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Combining Elimination Diets: Bad Idea

A few months ago, Kate Scarlata wrote a great post about restrictive eating and IBS. As she pointed out, when IBS flare-ups occur, a very common response is to feel guilty–often about something you ate. It happens to me all the time.

“I feel wretched” becomes “What did I eat?!”

I think I respond this way in part because it’s particularly frustrating, when I have an IBS flare-up, to feel that there’s nothing I can do to make me feel better or avoid feeling this way again in the future. It’s very tempting to want to identify some dietary culprit; if I can identify the culprit, I can avoid eating it in the future, and if I avoid eating it, I can avoid the symptoms.

However, as Kate points out, this kind of thinking can lead to over-restrictive eating. Even the low-FODMAP diet, developed by researchers and dietitians at Monash University to help mitigate IBS symptoms, is itself very restrictive. You should follow it strictly only for about two to six weeks before re-introducing high-FODMAP foods to find which are the personal trigger foods for you.

Yet, not only do IBS sufferers often feel anxiety about re-introducing foods once the elimination diet starts to reduce their symptoms (myself included), but it can be very tempting to start trying additional elimination diets–on top of the low-FODMAP diet!

On the one hand, I understand this knee-jerk reaction, and I understand that there are people out there who make compelling arguments for eliminating all kinds of foods for health, the environment, and yes, your digestion. Grains. Meat. Dairy. Sugar. Fat. Everything! But over-restricting your diet can be a major detriment to your health and overall quality of life, not even to mention the risks for those who develop more serious eating disorders like anorexia and orthorexia.

There are some elimination diet combos that actually work quite well. If you have celiac disease and already follow a gluten-free diet but seem to still experience IBS, trying the low-FODMAP diet makes a lot of sense. There are a handful of fermented, wheat-based foods that are low-FODMAP but not gluten-free, such as sourdough bread, sourdough spelt bread, and beer, but for the most part the low-FODMAP diet heavily relies on gluten-free foods anyway, which are becoming more and more available both health food stores and major supermarkets.

I also understand that many people, including people who have IBS, have an allergy or intolerance to a specific food, such as dairy.

The low-FODMAP diet is a low-lactose diet, not a 100% dairy-free diet. Low-lactose dairy foods such as butter, cheese, and lactose-free milk are permitted. However, there are viable low-FODMAP alternatives to these dairy foods, such as almond milk, soy milk made from soy protein, Earth Balance margarine, nutritional yeast (tolerated in up to 1 Tbsp. servings), and Daiya cheese (which has not been tested for FODMAP content but, according to Kate Scarlata, seems to be well-tolerated.) My recommendation would be that if you choose to try the low-FODMAP elimination diet while also eating dairy-free, get through the elimination phase as quickly as you can. If you’re doing low-FODMAP and dairy-free, definitely start re-introducing high-FODMAP foods after 2 to 6 weeks so that you can find your tolerance level for other sources of calcium, such as almonds and broccoli, as well as freeing up your diet a little more.

Paleo and low-FODMAP, though, makes me really nervous. I understand that paleo is also recommended for digestive issues, and I also understand that paleo and low-FODMAP do at first seem compatible in the sense that they eliminate a few of the same foods (high-lactose dairy, wheat, etc.) However, there are many staples of the paleo diet that are disallowed or limited on the low-FODMAP diet, including sweet potatoes, almonds, cashews, honey, butternut squash, cacao, etc. Meanwhile, there are many staples of the low-FODMAP diet that are not allowed with paleo, such as rice, quinoa, peanuts, and lactose-free dairy.

If you combined paleo and low-FODMAP, the only allowed sources of starches in your diet would be bananas, plantains, white potatoes, and parsnips. Not only does that sound like a very bad idea from a physical and mental health perspective, but talk about diminishing your quality of life! It would be super-difficult to go out to eat, go on vacation, go to a party, etc., and I’d get so bored eating those same things over and over again. Not to mention hangry with so few carbs in my diet!

Low-FODMAP and vegan also makes me super-nervous. I know people do it, and I know that there are compelling reasons to eat plant-based. However, your protein sources would be almost as limited with this diet combo as your carb sources would be in the above-mentioned combo. You’d be limited to firm tofu, rice or soy protein isolate, small servings of a few kinds of canned legumes, a few kinds of nuts and seeds, and a few high-protein grains like quinoa. Many vegan staples like beans, cashews, almonds, edamame and numerous vegan protein powders and supplements would be disallowed or very limited.

I’m sorry, but I just don’t think that’s a good idea.

Sure, you can certainly eat some vegetarian and even vegan meals in the elimination phase the low-FODMAP diet–many of the recipes here on my site are vegetarian and vegan, and you’ll find some on other sites as well–but I think it’s really important for your physical and mental health to rotate through some animal-based foods, too, such as meat, fish, cheese, and eggs.Obviously, this is my opinion. There are resources out there that will instruct you how to combine these diets, if you choose to do it.

But frankly, I think the low-FODMAP diet is restrictive enough, and adding other restrictions on top of it is stupid and even dangerous.

What’s my guiding principle for eating with IBS? To eat as wide of a variety of foods as I can without feeling like a rhinoceros has moved into my abdomen.

After all, the whole point of learning to manage your IBS symptoms is to better enjoy your life again. It’s really hard to enjoy your life if you can hardly eat anything.Have you ever tried an elimination diet to manage digestive issues?

If/when you have tummy troubles, do you ever find yourself blaming yourself and feeling guilty?


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  1. Alyssa says:

    I have tried an elimination diet back in the day. I know certain things that aggravate my stomach, but I have learned to recognize that fact before I eat them (especially if it’s something I really enjoy!)

  2. Diane Wahto says:

    A good analysis of IBS and what it takes to deal with it. Recently, I read that, even though we are supposed to eat fiber, too much fiber is a bad choice for those of us with IBS. I figured that out on my own some time ago. Of course, at this point in my life, I’ve figured out generally what works and what doesn’t. It also helps that I don’t have to go to work every day either. No stress means fewer stomach problems. Good luck.

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