Unfortunately for many with gut problems, long term use of a restriction diet probably has them eating a very small number of foods. There are a number of restriction diets to help with gastrointestinal disorders: Low Fodmap, the Specific Carbohydrate Diet, the Autoimmune Protocol, Keto, and Carnivore.
While restriction diets are very useful for managing symptoms while attempting to correct the underlying cause of a problem, many see them more as a permanent solution to their gastrointestinal woes. This has never been the purpose of these diets, outside of the avoidance of gluten in people with Celiac disease. As a consequence, many people end up with an every-dwindling list of foods they can tolerate.
Thus, it’s becoming more important to begin re-introducing foods as soon as you can. But, it’s not wise to go about this willy-nilly; it’s important to have a solid plan in place to optimize your chances of success. In this blog I’ll cover 10 tips for the successful reintroduction of foods after a restriction diet, no matter which diet you’ve been following.
1)Clear hyperglycemia as a contributing factor
This is huge one, particularly since most restriction diets are eliminating or drastically reducing carbohydrate intake. Hyperglycemia can cause a range of GI problems from gastroparesis to leaky gut, which I covered last year in a blog you can find here. It’s important to determine if a food is causing GI distress because of specific components in that food or because it’s causing hyperglycemia.
This is particularly an issue for those coming off of Keto, Carnivore, or just a really low carb diet. These diets induce a temporary form of insulin resistance that can be reversed with the gradual re-introduction of carbohydrates to the diet. One can easily see this if they attempt an oral glucose tolerance test.
Randomly reintroducing higher carb foods may cause GI symptoms strictly via hyperglycemia, so it’s important to test for this first. You can do that by performing an oral glucose tolerance test before you reintroduce foods, or even just follow how reintroduction affects your blood glucose. You’re clear if your blood glucose doesn’t go over 160mg/dL after an oral glucose tolerance test(75g glucose/dextrose) or reintroduction meal and returns to fasting levels within 2 hours.
2)Develop a control diet
In every experiment it’s important to control for confounding variables that can screw up your results. It’s important to look at reintroducing foods to your diet in much the same way, by controlling for things that can change the outcome.
Nothing is more detrimental to getting clear results on your reintroduction diet than chaos. Thus, it’s important to make sure that all other foods you eat during the reintroduction phase are the same. Ideally you consume a symptom-free control diet for at least a week prior to reintroduction and continue it throughout the reintroduction period. That way you know that it’s the food you are reintroducing causing the problem, and not that you changed something else.
I’d love to hook you up with the dopest control diet that would work for anyone, but that is going to be highly specific to the individual.
3)Take objective measures such as HRV, sleep, or postprandial glucose
While gas, bloating, abdominal pain, diarrhea, and other GI symptoms will be the primary focus during your reintroduction diet, it’s important to have other more objective measures to help guide you along the way. I’m a big fan of measures such as heart rate variability(HRV) and sleep to help optimize your chances of successful reintroduction.
Both sleep and stress are factors known to affect GI symptoms in people with gut disorders. You can use these measures not only to determine if a food is increasing your symptoms, but also to determine if your body is ready to reintroduce foods. Poor sleep the night before or high levels of stress on the day you intend to reintroduce may indicate that today is not the day to start.
For HRV I use the HRV4Training app on Iphone as it doesn’t need additional equipment and is easy to use. For sleep I use a Fitbit Charge 2 HR which also measures average resting heart rate so you can use that information as well.
4)Start with single, healthy, whole unprocessed foods
Sure, there really is no flare or excitement behind reintroducing Brussels sprouts over something like, say, pizza. But, increasing unprocessed foods has a much greater chance of success in the short term and the long term. The goal, especially if you’ve been avoiding fiber, is to build up your microbiome and mucus layer, particularly in the colon where most of your gut bacteria reside.
When starved of fiber, the bacteria in your colon begin snacking away on the mucus layer there. This reduces the thickness of the mucus layer in 2 ways. First, the bacteria are literally consuming it so it gets thinner. Next, when certain bacteria ferment fiber they make something called butyrate which increases production of the mucins that make up that mucus layer.
The problem here is that the bacteria that make up your microbiome are in closer proximity to the intestinal wall. This increases the risk of them triggering inflammation in the colon. The truth of the matter is, increasing fiber early on will make your efforts much more effective later down the road when you begin adding less healthy foods such as pizza or the like.
If you have SIBO, start w/low, but some fiber foods that are easy to digest like peas, green beans, carrots, or asparagus. Better yet, if there are foods with fiber in them that you tolerate, slowly increase those foods the week before you reintroduce, and then dial back on reintroduction week and swap out equal parts fiber.
5)Start with a low dose of the food(1/4-1/2 serving)
When planning to reintroduce foods, I like to start with a very low dose of the food, particularly if it has something hard to digest such as fiber or casein. That’s why I recommend people start with only 1/4 of a serving and wait it out. Then, follow the pattern below…
6)Consume, then skip a day, then consume the same amount, skip a day then double the amount.
I recommend trying a food out and then skipping a day to see if it leads to a negative response while in the colon. Even in people with healthy digestion, it takes a full day for something to go all the way through. By giving a day off in between, you can minimize your risk of bloat and give the microbiome time to adapt.
After you’ve successfully introduced a food twice, wait a day and then double the dose until you get to a full serving. If you get to an amount that you don’t tolerate, dial it back to the last dose you tolerated and stick with that. It may just take time to rebuild the microbiome and mucus layer.
7)Mix or blend with a food you tolerate
If you’ve had bad digestion, you’ve probably experienced the way the entree/side dish style meals “come out” if consumed separately. Even people with healthy digestion can experience this if they consume enough corn without anything else. Rather than consuming the food you are reintroducing on it’s own within or at the end of a meal, mix or blend it up with a portion of the control meal.
For example, if you’re reintroducing peas, mix it in with some ground beef or even blend it together before consuming it. If the food is particularly hard to digest or contains a lot of fiber, mixing it up will decrease the amount of bloat it could give you.
8)Chew, chew, chew
For the same reasons mentioned above, it’s a really good idea to chew your food to ensure that it’s broken down well enough early in the digestive process. This allows the steps following the chewing process to complete their tasks more effectively. But, there’s an even better reason to chew your food well, it increases blood flow and oxygen consumption in the gut.
So, not only does chewing mechanically break down food, it ramps up energy production throughout the digestive tract. This increases ATP production to more thoroughly mix and move the food along while chemically digesting it with digestive enzymes. Chew each bite at least 30 times from beginning to the end of the meal, not just for the new food.
9)Relax and/or meditate for at least 30 minutes after reintroduction meal
The vagus nerve is the conduit through which the brain-gut axis communicates. When we are stressed or hurry through our meals, this decreases vagal tone and impairs digestion. As such, it’s important to relax prior to and throughout your reintroduction meal, almost meditating throughout and 30 minutes after. Focus on diaphragmatic breathing as this stimulates the vagus nerve and improves digestion.
10)Once you’ve added 2-3 foods back, get it to “stick”
I know one can become eager when adding foods back, but rather than increasing the foods you eat week over week, it may be a good idea to begin messing round with combining the foods in different ways and times. This can be especially important once your fiber intake creeps up because you can’t just eat all of your fiber at 1 meal and not expect to eventually experience bloating.
For example, if you’ve successfully added back green beans and peas, try moving those to different meals and with different combinations of food before you attempt adding in your next food, say onions. You want to establish a new control diet and decrease the number of moving parts that may cause your progress to go kaflooey.
11)Use a food/symptom journal or mySymptoms app
There’s absolutely no point in beginning to reintroduce food until you’ve absolutely bought in to the process. You will fail, repeatedly, and you’ll hate it. Everything in life works this way, so make sure you’re prepared. Be pragmatic and meticulous in keeping your records, and nothing will more important than having a food/symptom journal.
For the most part, people have always done this by hand. But there are a number of phone apps that have come out that may be useful. A study recently came out showing that the mySymptom app available via iOS and Android is an effective way to identify food intolerances. I covered that study in a blog you can find here.
Note: I make nothing off promoting mySymptoms, but I hope to interview the person who developed it. Seems like they are looking to improve it.
The reintroduction of foods is a critical step in optimizing gut health. Unfortunately, many wander down the rabbit hole of restrictive dieting without realizing reintroduction is a thing. When you are regularly experiencing gastrointestinal symptoms such as gas, bloating, GERD, or diarrhea, you’ll do anything to to get them to stop as soon as possible.
An elimination diet is warranted, but that should never be considered the final step. Personalizing it through reintroduction is an important step in rebuilding a healthy gut. Working with a good RD is a great idea if you have access to one, but in the end, your experiences are what drives progression. All the more reason to prepare a plan and follow it to a T. Follow these 11 tips to help make your reintroduction as seamless as possible.