The Value of an Elimination Diet in the Treatment of Crohn’s and Colitis
Note: I couldn’t have written this post, nor could I have tweaked my diet to see results without closely tracking my diet and tracking my symptoms.
In this post, I will share yet more evidence that diet is essential to the management and treatment of inflammatory bowel (Crohn’s and Colitis). It is also essential, I believe, to the management of IBS, and many other idiopathic (of unknown origin) conditions, but I don’t have time for that here.
I have been on the Specific Carbohydrate Diet for a little over two years now. As I have alluded to in past posts, the diet has gotten me most of the way (80-90%) back to normal—but it didn’t get me fully back to normal.
For two years, I’ve been saying that the SCD, while the foundational component of my treatment, is not the only treatment I will need to fully heal. Today, I may change my tune some…Let me explain.
Four weeks ago, on my naturopath’s advice, I started an elimination diet. After my ELISA blood test showed strong reactions to cabbage and dates, and moderate reactions to apples (I ate lots of those), tuna, clove, peas, and nectarines, I decided that I would do a full elimination diet and see what comes of it.
To start, I did a 24-hr juice fast. I drank only freshly juiced vegetables for one day. The next day, I added banana and avocado (safe foods for me), the next I added some salmon and simple salad (also safe). By the fourth day I was fully into my elimination diet. By that I mean that I ate strictly SCD, but I eliminated:
All of the culprits from my blood test:
And I eliminated the most common SCD culprits, the foods that most often cause people to fail the SCD:
- Dairy (and yogurt)
- Other nuts
It was excruciating at first. I lost 5 lbs in a week. Then something happened. On the eighth day of the elimination diet, I had two mostly solid poops—only two. All day, I only went twice, and it was mostly solid. That was the encouragement I needed to keep going.
The ninth day was about the same. The tenth, I improved even further, with one completely normal stool, and one slightly loose stool.
Then I did something really impulsive and stupid—I added a new treatment; one my naturopath recommended. I began butyrate enemas and totally threw myself into digestive hell in 48 hours. After four enemas, I was puking and had four major Ds per day. I immediately quit the enemas, groping to regain the healing I had seen just two days before. The idea in starting the enemas during the elimination diet was, in theory, to add the butyric acid (primary fuel for epithelial cells in the colon) to my system (my levels are low) during a time where other irritants were at a minimum. I hoped by doing this I would speed the healing process.
It was the opposite. It took seven days for my system to get back to where I was before I started the enemas.
I put this paragraph about the butyrate enemas in this post because it illustrates a point I want to get across: Layering too many treatments at one time can really set you back. Don’t be impulsive. Add treatments one at a time, and give each treatment time to work before you add something else. Just because a treatment works for others, doesn’t mean your body will take it well.
That setback was a hard mental blow, and I struggled with depression and self-pity during the recovery period. In retrospect, I should have gone back to my journal and repeated the journaling exercises I wrote about in a previous post. Live and learn.
Since then I have recovered nicely, regained the weight I lost, and enjoyed almost two more weeks of symptom free living before I began testing the foods I eliminated. The process is still going on, but I will let you know
Where I stand right now.
I was reluctant, after three years of some level of flare symptoms (I’ve had moments, weeks even of complete normalcy, but they have been evanescent), to do anything that would disrupt my new digestive nirvana, but my wife gently encouraged me and I eventually admitted that at some point I would have to test those eliminated foods.
Who knows? This could be the last layer of healing; the unknown Other that kept the positive results of bacteriotherapy from sticking around. I have to know.
So we made a plan, a food re-introduction order. At first, the order rmay seem arbitrary, but it is based on me: Which foods I like to eat most (which I could most wanted to eat), and on which were the most likely culprits.
The introduction timeframe for the foods from the blood test was already planned for me: 3-4 months of abstinence for apples, cloves, tuna, peas, and nectarines; and 6-9 months for cabbage and dates. I am fine with that. It takes six months to make a good batch of sauerkraut anyway.
That left only the SCD culprits, or as SCDLifestyle calls them, the “four dark horsemen” of the SCD: dairy, eggs, nuts, and fructose (fruit and honey). To this, I added legumes.
Eggs were first. The elimination diet requires that you remove all irritants for at least three weeks before re-introducing a food. From there, you add the food in sufficient quantities to produce a reaction (if it’s going to do that) for four days. So being the hungry man that I am, I ate four eggs that first day, eight the next, and only God himself knows how many eggs I ate on the third day. By day four, I was still fine. Glory!
To do the elimination diet properly, after testing a food, you then need to remove it before re-introducing another. The idea is simple: each new food introduces more complexity into the system. Testing one-at-a-time keeps it simple.
After 48 hours with no eggs, I went to try dairy—yogurt to be explicit. My wife had to coax me, as I had a gut feeling (pun intended) that dairy was the culprit. Pre-elimination diet, I ate more calories in dairy alone than most people eat all day [sic].
After about 15 minutes of coaxing and a little friendly trash talking, Michelle roused my ego enough that I tried it: 1 cup of SCD yogurt at lunch, and one at dinner.
The next day? D. Sh—oot. Fu—dge! (Remember, I have little kids in the house.)
That was four days ago. My system is still recovering from its fight with yogurt. Today is my first quasi-normal day, but things are gradually getting better. To think, the very thing that Elaine Gottschall insists must be a part of the diet (once you can handle it), the very food that was ubiquitous in my daily routine, was holding me back.
I wonder what other foods were irritating my system, hindering my healing?
From the size of my reaction to such a small amount of yogurt, I’m inferring that yogurt was a substantial trigger for my body. When I finish the elimination diet, I will do another summary/closing post to recap the entire experience.
Bottom Line for Matt:
Practice what you preach, brother. I say it over and over: Diet is the foundation of healing. It holds the largest potential for gain in the healing process. My story with the elimination diet supports that theory. But you don’t have to take my word for it…
Studying an Elimination Diet for the Management of Ulcerative Colitis
Dr. S. Candy et al., from the Gastro-intestinal Clinic of Cape Town[i] studied an elimination diet in the management of ulcerative colitis. They found that the diet group demonstrated statistically significant improvements over the placebo group.
Though there was no single food that provoked symptoms in every person in the study, dairy, high fructose and citrus fruits, and spicy-hot foods were specifically mentioned as common irritants.
Encouragingly, four of the eleven in the elimination diet group went into full remission using diet alone, and five saw statistically significant improvements as measured by sygmoidoscopy. None of the control group went into remission, and only one improved symptomatically.
Other studies[ii] show that people with a high intake of refined sugar, bread, and fast-food products (including junk food) have more trouble inducing remission. This supports the use of the SCD or GAPS in producing improvements in inflammatory bowel.
Bottom Line for You:
- Layer treatments slowly and methodically. Allow adequate time for each treatment to work.
- Diet is the foundational and first treatment course you should undertake. If you do it well; if you do it without cheating; if you track your symptoms and are diligent about following a diet such as the SCD, you will see improvements.
- If you are careful with it, diet may be the only treatment you will ever need to reach the goal of full gut health.
- If you get stuck in tweaking your diet or treatments, get help from someone who knows more than you.
Onward to Health.
[i] Candy, S., et al., 1995. The Value of an Elimination Diet in the Management of Patients with Ulcerative Colitis. S. Afr. Med. J. Vol. 85 (11): 1176-1179.
[ii] Persson, PG et al., 1992. Diet and Inflammatory Bowel Disease: A Case-control Study. Epidemiology 3(1): 47-42.
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