Persistent GI Troubles with Whole30, Paleo, and low FODMAP


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This is probably going to be long. First, my question: Any ideas how I can prevent chronic GI upset (mostly diarrhea, with bouts of constipation) with the Whole30 and strict paleo with low FOMAPs?

Background:

During grad school I started having problems with shooting stomach pains and eventually was eating nothing but yogurt. After a colonoscopy I figured out that I had celiac disease and started eating vastly different. Those stomach issues were solved. I did what many do and substituted all my gluten carbs with non-gluten carbs - rice, gluten-free alternatives, etc.

Two years after that I was still having other GI upset. A subsequent colonoscopy revealed nothing new and I was diagnosed with the ever-helpful IBS.

A year and a half ago, due to the stomach problems and my ballooning weight, I stared a Whole30. It was fantastic. I stayed strict paleo after that, eventually loosening up enough to allow for a small piece of chocolate twice a week. My biggest "issues" ever were fruit and sweet potatoes, but it was never ridiculous (a sweet potato each day, two or three pieces of fruit each day). During this time I began CrossFit and exercising regularly. I lost 50 pounds, my BP went back to normal (I'm only 27) and my cholesterol dropped down to healthy ranges.

Everything went well for a while. My stomach was feeling great, my bowel was moving along beautifully, etc. I did a couple more Whole30s, though it was pretty much the same thing I already ate (minus chocolate).

Then my weight plateaued at 200 pounds (female, 5'6", I know weight isn't everything, but that's rather high still). In an attempt to get it moving, I revamped my diet, added many more veggies and varied up my old food choices. It was still paleo, just different. I got down to 188 when I stalled again.

Through that jump start and up until now, for about 9 months, my GI problems have started again. I don't have any pains as I did when I ate wheat, but I have chronic diarrhea (about 5 days a week) with bouts of constipation. On top of that, my weight moved back up, to 200 pounds.

My research seemed to show I needed to try a low FODMAP diet, especially as I feel like adding a large amount of veggies to my diet started the problems. Three weeks ago I went low FODMAP. In addition I've been trying to be lower carb for weight loss.

What it comes down to is that, even low FODMAP and strict paleo, I'm still having GI issues. For a while I was on a probiotic, but thought maybe that was causing me to over regulate.

I can't, for the life of me, think of what else to do. Not to mention I'm already heavily restricting food. I'm wishing more and more I could get all my nutrients from just a pill. Is it possible that it just will take longer to even out with being low FODMAP and that really is the answer? So what do I do when I'm still sick even on the Whole30? Especially after I was well for a while?

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Yes, thanks. I was just thinking that adding what I'm taking would help.

I have iron-deficiency anemia, but also had terrible problems with the iron pills. So I'm taking liquid iron right now. All natural, sweetened with fruit juice. I just started it over a week ago, though. Then I take fish oil sporadically but have trouble getting into a habit.

Otherwise I'm not on birth control, though I was until two months ago. I'm not on antibiotics. The only thing I'm on is Effexor XR, which I really can't get off at this juncture in my life.

At the time the GI problems started, I can't think of anything that changed. This year has had it's stressors (I got married, but in a tiny ceremony, and I have a job) but nothing at the time it started and nothing out of the ordinary.

Oh and if it helps, I'm really good about getting 8-9 hours of sleep a night in a fully dark room. I love my sleep.

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TurtleKnitta - Effexor may be at the root of your GI disturbances. I've heard of it causing problems and WebMD lists a bunch of GI issues as common, infrequent, or rare side effects of Effexor XR. Given how helpful Effexor is otherwise, you might be faced with minimizing the side effects as much as you can and then living with them. Gut flora takes time to adjust. Your low FODMAPS experiment might need more time to know if it helps.

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Wish I could offer some help, I'm in a similar position in that my IBS was great at first on strict paleo, but now I seem to be reacting badly to more and more foods, mainly FODMAPS. Have you looked into doing Robb Wolf's auto-immune protocol? I'm thinking that might be my next step.

Forgot about that one. I did try it for several weeks this summer with little to no change. But if FODMAPs are also causing problems, I was eating them then, so maybe they kept the gut upset going.

TurtleKnitta - Effexor may be at the root of your GI disturbances. I've heard of it causing problems and WebMD lists a bunch of GI issues as common, infrequent, or rare side effects of Effexor XR. Given how helpful Effexor is otherwise, you might be faced with minimizing the side effects as much as you can and then living with them. Gut flora takes time to adjust. Your low FODMAPS experiment might need more time to know if it helps.

I never considered the Effexor. I have always told my doctor it makes me gain weight, but she doesn't believe me. However, if it causes gut upset that could lead to some imbalance and weight issues. I've been on meds for anxiety since I was 12 and I never thought about them being the problem, because they are such a part of my life.

This summer I was hoping to try and taper off them to see if my lifestyle changes (diet and exercise) have made my anxiety more manageable. Unfortunately it's a very long process to stop them, but that allows me gauge my mood as I go.

I'll keep trying the FODMAP diet, then, too. I always find it funny that I put up with the GI problems for so long but then want a fix immediately.

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Hi TurtleKnitta,

I have some experience in this area. For years I was on anxiety meds and did not experience much of a GI issue. About 2 years ago I began to eat Paleo and was not on any meds, but soon after, I got back on anxiety meds. To put it succinctly, My GI system was a mess. I had chronic diarrhea, was bloated and I hated how I felt. I had never had these issues when I was younger and eating a "Normal" Western diet. The med I was taking at this point was Symbyax which is a fluoxetine and olanzapine mix. Although it is different than effexor (VENLAFAXINE), it uses some some the same distributive pathways. I have since been off the med for about 8 months and it took my GI about 6 months to recover. For me, there was some disruptive correlation between eating healthy and taking anti-anxiety/antidepressants--may have to deal with the macrnutrient distribution in the whole30 diet. The effexor may very well be the cause of some of your issues.

With that said, I have LOVED the whole 30 and I found a way to incorporate it and work around my meds.

As for the weight loss, it's very well known that many of these meds cause weight gain. That's very common and I've experienced it (although I liked it, I'm pretty slim).

I'm not suggesting you can the effexor. Maybe get a second opinion of a doctor that can help you out. If you want, I can give you some references. Best of luck, I feel your pain.

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Thank you for your perspective. That's an interesting correlation.

It's weird because I talk to people about my GI issues and they assume I must be feeling terrible. But other than that, I'm feeling better than I ever have before. And so yes, I agree about loving the Whole30 and I want to work around my meds, too.

My doctor has the usual "eat less, move more" approach to weight. She's convinced the only reason I couldn't lose weight on a standard weight loss program was that I didn't try hard enough. And my previous doc was the same way. So really I just let it roll off my shoulders and she's good about letting me manage my meds myself. So even if she disagrees with my reasons for wanting to go off them, she'll still let me.

I've been thinking about going off my meds for a while now anyway for other reasons and side effects. So I may try it out with the plan my doc gave me and see how it goes. I'm thinking it will mean I have to be more strict with my diet - no weekend-long cheats or nibbles here or there. Normally I'm good about that, but now it will be my way of regulating my anxiety. And I'm more than okay with that.

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Hi TurtleKnitta,

Sounds like you've tried a lot of different eliminations, and I know how emotionally draining that can be. Have you ever taken a stool test to see exactly what's going on in your gut? The GI Effects Stool Profile from Metametrix is incredibly enlightening and can be ordered by your doctor: http://www.metametrix.com/test-menu/profiles/gastrointestinal-function/dna-stool-analysis-gi-effects

If you doctor doesn't want to order it, use this form to get help finding someone in your area who is on board: http://www.metametrix.com/patients/how-to-get-started/find-a-doctor

In my case, I was having loose stool every day for months before learning from my results that I had incredibly low levels of beneficial gut bacteria. A daily prebiotic and high dose probiotic helped a lot.

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Could you have fructose malabsorption? That would mean you can't have most fruits, sweet potatoes (or yams pretending to be sweet potatoes), onion, tomato, asparagus, and so forth. It's pretty easy for a doctor to test for.

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I may try that next. Right now, with FODMAPs, the only way I can get enough calories is to allow FODMAP friendly fruits and sweet potatoes. If I got rid of those I can't seem to get above 1200 calories (I weigh 200 still and am quite active), since I can't have avocado or nuts. And I haven't been sick in three days so I'm going to hope it's kicking in.

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Welp, the diarrhea is back. My RN mom says if it isn't debilitating, then I shouldn't worry about it. But I just don't think bouts of diarrhea nearly every day can be a good thing.

So, I've got a theory. (Bonus points to anyone who now has that Buffy song stuck in their heads.)

When I was working with a personal trainer, she was very respectful of my paleo eating, though she didn't entirely subscribe to it. We agreed about food quality and eating whole, unprocessed foods, so we just stayed there. But she asked me to try a few weeks of adding in more grain-type carbs. They ended up being steel cut oats (gluten free) and rice (she said brown, I ate white). I had some weight gain - 8 pounds in a week - and freaked. Now I don't weigh myself and understand that the number was not actual weight gain, etc. But that scared me enough I went back off the grain carbs.

What I remember most, though, is how regular I became. No sickness. Unfortunately I also remember being quite tired, but she said that was a good sign - that my body was using the carbs to rebuild my muscles, etc. I apologize in advance for bringing this topic up instead of doing my own research, but the research seems so conflicting, even from trusted/vested paleo sources.

My theory is that adding back some of those carbs - I'm thinking specifically about rice with my lunch, as for some reason I tend to get sickest after lunch - might help me? I've seen rice declared a "safe" starch, I've seen the idea of a safe starch be ridiculed, I've been told it's okay in moderation, I've seen to eat white not brown, etc. Could my theory have any backing? Is rice something that might be okay for some - even helpful - and bothersome for others? Is it like white potatoes where the real problem with it is lack of nutrients and overeating, not what it contains? I know I can sit down with a pile of it and chow away, so I'd restrict it and just have a small portion with lunch, to keep from overdoing the carb and would keep my other nutrients in check.

Thanks for all feedback!

ETA: I've seen some studies that contribute the success of adding some of those grains back to butyratic (sp?) acid (butyrate). And some people on lower carb/higher protein diets have good success with supplementing it, so I may give that a go. Seems to be fairly affordable.

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I know exactly what you mean. When I had low levels of gut bacteria and was constantly having loose stools, "cheats" with rice or cheese mysteriously helped me produce reasonable stools. What I later realized was that these foods were making me constipated, which because of my overactive digestive system (hyperperistalsis), was bringing me to a "normal" level. My feeling is still that you have low levels of beneficial gut bacteria (maybe from the Effexor), or maybe even a gut pathogen, hence the push for the stool test. The safe starch may help, but honestly, lack of starch is unlikely to cause diarrhea like this.

Without knowing what gut bacteria you're deficient in, I can't make a recommendation as to what pre/priobiotic to use, because we don't want to cause dysbiosis either.

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Hi, it is so cool to be on your forums. I am new to the whole 30 but have been doing my 30 for 2 weeks and 3 days. I didn't actually know that the whole 30 existed. I just was feeling so crappy and had done some reading that lead me to believe that eating this way might help me to feel better. So, I did and then met a girl at whole foods that lead me to you all. I am so thankful I found you all because since starting this I have gotten sicker and sicker to the point that I got sick on myself at work today and am now having to take time off of work and I don't know what to do. I am hoping you all can help me out with some direction cause I'm about to give up in this.

So hereis what is going on with me.

I am eating whole thirty. I usually shoot for protein at every meal and 2 cups of raw leafy greens a day and 1 cup of some other type of veggie. I don't do fruit as I am battling insulin resistance per my dr. Not yet diabetic but headed there someday.

I eat lots of fat, in the form of a flax seed supplement, coconut butter , olive oil and coconut oil. I have been using butter but I am going to go buy clarified butter now that I have found the whole30 and understand that butter can be problematic.

I eat mostly lean meats due to the fact that I have food intolerance to beef and pork and tuna as well.

From Friday till yesterday I had a morning protein shake that was made outof egg protein but containers xylitol which I have stopped due to the xylitol.(I did the protein shake as a left over from weight training cause I just really liked it I didn't realize sugar subs were bad even in small quantities till I found you all.)

I eat no grains, no sugar, sugar substitute or any kind of potato or sweet potato or corn.

So here is what is happening to my body.

I started out with loose stools and feeling tired, run down, stomach upset, brain fog, fatigue but i was managing to cope. Then it continued down hill from there. I started with a depressed mood,irritability, lethargy and diarrhea.It started to impact my work cause all I wanted to do was sit and stare. Now I have explosive dirrheathat that has sent me home from work, am so tired i have just slept 4 hours, had chills and fever with the diarrhea last night.I am feeling so upset in the stomach and bowel that last night I started on a liquid only diet. Hot chicken broth and this morning I made a drink of coconut milk, coconut butter, and decaf coffee, probiotic powder and fos powder trying to get some easy to digest protein in my body for the day and also some probiotics to deal with the diarrhea. After this had an extremely soft almost diarrhea stool, followed by dirrhea and then explosive diarrhea.

I feel horrible, am hungry but so sick I have no desire to eat. Do you all have any ideas? I am feeling very desperate.

Oh and I am taking antidirrheals cause I am so miserable. They're no working. Thought you might need to know.

Thanks in advance!

p.s. sorry for any spelling mistakes. Am typing onmy new tablet and still am learning to eo it so I have lots of typos I'm sure.

-mkallen81

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Mkallen,

Sorry to hear you're feeling so crummy. My guess is that you are dealing with a severely leaky gut. Anytime I hear that someone has an intolerance to uncommon foods (like proteins in your case), it's almost always related to permeability in the gut lining.

The good news is, you're doing a lot of the right things. I'd caution against the antidiarrheals though; diarrhea is your body trying to expel toxins, and keeping them in is going to just do even more damage. It sucks, I know, but you've got to get all the bad out before you can get the good back in. Also, you'll want to avoid extra fats right now, as in your current state, they're going be really hard to digest. Stick to protein and simple veggies (like carrots, asparagus, squash, zucchini, not cruciferous ones that are hard to digest).

When you start feeling a little better, here's what you can do:

1. Start adding sauerkraut or kimchee or other fermented vegetables to your diet. They have to be legit, raw, live cultures. You'll know if it requires refrigeration before you open it. This is the fastest way to repopulate your gut. Drink a bunch of water, then wait 30 minutes, then eat a bunch of fermented veggies. You should start to feel better almost immediately.

2. Take a short-course probiotic like the Jarrow Allergen Free. Every meal as indicated for a few weeks.

3. Bone broth several times a day. It's legit. The glycine will start to repair your gut lining.

4. When your bacteria levels are back to normal (you'll be able to tell because your elimination will be better and regular), start the course of L-glutamine. You should start to see improvements in the foods you can tolerate after a few weeks. Feel free to do a food challenge with some of the foods that caused problems before. There is a chance that you'll never be able to fully heal your gut, but if we can eliminate as many of the problems as we can, you'll feel a lot better.

5. If you still aren't improving, it's time to see a professional who can test for gut pathogens.

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Hi Megan! I know how exhausting GI troubles are! I thought I´d share how I´ve adapted the whole30-style of eating, maybe something resonates with you. My gut is now slowly healing after years of binge eating disorder and sugar addiction. This is is what I do:

  • no nuts, I cant digest them and they trigger cravings
  • no fruit or starchy veggies, due to their yeast-feeding and bloating properties, they also trigger cravings
  • no eggs, turns out I´m intollerant
  • no ghee, I´m severly intollerant to all dairy
  • taking a digistive enzyme with every meal
  • plenty of omega-3/fish oil, to fight inflamation

It´s not always easy but when I stick to my formula of non-starchy veggies, fish/meat/poultry and fat my gut is happy most of the time. I still battle constipation but my plan is to add a good probiotic when the candida/yeast has been reduced. Good luck!

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AnnaO,

Thanks for the suggestions. I think I'm sort of the opposite of this, though. When I eat eggs or sweet potatoes or fruit, or even ghee, I feel great. There is no pain, no diarrhea, no digestive upset of any sort. Then, no matter how long it is between meals, if I eat something of lean meats and veggies, I immediately get sick after eating. For a while I was staying away from FODMAP veggies, but now it happens when I eat spinach or zucchini too.

My plan right now is to just do the best I can. Then I have a honeymoon in London in a few weeks and although I'm sure I shouldn't, I'm going to be eating fairly badly (especially as our hotel has no place for me to cook). That's what I would consider a legit reason to make that choice.

So, when I get back, I'm going to start a course of probiotics as was recently discussed on Whole9. My one right now is apparently a pathetically small amount that wouldn't be doing anything at all.

Mostly my fingers are crossed that my Effexor is causing most of the problems. I'm easing off it right now (with doctor's supervision) and it'll be all out of my system once I'm back from London. I'm hoping I start to see some better results after that, combined with the probiotics.

The worst part of this is that I'm starting to live in fear of food, which I know is an unhealthy mindset. I'm really just trying to see the whole picture and remind myself that many of the "bad" foods I have now are only bad because I'm sick and will be okay in the future, once I heal.

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Megan,

Yes, it does seem like we have opposite issues, although I´ve read somewhere that constipation and diarrhea really are like two sides of the same coin. I´m sorry I can´t be of any help to you. I found my way through trial and error and it seems like you are to, it does take a lot of patience and perseverence though. The mindset of emphasising what I can eat instead of what I can´t has been crucial because, like you said, it´s easy to slip into fear and obsession. Keep us updated on your progress and have a great time in London!

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Thanks! And yes, I agree, it's trial and error.

The greatest thing about the Whole30 is that it has put an emphasis on health and how I feel, not the food. So although I'm getting frustrated now, if I think "This will make me feel better" then I'm okay with anything. It's really such a new perspective.

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So if I'm an experiment of n=1, then I've got to stop changing so many variables. But this week I started taking butyric acid, eating saurkraut (maybe a cup a day?) and today I started bone broth (sipping my first cup as I type this). So I know the bone broth didn't do it. I suspect it's the butyric acid. I'm also going down on my Effexor, so that could be part of it. While I'm on vacation I'll keep the butyric acid up and won't have access to the other two, so that should help me figure it out.

What has happened is that my GI is no longer upset, most pain is gone, I'm becoming more regular, and I feel better than I have in a while (although not debilitating, the constant diarrhea apparently was taking it's toll). And I'm back to eating all the veggies I was. Fingers crossed that I've gone down the right path. All I care about now is healing my gut, so I'll keep up my full force attack (and by attack, I mean love and coddling).

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That didn't last long. I got sick soon after typing that and spent the next few days nearly constantly sick. So after a few days of that, equaling well over a month of GI upset, I added rice back to my diet. And, it worked. I'm regular, not sick, with a happy stomach. I don't know why and I don't know if there are better ways. I'm going to keep researching. But for now I'm sticking with the rice and monitoring amounts closely and just glad that I've gotten back to normal.

I'm also nearly a week without meds and as I slowly heal, I plan on taking the rice back out during several trials to find out if my meds had anything to do with it.

ETA: I do not endorse eating rice as an optimal thing, only that it managed to make me feel better. I'm definitely going to actively seek out ways to do that without rice. And I'm not loving the water weight I've gained back, but I'll manage. I've also started a lot of probiotics and am hoping that could help.

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I haven't read this whole string but did you just start the sauerkraut? When I started it I had to slowly work up to it because too much gave me stomach cramps and made me ... well ... sick. Same happened with kombucha.

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