Increased Diarrhea and Fatigue on Paleo

[ElizaKate]

I am a big believer in Paleo/SCD to help with inflammation and have tried to encourage my husband, who has Crohn's, to adopt the diet. After his last dismal MRI, he's willing to try dietary changes to avoid surgery. The problem is that when he switches to Paleo/SCD, he gets unrelenting diarrhea. His pain is less and the horrible noises that his stomach makes disappear, but the diarrhea ultimately turns him back to his standard high carb diet. He also complains of worsened fatigue. Did anyone who has had success with these diets have a similar situation at the outset? Is the diarrhea phase normal and if so, how long should he give it before he gives up?

 

[Guerrero]

So far there is no scientific evidence or studies/trials proving any diet alone help with crohn's inflammation.

Maybe he should tell his doctor about the worsening of his symptoms to eventually adapt the therapy.

 

[ElizaKate]

He and I both understand there is no one diet that is curative. Just as there is no one medical therapy or procedure that produces remission in all patients. He's just looking for another option to add to the treatment arsenal. We aren't intending to supplant all medical advice with a dietary approach. We were just looking for other options and experiences as his doctor believes that what you put in your mouth has no impact on the course of the disease. Others within this forum feel differently. I was hoping they might share their thoughts.

 

[Guerrero]

I hope they'll share their thoughts with you too, I just wanted to specify there is no evidence so far that a diet can help with inflammation, so I was wondering you would just not bet on the diet only to expect inflammation ease.

 

[Beach]

Good luck to your husband. Just to quickly mention, is your husband eating grass fed meat? I only mention as I'm following a type of paleo diet, there are several, and it is helping me. Organic and commercial meats appear to make my condition worse on the diet. Grass fed beef looks to be improving my condition. Fingers crossed this continues.

I have a type of colitis though so don't know what I'm doing will help someone with Crohns.

If it might help I'm writing what I'm up to and how I'm feeling here on the sight:

http://www.crohnsforum.com/showthread.php?t=82027

 

[Shmili]

As the husband of a wife who believes that the SCD diet could heal MY crohns, Let me just explain what I your doctor meant by saying "what you put in your mouth has no impact on the course of the disease" it means that the diet doesn't do anything to the crohns itself however it may help you while you're on it because you're not irritating your bowls at the time, however once off the diet it won't have any effect on him.

 

[Magnolia24]

What specifically is he eating? Have you read about the SCD intro diet? Some paleo/scd foods may not be tolerable for your husband, or may just not be tolerable for now while his gut is healing. The intro diet starts with a few easy to digest foods, then adds in more over time. scdlifestyle.com has a free guide that breaks the intro diet down in a pretty user-friendly way. It's still a big commitment, but I've found it to be really helpful.
You might also want to read about die-off. That could be part of his symptoms http://scdlifestyle.com/2012/06/5-die-off-myths-everyone-needs-to-know-about/

 

[hugh]

The problem is that when he switches to Paleo/SCD, he gets unrelenting diarrhea. His pain is less and the horrible noises that his stomach makes disappear, but the diarrhea ultimately turns him back to his standard high carb diet.

Tell us about your husbands standard diet and SCD/Paleo diet.
When big changes are made lots of things happen and it is very hard to know what causes it.
Maybe back up to a stable diet and re-evaluate?

What is he eating and why, and what was he eating before?
SCD is a very low carb not quite paleo diet and there is a recommended introduction phase,

He also complains of worsened fatigue. Did anyone who has had success with these diets have a similar situation at the outset? Is the diarrhea phase normal and if so, how long should he give it before he gives up?

The fatigue on its own is not uncommon, often it is 'low carb flu', but not with diarrhea.
The diarrhea phase is not normal.

I'm a big believer in diet too, but it is a very individual thing.

Perhaps there is a specific new food causing it, or perhaps the overall change is too sudden or profound for your husband or his microbiome....

The term Paleo covers a fairly wide range of eating patterns, some a bit too extreme and some a bit too relaxed.
When I first tried the SCD diet thought I could eat whatever I wanted because it was SCD 'legal'.
Turns out that's not how it works.[1]

Perhaps he would benefit by gradually transitioning[2]

I think Paul Jaminet's Perfect Health Diet is a good starting point and I recommend reading the series on gut issues posts he did [3]

[1] The SCD Intro Diet
http://pecanbread.com/f/how/introdiet.html

[2] “I Want to Eat Paleo, But I Don’t Know Where to Start!”
https://www.thepaleomom.com/i-want-to-eat-paleo-but-i-dont-know/

[3]

I'd start with Paul Jaminet's Perfect Health Diet.....

Bowel Disorders, Part I: About Gut Disease
“In our view, various dietary and nutritional tactics are critical, with toxin elimination and vitamin D normalization among the most important steps. Most medical treatments are likely to be ineffective if the diet is bad.”
http://perfecthealthdiet.com/2010/07/ulcerative-colitis-a-devastating-gut-disease/
Bowel Disease, Part II: Healing the Gut By Eliminating Food Toxins
“Summary of Toxic Foods to Eliminate or Avoid
In short, bowel disease patients should eliminate toxic foods from their diet:.”
http://perfecthealthdiet.com/2010/0...i-healing-the-gut-by-eliminating-food-toxins/
Bowel Disease, Part III: Healing Through Nutrition
Summary
Although not a complete list of the vitamins and minerals which may be helpful to bowel disease patients, these are among the most important – and most often overlooked:”
http://perfecthealthdiet.com/2010/07/bowel-disease-part-iii-healing-through-nutrition/
Bowel Disease, Part IV: Restoring Healthful Gut Flora
“Conclusion
Fecal transplants are the best probiotic. Tactics to disrupt pathogenic biofilms can assist probiotics in bringing about re-colonization of the digestive tract by commensal bacteria.
http://perfecthealthdiet.com/2010/07/bowel-disease-part-iv-restoring-healthful-gut-flora/

link from thread “Alternative Medicine”
http://www.crohnsforum.com/showpost.php?p=987533&postcount=11

 

[hugh]

So far there is no scientific evidence or studies/trials proving any diet alone help with crohn's inflammation.

Maybe he should tell his doctor about the worsening of his symptoms to eventually adapt the therapy.

there are many studies showing diets or foods to be beneficial, not a cure but definitely worth investigating, Always keep your doctor informed .

http://journals.lww.com/ibdjournal/...f_the_Autoimmune_Protocol_Diet_for.98474.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877178/

 

[Guerrero]

there are many studies showing diets or foods to be beneficial, not a cure but definitely worth investigating, Always keep your doctor informed .

http://journals.lww.com/ibdjournal/...f_the_Autoimmune_Protocol_Diet_for.98474.aspx
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877178/

Well those studies are not great...

First of all the number of patients is too low to make any conclusion. If you go through analysis of the data well, some indicators are missing (what about endoscopic results? calprotectin? in my opinion indicators are lacking to conclude there is a real remission...) if you look at hemoglobin and CRP the case 9 looks like good and is in remission despite he "had alcohol at supper every night and frequently ate fish and sweets" :lol:
During the study patients were still on medication and they induced remission through infliximab before starting the study...

... by the way I apreciate more this Semi Vegetable Diet, which is a kind of japanese regime with Miso etc... compare to some 'Paleo' or 'SCD' diet recommended in some best seller's guru book...

 

[wild_one353]

This study on vitamin d put crohn's into remission.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4009525/

Ive tried SCd and will testify eliminated refined sugar and lower natural sugar helps immensely to reduce symptoms. however, I eat wheat oats and beans, and find much benefits except when beans aren't cooked well, beans are very hard to cook correctly.\

From what i recall the paleo is elimination of grains for good, I don't agree with that because there is beneficial fiber and fibers is the number one most important nutrient, kinda the good bacteria can eat this and reduce inflammation. avoiding yeast is important too I believe. Even scd says to slowly reintroduce certain foods. i may be wrong on that though just mentioning it.

 

[hugh]

Well those studies are not great...

I'm not putting forward any arguments about the quality of the studies or even the quality of the conclusions drawn from the studies, That's a whole other issue.....

I'm saying there is plenty of evidence that diet and nutrition play a huge part in this disease.
A few small trials, hundreds of case studies and thousands believable anecdotes testify that diet and nutrition are important.

First of all the number of patients is too low to make any conclusion.

We can conclude that those on the diets had less indication of disease.
We can't conclude why, but we can speculate and design other studies to test those hypothesis.
Unfortunately there is little money in telling people to eat food that nourishes them and to stop eating crap, so there is little money for the studies

If you go through analysis of the data well, some indicators are missing (what about endoscopic results? calprotectin?

“C-reactive protein did not significantly change during study. Mean fecal calprotectin improved from 471 (SD 562) to 112 (SD 104) at week 11 (P = 0.12). Among those with follow-up endoscopy at week 11 (n = 7), improvements were noted in simple endoscopic score for Crohn's disease (n = 1), Rutgeerts score (n = 1), and Mayo endoscopy subscore (n = 4).”

in my opinion indicators are lacking to conclude there is a real remission...)

The OP's statement was “I am a big believer in Paleo/SCD to help with inflammation”, not that diet cures so you are arguing against a claim that no one has made.

... by the way I apreciate more this Semi Vegetable Diet, which is a kind of japanese regime with Miso etc... compare to some 'Paleo' or 'SCD' diet recommended in some best seller's guru book...

I also appreciate the semi-vegetarian diet as an example of a real food diet[1] prolonging remission, but I took issues with the deceptive nature of it's representation[2].
I think the SVD study has far more evidence to recommend a paleo/scd/gaps/PHD diet than anything else.
It has no evidence to recommend a vegetarian diet.
It also has absolutely no evidence in it to suggest that a semi-vegetarian (without the quote marks) diet is beneficial.
It is a piece of propaganda

Ive tried SCd and will testify eliminated refined sugar and lower natural sugar helps immensely to reduce symptoms. however, I eat wheat oats and beans, and find much benefits except when beans aren't cooked well, beans are very hard to cook correctly.\

From what i recall the paleo is elimination of grains for good, I don't agree with that because there is beneficial fiber and fibers is the number one most important nutrient, kinda the good bacteria can eat this and reduce inflammation. avoiding yeast is important too I believe. Even scd says to slowly reintroduce certain foods. i may be wrong on that though just mentioning it.

I'm a real believer in fibre too, but less while the disease is active may be beneficial
There is a strong suggestion that reducing bacterial activity will reduce symptoms.
But people disagree on how to interpret studies, and which studies carry more weight than others etc. so elimination and reintroduction is a valuable tool.[3]
Even then some fibres may be beneficial while others are not, it's not just “fibre good”. Paul Jaminet recommends resistant starch, Criss Kressler recommends beans (if tolerated), the paleo mum recommends against psyllium (but I find it wonderful).

There is sooooo much fibre available from other sources and so much indication that gluten containing grains are problematic for many people and that eliminating them can be hugely beneficial that it is just common sense to eliminate them along with all other potentially problematic foods.
If they can be reintroduced without issue all well and good, but it would be incorrect to just assume that the benefit outweighs the risk

[1]”For the purpose of this study the 'semi-vegetarians' (from the links in the original study [20-30]) refrained from sugar[20,23,24], carbohydrates[21], fast foods[24], cola,chewing gum and chocolate[25], western foods (bread for breakfast, butter, margarine, cheese, meats, and ham and sausage)[27], and were encouraged to eat more fruit and vegetables.”
Well, it must have been the sausages then? go team veg, meat is bad!
http://www.crohnsforum.com/showthread.php?t=59617

[2]”“most prebiotics are extracts of plants. Therefore, we thought that a vegetarian diet would be suitable for IBD.”
- a bit of a leap, don'cha think? Maybe 100% fibre (prebiotics) is the next logical step?
“Foods that have been shown to be a risk factor for IBD in or outside Japan, including sweets, bread, cheese, margarine, fast foods, carbonated beverages, and juices, were discouraged. Healthy habits were encouraged: no smoking, regular physical activity, moderate or no use of alcohol, regularity of meals, and not eating between meals.”
- that's a lot to say, lets just call it “semi-vegetarian”, they will know what we mean......
http://www.crohnsforum.com/showthread.php?t=59617

[3] Episode 299 – Dr. Ruscio – The Real Deal With Gut Microbiota
the opinions of someone reviewing all the literature, rather than cherry picking individual studies that he likes....
https://robbwolf.com/2015/12/08/episode-299-dr-ruscio-the-real-deal-with-gut-microbiota/

 

[MaryCherub]

The problem is that when he switches to Paleo/SCD, he gets unrelenting diarrhea.

Whilst I think Paleo is an excellent way of eating, I cannot do it.

Paleo is heavily meat based.

And I have discovered through trial and lots of errors, that a high meat diet is just terrible for my own UC.

I find the bone broth helpful. But eating a big lump of meat is not.

 

[MaryCherub]

But eating a big lump of meat is not.

I have found that "easy to digest" foods are the key.

Meat is hard to digest, and leads to pain, gurgling, wind and fatigue for me.

Easy to digest foods are things like: stewed apples, fruit smoothies, warmed ginger water, vegetable juices and light but nourishing foods such as kichari (soft Indian dahl).

 

[Dawn101]

The food you eat or don’t eat has a huge impact. Don’t understand how doctors say it doesn’t matter. Diet is key. That said it is also individual and jumping into diet plan a or b is not the answer. Your husband may have had less stomach grumbling when he eliminated a food he does not tolerate. Wheat, dairy products are common intolerances. As far as paleo diet and diarrhea and fatigue. Maybe the fat in the meat was not being digested well. We’re the poops full of yellowy bile? Lack of carbs, especially a quick dietary change will cause fatigue. Oats, teff, rice all good. I always pick an choose what’s best for me out of every diet. There is no one best diet for every person. I would have your husband start with the easy to digest foods (look at aid for ibd food list). And go from there. I know for myself I when I cut out dairy, wheat, red meat, pork and sugar everything came together. Even though all those foods are healthy (minus sugar). My body was not digesting them well and were causing issue. We can change our gut flora by the foods we eat which will increase absorption and overall health. Good luck. I know it can be frustrating. Stick with and think small steps make good habits easier.