Why Paleo didn't fix my IBS

 Now that it's been over four years since I first heard about "paleo" diets, I have been reflecting on how such diets have worked for me. When I first heard about paleo, I definitely thought it was a solution to all my problems and it worked really well for most of them. The original bane of my life in the pre-paleo era, GERD, is gone. But my IBS symptoms were harder to fix and even now I find myself experimenting. In the beginning, I often thought the solution was more "purity" in my diet. I thought if I just were better at my diet, then my problems would go away. But IBS is too complex for that. And it doesn't seem to care about evolution all that much. While evolution can be useful for hypothesizing, my gut is the product of a C-section birth, a subpar diet for almost two decades, and many many courses of evolution. I think of my maternal grandmother who is in her nineties and claims to have only had a stomachache once in her life. Compared to her stomach, my own stomach is a rather unfortunate thing. 

So when I ate a pure "paleo" diet, what happened? My stomach problems got WORSE. 

Luckily I found the SCD (specific carbohydrate diet). It's really for people with worse problems than mine, but it clued me into some of the things that were going on, namely that there was something wrong with how I process certain carbohydrates. Well, not just me, but my own microbiome in my gut. They were taking something I was eating and having a party consuming it and belching out all kinds of bad things. Bloating, cramping, gas, bouts of IBS-C and IBS-D were the result. 

Unfortunately SCD is both too strict and not strict enough. The "legal" list of SCD foods, like the typical "paleo" list, contains foods I cannot digest properly. The specific carbohydrates I'm sensitive to are not the same as those that the SCD concerns itself with. I ended up just going carnivore for awhile, which helped with a great many things, but I had other symptoms on that diet (like extremely low blood pressure) and it is on the pretty extreme of restrictive. I also think that some products of carbohydrate fermentation are important.

I have no idea where I first encountered FODMAPs, which stands for 

  • Fermentable
  • Oligosaccharides (eg. Fructans and Galactans)
  • Disaccharides (eg. Lactose), Monosaccharides (eg. excess Fructose) and
  • Polyols (eg. Sorbitol, Mannitol, Maltitol, Xylitol and Isomalt)

But the theory is similar to the SCD, which is that for certain people, certain carbohydrates aren't processed correctly by the gut and end up feeding bad bacteria. But I think it was more useful for me because it breaks down the issue into a variety of potential baddies to experiment with. Lactose intolerance is the most famous type and all the other types are similar in that they can be dose-dependent. That's why I was so confused at first. Sometimes I'd eat potentially bad food X and feel fine and other times I'd feel terrible. Amount effects it, but that's the tip of the iceberg, because the context can affect it too. For example, with fructose, the amount of glucose ingested at the same time can affect tolerance. 

So far you can see where my experiments have left me vs. the typical paleo diet:

It seems I have some fructose intolerance, but my tolerance is comparatively high. I can eat an apple, but if I start eating a bunch of dried apples (more concentrated fructose), then I start getting into problems. 

Then there are foods that I can tolerate almost none of, such as brassica vegetables like cauliflower. Many "paleo" recipes use cauliflower in place of rice. I am much worse off if I eat that compared to real rice and in fact I've found that rice soothes my stomach quite nicely when it's upset, particularly when cooked in broth as a congee. 

I'm still torn about wheat. I think I've tried every possible type of wheat at this point, including wheat that was fermented to remove gluten and a variety of "heritage" wheats. I still didn't tolerate it, which makes me think that it was never about gluten for me, but about fiber. 

It's also pretty important to self-experiment and not just write entire foods off because they contain something that might be the culprit in causing you problems with another food. Onions are a major issue for me, but I've found I can tolerate them pretty well if they are cooked into oblivion (for example, in a sauce), which frees me to enjoy certain delicious Indian dishes. Tomatoes are only an issue for me raw.

I think this jives very well with the evolutionary idea that cooking was important in human evolution because it transferred digestion to the small intestine rather than the large. That seems to be exactly what is happening here. The large intestine is where fermentation takes place, so if fermentable carbohydrates are the issue, then cooking them to make them more available to the small intestine could help. Of course there is all kinds of fancy cooking science here I'm not getting into, which I need to research further. There is also the issue of tolerance improving if you manage to heal the gut lining and balance the gut bacteria somehow. I think that overall my tolerance has improved as I've eaten healthier. I used to not tolerate spicy food at all, which was practically a tragedy for me since I love it, but now I eat it quite often without an issue. 

But people are always asking me to do an IBS post or series. And I kind of can't because it's been just all one weird experiment of me trying to figure out what I can tolerate and at what level. That's why I'm such a huge proponent of self-experimentation and not such a huge fan of dietary dogma.