Thursday, March 18, 2010

A meat-and-potatoes kind of girl

The other night, for pretty much the first time in months, Susanna got through the night with absolutely no sign of a bellyache. No being startled awake and alternately stretching out and drawing in her knees, no shouting in discomfort, desperate to get herself back to sleep, no gas.

It was lovely. And it was simultaneously exciting and very daunting, because we think we figured out what we need to do: we need to feed her no fruits or vegetables, ever. It seems that she has a lot of trouble with fructose, which is in a lot of pretty prevalent foods: all fruits, most vegetables, table sugar, honey. Then there are these things called fructans, which are long chains of fructose, chemically speaking, and some people (including my little person) have trouble with those too. Foods containing fructans include wheat, brown rice, legumes, and lots of other vegetables.

Here's a little science lesson that I've cobbled together for myself over the last three and a half days of frantic research: none of us can actually digest fructose, in the truest sense of the word "digest." In other words, there is no digestive enzyme that breaks fructose down, the way lactase breaks down lactose. There's no such thing as fructase, as far as I know. A certain amount of fructose can be absorbed by most people's small intestines, which is important because if it gets to your large intestine, the bacteria there have a bit of a feeding frenzy. Except they're feeding themselves, not you. And that's a bad thing, and it can make you very uncomfortable, and it can make you startle awake and alternately stretch out and draw in your knees to relieve the acute gas pain, if you're a little baby named Susanna.

At least, that's what we think is happening. We think she's, at least for now, unable to tolerate much fructose at all. The other day, when I was hot on the trail of this fructose business, we tried a no-fructose day for her, and that night was the lovely one. It was a dramatic difference. I can't attribute it to anything but the diet.

So I'm relieved, for the short term, to have a plan to keep her comfortable (meat, potatoes, eggs, white rice, and breastmilk). But my long-range brain is frantic, because there's a wide range of conditions that we could be dealing with. And of course because I am this child's mother, I fixate on the most severe one, which is something called Hereditary Fructose Intolerance. This is a serious disease which involves a lot more than gastrointestinal discomfort. It involves the possibility of liver failure if a strict diet is not followed (and even sometimes when it is). It usually shows up as soon as solid foods are introduced to a child's diet (eek! that's how it happened for us!), and it usually means extreme reactions to sugar of any kind (not the case for us, whew), and extreme aversion to sweet tastes (doesn't look like that's the case for us).

The next possibility is known as Fructose Malabsorption, which is a long-term problem requiring major diet modifications, but can't actually make you acutely ill. You just have to to figure out the severity of your problem-- how much fructose your small intestine is able to absorb-- and avoid foods containing fructose and fructans to the extent that you need to. Some people report that they do ok with citrus fruits, for example, and others can handle berries. The trick for most people seems to be to make sure the balance of fructose and glucose is in check. If you have more fructose than glucose, that's bad. Apples and pears have bad ratios. Grapefruit is better. Apparently, if there's enough glucose present, the fructose can chemically bind to it before it becomes a problem, and be whisked away without ever getting the opportunity to wreak havoc in the large intestine. In fact, some sufferers will even carry around a little bag of glucose powder to sprinkle on foods that they suspect may be overly fructose-ified. Or eat Smarties. Smarties are 100% glucose. (Ericka Samuels Nicol, are you reading? One testimonial I read was about a guy who craved Smarties all the time and literally wore away the enamel on his teeth because of all the citric acid. Later he found out his IBS was actually undiagnosed Fructose Malabsorption. His hunch was that his glucose-craving was an instinctive measure of self-protection.)

Anyway, it's probably neither of those things. There's also something called "toddler's diarrhea," which is just this weird, chronic diarrhea full of undigested food, that can last for weeks or months or even a couple of years in an otherwise-thriving kid. Almost everything you find if you Google it says that nobody really knows what causes it, that it eventually goes away, and oh by the way you should probably steer clear of apple and pear juice, because that seems to make it worse. Hmmm, apple and pear juice, you say? My mama-detective brain saw that and flashed "fructose!" So I dug a little more and found one study that postulated that fructose malabsorption is probably responsible for most cases of ongoing toddler's diarrhea. The problem that usually goes away before anybody's able to pin down exactly what's causing it.

It wasn't a conclusive study, and that's not exactly the problem Susanna has. "Diarrhea" wouldn't be my first descriptor of what's been plaguing her, "acute gas pain" would. ("Chunks of apple in her poop" would be the second.) But I'm certain it's all related, and I'm optimistic that what we're dealing with here is just a digestive system that is developing more slowly than we might expect. I keep saying to myself: newborns can't digest anything but milk-- adults can usually digest almost everything-- the process of getting from point A to point B can't possibly be the same in every person, and even though Lea was happily slurping down applesauce and mainlining green peas by this age doesn't mean that every child is ready to do that. I've even seen it theorized that a lot of pureed baby foods are probably passing straight through a lot of babies' guts without actually being absorbed at all, but nobody notices because let's face it, a lot of baby food looks something like baby poop in the first place. It seems to me that the ability to absorb fructose is one that perhaps develops a bit more slowly in some of us, but if we don't recognize that and keep pushing produce, ouch.

So, for now, we're going fructose-free, as much as we can. I've been doing some wheat-free baking and forcing myself to rethink my notions of what's a "healthy diet." As much as I'd like to institute good veggie-eating habits starting today, vegetables are not, at least for the moment, healthy for my particular child. We'll try to give fructose- and fructan-containing foods another shot, one at a time, every month or so and see if there's any change. In the meantime, we have an appointment with a pediatric GI specialist in a few weeks, who will be able to shed a whole lot more light on the situation and maybe administer some tests to see if we're on the right track (and hopefully rule out the much more serious HFI).

So that's where we're at. Susanna hates to be left out of the fun at mealtime, and we've got to supplement the (still mercifully easy for me) breastfeeding with a fair amount of table food. That means lots of scrambled eggs, meatballs, ground turkey, plain potatoes, oatmeal, and samples of the various wheat-free breads I'm experimenting with. Dairy seems to be ok, though she's never had much of it, so we'll go slow with introducing that as well.

Poor little girl has just been in so much pain for too much of her life so far. All I want to do is fix that. I want these screamy nights to be a thing of the past, and so far, switching up her diet is at the very least, a step in the right direction. I really hope that this problem, whatever it is, resolves itself soon, and you get a sheepish "Um, nevermind" post from me sooner than it usually takes for me to update this blog. I hope my little girl can eat apples some day. I hope she's not grinding up Smarties in her spaghetti sauce. But if she is, I know someone who just got a brand new flat-top stove that will be more than happy to help her come up with the perfect recipe.