Saturday, 12 March 2016

Cooking around endometriosis

This isn't an endo diet but rather how to cook around endo: how to cook when you can for when the endo is bad and you can't. It's not just for people with endo, of course: the same approach is useful for any illness or disability which gives you up-times and down-times.


Unless my endo is very bad, I ususally have a couple of weeks a month, or a couple of days at least, when I'm well enough to cook. I'm exceptionally lucky in having a supportive partner who's also a great cook, but I still try to use that time to cook, for a couple of reasons. Firstly, I genuinely love cooking. A clean kitchen, with sunlight streaming in or cosy rain hammering down, and a pile of ingredients and pots, Radio 4 playing a drama or something about the tibula or Boudicca, brings me such peace. It makes me feel like me. Secondly, even though my partner could take over all the cooking, I'm aware how much else falls on his shoulders when I'm ill. We usually share cleaning, cooking, shopping, unpacking groceries, etc, then suddenly he's doing all of that on his own for two people. Being able to cook ahead, when I can, brings me the added pleasure of contributing. Even when I'm on my own, there's a joy in looking after future-me - as if to say to that woman white with pain on the sofa and so tired, "It's okay, love, I've got your back. Look, I made this for you."

These are my favourite recipes and strategies for cooking ahead, with notes on whether they need any effort that hurts when you're sore. A couple of caveats. First, they don't follow any of the endo diets (I've got more thoughts on those at the bottom of the post) but I have marked up key food groups included / excluded, if you're using such a diet. Second, I know suggestions can feel like criticism, especially when you're sore and exhausted, so please don't feel this is just another thing you should be doing. You don't have to. Even if you do have a bit of up-time and energy, you may well have twenty other uses for it. Remember that this is written by someone who loves cooking. If you can afford it, look at readymeals as a medical expense. In my experience, the healthiest readymeals are usually M&S, who put almost zero junk in them - the ingredients list reads like your own mum's recipes. You can even do it in style: a friend of mine pointed out delightedly that their meal-for-two-with-wine-for-a-tenner deal made two brilliant meals for one and half a bottle of wine each night: not a bad treat for a fiver. Their everyday meals are cheaper, especially in multi-buy deals. Other supermarkets also seem to be catching up with the less-junk policy.

These recipes come from one of my other identities, megancooksandovershares. You do need freezer space, but you can do a surprising amount with your existing freezer if you have tupperware that's square or rectangular - the Sainsbury's Basics range of tupperware is perfect for that. Two years ago, though, when the endo was returning yet again, we found a second little waist-high freezer on the local classifieds for £20 and that's been a massive help. It doesn't fit in the kitchen but with a cloth over the front and some pot plants on top, it's not too intrusive. As well as freezer-space and a decent supply of affordable stacking tupperware, I'd strongly recommend a little wipeboard (WH Smiths do magnetic A4 ones) where you can write what you put in the freezer and wipe it out when you take it out. The last thing you want to do when you're sore is bend over, tug out heavy drawers, and root through frozen tupperware to figure out what's what. That's in an ideal world, though, so start from where you are.

You also need to pay attention to basic food safety: clean hands and equipment; cool fast, freeze promptly, and heat fast. This matters more than usual when you're cooking ahead. I've had food poisoning alongside bad endometriosis once: I wouldn't recommend the experience. I ended up punching the wall. Repeatedly. So here's a handy post on the basics of freezing and food safety, also from my other blog.  And here are the splendid recipes! Most of them are slow-cooks, because that's the food that freezes best. Click on the titles for the details.

Colour-ratings:
If you're sore: green = minimal effort, orange = some chopping / lifting, red = leave it for another day
Serving effort: green = just heat, orange = some extra work

Dinners

  The Magnificent Bolognese

omnivore | wheat-free | dairy-free
This beauty is a winner for cooking ahead because it loves being cooked in vast quantities and it can turn into so many different dishes: lasagne, chilli con carne, cottage pie, Balti keema, nachos, tortilla... plus, if you defrosted it and you run out of energy / strength to do any of those, you still have delicious bolognese! When I had three days' warning for an operation last year, this is what I made. You can't control much, with an operation. You can control the availability of bolognese.
  • If you're sore: plenty of time to rest between stages, for this one. Rest after the initial prep, if you need to. Light chopping only; no grinding, shaking, or straining. If you're having it with spaghetti and that pot's too heavy to lift, you can take the spaghetti out with a slotted spoon or tongs.
  • Serving effort: however much or little effort you want. You can make it into multiple other dishes or just serve it with spaghetti or serve it on baby spinach or kale.

The generous kedgeree

vegan | wheat-free | dairy-free
This dish also loves being cooked in vats, which gives you plenty to freeze and (in keeping with the spirit of it) some to give away. It's a Hare Krishna recipe, so not the traditional fishy kedgeree. I know it as my most economical and one-pot dish, but my friends and partner rave as if it's a rare splendour. Perhaps one dish can be both. It freezes beautifully and you can also make leftovers into a bake, by adding some grated cheese and a raw egg, and baking it. If you're vegan, use oil instead of butter, and whatever is a good substitute for raw egg to bind it if you're making a bake - I've heard chickpea broth works well.  You can also make it without the rice, potatoes, and green veg, as a dahl soup.
  • If you're sore: again, plenty of time to rest between stages, as well as after the initial prep; light chopping only. No grinding, shaking, straining, or lifting.
  • Serving effort: just reheat and serve on baby spinach, with some yoghurt if you have any

Lots Lasagne

omnivore | wheat | dairy
You can turn existing bolognese into lasagne; use this recipe if you want to fill the freezer with lasagnes. Making three isn't much more hassle than making one and it freezes beautifully. These tins each serve four; you could use smaller containers to make one- or two-person lasagnes.
  • If you're sore: best to leave this one for another time. The white sauce needs plenty of whisking and then you need to layer up the lasagnes immediately after, which means lifting pots and more standing.
  • Serving effort: just reheat. If you have the werewithal to make a salad to go with it, that's great.

Ratatouille (vegan)

vegan | wheat-free | dairy-free
Colourful, healthful, warming, soothing, one of my favourite dishes when I'm feeling rubbish and another that loves being cooked in a vat and freezes well.
  • If you're sore: rest after the initial prep, and then plenty of time to rest more while it simmers. No shaking or grinding. You do need to lift the pan as you batch-fry the veg; if that's too hard, use a slotted spoon to lift them out into a bowl instead, and fry the garlic + tomato in the pot it will cook in, so you don't have to lift the pan to pour that.
  • Serving effort: just reheat. No sides required.

Mushroom and lentil bake

vegetarian, poss vegan | wheat-free | dairy
An unpromising name for a very delicious dish, especially if you have leftover bits of nice cheese to chuck in - though it's also great with ordinary cheddar. The recipe serves 4 and we're 2, so I usually put half in the freezer (in tinfoil / clingfilm).
  • If you're sore: leave it for another day. The chopping and frying are light, but you have to tip two pots into a big bowl to mix it all together.
  • Serving effort: just reheat (I butter the top first) and serve on baby spinach or some lettuce.

Every stew

omnivore | wheat-free | dairy-free
All stews freeze beautifully, given their magic combo of slow-cook food and liquid. My aubergine sausage and olive stew is a bit demanding, as I uncharacteristically insist on real chicken stock, but it rewards you for that and doesn't need any sides. The Moroccan stew wants you to marinade the meat in spices the night before, though I'm increasingly unconvinced about that. You probably have your own favourite stew recipes as well.
  • If you're sore: not too much chopping, for most of these, but you do need to put a heavy pot in the oven and lift it out at least once.
  • Serving effort: if your stew includes veg, just reheat a bowlful. A meatier stew should have some veg sides, in an ideal world. (This is clearly not an ideal world: for a start, we have endo.)

All the curries

omnivore/veggie/vegan | wheat-free | dairy-free
Curries win the freezing competition: slow-cook food plus liquid plus spices that develop in flavour. They're also easy to make in large quantities. I freeze them in very small containers, so that I can make one big curry dish and pull 2-3 other little ones out the freezer, and then most of that big curry dish goes into the freezer as well. (I call this the Curry Cascade!)
  • If you're sore: leave these for another day. Lots of chopping and frying, tipping from a pan into an oven dish, plus you have to take a heavy dish out of the oven at least three times.
  • Serving effort: just reheat, if you want. If I'm well, I make another dish to repay the freezer; if I'm not, I just defrost 2-4 curry dishes and we eat in splendour.

Lunches

When I'm well, lunch is usually a salad (I make a big one for most of the week) or a simple frittata. When I'm very sore, and even walking to the kitchen is a serious Quest, I really need previous-me to have laid in a few options.

All the soups

omnivore/veggie/vegan | wheat-free | dairy-free
Soups are brilliant freezer-lunches as they're easy to make in generous quantities, the liquid means they freeze well, and they're generally healthy and veg-packed. Plus, like stews, they're super-flexible about ingredients.
  • If you're sore: you need a stick blender. A jug blender means lots of heavy lifting; a stick blender, you can just stick into the soup pot. When it's cooled, use a ladle to decant it into its freezer tupperware, so you don't have to lift the heavy pot.
  • Serving effort: just reheat. No need for sides.

Hummus, green tapenade, black tapenade

vegan | wheat-free | dairy-free
I collect little ramekins from everyone whose cupboards are overflowing with the things, and use them to freeze these dips in. That makes the perfect quantity to pull out a few, for a shared lunch, or as the centrepiece for a lunch for one. I also sometimes freeze larger quantities in tupperware, so if I'm asked to bring something to a gathering, I can easily. All three are incredibly easy and quick, and just need the ingredients blended together. Having these in the freezer is a life-saver when I'm very ill, because it means I'm eating a bit more healthily even if I only have the energy to make toast.
  • If you're sore: very little effort for these, no heavy lifting at all. Use a wide-topped jug to blend it in, so you don't have to lift a jar to scrape it out.
  • Serving effort: as you wish. If you have the energy, then serve it with some fresh raw veg / salad stuff (celery, gherkin, sliced cucumber, sliced peppers, whatever you have) and oatcakes; if you're very sore, you can just spread it on toast or eat it with oatcakes.

Green masala paste

vegetarian / vegan | wheat-free | dairy-free
This isn't a meal in itself, but it's an unbelievably helpful thing to have in the fridge or freezer when you're not well. It's packed with bright, zesty energetic flavours, and you only need about a third of a teaspoon to transform a dreary look-what-I-found-in-the-fridge meal into something amazing. I make it in big batches when I'm well, then stash most of the jars in the freezer and keep one in the fridge. I mostly use it to make a simple egg curry with scraps of veg or served on salad, which is easy enough to do unless I'm completely crippled with pain. You can also stir a spoonful or two through some cooked lentils to make an instant brilliant dahl, which is also vegan.
  • If you're sore: not too much effort for this and no heavy lifting - but it makes such good quantities, and lasts so long, that I usually wait for an up-day to make it.
  • Serving effort: medium - the egg curry means you need to boil a couple of eggs and find some veg / salad; for a dahl, you just need to boil some lentils.
Enjoy, and do share any of your own favourite cooking-for-future-you dishes in the comments.


On endometriosis diets

I've seen various claims about diets that help with endometriosis. If you're on a diet like that and you feel it works for you, that's great. For myself, I remain sceptical. Firstly, most of these diets seem to centre around avoiding the same food stuffs that almost every cure-it diet targets - wheat, dairy, coffee, etc, and often to correlate with current food fads. Secondly, there's no evidence base that I know of for any of these diets. That doesn't mean in itself they don't work; it means they haven't been shown to work. If something works for one person, that's great, but it's not in itself proof that the thing works, because it's based on a sample of one. There may be many other factors, including the endo easing of itself, the placebo effect (which is powerful and wonderful and not to be scorned), related conditions easing, and so on. The only way to rule out those other factors is with a large-scale double-blind study. That said, if it works for you, for whatever reason, go for it.  Whatever works. If standing on my head dangling crystals from my toes worked for me, I'd do that.

I looked very hard for evidence about wheat and endometriosis in particular, because that was talked about on so many forums. PubMed turned up not a single study. Again, that doesn't mean it doesn't work. It means a) no studies have been done on it, or b) studies were done, it doesn't help, and the negative data wasn't published. (Non-publication of negative data is a massive issue, which Ben Goldacre campaigns strongly about.)  My pet immunologist suggested trying it anyway, as simply easing digestion might help, given the area around that is inflamed. I cut out wheat and it eased my symptoms dramatically, but I did continue to worsen anyway. Effectively it seemed to rewind the worsening by about three months, and then it proceeded as normal. For a year or so I stayed wheat-free; later I went back onto wheat; it didn't ultimately seem to make much difference, for this sample of one.

The problem is that without large-scale, well-designed studies, everything is just a wild guess and down to individual trial and error. Given how few options we have to treat endometriosis (especially for those of us who're progesterone intolerant), trying whatever we can is a natural response. And eating healthily is always helpful. Avoiding wheat and other food groups is not necessarily healthier, though. For one thing, it automatically limits your diet, and a varied diet is a keystone of good eating. More importantly, wheat-free (and dairy-free) products are often packed with other things you really shouldn't be eating (like heaps of corn syrup). If you're subsituting wheat with vegetables, though, that's diamond. If avoiding wheat means you broaden your diet, great! Michael Pollan's advice is still the best: "Eat food, not too much, mostly plants." To which I'd add: as much variety as you can afford; home-cooked as much as is possible for you. But whatever you do, or can't do, don't beat yourself up. Endo beats us up enough already.

1 comment:

  1. Hi. I really enjoy your recipes. I have Crohn's and gluten-free living has drastically helped with my symptoms and I am in remission, when medication alone did not help. I got the idea from my cousin actually. She had several in her family with digestive issues.and it helped them. I've read articles which stayed that approximately 60-70% of our immunity comes from our gut. Unfortunately, with the rise in GMOs and other chemicals, it's a wonder more people don't have problems with digesting food products. I'm sorry you have endo. My adoptive mother had it as well as her mother, and well...that's how I happened to be adopted. If you have any tips of meds and diet for endo, please let me know. I know a young lady who is newlywed and suffering. She wants kids but who knows. Thanks again for the recipes and I enjoyed reading your blog.

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