Substitutions

If you've spent any time in my kitchen in the last three years, you've seen a lot of these in the meals I prepare.

Ever since D and I stopped being able to eat much refined sugar and starch, thanks to reactive hypoglycemia, we've been using any stand-ins that would produce similar results in cooking -- even if the ingredients in question weren't those that naturally occur in foods you could buy at the farmer's market. We're talking products that have been enzyme-modified or chemically transmogrified to fool our bodies into ignoring them. Our pantry was a shrine to the gods of Splenda (packet-style, available in boxes of 700 from Amazon's subscription service), maltitol syrup (straight for baking or flavored for coffee), erythritol (granular for creaming into batters and powdered for whipping into frostings), and xylitol honey (in a squeezable bear-shaped bottle to boot).

It turns out our bodies don't take lightly to being deceived. Cue insidious digestive deterioration.*

The elimination diet forced me to stop using our usual sweetener stock, among many other staples: wheat flours; corn, soy, and dairy products; even eggs and yeast. Did you know that baking powder contains corn? And some vanilla extracts too? What in the name of all baked goods is left to make a pan of muffins with?

Plenty.

Of late, I've been craving cornbread. It's cold out, hearty soups have returned to our menu in full force, and I've been missing the sweet-savory flavor of a fresh-from-the-oven pan of golden goodness to go along with a bean-and-chicken stew. D's mother's cornbread recipe had been languishing in our kitchen file for too long, and I was getting tired of eating rice at every meal. So I pulled out the instructions and started making substitutions.

But wait, you're thinking. How do you make cornless cornbread?

With millet.

The results were more than I could ever have hoped for. These tiny little grains, when cooked, produce an uncannily cornmeal-like texture and flavor. I won't say the final product was indistinguishable from true cornbread, but it was a more than respectable stand-in that I had to remind myself not to consume in a more than reasonably sized portion. (For anyone with reactive hypoglycemia, it's still full-strength on the carb scale, even though it contains no refined sugar.)

The success made my week. It's been hard not to think of the food I've been allowed to eat as a second-rate option to the foods I've had to give up. But that is exactly what I've needed to change in order to move forward with the body I have now -- the one that probably will never be able to eat wheat or dairy again. No more thinking of our allowed options as substitutions. They're alternatives, incredibly freeing ones because they won't mistreat my body.

That said, I'm not settling for lesser quality in our baked goods. If an alternative bread or scone or muffin doesn't make me want to go back for seconds (against my better judgment), then the recipe needs tweaking.

So. I'm posting this week's cornbread recipe with original and alternative ingredients side by side. For anyone with food sensitivities or just a curiosity about different baking options, you can employ as many or as few of the suggested changes as your palate desires. (N.B.: the directions account specifically for alternatives; if you use only standard ingredients, simply mix the dry then add the wet and pour into your chosen pan.)

Corn/{millet} bread

2 cups all-purpose flour / {1 cup gluten-free oat flour and 1 cup brown rice flour}
4 tsp. salt
5 tsp. baking powder / {2 tsp. arrowroot starch, 2 tsp. cream of tartar, and 1 tsp. baking soda}
4 tbsp. sugar / {3 tbsp. sucanat** and 4 tbsp. pear butter***}
1 1/2 cups cornmeal / {3/4 cup millet flour and 3/4 cup cooked millet****}
2 eggs / {2/3 cup water and 2 tbsp. ground flaxseed}
2 cups milk / {2 cups coconut, rice, or almond milk}
1/2 cup plus 2 tbsp. melted shortening / {1/2 cup plus 2 tbsp. olive oil}

1. Mix flours, salt, arrowroot, cream of tartar, baking soda, and millet flour in a large bowl. Add sucanat and cooked millet, breaking up clumps with a fork.

2. In a separate bowl, mix water and flaxseed. Allow to stand 5 minutes (mixture will gel slightly). Stir in pear butter and milk.

3. Add wet ingredients to dry; beat quickly with fork. Stir in olive oil until combined.

4. Pour into 12 muffin cups (place extra, if any, in mini loaf pan or ramekins). Bake at 400 F for 35 minutes or until toothpick inserted in center comes out clean (crumbs are okay, batter coating is not). Cool in pan for 10 minutes, then unmold and transfer to wire rack. Centers will fall slightly -- without gluten or egg, the bread has less structural integrity -- but should not cave in. (Xanthan gum is a recommended additive to rectify this problem, but I'm holding off on experimenting with it until after the remaining food trials are done.)

Makes 12 muffins plus one mini loaf. Half recipe makes one 9-inch square pan of bread. We use a muffin pan to make single servings easier to measure.

* I do not claim that substitute sweeteners single-handedly caused the GI disaster of 2009-2011. But they were certainly associated with the problem; once they were eliminated from our diet, I started to feel better. Symptoms returned during repeated trials with at least one of the sweeteners mentioned above, as they did during trials of a number of other foods. Which just means I won't be consuming any of those items in the near future.

** Sucanat is plain old dried sugar cane juice (but not the same thing as evaporated cane juice, which undergoes more processing). We've found it at Whole Foods, on Amazon, and in our local co-op.

*** We make our own pear butter by boiling down ripe pears with a little water and honey. If you want our recipe, just send me an e-mail; otherwise, similar fruit purees can be used (e.g., unsweetened applesauce).

**** I had leftover millet that I'd prepared in our rice cooker (one part grain to two parts water). For simple guidelines on cooking millet on the stove, check out this site.

Nine weeks

That's how long I've been on this crazy elimination diet.

Yes, I chose not to write about the testing while it was ongoing -- it was life-consuming enough that I needed this space to think about other things, like what I've been examining through my most recent series of musings. I plan to continue adding to that, but more intermittently now that it's established (for me, as a commitment through habit of thought).

In the meantime, I'm beginning to get the much-wanted answers I'd been looking for. Preliminarily, we've determined that dairy products from cows do not love me, as much as I love them. Goat dairy is kinder, but ambiguously so. Eggs lie somewhere in between on that spectrum. Corn and soy are friendly.

Today I will complete one of three different gluten trials, and then we will suspend testing until our return from Hawaii. Our original plan was to be done with all the trials before the trip -- this Thursday! -- but because the dairy tests worked me over so thoroughly, I needed a lot of extra recovery time between each of them, which pushed our testing timeline much further into the fall than I'd anticipated.

I'm a mess of mixed feelings about it all. Relieved to have results at last, some of them quite definitive. Frustrated but resigned to the fact that more testing has to continue when we get back. Disappointed that the dietary limitations we've discovered so far will mean some significant changes to our original vacation plan.

I'd wanted a true getaway, where we'd have largely unstructured time to lie on the beach with a stack of books, bob around in the ocean, catch some tropical sunsets, feed ourselves on inexpensive local cuisine. We can still do plenty of all this -- but we'll have to be vigilant about what I eat that I haven't personally prepared (don't get me started on the pervasiveness of dairy in commercial foods, but do check out this site if you need guidelines for your own dairy sensitivities). And we'll need to cook some food as backup for moments when we're unable to find something that works at those mom-and-pop restaurants (or roadside stands) whose plate lunches or noodle bowls we were so looking forward to sampling. I guess it's the dream of being totally carefree -- not having to think so hard about what needs to be done ahead of time or what contingencies we ought to anticipate -- that is looking more and more unrealistic, and it makes me sad.

Still, I'm determined to be over this by the time we leave. This trip is meant to celebrate our surviving much, much worse. Like, say, all of 2010; the residual aftermath of an extended thesis year; the accumulated tension from the two-year commute that changed us both indelibly.

So I'm making a plan now, to minimize the mental effort we'll have to put in when we arrive. Grocery stores? Located. Cooking facilities? Secured, through our bed-and-breakfast hosts. Restaurant menus? Downloaded and vetted. Restaurant staff? Where practical, already contacted to ask if they can accommodate my dietary needs.

I hope, hope, hope that it all pays off. We may not get to throw caution to the wind, but at least these preparations will let us use the majority of our time to relax, rather than spend it on pesky logistics ...

Things I can no longer ignore

It's funny how timing works out.

I've had my head in my thesis pretty steadily (and intensely) since February -- and in the midst of concentrating on the project with so much of my brain, I had to let a lot of other things on my radar remain, at best, peripheral. Which included some aspects of my health. Nothing debilitating: some skin irritation, nerve wonkiness in my hands and feet, intermittent GI protests. The last issue has been ongoing since the middle of 2009 (despite the work-up a year ago), and after so long, I'd practically gotten used to it.

But about two days before I turned in my thesis to my committee, things started to get noticeably worse. Fortunately, I had a follow-up appointment with my doctor (the new one) the day after my draft was due, and her advice, after hearing everything that had been going on for so long, was to consider a food sensitivity as the culprit.

"Gluten and dairy," she said -- these were the most likely suspects. So she suggested an elimination diet followed by an allergen challenge. "Just try going gluten-free for three weeks then dairy-free for three weeks," she said, "and see what happens."

What else is a girl to do with all her newly available time?

I took the news back to my dietitian, who happens to specialize in this kind of testing, and she printed up the protocols. I figured the process wouldn't be fun, but it would be short-lived. Then I looked at the instructions.

"To make this kind of testing accurate and meaningful, you'll want to do more than eliminate gluten and dairy," she told me, pointing to a greatly expanded list of foods and food additives. "Sensitivities can occur in groups. So ideally, you'll want to test all of them."

I won't reproduce the whole catalog here. But let me name a few choice items besides gluten and dairy. Corn. Soy. Eggs. Peanuts. Tomatoes. Peppers. White potatoes. Processed and/or non-organic meats. Shellfish. Strawberries. All citruses. Caffeine. Alcohol. Refined sugars and artificial sweeteners. Processed oils. The list is, even for someone who already has experience with dietary restrictions, more than daunting. And the diet has to be followed for nine weeks, four to allow the body to get rid of residual allergens, then five that cycle in -- very carefully -- each group of potential irritants, one set at a time every third day.

Let's just say this isn't how I envisioned I'd be spending most of the summer.

There is an upside: if I can get this done by mid-September, I will potentially know exactly what's making me feel less than terrific -- and, after getting rid of the little menace(s), be able to go to Hawaii feeling better.

So. After the thesis is officially finished, I'll be looking into the logistics of this new project. It wouldn't be quite so intimidating if I lived on my own and had no one else to answer to. But we've been looking forward to being more social, inviting people over for potluck, taking an extended bike trip with a few friends, visiting and being visited by family. All of that suddenly seems incompatible with the trial because it's inconvenient for the people around me. Imagine subjecting visitors to all of those restrictions when we eat at home or outside the house. Or, in the opposite vein, consider the culinary acrobatics of preparing dual meals so guests can eat "normally," hosting a potluck but not eating what your friends have prepared, going to restaurants but not ordering anything and packing my own food to consume before or after. (Seriously, what are the chances a mainstream eatery will have something, besides a naked lettuce leaf, free of refined sugar, processed oil, corn, soy, eggs ...)

And then there are those looks. The ones you get from people who don't understand your limits and, once they realize just how many there are, back away warily. I shouldn't have to apologize for my circumstances but I often feel like it's warranted -- for the relatively few restrictions I have now, which already make some people uncomfortable.

I know -- those instances are occasional and I shouldn't expect to run into them all the time, but they reduce me to a sense of profound and irrational loneliness. I can't let that prevent me from doing the testing and I can't let the testing keep me from having a life. But how?

Well, if there's anything I'll learn from this experiment, it will be some kind of answer to that question.

Drink and be wary

I meant to blog last week, really. But I didn’t bank on a minor medical mess getting in the way of that.

As I mentioned earlier, my gastroenterologist had me schedule some more tests after my unfortunate GI problems didn’t clear up. One of those tests, just a regular old CT scan to look at my pancreas, was Wednesday morning. It meant getting up at 5 a.m. to start drinking the barium shake (foul-tasting stuff, see photo) so my insides would show up nicely on the x-ray. No problem, I thought; I’ll chug it, sleep a little more, then head to the hospital to get the scan over with.

I arrived on time, did my paperwork, changed into hospital scrubs, and got my IV put in for the contrast dye that, when injected during the scan, reacts with the barium to produce all the fun images on the film. That went fine. You get a very warm sensation as it’s happening, but it’s nothing particularly uncomfortable. When it was all over, the CT technician asked me if I was experiencing any tightness in my throat or itching. And at that time, I wasn’t. So he sent me off to change back into my own clothes.

It’s a good thing there was a mirror in the dressing room. As I was pulling my shirt on, I noticed that my face was slowly turning bright pink. As in the color it takes on after I’ve had a drink (yes, I’m one of those Asians without the enzyme that breaks down alcohol) but more so. As I peered into the mirror, I watched the pink stain spread down my neck toward my chest. Uh oh, I thought. Not good.

I went back to find the CT technician, who took one look at me and said, “Well, I think we’re going to have to keep you here a little longer.” He showed me to a large chair and handed me a very tall glass of water. “Drink this,” he said. “Sometimes people have a little reaction to the dye. We’ll just get your kidneys kick-started so they’ll pull it out of your bloodstream. Just sit tight, and I’ll check on you in five minutes.”

Now I know what an allergic reaction looks and feels like. My sisters and I each have our allergens that produce full-body swelling when we get exposed. So the feeling creeping down my body as I obediently downed the water was very familiar -- and it wasn’t going to go away without proper antihistamines. By the time the CT tech returned, the hives were progressing down my arms. “Hmm, I’m going to go get the doctor,” he said.

Sigh.

They kept me for another thirty minutes to “monitor my reaction,” asking me to drink even more water. By the time they were ready to release me, I’d had nearly a quart of it, to no avail -- the hives were all the way to my knees. So they sent me home with two tabs of Benadryl with strict instructions to call 911 if I “experienced any shortness of breath, increased swelling, or other symptoms.”

Of course, since I had to drive myself, I couldn’t take the Benadryl until I got home. It worked very quickly, but it also knocked me out -- for six hours. I think I fell asleep on the couch around 10 a.m., dozed intermittently, and woke up after 4 with a massive headache. And a first thesis installment deadline 24 hours away. I had a good number of pages written, but they needed serious attention. So, no blogging until I got that done.

The installment has been sent, and I’m happy to say I’m back to normal (no more hives, headache, or haziness). Can’t say I quite feel great about the writing, but more on that later. Feedback from my advisor is forthcoming. As for the CT results, I’m hoping to have them before my endoscopy, which is in just over two weeks. So much to look forward to …