Mainly Tired

NOTE: I'm not a doctor nor a nutritionist nor anything like that. I'm just going to tell you about my own personal experience, which may or may not be of use or of interest to you. Talk to your doctor blah blah blah.

About 18 months ago, I was in a pretty rubbish state- physically and mentally and... "energetically". There were days when I was unable to get out of bed. I had gained a lot of weight and felt 'swollen'. It wasn't just the exhaustion, I was also 'achey'. It was a kind of non-specific widespread 'ache'. Nothing sharp or debilitating, but just there. All. The. Time.

I was several years into FULL ON perimenopause, had started HRT (oestrogen and progesterone only, I hadn't yet started on testosterone) and basically just assumed that this was my life now. It was all downhill from here, I guess... I was sleeping OK, but often in pain at night. I was taking supplements and keeping myself busy and trying my best to be a part of the world... but still I was exhausted and unable to move every few days.

Also, about a month before the first lockdown- 18 months or so before I ended up in bed a lot- I injured myself. I snapped my ACL, tore my PCL and MCL and had multiple tiny fractures in my femur and tibia (Google it all)- and couldn't walk properly for a year. I'd expected that after such a huge injury I would be dealing with inflammation and consequently suffer from depression. I felt like this prior knowledge would insulate me from the worst of it. Mind over matter and all of that... Also, I was taking vitamin D to try and help with the inflammation and yet here I was 18 months later in bed every few days.

Menopause, life-changing injury... Everything was pointing to depression. I was aware of this and I kept interrogating myself: am I depressed? And I could never honestly answer 'yes'. I was fine, I was just annoyed more than anything that I couldn’t walk properly and had no energy. But maybe I had no energy because I was depressed??? Again, I couldn't honestly accept that. I've suffered from depression before and this was different. This was… physical somehow.

For a few years previously, a friend of mine and I said that, if we wanted to, we were positive that we could go to our GP and, without telling a single lie, get diagnosed with either fibromyalgia or chronic fatigue syndrome. We were just tired and achey and bleurgh. In fact, my Instagram profile still shows you how I felt all that time...

But this new phase was even worse. It wasn't just that I felt a bit low energy, I was unable to get out of bed. It could have been menopause or 'fibro' or chronic fatigue related, of course, and had I just assumed any one of those, I'd still be in bed every few days right now.

But I’m not.

I'd spent the previous summer in France - as I usually do - and had noticed that I always felt amazing in France. Healthy, happy, energetic. I assumed it was a combination of things: the sun, the fact that it was the summer holidays so I wasn't being woken by my alarm every morning at fucking 6am for the school run holy shit all of that is about to start again for fuck's sake... But also I felt great in France because of the food. I felt... clean. I can't explain it, but internally there was a huge difference that I felt when I was in France. I felt lighter, less… bleurgh. Surely, if it was menopause or 'fibro' or whatever where I was located in the world wouldn't matter... right?

During one of my many stays in bed in Spring 2022, I was thinking about how in a few months, I'd be back in France and feeling better again. And then thought 'Why do I have to wait until then? What am I doing the rest of the year that I don't do in France?' I started investigating. Right away I found articles about how the French lifestyle is healthier. But I exercise less often when I'm in France, drink more booze, eat LOADS of bread and cheese and cream and I feel better… and don't gain weight or often lose weight... it didn't make sense.

Then I started to find articles about people who couldn't eat bread when they were 'at home', but were fine with it in France. It seemed that it wasn't just anecdotal: "The French population as a whole has a lower incidence of obesity, type 2 diabetes, metabolic syndrome, irritable bowel syndrome and as recently has been discovered, coeliac disease, than most western countries. Childhood obesity levels in 2012, were 13.9% in France compared to 17.8% in England."

Could I have an issue with... gluten??

Oh god. Please, no.

Basically, better than sex. You know it is.

One of my very good friends has celiac, so I emailed her right away. I told her what I suspected, how I felt better in France and, if I really thought about it, I've felt a bit 'funny' with wheat for a while now...? She replied saying that it's highly unlikely that my issue is with gluten and most people who think they have an issue with gluten do not. Instead, it is more likely they have an issue with FODMAPs.

Okaaaaay?

This was something new to learn about… I looked at a list of high FODMAP foods and thought perhaps this could be my issue. There were some types of FODMAP groups that I clearly didn't have an issue with another others that I realised I did. Wheat was a big one for me, but also I know I didn’t like to eat things like kidney beans, oat milk, and green bell peppers (but not red).

I decided to look into it more: “FODMAPs are a group of sugars that are not completely digested or absorbed in our intestines. When FODMAPs reach the small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas as a result. The extra gas and water cause the intestinal wall to stretch and expand. Because people with IBS have a highly sensitive gut, ‘stretching’ the intestinal wall causes exaggerated sensations of pain and discomfort”. And almost immediately I realised: this has got to be it.

But also... IBS??! Did I have IBS?? I really didn't think so. Anything I'd heard about it wasn't recognisable. According to the NHS:

The main symptoms of IBS are:

stomach pain or cramps – usually worse after eating and better after doing a poo

bloating – your tummy may feel uncomfortably full and swollen

diarrhoea – you may have watery poo and sometimes need to poo suddenly

constipation – you may strain when pooing and feel like you cannot empty your bowels fully

Nope. Not me... I mean, sometimes things would make me bloat, but that’s normal, isn’t it? The symptoms go on...

IBS can also cause:

farting (flatulence)

passing mucus from your bottom

tiredness and a lack of energy

feeling sick (nausea)

backache

problems peeing, like needing to pee often, sudden urges to pee, and feeling like you cannot fully empty your bladder

not always being able to control when you poo (bowel incontinence)

OK. Not really me other than I was a bit farty sometimes, but that's normal, isn't it? But also 'tiredness and a lack of energy'? Is that enough to be IBS? Could I just have mild IBS which was mainly causing exhaustion? Really?? Let’s see…

I went back to the Monash University site- they are the world leaders in FODMAP research - read everything I could and got information on doing an elimination diet. I downloaded the Monash App and started an elimination diet right away. It was pretty easy. I found loads of great recipes and never felt like I was depriving myself of anything. I started feeling better almost immediately... After 5 or 6 weeks, feeling great, full of energy, happy, I decided to start the reintroduction phase. The first things I wanted to test were garlic and then onions because if I couldn't eat either of them WHAT THE FUCK IS THE POINT OMG???????

They were totally fine. Phew.

Then wheat. Right away I felt shit and realised that I had digestive issues. For the first time since I started this elimination, I could "feel" my digestion. It was uncomfortable... and I'd just taken it as 'normal' for years and hadn’t even realised it was unusual. So that was clear. I had IBS, but just not in a way that I recognised from the way others spoke about it.

A few other early FODMAP positives for me: kidney beans, oat milk, green peppers (as I suspected), but also chickpeas (there goes hummus ::sad face::), the stems of tender stem broccoli (WTF?) and inulin (literally don't know)...

By this point we were heading off to France, so I decided to abandon the elimination diet. I'd got the most important answer for me- wheat was a big issue - and if I had 'flare ups' in France, I'd be able work out what else I had issues with (hello, butternut squash), but it was clear that my issues were with some fructans and GOS... OK...

But the question remained why could I eat bread in France and feel fine? I understood that the fermenting process of the sourdough process to make baguette breaks down the fructans, but I can eat croissant and tarts and all kinds of things made with flour in France without any issues. This is tricker to work out, but basically France (and Italy and probably other European countries, I don't know) uses "soft wheat" for its bread flour and "hard wheat" for its pasta (which is why pasta still can be tricky for me in France) and they have differing amounts of proteins and gluten etc. There seems to be some research on FODMAPs and wheat variety, but it's behind a paywall and I can't access it, so no idea if it's relevant in France or not. But in the UK (and the US) we tend to use "hard wheat" for everything as it's higher in gluten and so better for bread cakes etc (ever notice how they don't really do cake in France?)... So, it's likely that it's the type of wheat used in France which I am more able to tolerate. But I don’t have any more specific information on that.

Eighteen months on and how am I doing? I've been taking probiotics and prebiotics (but staying away from inulin/chicory root!). I'm not really eating bread or wheat-based foods - though I've found a bakery that does 4-day fermented sourdough which works for me. I tend to have things like gluten free pasta or oat crackers because it's easier than ending up exhausted. I only occasionally have foods that I'm overly sensitive to - the aim is to heal and be able to eat FODMAP foods I'm currently sensitive to, so I keep trying them. But I'm no longer exhausted and remaining in bed every other day. I'm not achey. I feel less 'swollen'. I've lost a bit of weight. I feel better than I've felt in ages.

So, if you are exhausted, run down, maybe achey and maybe have digestive issues (but maybe not ones you realise are obviously IBS, ie bloating), have a look into FODMAPs and see if any of it rings true for you. It's helped me enormously and hopefully it will help some of you.

Again, the first port of call should be Monash University, stay away from woo, follow the science. Good luck!