Special Diets

Diet Impacts Everything

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 GP 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 practic

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.

mushrooms on yellow background
noodles in bowl on blue background
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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:

 

pie chart related to dietary issues

Specific 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.  90% of all acute food allergies re associated with 8 key foods:
  • Milk, egg, peanuts, wheat (gluten), soy, fish, shell fish and tree nuts (e.g.walnuts, cashews & almonds)

What to remove

The best elimination diets remove the largest number of foods. Generally speaking, the more restrictive the better. Yes, it’s more work. But, as with most things, the more work, the greater the payoff.

To begin with, a good elimination diet will remove gluten, dairy, soy, eggs, corn, pork, beef, chicken, beans/lentils, coffee, citrus fruits, nuts, and nightshade vegetables. That might sound like a lot, but it leaves plenty of options for a satisfying diet comprised primarily of rice, meat (i.e. turkey, fish, lamb), most fruit, and most types of vegetables.

The following table gives an example of what to include and exclude during an elimination diet.
Foods to includeFoods to exclude
FruitsAlmost all fresh fruitCitrus fruits
VegetablesAlmost all fresh raw, steamed, sautéed, or roasted vegetablesTomatoes, eggplant, potatoes (sweet potato and yams are okay)
StarchRice*, buckwheat*Wheat, corn, barley, spelt, kamut, rye, oats, all gluten-containing products
LegumesSoybeans, tofu, tempeh, soy milk, all beans, peas, lentils
Nuts and seedsAll nuts and seeds
Meat and fishFish, turkey, lamb, wild gameBeef, chicken, pork, eggs, cold cuts, bacon, hotdogs, canned meat, sausage, shellfish, meat substitutes made from soy
Dairy products and milk substitutesUnsweetened rice milk*, coconut milkMilk, cheese, cottage cheese, cream, yogurt, butter, ice cream, non-dairy creamers
FatsCold-expeller pressed olive oil, flaxseed oil, coconut oilMargarine, butter, processed and hydrogenated oils, mayonnaise, spreads
BeveragesDrink plenty of fresh water, herbal teas (e.g. rooibos, peppermint, etc.)Alcohol, caffeine (coffee, black tea, green tea, soda)
Spices and condimentsSea salt, fresh pepper, fresh herbs and spices (i.e. garlic, cumin, dill, ginger, oregano, parsley, rosemary, thyme, turmeric)Chocolate, ketchup, mustard, relish, chutney, soy sauce, barbecue sauce, vinegar
SweetenersStevia (if needed)White or brown sugar, honey, maple syrup, corn syrup, high fructose corn syrup, desserts
*May also be removed if you suspect specific sensitivities to grains.

As mentioned, this is a fairly restrictive elimination diet. There are lists available on the Internet allowing more, and sometimes fewer, foods in the diet. The key here is to not get too dogmatic.  Self-experimentation rules the day.  So try different things and see what works for you.

The only caveat here is that the more you remove, the more likely you are to discover foods you’re intolerant to, which is a good thing for your health.

And here’s another tip: consider removing any other foods you eat frequently. For example, eat turkey or asparagus every day? If so, try replacing them during the elimination experiment. You may find that you’ve become intolerant to one of your daily staples because you’re eating it so frequently.

How long should the diet be?

The length of an elimination diet can vary depending on your age and the severity of symptoms.  Children can usually see benefit from a 7-10 day elimination diet, while most adults seem to do well following the program for around three to four weeks.

Just don’t make things too complicated on yourself.  Macronutrient ratios, calorie intake, etc. aren’t very important during an elimination diet.  The only really important thing is to completely avoid the foods discussed above.

Also, during the elimination diet, be sure you consume adequate amounts of water.  Anywhere from 2 to 4 liters daily should do the trick.

Reintroduction

Of course, it’s not the purpose of the elimination diet to get rid of all the foods above forever. That would be awful.  Rather, the point is to eliminate the foods and then slowly reintroduce them, one at a time, so you can monitor yourself for symptoms.

So, at the end of the three weeks of elimination, reintroduce a single food group for one day only.  And then monitor your symptoms for two days.  For example, you might decide to reintroduce dairy on a Monday.  That day you could eat some cheese, ice cream, and drink a glass of milk.  While getting right back to your elimination diet, monitor for any abnormal reactions on Tuesday and Wednesday.

If you have no observable symptoms, you may try reintroducing another food (i.e. eggs) on Thursday.  You can continue this process for a couple more weeks, reintroducing one new food every few days, until you’ve determined what foods may cause you an issue (if any).

The whole process will take approximately 5-6 weeks and, at the end of the experiment, you’ll know a heck of a lot about how your body responds to different foods.

What to look for

Diet impacts everything. The key to the approach is this: pay attention to how you’re feeling.  For example, you’ll want to monitor your sleep, mood, energy, digestion, bowel habits, etc.

In fact, we recommend keeping a journal during the elimination phase and tracking any physical, mental, or emotional signs and symptoms.  If you feel better during the elimination period (i.e. more energy, better sleep), it may indicate that a food you commonly eat is causing you a problem.

The second thing to watch for is symptoms – negative or positive – during the reintroduction.  Negative reactions can include:
  • insomnia
  • fatigue
  • joint pain and/or inflammation
  • skin breakouts or rashes
  • headaches
  • bowel changes or GI pain
  • bloating
  • brain fog
  • sinus or other respiratory issues
Because you’ll be introducing eliminated foods one at a time, you can be very observant of food-related changes.  And virtually anything that is different than you felt during the previous three weeks could be a symptom, negative or positive.

Interestingly, some people actually report increased energy when a given food is reintroduced. Unfortunately this may be created by a stress response to the particular food.  And that’s actually a negative thing.  So it’s important to keep a log of all reactions – positive or negative.
Specific Carbohydrate Diet (SCD)  foods are grain-free, sugar-free, starch-free and unprocessed.  So 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.

Where Did SCD Come From?

Dr. Sidney Valentine Haas was treating Celiacs and other IBD patients in the 1950s.  A young patient of his was very sick with Ulcerative Colitis. Dr. Haas helped the patient to achieve lasting remission through diet and the use of fermented foods.

The patient’s mother then dedicated her life to researching the diet : gut connection. She named it the Specific Carbohydrate Diet.

What Science Is Behind the Specific Carbohydrate Diet?

Not everyone’s digestive tract can digest complex carbohydrates and other man-made food products like sugar. The main principle of this diet is to classify the chemical structure of carbohydrates. They are monosaccharide, disaccharide, or polysaccharide. The diet allows only monosaccharide carbohydrates. It takes Eextra digestion steps to break down the chemical bonds in both the others to monosaccharide carbohydrates.

Any food that is not properly digested causes bacterial and yeast overgrowth. Undigested carbohydrates nourish on bacteria and yeast in the intestinal tract. This creates a chain reaction of excess toxins and acids. The result is  irritation of the small intestine cells. They are also damaged, causing food absorption issues. So the cycle continues.

The diet breaks this cycle of bacteria and yeast overgrowth. Eliminating the food sources they feed on is the start of the process. Restoring gut flora to normal levels lets the intestinal tract begin repairing damage itself.

How Does the Specific Carbohydrate Diet Work?

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

An introduction features easy to digest, natural foods. Once starts the healing process starts the diet can gradually take more complex food. This allows for tailoring of the diet to each patient’s individual conditions

a list of dietary do's and dont's for ibs
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
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 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.
In the 1st century BC, Lucretius wrote “what is food for one man may be bitter poison to others” (quod ali cibus est aliis fuat acre venenum). Such is the case with food allergies. 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, we offer food sensitivity testing as standard, with the results of the sensitivity test being then used to form the basis of an elimination diets. Often re-introduction of these foods after a period of abstinence is possible, so lifetime avoidance of identified problem foods is often not necessary.
 

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 to reintroduce these fibres again.


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.

If you have specific questions, or would like to know more about any off these diets, please set up a time for a call