For many people with gut problems like mine (IBS/IBD), following some gluten-free, low carb diet usually alleviates most of their symptoms within a few weeks/months. But sometimes, for some people, it doesn’t. In that case, specialized diets, all similar, but also each more restrictive than the previous, must be followed. Elimination diets are not as effective in my opinion, because some foods can create irregularity as late as 1-3 weeks after they’re consumed, making it impossible to know which food was the offending one.
Please note that I’m not a doctor, but I read and I experiment a lot, and this is the guide I’d follow myself:
1. Start with a doctor’s visit
A stool, allergy and blood tests (and possibly a colonoscopy) can find out if the source of your problem is mechanical, food intolerance, auto-immunity, or an infection. If it’s an infection, e.g. C-Diff, some protozoa like B. Hominis, H. Pylori, listeria or gardia etc. then you need antibiotics or a fecal transplant. As bad antibiotics are, these bad organisms can’t always be eradicated with diet, because they are capable of eating everything you eat (while most “good” gut bacteria only feed on carbs). However, new research has shown that home-made kefir can help kill C. Diff (commercial kefir has less potency).
This is the least restrictive diet, the most balanced of all in terms of nutrients. It has to be 100% gluten-free to see health benefits. Go for up to 100 gr of “net” carbs per day (for net carbs, just don’t count the fiber). In addition to the Paleo diet, also add this list of superfoods (bone broth is super-important for gut health, for example). Reading online, I found that the vast majority of IBS, GERD, diverticulitis, and Celiac sufferers find relief with plain Paleo. Crohn’s and UC patients range from finding full relief, to partial, to not at all. So for some of these more difficult cases, they have to either add 24-hour fermented home-made goat or water kefir (while cutting down all other dairy for a while), or read next.
3. FODMAPs + Auto-immune Paleo
If Paleo (or the similar SCD & GAPS diets) don’t work, try to cut down FODMAPs and follow the auto-immune Paleo protocol additionally. Three diets in one. Please note, this is an extremely restrictive regiment.
The Auto-immune Paleo is the same as Paleo, but without any dairy (not even butter), nuts, seeds, fruits (except a few berries rarely), yeasts, eggs, shellfish, pepper spices, and no nightshades (no tomatoes, peppers, eggplants, white potatoes). It’s basically just fat (olive oil, tallow/lard/duck fat and coconut oil IF you can tolerate it), meat/fish/organs (preferably grass-fed/pastured/wild), and veggies/seaweed. This diet is best for people with strong auto-immune problems (e.g. Multiple Sclerosis), but sometimes it works for gut problems too.
FODMAPs include specific food groups (e.g. onions, brassicas, apples etc) that are allowed in all other diets, but you can’t consume in this diet. So for this, you need to follow both FODMAPs and Autoimmune Paleo, which removes most foods. DO NOT stay on this diet for more than 1-2 months. After your regularity has returned, add foods one by one, one every 4-5 days. This way, you will find out, if for example, nightshades are bad for you still, or if eggs are now more tolerable than before. Continue adding foods (unless you’re really intolerant to them) until you reach normal Paleo again, which you will have to sustain for life. Also, check your D3 & Mg levels with a blood test, and get a good digestive enzyme that can break down carbs and fats.
4. Fecal Transplant
If you’re among that 3%-5% of the IBS/IBD patients where none of the above works, then it’s possible that your problem is an infection of an unknown origin, that tests won’t identify. In that case, revert back to Paleo (plus home-made goat kefir), for life, and get a fecal transplant from a healthy donor. Until modern medicine catches up, this is your only hope.
Personally, I was lucky to be able to fix my IBS-D with a mix of Paleo and SCD. That is: Paleo + home-made goat kefir, up to 100 gr of “net” carbs per day (I also followed the Paleo-ketogenic diet for a few months, up to 50 gr “net” carbs per day), vitamin D3 3000 IU per day, and only few tubers/starches. Since almost all these IBS/IBD conditions eventually create malabsorption problems (I was very surprised to find out via a blood test that I was short on B12, since I eat a lot of meat/fish), I supplement a few times a week. I track what I eat via Cronometer, so if I seem short on a nutrient on a weekly basis, I supplement with it once. Put money aside to check your hsCRP (inflammation), B12, iron, calcium, folate and D3 levels via a blood test every year. It’s all about optimization, especially for us with a sensitive gut.