My Process
Disclaimer: If you are reading this and dealing with ANY health related problems I am NOT recommending you take the same unconventional approach as I have in my battle with Crohn’s disease. Any changes you wish to make in your care plans should be done in partnership with the team of qualified healthcare providers who treat you.
What did health journaling look like for me?
My initial attempt at health journaling started with hair loss. I thought I might be starting to lose hair in the spring/summer of 2018 but I didn’t know what was “normal” hair loss and what was more than expected. I started tracking my hair loss in the morning as I was getting ready for work. Every morning I’d get ready the same way and I’d count the number of hairs l lost and write it down with the date.
About a month later I started to have a Crohn’s flare - this was when I started tracking my GI related symptoms. Every day I’d document trips to the bathroom, if there was blood, and the level of abdominal pain I was experiencing.
At first I started tracking on a high, medium, low scale for each factor and I didn’t do a great job associating my results to specific foods. I included notes on the things that might have contributed (examples: “high ragweed pollen”; “started Keto”; or “ate wheat”) but I had too much variation in my diet to really be able to pinpoint specific triggers like I had done with egg. I kept a TON of raw notes, documenting 87 pages in just the first six months - but honestly there was no organization and nothing that really helped me pinpoint specific problem ingredients except by sheer luck. I was starting to realize that I needed to limit variability and be less subjective in my journaling.
What about an elimination diet?
People hate the idea (myself included) of not being able to eat the things they want - even just for a short time. It impacts everything - our personal preferences, childhood memories, and relationships are all connected to the food we eat! But there is a beautiful moment in the life when someone has had enough - they choose to change.
After my hospitalization, I knew if I was truly going to get to a place where I could eat the things I enjoyed again I had to figure out exactly how specific ingredients impacted me. But while that premise sounds simple it is actually an incredibly complex goal to achieve.
Think for a moment how many ingredients you take in on a daily basis. The cereal you eat for breakfast had about 15 different ingredients on it's label. The sandwich you nabbed for lunch from your favorite “healthy” fast casual restaurant showed roughly 50 ingredients on its website. And the pizza you just threw into the oven as a last minute dinner option had at least another 50 ingredients on its label! That’s not even counting number of ingredients in the drinks and the snacks we eat between meals!
With the large number of ingredients that we put into our body on a daily basis how is anyone supposed to pinpoint exactly how each impacts them? And what about the other substances our body comes into contact that can have an impact on the way we feel? Beauty products can absorb through our skin and environmental factors can enter our airways. It all just seems impossible!
But now that I’ve scared everyone away… I want to walk through the approach I took to solve this complicated problem.
This was my approach to finding a baseline:
I cooked every meal using whole foods so I knew exactly what was going in my body
For breakfast: I ate the same 2-3 ingredients every morning
For lunch and dinner: I chose 7 - 8 ingredients (including salt, pepper, and olive oil) that I assumed didn’t cause me any problems and created a well-balanced starter meal containing healthy carbs, protein, and fat. (Rice, black beans, potatoes, and ground turkey were all key ingredients for me).
I ate the same meal for four days straight and journaled how I felt each day
I also was very intentional to keep all products (shampoo, detergent, etc.) I was using the same - I didn’t want unexpected variables to skew my results.
This approach allowed me to reduce the variation in my diet from a few hundred ingredients a day down to 10. This made pinpointing trigger ingredients significantly easier than if I was eating everything I wanted to.
I had to be comfortable in the short team sacrificing things that I enjoyed so that I could have some security that I wasn’t going to flare up again.
When I first started this kind of elimination diet my number one goal was to pinpoint and eliminate the foods that were triggering the worst of my Crohn’s symptoms - diarrhea and bleeding! If I could get those two symptoms under control then I knew it would help minimize some of the other problems I was also experiencing including: weight loss, dehydration, and low energy.
How did I my health journaling improve over time?
The next year I still was documenting raw notes (I ended up with 138 pages in year two) but I also got away from subjective “high, medium, low” tracking and started to think through how I could be more specific with each of the factors that were important to me. Here are a few examples of factors I have tracked over the years:
Frequency: A count of the number of times I went to the bathroom (poo).
Consistency: I built a scale from 1 - 10 for consistency. I would measure each time I went to the bathroom and at the end of the day I would average.
1-2 was used for times where I had bleeding
3-4 was used for diarrhea but no blood
5-6 was used for lower than normal consistency but better than diarrhea
7-8 was used when I was happy with my consistency
9-10 was used when I was constipated
Hair Loss: A count of noticeable hairs lost throughout the day
Weight: My weight taken every morning at the start of the day - before bathroom - undies only (goal here is to limit variability)
Acne: A count of new pimples appearing on my face that day
Low Energy: A count of each hour in the day that I yawned or had to lay down and rest - excluding bedtime
Brain Fog: A count of each hour in the day where I felt cloudy (blurry eyes, unable to think clearly, sinus congestion)
Anxiety: A count of each hour of the day where I feel anxiety (chest tightness, sadness, irritability, helplessness). I’m currently tracking different emotions (sadness, irritability, anxiety) as separate measurements.
Urination: A count of the number of times I went to the bathroom (pee)
Now that I knew what I wanted to track, I needed a good streamlined way to keep track of these factors.
How did I tie my symptoms to foods I ate?
Here is the syntax I landed on in 2020 to help with this:
[date range]: [meal name] + [new ingredient]
[symptom (result) | symptom (result) | symptom (result)
To give an example, let’s say I wanted to start a new meal based on my favorite Indian dish - Tikka Masala. Once I had selected the 7 - 8 ingredients I wanted in the meal, my goal was to start comparing my average symptoms (my baseline) to how I felt with any new ingredients I added.
At first, my baseline was just my first attempt at eating the meal but as I ate the same meal more frequently it became the average that I could compare when I started adding new ingredients. The three example entries below would have become the baseline / average I would have built future tests upon.
11/11 - 11/14: Tikka Masala
Frequency (2) | Consistency (8) | Weight loss (0 lb) | hair loss (30) | pimples (1)
11/23 - 11/26: Tikka Masala
Frequency (1) | Consistency (7) | Weight loss (0.5 lb) | hair loss (35) | pimples (0)
12/5 - 12/8: Tikka Masala
Frequency (2) | Consistency (6) | Weight gain (0.5 lb) | hair loss (25) | pimples (1)
Before adding new ingredients I had to feel comfortable that my baseline ingredients didn’t cause me any issues. There were several times I had to go backwards in my testing and actually remove ingredients from my initial baseline before I was able to get to a true baseline that I could move forward with.
Here is how things started to take shape as I started adding new ingredients:
Baseline/Average: Tikka Masala
Frequency (2) | Consistency (7) | Weight loss (0 lb) | hair loss (30) | pimples (1)
Test 1) 1/6 - 1/9: Tikka Masala + Bell Pepper
Frequency (4) | Consistency (5) | Weight loss (1 lb) | hair loss (60) | pimples (2)
Test 2) 1/18 - 1/21: Tikka Masala + Paneer Cheese
Frequency (1) | Consistency (8) | Weight gain (0.5 lb) | hair loss (35) | pimples (1)
You can see in my entry from 1/6 to 1/9 that bell pepper was the new ingredient I was testing. You can also see from the results of my testing that my frequency increased and consistency decreased between it and my baseline in the row above.
Now compare that to my 1/18 to 1/21 entry for paneer cheese where my frequency and consistency went back at baseline levels.
Based on these example results I could have concluded that bell pepper was something that I might have had a slight problem with (but there was always a chance this was a false positive as well). In this case I would have retested bell pepper again a few weeks later to confirm if I saw similar results.
By testing and retesting over time, I felt more confident in my findings and helped me identify trends and pinpoint trigger ingredients. It also allowed me to account for any seasonal or environmental variability that could have existed in my results.
Update: October 2023
This process of elimination is not an easy one. It can take years to find true causation. I often see patterns pretty quickly but with so many variables (and as long as it takes to conduct each test) I am more often left with more questions than answers at first. Largely I look at how my overall health has improved over the years to show that this process has been incredibly successful for me but it is easy to forget in the moment when I can't seem to find a trigger right away.
This process is a good one in that it empowers you with a different way to think and approach the symptoms you have. Listen to your body (journal) and limit variability (elimination). It truly is a lifestyle change - not a quick fix.
Original note:
Right now, I'm averaging about 50 ingredients a day. I still cook about 95% of everything I eat but since I've tested so many ingredients now that I feel comfortable with I've been ok with increasing the number of ingredients I'm taking in.
A few other important things to call out here:
- You can see missing dates in between my journal entries above. I generally rotate testing between three different meals so that if I am having an issue with any of the ingredients in one meal it would give me a few days to recover before eating that ingredient again.
- The list of symptoms I tracked changed over time depending on what I wanted to accomplish/understand. At times I’ve tracked blood pressure, belly fat, glucose, etc. but I’ve generally stuck with the list above.
- Another good option for tracking consistency is by using the Bristol stool chart. Check it out! https://www.continence.org.au/bristol-stool-chart
