How to Optimize Gut Health with Diet: Gut Health Series, Part 3
Updated: Jan 10, 2020
It is my opinion that everyone has a different "threshold" of what they are willing to put up with. Once that threshold has been crossed, they are more willing to make a drastic change. At first I thought my threshold was pretty low, because I made a drastic change pretty quickly after being diagnosed with Ulcerative Colitis. But when I look back, I actually did put up with symptoms for years leading up to that time. Examples include constipation, bloating, acne, and inability to gain weight, especially after I had my second child (I still cringe when I confess the constipation part. It's kind of personal. But, if my being open about my struggles can help even one person, then it is worth it!). It's not that these symptoms didn't bother me, but I just figured they were a part of life. I didn't realize there was a lot I could do about them, and it also never occurred to me that changing my diet might help these issues.
In Part 1 of this Gut Health Series, I opened up about my own story, and how I was able to heal my gut with diet. In Part 2, I discussed how things can go so wrong with our gut health. I do have some people who are anxiously awaiting Part 3, because they need solutions! Getting to this part has really taken so much longer than I hoped, because, well, life happens. Plus, I really wanted to make sure I got it right, and didn't leave anything out. As it turns out, I had to split the solutions into two parts. Part 3 will focus on diet for gut healing, while Part 4 will focus on possible supplements and other treatments that may be necessary.
How Do You Know There's a Problem In the Gut (or Leaky Gut)?
Remember this picture? It's so helpful in understanding Leaky Gut. As we get into this next part, keep this image in mind. It's so important in helping to understand why we can get symptoms, both inside and outside of the gut, when Leaky Gut is present.
Obvious Symptoms of Gut Problems and Leaky Gut:
Anyone who has IBS, Ulcerative Colitis, Celiac Disease or Crohn's clearly has gut issues including Leaky Gut, if they have not gone through an effective gut healing process. Symptoms included in this umbrella of gut diagnoses might be frequent or mild diarrhea, severe or mild constipation, blood in stool, mucous in stool, chronic abdominal pain. Also, don't forget chronic bloating and gassiness. It's amazing that so many people think symptoms like this are normal, especially if they are more or less functional in life. But, let me assure you, if you experience these symptoms on an ongoing basis, it is NOT normal and you should not have to put up with it. Now, if you have any of the severe symptoms, obviously you should go to a health care provider and get a diagnosis. You need to know what you're dealing with.
In some ways, I felt I was lucky that it was so obvious I had gut problems, because there are a myriad of other issues that are caused by poor gut health, but that have NO symptoms in the gut, whatsoever!
Not So Obvious Symptoms:
Many of these will be a review from Part 2 of this series, but it's helpful to have the reminder as we dive into the HOW part of gut healing.
1. Food intolerances. Food intolerances can certainly cause leaky gut. But, leaky gut can also result in food intolerances. Especially if you find you are reacting to multiple different foods, including foods that would normally be considered good for us. Think meats, bananas, nuts, peppers, tomatoes, or really just about anything. This is because when we have leaky gut, undigested food particles are allowed to pass through our now damaged gut lining, and into our bloodstream. When this happens, our immune system recognizes the foreign substance (food particles) and attacks.
2. Anxiety or Depression. The gut has more neurotransmitters than the brain! So if your gut is not functioning properly, this will most certainly affect those neurotransmitters and possibly cause anxiety or depression.
3. Skin concerns. Chronic acne, eczema, periorificial dermatitis, other skin rashes and even psoriasis are absolutely signs of leaky gut. Many people try to treat skin concerns from the outside, but often this is unsuccessful because the root cause of these issues results from systemic inflammation, caused by leaky gut.
4. Chronic pain. This might include ongoing joint pain, muscle pain, fibromyalgia, myofascial pain syndrome, or other chronic pain issues. When you have leaky gut, remember, foreign substances pass out of our gut and into the bloodstream. Our immune system goes on high alert, because it will attack foreign substances. This results in widespread inflammation!
5. Autoimmune disease of any kind. This includes autoimmune diseases of the gut, as previously mentioned, AND any other disease. Hashimoto's, rheumatoid arthritis, ankylosing spondylitis, psoriasis, asthma, Type 1 Diabetes, the list goes on. I want to stress that you may still need ongoing care and treatments along with these issues, but healing the gut can help immensely.
6. Overweight or Underweight, Craving and Satiety Issues. Being overweight or underweight are sure signs of gut issues. If you are underweight and otherwise eat a fairly normal diet, this means you are not absorbing nutrients properly. If you are overweight, and can't seem to lose weight no matter what you do, this can also be an absorption problem, believe it or not. Much if it may have to do with having the wrong kinds of bacteria in the gut. Remember, gut dysbiosis is often present in gut problems, and causes craving and satiety issues. People who are overweight are likely to also have problems with insulin resistance, and healing the gut can help this issue, as well.
7. Short stature in a child. This is where my experience as a pediatric RN comes in. When we can't point to other causes for the short stature of a child (meaning a child below 3rd percentile in height), we may test for Celiac. Short stature may be the ONLY sign of Celiac disease, believe it or not! So, I include this symptom in here, not because you should have a child immediately jump to a diet change, but because it can be a symptom that might be worth looking into. It's always important to identify Celiac if it's present.
OK, Seriously, How Do I Heal My Gut?!
Yes, we really need to get into this now. I felt the above review was necessary in helping to identify whether there is a gut problem or not, so thank you for bearing with me! As I mentioned, in this part we will dive into diet changes that are effective in helping solve gut problems.
Diet for a Mild Case
If you don't have severe gut issues or autoimmune disease, and have mild health concerns that are not debilitating, you should be able to get away with some less drastic changes than people who do have these issues. I don't mean that these changes are easy, but just that an intensive gut healing diet is going to be more difficult than trying to solve less severe health concerns. Examples mild, non-debilitating health concerns might be: ongoing joint pain, persistent acne, mild ongoing rashes, or just poor energy levels in general.
Humans were not meant to eat a diet full of processed foods that are inflammatory, and devoid of nutrients. Although my parents really did not embrace this type of diet when I was young (my mom was one of the only people in her circle who shopped at a co-op!), many people did. I grew up in a time of packaged, convenient foods, and it is not a coincidence how many more people in my generation have significantly more health problems at younger ages than our parents did.
We NEED to ditch the packaged, processed, convenience-oriented foods. This means eating real, whole, unprocessed foods, that are organic and GMO free. What exactly does this mean, though? In my opinion, based on the mountains of research I have done, a paleo type of diet is immensely helpful in mild cases. This may sound super drastic if you are used to eating whatever you want. And you're right, it is. But the reason I feel it is less drastic, is that you can make the switch to paleo all at once, without having to go through various different steps that a person with a more severe case may have to take. I'll talk more about that in a bit.
Paleo Diet (But Make It Your Own Version!)
The basis of a paleo diet is to eat foods in the most natural state that they are available in, and to avoid grains, sugar, and possibly dairy. Our ancestors ate this way, and research shows that they did not have the chronic types of health problems that are so prevalent in our world today. Some people have the misconception that people who eat paleo eat tons of meat, and this is really not accurate.
WHY does paleo work so well? Basically, it cuts out inflammatory and processed foods, and emphasizes only nutrient dense foods. These foods encourage good gut health by feeding good bacteria, and lowering inflammation, allowing the lining of the gut to become strong and healthy again, eliminating issues that arise from leaky gut. Cutting out grains was so foreign to me, at first. But what I learned was that each different type of grain has it's own protein, such as gluten in wheat, that is an "anti-nutrient". Corn has its own version of gluten, as do oats and rice. These proteins were meant to protect the plant from being eaten, in effect, to deter us from eating them. These proteins cause inflammation at best, and major GI distress in the worst case scenarios.
Here is what paleo has come to mean for myself:
Lots of veggies and some fruits. I'm not perfect, but my goal is to load my plate with veggies, especially green ones. Fruits are great too, and are really meant to be more like a dessert. Large amounts of fruits do tend to spike blood sugar and possibly be difficult to digest. Make sure to buy organic veggies and fruits as much as possible.
Sweet potatoes and potatoes. Yes, these are totally in the veggie category. But, they are a little different because they are so starchy.
Nuts and seeds. These foods are really helpful when it comes to snacking, as well as converting traditional recipes to paleo. Against All Grain, Nom-Nom Paleo, PaleOMG, and Elana's Pantry are great resources for these types of recipes.
Healthy fats. These include avocados, avocado oil, extra virgin/organic coconut oil, grass-fed butter and ghee, high quality olive oil (not recommended for high heat), nuts, and seeds. Yes, there is some crossover here into other categories. But healthy fats are SO important because they provide us with sustained energy that our bodies were meant to thrive on. Don't buy into low fat anymore, please! The low fat craze was based on flawed research and caused more health problems that I care to mention.
High Quality Meats, Fish and Eggs. I lump these together, because these all provide high quality animal protein. But, don't just eat the cheapest animal protein you can find. Go for grass fed beef, pasture raised chicken, turkey and eggs, and wild sourced fish such as salmon. Low quality versions of these foods can actually be highly inflammatory. Animals should be fed what they are meant to eat, which is NOT grains and soy. They should also not be treated with antibiotics, nor should they eat food laden with pesticides. Not to mention, I am a big believer in only eating meat from animals that had the best possible quality of life.
Healthy versions of sweeteners. These can include raw honey, maple syrup, coconut sugar, and stevia. If you are someone who struggles with blood sugar regulation, then please, by all means, minimize or eliminate sweeteners. But, I include them because they can be a healthy part of a paleo diet, and they can help normalize the diet so that we can eat versions of foods that we used to love that have been modified to be easier on the gut. I can't stress enough the problems that cane sugar, high fructose corn syrup, and other processed sweeteners cause to our gut, by feeding pathogenic bacteria, and simply by inflaming our gut.
Dairy, Maybe. I say maybe, because dairy intolerance is so prevalent these days. If you can tolerate dairy, choose full fat and grass-fed/organic. I would even go as far as to say that raw dairy is the way to go, because it contains enzymes such as lactase, which help you to digest it! Raw dairy should always be from a trusted local source. If you can't do cow's dairy, try
All of this being said, I truly believe that there is no one size fits all approach for every person! Some people may thrive on keto, while others may need more carbs like quinoa, and still others may do well eating soaked beans.
And what about vegan? Well, if you are someone that can thrive on vegan, then go for it! I would implore you to do your research, though, and supplement with B12 and other vitamins and minerals that may be lacking in a vegan diet. If you are trying to heal your gut, you should not be eating grains, even though they are vegan. Also, if you find after some length of time that you are no longer thriving on vegan, then consider adding some high quality animal proteins back in. I am definitely not a vegan expert, but rather, someone who has a lot of experience in gut healing. I have found that for myself, and many others who need gut healing, eating high quality animal protein is a key part of the process.
Do it for 30 Days! Finally, if you believe you have a mild case of leaky gut and are looking to make a change, I would encourage you to commit to this for 30 days. You could even consider doing a Whole 30, if you are someone who needs a plan to be accountable to. If you stick to these changes for 30 days, you will likely be amazed by how you feel. At that point, consider what type of lifestyle change you see yourself embracing long term! You may be surprised to find that many of these changes are very doable on an ongoing basis. Finally, if you plan to add some foods back that you cut out during the 30 days, add them back one at a time, every 3 or 4 days, so that you can identify any reactions.
Intensive Gut Healing for the Severe Cases
A "Severe Case" includes anyone who has active symptoms of Ulcerative Colitis, Crohn's, Celiac, or severe IBS. If you've ever been on a medication to manage these symptoms, you are likely to be a more severe case. In addition, if you have any autoimmune disease, consider do this more intensive version, at least for a short time, before moving on to paleo (as above).
A severe case will be more obvious in someone with severe gut symptoms (frequent diarrhea, blood and/or mucous in stool, chronic abdominal pain). If you read Part 1 of this series, I described going in for my diagnostic sigmoidoscopy, during which I saw my raw, bleeding insides. It was clear that there was significant healing that was needed!
I would recommend the Specific Carbohydrate Diet (SCD) or GAPS diet for anyone with these types of symptoms. I'll refer to this as SCD, since that is what I did. SCD is really a version of paleo that is geared toward healing a severely damaged gut, so see the previous section on paleo foods to get an idea of some the types of foods you'll see in SCD.
What's the difference between SCD and Paleo?
Intro Diet. SCD has you start with an Intro Diet which lasts 5 days. This helps you to jump start your healing. It then has you add various foods back in one at a time.
Cook and ALL Fruits and Veggies. All fruits and veggies (with the exception of avocado and banana) are cooked well.
No Complex Starches. This means no sweet potatoes or regular potatoes.
Only Lactose Free Dairy. Dairy is only allowed in the form of hard cheeses (aged at least 30 days), and homemade yogurt that has been fermented at least 24 hours (this ensures there is no lactose in the dairy). Note: lactose free milk does not count. It is still very difficult to digest! I did start out eating dairy, and based on my experience, I would recommend NOT having dairy when starting out on SCD. Instead, add it in after 30 days or so and see how you do.
No Sweeteners Except Honey. Honey is the only sweetener that is allowed; no maple syrup or coconut sugar, or even stevia. Read on, and I will explain why.
The Science Behind SCD, in a Nutshell: Simple Carbohydrates Only!
1. Easier to Digest. SCD has you eat foods that have only one molecule in their simplest forms, because these foods are much easier for the gut break down. During intense gut healing, we need for the gut to do the least amount of work possible. This is so that the gut can focus on healing, and also so that it can actually begin to absorb nutrients again.
2. Starving Pathogenic Bacteria. In addition, foods that have more than one molecule (either two, as in maple syrup, or multiple as in complex carbohydrates like sweet potatoes and potatoes) actually feed pathogenic bacteria in our gut. So, the goal is to starve this pathogenic bacteria! Trust me, it works, and I will talk about my experience with this process in a bit.
3. Cooked Fruits and Veggies. The avoidance of raw fruits and veggies may sound counterintuitive, because don't they have higher nutrient content than their cooked counterparts? Well, in some cases, yes, but actually in some cases, no. In cruciferous vegetables, for example, many nutrients are actually "unlocked" by cooking them. The same is true of carrots and spinach. True, cooking destroys helpful enzymes in these foods. But an unhealthy gut is not capable of utilizing these enzymes.
If your gut is that messed up, you're not absorbing any nutrients, anyway! You've got to heal the layers of your gut so that proper absorption can start happening again. This happens by eating foods to strengthen it, and by eating foods that do not irritate it more. When the intestines are raw and/or bleeding, raw veggies are like a brillo pad to that tissue.
Here's How I Did SCD to Heal my Severely Damaged Gut:
So, enough on this. HOW do you actually start this type of diet? I love how Jordan and Steve at SCD Lifestyle outlined the whole thing. If you need a gut healing diet, go to their website and download the Quick Start Guide! It is very helpful. They have recommendations outlined in their e-book, which starts with an Intro Diet.
1. The Intro Diet
For 5 days, I ate only homemade bone broth with chicken and gelatin in it, pureed carrots, bananas, salmon, eggs, and beef patties. Yes, you heard me right. And it wasn't fun. But guess what? It was only for 5 days! And, by the end of the 5 days, I went from 10-15 trips to the bathroom per day to about 3. The blood was significantly less.
Note: If you remember in Part 1, after the Intro Diet, I went to a modified regular diet (basically gluten free, lactose free, and cooked, not raw, veggies). I do not recommend you do this, but it was a part of my very human, very flawed story. It did not work, and my symptoms began to come back shortly after. When I committed to doing SCD long term, I restarted the Intro Diet and then moved on to the next phase.
2. Introducing New Foods in Phases
After my interlude of going off SCD, I restarted the intro diet, and then begin the various phases outlined in the SCD Lifestyle e-book. Basically, it has you add foods in phases, starting with the foods that are typically the easiest to digest. You add these foods one at a time, and each new food should be added about every 3 days. In this way, you can tell which foods you might be reacting to. In addition, they have you cook and puree all fruits and veggies at first. This part may last as little as a week or less for some, and longer for others, depending on the extent of healing that needs to happen. I, personally, was in the pureed fruit and veggie stage for 2 weeks or less. I continued to cook them without pureeing, however, for about 8 months. Every person is different, so you have to listen to your body. If a food that other people can easily tolerate doesn't work for you, just move on to another.
How do you know if you're not tolerating a food you've added? Well, most likely you'll experience some distress in your gut. Sometimes you'll see a skin rash, or have brain fog that wasn't there before. Note that it may take 1-2 days to see a reaction, so this is why we wait 3 days in between each new food that is added.
3. Management of Roadblocks.
There are several roadblocks that can occur when healing from severe gut issues, and it's important to troubleshoot them, or even just ride them out.
This phenomenon is VERY important to mention, and is technically very likely to be a part of the Intro Diet phase. Remember when I mentioned that one of the goals of SCD is to starve pathogenic bacteria in the gut? Well, if you do have a lot of pathogenic bacteria, or gut dysbiosis, this bacteria will start to die in the first 24-48 hours of the Intro Diet. When this happens, they leave behind endotoxins that our body has to clear, and it makes you feel bad, plain and simple. Keep in mind that these pathogens causing gut dysbiosis are likely a big cause of your gut symptoms! We WANT them gone.
I actually tried to go to work 2 days after starting the Intro Diet. I knew about Die-Off, but since it hadn't happened for me up to that point, I figured I was out of the woods. Boy, was I wrong. About an hour after I got to work, I started to experience heart racing, sweating, hot and cold flashes, achy muscles, and brain fog. I even had a low grade fever! I mean, I felt horrible. I made it home, went straight to bed, and stayed there for about 24 hours. During that time, I had intense cravings for chocolate yogurt, of all things. I was super fixated on this, and could not stop thinking about it (we usually never had chocolate yogurt, but for some reason we had it in the fridge, and I all knew was that I wanted it). I knew better than to eat it, and eventually ALL of these symptoms subsided. Now I know that the reason I was craving something sugary was because those dying pathogens in my gut were desperate for sugar.
Symptoms of die-off can be minor, as in a bit of tiredness for a day or two, or more severe like mine were. Some things you can do to help with Die-Off are to rest, drink plenty of water, and even take an epsom salt bath. Work through it, and it will subside.
Decreased Energy (At First)
As you get 1-2 weeks into SCD, you might notice a drop in energy, and possibly even some brain fog. This is due to the body transitioning from getting less carbohydrates and more fat as fuel. Rest as needed, and stay the course, because this stage will also pass. Typically you'll see improvement in energy by week 3 or 4.
Falling off the Wagon
I did this a fair amount, I'm not going to lie. I feel like it's important to mention, too, because we are all human, and it can feel unfair that, not only do we have this debilitating condition, but then we have to give up certain foods that we may have previously loved.
I remember people telling me, "you must have a lot of willpower! I could never do what you're doing." Gosh, I didn't even feel like I could do what I was doing, and I really didn't feel like I had any willpower! I would go crazy, would feel like I couldn't take it anymore, and eat something I wasn't supposed to, like a whole Theo chocolate bar. I would feel sick and have some "GI distress" afterward, and then would often feel exhausted. I would feel sorry for myself for a bit, and then pick myself up by my bootstraps and carry on. It helped to remember my raw, bleeding insides, and my resolve to avoid harsh medications, to remind myself of what my goal was.
Eventually, it WILL become easier to stay the course, as you get used to feeling better, and as you get used to the foods you are now eating. As I began to discover that these foods were like my medicine, I started to embrace them and even love them. My taste changed, and the transformation was amazing! Ask anyone who knew me before; I had a major sweet tooth and adored pizza. If I can change my tastes, then anyone can!
New Food Intolerances
Some people immediately start to heal on SCD, like I did, while others do not see as drastic of results. Or, they may improve right away, and then start to plateau or even backslide a bit. SCD Lifestyle points out that some people may have problems with Dairy, Eggs, Nuts, and/or Nightshades (nightshades include tomatoes, peppers, white potatoes and eggplant).
I definitely experienced this issue. My healing started off with a bang, and a couple of months in, I started feeling like I wasn't tolerating foods that I previously was. This was likely because my gut was trying to achieve the next level of healing, but certain foods I was eating were getting in its way. I had to drop nightshades, eggs, certain nuts, and dairy for several months. The good news is, I was able to add eggs and nuts back in within 4-6 months. Years later, I can also eat goat dairy and even tomatoes. Each person is different!
4. Homemade Bone Broth on an Ongoing Basis. The Homemade Bone Broth is a HUGE key in helping to heal the gut. Don't underestimate it! It is so rich with collagen and healing minerals that help build the gut lining back up. Plan to have it on hand at all times, if possible. You don't have to always have it plain, as there are plenty of SCD soup recipes out there that use the bone broth. Kettle and Fire makes a great bone broth if you can't make your own all the time, but it is expensive, and I can't think of many foods that are easier to make than bone broth, especially from chicken bones.
5. Transition to Paleo
This started to happen for me about 8 months in. I did not do it all at once! I tested out paleo foods one at a time. First I tried uncooked spinach, then raw berries, then sweet potatoes, maple syrup, 80% dark chocolate, and so forth. I did not add anything new until I knew I was OK with the last food. But it was really fun to have more freedom, and I was so encouraged that it really was happening!
It is important to know that the goal is to be able to make this transition to paleo or something similar. One reason is that we need to keep pushing our bodies, as appropriate, to achieve the next level of healing. Another reason is that more starchy foods like sweet potatoes will help to feed the friendly bacteria in our gut, which we do want to start proliferating again.
What About Food Allergy Testing?
Food allergy testing can be incredibly helpful, and may at least help to bypass some of the above steps by identifying some key foods to avoid up front for mild or severe cases. The downfall though, is the assumption that you can eliminate these foods and then go about your business without making any other changes. For mild cases, I still recommend following whatever version of a whole foods/paleo diet that works for you. For severe cases, follow the above steps, adding each new food in one by one. You can just skip over any foods that have been identified as an issue for you.
Is Diet the Only Factor in Gut Healing?
The answer to that is, in many cases, NO. Supplements are vital for most people who need gut healing, and often there may be pathogens that need to be addressed, especially in more severe cases. I'll be talking about this in Part 4!
Is it all Worth it?
I'm sure you already know that my answer is YES. I have been able to achieve a level of health that I never thought possible! And I know many others who have been able to do the same. Most of these people did not think it was possible to change their diets so drastically, and now they've embraced it as a way of life, because not only do they feel amazing, but they fully enjoy what they eat.
Do you think changing your diet is doable, or does it seem insurmountable to you? Have you crossed your own personal threshold of what you are willing to put up with, or are you not there yet?