5 signs you’ve been on an IBS elimination diet for too long
As a clinic of nutrition practitioners who work with people suffering from IBS symptoms, we frequently use elimination diets as a clinical tool to reduce symptoms while clients are moving through the healing journey and addressing root causes. Diet changes are one of the best tools we have to help people feel better in the short-term.
Lots of clients come to us having already placed themselves on some form of dietary restriction or elimination for a long time because it helps to manage their symptoms. What they were not aware of is the long-term damage they could be doing to their gut microbiome and all of the other downstream health consequences this can bring.
This is a topic we are discussing with clients weekly at The Functional Gut Health Clinic. It's so common that we wrote a blog about it in case it was helpful for those who are figuring it out alone. Here are some of the topics we cover in this blog:
> What is an IBS elimination diet?
> Why they should be used and why they shouldn’t be abused.
> Why you shouldn’t be on an IBS elimination diet long-term.
> Signs you’ve been on an IBS elimination diet for too long.
> Where to start with getting yourself off the restrictions and eliminations so you can get back to a diverse and balanced diet again.
What is an IBS elimination diet?
An IBS elimination diet is a short-term eating plan that systematically eliminates certain foods that commonly cause digestive symptoms, before reintroducing those foods one at a time to work out which of them are well tolerated… and which are not.
The most common IBS elimination diets used by practitioners include the Low FODMAP diet, the Specific Carbohydrate Diet (SCD), the SIBO BiPhasic Diet, the SIBO Specific Food Guide, the Gut and Psychology Syndrome (GAPS) diet, the Paleo Autoimmune Protocol (AIP) diet, as well as a few others that pop-up from time to time. Some remove whole food groups like gluten and dairy, while others are more focused on fermentable fibres and are very dosage specific.
And while there are many variations, they are all useful for two main things:
1. Figuring out potential underlying causes of IBS related to our microbiome, pathogens and overgrowths when you don’t have lab testing to guide you; and
2. Starving off pathogens and overgrowths as part of an antimicrobial-based protocol.
What they are not supposed to be used for is trying to manage symptoms indefinitely (more on that below). This however, is how they were initially promoted by many and despite the latest science, it is an approach which many IBS sufferers still follow. So before we get into why you shouldn’t be on an IBS elimination diet long-term, let’s look at some of the warning signs that you have been on one for too long.
Signs you’ve been on an IBS elimination diet for too long
You’re progressively getting more and more restrictive with your diet.
When you’ve finally arrived at a diet of grilled chicken, olive oil and steamed broccoli (been there), but still have massive bloating or other symptoms, the realisation that restrictive diets alone aren’t going to solve the problem should have well and truly set in.
We also see many IBS sufferers scrambling to layer multiple IBS elimination diets on top of each other to cover off every potential trigger. If you started with reducing carbs before moving onto a Low FODMAP diet and have since layered Paleo AIP and/or a Low Oxalate diet over the top, it’s time to slow down. At this point the obvious question is: where to next? And no, breatharianism isn’t a real option, unfortunately.
You struggle to reintroduce any foods.
If you have repeatedly tried and failed to successfully reintroduce a broad range of foods after completing an elimination diet, then it’s time to move onto the next level of intervention - investigation. While an elimination or restrictive diet alone can help with mild microbiome imbalances (think a dysbiosis), significant digestive imbalances and microbiome changes require a more in-depth and holistic approach.
This doesn’t apply for those with specific intolerances to foods like gluten and dairy. These are foods that humans can genetically or generally struggle to digest and so your symptoms are more likely a result of, for example, the natural loss of lactase enzymes or the gradual breakdown of the gut lining caused by gluten/gliadin that leads to a leaky gut. In this case, not being able to reintroduce these foods isn’t always a reflection of underlying gut dysfunction.
You haven’t been out for dinner with friends in the last six months.
With restaurants in most cities that provide gluten and dairy-free options as well as making changes to dishes to accommodate intolerances, going out for dinner with friends shouldn’t be a dreaded experience. That is, unless you’ve been on an IBS elimination diet for so long that you’re struggling with anything that isn’t that delicious combination of grilled chicken with olive oil and steamed broccoli we talked about above.
If you’re in the middle of a gut healing protocol that incorporates a restrictive diet, that might be a different story. But if you can’t remember the last time you put on a nice outfit and headed out to dinner with friends, for fear of bloating up like a balloon or spending half the night on the loo, the time has come to get serious about healing your gut.
Your symptoms are slowly returning or getting worse.
A lot of IBS sufferers see an initial improvement in symptoms on an IBS elimination diet like the Low FODMAP or SCD diet. This is the most addictive feeling there is when you’ve been struggling with food and symptoms for such a long time. Commonly, a reduction in symptoms masks the underlying deterioration in gut dysfunction, and eventually the effectiveness of a restrictive diet starts to wear off. But because of that initial connection between diet and symptoms, it seems logical to keep finding and eliminating the ever-growing list of triggers.
And it is at the point that you’ve run out of triggers that you realise your symptoms have returned or are now a whole lot worse than when you began the elimination journey in the first place. I’ve been here and it’s a tough place to enjoy anything to do with food.
You’ve stopped relying on apps and resources to tell you if something is Low FODMAP, SCD, etc.
Some of these diets are very complex in terms of what is and isn’t ‘allowed’ and in what quantities. As such, it can take quite a long time to get your head around whether something you’re about to put in your mouth is ok. A good rule of thumb to know if you’ve been on one for too long is when you’re no longer needing the printed food lists in your handbag, friends are reaching out for help from you as the expert or you’re considering starting an SCD-friendly recipe blog...
Why you shouldn’t be on an IBS elimination diet long term
If IBS elimination diets are supposed to help, you’re probably wondering why we shouldn’t be on them long-term and why they can cause some of the warning signs listed above. The short answer is; detrimental changes in our microbiome, particularly a reduction in good gut bacteria abundance and diversity.
What makes an elimination diet effective is often the same thing that causes long-term damage; prebiotic fibre and fermentable carbohydrate restriction. Many IBS food triggers cause digestive symptoms because they feed pathogenic or overgrown organisms in our gut that produce byproducts or other imbalances that lead to constipation, diarrhea, bloating, gas and other symptoms. But, they are also food for good gut microbes and essential to maintaining a balanced gut microbiome.
Much in the same way that antibiotics cause collateral damage and long-term health side-effects associated with not enough good gut microbes, prolonged use of an IBS elimination diet can have a similar impact.
Even the researchers behind the FODMAP diet have stressed that it is for just 2-6 weeks and is not a strict diet for life.
So what’s next if I want to eat normally again, without the IBS symptoms?
If any of these warning signs sound like you, then it’s likely time to consider functional testing to help identify underlying root cause/s of your IBS symptoms (think parasites, bacterial dysbiosis, SIBO, etc). Once you have them identified you can set to work addressing them in sequence, with the goal of eradicating symptoms for good.
If you’re interested in support with eradicating IBS symptoms and adding food back into your diet, please head to the Work With Us page to learn more about how we support clients. Please know that you can overcome IBS, and you can get those foods you miss back into your life, without causing symptoms. It is possible.