Gluten Free Asian

Getting (A Little Too) Intimate with Doctors

2011-03-08T08:36:00.001-08:00

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...

2011-03-05T07:34:00.000-08:00

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!)

2010-05-17T09:02:00.000-07:00

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

2009-12-14T21:42:00.000-08:00

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...

2009-12-13T06:07:00.000-08:00

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

2009-12-06T07:25:00.000-08:00

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?

2009-11-06T19:15:00.001-08:00

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.

The Proof in the Bowl

2009-10-27T07:25:00.000-07:00

I had a classmate once, Daphne, who used to have the most bizarre, vivid, memorable dreams, which she used to roller-coaster through nightly and then regale us with the next morning after class at the university. That she could recall her dreams in such detail was particularly mind-boggling for me, one of those unfortunates whose memories of dreams, even the harder-hitting ones, fade away to nothingness minutes upon waking.

Anyway, once Daphne told us about how, after a particularly heavy seafood dinner, she went to bed with a rumbly tummy, and once in Dreamland, after many bizarre twists and turns, was led by a talking owl (yes, a talking owl) to her bathroom, whereupon her chatty feathered friend pointed an accusatory wing at her toilet bowl and intoned gravely: "Now just look at what you've done!". And peering into the porcelain (I have visions of Daphne in her nightie looking like a sleepy, slightly-alarmed fortune teller, but with a toilet bowl for a crystal ball), she saw... the stir-fried crabs she had had for dinner, but strangely very much whole and very much alive, and sans the chilli-coriander gravy they'd been dressed in just hours before.

Not much connection to the rest of my post but this story always makes me think how the evidence we leave behind in the toilet bowl can tell us so much more than we think.

For us GI sufferers, if you've been longtemps afflicted, you may often see the floaty yellow poo in the bowl. That's probably cos the intestinal villi have been so much damaged by the body's reaction to gluten that they can't digest fat properly anymore, so it goes out the body as part of the waste (thus the characteristic yellowish colour -- a sign of undigested lipids -- and the fact that it floats, as fat does in water).

The reason I think gluten intolerance is really widespread, just not often diagnosed here, is because I see signs of it all the time. It's no secret some of Asia's public loos are absolutely filthy. (Wipe that smug look off your face you non-Asians, it ain't all of us Asians at fault and you know that one bad apple, yadda yadda. It just takes that one guy to mess it up and everyone gets a bad name. I also think that Western toilets aren't necessarily cleaner -- they just have more cleaners.) Well, anyway. Some of the public toilets here are really bad, and I often think it's because of GI sludge. Brown poop in the bowl that just won't flush away. If you're going through the dark brown sticky phase, you'll know that that stuff sticks.

So on to tip number one. To avoid leaving brown evidence that can't be flushed away, toss some toilet paper in the bowl before sitting down. That way, poop hits paper, not porcelain, and won't stick where it's not supposed to. Minimises splashing too. Another thing you can do (I had this brainwave on a recent trip to France, staying in someone's apartment where detergents and other stuff were in easy reach of the toilet bowl) is squirt some detergent around the bowl before doing the deed. That pretty much helps to prevent unwanted adherence too, though this is more a tip for home than outside, where you'd look mighty strange walking into the cubicle with oh just a bottle of Mama Lemon to help things along.

Now, still on the dirty stickiness (thank you Hiroyuki Nishigaki, but I've learnt other ways to good-bye depression)... aside from not being able to wipe yourself fully clean (because there's Klingons backed up all along your pipe work, and ah aint gonna go in that far, thank you), you might use up rolls of loo paper in the process. I know I have. Some nasty things can result. All that paper can block up the toilet (I've had this happen so often it's not funny. Made even worse since the government, championing water-saving, began mandating WCs that use less water for flushing. Less water equals less power flushing things away.) So the next tip -- flush often, mid-way, even if you're not fully done yet. You can always flush again. But there is a problem with this, in that is it's not fun to get splashed if you're still seated, as might happen. And don't delay-- if there's already a pile of paper in the bowl, and you're not done, a weak flush might still block the outlet, and then you have a real situation. Half-done pooping, not wiped clean, a blocked toilet overflowing, pants around your knees. Not a pretty picture.)

Another tip, this time to help with the wiping, and another doff of the hat to the French. The creators of the bidet were on to something-- a bit of water helps a millionfold with wiping yourself clean. Here's what I did (and still do). Wipe as clean as you can. Exit the cubicle with a wad of clean toilet paper. Use it like a sponge to soak up some tap water, then re-enter the cubicle, and using your wet paper sponge, moisten other pieces of toilet paper to help with the wiping. That way you have an ample supply of wet wipes on hand, and not just the one wet piece.

Why all this fuss and bother? Well, if you're GI, you spend a lot of time in the loo. These are just a few ways to make things a bit more pleasant for you (and the next user too).

A Brief History of Bowel Habits, or: Windy the Poo (Recognise Any Symptoms Yet?)

2009-10-09T09:13:00.000-07:00

It all kind of started about ten years ago. Little by little, I noticed my bowel movements becoming more and more difficult. And the odd thing was, it wasn't always consistently one thing or the other.

Sometimes it was diarrhea, with the associated cramping. But with the stools a strange, not fully liquid but definitely not solid, squirty yellow mess that seemed to float on the water. Other times, it was dark, heavy, sludgy and impossible to move. Constipation suggests really hard stools that you can't move. Well mine were not hard at all, but imagine poo like sticky sludge, and well, that doesn't move too well either.

And in either case, you just can't wipe yourself fully clean, no matter how good your paper is. Always had to use a bit of water and even that wasn't 100% effective. So you go through your day hoping fervently that it's only your prayers reaching high heaven, and not any lingering odours.

As if that wasn't embarrassing enough, through it all were the oft-present symptoms of bloated gassiness. At least, that's what it felt like. You see, to add to the embarrassment of leaving the cubicle not fully sure if you got yourself clean enough, you walked around constantly with the urge to poot. But there ain't no quiet, smell-less farting to be had with GI, nosiree. You see, often you were walking around all sludged up down below, so much so that any escaping gas was going to announce its gleeful entry into the wide world with a raspberry worthy of the largest untied balloon with the smallest neck. Hmph.

At least, if it was gas. To add to it all, sometimes you're so plugged up you don't know if the resulting emission is going to be solid, liquid or gaseous. Much like a Chemistry lab test, but with far more embarrassing consequences if you guess the wrong output. Like expecting gas but getting liquid. Get the picture?

Which brings me to my earlier post: sometimes constipation and diarrhea at the same time. You see, often you're so blocked up with the unmoving sludge, and yet, backed up further along the system the body is trying to rid itself of waste. So it sends more water into the gut, trying to flush out the perceived toxins (or so I imagine). And it sends you signals you need to go potty. RIGHT AWAY, AND DON'T DELAY. Hence the cramps. But once you sprint to the loo, and position yourself for action... the sludge still ain't goin nowhere, not till you strain and wash and wipe and repeat (I've used up two rolls of toilet paper in sessions lasting 30 to 45 minutes), and the sludge finally moves its slothful way onward, and then you get to evacuate the diarrhea your body is telling you to move. Not a pleasant experience. You see why we GI sufferers hate it so much?

A New Beginning

2009-10-09T04:44:00.000-07:00

Hi to all the folks out there. I've been thinking about setting up this blog for quite some time now, but never got around to doing it for a number of reasons (I'm not exactly tech-savvy, and also have a full-time job in the building industry, being the two chief ones).

But really, I just got tired of reading that gluten intolerance doesn't really affect Asians, when the truth of the matter is that it DOES (I'm living proof) and after having suffered for something like eight years from this insidious affliction, and then going blissfully gluten-free for the past two, I felt that it was time I said something about the matter.

Hence this blog. My hope is that I'll be able to share some of the knowledge I've gained in getting out of the time-stealing, style-cramping, inconvenient, uncomfortable, yucky weirdness that is gluten intolerance, from the point of view of an Asian guy living in an Asian city, with a predominantly Asian diet.

This is still a journey, and there is still much to learn, but just knowing what was wrong -- what was causing my digestive system to go haywire the way it did -- is half the battle won, in my opinion.

In case you didn't know it (although if you've stumbled upon this blog from a web search you probably already have some inkling), gluten intolerance is the inability of the body to digest gluten, which is a protein found in wheat, barley, rye and some other related cereals (such as kamut, spelt, and triticale). This digestive inability results in some pretty nasty stuff happening to you, as what you've eaten trundles through its rumbly journey to emerge out the other end. The tough bit about suffering from gluten intolerance is that wheat is such an important grain, and it's in so many things we take for granted as safe to eat: bread, cake, pizza, cookies, biscuits, breakfast cereals, and many types of noodles, both Asian noodles as well as Italian pasta. And did you know it's in soy sauce? And that wheat-based starches are a common thickener in many foods? Oh and it's in some beverages too, like beer and malted drinks? (No more refreshing Tiger beer sorbet! No more comforting Horlicks ice-cream...*sob*. I really do weep for this last one. I love Horlicks ice-cream.)

(Actually, at a molecular level, it's supposedly the component proteins of gluten, not gluten itself, that may be the offending agent, which is why different cereals can affect the digestive system. But for ease of explanation -- and discussion -- I'm going to be using the G word as shorthand.)

Not all grains are bad for us GI folk. Corn and rice (thank heaven) are perfectly acceptable (take note please, people -- I can't believe how many times I've been asked "Oh, this has rice/corn in it -- can you eat it?"). Oats may be on or off the taboo list, depending on who you listen to. Me, I listen to my body, and oats are a no-no for me.

Symptoms of gluten intolerance (GI) are manifold, and my favourite way of describing it to curious non-sufferers is this: "Well, just imagine every possible symptom of gastro-intestinal distress you've ever had -- like cramping, bloatedness, gas, diarrhea and constipation -- and then imagine very often having them ALL AT THE SAME TIME."

I can hear you now, dear reader: diarrhea and constipation at the same time? Well, yes, in a weird way. I'll post more about it later. If you've suffered gluten intolerance, you'll know what I mean.

And if you don't know it already, this blog is paradoxically going to be about two things we don't normally like to discuss together in polite company: food and poo. Although I may post recipes in a separate blog; somehow that just seems more decent (or maybe it's just me at this time). Yeah, well, I make no apologies for anything. I'm naturally a polite person, but there's no going into GI territory without having to do the nasty and talking about bowel habits. So get ready. A lot of GI is not diagnosed because people don't know the symptoms to look out for. Or if you as a sufferer, do realise something's wrong, your doctor may not recognise the symptoms. It's my intention to go where few have gone before, and describe what goes on in all its unpleasant detail. But if you're already a GI sufferer, just reading about it cannot compare in any way with the grossness of the actual experience, so I trust you will be able to handle it.

A few short notes about this blog. English is my first language, but I wasn't raised in a Western country, so you may find certain turns of phrase, or bits of slang and spelling unfamiliar (yeah, I'm talking 'bout you, ya Webster-wieldin Yanks). It's a big wide varied world out there, all brought together by the magic of the Internet, so as long as you can understand the gist of what I'm saying, deal with it, people. And yes, I do hope to post tips and recipes and bits of experience in navigating, nay creating (for myself at least) a wheatless world, in a country where I've yet to meet someone else who has the same problem: Singapore. I know you GI Joes and Janes are out there, maybe you just don't know it yet. I'm hoping this blog will help you find your diagnosis and end your suffering on the porcelain throne. We don't have to trudge through the sludge no more.

Oh and I haven't mentioned that word yet: celiac, as in celiac disease. (Or coeliac for them folks across the pond. On this one I side with the Yanks; you don't pronounce the O so it does seem a bit unnecessary. And it's harder to type.) Mention "celiac" and people automatically think, oh childhood disease, extreme intestinal problems, etc. etc. I've never had the official test done, so I don't have the black and white diagnosis. Though it seems clear to me, from observing what a huge change avoiding gluten has done for my system, that I may have a mild form of the disease. So no, it's not necessarily an affliction that only white kids may be affected by. But I'm not going to call myself a celiac. My symptoms seem relatively milder compared to celiac sufferers I've read about on the Internet, and for now I think gluten intolerance is the term I will use.

I have my own theory about what gluten does to the system. But more about that in a later post. Right now I'm hungry for my gluten-free dinner.