Meal Planning When Multiple Chronic Conditions Have Conflicting Needs
I don’t know if my body is building up to the biggest “hold my beer” moment of all time, or if there’s some kind of prize no one told me about for “person with the most chronic conditions.” Whatever the case, with five chronic conditions, apparently I’m a strong contender for the gold.
what is multimorbidity?
Multimorbidity, on top of being just a really cool word, describes the presence of two or more long-term conditions in an individual, which can be physical, non-communicable, infectious, or mental health conditions.
In 2023, 51.4% of US adults had multimorbidities, and 27.2% of adults in England had them. Multimorbidities favor women (me) and the elderly (I’m 60 as of this writing, so, erm, me).
It took me a decade of living in constant flare-up mode, from one condition or another, to get my act together. This isn’t because I was lazy; I simply didn’t know how to feed myself amidst the landmines each condition brought with it.
Nor do doctors tell you much. One of my doctors told me, “No garlic or onions.” Another said, “Don’t eat fried foods.” Still another told me to “avoid citrus.” None of them treated these conditions with the gravitas they deserved.
If I mentioned anything to my doctors, I would hear, “Well, you do have <insert name of offending condition here>.” The result? I believed feeling awful all the time was my new normal.
“Feeling awful became my baseline — and I thought that was just life now.”
Planning meals around one chronic condition is challenging. Learning to plan them around five? A nightmare, even with the internet. How do you easily and reliably cross-reference foods that suit five separate conditions, each with its own set of rules?
The HUNGRY GAMES - Food Rules for Managing Chronic Conditions
First, let’s discuss the rules of engagement for each condition.
GERD(US)/GORD(UK) (Gastroesophageal Reflux Disease)
Meals need to avoid foods that trigger acid reflux—like tomato, citrus, coffee, chocolate, fried foods, and heavy spices. This can conflict with CKD or IBS needs, since many “gut-friendly” fruits and vegetables are acidic or high in fiber, and gluten-free substitutes for celiac can be more processed and thus, more reflux-triggering.
IBS-D (Irritable Bowel Syndrome – Diarrhea predominant)
Food choices focus on reducing gut irritation, often through low-FODMAP¹ swaps and avoiding greasy or high-fat meals. The problem is that some gluten-free flours and kidney-friendly substitutes are higher in FODMAPs, while GERD limits many seasonings and mild-acid foods IBS patients sometimes tolerate better.
Celiac Disease (autoimmune)
A strict gluten-free diet is the only treatment, cutting out wheat, rye, and barley. The clash comes when gluten-free breads or pastas are processed, high in sodium (hard for CKD), or made with ingredients that can irritate IBS-D or trigger reflux.
CKD (Chronic Kidney Disease)
Protecting the kidneys means watching sodium, protein, potassium, and phosphorus, which often rules out otherwise healthy foods like bananas, beans, nuts, tomatoes, or dairy. This can run straight into conflicts with IBS (which relies on soluble fiber from beans or oats), GERD (where low-acid fruits are hard to find), or celiac (since many GF substitutes use legumes or high-phosphorus additives).
Hashimoto’s Thyroiditis (autoimmune)
With this condition, the immune system attacks the thyroid gland. Supporting thyroid health often means steady nutrition, and timing medication around meals rich in fiber, calcium, or iron. This can conflict with CKD limits (since many iodine-rich foods are high in phosphorus) and GERD (since spacing meals and meds can affect reflux timing).
Gluten itself is a protein that, at the molecular level, looks a little bit like proteins in thyroid tissue. Some researchers suggest this “molecular mimicry” may confuse the immune system. Specifically, they suggest that immune reactions to gluten may mistakenly target thyroid tissue because the two share a similar structure.
The American Thyroid Association notes there’s no evidence that eliminating gluten helps prevent or treat hypothyroidism, and only highlights gluten-free diets in the context of confirmed celiac disease, which is more common in people with Hashimoto’s.
Now that we know the basics, it’s time to talk about Always Safe Foods.
A FEW GOOD MEALS: Chronic Illness Meal Planning
As it turns out, there aren’t a whole lot of foods that fall into the “always safe” category for all five chronic conditions. What does make the list isn’t particularly glamorous; literally no one is going to want a taste of your food (including you, at times). However, what it lacks in the flavor department, it more than makes up for with gut-healing. The foods on my list are safe to eat even during flares. No. Especially during flares. This is what I lived on for three months after the “Flare to End All Flares” nearly took me out. I can legitimately say my “Always Safe” foods saved my sanity and my life.
“My ‘Always Safe’ foods saved my sanity and my life.”
🌾 STARCHES & GRAINS
Basmati rice (plain, boiled or microwave pouch)
Plain polenta
Gluten-free toast (white, not wholegrain)
Be Free table crackers
Nairn’s gluten-free oatcakes (plain)
White potatoes (peeled, boiled or mashed)
Plain rice cakes (unsalted)
🥦 VEGETABLES (Cooked Soft or Peeled Raw)
Courgette (peeled, steamed or dry-fried until very soft)
Green beans (well-cooked)
Peeled cucumber (raw or lightly steamed)
Butter lettuce or romaine (small raw amounts)
Peeled, boiled parsnip (cooked very soft, in small portions)
Peeled, boiled carrots (cooked very soft, in small portions)
🍌 FRUITS (Low-FODMAP, Peeled or Cooked)
Ripe banana (no green ends)
Blueberries (small portions)
Pear (peeled, boiled or canned in water or juice)
Strawberries (occasional, in small portions)
🧅 PROTEINS (Pescatarian, Low-Irritant)
White fish (cod, haddock, pollock)
Eggs (boiled or scrambled)
Soft tofu (plain, small portions)
Cottage cheese (low-sodium, small serving if tolerated)
Tilapia or other mild white-fleshed fish
If you eat meat:
Skinless chicken breast (plain baked, boiled, or poached)
Skinless turkey breast (plain baked, boiled, or poached)
Very lean pork tenderloin (plain baked)
Extra-lean ground poultry (plain chicken or turkey)
🧈 FATS & SPREADS
Small amount of butter
Olive oil (extra light or cold-pressed)
Pure sunflower spread (e.g., Pure brand)
🥛 BEVERAGES
Ginger tea
Fennel tea (test carefully)
Chamomile tea
Warm oat milk (e.g., Oatly No Sugars)
Water (room temperature or warm)
🍽️ EXTRAS & SEASONINGS
Table salt (used minimally)
Dried parsley or chives
Maple syrup (tiny drizzle)
Ground ginger or cinnamon (sparingly)
THE GOOD, THE BAD, AND THE HUNGRY: COPING WITH CHRONIC ILLNESS
I’ve been blessed with an amazing husband — 25 years and going strong — who has somehow managed to adapt to my ever-changing dietary restrictions and needs without developing a nervous tic or a drinking problem. He certainly has made my journey to gut recovery a lot less difficult than it might have been otherwise, simply by deciding to (more or less) eat the same foods I eat at home.
For those of you with families who, for various important reasons, have to prepare and cook multiple meal types, I feel for you. It’s hard on everyone involved. My husband still struggles with eating foods I used to enjoy in front of me; it doesn’t bother me, but it hurts him.
That said, here are a few things we’ve learned together:
Labels, labels, labels! Read them. Unless you’re buying strictly whole foods, you need to keep an eye on what’s in everything you purchase — especially in the USA, where food standards aren’t as stringent as in the UK. This is because labels are the only way to catch the hidden ingredients (like phosphates) that can sneak into processed foods. For someone like me, and since you’re reading this, possibly you or someone you love, those little extras aren’t just harmless fillers — they’re exactly what can wreck the stomach and cause a flare.
Patience is often the most annoying virtue, but it’s important, especially during and after flares, to give yourself grace, and the time to heal. Depending on the severity of the damage done, and the length of time a flare lasts, it could take the gut six months to a year to heal.
Same food, different day. Get used to eating the same, or similar, “Always Safe food” meals every day. Personally, I eat the same breakfast and lunch every day. My dinners contain slight variations, but I don’t stray very far from my Always Safe foods — they’re the home I return to during flares, and they’re the foundation I build meals on when I’m not flaring.
Consider a multivitamin. With five chronic conditions, my diet is super-limited. While I’m still able to get most of my nutrition through my food, there are a couple of areas where I lack, especially during the long months of recovery. A gentle multivitamin can fill in those gaps, but I want to note, if you’re on other medications as well, speak with your doctor before adding a multivitamin to your regimen.
Find your tribe. This one can’t be overstated. Chronic illness can be isolating. Oftentimes, healthy people don’t understand and can be impatient, because “you look fine to me.” You have to cancel plans at the last minute because you’re stuck in the bathroom. Restaurant choices have to be made based on your dietary needs. People make you into a game. “Can you eat this? No? What about this? This??” Or you just don’t get invited. “Well, I mean, of course, we wanted you to come. But it was a potluck, and, well, you know…” Find your people.
Timing is everything. Sometimes, it isn’t the food that’s wrong; it’s the time of day. I thought I couldn’t eat bananas anymore, even though they’re on my Always Safe list. Turns out, I can’t eat sugary things (even fruit) in the evenings. Many people with IBS or sensitive digestion notice they can tolerate certain foods, like bananas, in the morning but not later in the day. This has to do with gut motility — the speed at which food moves through your digestive system — and how it changes with your body’s natural rhythm. In the morning, gut motility is stronger. Food moves along efficiently, sugars get absorbed quickly, and there’s less chance for them to linger and cause problems. In the evening, motility slows down. Sugars may sit longer in the small intestine, and if they spill over into the large intestine, gut bacteria ferment them. This fermentation produces gas and bloating, which can trigger IBS symptoms.
FOOD CLUB RULES: LiVING IN Your Body with Chronic Illness
The first rule of Food Club is: Listen to your own body — what’s safe for you is safe, no matter what anyone else’s rules say.
The second rule of Food Club is: Never feel guilty about what your body can or can’t handle — food is about keeping you well, not about following some random standard.
The third rule of Food Club is: Timing matters — the same food can be safe at one time of day and rough at another, so trust the rhythm of your gut.
Finally, the fourth rule of Food Club is: If your gut yells ‘stop!’, goes limp, or taps out, the meal is over.
I won’t lie and say it’s easy. But it’s possible — with planning and a fair amount of bloody-minded stubbornness.
¹FODMAPs are types of carbohydrates (sugars and fibers) that some people’s guts don’t absorb well. When they stay in the gut, they can pull in water and get fermented by bacteria, which may cause bloating, gas, pain, or diarrhea/constipation in sensitive people.
The name is an acronym:
Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols
“Listen to your own body — what’s safe for you is safe, no matter what anyone else’s rules say.”
