Diets for Digestive Issues

Navigating the right type of diet to support your unique digestive symptoms can be a minefield. Most of these diets are designed to be therapeutic interventions and not long term. Significant dietary changes should only be undertaken with the support of your Nutritional Therapist and specific testing to make sure the diet is working for you.

Bacteria imbalances can often be exacerbated by consumption of different types of carbohydrates. These are often not foods we think of as unhealthy. We commonly see clients on excellent diets suffering from painful bloating, cramps, constipation, diarrhoea or other IBS type symptoms. Acid reflux may also be common or a coated tongue, delayed gastric emptying and burping. Indeed there can also be non-gut related symptoms such as fatigue, brain fog or anxiety or skin issues such as rosacea or acne.

Carbohydrates are classified by their molecular structure and the therapeutic diets outlined below omit certain subgroups of carbohydrates.

Low FODMAP diet

FODMAPs is an acronym for Fermentable, Oligo-, Di- and Mon osaccharides and Polyols, used to describe a group of fermentable short-chain carbohydrates. These are widely found in a typical western diet.

The FODMAPs approach addresses the total amount of fermentable sugars consumed rather than looking at each sugar individually. There is a threshold amount of FODMAP foods someone can tolerate at one time. FODMAPs can be easily fermented, resulting in gas, pain and diarrhoea. Growing evidence reveals the beneficial role of minimizing FODMAPs for the short term for those with IBS. These include

Lactose
Lactose is the sugar found in cow’s, sheep’s, and goat’s milk. Lactose-rich foods such as ice cream, milk, condensed milk, many cheeses and all fermented dairy products such as yoghurt and kefir should be avoided.

Fructose
Fructose, most commonly known as fruit sugar, is also found in honey, high-fructose corn syrup (HFCS), agave, sucrose (table sugar) and fructans. Foods with excess fructose such as apples, pears, and mangoes, may trigger abdominal symptoms. Limit consumption to two servings of FODMAP-friendly fruits per day.

Fructans
Fructans are made of fructose molecule chains that are cannot be absorbed. For this reason, they can contribute to bloating, gas, and pain. Wheat accounts for the majority of people’s fructan intake. Inulin and FOS, sources of fructans, are added to many foods to enhance their fibre content and to some probiotic supplements.

Galactans
Galactans are oligosaccharides that humans cannot digest but that provide food for bacteria. Consequently, galactans can contribute to gas. Dietary sources include chickpeas, kidney beans, black-eyed peas and many soy-based products.

Polyols
Polyols are also known as sugar alcohols which may contribute to loose stools. These can be found in sugar substitutes like mannitol.

Specific carbohydrate diet (SCD)

The specific carbohydrate diet (SCD) is a grain free diet, low in sugar and lactose. It was developed by Dr. Sidney Haas, a pediatrician, in the 1920’s as treatment for celiac disease. In 1987, Elaine Gottschall published “Breaking the Vicious Cycle”, after her daughter’s inflammatory bowel disease (IBD) improved with use of the SCD.

The specific carbohydrate diet removes specific carbohydrates (polysaccharides, some oligosaccharides, disaccharides and polyols). It utilizes a system of “legal/illegal” foods and recommends very strict adherence. It recommends starting with an introduction diet and expanding the diet from there. Monosaccharides are permitted on the SCD diet due to the fact they have a single molecule (mono) structure that allows them to be easily absorbed. Complex carbohydrates such as disaccharides and polysaccharides which are not easily digested feed that bacteria in our gut. This can be helpful if they are feeding the beneficial bacteria but not so helpful when there is an overgrowth of bad bacteria being fed or bacteria in the wrong location (such as the small intestine).

Bi Phasic diet

This protocol of diet, combined with specific gut healing and antimicrobial phases, was created by Dr. Nirala Jacobi. The diet is based on Dr. Allison Siebecker’s SIBO Specific Food Guide and is a therapeutic diet combining the low FODMAP and SCD, a hybrid of the two. The goal of the protocol is to help eliminate bacterial overgrowth from the small intestine.

The Bi-Phasic Diet Protocol uses a phased approach to diet and treatment which is reported to limit the side effects of bacterial and fungal “die-off”. The die-off process occurs when bacterial and fungal endotoxins, released by their elimination, are absorbed and cause physical symptoms. Die-off can be intense for some people. Phasing the treatment through stages also aims to prioritise the repair of disturbed digestion over the use of antimicrobials.

The initial phases of the diet are very strict. The phases are designed for progression and not to stay at any one phase for a prolonged period. In fact, the bi-phasic diet introduces foods relatively quickly, often while addressing the bacterial imbalance.

Histamines, amines and other reactions

Bacterial imbalance can cause additional complexities by damaging the villi of the small intestine, thereby reducing enzymes like lactase and diamine oxidase (DAO). This can result in the development of lactose intolerance which means that dairy products may cause gas, bloating, cramping and loose stools. It can be difficult to then distinguish this as a stand alone issue when you are already avoiding specific types of carbohydrates.

High histamine foods may also become part of the problem. Histamine in the gut may contribute to symptoms of IBS, alter gastric motility and irritate the gut lining. Histamine also causes an allergy-type reaction and may dilate blood vessels. Symptoms of excess histamine external to the gut might include skin issues, hives, itching, rashes, sinus problems, headaches, fatigue, brain fog or migraine. High histamine foods include aged foods such as processed meats, smoked salmon, fermented foods, tinned foods and a selection of naturally-high histamine foods such as strawberries, avocados and tomatoes.

Tests

Where to start or when to stop?

People can typically find themselves removing more and more foods from their diet to minimise symptoms. Managing a restrictive diet is very stressful and not supportive of long-term health. Nutritional deficiencies are a significant concern. Fermentable fibres are also an important part of a healthy diet as they feed our microbiome—the communities of organisms living in our gut which perform many vital functions for us. When you withdraw fermentable fibres from the diet, you ‘starve’ out the beneficial bacteria in your gut also. The goal of any protocol should not be to restrict the diet permanently, but to eventually reintroduce these fibres again with less or no symptoms.

We are often concerned when our patients tell us that they have been following a restricted diet for a long time, without ever really addressing the underlying issues. Our approach will always be to find out the root cause of your symptoms using advanced testing. We will then support our patients with dietary changes and a specific tailored protocol. The ultimate aim is for the client to be able to enjoy a broad range of foods without digestive discomfort or other unwanted symptoms.

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