When Elimination Diets Become Too Restrictive

As a gastroenterologist, I must strive to keep an open mind when it comes to any new therapeutic opportunities for my patients. However, new treatments are not without risk. It is my duty to counsel patients in my care on when to pursue some treatments over others. This is based on risks or benefits and the severity of symptoms.

Dietary changes for IBS are not only intuitive but attractive choices. That is because changing the way you eat is typically a low-risk intervention with the potential for high benefits. In my clinical practice, I have observed that looking into dietary choices can successfully lead to healthy recommendations on elimination and re-introduction of certain foodstuffs.

The perils of dietary manipulation

However, I have also seen the perils of excessive dietary restriction. A whole host of ‘diets’ are abundant in cyberspace. Some are geared towards individual dietary preferences (e.g., vegetarian, vegan, pescatarian), evolutionary/physiologic beliefs (e.g., Paleo, Ketogenic), or have a specific outcome in mind (e.g., detoxification).

Any responsible healthcare provider will tell you that the word ‘diet' is problematic as it implies a goal for weight loss. There are unrealistic expectations of the ideal body image. In IBS, there is already a high rate of body dysmorphia and eating disorders. Restrictive diets have the potential to worsen and reinforce these disorders.

As practitioners, we must be mindful and vigilant. We must screen patients entrusted in our care for these disorders when providing education and counseling on elimination regimens.

As patients, we must be honest with ourselves and our healthcare professional team. If we identify with these disorders, we must speak up, so health does not worsen on an elimination diet.

I am not the first to propose a ban on the word ‘diet.’ That is why I refer to the Low FODMAP way of eating as a ‘regimen’ and not as a ‘diet.’ Perhaps we should rebrand or reword elimination diets as elimination or reintroduction regimens. Healthcare providers need to consider a self-ban on using the word ‘diet’ for many of our IBS patients as well.

Be mindful of unintentional changes

Unintentional weight loss

This should prompt a discussion with your doctor. They will learn whether this is from your dietary changes or from another disease.

Nutritional deficiencies

There are also many manifestations of nutritional deficiencies. This list is not meant to be comprehensive but reflects subtle and common signs and symptoms of nutritional deficiency. Please talk to your physician if you have any concerns at all.

  • Iron deficiency causes signs or symptoms of anemia: appearing paler than usual, shortness of breath especially with exertion, cold intolerance, lightheadedness, loss of hair, or craving non-nutritional things such as ice, soil, clay, or glass.
  • Vitamin B complex deficiency can cause cracked lips especially at the side angles of the lip crease, a beefy red tongue, numbness/tingling in the extremities, or fatigue.
  • Vitamin A deficiency can lead to dry skin or poor night vision.
  • Vitamin E deficiency may cause muscle weakness.
  • Vitamin D deficiency can lead to bone loss/weakness, depression, or fatigue.
  • Vitamin K deficiency may show up as easy bruising on the body or intestinal bleeding.
  • Vitamin C deficiency can also cause bleeding, including from the gums.
  • Zinc deficiency might lead to changes in appetite, cognition, or onset of diarrhea or poor wound healing.

Again, this list is not exhaustive, and everyone should speak with a physician about any symptoms.

Should I reintroduce food on a low FODMAP regimen?

Yes. Absolutely!

IBS dietary changes focus on finding food sensitivities by temporarily cutting them from our diet with an intention to slowly reintroduce at lower, symptom-free portions. The Low FODMAP regimen has a wide range of success rates, in 40 to 75 percent in some patients.

It is important to reintroduce eliminated food triggers. This is to widen the variety of food you can eat. More variety means more access to different types of nutritious building blocks to promote good immune function and health. Over restriction only promotes a bland diet and restricts your body’s access to important nutrition.

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