DIETS TO AVOID
There are some diets that I do not recommend.
Although these diets are commonly discussed online, or even recommended to patients, in my experience these diets hurt more patients than help.
That is not to say that these diets are never helpful, only that these diets should be approached with caution.
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Elimination and Reintroduction Diets
When I first trained in functional medicine, it seemed that just about every lecture I attended promoted the idea that if you simply remove the specific foods that your body is reacting to that you would lower inflammation and your body would heal. This approach has rarely helped my patients, and usually leaves them worse off.
One reason that this approach fails is that it is based around food sensitivity testing that are simply not accurate. This causes fear and confusion around food which slows down healing and can lead to eating disorders.
Another reason this approach doesn’t work is that it is impractical. Promoters of elimination diets always make a point to talk about how food reactions can be delayed up to 48 hours, so dieters need to be extra vigilant in tracking their food and symptoms. The problem is that it is all to easy to mistake a side effect of a supplement or a poor nights sleep for a food reaction.
Why do patients with SIBO react to food?
People with SIBO tend to react to a lot of foods because when bacteria takes over the small intestines, it damages the cells of the intestinal wall. As a protective response to this damage, the immune system begins inappropriately reacting to food, often by activating a defensive cell called a Mast Cell.
Regardless of the reason for the reaction, the good news is that in the majority of cases, when the bacteria have been removed and the gut wall repaired, the immune system will “stand down” and the reactions naturally decrease.
Carnivore Diet
The all meat carnivore diet is extremely popular these days. Proponents of this diet tout benefits ranging from improvements in energy, to reduced GI symptoms as well as weight loss and even to improvement of autoimmune conditions. I see these improvements in many patients. So why have I included it in the section?
The biggest reason is that the benefits of the carnivore diet can be found with less restrictive diets.
Patients with GI symptoms generally feel feel better on the carnivore diet because eating an all-meat diet means that you are eating a no-fiber diet. As you can read about on another page, starving bacteria by depriving them of fermentable fibers is an excellent way to decrease SIBO symptoms of bloating and gas. However, these carnivore dieters would almost certainly get the same benefit on a much broader low FODMAP diet, or simply by by adding periods of fasting into another healthy diet.
Another reason that patients feel better when they go carnivore has to do with protein intake. Patients suffering from chronic GI illness or chronic fatigue are usually not eating enough protein to make up for the increased demand due to inflammation. However, you do not need to be on a meat-only diet to increase protein intake. I ask many patients to increase their protein intake by eating half their body weight in grams of protein each day - while those eating a carnivore diet may be eating 1.5-2g per pound.
A final reason why patients feel better on a carnivore diet is that if you only eat meat, then you are naturally excluding many of the processed foods & sugars that make people chronically ill. But, once again, there is no reason that you can’t cut down on sugars without resorting to an extremely restrictive diet.
In my experience, the more restrictive the diet, the more likely one is to have depression, eating disorders, loneliness and anxiety.
There are several downsides to a carnivore diet. First, an all-meat diet lacks the healthy nutrients found in plant based foods. I have seen many patients who switch to carnivore who feel better for several months, but then steadily decline once their nutrient stores are used up. (This also happens to vegans.)
I have also observed that the longer a patient has gone carnivore the harder it becomes to get off this diet. The GI system has to reboot and slowly remember how to digest fibers and plant products. Many patients get stuck at this point because GI symptoms can return with even small amounts of fiber.
My final concern about this diet diet has to do with watching a few patients develop metabolic problems on carnivore- especially fatty liver disease, increased blood sugar and elevated lipid levels.
The Candida Diet
The idea behind a candida diet is is to suppress the growth of a yeast called candida. Although candida is found in healthy GI tracts, there are times when this yeast can inappropriately grow (especially following heavy antibiotic use). Anti-Candida diets are purported to limit the specific sugars that feed this yeast.
One problem with this approach is that there is no agreement over what foods should be included or excluded in this diet.
There are dozens of variants of this diet online - which causes patients a huge amount of worry and stress as they try to avoid any possible food that could promote candida growth.
Finally, candida diets are a problem because there are still practitioners pushing the idea that it is candida alone that causes illness, when this is rarely the case. I still see patients who tell me that they were given candida focused treatments for years without healing. They tell similar stories of being put on excessively strict anti-candida diets, then being given antifungal medications for years. If they returned to their doctor with complaints that they weren’t getting better they were told the simply weren’t following the diet strictly enough.
Finally, much like the carnivore diet, the candida diet is unnecessarily restrictive - and my preference is for patients to always try simpler and more straightforward approaches first.
"Can I drink alcohol?"
This site is called SIBO NOLA. It’s probably not a surprise to anyone reading this that people in New Orleans drink a lot. So let’s address this straight on.
Alcohol is a direct toxin to the lining of the gut. When the gut lining is damaged, it is much easier for bacteria to gain a foothold.
Regular use of alcohol, even in amounts that are generally thought of as safe and socially normal can be enough to cause SIBO.
One patient really brought this home for me - this gentleman suffered from severe diarrhea and bouts of gas that would occasionally result in incontinence. We had worked together for months, and I offered him just about every GI treatment that I knew: dietary work, periods of fasting, probiotics, immunoglobulins, and both herbal and prescription antimicrobials. After all that his symptoms were reduced by about 50%.
The reason that he wasn’t fully better was that he continued to drink. Every patient needs to make their own decisions about how to live their life, but if you have been struggling to heal from SIBO please consider if drinking alcohol has been contributing to the problem.