Sometimes we don't like the taste of medicines.

6. Can I include some cashew butter/flour in my safe diet plan? I know chicken, pork, and cashew are in the 2 category, but they rank lower, and if I eliminate everything else maybe it could be safe?

Maybe, but don't overdo it, because every food we include in our diet that doesn't meet the approval of our immune system is limiting the chances that we will reach remission, and at best, they're postponing the time at which we will reach remission.

7. Is it safe for me to add GF oats? I have suspected that oats aren't great with me, but my score is a only a 1.

As I mentioned above, your test results are probably suppressed because of the budesonide, so I wouldn't take that score as gospel. Virtually all of us react to oats.

8. Is there any fish I can safely eat? Wild caught salmon or cod? Can I have wild caught shrimp? Rainbow trout?

I can only guess. In general freshwater fish are more likely to be safe than saltwater fish. However, all shellfish should be safe, because they're safe for most of us unless we were previously allergic to them. So shrimp, prawns, mussels, crabs, lobsters, oysters, squid, etc. should all be safe choices

9. Can I still eat small amounts of raw strawberries and melon? Can I add applesauce?

Applesauce should be safe and strawberries might be safe (in moderation), but we all react to watermelon. Other melons may or may not cause problems

10. Is it okay to keep a little bit of tomato (occasional use of tomato paste or ketchup)?

Tomatoes are a citrus fruit. We all react to citric acid if our MC is not in remission.

12. Can I continue to use a little bit of the anti-inflammatory spices I listed (powdered form, or grated and cooked)?

If you feel that helps, maybe, But many of us react to significant amounts of turmeric, for example, and according to published research, you would have to ingest about a wheelbarrow full of most of these supplements in order to be able to suppress the inflammation associated with MC.

13. Can I still use almond milk? Or should I switch to cashew?

Those of us who are sensitive to almonds typically have no problem using almond milk, I don't have enough information available to be able to judge cashew milk, but I suspect it would probably work similarly.

14. It's obvious that eggs have to go (sob, what to do for breakfast?). I honestly don't know if I can stomach eating dinner for breakfast. Is there a safe turkey bacon? Can I have uncured pork bacon? Can I have quinoa, or is it laxative? I have also been diagnosed with diverticulosis, so not sure this is safe for me.

Eggs are probably your main problem that is keeping your inflammation level so high. Turkey bacon should be safe. Where did you get the idea that quinoa is a laxative? That should be a safe choice, and so should amaranth and rice. Rice Chex with almond milk should be safe as a breakfast option. There are surely other safe options that you can find if you put a little thought into it.

15. Are there any other issues with my current diet that I should be aware of?

You are eating way too much variety to realistically expect to put your MC into mission. The greater the variety in our diet, the less likely we are to ever reach remission. Most of us reach remission by eating large enough portions to get our nutrition needs from only a few safe foods. Variety is totally unnecessary. Up until roughly 100 years or so ago, most people lived on farms, raised their own foods, and ate a very limited diet. In general, they were much healthier than we are today.

And finally, what do you make of this in the test notes:

Those suggestions might be fine for someone who doesn't mind taking a year or so to reach remission. Personally, I found it beneficial to reach remission as quickly as I possibly could, because this disease was ruining my health, and seriously interfering with my life. By buckling down and avoiding everything that is causing us to react, all our digestive problems can usually be promptly stopped, so that our digestive system can begin to heal, and allow us to get our life back. Why would anyone want to postpone escaping the clutches of this disease?

At least, those are my opinions.

Tex

[ilsebb]

Thank you so much, Tex, for this response. It's all very helpful and I really appreciate it.

A few more questions:

1. Can you explain a bit why variety interferes with remission? If I only choose from safe options, then what would variety have to do with it?

2. Does anyone know if Kirkland ground turkey from Costco (in the big tube) has the rosemary extract? They don't list ingredients, which suggests to me that it's only turkey, but that may not be a safe assumption?

3. Is cornish hen safe if you are sensitive to chicken? Is wild boar safe if pork is not?

4. Also, turkey bacon - how can it be safe if the ingredients include all kinds of chemicals/additives, not surprising since it's such a processed food?

[tex]

1. Can you explain a bit why variety interferes with remission? If I only choose from safe options, then what would variety have to do with it?

Sure. Besides foods that cause our immune system to produce antibodies there are many foods that irritate our intestines when they are already inflamed because of the disease. We've learned in the school of hard knocks that most products that contain more than 5 ingredients will either cause us to react outright, or slowly increase our chances of a flare, simply because the more ingredients a product contains, the more likely it is to be cross contaminated during handling, storage, processing, or whatever. The same principle applies to various foods in the diet. The more variety we seek, the more likely that something in our diet will be cross contaminated, Or will interfere with our recovery for some other reason. It boils down to this: if we want to recover as soon as possible, we eat a few simple foods, at least, until we reach remission: but if we're not really serious about recovering, then variety is fine.

2. Does anyone know if Kirkland ground turkey from Costco (in the big tube) has the rosemary extract? They don't list ingredients, which suggests to me that it's only turkey, but that may not be a safe assumption?

Look on the bottom of the package for labels of that sort. Apparently, usually it does contain rosemary extract, but some reports differ.

3. Is cornish hen safe if you are sensitive to chicken? Is wild boar safe if pork is not?

No. Cornish hens are just another type of chicken, not a different species. Think turkey, quail, pheasant, duck, goose, emu — All different species. The meat from javelina would be safe, but all swine are from the same family, Which includes wild boar.

4. Also, turkey bacon - how can it be safe if the ingredients include all kinds of chemicals/additives, not surprising since it's such a processed food?

It's not safe, if it contains all sorts of suspicious ingredients. If you can't find one without all those ingredients, pass them all up.

Tex

[Gabes-Apg]

To expand on the answer to your first question about variety of foods.

100 years ago - working class people ate a base diet of small amount of ingredients the only processed food was bread!
there are still areas of the world in third world countries that the inhabitants only eat a small base of ingredients

there was no autoimmune or IBD issues in those era's or tribes.

Variety of foods was a marketing ploy to sell more products not a health necessary decision
the food industry now is about profit not quality.

in my MC healing journey I went back and looked at the ingredients my ancestors ate and their cooking method.
for me it was English/Irish. meat on the bone slow cooked with a few veggies. That is the basis of my eating plan.

when the immune system is fragile/triggered, we are more sensitive to change.
in the early stages of my healing journey drinking tap water with chemicals would cause a reaction (I always drank filtered water)
with healing I am not that sensitive.

The limited diet is recommended as the path to lower inflammation, minimise triggers and let the gut heal
With healing you get more accurate reactions to what a trigger is, when inflamed any new ingredient causes issues.