“So what can he eat?”

The other day, Patrick asked his dad for a snack. Brian sent him to me and I heard him say, “She’s your dietitian.”

Yup. That’s what it feels like. All day long, every day, I keep a tally in my head of what Patrick’s eaten. What his reactions have been. What nutrients he might still need. What exposure he’s had to challenging foods vs. preferred foods. And all day long, because Patrick is hungry and asks for food all day long, I am planning what he can eat.

In some ways it’s getting easier. Outgrowing his milk allergy is a really big deal that has opened up a ton of possibilities. If Patrick could live on string cheese, he totally would. In other ways, it’s just gotten more complicated.

Last week, I took Patrick back to his allergist. We’d communicated through his assistant and he’d called me at home to go over allergy test results. But in the end, things were still confusing. So he said to experiment for a month and then come in and he’d help me figure out the results.

He printed out two copies of the test results. And then we sat down and went through them food by food, comparing the blood test with the skin test and them my own personal experience.

Towards the end of the conversation, he said something about like this. “Patrick is really allergic to a lot of foods. With these numbers, I’d probably tell most patients to avoid them. But Patrick is different. There are two considerations for him: how does he react to allergens? and how does he react because of his transplant? And so we can’t just say he can’t eat any of the foods he is allergic to. For whatever reason, he seems to tolerate a lot of his allergens when they are cooked. So you will keep cooking foods for him with the foods he’s allergic to. And you’ll be very cautious. And you’ll figure out what he can actually eat.”

So in summary. Dear world.. I am very sorry that we are misrepresenting the severity of food allergies in some regards. Really, VERY truly there are people who must entirely all forms of the foods they are allergic to. There are some foods that we still avoid 100%. But if there is some confusion about why Patrick is still eating some things that I have mentioned as an allergy, the simple answer is that if he didn’t, he’d be being fed elemental formula through a tube for the rest of his life. So we are making d0 with a cautious diet.

That said, if you are one of the handful of people still trying to make a sincere effort to cook and/or serve food to include Patrick.. let me give you a rundown of his current diet.

Because of intestinal transplant . . . 

Patrick is on a low sugar diet. This isn’t like a diabetic’s low sugar diet where his blood sugar will swing one way or the other or where carbohydrates need to be avoided. Sugar and some other sweeteners are not easy to digest and sugar can cause Patrick’s gut to not absorb, costing him both nutrition and hydration. In general, I look for 12g or less of sugar on the label. We mostly avoid fruit and fruit juices. And, although Patrick isn’t allergic to cow’s milk anymore, milk is 12g of sugar so I allow him to only drink this in my presence and in small quantities right now.

Also, because transplant didn’t give Patrick the 2/3 of colon that he is missing, he can eat fibrous veggies, but he won’t absorb them. His GI compares this to eating sticks and leaves. Therefore, since these foods are also hard to learn to chew, I haven’t put a lot of effort into teaching him to eat these foods. He loves the softer ones: squash with skins cut off, cooked carrots, mushrooms, cooked onions. We are working on green beans, soft and french style are easiest. He does not like peppers. Patrick is mildly allergic to lettuce, however, and doesn’t digest it at all so I only let him have it when he’s feeling quite left out and insistent. Salads are discouraged.

Because of medication reaction, Patrick isn’t allowed grapefruit. Grapefruit is in fresca. And other fruit drinks. Not that he should have much of those, but watch labels.

As far as allergies go…

Patrick has outgrown his dairy allergy. And if he could have his way, he’d be enjoying an all-dairy diet. He especially loves cheese, though he isn’t a fan of sharp cheddar. He would happily eat sour cream by the spoonful. He eats milk on his cereal. He is getting better with yogurt. I’m still reading labels to pick varieties that are less than 12g of sugar. And we’re doing greek yogurt when possible because it has more protein. His favorite flavor is blueberry.

Yogurt can be tricky, though, because despite not eating much fruit, Patrick does have allergies to it. Patrick is allergic to peaches, oranges, and strawberries. Orange is especially high. Mostly, it’s easy to avoid these as he generally can’t have fruit. I do sometimes give in and let him nibble on a strawberry. In my presence. With benadryl on hand. Also, did you know sweet and sour sauce is made of peaches? We also avoid apricots and mangos because they are similar fruit families. Just FYI.

Eggs are scoring an off the charts 11.7 in the blood test reaction. This number is PHENOMENAL. A 4 or a 6 is considered pretty significant. Therefore, we do our best to keep Patrick away from anything with concentrated egg. Scrambled eggs, crepes, egg noodles, mayonnaise, ranch dressing, tartar sauce, dijon mustard. Be advised that we discovered the vegan brand Just Mayo over the summer, though, and Patrick does eat a lot of “mayo” recipes made from this. He also eats at least a cup of vegan ranch dressing throughout the week. It’s his preferred dip. And he’ll ask for it away from home. The simple answer to this is that he can have only mom’s recipe. He shouldn’t have food cooked on a grill or pan that also cooked eggs.

Nuts are still causing a tremendous reaction in skin tests. Especially cashew and pistachio. And nuts are processed all together in factories. Therefore, we are a nut-free household. We don’t allow them in the door and ask you wash and brush teeth before contact with Patrick if you’ve been around these foods. Peanuts are scoring lower but still high. Therefore, we use sunbutter not peanut butter. And we do still watch out on ingredient labels for “manufactured with peanuts” warnings.

Oats are a pretty low scoring allergy and we’ve opted, based on previous reactions, to avoid them completely in Patrick’s diet. We don’t see a traditional allergic reaction. But they really do upset his stomach. Mostly, you only have to watch out for oats in breakfast food, but really read the labels on cereal.

Corn is also quite high with a significant skin reaction. We have a hard time making heads of tails of this. Corn is so hard to entirely avoid. Therefore, we do entirely almost entirely avoid corn chips, corn tortillas, corn bread, and plain corn. I do let him choose to eat corn dogs as I see little consequence. He sometimes chooses on his own to remove the breading. You might catch me taking mercy on Patrick and letting him splurge on Doritos, Cheetos or corn on the cob. Like oats, Patrick’s reaction is stomach upset and these foods are so yummy and ingrained into our culture that sometimes he and I have a talk about the consequence he’ll pay for eating these foods and then I’ll let him choose. As a rule, leave this kind of spoiling to me. I’m keeping track of what else he’s had in the day and if he can afford the consequences.

Tomatoes also caught me off guard a bit. We tested because I’d seen Patrick react to some spaghetti sauces. But he is usually fine with ketchup. Our best guess that is that the difference is how long the tomatoes are processed. So, when I serve pasta at home, I try to cook the sauce at least several hours. And he seems ok with pizza sauce. Perhaps because it’s baked again before serving? In general, Patrick avoid tomatoes on his own. He’ll choose olive oil over tomato sauce. He’ll choose vegan ranch over ketchup and ranch on his pizza over tomato sauce. I really need to do some exploration into the ingredients of alfredo sauce and I need to let him try besciamella now that he’s allowed milk. But when he has no other option, tomato is another food where I explain the consequences and let him choose. Please know, you can give him ketchup with confidence.

Soy was a surprise to us. Almost. I knew soy milk upset Patrick’s belly which is why we tested for it. But Patrick was eating a lot of other soy foods when we were avoiding dairy. This is a fairly low allergy, but still enough that I see a difference. So we are trying to transition from margarine (still a no no) to butter. (I am finding a big learning curve here.) Patrick’s accepted that it’s ok to eat dairy cheeses but will still check and be nervous about other foods that used to require substitutions. We aren’t avoiding soy all-together. It’s in so many foods. And his score was only a 1. If it’s cooked, like soy sauce or in crackers or whatever, it’s absolutely ok. But if it’s possible to skip it, we do. He had a reaction to canned cream of chicken soup the one time I tried it. Soy is my best guess as to why.

Finally, there’s these crazy little positive results for wheat and barley.  I said, “Barley, no big deal.” Really, I only eat barley like once a year in soup. But wheat? Well, here’s how that conversation went. The allergist said, “He’s allergic to wheat.” And I said, “His diet is over 50% wheat.” He said, “Well, maybe that’s because the wheat is baked.” And I said, “Well, what does unbaked wheat look like?” Him, “Flour. But he wouldn’t like to eat that anyway.” So I said, “So can he bake?” He said, “Of course. Just keep an eye on him.” Me, “And the rest?” Him, “Let him eat wheat.” In other words, don’t feed him gruel. And if you’re baking with him, keep an eye out for inhaled reactions. Otherwise, let the kid eat all the wheat he wants. As long as it’s highly processed. White bread, not whole grain. Since his gut won’t digest whole wheats anyway. That’s a transplant/short gut thing.

So what can he eat . . . 

Patrick’s very best foods are still meat and potatoes. He’s making good progress with oral aversions. But he still has a hard time chewing “grown up” meats, though. So I’m talking about chicken nuggets, hot dogs, corn dogs, lunch meat, fast food hamburger (because it’s super duper soft, unlike what I make, apparently), really tender meats like roast, bacon (because bacon’s good enough that he learned that one). We’re working on canned chicken. We are working on the other meats. It’s slow. But we’ll get there.

Patrick thinks mashed potatoes and gravy are manna sent from heaven. I can’t sort out why he tolerates some gravies better than others. Soy maybe? Or corn starch? I dunno. But I used packaged gravies for him at home and he does great and loves them all. Yes, it is ok to make mashed potatoes with milk now. But not margarine. Plan on Patrick eating at least a cup and a half on his own.

Other potatoes are also really, really good for him because they slow his gut down so he absorbs the whole meal better when he eats them. Plus, they are easy to eat.. Roast potatoes, Potato chips. Tater tots. French fries. The oil which most of us would avoid provides calories for him. Someday we’ll worry about avoiding oils. Right now, we are packing calories.

He’s a big fan of pasta salads. Tossed with olive oil and either italian or ranch seasonings (again, not ranch dressing or real mayo.) I make a big pasta salad every week and he eats it throughout the week until it’s gone. Kraft Macaroni & Cheese has been tested with great results. I make him the old recipe with half a stick of butter in it because, again, I’m packing calories. He really likes to slurp spaghetti noodles and those are always eggless, FYI.

He loves string cheese. He thinks cheese pizza is wonderful, though he’s gaining a taste for ham and mushroom, bacon and vegan ranch, and pepperoni, too. Choose “light” on the sauce if that’s an option. We discovered totinos this week and he would eat it at every meal.

He still loves soups. Progresso’s beef soups are egg-free. They have tomato but it seems processed enough to be ok. Also, the noodles in campbell’s brand shaped chicken noodle soups (goldfish, disney characters, etc.) are also processed enough that they are ok, despite the egg warning on the label. He had his first cream soup this weekend and devoured it. He loves grilled cheese and saltine crackers with soup.

He really enjoys stir fry with rice noodles. Especially if you put zucchini, mushrooms, and onions in it. He’s getting better at eating rice and rice-a-roni.

Other favorite foods include hummus, ham and cheese on their own or in sandwiches, as lunchables, etc., goldfish crackers, cheez-its, and veggie thin crackers, pretzels, chips, rice krispie treats, little smokies, pancakes and waffles, popcorn, cake, donuts, cookies, guacamole (but check the label), Arby’s roast beef sandwiches and curly fries, sunbutter, bananas, apples (though he’s still learning to chew them, black beans, refried beans. We are working on fish sticks, salmon, and other fish.

He wants capri sun, but can only have the low-sugar waters like Roaring Waters. He wants anything other food that is restricted extra exactly because it is restricted. He will do almost anything to earn a tootsie roll or starburst so those, since candy is very restricted, must follow very specific rules. He can have powerade zero and gatorade’s g3, but is kind of tired of them and mostly chooses to drink water.

And dislikes? Well, he doesn’t like stuffing. He doesn’t like peppers. He doesn’t like crust on his bread or skins on anything. He isn’t a big fan of melons. He’s undecided about biting cucumbers. He only sometimes likes pickles. He doesn’t much like foods that are hard to chew. And otherwise, he follows most of the same rules of “gross” that other kids his age abide by.

We went over some of this with the transplant surgeon last week and he said, “Butter, cheese bacon, potatoes. He’s got what he needs to gain weight.” So, although I know this goes against what most people would call an ideal diet, it will work for now while we work towards better.

This summary is long. But I hope it helps. At least to explain what’s going through my head when mealtime rolls around. As I’m trying to turn this list into at least 1600 calories consumed every day.