Conquering chronic crud
How I diagnosed and remedied the food intolerance that took six years out of my life.
“Chronic crud” symptoms disabled me for years. Those are caused by just about everything, which makes diagnosis and treatment difficult.
I have been symptom-free for more than a year. I definitively determined the cause in my case, and how to prevent it.
This post explains how you can test whether it’s the same cause for you, and what to do about it.
The symptoms of most medical conditions include some of these:
diarrhea, constipation
abdominal pain, bloating
nausea, flatulence
rashes, hives, eczema
runny nose, cough, headache, sinusitis, asthma
fatigue, brain fog
anxiety, depression
Chronic crud—unexplained persistence of several of these symptoms for years—can range from inconvenient, to a serious drag on life, to fully disabling. Mainstream healthcare frequently fails, or refuses, to deal with it.
In my case, the cause was food intolerance. The predominant symptoms were diarrhea, fatigue, and brain fog, which put most normal activities out of reach. Once I had figured out which foods triggered them, and rigorously avoided eating them, the symptoms stopped completely.
It took me several years to figure this out, because the healthcare system was unhelpful and actively counterproductive, and most online information is actively misleading.
And, for a long time I didn’t believe that food intolerance was even a thing. It sounded like neurosis, plus holistic woo. But, a definitive experiment showed that it is unquestionably a thing.
If you have chronic crud with gastrointestinal symptoms, food intolerance is a likely cause. Fortunately, there is a simple, safe, reliable test. It has zero financial cost, but does require significant discipline.
The test requires no involvement from doctors, dieticians, or holistic healers. It is never recommended by them—although they don’t recommend against it, either. The things they do recommend usually don’t work. I’ll come back to that later in the post.
The test does not depend on any medical theory or biological factoids, whether mainstream or alternative. It’s based solely on logic, not on dubious clinical trials, nor on holistic woo. After reading this, you will agree that it obviously does give a reliable result.
Phase 1: definitive diagnosis with an extreme elimination diet
The test is an extreme elimination diet. In short, you eat only a very few things, ones that are unlikely to cause food intolerance, for a few weeks. If your chronic crud ends, you know that something you normally eat is the cause.
That was my experience! Within a few days of starting the extreme diet, the crud was gone, and it stayed gone. I’ve been symptom-free for a year and a half.
The extreme diet is not healthy; it is diagnostic. I stayed on it for many weeks, just because it felt so fantastic to be functional again. That’s overkill, for diagnostic purposes. Three weeks symptom-free is definitive, if you are used to having crud most of the time.
Once you know food intolerance is the cause, you can go on to the next step, which is carefully trying different foods to see which you can tolerate and which you can’t. More on that in the next section.
So, an extreme elimination diet consists of a minimal number of foods necessary to sustain you for a few weeks, chosen because they are unlikely to cause intolerance. Mine was: plain white rice, skinless chicken breast fried in olive oil, and salt. Those have all the macronutrients you need.
These are things that rarely trigger intolerance symptoms. (According to unreliable online sources, anyway!) And, from experience, they had seemed not to be triggers for me. Chronic crud characteristically comes and goes, or waxes and wanes. I had eaten these few foods during periods when I was relatively symptom-free, so I guessed they were OK.1
You may want to pick a different set, depending on what you think you can tolerate, what you like to eat, and checking against unreliable online lists of common triggers.
Eating nothing but a very few foods for several weeks is mildly unpleasant, and may be socially difficult depending on your circumstances. If you’ve suffered from serious crud for months or years, and the healthcare system isn’t helping, it’s worth making the effort.
If your symptoms end, you can rejoice! Or, I did, anyway. What an enormous relief, to be able to do things again!
If this doesn’t relieve the symptoms, then either something else is the cause, or you are intolerant to one of the items in the diet. You could try a different minimal combination, in that case. (But, pursuing other plausible causes may seem more worth the effort, given that trying an extreme diet is relatively difficult.)
After a few weeks on the extreme diet, it occurred to me that it contained nearly zero vitamins or essential minerals. So, I started supplementing everything supposedly necessary. I didn’t notice any bad effects during the weeks of missing them, but it would be mature and responsible to do this from the beginning.
Phase 2: expanding your diet
Once you know you can definitely be crud-free, the second step is to figure out what you can and can’t eat.
The general approach is to try things and see if you get symptoms from them. This is surprisingly difficult and time-consuming. More than a year after definitively determining that food intolerance was the sole cause of my chronic crud, I’m still working through this phase 2, gradually expanding the range of things I regularly eat.
There are several difficulties.
Symptoms may take several days to show up after you eat a trigger food.
So you need to try something, and then maintain your known-OK diet for several days to see if anything bad happens. It is tempting to conclude that blackberries are OK after eating them once and getting no symptoms, and then trying pineapple the next day, and avocados the next, and then you get bad diarrhea, and you say “NO AVOCADOS EVER AGAIN.” But it was actually the fault of the blackberries, and avocados are fine.
Supposedly the delay from consumption to symptoms can be up to two weeks. Commonly, for me, it’s a couple hours, but in some clear-cut cases it’s been three or four days.
So, each test takes about a week. You have to space them out by about that long, to avoid misidentifying a trigger.
There’s a “dose-response effect” that varies from trigger to trigger.
Put less technically: some things are strong triggers, and some weak. A single sip of red wine will incapacitate me for days. I can drink a full glass of white wine, and will usually just feel vaguely off the next day. But, if I do that two days in a row, I’ll also get quite ill.
So, usually I start with a very small amount of something, and ramp it up over several days if it seems to be OK, until either I’m eating a normal amount of it, or I get symptoms.
There’s an “explore-exploit tradeoff.”
“Challenge tests” are valuable to gain knowledge, but costly. Each one risks a week of disability, if the food you try turns out to be a strong trigger. I’m unwilling to experiment often. I said earlier that I had been symptom-free for more than a year. That’s true, except when I’m doing challenge tests.
After about four months in phase 2, I had expanded my diet enough that it would pass mainstream nutrition’s dubious criteria for “a healthy balanced diet.” Additions since then have been a luxury, rather than a necessity.
I recently did a series of tests that determined that I can eat most fish. I had avoided the whole lot of them, because I discovered early on that salmon are right out,2 and overgeneralized. Being able to eat the other fish is fantastic—but not necessary.
Optimal experimental design is difficult.
I’ve usually tried only one new food at a time. In retrospect, this was not optimal, especially near the beginning of the process.
If you eat five foods you are unsure of, wait a week, and get no symptoms, then all five are fine. If you get sick, at least one of them was a trigger, but you don’t know which one, and it may have been more than one. Then you could try two of them at a time, and so on. Proceeding this way would get you more information faster, at an upfront cost of being more sick more often.
There’s whole subfields of statistical theory devoted to optimizing this sort of process. For a certain sort of geek, using that would be a lot of fun. I am that sort of geek! But it didn’t occur to me to try this until a year into the process.3 And there are several reasons it would be difficult.4 So I still haven’t done it.
Knowledge doesn’t grant all the power one would hope for.
I can eat quite normally at home. There are many things I can’t eat, but the restrictions aren’t a problem.
Eating in restaurants is still risky. Most dishes have a long list of ingredients, and the likelihood that one is a no-no is high. And not all ingredients are disclosed, so eating out is a bit Russian roulette. This makes travel difficult. Enough so that I basically don’t.
Phase 3: probably, there is no phase 3
It would be great if phase 3 was “do this, and you can eat whatever you want and go back to normal life.” For most people, that isn’t possible—yet.
Food intolerance is common. Some estimates suggest it affects around a sixth of the U.S. population. These estimates rely mainly on self-report, which is unreliable. I have not found any serious attempts to get a better number. This is symptomatic of the medical establishment’s general neglect of the condition, which it describes as “of personal but not clinical significance.” If you are permanently disabled by it, I would consider that “of clinical significance,” but apparently my lay understanding of “clinical significance” is mistaken.
If you have chronic crud, you would probably like answers to some questions. Most of the rest of this post is about these:
What is the official diagnosis?
What are the official diagnostic methods?
Can’t I just get a laboratory test, instead of doing a difficult diet?
What is the cause?
What is the mechanism?
What is the treatment? (Is there a pill to make it go away?)
What is the prognosis? (Will I ever get over this?)
The answers to these are all mainly unsatisfactory. In a sane world, this state of ignorance would motivate a vast effort to find causes, mechanisms, and effective treatments. We do not live in a sane world. Medical research is pervasively terrible, and medical practice is pervasively terrible. We are all much less healthy than we could be, and should be, as a result.
Fixing this is very important, and very difficult. It will require eliminating enormous powers of authority and control, and taking trillions of dollars away from the healthcare establishment. It will resist. I discuss that briefly at the end of this post. Max Shen and I also discussed it at the end of this podcast episode.
The rest of this post summarizes my reading of medical research journal articles; establishment recommendations to doctors and to patients; and explainers for patients from less-authoritative institutions, shading into “alternative” health woo. I went through a ton of this stuff while trying to figure out what I was afflicted with. I find all of it dubious, and mostly unhelpful.
I also draw on many first-person accounts, online and in face-to-face conversation. I discuss several remarkable stories in which severe symptoms led sufferers to work out cures that profoundly transformed their health and well-being.
Plus, more about my own case. It includes “what happened next?” after the events in my 2017 “Post-apocalyptic life in American health care.” That was about my managing my critically ill mother’s healthcare in the face of extraordinary institutional dysfunction. My food intolerance began three weeks after I wrote that post. I explain why I believe there’s a causal connection from my intense entanglement with my mother’s healthcare, in the light of what’s known about food intolerance causes in general.
There’s also a bit about my time working professionally in pharmaceutical research, and how that might be relevant.
The rest of this post is behind a paywall. It’s about three times as long as what you have read so far.
The greatest practical value of this post is in the explanation of phases 1 and 2, above. The rest may be useful if you have, or suspect you may have, food intolerance. I am, however, not a doctor, may get things wrong, and you should treat everything I say accordingly.
Even if it’s not personally relevant, you may find it interesting as science, and as a study in social and institutional dysfunction.