Is the pursuit of diet perfection making you sicker?

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July 11, 2017 by Amy Hollenkamp

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Me with my favorite treat!!

I remember feeling so overwhelmed when my functional medicine practitioner emailed me this infamous infographic of the SIBO specific diet. The dreaded columns of “yes” and “no” foods still haunt my dreams.

But, I was desperate to feel better….to feel like myself again. My functional medicine practitioner was adamant that starving the bacteria of fermentable fibers was not an option, but a necessity. I felt as though if I didn’t stick to this list 100% I was going to fail.

I saw so many other people in the SIBO Facebook group struggling to get better and I mistakenly assumed that they must not be following a strict enough SIBO diet. They must be feeding the beast. There was no way in hell I was going to feed the beast.

I was religious about eating low FODMAP/SCD foods. I cut out foods that I never had issues with because they had fermentable fibers. Onions and brussel sprouts were the enemy! Every meal felt like a psychological battle in this war against SIBO. I obsessed over every bite of food that entered my body.

Being around food at parties and restaurants was too difficult, so I avoided social gatherings as much as possible while I was on this diet. When I would go to parties, I felt so stressed and deprived. Every ounce of will power was used to avoid an all out binge fest on pie or pizza.

Plus, I always had to answer the most annoying questions about my diet every time I would see my extended family or friends. So what can you eat!? When are you going to be able to eat normal again? Just a little bit won’t hurt, right? It is weird how much of our human connection centers around food. We use food as a vehicle to show affection and to share memories. SIBO can feel especially isolating when you can’t share in these food centered social experiences.

Another problem I ran into was unintentional under-eating. Eating the same 10-15 foods can grow incredibly stale. I found myself losing all interest in food. Nothing “SIBO friendly” sounded appetizing, so I found myself not eating a whole lot of food. Maintaining my weight was a constant struggle and I felt like a zombie.

The stress of being the perfect SIBO dieter wrecked havoc on my hormones too. My cortisol and thyroid hormones were all kinds of crazy. Not to mention my absent menstrual cycle.

After white knuckling it through 3 months of this super strict SIBO diet, my health was continuing to spiral out of control. But, I failed to listen to my body’s cues that this diet was not right for me. Instead, I listened to my foggy brain that was deleteriously focused on completing operation “starve bacteria” at all costs.

It wasn’t until I switched practitioners was I able to gradual loosen the reigns on my diet. When I came to her, I was clearly malnourished. She smartly advised me to increase my food intake and to broaden my diet. Through working with her, I was able to come to my senses. By trying to starve the bacteria, I was starving myself.

It wasn’t a fast process to unwind some of the disordered eating patterns and fear I had developed while on this restrictive diet, but eventually I was able to eat restricted foods without the fear that my gut would explode! Plus, my body felt better when I was providing it with the nourishment it needed to thrive.

These overly restrictive diets leave SIBO sufferers vulnerable to orthorexia. For those unfamiliar with orthorexia, here is a good description from the National Eating Disorder Association:

Those who have an “unhealthy obsession” with otherwise healthy eating may be suffering from “orthorexia nervosa,” a term which literally means “fixation on righteous eating.” Orthorexia starts out as an innocent attempt to eat more healthfully, but orthorexics become fixated on food quality and purity. They become consumed with what and how much to eat, and how to deal with “slip-ups.”

Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating.  Eventually, the obsession with healthy eating can crowd out other activities and interests, impair relationships, and become physically dangerous.

SIBO diets should be viewed as a tool to manage symptoms and allow the sufferer to optimize their daily life. You should be able to accomplish more throughout the day. But, so often, SIBO diets seem to do the exact opposite. They consume our lives leaving the strict dieter more worn down and isolated.

Even after you clear the SIBO, the fear of food tends to linger and prevent experimentation. In my opinion, this continual stress and fear around diet can be damaging to the SIBO recovery process.

When we are chronically stressed, cortisol (our stress hormone) will become chronically elevated. We evolved this “fight or flight” stress response to help us escape acute stressors such as predatory attack. Cortisol is not supposed to be chronically activated.

Our stress hormones activate our sympathetic nervous system, which shuts down digestion. The stress response reduces blood flow, motility and immunity in the gut. Chronic stress can compromise the intestinal barrier making you susceptible to leaky gut, which will lead to systemic inflammation. The stress response can also down regulate the activation of thyroid hormones. Motility will be further repressed if your thyroid hormones are not activated.

Orthorexia will promote this stress response and wreck havoc on not only your gut, but your whole body! It can be quite challenging to work yourself out of orthorexic eating patterns, but I believe it is a crucial step in the healing process.

That is not to say that you should eat what ever you want if you have SIBO. I believe eating a  whole foods nutrient dense diet is important for healing. I am rather trying to raise awareness about two potential problems that I see with the current SIBO diet paradigm.

These are just my opinions, so take it or leave it. First, these diets are unnecessarily restrictive. They tend to restrict foods that you may be perfectly okay eating. Second, their seems to be too much weight on the impact of the diet on treatment outcomes. Adjusting your diet should always be viewed as one strategy in a multifaceted approach to treat SIBO.

Here is a list of personal insights that I gained through my restrictive dieting and SIBO experience:

  1. There is no perfect SIBO diet. Every one has different needs and sensitivities. I find it interesting that the individuals with the strictest diets in the SIBO sphere tend to be the sickest. By religiously focusing on diet perfection, you could become more stressed and isolated, which is not conducive to healing.
  2. Don’t be afraid to experiment. The best diet is one that is customized to your individual needs, not one based off of an arbitrary list of yes and no foods. Experimenting seems scary when you are used to following a strict SIBO diet. But, experimenting allows you to truly hone in on how your body is responding to foods. Experimenting also helps you learn to trust your body. If you try a new food that you react to, don’t fret! Just steer clear of it for a little while.
  3. Diet changes will not cure the SIBO, but should be seen as a symptom management tool. Like I have harped on in all my posts, you must find and treat the root to cure SIBO. Eliminating all fermentable fibers will not cure the underlying root cause. I would argue that long term low fermentable fiber diets may even exacerbate SIBO by depleting the population of healthy bacteria in the colon. You should definitely eliminate foods that you react severely to, but overly restricting could be damaging to the health of your GI tract.
  4. Restrict the foods that you react to, but don’t be afraid to add them back in later. It can be challenging to add food back in when you know you reacted to it in the past.  Starting slow with a couple bites and seeing how you respond is a good way for your body (and mind) to re-acclamate to the food.
  5. Give yourself a break! Nobody is perfect and trying to be perfect is exhausting. Don’t beat yourself up about eating something you shouldn’t have. Sometimes having a treat or a cheat meal is necessary for your sanity.
  6. Be grateful for the foods you can eat. At the beginning of treatment when you might have a higher number of foods that you are reacting too, it is very easy to feel  frustrated and deprived. But, I think it is important to remind yourself that these restrictions are just temporary! In the mean time, trying to shift into a positive mindset by giving thanks at each meal for the food you can eat can help combat the stress and negativity that come with the restrictions. Recipes can also help create some fun and exciting ways to enjoy your meals during more restrictive times of treatment.
  7. Work with someone! If you find yourself struggling with the constant fear and anxiety about your diet, I think it may be a good idea to work with a professional that has experience with disordered eating patterns.
  8. Find a diet you can maintain. Focusing on finding a diet that you can comfortably maintain while reducing symptoms is going to reduce the anxiety around food and increase the chances of long term success.

Bottom Line:

If your restrictive SIBO diet is disrupting your life and making you sicker, don’t be afraid to broaden your to find a diet that works best for you!

If you liked this blog, please like the Facebook page, so that you don’t miss any posts! Click here to go the the SIBO diaries Facebook page.

I’m going to go eat some non-dairy ice cream! Until next time!

12 thoughts on “Is the pursuit of diet perfection making you sicker?

  1. Anna says:

    This is awesome. As a fellow SIBO sufferer, I agree. I was diagnosed with it just prior to finding out I was pregnant. My Dr didn’t want to put me on any of the typical SIBO eradiciating treatments at that point, but she did want me to do the diet for awhile. She also gave me a special probiotic, digestive enzymes, and ginger capsules. I didn’t do the diet. I was also afraid of becoming obsessed and stressed over food, because I’ve been there before. Instead I tried to just eat nourishing, whole foods. Crazily, my gut symptoms have actually improved since then! I will have to address this again in more depth after the baby is born, but for now I am thankful for little to no symptoms. (I say all this because I’ve totally been where you say you were in the post above. Stress over food can be worse than your food!)

    Liked by 1 person

    • I am so happy you stuck to your guns and didn’t jump on a super restrictive diet while pregnant. I feel like that is a recipe for a disaster! Stress over food can definitely be worse than food. Thanks for reading!

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  2. I can’t LOVE this enough! Thank you for sharing your experience. I’m going to share this with my patients!

    I am frequently the doctor taking people OFF of their SIBO diets and it can be really amazing to watch the transformation. In addition to the stress of eating SCD/FODMAP, you’re also starving your colon and it’s bugs, which makes you gradually shift to a more inflamed state. The diet is a tool to manage symptoms and it is a great diagnostic tool, but it doesn’t treat SIBO.

    Liked by 1 person

  3. M. Tracy says:

    Amy, I too have been battling SIBO/digestive problems for 4 years, and the more diets/supplements I go on, the worse I get. Do you mind sharing the name of your new functional medicine doctor or suggesting what diet you follow now?

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    • Hi Tracy! I see a local functional MD in Cincinnati named Dr. Kristen Harding. My current diet doesn’t fall into any specific diet. I pretty much just eat a mix of whole foods, but I still steer clear of gluten and I sprout my legumes/grains before I eat them.

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  4. Darius Liddell says:

    I enjoyed this post, and think you are on the right track of how most people with SIBO (or SIBO-like symptoms that don’t test positive for the breath test but can’t test positive for any other test) can drive themselves crazy trying to be symptom-free. There seems to be a quasi-perfect balance of not trying too hard to cure yourself — a tao-like approach. I bounced around with elemental and fodmap and scd a number of times over past few months with no complete remission yet.

    Since you don’t believe in SIBO diets, how do you feel about a short-term (2-3 weeks) elemental diet to get to remission? I’m trying this now with atrantil, ginger, 5-HTP, and biofilm defense (all for motility for IBS-C).

    If I may ask, how long did you have SIBO (as diagnosed by breath test) for? And are you symptom-free now (or have you had a negative breath test last time you checked?) Just curious.

    I was never able to get a positive breath test (And all other GI tests passed (fecal calprotectin, etc) no procedures (endoscopy, colonscopy) done).

    Please keep writing. There are so many people with SIBO-like symptoms out there who are in the dark and misinformed — and consequently (not totally their fault) driving themselves crazy trying to get their quality of life and sanity back.

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    • Hi Darius! Thanks for reading. Personally, I don’t consider the elemental diet a form of treatment not a SIBO diet. Some people have great success doing ED. I would be careful if you have any fungal problems too.

      I had a mild positive methane breath test, but was still symptomatic even when it cleared due to large intestine dysbiosis and hormonal imbalances that were a consequence of my treatment strategy. I can’t really pinpoint how long it took me to clear the overgrowth, because I didn’t retest right away, but I did one like a year after treatment and it showed a negative for both hydrogen and methane. My gut symptoms are much better. Things are operating much more smoothly.
      I also agree that there is a fine balance between stressing about diet and symptom management through diet.

      I will definitely keep writing! Thanks again for reading!

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      • Darius Liddell says:

        Oh right elemental is not a true diet obviously, but something short-term (unless you have IBD which in that case can turn into long-term maintenance or backup plan).

        I’ve seen/heard of cases where “clinical SIBO” cleared up (meaning breath test was negative, which positive pre-treatment) but symptoms remain. And the total reverse, this woman went through all the treatments and was totally asymptomatic at the end …. but her breath test was positive (hydrogen 40, methane 38). actual story is in here if interested: https://drruscio.com/sibo-treatment-protocol-episode-39/

        Just case study proof that breath tests aren’t the be-all, end-all.

        Given the 80-85% success (breath test wise) of treating SIBO, I’d guess if the elemental diet doesn’t work for me, then I can safely get off the SIBO train, and chalk it all up to “leaky gut” (still not sure what it is except for chronic inflammation and brain fog) or chronic stress. Past year/two was stressful given my symptoms started out as chronic prostatitis (june 2015), but so that’s a part of my overall syndrome along with SIBO-like symptoms. So if elemental doesn’t work, I’ll just take the low stress route, promote motility and eat without stress.

        What is the most definitive test you would recommend for yeast overgrowth? It seems like all of the antibiotics/antifungals (allicin, berberin, oregano, caprylic acid) used for SIBO also work for yeast/candida, so I wouldn’t have to change anything there, if i wanted to kill two/three birds with one stone.

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      • Personally, I think a lot of people continue to have symptoms when there breath tests is negative because they still have imbalances in the large intestine that they need to address and/or there motility problem is still an issue causing bloating etc.

        I think an organic acid test and/or comprehensive stool analysis is going to be your best bet for diagnosing yeast. Also, you may notice coating on the tongue if you are dealing with any sort of yeast overgrowth. I do think that some of the herbs can kill two birds with one stone. Yeast is just something to be aware of when going on an elemental protocol.

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