I sent the following message to folks who are coming to Thanksgiving to (attempt to) let them know what I can and can't eat. This is the first time I've written this all down, so it seems worth documenting for posterity. Hopefully I won't have to refer people to it for too many more months.
Most importantly: I don't have to eat every dish you bring! Feel free to make something delicious even if I won't be able to have it. There will be enough food on the table that I can eat.
Executive summary: texture and thickness are key; spices are limited; strong acids are suspect; fats, sugars, and salts are fine. The simple version is "No dairy, no eggs, no to most spices; either very soft or very crunchy."
The details follow. I realize this is long; feel free to send me a recipe and let me call out anything that will cause me trouble.
The most probable explanation for my eating challenges is that the sphincter at the bottom of my esophagus has trouble opening. This manifests in food restrictions based more on consistency and texture than on ingredients. For instance, I can drink a smoothie with blended peanuts, wheat germ, and barley malt but I have trouble with peanut butter on bread.
The texture spectrum:
- SAFE: Foods that can be sucked through a straw (broth, smoothies…)
- SAFE: Foods that dissolve in your mouth or otherwise can be eaten without teeth (ice cream, banana, pumpkin puree, mashed potatoes, hummus, halva…)
- SAFE: Soft blocks of protein (lunch meat, ham, tofu…)
- SAFE: Firm foods that chew into small pieces (nuts, carrots, some chips and crackers…)
- PRETTY SAFE: Foods softened in water (boiled or canned vegetables, noodles, cooked legumes, cooked grains…)
- POTENTIALLY DANGEROUS: Soft but sticky foods (bready substances, nut butter, french fries, lettuce…)
- DANGEROUS: Foods with gristle or fibrous bits that are difficult to fully masticate (steak, ground beef, kale, spaghetti squash, many fresh vegetables…)
Additionally, there are some ingredients which my body has painfully rejected in the past few months and I now avoid. Aside from dairy, most of these are foods I've loved eating regularly over the last twenty years, so I really hope I can eat them again by next Thanksgiving.
- Dairy (milk, cheese, cream, butter… anything derived from a mammal's udders)
- Eggs (this prohibition adds a lot of challenge to my diet)
- Extra-virgin olive oil
- Red wine
- Capsicum peppers (both spicy and bell)
- Peppercorn/black pepper (basically anything with the word "pepper" in it)
Since several spices have led me to have absolutely miserable days, I'm taking a very cautious approach to spice. I'm able to handle cinnamon, cumin, ginger, and garlic. If a product lists "spices" as an ingredient, I don't eat it. For individual herbs and spices not explicitly listed I decide on a case-by-case basis. If there's a spice you'd really like to bring to Thanksgiving (particularly in the savory category), let me know and I can do a trial in advance–I'd love to collect some more data.
I'm also taking a cautious approach to highly acidic foods like tomatoes, many fresh fruits, and alcohol. I might accept these if offered or I might decline.
Fat, sugar, and salt are all good. I'm currently dramatically underweight, so the standard dietary advice given to Americans doesn't apply to me–I'm finishing a whole pint of non-dairy ice cream as I write this and I eat plenty of bacon. I can eat plenty of fat as long as it doesn't make food stick to the throat like salad with dressing (and as long as it's not butter). High sugar is fine too; my morning smoothies feature honey, molasses, or syrup. My dietitian also recommended I have 50% more sodium than the max recommended level, so salt is fine. (I'm currently trying to keep dietary fiber low, but I don't worry much about fiber content at social events, so don't sweat it.)
Common food restrictions:
Other than dairy and eggs, I seem to be okay with all the common allergens (nuts, legumes, gluten, soy, shellfish…). I don't follow any preparation-based restrictions (kosher, halal, raw, fair trade…). For the most part, if I can easily swallow it then I want its calories in my belly.
I know you mean well, but whatever diet or food you've heard is good for something or other is probably not applicable to me. Most diets have weight loss as a goal, but losing more weight would significantly compromise my health. It's hard to sell diet books if weight gain is a side effect, so if you've heard of a diet, it's probably not right for me (unless you've got a good recipe for chanko nabe). Similarly, I'm actually trying to avoid anti-inflammatory foods for a while. When I was diagnosed with an autoimmune disorder I went full haul on anti-inflammatories. Unfortunately, I think the COX-blocking effects may have negatively impacted my gut, so I cut them out of my diet (with the exception of omega-3 fatty acids and ginger). If you saw an article about some wonder food or supplement, I'm probably avoiding it.