[cjdell]

I initially wrote this as a reply to a comment by "NotGMan" mentioning fasting/paleo that got flagged. They could have approached the subject more delicately but I believe they have a point.

About 3 years ago I had gut issues so bad I thought I was close to death. NHS couldn't see any problems and were basically telling me I'd gone nuts. They refused to do any further testing.

After a year of suffering I tried a 7 day water-only fast and the pain finally went away. I broke fast with only paleo foods and stayed that way for 6 months. I gradually introduced other foods after that period with the last being gluten about 2 years after the initial fast. I am almost cured, however I will never abuse my gut in the same way again. Less carbs, more salads...

This is just my personal experience of course but I have discovered so many other people with similar gut issues who are also being ignored by their doctors that you can't blame one for wondering if there is a conspiracy at play.

I wouldn't have believed any of this a few years ago but now I have serious doubts in modern medicine's ability to deal with chronic health issues, especially in the gut.

We do eat so many more processed foods (and other things) that it doesn't require that much of a stretch to the imagination that diet is a part of the problem or indeed the root cause.

Lack of openmindedness bothers me immensely and the nature of human biology is under no obligation to fit into tidy boxes for the sake of our understanding. The real world is fuzzy.

[Buttons840]

Decades ago, about 30% of the people who had celiac disease would waste away and die, especially children. Until a doctor noticed that if the people ate 12 bananas a day they seemed to do better. Of course, 12 bananas a day is a kooky diet, but people who eat 12 bananas a day tend to eat less of everything else, including less bread and gluten and so they would do better. Later science figured out bread was a problem and then eventually identified the specific protein (gluten) that effects people with celiac disease.

I think there are other foods that bother different people, but we haven't managed pin down exactly which foods bother which people. It's a hard problem, but surely there are other cases of "if you just avoid this specific food ingredient, you will recover", just like celiac disease.

So, on the one hand, sharing advice about which diets worked and didn't work can be helpful (like the 12 bananas a day diet). On the other hand, "I tried an unusual diet, which also happens to have a good amount of marketing behind it, and things are better" is one of the most common bits of advice you'll find for many diseases, and the problem is everyone recommends a different diet.

A relative of mine has Chrons disease and was close to death before it was diagnosed, the doctors recommended a junk food diet basically, high calorie foods with almost no fiber, and that's how he eats now and is doing much better. I don't recommend everyone follow the same diet, but for whatever it's worth, eating junk food has helped my relative, true story.

And this is what I mean, there's so much conflicting advice about which diet to try. I can't fault people for trying different diets, because I believe there are many unknown disease, like celiac disease, which can be treated with an exact (but as of yet unknown) diet. I also don't fault people for giving up and not enthusiastically trying every diet-of-the-week that gets suggested, it's tiring. Also, it's notable that the diets with the most marketing tend to be the ones most recommended.

[yterdy]

Taking this tangent and riding it: it's well-known that undiagnosed celiac disease in children stunts growth. After diagnosis and transition to a gluten-free diet, there is usually a period of catch-up growth (which unfortunately does not close the gap fully, usually). If there are a bunch of these silent sources of malnutrition, it could - alongside things like poor perinatal care for mothers and children, as well as the various sequelae of America's high level of economic inequality among developed nations - be one piece of the puzzle for why the adult height of Americans has stalled when compared to Europe (which would be an empirical finding and not just gussied-up scientific racism).

[CWuestefeld]

I don't recommend everyone follow the same diet, but for whatever it's worth, eating junk food has helped my relative, true story.

Crohn's disease affects each patient differently. Depending on what part of the gut is being attacked [1], different digestive processes are implicated. That will lead to different kinds of foods being potentially problematic (as well as leading to a need for different kinds of supplementation).

The bottom line is: your mileage WILL vary.

(I've had Crohn's for nearly 45 years, since I was an adolescent.)

[1] My doc once told me about a patient he had that was affected in the throat!

ETA: for my personal experience, the one thing I can't eat is whole-kernel corn in any non-trivial quantity. It actually clogs me up. Oddly, popcorn is perfectly fine, as are corn tortillas and the like. It's happened to me twice. The first time I went to the ER and said I thought I had an obstructed bowel, and the admitting nurse said "can't be, if that were the case, you wouldn't be able to walk in yourself". I think that gives some perspective about what kinds of pain you can get used to. Second time it happened, I didn't bother, since there turned out to be nothing the ER docs could do other than monitor me. I just let it work itself out over the course of a couple days.

[semi-extrinsic]

The "your mileage will vary" part is definitely true, as well as the "incredible what kinds of pain you can get used to". I had 30 cm of my upper intestine removed 12 years ago. Doctors said it was so constricted you couldn't pass a pencil through, but I was still managing to ski double black diamonds two weeks before surgery.

When it comes to fiber in particular, I think what can confuse people is the difference between water soluble fibers like oatmeal, and extremely insoluble "macrofibers" like raw green asparagus, leafy greens, orange pith etc. The former is OK for some, the latter is no-go for everyone AFAIU.

Another curveball is nearly underbaked dough, like you'll find in a lot of commercial bread and rolls, even if it has zero fiber. If you can knead it back into dough with your hands, it might just form a nice lump in your gut as well.

I have the same thing as you with corn, and also with nuts unless eaten with lots of liquids. I think it goes back to the possibility of forming tough paste in the gut.

[polishdude20]

I wonder if water balance plays a big role. Like, you drink water but it easily gets absorbed by your stomach or small intestine before it gets a chance to work it's way down with the food. Then as the food is passing through, the water dries up. It's as if your body wants the water more than the intestines. Drinking the extra water with the nuts may help because of that? Just spiralling

[asdfqwertzxcv]

Have Chron's with stricturing and anything more than a quarter cup of corn, popcorn, pineapple or leafy greens would bring me to my knees in about 5-8 hours. Nuts are a little hit or miss, I need to chew them up really well and not eat them on an empty stomach and I'm good for a few handfuls.

I tell people that if it looks the same coming out as it goes in, I can't have that banging around my guts.

Any fast or junk foods are totally fine since they're mostly low fiber, but high fiber foods are mostly okay, too.

Due to my strictures and the nightmare stories I've read from people online, I specifically eat foods that are mushy or smoothies and soups. Basically, I'm pre-digesting the foods before they're eaten so they're easier to pass through a narrowing intestional wall and it has worked well for years now. Only time I've had issues are when I eat too quickly, too much at once or have one of my problem foods.

I'm also on a biologic, which made all the difference after being untreated for about 6 months, which I wouldn't wish on my worst enemy.

[polishdude20]

I wonder if that's something I should do. I noticed once or twice if I ate something with pumpkin puree in it, the next day my bowels were heavenly.

Do you have a different reaction to soluble vs insoluble fiber?

[asdfqwertzxcv]

No real difference for me. It mostly comes down to quantity, speed and how much it’s broken down by chewing, cooking or blending.

[cjdell]

Thank you for taking the time to reply and not just downvoting me. That is enlightening and I'm glad your relative is in better health now.

I'm certainly not suggesting there is a single treatment plan that'll work for everyone. As I said biology is fuzzy and it annoys me when people try to debug health issues like they were pieces of software. Discussing these things openly does help however.

[ibash]

I have chrohns. The diet change recommendation is something we hear often.

For me my doctor recommends a mediterranean diet and to avoid emulsifiers, but it’s definitely not a cure and not universal.

If you go look at chrohns forums you’ll see a lot of experimenting and a lot of different diets because (to my understanding) chrohns has a lot of different and unknown causes.

For me high fiber foods can put me out of commission for the next day, for others it’s the opposite.

[wholinator2]

Yeah, there was a vegan girl once who heard i ha Crohns' and just would not stop telling me to go vegan. Apparently it had helped her IBD but she seemed incapable of believing that i had tried all that and that eggs and meat were the best diet for me. High protein, high calorie. I'll eat vegetables with make but always well done. If i ate vegan I'd probably be dead in 2 weeks.

[SirMaster]

>I think there are other foods that bother different people, but we haven't managed pin down exactly which foods bother which people. It's a hard problem

Sounds like a job for a neural net. If people would log all what they eat and how they feel. If the neural net had access to all the components of the foods they are inputting, surely with enough data a pattern would emerge of what common component in what they eat is correlated with worse symptoms.

[hanniabu]

Not that easy. I have sibo and depending on what I eat and how I eat it, it changes the effects it has on me. Also the amount and frequency. For example, if I have raisins at the start of my meal then I don't see issues, but if I have them at the end of my meal then I do. If I have it here and there then no issues, but if I have it a few meals in a row then it'll give me issues.

And raisins affect me within 20min, but if I were to face something like potatoes or tomatoes then it doesn't give me issues until hours later (after my next meal or even the next day).

[cjdell]

You may benefit from speaking to a nutritional therapist. You might have a biofilm problem at specific points along your digestive tract but I would let them make that determination and come up with a personalised treatment plan. Nutritional therapy is about "eating yourself well" and you might be surprised how effective it is. Good luck!

[polishdude20]

I thought sibo was fairly treatable with antibiotics? Or is it a recurring thing that just won't go away?

[tonnydourado]

> If people would log all what they eat and how they feel.

Dietary data is one of the hardest things to collect. Either you need to hospitalize people and control their whole diet, and your sample size is small, because of costs, or you need to rely on self reporting, and your data is unreliable.

Basically, much easier said than done.

[ijustlovemath]

Biological systems are highly nonlinear and time-dependent, and also very individual! People have been trying learning techniques in glucose control since the early 2000s, and have only seen limited success in very controlled scenarios. I think a simple neural net would fall short of catching all that complexity, at least using the current architectures

[Buttons840]

Yes. I have celiac disease and I know people report following a strict gluten free diet for a whole year or more before they start to feel better. For me, I never did feel better, but blood tests show that certain celiac-related antibodies have returned to normal levels.

That's a very delayed and weak signal.

[BurningFrog]

People won't log all the food they eat, but supermarkets actually have data on what food people buy.

So correlating that data with people's health could be very interesting!

I don't think that has much chance getting past an IRB though.

[ijustlovemath]

Youd have to somehow control for waste and individual consumption within a household, which would be very difficult!

[BurningFrog]

Not for statistical studies across a population.

[olyjohn]

God forbid we use the data to do something good. But for marketing? Yeah no problem.

[loudmax]

I do want to offer a limited defense of the medical community's "lack of open-mindedness". By the nature of their job, their work is inherently life risking. Most of us working in IT can afford to make experiments that doctor's cannot afford. I may be willing to try some unconventional approaches if the cost of error is an application crash and nuisance to the end user. If the cost of error is death of the user, I'm going to be far more conservative.

When a patient dies, society will treat a doctor very differently if it's perceived that the doctor was being unorthodox compared to too cautious. This doesn't mean that too cautious doesn't also cost lives. It's just really difficult to balance when the stakes are so high.

Anyway, good on you for taking ownership of your own health, and thank you for sharing your experience. I hope you continue to get better.

[abecedarius]

I'd respect this defense of medicine if medicine had resisted the U.S. dietary guidelines, which started as pseudoscience chosen by politics in the 1970s. Instead of being conservative about evidence and risks, the profession mostly was conservative about questioning that imposed consensus.

[pants2]

I'm convinced that dietary restrictions are extremely powerful for treating Crohn's and similar diseases, but patient adherence is so bafflingly low that the treatment may as well not exist in doctors' eyes.

Just as an example of a more studied case, the probability that an overweight person reattains normal weight through diet and exercise is well under 1% [1]. Now consider that diets for Crohn's (like a water fast and strict elimination diet) are considerably more difficult to follow than a weight loss diet - it's no wonder that diet appears to be ineffective for most people.

After a similar experience to yours I haven't had any foods with the 8 major allergens (and a few more select things) for over seven years, aside from a handful of accidents early on. That's not an easy diet to follow, but gets easier with time and experience.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/

[wholinator2]

What are the 8 major allergens you're avoiding? Do you avoid anything else?

[pants2]

The 8 most common allergens as identified by the FD: milk, eggs, fish, Crustacean shellfish, tree nuts, peanuts, wheat, and soybeans. These are called out on all packaged foods, which makes it easier, though I'm OK with some derivatives like soy lecithin. I also avoid yeast (brewer's or baker's) and a few other small things like black pepper.

I've been in remission for long enough that I could probably start eating a lot of these things again, but I have no desire to go through another Crohn's episode, so I'll probably continue to avoid these foods for the next 40-50 years (unless there's a miracle Crohn's cure in the meantime). After that, as I understand, a weakening immune system from old age makes Crohn's symptoms significantly less likely or severe.

[aeblyve]

Indeed. It is difficult to have good-faith conversations about this subject with others sometimes because trust in "The System" (as it were) is often a core of peoples' relating to society. Western medicine does have excellent treatments for problems like appendicitis (in my case...), but is very much lacking in the holism that prevents the issues to begin with.

A quote from Ray Peat:

>“Besides fasting, or chronic protein deficiency, the common causes of hypothyroidism are excessive stress or “aerobic” (i.e. anaerobic) exercise, and diets containing beans, lentils, nuts, unsaturated fats (including carotene), and undercooked broccoli, cauliflower, cabbage, and mustard greens. Many health conscious people become hypothyroid with a synergistic program of undercooked vegetables, legumes instead of animal proteins, oils instead of butter, carotene instead of vitamin A, and breathless exercise instead of stimulating life.”

We see that health-consciousness, when lead somewhere by ideology, is not in itself sufficient to make progress.

[Workaccount2]

Too many doctors erroneously just go along with "If the [front line] tests show nothing, it is nothing", such a shame.

[dghughes]

I recall on an ask reddit a group of gastroenterologists were answering questions. One thing that stood out was they said "let your stomach rumble it's a necessary part of gut health".

Fasting would help initiate that, but I think so many people these days never stop eating long enough for their stomach to rumble.

[cjdell]

I have also read that our gut doesn't like being in constant operation. Our ancestors didn't have access to food 24/7 and it makes sense our bodies adapted to take advantage of this by entering a self-cleaning state during long periods without consumption.

[polishdude20]

Have you noticed any trigger foods since then?

I'm kind in the same boat as you were in. Nothing live threatening but definitely daily annoyance of gut issues that impacts my life.

Mind sharing some meals you eat for breakfast, lunch, dinner? I'd love to try some new healthier options.