Why when newbies arrive with very high BS 20+ and go onto a Very Low Carb Diet

[phoenix]

Some people who are newbies are not new to diabetes.Some people who are newly diagnosed may have had undiagnosed diabetes for a long time .
As Indy says beta cells can be lost . And of course there are people who may have been labelled as T2 but who actually produce less insulin. Beta cells may have been destroyed by the immune system (LADA), they may have a defect in the signalling system( some types of MODY) or something else entirely.
If insulin levels are low then glucagon levels will rise and gluconeogensis will increase .The liver will use protein or break down body muscle to make glucose (that's what happens in T1 before diagnosis but it can also in longstanding T2. It may also be that people are actually producing far more glucagon than they should do (so more glucose is being made/released.
In some of these cases then people may not be able to lower their levels with diet , of any kind ,without some form of medication ( for example metformin acts,in part, to reduce the glucagon response)
Can you imagine how someone in this situation would feel if they were told that they somehow weren't doing it right?
(in any case I can give examples where people use other diets successfully but that isn't the thrust of this thread.)

My second point is that in a minority of cases getting levels down as quickly as possible isn't necessarily a good thing.
In someone who has developed some degree of retinopathy, a rapid reduction of HbA1c may lead to a more rapid progression of the existing retinopathy. In the long term a lower level is certainly better but taking many months to get there may , according to this hospital website, be sensible .
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
also from the same website :
Late diagnosis " is very common, even in wealthy areas such as North Birmingham. 15% of patients have retinopathy at presentation, and diabetes may have been present 5-9 years previously"

 

[rowan]

Just bought the app for my iPhone. Hope that's as good

The book Eat Fat also explains it very well, the link for that is in my signature. It's a very different book to Carbs and Cals, but both equally helpful

 

[jack412]

Some people who are newbies are not new to diabetes.Some people who are newly diagnosed may have had undiagnosed diabetes for a long time .
As Indy says beta cells can be lost . And of course there are people who may have been labelled as T2 but who actually produce less insulin. Beta cells may have been destroyed by the immune system (LADA), they may have a defect in the signalling system( some types of MODY) or something else entirely.
If insulin levels are low then glucagon levels will rise and gluconeogensis will increase .The liver will use protein or break down body muscle to make glucose (that's what happens in T1 before diagnosis but it can also in longstanding T2. It may also be that people are actually producing far more glucagon than they should do (so more glucose is being made/released.
In some of these cases then people may not be able to lower their levels with diet , of any kind ,without some form of medication ( for example metformin acts,in part, to reduce the glucagon response)
Can you imagine how someone in this situation would feel if they were told that they somehow weren't doing it right?
(in any case I can give examples where people use other diets successfully but that isn't the thrust of this thread.)

My second point is that in a minority of cases getting levels down as quickly as possible isn't necessarily a good thing.
In someone who has developed some degree of retinopathy, a rapid reduction of HbA1c may lead to a more rapid progression of the existing retinopathy. In the long term a lower level is certainly better but taking many months to get there may , according to this hospital website, be sensible .
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
also from the same website :
Late diagnosis " is very common, even in wealthy areas such as North Birmingham. 15% of patients have retinopathy at presentation, and diabetes may have been present 5-9 years previously"

I think it's about 50% pancreas function by the time T2 is diagnosed

from your page.." Nevertheless I think it is preferable to accept this [retinopathy] rather than delaying good control several more years."

 

[daddys1]

Some people who are newbies are not new to diabetes.Some people who are newly diagnosed may have had undiagnosed diabetes for a long time .
As Indy says beta cells can be lost . And of course there are people who may have been labelled as T2 but who actually produce less insulin. Beta cells may have been destroyed by the immune system (LADA), they may have a defect in the signalling system( some types of MODY) or something else entirely.
If insulin levels are low then glucagon levels will rise and gluconeogensis will increase .The liver will use protein or break down body muscle to make glucose (that's what happens in T1 before diagnosis but it can also in longstanding T2. It may also be that people are actually producing far more glucagon than they should do (so more glucose is being made/released.
In some of these cases then people may not be able to lower their levels with diet , of any kind ,without some form of medication ( for example metformin acts,in part, to reduce the glucagon response)
Can you imagine how someone in this situation would feel if they were told that they somehow weren't doing it right?
(in any case I can give examples where people use other diets successfully but that isn't the thrust of this thread.)

My second point is that in a minority of cases getting levels down as quickly as possible isn't necessarily a good thing.
In someone who has developed some degree of retinopathy, a rapid reduction of HbA1c may lead to a more rapid progression of the existing retinopathy. In the long term a lower level is certainly better but taking many months to get there may , according to this hospital website, be sensible .
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
also from the same website :
Late diagnosis " is very common, even in wealthy areas such as North Birmingham. 15% of patients have retinopathy at presentation, and diabetes may have been present 5-9 years previously"

Hi Phoenix, thank you for this, it is indeed very informative and gives a very good understanding of why we cannot all expect a sudden fall in numbers, where lots of us do.
When I started here and I followed the LCHF, the numbers dropped very quickly for me, I was then telling other diabetic friends, outside this forum, without fully understanding all the intricacy's, that they should be doing what I have done and it will work for them, but at that time not having the knowledge I do now & did know or appreciate how different we all can be.
Thanks, Neil

 

[cold ethyl]

I seem to recall Prof Taylor suggesting that in type 2, certainly in the early years, the beta cells are not so much destroyed as hibernating. By losing the excess weight that many of us carry at diagnosis, we give our bodies a chance to heal itself. I can't say I did any fancy calculations with calories, percentages of fat, protein etc other than jotting stuff down on paper in the early days and making the decision that high fat was better viewed in my case as enough fat as I could so easily have just over eaten fat as I had previously over eaten carbs. Something clicked and ice lost over 5st since last May. My BS levels came down as I lost the weight , even though I dropped Metformin tablets so I think for some people it may not be until significant weight loss has occurred that they see a substantial drop in BS levels. Also even now, I notice elevated levels for me following an excess of protein so I do think that is something we all need to be mindful of. Also if the person has eating issues , they do need to be mindful that low carb while alleviating carb cravings and helping BS, in itself may not address weight problems if a mountain of food of one type is just replaced by a mountain of food of another type- some folk won't lose weight on bulletproof coffees or a cow's worth of dairy - this isn't them doing it wrongly, but rather that a one size fits all approach is doomed to fail someone. Only by testing and recording can we decide what works for us as individuals within an overall lower carb framework. Sadly Prof Taylor also pointed out that our personal fat thresholds ( the going over of which he cites as major cause of type 2 ) may be a lot lower than we'd like - as a generation our weight distribution curves have shifted right wards so just because I'm not the fattest person I see, doesn't mean I'm not too fat in my liver and pancreas for me.

 

[mehhh2015]

When I started low carbing, I did it gradually - going from 100 to 50 to 30. However, it was only when I took the final step of going below 20 that I saw dramatic reductions in my readings and got them to the levels they are now.
I'd agree with what others have said that when people start they are eating more carbs than they realise - they hide everywhere

I'm with you here. I only see dramatic results when I am well below 30 grams or in other words (that seems like a crime to say sometimes in this forum for some reason) Atkins induction (the forbidden diet it seems...).

I never refer to my approach as high fat because although I do consume fats in a wide range and variety of sources (and have no issues about it), it can give people, particularly people new to low carb that are at the very beginning of their journeys, a wrong idea of how it works. Both fats and carbs need to be adjusted to individual requirements, as well as protein. However, in my experience, the most determining factor is and always will be: carbs.

I don't find it hard at all to keep myself at that level of 30grms or less. If anything, is much easier than higher levels of carbs, but certainly, and probably for most people, is the most boring way of doing it, and I can't blame them for it.

In my case it gives me consistency and peace of mind: I don't have to constantly be thinking what am I going to eat, or how much of it, I set the rules and stick to them, end of the story. It's not easy though, and many times previously I have found it frustrating, particularly when stressful situations triggers my emotional need for starches.

One important aspect for me, is the non processed character of my food intake. Because I was used all my life to a non processed food lifestyle, I don't get exposed as most people is to hidden carbs. I keep it as simple and as practical as I possibly can. And I guess that works on my benefit.

The introduction of nuts and seeds is another factor that affects the diet in my personal opinion and experience, particularly in the weight loss department.

Also, insulin sensitivity increases gradually and even if a person is seeing results but a lower rate doesn't mean it isn't working, it might mean they have a higher level of insulin resistance (in some cases obviously not all), I don't think it necessarily means beta cell burnout, it might mean decreased insulin sensitivity. Me thinking...

 

[jack412]

I seem to recall Prof Taylor suggesting that in type 2, certainly in the early years, the beta cells are not so much destroyed as hibernating. By losing the excess weight that many of us carry at diagnosis, we give our bodies a chance to heal itself. I can't say I did any fancy calculations with calories, percentages of fat, protein etc other than jogging stuff down on paper in the early days and making the decision that high fat was better viewed in my case as enough fat as I could so easily have just over eaten fat as I had previously over eaten carbs. Something clicked and ice lost over 5st since last May. My BS levels came down as I lost the weight , even though I dropped Metformin tablets so I think for some people it may not be until significant weight loss has occurred that they see a substantial drop in BS levels. Also even now, I notice elevated levels for me following an excess of protein so I do think that is something we all need to be mindful of. Also if the person has eating issues , they do need to be mindful that low carb while alleviating carb cravings and helping BS, in itself may not address weight problems if a mountain of food of one type is just replaced by a mountain of food of another type- some folk won't lose weight on bulletproof coffees or a cow's worth of dairy - this isn't them doing it wrongly, but rather that a one size fits all approach is doomed to fail someone. Only by testing and recording can we decide what works for us as individuals within an overall lower carb framework. Sadly Prof Taylor also pointed out that our personal fat thresholds ( the going over of which he cites as major cause of type 2 ) may be a lot lower than we'd like - as a generation our weight distribution curves have shifted right wards so just because I'm not the fattest person I see, doesn't mean I'm not too fat in my liver and pancreas for me.

I think...
yes, if you get rid of the organ fat, your pancreas function improves and 'hibernating' cell mass start again. also the 'insulin resistance' load is taken off the pancreas and what cells are left can work better.
But if the cell is dead..it's dead

 

[mehhh2015]

I seem to recall Prof Taylor suggesting that in type 2, certainly in the early years, the beta cells are not so much destroyed as hibernating. By losing the excess weight that many of us carry at diagnosis, we give our bodies a chance to heal itself. I can't say I did any fancy calculations with calories, percentages of fat, protein etc other than jogging stuff down on paper in the early days and making the decision that high fat was better viewed in my case as enough fat as I could so easily have just over eaten fat as I had previously over eaten carbs. Something clicked and ice lost over 5st since last May. My BS levels came down as I lost the weight , even though I dropped Metformin tablets so I think for some people it may not be until significant weight loss has occurred that they see a substantial drop in BS levels. Also even now, I notice elevated levels for me following an excess of protein so I do think that is something we all need to be mindful of. Also if the person has eating issues , they do need to be mindful that low carb while alleviating carb cravings and helping BS, in itself may not address weight problems if a mountain of food of one type is just replaced by a mountain of food of another type- some folk won't lose weight on bulletproof coffees or a cow's worth of dairy - this isn't them doing it wrongly, but rather that a one size fits all approach is doomed to fail someone. Only by testing and recording can we decide what works for us as individuals within an overall lower carb framework. Sadly Prof Taylor also pointed out that our personal fat thresholds ( the going over of which he cites as major cause of type 2 ) may be a lot lower than we'd like - as a generation our weight distribution curves have shifted right wards so just because I'm not the fattest person I see, doesn't mean I'm not too fat in my liver and pancreas for me.

I have to say, me: under 30grms equals dramatic weight loss fast and (seemingly judging by my results so far) equals normalized BGs. BG's and weight loss going hand in hand in my case.

 

[phoenix]

Jack: If anyone is in that situation they can read the link.The phrase that you have used is referring to one specialists opinion that HbA1c should be lowered at the level of 1% a year. The writer disagrees and suggests that is too gradual. There is a matter of degree (all of which is discussed in the link)
My points were that some may not be able to reduce levels with diet alone. Not everyone is in that position. I wasn't . I reduced to 4.9% very quickly became one of the 2% of people who find that they develop some retinopathy in this scenario (fortunately, it hasn't worsened from there but TBH I could have done without the worry and without the injections of dye every year. It's taken 8 years to get the nod from the opthamologist that it is stable)
Here also is one T2 members account which speaks for itself http://www.diabetes.co.uk/forum/threads/diabetic-retinopathy.21830/

 

[Muggle71]

The book Eat Fat also explains it very well, the link for that is in my signature. It's a very different book to Carbs and Cals, but both equally helpful

Thanks rowan I will look for that one too

 

[jack412]

Jack: Where did I say years? If anyone is in that situation they can read the link.
My points were that some may not be able to reduce levels with diet alone. Not everyone is in that position.
Here also is one members account which speaks for itself http://www.diabetes.co.uk/forum/threads/diabetic-retinopathy.21830/

I didn't say you did, what I'm pointing out is that although reducing A1c can trigger increased retinopathy, it is still recommended as the long term outcome is worth the initial worsening.
" Enlarge A 3% drop in HbA1c may increase the progression rate for 1-3 years. But after 3-4 years of good control, progression rates drops significantly (lilac line). In the long term, good control causes much less progression."
"A sudden improvement of control, perhaps with a 3% HbA1c drops, causes an increase in retinopathy progression for 1-3 years. After 3-4 years of very good control retinopathy usually stops progressing completely and most patients will never need laser again (our patients are discharged back to the retinopathy screening service)."

I agree with diet and meds as needed, I'm on 2000 metformin and will move on to other drugs as and when needed

 

[mehhh2015]

This is me exactly - as you see in my sig I had a high A1c at diagnosis and feel I probably been undiagnosed for about 4 years. I was on max meds at the start and I have now reduced as far as I can. I did try for a few weeks without gliclizide at all and very low carb and made my diverticulitis worse to the point of avoiding an op by the skin of my teeth and my bs gradually begun to rise and weight gain

I am happy to use a small dose of gliclizide that keeps my A1c below 6 along with about 90g carb a day rather than very low carb and a A1c in the high 6s. Sometimes on here I do feel that the impression is given that if you extreme low carb you won't need the meds sadly it's not always the case and we have to decide personally what we are happy with. There is no shame in taking meds if you need them

I think the point you are making is extremely important. Because a generalized one size fits all approach can be very counterproducent in the wrong individual. I had the opposite experience, I was convinced that my problem was not lack of insulin but lack of sensitivity. I was given Gliclazide and thought that it was not the right protocol for me, however, I took it, due to the pressure that my other half put on me to take them and me being scared after hospital experience, the result: my acne came back in full rage... which only means (in a PCOS lady who is IR since as long as she can remember) one thing: excess testosterone induced by the effect of insulin over the ovaries. FBG didn't drop properly until I got rid of the Gliclazide. But I do agree the right medicine for the right case should be considered a way through and not a stigma, and I am happy with the results I get from metformin. But I do certainly acknowledge that a person that isn't insulin resistant or that is not having results while LC might have a problem of insulin production. So thank you for de-stigmatizing meds.

 

[mehhh2015]

I didn't say you did, what I'm pointing out is that although reducing A1c can trigger increased retinopathy, it is still recommended as the long term outcome is worth the initial worsening.
"A sudden improvement of control, perhaps with a 3% HbA1c drops, causes an increase in retinopathy progression for 1-3 years. After 3-4 years of very good control retinopathy usually stops progressing completely and most patients will never need laser again (our patients are discharged back to the retinopathy screening service)."

I'm not sure I have retinopathy (I hope not... need the test) but certainly my eyes went from been utterly blurry from distance (at high BG) to been unable to focus from nearby for a week or two after lowering the BGs. I can see fine now after a month

 

[jack412]

I'm not sure I have retinopathy (I hope not... need the test) but certainly my eyes went from been utterly blurry from distance (at high BG) to been unable to focus from nearby for a week or two after lowering the BGs. I can see fine now after a month

I think there is the normal blurry that happens when you drop BG, it's said to be the 'sugar' leaving the lens and does settle down ..as you found out.
but I think you still get your eye examination..to see what's going on, just incase you have some retinopathy that may need treatment.

 

[Kezzer4321]

I'm looking at what I have stopped eating, which is: spuds, all root vey, all bread, cakes, crisps, ALL fruit, fish and chips, Chinese takeaways.
I used to eat lots of roasted root veg.
Now if I have cut all that out, which I have. That's got to be good. However, if that doesn't lower my bs when I go back to nurse in April I will throw in the towel. I can't live on salad for ever. I have IBS and green lettice kills me.

@millysue - why are you being a defeatist. Instead of looking at what you cant eat - look at what you can . For example - why not check our the LCHF recipe section. I use the cauli-mash instead of normal mash - and its fantastic on a shepherds pie. You can eat all types of meet - you can eat fruit but in moderation - most people seem to stick to anything with berry in, ie, raspberries, strawberries, blackberries. I am not a lover of salad (as in lettuce) but I eat lots of other things in my salad and only ever have it for lunch. I have learnt how to make crustless quiches - which there are no end of varieties. There are lots of people on hear who follow their own version of LCHF - a lot of people still have takeaways, chinese, indian and even fish and chips - but they have it in moderation. You dont have to live on salad you just need to experiment more. You can still have your cake and eat it... look at all the fabulous LCHF recipes there are for sweet things.

 

[phoenix]

I'm not sure I have retinopathy (I hope not... need the test) but certainly my eyes went from been utterly blurry from distance (at high BG) to been unable to focus from nearby for a week or two after lowering the BGs. I can see fine now after a month

Blurry is relatively normal, it's the difference in pressure at high levels and low levels This isn't retinopathy .
Sorry I don't want to worry people and have tried to be careful in what I say. It is about people mostly who require medication that faster isn't necessarily better.
Everyone though really needs to have a retinopathy check as soon as possible after diagnosis.

(Jack,I'm sorry , I edited my post before I saw your reply , I had realised that I had read what you said wrongly)

 

[mehhh2015]

I think there is the normal blurry that happens when you drop BG, it's said to be the 'sugar' leaving the lens and does settle down ..as you found out.
but I think you still get your eye examination..to see what's going on, just incase you have some retinopathy that may need treatment.

Yeah I agree, but I'm still happy I can see wiiiiiiiiii!!!! because it got really ugly during high BG and it scared me.

 

[millysue]

@millysue - why are you being a defeatist. Instead of looking at what you cant eat - look at what you can . For example - why not check our the LCHF recipe section. I use the cauli-mash instead of normal mash - and its fantastic on a shepherds pie. You can eat all types of meet - you can eat fruit but in moderation - most people seem to stick to anything with berry in, ie, raspberries, strawberries, blackberries. I am not a lover of salad (as in lettuce) but I eat lots of other things in my salad and only ever have it for lunch. I have learnt how to make crustless quiches - which there are no end of varieties. There are lots of people on hear who follow their own version of LCHF - a lot of people still have takeaways, chinese, indian and even fish and chips - but they have it in moderation. You dont have to live on salad you just need to experiment more. You can still have your cake and eat it... look at all the fabulous LCHF recipes there are for sweet things.

I am a veggie. Not bothered about sweet things

@millysue - why are you being a defeatist. Instead of looking at what you cant eat - look at what you can . For example - why not check our the LCHF recipe section. I use the cauli-mash instead of normal mash - and its fantastic on a shepherds pie. You can eat all types of meet - you can eat fruit but in moderation - most people seem to stick to anything with berry in, ie, raspberries, strawberries, blackberries. I am not a lover of salad (as in lettuce) but I eat lots of other things in my salad and only ever have it for lunch. I have learnt how to make crustless quiches - which there are no end of varieties. There are lots of people on hear who follow their own version of LCHF - a lot of people still have takeaways, chinese, indian and even fish and chips - but they have it in moderation. You dont have to live on salad you just need to experiment more. You can still have your cake and eat it... look at all the fabulous LCHF recipes there are for sweet things.

@millysue - why are you being a defeatist. Instead of looking at what you cant eat - look at what you can . For example - why not check our the LCHF recipe section. I use the cauli-mash instead of normal mash - and its fantastic on a shepherds pie. You can eat all types of meet - you can eat fruit but in moderation - most people seem to stick to anything with berry in, ie, raspberries, strawberries, blackberries. I am not a lover of salad (as in lettuce) but I eat lots of other things in my salad and only ever have it for lunch. I have learnt how to make crustless quiches - which there are no end of varieties. There are lots of people on hear who follow their own version of LCHF - a lot of people still have takeaways, chinese, indian and even fish and chips - but they have it in moderation. You dont have to live on salad you just need to experiment more. You can still have your cake and eat it... look at all the fabulous LCHF recipes there are for sweet things.

I don't eat meat, not bothered about sweet things. Quiches, no thanks any pastry gives me indigestion.
What I was trying to say, look at what I have cut out, and that must be good.
My salad is. Peppers, celery, cucumber, Chinese leaves, sundried tomatoes, radishes and full fat Mayo.
My styfry veg is almost the same as above but with courgette.

I love cheese and peanuts, I was told that was ok, but on reflection I think I have been eating too much of that.
I have been type 2 for 6 years plus. I am now thinking the damage may already have been done.

 

[rowan]

I don't eat meat, not bothered about sweet things. Quiches, no thanks any pastry gives me indigestion......
.....I have been type 2 for 6 years plus. I am now thinking the damage may already have been done.

The crustless quiche is good though, you can add any veg you like to it, I like egg, cheese, courgette, onion and mushroom. I've just bought a 4 hole yorkshire pudding tin to make them in, or you could use cupcake tins for smaller ones.

And even if some damage has been done you can avoid doing any more, don't 'throw in the towel' because if you do all your hard work so far will go to waste and you'll be in a much worse position this time next year.
I'm finding it's taking longer than I thought to get to 'normal' levels, but i have other health problems getting in the way and I know if I just persevere it will work and I'll save myself an awful lot of heartache in the future

 

[mehhh2015]

I am a veggie. Not bothered about sweet things



I don't eat meat, not bothered about sweet things. Quiches, no thanks any pastry gives me indigestion.
What I was trying to say, look at what I have cut out, and that must be good.
My salad is. Peppers, celery, cucumber, Chinese leaves, sundried tomatoes, radishes and full fat Mayo.
My styfry veg is almost the same as above but with courgette.

I love cheese and peanuts, I was told that was ok, but on reflection I think I have been eating too much of that.
I have been type 2 for 6 years plus. I am now thinking the damage may already have been done.

I thought to give you some hope, and options and suggestions in case you want to try them out. I was vegetarian for 4 years of my life, and I never managed to loose all the weight I had, but I ate carbs at that time, I wasn't diabetic but I certainly was insulin resistant.

I'm sure you know what to eat and what you like, but this is my veggie side of the diet in case it might help you. if it doesn't work it doesn't work for you but you tried.

Are you measuring how do you react to food after eating, it might help you identify what is affecting you?

What you have done already should have an impact in your BG's if you are a normal type 2 and not too late stage, or if you are insulin resistant, but maybe the diet could be a bit more sustainable for you than it is right now and you might be able to see changes (no certainties just suggestions)...

There is a thread with vegetarian recipes. Although I'm not a big fan of complicated recipes, but some people are.

She was talking about crustless quiche, no pastry in that, and you can make it with nice veggies and cheese if thats what you like and keep it ready to go.

I make pancakes and a small bun with linseeds (easy and fast in the microwave), it feels like I'm eating carbs and sandwiches when I'm not .

You could try Chia seeds if you don't mind the texture, as a pudding with berries. It makes a nice breakfast or supper.

Excess peanuts and excess cheese might affect you. Try almonds, walnuts, pecans and measure how do you react to those (5-10 almonds do rise my BGs)

Aubergines, courgettes, avocados, linseeds, broccoli, cauliflower, cabbage, spinach, there are lots of things that could help you to make it at least slightly more interesting and maybe even more effective.

I make lots of simple soups with those vegs (vegetable stock, a garlic and a small bit of onion, season... boil and blend) you can frieze them (I add them a tablespoon of sour cream or greek yogurt when I eat them, they fill me up and they are tasty.

I'm not a salad (lettuce) fan either but I eat it as you do. You can include olives, a small amount of red onions... all within reason.

I don't know if its true or not, but some people claim apple cider helps reduce BG, I eat it all the time with my salads and vegs and it tastes good, so I give it a go just in case.

Tomatoes are high in carbs and do affect my BG however I eat them in moderation, you might test and see how much they affect you?

Have you tested how do you react to pulses? or to sweet potatoes? You might be able to tolerate them in moderation... I have found out they don't affect me in the same way as other carbs.

And yes, you deserve recognition for all the carbs you had to leave behind, as for a vegetarian it certainly isn't easy and I know is not so obvious what to eat, and one ends up stucked in salad until one can't face it anymore.

I understand you have IBS so this are all suggestions in case those vegs don't affect you.

I hope that might be of some help...