I suspect that many of you are thinking right now, How am I going to do this? I feel horrible when I eat those foods. What if my body hates fiber? Statistically that’s 15 to 20 percent of people, but since you’re reading this book, there’s a decent chance you have irritable bowel. Fifty to 80 percent of people with IBS have food sensitivities. But you are the person who needs this book the most. That’s the great irony. The people who need fiber the most are the ones who will also struggle the most to eat it. You have to fix the gut to reap the reward of better health. And to fix the gut, we know we need fiber and diversity of plants.
So what does it say that you struggle to process fiber or certain types of plants? Well, it indicates that your gut has been damaged. Of course people with digestive disorders are going to struggle more with these foods. But it’s not just them. This may also be true for people with allergic and immune system disorders. Or migraines, anxiety, or depression, or, frankly, any of the litany of conditions that we learned is associated with dysbiosis in Chapter 1. Where there’s dysbiosis you’ll also find food sensitivities. If that’s you, then I want to help you the most because then we are correcting the root cause of your problem and helping you enjoy your food again.
That doesn’t mean it’s going to be easy. You’ve been searching for solutions to your problem and the solution that’s been offered to you for the last fifteen years has been, “Well just get rid of it.” And when you do this, you may feel better in the short term. But are you better in the long term? Generally not. Elimination, particularly categorical elimination, is short-term gain and long-term pain.
It’s clear that the Golden Rule is in direct conflict with the idea of eliminating entire plant categories. We learned in Chapter 4 that when you eliminate plant categories you deprive yourself of the health benefits and alter the balance of bacteria in your gut to favor dysbiosis.
So why do people do it? Why do people eliminate beans, grains, and nightshades?
Part of the reason is that many of these foods bring out the worst in their gut—gas, bloating, cramping pain, and weird noises. I’m sure you’ve seen the photos on the internet that show a protuberant, pregnancy-like belly and a flat belly from the exact same day. I can’t tell you how many patients have brought these photos to my office as evidence of a problem. They’re not as helpful as the poop selfies, but I understand that you want to show that something is wrong.
The thing is that these symptoms of digestive distress have been, unfortunately, misinterpreted. I see a lot of people on the Internet, even some medical doctors, claiming that bloating and gas brought on by plant foods means that they’re inflammatory. But as we discussed in Chapter 4, these foods have repeatedly proven to be the opposite—anti-inflammatory. I’ve also taken care of plenty of patients who think that because they have these symptoms it means they’re incapable of eating these foods, and therefore it makes sense to acknowledge the problem, eliminate the triggers, and move on.
But think of it this way: If you have arthritis in your knee, does that mean you should buy a motorized scooter and stop walking? Sure, if you quit walking, you’ll never feel that discomfort in your knee again, right? But then your exercise falls off, your legs atrophy, you gain weight, then end up on multiple medications to control your blood pressure/cholesterol/diabetes, and you feel depressed and weak. But hey, your knee doesn’t hurt! Is that worth it?
If, instead, you put in the effort and decide, I’m going to walk, do some physical therapy, exercise my leg and knee, then you’ll actually be able to lessen the pain and at the same time maintain health throughout your body. For the person with arthritis, it’s painful in the beginning to start healing through exercise and therapy. But weathering that initial discomfort, the reward is a stronger knee, increased functional capacity, and better health that extends beyond the knee. The same is true with food sensitivities—if you accept that while it may not be easy in the short term, it’s so much better in the long term, we can work through the short-term effects together. The point is that there will be unintended consequences when we allow unhealthy lifestyle habits to form. But there’s also the flip side, which are the unintended benefits that come when we choose health and opt for plant-based diversity.
In the coming pages I’ll break down the science behind why people develop food sensitivities and lay out our plan to address them. If you take it slow and take your time adding in plant-based foods, you’ll reach the long-term reward for short-term discomfort: a stronger gut, broader plant-based diversity, and better health that extends beyond the belly.
It’s your gut microbiota! When you curse the heavens as you watch your friend scarf down unlimited quantities of that six-bean chili while you try to maintain a straight face and not show the discomfort you’re experiencing, just know . . . it’s not you. It’s your bugs. Yes, you are 99.9 percent genetically the same as that person sitting across from you. But your gut microbiome is a totally different story, completely uniquely yours. It’s just as personal as your fingerprint. There is literally no one on the planet with a gut microbiome exactly like yours. If you had an identical twin, you’d most closely resemble your twin followed by your mother, yet still be entirely distinct.
Your unique gut microbiome has strengths and weaknesses that are uniquely yours. It may be really good at processing beans but really struggle with garlic and onions. In a perfect world, if your diet perfectly complemented the strengths and weaknesses of your gut, then you wouldn’t have any food sensitivity at all. None.
Since your diet and your microbiome are completely intertwined, your diet needs to be just as personal to you as your microbiome is. You need to use some trial and error to discover your custom, ideal diet. Now it may seem contradictory to say “There’s no one size fits all” immediately after defining “one Golden Rule for better health.” But it’s rather simple: You follow the Golden Rule of maximizing diversity of plants with every meal, but recognize that how that looks for you is going to be different from the person sitting next to you who is eating from the same selection of foods.
The goal is to hit that sweet spot where your dietary choices are perfectly matched to the strengths and weaknesses of your gut, and then magic ensues. No digestive distress, maximum plants, healing gut and body. We’re going to help you identify some of the strengths and weaknesses in your gut so that we can get started fine-tuning, not by eliminating foods but by going slow. We’re going to get you to that sweet spot.
The important thing to remember is that it’s not about perfection. And yes, there will be times when you’ll have gas, bloating, discomfort, or altered bowels. We all have that from time to time, myself included. But what we are going to do is optimize your gut and, in doing so, make those symptoms infrequent to the point that they no longer command your attention or affect your quality of life.
The way we accomplish this is by treating your gut like a muscle. Every time you sit down to eat it’s like your gut is going to the gym. Physical fitness is defined by health and well-being achieved through nutrition, exercise, and sufficient rest to optimize performance in some way, whether it’s sports or just activities of daily living. If our gut is a muscle, gut fitness means digestive health fueled by fiber and achieved by training your gut through plant-based diversity.
In the gym, if you always work out your biceps but never work out your triceps, you’re going to have some unbalanced, funny-looking arms. If you don’t work out a muscle group, it atrophies. If you don’t use it, you lose it, right? Same rules apply to the gut. If you eliminate a food group, your ability to consume that food dwindles.
What if you’ve been out of commission for a few months due to an injury? If you go to the gym and try to lift three hundred pounds on your first day, you’re going to hurt yourself. In the same regard, if you haven’t been eating beans and you scarf down a big bowl of the six-bean chili, you’re going to feel it because your body isn’t adapted or trained for what you’re doing.
So what’s the best approach in the gym? Work out every single muscle group, just enough to promote growth without injury, and often enough to keep them all maintained or growing. This is exactly the way we should handle our food. We need to work out our gut with every plant category, just enough without overdoing it, and often enough to build our tolerance. Think of every single plant variety as working out a different muscle group. By emphasizing diversity of plants, you are giving your gut the dynamic workout that it’s craving. So all plant groups need to be on the menu from time to time, not necessarily daily but often enough to maintain our gut fitness.
We all know the building block of muscle. It’s the thing we’re getting too much of yet still worry it’s not enough—protein. But if we’re treating the gut like a muscle, we should recognize the building block of that muscle—fiber. You can’t build a healthy gut without fiber.
And here’s what’s cool: Just like with exercise, your gut will get stronger and become better adapted to what you’re trying to do. That’s a big takeaway from this book. Your gut is adaptable, and it will adjust to your choices.
Consider this example: Remember in Chapter 2 when we discussed the modern-day hunter-gatherer Hadza tribe of Tanzania? They consume more than 100 grams of fiber per day, about six hundred varieties of plants per year, and have 40 percent more gut diversity than the average American. It turns out that there’s a seasonal variation to how they eat that causes a seasonal change in their microbiota. In the wet season, which lasts from November to April, they’re more likely to forage for berries. During the dry season from May to October, they hunt animals. Meanwhile, year-round they consume tubers and a variety of plants to get 100 grams of fiber or more per day.
When researchers studied the microbiome of the Hazda, they saw that many species of bacteria disappear for a season and then reappear. And the functional ability of their microbiome alters as a result. Researchers found that foods eaten more regularly resulted in enrichment of the enzymes necessary to digest them. In the wet season when the Hadza consume more berries, they noticed enrichment of the enzymes needed to process a specific component of the berries called fructans. Sear that last sentence into your brain because we’re going to come back to it in a moment.
Here’s another example: Consider lactose, a short-chain carbohydrate (or sugar) found in dairy products. When I use the term “sugar” here, I don’t mean table sugar or glucose, but rather I’m referring to a simple carbohydrate, as opposed to fiber or starch. In order for lactose to be processed we need the enzyme lactase. But 75 percent of the world’s population are deficient in this enzyme, and therefore lactose intolerant. So three in four people have the potential for gas, bloating, digestive distress, and altered bowel habits if they consume dairy.
But can people make themselves less lactose intolerant? Is it possible to train the gut to handle lactose?
First of all, there is an amount of lactose that can be tolerated in these cases. If I take a medicine dropper and put two drops of cow’s milk on someone’s tongue, they’re not going to have blow-out explosive diarrhea from that. No one is that lactose intolerant. So there’s a threshold that needs to be crossed to trigger the symptoms.
Second, the gut adapts to regular exposure to lactose. For example, regular consumption of lactose over the course of ten days led to adaptation of colonic bacteria with more lactase activity, less digestive distress, and objectively far less production of gas. In another study, ten days of regular lactose consumption led to improved efficiency of lactose digestion and reduced gas production by threefold.
What does this all mean? First, there is a threshold of tolerance that exists and if we cross that threshold we get symptoms but if we stay within the bounds we should be feeling pretty good. Second, your gut adapts to what you give it. In other words, your gut can be trained to tolerate foods that you’re sensitive to. Third, your gut needs to be fed in order to be trained. In other words, elimination diets will only heighten food sensitivities.
Let’s take a step back for a moment. Remember in Chapter 3 when we discussed that we humans only have seventeen of the carbohydrate-processing enzymes called glycoside hydrolases? Meanwhile, our gut bacteria have been estimated to have as many as sixty thousand of these digestive enzymes! What this means is we’ve outsourced carbohydrate processing. Why? Because it makes us adaptable to a variable diet and environment.
It also means that carbohydrate processing—including fiber—requires a healthy, properly adapted gut microbiome. When we damage the gut and reduce diversity, we also reduce the number and types of digestive enzymes in our gut. And that is the reason why there are so many people struggling to deal with carbs these days. We’re not eating enough of them to train our gut, and then we’re damaging our gut with the other aspects of our lifestyle—processed food, meat and dairy, antibiotics, medications, hypersterility, and sedentarism.
The irony is that we need complex carbohydrates in our diet . . . terribly. They’re our prebiotic foods. That’s how we Fiber Fuel our body and reap the healing benefits of SCFAs. So there is this vicious cycle where complex carbs cause digestive distress, which motivates us to reduce our intake or, worse yet, eliminate them, which weakens the microbiome and makes it less capable of processing carbs so that next time you try them your digestive distress is even worse. So then we label all carbs as being inflammatory and bad for us when in fact they’re actually the solution. It’s a common mistake that’s been prescribed by numerous fad diets, and at best it’s short-term gain with long-term loss.
So how do we break this vicious cycle? It starts with a carb intervention. But let’s address the hurdles we need to clear before we can begin the program.
First and foremost, if you’re dealing with gas and bloating we absolutely need to make sure there’s no constipation. This is by far the number one cause of gas and bloating that I see in my clinic. It has its own vicious cycle—methane gas slows gut motility, causing constipation. Then, constipation increases the amount of gas we produce from our food. In other words, gas causes constipation, which causes more gas. I’ve found in my practice that if my patients maintain bowel regularity and correct the constipation, they feel so much better and the gas and bloating issues go away. But first you have to know whether or not constipation is present, and the truth is that it’s more common than most people realize.
Even if you don’t feel constipated, your ears should be perking up if you have a history of constipation, ever strain to poop, drop little nuggets or turds, or sometimes go a day without a movement. And here’s the crazy thing . . . even if you have diarrhea, believe it or not you may be constipated. The most severe constipation presents with diarrhea. Basically what happens is you have a column of impacted stool stuck somewhere in your colon, and the solid stuff piles up behind the “log jam” but the liquid can still sneak through the cracks and crevices to come down to the bottom and come out loose. It’s very confusing to both the doctor and the patient because severe constipation is manifesting with loose bowel movements. We call this overflow diarrhea, and the treatment is actually to purge the colon to relieve the blockage. So if there’s any change in your bowel habits or a possibility of constipation, you should ask your primary care doctor to check an abdominal x-ray to rule out constipation or (under the guidance of your doctor) drink a bottle of magnesium citrate to initiate a colon purge and essentially have a fresh start.
You absolutely will not have success on a plant-based diet if you are trying to ramp up fiber consumption while being constipated. In my clinic, we don’t even consider dietary changes until the constipation is corrected. I’d recommend consulting with your primary care doctor or a gastroenterologist locally to get the constipation under control before moving forward with a dietary overhaul.
The next thing we need to understand is whether you may be experiencing a food sensitivity or a food allergy. I hear a lot of people describing their gas and bloating as a food allergy. To me, this is more than just semantics. If you have a specific food that you’re proven to be allergic to, then you actually do have a medical reason to eliminate that food. Although it is technically possible to build tolerance to a food allergy, it is a fragile, complex process that needs to be done under physician supervision. Most will just eliminate the food. Why? Because a food allergy is your immune system reacting when it’s stimulated by that particular food. The most common food allergies are to milk, fish, shellfish, eggs, nuts and peanuts, wheat, and soy. When people with an allergy eat these foods the immune system goes on the attack, launching IgE (Immunoglobulin E) antibodies like missiles to attack the allergen. This process releases chemicals that cause an allergic reaction, which can include itchiness, hives, swollen lips, a throat that closes up, trouble breathing, or even loss of consciousness. This is very different from a food sensitivity, where you may feel bloating, gas, diarrhea, abdominal discomfort, and fatigue. It’s an important distinction because if you really do have a food allergy, then you absolutely should eliminate that food from your diet. But if it’s a food sensitivity, then it’s not your immune system reacting and you should be able to train your gut to be able to process it. If there’s any question whatsoever, you need to work with your doctor to determine whether or not it’s a food allergy. There’s no one test that is adequately reliable to answer this question alone, and therefore you need the assistance of a qualified health professional.
Let’s deal with gluten for the last time. There are three major groups of people who should not be consuming gluten, and there are two groups who should be consuming gluten. Everyone falls into one of these five groups. For what it’s worth, the latter two groups make up at least 90 percent of the American population. I’m going to describe each one and walk you through how you can determine whether or not you meet these criteria.
You should not consume gluten if you have:
CELIAC DISEASE—If you have celiac disease, you need to be 100 percent gluten-free for the rest of your life. Continued gluten consumption isn’t just disruptive, it’s dangerous and can lead to small bowel T-cell lymphoma, which is almost universally fatal. About 1 percent of Americans have celiac disease. Classic symptoms of celiac disease include diarrhea, bloating, gas, abdominal pain, and weight loss. Occasionally you’ll find it in someone who is constipated. I also think of celiac anytime I see someone with low iron levels. The intestinal damage from celiac affects the small intestine, where iron is typically absorbed. If you have any of these symptoms or are worried that you may have celiac disease, there are two tests for you to consider that can definitively tell you whether or not you have celiac:
Genetic testing for HLA-DQ2 or DQ8: In order to have celiac you must meet three criteria—have the genes, consume gluten, and activate the gene through dysbiosis. In other words, it’s impossible to have celiac disease if you don’t have the gene. So you can have your blood analyzed for the celiac genes, and if they’re not present, you don’t have celiac. If you do have the gene, it doesn’t necessarily mean you have or will ever have celiac disease. In fact, there’s a 97 percent chance that you don’t have celiac despite having the gene. But if you are genetically positive, it means that celiac is possible and therefore additional testing is necessary to determine whether or not it’s present.
Upper endoscopy with biopsies of the small intestine: This is the gold standard test for determining whether or not celiac is present. Basically, you will need to see a gastroenterologist such as myself to be scheduled for this procedure. After you are sedated, a doctor will run a flexible tube the size of a pinkie (a cute pinkie! Not too big!) with a light and camera down into your stomach and small intestine. This allows biopsies to be taken from the small intestine—two from the first segment of the duodenum and four from the second segment. The entire procedure typically takes just five minutes. It’s important for you to consume gluten in the days leading up to the procedure because that’s the only way to tell if gluten is causing damage to the intestine. It is these biopsies that ultimately tell the story. A pathologist uses special criteria for evaluating for celiac disease called the Marsh classification to determine what damage, if any, is present. Marsh grade can be from I to IV, with IV being the most severe. Traditionally, grade III or IV disease is classified as celiac. But this is a spectrum, and in recent years there have been studies showing that Grades I and II are celiac, too. The reason I’m breaking this down for you is to tell you that blood tests for celiac disease are usually positive for Grade III or IV disease yet usually negative for Grade I or II. So the blood test can be negative and be wrong! Therefore, if you suspect you have celiac, you should skip the blood test and do either the genetic test or move forward with upper endoscopy with biopsies. The vast majority of celiac disease that I diagnose is Marsh I, and these people do incredibly well when I put them on a gluten-free diet. But I would have missed them if I’d just done the traditional blood test.
WHEAT ALLERGY: This isn’t necessarily a reaction to gluten, but it is a reaction to proteins found in wheat. Similar to other food allergies, the results are generally dramatic: hives, lip or throat swelling, difficulty breathing, or anaphylaxis. GI symptoms such as diarrhea and abdominal pain may also be present. Wheat allergy almost always develops in childhood, and affects 0.4 percent of American kids. It is extremely rare to develop wheat allergy as an adult unless you have occupational exposure, so bear that in mind. If you have wheat allergy, that would also be grounds to be completely wheat-free. Since it may not be gluten, it’s possible that barley and rye can remain on your menu. Testing for a wheat allergy is not quite as straightforward and decisive as it is for celiac disease, so it’s best to address this issue with a qualified health professional. That said, if you’re having hives, lip or throat swelling, difficulty breathing, or anaphylaxis in relation to any food, I’d recommend you stop eating that food. Pretty straightforward.
NON-CELIAC GLUTEN SENSITIVITY WITH EXTRAINTESTINAL SYMPTOMS: Okay, of the five categories that I’m going to describe, this is the one that we’re working the hardest to figure out. The challenge is that we use one diagnosis to describe a whole bunch of different conditions, all of which are exceedingly rare. It’s incredibly difficult to study a heterogenous group of extremely rare conditions. They are even rarer than celiac disease. These conditions can occur outside the intestine, may be tied back to gluten, and may improve on a gluten-free diet. Specific symptoms I’m referring to are joint or muscle pain, leg or arm numbness, or neurologic symptoms like altered mental status, loss of balance or muscle control, or a rash. The classic rash is called dermatitis herpetiformis and is characterized by an itchy, vesicular rash symmetrically on the elbows, knees, butt, and trunk. Psoriasis can also be associated with celiac disease. If you or your doctor suspect celiac, it’s absolutely imperative that you have celiac testing done. For example, 85 percent of adults with dermatitis herpetiformis actually have celiac. Similarly, antibodies to gluten are found in 85 percent of people with gluten-related neurologic conditions, often in association with Marsh I histology on small intestine biopsies. If you definitively test negative for celiac disease yet wonder if gluten is causing your arthritis, leg or arm numbness, neurologic symptoms, or rash, then it would make sense to try a gluten-free diet for a few months to assess your response. If you improve, you can challenge yourself by reintroducing gluten and if symptoms come back, then you have your answer. Of course, this would be done under the guidance of a qualified health professional.
You should consume gluten if you are:
COMPLETELY SYMPTOM FREE: Let me keep this short and sweet. If you have absolutely no symptoms and absolutely no reason to suspect you have celiac disease or any of these conditions, you should not be on a gluten-free diet. As we discussed in Chapter 4, you are unintentionally damaging your gut and increasing your risk for other conditions like coronary artery disease. ’Nuff said!
NON-CELIAC GLUTEN SENSITIVITY WITH ONLY DIGESTIVE SYMPTOMS: If you suffer exclusively from digestive symptoms after ingestion of gluten-containing foods—bloating, gas, distension, abdominal pain, diarrhea, or constipation—then you absolutely need to have testing to rule out celiac disease. But if those tests prove decisively that you do not have it, then we need to regroup.
Recent research reveals that for many people, gluten may not be the real culprit. Consider a study in which researchers gave people with “gluten sensitivity” an oatmeal bar every day for a week. Concealed within the bar was one of three things: a placebo (sugar), gluten, or fructans. Fructans are short-chain carbohydrates that you’ll find in gluten-containing foods (wheat, barley, and rye). Every person was exposed to a different bar after taking a break for a week to let his or her system settle down. During each week they measured the average GI symptom scores for each person. Here’s what they found: Compared to placebo, the patients actually had fewer GI symptoms during the week that they were eating the gluten bar. Fewer symptoms! Let that register for a moment. Then when they ate the fructan bar they saw a big increase in digestive symptoms relative to both the placebo and the gluten bar. In other words, most people who have non-celiac gluten sensitivity aren’t even sensitive to gluten. They’re sensitive to fructans. And their symptoms are being triggered because they have underlying dysbiosis with irritable bowel syndrome. So what are these fructans? We will cover them in the next section.
Just a few pages ago we were chatting about how the gut microbiome has shown the ability to adapt to lactose exposure. We also talked about the Hadzas’ seasonal variation in diet and how when they ate more berries they trained their microbiome to process fructans. Then we discovered that most people with GI symptoms from gluten don’t actually have a problem with gluten, but likely have underlying irritable bowel syndrome being triggered by—here’s that word again—fructans. So what are we referring to here? We’re talking about FODMAPs. Perhaps you’ve heard this term dropped in conversation. FODMAPs are simple or short-chain carbohydrates found in our plant food. FODMAP is actually an acronym—fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. You need to memorize that because I’m going to test you on it later. Just kidding—no, I’m not.
Anyway, these FODMAPs are foods that are, by definition, fermentable. They’re also poorly absorbed, which means that they draw water into the intestine and can cause diarrhea. By escaping digestion, they reach the lower intestine where the gut bacteria reside. These gut bacteria then feast on these carbs, in the process producing hydrogen gas along with potentially other by-products. We rely on our gut microbiota to work their magic and process these foods for us with their glycoside hydrolase enzymes. In people who have damage to their microbiota, such as those with irritable bowel syndrome, the loss of digestive capacity can lead to maldigestion, gas, bloating, discomfort, and diarrhea.
There are five categories of FODMAPs to be aware of. As you’re reading this section, if you suffer from food sensitivity, consider the foods within a specific category. Do you have a sensitivity to more than one?
Lactose—A disaccharide found in dairy products like milk, ice cream, and some cheeses. For aforementioned reasons, I support the elimination of lactose from the diet. Many of you will see improvement in digestive symptoms with this simple move.
Fructose—A simple sugar found in many fruits (cherries, watermelon, apples), some veggies (asparagus, Jerusalem artichokes), high-fructose corn syrup, and honey.
Fructans—Oligosaccharides found in a variety of foods, including gluten-containing grains (wheat, barley, rye) as well as fruits and veggies (garlic, onions).
Galacto-oligosaccharides (GOS)—Complex sugars classically found in beans. Toot toot!
Polyols—Sugar alcohols like mannitol and sorbitol, often found in artificial sweeteners and some fruits and veggies.
Since FODMAPs can cause digestive symptoms, we should eliminate them, right? Not so fast, my friend! We need to be careful about vilifying these parts of our food when in fact they can be incredibly healthy for us. For example, fructans and galacto-oligosaccharides are prebiotics! As discussed in Chapter 3, this means that they are fuel to grow and energize the healthy bacteria in your gut and ultimately yield more postbiotic SCFAs.
Perhaps you’ve heard of the low FODMAP diet? The idea is that appropriate restriction of FODMAPs can reduce digestive distress in people with irritable bowel syndrome. And for some patients with irritable bowel syndrome this does work. The problem is that many people, doctors included, have misinterpreted these studies to mean that FODMAPs should be eliminated permanently. But this cuts against the Golden Rule. Plant-based diversity is the greatest predictor of a healthy gut. And, again, FODMAPs are actually incredibly healthy and most of them are prebiotics.
So what happens if we permanently restrict FODMAPs? Their restriction, in the setting of the low FODMAP diet, may lead to harm of the beneficial bacteria and a drop in total bacterial count. So now we have fewer SCFA-producing bacteria and simultaneously are restricting prebiotics. This is a recipe for less postbiotic SCFAs. Not good.
Finally, the restrictive nature of the low FODMAP diet can lead to micronutrient deficiencies. In one study the low FODMAP diet led to significant declines in several important micronutrients: retinol, thiamin, riboflavin, and calcium. What this means is that if we want a healthy gut, then we actually need our fructans and galacto-oligosaccharides.
It’s important to recognize that the low FODMAP diet, as developed at Monash University in Australia, was never meant to be a permanent elimination diet. Instead, it was meant to be a temporary FODMAP restriction for two to six weeks followed by a systematic reintroduction of the FODMAPs. The actual point of the diet is that our food sensitivities may vary among the categories of FODMAPs and that increased awareness of this can make us smart consumers. This is exactly how these FODMAP categories should be used: If you have difficulty in dealing with one particular category, then you know where the weakness in your gut lies and that you may need to go slow and easy on building up strength there. If you want a list of foods that fall into certain FODMAP categories, email me at fodmap@theplantfedgut.com and I’ll send you what you need.
Bringing it back full circle now, we know that following the Golden Rule and maximizing plant-based diversity in our diet is the key to a healthier gut. It offers the prebiotic fiber and micronutrients in both balance and variety. This is fiber fuel for health. The result is a strong gut microbiota that’s firing on all cylinders and optimizing health throughout our entire body.
But many of us are going to have difficulty in processing our plant carbohydrates, specifically fiber and FODMAPs. The reason for this is that we humans rely almost entirely on our gut microbiota to do this work for us, so if the gut is damaged, then the struggle is real!
It’s incredibly important to understand that the plant foods we need the most to get our gut stronger are also the same foods that cause digestive distress in people with a damaged gut. Yes, it’s frustrating. But it’s the way it works, and we’re about results so it’s important to know the rules of the game. So how do we break this vicious cycle, get our guts back, and start enjoying more plant food in our diet? We have to treat our gut like a muscle and train it. Think of Rocky, running through the streets of Philadelphia and up the steps of the Museum of Art. He didn’t just wake up one morning and do that. It took time and effort to build up that level of fitness to propel him to the championship. That’s what the Fiber Fueled 4 Weeks (see Chapter 10) is going to be for you. It’s a structured four-week plan to start from scratch and build that gut.
Ultimately, the plan will help you understand the FODMAPs your gut is good with and which ones it needs help with. As we progressively introduce fiber and FODMAPs, it’s important to start low and go slow. This may be the most important sentence in the chapter, so please sear this one into your brain. To properly train our gut, we need to start low and go slow with fiber and FODMAPs. Low and slow to grow—that’s the motto. You feel me? That’s the “Rocky” approach to building up your gut fitness. You can do this. And I’m here to help you.
To view the 25+ scientific references cited in this chapter, please visit me online at www.theplantfedgut.com/research/.