Why I Don’t Take a Diet-First Approach to Healing Gut Issues

You might assume that, as a dietitian who works with those with digestive problems and gut microbiome imbalances like SIBO and dysbiosis, I spend the majority of my time counseling my clients on diets like the low-FODMAP diet, SCD diet, GAPS, or any other number of restrictive dieting approaches out there.

Want the truth?

I spend the majority of my time talking to my clients about things other than the types of foods they’re eating. We talk antimicrobial herbs, stress reduction, sleep, exercise, calorie intake…but specific food choices? We don’t spend much time on those beyond general healthy eating concepts.

In my 7 years of working with digestive health clients, I’ve found that taking a diet-first approach to fixing microbial imbalance in the gut is the wrong move.

Here’s why.

Restrictive Diets Don’t Address the Real Problem

If you have gut issues like SIBO or dysbiosis, heavily restricting your diet doesn’t solve the problem. I’ve written about this concept specifically in regards to a low-FODMAP diet before, but it applies to practically every other restrictive dietary approach out there. The only exception to the “rule” would be the elemental diet (which I don’t even consider to be a “diet” per se; rather, it is a supplement food alternative), which is quite effective in clearing SIBO.

You can’t “starve” bacteria while you’re eating real food. Sure, when they’re not getting enough fiber or prebiotics, they’ll become somewhat dormant and symptoms will dissipate. But bacteria aren’t going away or being killed off by a restrictive dietary approach.

This is something I’ve talked about before quite a bit, but it really does bear repeating given the massive amount of misinformation I see floating around the internet. There are health gurus out there promoting dietary changes as the way to get rid of bad bacteria in the gut.

Unfortunately, this is simply not true and ends up making people wait to get real treatment (i.e. antimicrobials or antibiotics) for the microbial issues.

It is necessary to actually kill off and get rid of bad bacteria, parasites, candida to feel better, and you can’t do that with diet alone.

Restrictive Diets Aren’t Necessary For Results

You might already know that diets don’t kill off bacteria, but still believe that a restrictive diet is a key element to a gut-healing protocol.

I used to think the same thing myself! I had clients following strict elimination diets, thinking that I was helping them to reduce inflammation and get them results faster than if they were just following a generally healthy diet.

But what I found was that my clients eating really restrictive diets and those who were following a much more liberal approach both got great results as long as they were balancing their microbiome, supporting their health in other ways, and keeping in mind their own personal dietary “triggers”.

That meant using targeted antimicrobial herbs or antibiotics to push out any unwanted bacteria, supporting digestion with digestive enzymes, demulcent herbs, probiotics, prebiotics, etc, focusing on sleep and stress, eating enough, exercising appropriately, and finding time to spend with family and friends and do the things they love.

It also involved identifying any major dietary triggers and keeping those out of the diet. Note that these are triggers that are extremely obvious to the person without having to do any sort of dietary restrictions to figure out.

It became rather clear to me at that point that if I could get my clients the same great results without having them go on a super restrictive diet, why on earth wouldn’t I do that?

These days, I’m recommending a pretty liberal diet (more on that below) to my digestive health clients and we’re still getting rid of bloating, excessive gas, diarrhea, constipation, and abdominal pain. No restrictive diet required.

If I can make the healing process just a little bit easier for my clients, I’ll do it all day every day. They are grateful to not have the added frustration, complication, and expense of eating an incredibly strict diet when they don’t have to and they still get the same end result: no more digestive issues.

Restrictive Diets Make You More Likely to Undereat

One of the biggest issues I have with really restrictive dietary approaches is that they make it so much more likely that my clients are going to accidentally eat less than they should. When you cut out a lot of foods and don’t have many choices to replace them with, chances are you’re going to undereat relative to your needs.

When you’re trying to heal and nourish your body, the last thing you should be doing is feeding it less than it needs. Undereating can lead to symptoms like irritability, moodiness, low blood sugar, hormonal problems, sleep issues, and more. My friend Laura Schoenfeld, RD goes into more detail on a lot of these symptoms and how they’re related to undereating here.

And this not something to think about just from a calorie and macronutrient perspective, either. When you’re on a restrictive diet, it’s also much easier to skimp on important vitamins and minerals that come from some of the foods you’re restricting.

Micronutrient deficiencies can lead to lots of health problems as well — so again, when you’re trying to heal your body, undereating becomes a massive problem.

Instead, I make sure my clients know how much food they should be eating to properly fuel their body and help them eat a diverse, nutrient-dense diet.

Restrictive Diets Mess with Your Relationship with Food

I can’t tell you how many people I’ve worked with who are just truly afraid of food. They get worried about every symptom they experience and spend a ridiculous amount of time trying to trace every symptom to a food they ate.

It makes for a really messed up relationship with food.

I have to spend a lot of time educating them that the root cause of these symptoms is more likely to be an imbalanced gut (and the resultant inflammation) than specific foods they’re eating. That inflammation can cause digestive issues regardless of the foods they’re eating.

When you’re dissecting your diet for potential problematic foods, all food becomes a potential “trigger” for the negative symptoms you experience instead of a source of nourishment and pleasure.

This mindset also tends to lead to further and further restriction. Someone might start off by just limiting FODMAPs, but then they read about other potential food triggers and take those out, read about other triggers and take those out, and the cycle continues until they’re barely eating any foods at all.

By only using more restrictive dietary approaches when they are truly necessary, you can avoid damaging your relationship with food and view food as a nourishing, pleasurable thing instead of something that is attacking your body.

Dietary Restrictions Distract from Other More Important Changes

When you’re so focused on diet, you’re less likely to pay attention to (what I would consider) the heavy-hitters like stress, sleep, exercise, and social relationships.

After all, we only have so much we can think about and dedicate ourselves to. When diet takes up a huge amount of our headspace, it’s easy to forget about these other, less “sexy” topics.

I’d argue that these other changes are more important things to focus on than diet (provided that you’re eating a relatively healthily). When my clients stop spending all their time focusing on what they’re eating and instead start paying more attention to their sleep quality, stress management, and exercise habits, they feel better than they ever have before.

Focusing less on diet also gives you more time to focus on yourself and your community. You can spend time enjoying your hobbies, or socializing with friends and family. Research has shown that social relationships play a huge role in our health, and that as society, we’re getting lonelier. Laura and I have talked about the importance of social relationships in the past and how prioritizing social relationships over diet can actually improve your health and well-being.

It might sound strange to hear a dietitian say this, but…there is so much more to life (and health) than food. Don’t let yourself get caught up in the idea that diet is a cure-all, and don’t let diet distract you from all the other healthy habits you could be incorporating into your healing regimen.

Long-Term Restrictive Diets May Negatively Impact Your Health

Most clinicians know that restrictive diets like the elimination diet should really only be used as a short-term therapy while we’re working on fixing the underlying root causes of your health issues.

But when patients start implementing these diets on their own and put off treating root causes of their problems, they often end up staying on restrictive diets for years. This can happen even if they are also treating the root cause of their issue, simply because they become too afraid to reintroduce foods once they start feeling better (see above).

Researchers are concerned about the health implications of staying on restrictive diets for the long-term, like changes in the microbiome, nutritional inadequacy, and fostering disordered eating habits.

While the jury is still out about the true consequences of long-term restrictive eating, those reasons alone are enough to give me pause.

If I can stop someone from getting on the restrictive diet train (and still get them results, of course), I’ll do it in a heartbeat.

Is a Restrictive Diet Ever the Right Choice?

There’s definitely a time and a place for a more restrictive diet, I just don’t believe it’s at the beginning of someone’s health journey (for most people).

The only time I might recommend an elimination diet or other restrictive approach right from the start is if someone has extreme health issues that are incredibly disruptive to their day-to-day life in a way that does not allow them to function. This might mean someone who is having diarrhea 8-10 times per day and can’t work because of it, or someone whose abdominal pain makes it so that they can’t even think about anything else because they’re constantly in pain. Of course, in situations like these, getting symptom relief is priority #1 and if we can do that in a way that isn’t necessarily fixing the root issue but is faster, that makes more sense.

But those with milder issues may never come to the point of needing a more restrictive diet. As I mentioned above, a restrictive diet isn’t necessary for most people to see great results. But if you’ve re-balanced your microbiome (and tested to make sure you’ve actually cleared out any bad bugs), addressed nutrient deficiencies, sleep, stress, exercise, socialization/community, and you’re still having some digestive problems or other health issues…that’s when you might want to consider taking out some additional foods to see if you have a true sensitivity that’s causing some of your problems.

If you’re going to implement any kind of restrictive diet, I highly recommend working with someone to do so, as there needs to be a solid reintroduction strategy that is incorporated after a short-term restrictive diet to avoid the potential health consequences of a long-term restrictive approach.

If I Don’t Need to Restrict… What Should I Do?

If you have digestive issues, the first thing you need to do is test your gut bacteria to determine if your microbiome is imbalanced. This is the top cause of digestive problems!

From there, you need to actually address the issue. That means getting on an antimicrobial protocol or taking antibiotics, using probiotics and prebiotics and other supplements to help balance your microbiome. Remember — this is typically the root cause of digestive issues (among other health issues), not your food.

Beyond that, you’ll want to put a strong emphasis on stress management, getting good sleep, exercising appropriately, eating enough, and prioritizing social relationships.

This is what I cover in my Build Your Biome program.

But from a diet perspective, I simply recommend focusing on general healthy eating principles. If you’re familiar with a real food, Paleo, Primal, or Weston A. Price way of eating, these principles will be very familiar to you.

If you’ve been caught up in restrictive dieting, this diet is going to look like it’s full of “triggers”. Please remember that you’ve now been conditioned to think this way — to view food as the enemy rather than something that can nourish and heal you.

Here are the things I focus on when it comes to diet for my clients:

  • Eat Real Food
    • Less processed food, more real, whole food
    • Organic, non-GMO as much as possible (especially for dirty dozen foods)
  • Limited Restrictions — just the things that I really think make a difference.
    • Take out any major triggers for that individual (remember, these are super duper obvious and don’t require an elimination diet to figure out)
    • Swap industrial seed oils for better fats (as much as possible — most people won’t be able to take them out entirely)
    • Reduce sugar intake (though I don’t require my clients to take out sugar completely)
    • Reduce alcohol consumption
    • Take out gluten (not always, but I do recommend this somewhat often)
  • Be Grateful for Your Food
    • This is especially important if I have clients coming from a more restrictive diet — I actually tell them to create a “mantra” of sorts to remind them that food is nourishing and healthy. They might repeat something like this to themselves at meal time: “This food will help nourish and heal me.” We also focus on mindful eating habits like paying attention to the smells and taste of their food.
  • Eat Enough
    • As we discussed above, eating enough is vital to the healing process, so I make sure that my clients are eating enough to fuel their body. This means getting enough calories overall, as well as making sure their macronutrient breakdown makes sense for the type of activity they are doing.
  • Balance Blood Sugar
    • Blood sugar surges and crashes can lead to HPA axis dysregulation, along with a host of symptoms like moodiness, anxiety, and hormonal symptoms. Making sure my clients have well-balanced blood sugar is crucial.
    • This typically means combining carbohydrates with fats and proteins, as well as consuming enough fiber, to help regulate blood sugar.

That’s it! Simple, easy, and just focuses on the things that will really make a difference. We don’t worry about FODMAPs, dairy, grains, or legumes (all things taken out on elimination diets quite frequently) unless it’s clear foods within those categories cause problems for that particular client.

I’ll admit that this way of practicing is quite different from how most digestive health experts practice. Heck, I’m sure I’ll get some flack for this article.

But at the end of the day, what matters to me most is that I get my clients results in the easiest way possible while making sure they have the capacity to focus on things beyond diet that are important for overall health.

So let me ask you: how restrictive is your diet and how long have you been following that approach?

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