The Nuts and Bolts
The object of the program is to restrict the ingestion of yeast and carbohydrate which become sugars. In the past I .prescribed all sorts of supplements in the form of vitamins and oils but now I know these are not needed. The body can sort itself out. It may take several weeks but if the recommendations are followed there is almost 100% success rate. If however the patient’s focus is lost the symptoms may return after some time so this becomes a life style of eating. I cannot emphasize enough this is NOT a quick fix. Initially the change in eating habits is challenging particularly in the first two weeks. This is made worse in some people by the die off of yeast in the body, the Herxheimer Reaction, which produces ‘flu like symptoms in about two weeks after the start of the program. These symptoms last about 24 hours and then the weight starts to come off and the energy increases.
It is essential that other causes of bowel upset are excluded before embarking on these recommendations namely cancer, ulcerative colitis, diverticular disease, Crohn’s disease and others.
A side effect of the program is weight loss of up to 10lbs in the first month. The weight loss slows down in subsequent months. If there is not a significant weight loss in the first month the food and drink ingested should be reexamined with another food diary.
There is increasing evidence to suggest that obesity may be linked to an imbalance in the gut flora. In particular a decrease in the Christensenella microorganism has been linked to being overweight. This dangerous situation leads to an increase in visceral fat around the abdominal organs. The cause of this is probably related to the ingestion of processed food and the general increase of sanitation of day to day living reducing our exposure to bacteria which in turn upsets the balance of intestinal flora .Chlorinated water is an example killing off GI flora.
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It has been suggested to address this problem one should eat bacteria rich foods such as sauerkraut and kimchi and avoid antiseptic mouthwash, antibiotics, junk and processed food.
One substance which makes food very tasty is vinegar. Unfortunately vinegar is made with yeast. Ethyl alcohol changes to acetaldehyde and then to acetic acid which is vinegar. Driving these reactions is yeast and unlike wine the yeast is not filtered off. Vinegar is ubiquitous in our food particularly in all the condiments some of which also contain sugar. A good substitute is lemon juice. It does not taste quite the same but it contains Vitamin C and helps the digestion. The tradition of squeezing lemon juice over fish began with the thought that the citric acid in the lemon would dissolve any ingested fish bones. A few teaspoons of lemon juice can decrease the sugar content of food by up to 30%.
This is NOT a high protein diet so the protein intake should remain the same and the green vegetable intake should be increased to ”bulk up”. In fact the problem of constant hunger at the beginning of the life style of eating resolves fairly quickly and portions become smaller. Constipation may be a problem at the beginning but this can be resolved by taking some psyllium temporarily, but again this settles with time .
As previously noted wheat contains lectins which are involved in the leaky gut syndrome. Our genetic make up is almost identical to cavemen who did not cultivate anything but ate meat fish eggs. and the occasional fruit and vegetable. Wheat was not cultivated until about 3000BC by the ancient Egyptians. Despite the high prevalence of wheat in the Western World diet it is not necessary and my recommendation is to avoid it. Almost 2,500 years ago the association of diet and health was known to Hippocrates (460BC to 377BC) who said “ let thy food be thy medicine and thy medicine be thy food”. Moses Marmonides a 12th century physician said “No illness which can be treated by diet alone should not be treated by any other means. More recently Thomas Edison (1847 to 1931) founder of the phonograph, motion picture camera and the electric light bulb said”The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.
If the patient has a birch allergy it is possible but not necessarily definite there may be cross reactions with some of the following foods.
Almond, apple, apricot, buckwheat, carrot, celery, cherry, coriander, fennel,hazelnut,honey,kiwi,nectarine,parsley,parsnip,pear,peach,peanut,pepper plum, potato, prune, wheat and soy.
The oroallergy syndrome induces tingling in the mouth or lips. With the oral allergy syndrome and birch allergy the potentially offending foods include:
kiwi,apple,pear,plum,prune,peach,nectarine,apricot,cherry,celery,carrot,parsnip,parsley,dill,anise,cumin,coriander,caraway,fennel,potato,tomato,greenpepper,lentils,peas,bean,peanut,hazelnut,walnut,almond,soy and
sunflower seed.
Ragweed may cross react with
banana,watermelon,cantaloupe,honeydew, zucchini and cucumber.
Grass may cross react with melon,watermelon,tomato,orange,kiwi,potato,cherry.
I then asked them to do a food diary. In this I wanted to know everything that passed their lips for 7 consecutive days. I explained I meant EVERYTHING. In particular ketchup, mustard, vinegar, mayo, sauces, salad dressings etc. I wanted a baseline so a “normal” diet was ideal but not with celebratory meals. I found it amazing what some people eat. Often it is the same thing again and again. I went through the diary pointing out the things I felt were contributing to their IBS.
The explanation for this is the following.
Everyone has yeast in their gut specifically along with the many trillions of other microbes. That is normal and necessary for the normal functioning of the gut. If more yeast is taken in the diet often in the form of bread or vinegar which incidentally is in all sorts of foods, more yeast accumulates in the gut. Patients learned to read labels. If sugar is eaten or things that become sugar the yeast is fed more. Then come lectins. They are contained in several foods but most in wheat and soy. There are good and bad lectins and the bad attach to the sugars in the gut and the cells lining the gut to make them move apart losing the previous “tight junctions”. This process allows toxins and yeast to escape the colon and to enter the bloodstream. These foreign proteins are recognized as antigens initiating an allergic reaction.
From a personal point of view if I take vinegar my nose will run in 2 minutes.
The Diet
The principle of the diet is to exclude yeast and sugar and things that become sugar from the diet. The body will correct the abnormal gut flora by itself once the patient stopped assaulting their gut with bad food. I used to prescribe all sorts of herbal supplements but found they are unnecessary. If you do the diet properly often, but not always, at about the 2 week stage the patient may feel like they have a 2 day flu. This is the so-called’die-off’ of the yeast known as the Herxheimer reaction. After that an increase in energy is reported with weight loss and an improvement in the IBS. If they did the diet properly about a 10lbs loss in the first month could be expected. If this is not the case then I questioned the patient about how closely they followed the diet and sometimes asked them to repeat the food diary. In general the foods allowed on the diet are meat of any kind including poultry, fish of any kind, eggs cooked in any way and green vegetables. The diet lasts 4 months. Some nutritionists would say 28 days is long enough but my experience does not agree with this. At the 4 month mark reintroduction of foods was suggested. By this I told the patient to choose a food. I suggested carrots as an example. Eat a tiny portion of carrots and wait 4 days to see if there is a reaction. If there is no reaction eat a normal portion of carrots and wait another 4 days. If there was no reaction then the patient could eat carrots in moderation. Moderation is the key to reintroduction. A reaction is the recurrence of the original symptoms usually the next day, but much worse than before the diet. Then try the next food in exactly the same way. Again a key is one food at a time. There is no point in trying several foods at the same time and wondering which one caused the trouble.
As I said some people just cannot do the diet. For them and in general terms when reintroducing foods a shortened diet may be useful.
I call it the ABC’s avoidance diet for easy remembering.
Avoid:
acetic acid which is vinegar (full of yeast as it is made with yeast)
bread (flat bread despite containing some yeast and sugar, wraps and soda bread which uses baking soda to make it rise are OK)
strong aged cheese ( mild cheese is ok eg parmesan, mozzarella)
sugars(or what becomes sugar e.g. potatoes, pasta, rice)
Soy.
Allowed
The foods allowed are eggs cooked in any way; any kind of meat including poultry; fish prepared in any way and green vegetables. Bread made using baking soda instead of yeast, flat breads such as naan or pita or raps. Diet pop, two small glasses of milk or a small plain yogurt, a small serving of oatmeal, and one fruit for the day the equivalent of an Apple.
The one meal that is difficult is breakfast. I suggested a full fat Greek yoghurt, or eggs or the fruit for the day or oatmeal which is not processed.
Not allowed
The foods not allowed include those containing sugar or become sugar, strong cheese and most dairy products excepting those above; chocolate, regular pop, soybeans, coloring and other additives, potatoes , rice, wheat, rye , corn and the vinegar containing condiments for example ketchup, mustard, vinegar, Mayo and salad dressings. Olive oil and lemon juice makes a reasonable substitute for commercial salad dressings. Vegetables other than green, moldy nuts such as peanuts, pistachios and cashews. Bananas, grapes, watermelon and pineapple. These fruits contain a lot of sugar. Carrots, turnips potatoes and other root vegetables as well as peas. In general foods that grow in the ground have more sugar than those that grow above the ground with the exception of peas. No alcohol. Tomatoes are interesting in that they contain a lot of calories but the glycemic index is fairly low so I suggest a maximum of 2-3 tomatoes per week. The glycemic index is a reflection of how the body metabolises the food as opposed to the calories which are measured in a laboratory.
Green vegetables
A list of green vegetables includes cabbage, cauliflower, celery, green string beans, cucumber, onion, green onions, leek, globe artichoke, broccoli lettuce of all sorts, spinach, arugula, green pepper, Swiss chard, asparagus, beet greens, parsley, bok choy, kale, anise, chives and garlic.
Alternatives to regular wheat include spelt, kamut, amaranth, quinoa, millet, buckwheat and oats.
Sweeteners.
Natural are agave nectar, Stevia, coconut or Palm sugar.
Artificial is Splenda.
Good foods
Elderberry, acai berries, oysters, almonds, grapefruit, Tea, sweet potato, full fat plain yogurt. This yogurt is better than low-fat yogurts because in the low-fat yogurts fat is replaced by sugar. It has been suggested skimmed milk is better than regular milk on this diet.
After some time subconsciously the patients refused those foods they knew would make them ill. This was a problem when they were invited to some one else’s house or a function where perhaps there was no choice. I suggested that before going they should discuss with the host or hostess their food problems to avoid embarrassment. I have been there and been brow beaten into eating a food that made me ill the next day.
Falling off the diet puts recovery back a bit, not to the beginning for one transgression but is best avoided. So it is the diet or not with no half measures.
For patients with severe IBS such that normal bodily function is interfered with may be eligible for a disability tax credit in Canada. After a while the lifestyle of eating becomes second nature and almost routine.
It was not uncommon for patients after some time on the diet to quietly lapse and suddenly find themselves feeling ill again. My suggestion was to keep the food diary going to identify the causative foods. This keeps the focus going and while it is not as good as a personal mentor it allows the patient to act objectively and if there is a recurrence of symptoms the offending food should be easier to identify. It is very easy to trick oneself in blaming a food if the diary is not kept up.