Special Diets

Diets for IBS and other gut disorders

There are several diets that are commonly diagnosed for people suffering from irritable bowel syndrome. Such diets for IBS are often accompanied by lifestyle changes, with the reduction of stress and physical exercise to the fore.

Diets for IBS represent more of a challange than maintaining a balanced diet, with measured fibre, protein in meals and adequate fluid intake per day. For example some diets increase daily intake of soluble fibre, whilst others reduce it.

Whilst these diets can provide self-help options for sufferers of IBS, it’s important to seek medical advice. Self-diagnosis involves clear risks, and you may not be fully aware of the full range of treatments and therapies available.

Indeed we recommend that anyone suffering from the symptoms of irritable bowel syndrome discuss their health with a nutritional speciliast before adopting any of these dietary programmes. This is particularly important as tests, as well as knowledgable management of the diet are important parts of the success of a given programme.

Of course guidance can also be delivered by a doctor, however most GPs will refer patients to a dietaition or nutritional specilist for this type of diet management.

As well as IBS a number of these diets are important in the resolution of other digestive disorders and diseases. In all instances the advice of a healthcare professional should be a pre-cursor to these diets. In fact some of the symptoms of IBS overlap with other gut problems, such as coeliac disease and inflammatory bowel disease. This emphasises that careful diagnosis as well as tailored advice should be part of your dietary programme.

The quality of your diet impacts everything you do, from how well you can digest and tolerate foods to your energy levels, your mental and hormonal health and your zest and enjoyment of life. Food advice provided by IBS Clinics aims to optimise all of these elements.

Allergy, Intolerance or Sensitivity

The term “allergy” describes reactions to foods. Yet, nutritionists make a distinction between types of reactions and have classified them as:

Allergy – this is also known as classic allergy. Your doctor will know about this type of reaction. It is caused by IgE antibodies. These types of reactions tend to be long lived (often life-long). They can be extreme in some instances, e.g. peanut allergy which causes anaphylaxis and can prove fatal. These types of reactions also cause hives and itchy rashes.

Intolerance – this term describes an inability to digest a food. For example lactose intolerance which is common, affecting 75% of the global population. In this case a person cannot digest lactose, the sugar found in milk products due to a deficiency of the lactase enzyme. The result is extreme bloating nausea and digestive upset (IBS in fact).

Sensitivity – this is also called a delayed food reaction because symptoms can start any time from 3 hours to 3 days after eating a problem food. For this reason these types of reaction can be hard to identify. Testing can be undertaken to look for IgG antibodies. This type of testing can be controversial. Unlike IgE allergy testing (above) there has been no global consensus on how to test for these types of reactions. IBS Clinics uses 2 key laboratories who are pre-eminent in this area of IgG testing. We have found this test to be useful in addressing IBS in clinical practice

Your diet influences everything you do.

How well you can digest and tolerate foods is a function of your diet. Diet also impacts your energy levels as well as mental and hormonal health. Even your zest and enjoyment of life stem from your diet.

Our food advice aims to optimise all these elements. Identifying imbalances and making changes to diet can return a body to its natural equilibrium.

Contents and reactants in foods

Diet impacts everything that you do, and there are many reasons why you might react to a particular food, for instance:

Specific diets for IBS and other gut disorders

Elimination Diets

Elimination diets are dietary programmes designed to clear the body of foods and chemicals that an individual may be allergic or sensitive to, helping the body handle and dispose of these substances. These diets require the removal of certain foods or food categories from the diet.

Elimination diets are considered to be the “gold standard” for determining if an individual has a food reaction.

Read our detailed advice on Elimination Diets or book a free 15 minute call to discuss why Elimination Diets can help you.

Specific Carbohydrate Diet

This diet removes many foods that are toxic and harmful. But it is natural and nourishing. SCD can “re-boot” your digestion and be an health boost. The need to give digestive support for certain gut conditions was behind the development of this diet. But even if you don’t have any issues, there’s a good chance that this diet will have you feeling healthier anyway.

The key is eliminating complex carbohydrates, lactose, sucrose and other man-made ingredients. Without these in the digestive process, the body can start healing. Gut flora levels stabilise. Reduced irritants from undigested foods, toxins and other man-made ingredients lowers inflammation levels.

Read our extensive advise on the Specific Carbohydrate Diet or book a free 15 minute call to discuss whether this diet can help you.

Hypochlorhydria Diet

We recommend the following dietary adjustments

Cider vinegar: Eating a salad with a cider vinegar dressing before a meal will help acidify the stomach and aid in digestion (although this is NOT recommended if you have active acid reflux).
Ascorbic acid (vitamin C): combined with your vitamin and mineral supplements at mealtime, they will react to produce mineral ascorbate and Hydrochloride, which are the optimal combination to digest and absorb these vitamins and minerals.
Maintain a diet with a low glycaemic index, low fat, and avoid food intolerances.
Increase your intake of fibre and omega-3 fatty acids.
Increase probiotic consumption either through eating yogurt or taking a probiotic supplement. This will greatly balance bacteria and yeast levels in the stomach and intestines.
Consume ginger and/or ginger tea. Ginger is a natural digestive aid and reduces bloating.
Avoid drinking ice cold water before, during, or right after a meal because it slows HCl production.
Avoid alcohol, excess caffeine, refined carbs, processed foods, MSG, wheat protein, hydrogenated and partially hydrogenated oils, fish with high mercury levels, refined sugar, and artificial sweeteners.
Eat smaller meals more regularly.
Chew your food thoroughly.
Remain sitting up for at least 45 minutes after eating to reduce the occurrence of acid being churned up into the oesophagus and to allow gravity to play its part
Take multivitamins that include B3 and B12 in case you have a deficiency caused by the hypochlorhydria

Paleolithic/Stone Age Diets

There are a few names and a lot of misinformation about this diet. In fact it’s eating a lot of vegetables, fruits, lean meats, fish, eggs and some nuts and seeds. This way is how we ate for most of human history. So it has shaped our genetics.

How we respond to the foods we eat, the prevention of disease, and the vitality of our species stem from this diet.

Humans do adapt to changes. But when looked at across generations we actually adapt very slowly. This can result in an incongruence between our physiology and our environment. That is the case with the typical modern diet in the West. The development of over 70 percent of the foods we eat is pre-dated by our last major evolutionary change. Our genes haven’t caught up

There are many nutritional advantages to following a more ancestral nutrient-rich diet. This features fresh fruits and vegetables. Also fresh fish and shellfish. Meats should be grass fed. Poultry and eggs free-range. Plus nuts, and certain healthful oils.

Inclusions and Exclusions

The Paleo Diet avoids or eliminates processed foods. Not permitted are any containing refined sugars, refined grains, refined vegetable oils. Trans fatty acids, salt, and added chemicals are also excluded.

Fresh fruits and fresh vegetables replace refined sugars, refined grains, and processed foods. As a result, The Paleo Diet is a low glycemic load diet. This promotes normalisation of blood glucose, insulin, and helps prevent the metabolic syndrome.

Also, the foods in a modern Paleo Diet contain few problematic dietary anti-nutrients. These elements, such as lectins, can cause several health concerns and autoimmune diseases.

This diet feeds our physiology to match our genetically determined nutritional requirements. That’s why The Paleo Diet will provide long lasting health.

FODMAPS

If you experience frequent or persistent bloating a nutritionist may probably suggest the low FODMAP diet. This diet can be very effective in relieving the symptoms of IBS. FODMAPS is an acronym and it stands for Fermentable Oligosaccharides (eg. Fructans and Galactans), Disaccharides (eg. Lactose), Monosaccharides (e.g. excess Fructose), and Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt).

These are all types of carbohydrates – sugars and starches fermentable by gut flora – and all have certain characteristics in common

They may be poorly absorbed in the small intestine and we therefore need the right levels of beneficial bacteria, in the right places in the gut, to digest them fully
They are the favourite foods of the bacteria which live in the large intestine and in some people in the small intestine too. When bacteria eat FODMAPs, a lot of gas is produced
FODMAPs can act as a sponge by drawing and holding excess fluid in the large intestine
Symptoms typically experienced by sufferers of this type of carbohydrate malabsorption are watery (sometimes explosive) diarrhoea, constipation or both.

Championed by Australian dieticians Jacqueline S Barrett, Professor Peter Gibson and Dr Jane Muir based at the Box Hill Hospital and Monash University, this diet involves avoiding foods containing FODMAPS and helps determine which types of carbohydrate are not tolerated by an individual. A period of exclusion of all FODMAPS before a careful re-introduction of each type of carbohydrate in turn can result in significant relief for some people. This dietary approach is increasingly being used in the treatment of IBS symptoms and is reported to be working well for many IBS sufferers.

Please talk to us or another nutrition specialist before removing these foods from your diet. The low-FODMAP diet requires monitoring, and is not for everyone, and should only really be adopted once your therapist has worked with you to eliminate other ways of easing your IBS symptoms.

Food allergies, intolerances and sensitivities

Individuals with food allergies or other types of sensitivities react adversely to eating foods and food ingredients that most people can eat with no problems.

Testing for food “allergies” can be controversial, partly because they are poorly understood. The term “allergy” is widely used to describe reactions to foods. However, Nutritionists make a distinction between the type of reactions and have classified food reactivities as

Allergy
Intolerance
Sensitivity

Food sensitivities & IBS

There are many reasons why you might react to a particular food. For instance:

Basic Contents – typically these are reactions to the proteins or lectins in food
Natural Processes – ageing, insects, worms, fungi, fermentation processes (tea, malt)
Protectant – pesticides, insecticides etc.
Spoilage – bacterial, fungal, toxins (seafood)
Genetic Engineering – our bodies don’t always recognise genetically modified foods as natural, so these can provoke a reaction
Treatments – marinating, smoking, salting, reezing, microwaving
Additives – preservatives, antibiotics, hormones, colourings
Allergies

In allergic reactions the immune response is mediated by the degranulation of mast cells and basophils as a result of antigen binding to IgE (and to a lesser extent, IgG) antibodies. As a result, immune chemicals which include Histamine are released. Histamine increases the permeability of the capillaries to white blood cells and some proteins, to allow them to engage pathogens in the infected tissues.

Unfortunately, when released into the body inappropriately or in too high a quantity, histamine is a potentially devastating substance.
It is immediate in nature and can be severe. Symptoms can include headaches, rashes, flushing, itching, swelling, runny or blocked nose, irregular heartbeat, diarrhoea, nausea, vomiting or abdominal pain.

The immune system is not infallible, cross-reactions are inevitable and arise when distinctive chemical features (epitopes) have look-a-likes. Cross reactions between inhaled allergens and foods are common.

Food Intolerances

These do not involve the immune system but may be enzymatic (e.g. lactose intolerance) or triggered by chemicals such as food additives e.g. salicylates, sulphites etc

Fructose intolerance happens when absorption of fructose is impaired due to insufficiency of fructose carrier molecules in the small intestinal lining. This results in fructose being retained inside the gut lumen, where it acts as a substrate for bacteria that ferment the sugar and can produce IBS-like symptoms
Lactose intolerance occurs when an individual has problems digesting milk sugar (lactose) as the lactase enzyme is missing. This results in the lactose being retained inside the gut, where like fructose, it acts as a substrate for bacteria, which ferment it. This also results in IBS-like symptoms.
It is possible to test, via hydrogen breath test for Lactose and Fructose intolerance
Lactose and fructose intolerance can be a sign of SIBO and may perpetuate the bacterial overgrowth

Food sensitivities

Food sensitivities are characterised as:

Immune system-mediated responses that involve various classes of antibody (including IgG and IgM) and the formation of immune complexes (antigen binding to antibody in the blood).
These reactions are more delayed with onset of symptoms between several hours to 7 days after ingestion
The gold standard for the identification of food sensitivities is via an elimination diet, whereby all known allergens are avoided for 2 weeks, then re-introduced one at a time at intervals to assess reactivity.

Food sensitivities and IBS

There is good research to support the use of IgG testing in IBS, a study by Atkinson et al, showed that patients who avoided the IgG foods that they had tested positive to, were able to achieve on average a 26% reduction in symptoms.

At IBS Clinics, our approach to diets for IBS includes food sensitivity testing as standard. The results of the sensitivity test are then used to form the basis of an elimination diet. Often re-introduction of these foods after a period of abstinence is possible, so lifetime avoidance of identified problem foods is often not necessary.

SIBO Bi Phasic Diet

This a therapeutic diet combining the low FODMAP and Specific Carbohydrate Diets. The elimination of bacterial overgrowth from the small intestine is the aim of this diet. A phased approach to dieting and treatment limits the side effects of bacterial and fungal “die-off”. Die-off happens through releasing bacterial and fungal endotoxins as part of their elimination. This cause physical symptoms which can be intense for some people.

Phased treatment prioritises the repair of disturbed digestion over the use of antimicrobials. Which means feeling better quicker!

PHASE 1: REDUCE AND REPAIR (4-6 weeks)

The first phase eliminates all grains, legumes, dairy, sugar, and certain vegetables. Also avoiding canned, processed, and fermented foods is part of Phase 1. But in Phase 2 some will be re-introduced.

Fermentable fibres are an important part of a healthy diet. They feed the communities of organisms in our gut which perform many vital functions. The goal of treatment is, under careful management, to reintroduce these fibres, so that they can be restored as a regular part of a person’s dietary intake.

Reduce: Fermentable starches and fibres. This is necessary to starve bacteria of their preferred fuel so they’ll begin to die-off.

Repair: Both the integrity of the intestinal lining and proper digestion are key to this phase. Gut healing nutrients and targeted probiotics help this repair process.

This phase divides into two groups to adjust the strictness of the diet.

Phase 1 restricted diet — everyone starts with this diet. Some have to stay on this diet for the entire six weeks. When a patient can move to the semi-restricted diet depends on how quickly their symptoms improve. If symptoms are much improved after the first week, patients move to the semi-restricted diet. Going back to the restricted diet is an option with a relapse of symptoms at any point during treatment.

Phase 1 semi-restricted diet – this diet builds on the restricted diet but allows for some starches such as rice and quinoa. The practitioner may recommend starting at this level if the patient is prone to rapid weight loss or needs more energy from starches.

PHASE 2: REMOVE AND RESTORE (4-6 weeks)

Remove: Remaining overgrown bacteria and fungi from the small intestines. This phase includes the prescription of antimicrobials. . Whilst still a low fibre diet, the protocol allows for some bacterial growth. This enables the antimicrobials to be more successful.

Restore: Normal motility of the small intestines is important to prevent SIBO relapse. In this phase can involve pro-kinetic medication or supplements. This phase also builds on the allowable foods from phase one.

Conclusion

In conclusion, managing diets for Irritable Bowel Syndrome (IBS) and other gut disorders requires a nuanced and individualised approach. It is evident that there is no one-size-fits-all diet for sufferers; instead, a variety of dietary strategies such as the Elimination Diet, Specific Carbohydrate Diet, Hypochlorhydria Diet, Paleolithic Diet, and the low FODMAP diet offer tailored solutions to address the unique challenges faced by individuals. These diets, while diverse in their recommendations, share a common goal: to alleviate symptoms through careful management of food intake, highlighting the importance of understanding the body’s reactions to different foods, whether they be allergies, intolerances, or sensitivities.

The critical role of professional guidance cannot be overstated. Consulting with a nutritional specialist or dietitian before embarking on any dietary programme ensures that the chosen method is not only effective but also safe, taking into account the potential for overlapping symptoms with other conditions such as coeliac disease and inflammatory bowel disease. This professional support extends beyond mere dietary adjustments to encompass a holistic management plan that includes stress reduction, physical exercise, and possibly, medical interventions.

If you want to know more about diets for IBS or other disorders, we would be very happy to provide some guideleines on dietary management, as well as discuss the triggers and habits that may lie behind amy symptoms that you are experiencing. Equally if you have specific questions, or would like to know more about any off these diets, please set-up a time for a free 15 minute call.

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