One of the most significant ways that foreign antigens, which may trigger the immune system to overreact, can enter the body is through what we eat. ~ Donna Jackson Nakazawa, The Autoimmune Epidemic
Even for people who are not ill, eating a Western diet high in carbohydrates, fats, and sugary foods causes the balance of micro-flora in the gut to change dramatically, creating an overgrowth of bad bacteria and yeast. ~ Donna Jackson Nakazawa, The Autoimmune Epidemic
In the first year of my life as a Sick Person, I kept struggling with the Why? of my illness. Why was this happening to me? How had I gone from thirty-five years of excellent health to sudden, inexplicable, chronic disease?
The causes of ulcerative colitis are unknown, and sometimes medical literature almost seems to imply that that means there is no cause at all. You did not cause your disease, experts and websites intone. The Mayo Clinic’s website, for example, reads:
Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause ulcerative colitis.
Despite such assurances, I couldn’t help wondering if I had somehow caused my disease. My friend Alison and I had discussed how stress might have contributed to my illness, and I had found some science to support this idea. But I had also made major changes to my diet and lifestyle in the year prior to onset. I often wondered about those changes, too. After all, if experts didn’t know what caused it, how could they be certain what didn’t cause it?
My dietary and lifestyle changes occurred when I began working from home. This was in January, 2013, ten months before my symptoms began. Instead of biking or walking a mile to and from work, I now stayed in. Exhausted after a rough year in 2012, I gratefully relaxed into the comfort of Ron’s and my lakeside apartment and my new writing endeavors. Writing about my dad, who had just passed away, was absorbing. I had little desire to be social, and besides, I was living in Madison and temperatures often dipped below zero in that first month. I sometimes went for days without leaving the apartment.
As the seasons changed and temperatures inched upwards, I tried to go for walks and do yoga for exercise. But that year I was also trying to gain weight for a healthy pregnancy–Ron and I were married now, and thinking about kids. A nurse had told me I should gain weight before getting pregnant. Keeping weight on has always been hard for me, but I was trying.
Why bother to stay in shape? As part of my new weight-gaining regimen, I heartily downed milk, ice cream, cheese, and more macaroni and cheese than I normally ate, which was already a lot of macaroni and cheese. These were my comfort foods. I deserved comfort this year. And besides–I must have internally reasoned–I wasn’t at risk for diabetes or other major health problems, because I was naturally slender.
Before 2013, I had worked with Ron and had eaten most meals with him, sharing oatmeal and beans and salads. But now, at home by myself, too often I lunched on mac n’ cheese. For health, I usually bought the organic, Annie’s version. For protein I mixed in tofu. When I wasn’t in a hurry, I’d have a small spinach salad on the side, completing what seemed like a reasonably healthy meal.
But I was often in a hurry.
There wasn’t always salad–spinach took too long to chew, anyway. My food was always hastily prepared, an afterthought, so I could get back to writing. Writing was what I had wanted to do all my life, and this year was my year to finally live my dream. Alone at the computer, without coworkers to distract me (or eat with), I often delayed lunch for hours to write just “one more” paragraph. Many days, by the time 3 pm rolled around, I was nauseous with hunger. Only then would I haul myself to the kitchen for today’s comforting, hurried box of mac n’ cheese. I can’t remember for sure, but I’ll wager I ate mac n’ cheese at least three days a week, and often similar meals, like spaghetti or pesto, in between. (Hey, they say you should eat a variety of foods.)
At the Columbia River Maritime Museum in Astoria, Oregon, a display states that the Chinook Indians consider themselves “people of the salmon.” I’ve also read that in Central America, the Maya consider themselves “people of the maize.” Looking at my diet for most of my life, I think the most accurate description for me would be “person of the noodles.”
In my first year of illness, as I looked back on my even-more-noodly-and-cheesy 2013 diet, my delayed meals, and my lack of exercise, I had no idea whether these changes had truly caused my colitis…but I also knew they couldn’t have helped.
Until colitis, I had never known anything about digestion, and had no idea I was at risk for a digestive disease. There was no IBD in my family. What’s more, for decades, I had appeared to have an exceptional, iron gut. I had no food sensitivities. For years, I had lived and traveled in Africa with minimal problems, seeming to get fewer bouts of illness than my fellow American travelers. I was a slender, fair-skinned, ginger-haired young woman who looked for all the world like a vegan, but who devoured hamburgers and bacon and cheese with gusto. This had even become a joke among my friends. They laughed each time I got asked if I was a vegetarian, because I got asked it so often.
In short, before colitis, I saw my gut as an efficient black box. In goes the mac n’ cheese, out comes the poop a day later, and there were never any problems.
But maybe, I thought now, in that year I had pushed some inner threshold beyond its limits. Maybe all that dairy and gluten had finally, fundamentally altered my gut bacteria. Maybe the stress of delayed meals that year, coupled with the lack of exercise, had finally led to severe inflammation.
Here is the story I was beginning to tell myself:
Since childhood, I had been careless about food, because I could be, because I was skinny. I probably routinely strained my system but didn’t realize it. I did have various inflammatory conditions, after all–chronic knee pain, acne, Raynaud’s disease–but just didn’t understand that they related to each other and indicated general inflammation. Then, in 2011, my chronic knee pain caught up with me and I stopped playing frisbee and jogging. Around that same time, I stopped working on a field crew in the summers at Ron’s and my streams job. I was becoming more sedentary. in 2013, as I settled into writing and trying to gain weight, I became even more sedentary and ate even unhealthier food, possibly altering my gut flora somewhat and making my body more vulnerable to inflammation. And I was also dealing with grief, stress, and anxiety over that same period, a prolonged period of stress from 2012 to 2013. It all tipped me over some kind of edge. My immune system went haywire, and my colon–the part of me that was under the most strain, due to my poor diet–eventually became inflamed.
This story made sense to me.