5 signs you’ve been on an IBS elimination diet for too long

As a functional nutritionist working with women suffering from IBS, I frequently use elimination diets as a clinical tool to help identify potential underlying causes of digestive stress and also as part of my holistic treatment protocols. Lots of my clients come to me having already placed themselves on some form of dietary restriction or elimination for a long time that helps to manage their symptoms, not aware of the long-term damage they could be doing.

This has become so common that I thought it might be helpful to cover some of the more frequent topics of conversation I have with clients around IBS elimination diets, including: > 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 normal 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 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. Diagnosing potential underlying causes of IBS related to our microbiome, pathogens and overgrowths; and
2. Starving off pathogens and overgrowths as part of an antimicrobial-based treatment 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 practitioners 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.

I 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 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. While an elimination or restrictive diet alone can fix mild microbiome imbalances (think a dysbiosis), significant digestive imbalances and conditions require a more in-depth and holistic treatment approach.

This doesn’t apply for those with specific intolerances to foods like gluten and dairy. These are foods that humans 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. If your symptoms go away when you stop these foods, they can be eliminated on an ongoing basis without the need for any further intervention.

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 30-day treatment 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 dress 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 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.

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 allowed. A good rule of thumb to know if you’ve been on one for too long therefore, 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 declines in good gut bacteria.

What makes an elimination diet effective is often the same thing that causes long-term damage; prebiotic fibre and fermentable carbohydrates. Many IBS food triggers cause digestive symptoms because they feed pathogenic bacteria in our intestines that produce gas byproducts that can also lead to constipation, diarrhoea and other symptoms. But, they are also food for good gut bacteria and essential to maintaining a balanced microbiome.

Much in the same way that antibiotics cause collateral damage and long-term health side-effects associated with not enough good bacteria, 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 you’re not using an IBS elimination diet in consultation with a health practitioner as part of either a diagnostic tool or as part of an antimicrobial-based treatment protocol then you probably shouldn’t be on one at all… and especially not long term.

If any of these warning signs sound like you and it’s time to actually test for and treat the underlying root cause of your IBS and gut dysfunction, please head to the Work With Me page to learn more about how I work online with clients in many countries to test for and treat the various root causes of IBS symptoms and other GI conditions. You can heal IBS, and you can get all those foods you miss back into your diet without causing symptoms.