The Paleo Diet and Irritable Bowel Syndrome (IBS): A Comprehensive Guide

The Paleo diet, designed to mimic the eating habits of our Paleolithic ancestors from about 2.5 million years ago, is a dietary approach centered around whole, minimally processed foods. While geographic variations existed, the core of the ancestral diet consisted of protein sources like game animals and plants like fruits and nuts. Modern Paleo diets exclude grains, dairy, most added sugars, legumes, and certain oils, emphasizing whole foods. While a carefully planned Paleo diet can be a healthy choice, potential side effects can occur if implemented without consideration. This article explores the relationship between the Paleo diet and Irritable Bowel Syndrome (IBS), providing insights into how this dietary approach can be both beneficial and potentially problematic for those with IBS.

Understanding the Paleo Diet

The modern Paleo diet focuses on consuming whole, minimally-processed foods. People following a paleo diet avoid consuming grains, dairy, most types of added sugar, legumes, and certain oils, like canola oil. A well-rounded paleo diet can absolutely be a healthy choice and may improve certain aspects of health. However, if you don’t plan a paleo diet carefully, it could lead to several side effects.

Irritable Bowel Syndrome (IBS) Explained

Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder characterized by a range of digestive symptoms, including abdominal pain or discomfort, bloating, gas, constipation (IBS-C), diarrhea (IBS-D), or alternating periods of both (IBS-M). It is estimated that approximately 1 in 6 Americans experience IBS symptoms. IBS is classified as a “functional disorder,” meaning that the symptoms aren’t obviously caused by any physical or metabolic abnormality. The lack of one clear cause implies that IBS is caused, not by any specific food or nutrient deficiency, but by a variety of interrelated diet and lifestyle factors that combine to do several types of damage to the digestive system.

Potential Causes and Contributing Factors to IBS

• Gut Flora Imbalance (Dysbiosis): An imbalance in the gut microbiome, with decreased levels of beneficial bacteria and increased levels of harmful bacteria, is often observed in IBS patients. Many different foods, lifestyle choices, and medications can disrupt your gut flora and create an imbalance. One particular imbalance strongly associated with IBS is Small Intestinal Bacterial Overgrowth (SIBO): this is a condition in which the bacteria in the small intestine grow too rapidly, causing general digestive symptoms like bloating, nutrient malabsorption, weight loss, and malnutrition.
• Inflammation: Systemic inflammation of the digestive tract is another common issue. Inflammation is nothing but the body’s response to injury, so gut inflammation is a general sign that something is harming the lining of your intestines.
• Stress: A strong association exists between IBS and stress. Elevated levels of cortisol (one of the major hormones produced by stress) interfere with a neurotransmitter called serotonin, which regulates not only feelings of happiness and depression, but also gut motility (how quickly you digest your food and how often you have bowel movements). People with IBS very often have abnormal levels of serotonin in the blood, indicating that chronic stress is a serious trigger not only for depression, but also for gut dysfunction.
• Leaky Gut: This condition, where the intestinal wall is abnormally permeable, can cause both gut flora imbalance and gut inflammation, contributing to IBS, especially IBS-D.

How the Paleo Diet Can Affect IBS

The Paleo diet can be both beneficial and problematic for individuals with IBS. Its emphasis on whole foods and elimination of common irritants can provide relief for some, while its restrictive nature may exacerbate symptoms in others.

Potential Benefits of the Paleo Diet for IBS

• Elimination of Common Triggers: The Paleo diet naturally excludes many food groups known to trigger IBS symptoms, such as grains, legumes, and dairy.
• Focus on Whole Foods: By emphasizing vegetables, fruits, and lean protein, the Paleo diet promotes nutrient density and can support overall gut health.
• Increased Vegetable Intake: A Paleo diet can assist gut recovery by increasing consumption of vegetables, fruits, and lean protein.

Potential Drawbacks and Side Effects

• Fiber Imbalance: Higher fiber diets, like well-planned paleo diets, could cause diarrhea in someone who’s not used to higher fiber foods, like fruits, vegetables, nuts, and seeds. Conversely, if a person is following a paleo diet that’s very low in carbs and isn’t eating enough fiber from produce, nuts, and other paleo-friendly fiber sources, they could experience constipation.
• Gut Microbiome Changes: Some research suggests that long-term adherence to a strict Paleo diet may negatively affect gut health by reducing beneficial bacteria and increasing harmful bacteria. Findings from a recent study suggest that people following a paleo diet long-term may experience negative changes in their gut bacteria.
• Potential Nutrient Deficiencies: Cutting out food groups like legumes, all grains, and dairy could increase your risk of underconsuming certain nutrients.

Specific Considerations for IBS and the Paleo Diet

Several aspects of the Paleo diet require careful consideration for individuals with IBS.

Read also: Paleo Granola Recipes

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols)

FODMAPs are a group of carbohydrates that are poorly absorbed in the small intestine and can trigger IBS symptoms. Foods high in FODMAPs include certain fruits, vegetables, and sweeteners. While the Paleo diet eliminates grains and legumes, it's important to be mindful of FODMAPs in other Paleo-friendly foods.

Other Potentially Problematic Paleo Foods

Some foods that are otherwise regularly consumed on a Paleo diet can be harmful to people with chronic gut dysfunction. IBS can cause your digestive system to become hypersensitive, or intolerant to foods that otherwise cause little to no problems. Nuts are inflammatory due to their high levels of Omega-6 PUFAs, nightshades (like eggplant, bell peppers, and tomatoes) can exacerbate autoimmune problems, and eggs (especially egg whites) can be irritating because they contain antimicrobial compounds as part of their natural defenses.

The Importance of Individualization

IBS affects individuals differently, so a one-size-fits-all approach is not effective. The best way to approach the Paleo diet with IBS is to personalize it based on individual sensitivities and triggers.

Tips for Implementing a Paleo Diet for IBS

1. Start with a Modified Paleo Diet: Consider a less restrictive version that allows limited consumption of grains, legumes, and dairy. Findings from one study suggest that a modified paleo diet may be a better choice for gut health than the unmodified version.
2. Identify Trigger Foods: Keep a food journal to track symptoms and identify specific foods that exacerbate IBS.
3. Consider an Elimination Diet: Exclude common triggers like nuts and seeds, nightshades, and eggs during the initial stages of gut recovery.
4. Focus on Nutrient-Dense Foods: Emphasize well-cooked vegetables, bone broth, and fermented foods to support gut healing.
5. Manage Stress: Minimize stress and anxiety through techniques like meditation, yoga, or cognitive behavioral therapy.
6. Work with a Professional: Consult a registered dietitian or healthcare provider to develop a personalized Paleo plan that addresses your specific needs and ensures adequate nutrient intake.

A Low-FODMAP Paleo Diet

A low-FODMAP diet reduces or removes certain foods which can relieve the symptoms of some IBS sufferers. The diet is not a diet for life, it is used as a diagnostic tool to monitor tolerance to foods which are high in FODMAPs. Some paleo-friendly foods that are high in FODMAPs include: apples, onions, cauliflower, garlic.

Gut-Healing Foods to Include

• Bone Broth: Bone broth is very soothing to the digestive system, and it contains a wealth of vital nutrients extracted from the bones. Many people with IBS or related problems (like leaky gut, poor gut flora, or gut inflammation) find that bone broth is extremely helpful in restoring and maintaining normal gut function.
• Fermented Foods: Fermented foods will help restore your gut flora to healthy levels.
• Well-Cooked Vegetables: Make sure to get enough of the vegetables you are able to tolerate, preferably very well-cooked (this makes them easier to digest).

The Elimination, Sensitivity, Personalization (ESP) Approach to the Low-FODMAP Diet

There are 3 phases to the low-FODMAP diet, and exclusion is the beginning, not the end. The acronym that I have coined is ESP: Eliminate, determine Sensitivities, Personalize. If a patient responds to the elimination phase of the diet-which should only last 2 to 6 weeks-then he or she should undergo a structured reintroduction of foods containing individual FODMAPs to determine his or her specific sensitivities. That information should then be leveraged to create a less restrictive, personalized low-FODMAP diet for that patient that can be carried forward. Anything that clinicians can do to make the low-FODMAP diet less restrictive will be much less burdensome for the patient, may increase the likelihood of long-term adherence, and reduce the impact of the diet on the colonic microbiome.

Read also: Paleo Diet Delivered: What You Need to Know

Recipes and Meal Ideas

• Pork Roast: This recipe makes a delicious entrée with plenty of leftovers to grab for a quick breakfast or a cold lunch.
• Shrimp and Mango Salad or Cinnamon Chicken: For a lighter meal
• Tuna Steak: This recipe even calls for garlic, a helpful natural antibacterial.
• Roasted Acorn Squash: For a rich side dish on long winter evenings, this would be a delicious accompaniment to a roast chicken or a nice, juicy steak.

Emerging Research and Future Directions

Research continues to explore the complex relationship between diet, the gut microbiome, and IBS. Future studies should investigate the long-term effects of the Paleo diet on gut health, identify biomarkers that predict response to dietary therapies, and explore the potential of supplementation to improve symptoms in IBS patients.

Read also: Paleo Mayonnaise Recipe

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