How to Determine Food Triggers for Digestive Issues - Ask a Nutritionist

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BRITNI: Hello and welcome to Dishing Up Nutrition's new midweek segment called “Ask a Nutritionist”, brought to you by Nutritional Weight and Wellness. My name is Britni Vincent and I am a Registered and Licensed Dietitian. And on today's show, we will be answering a nutrition question we've received from our Dishing Up Nutrition listeners. and today's question is how to determine food triggers for digestive issues, specifically ulcerative colitis and foods to prepare and eat to reverse the issue.

What is ulcerative colitis?

I think it's a great question, and if you're somebody who has digestive issues, maybe not that diagnosis of ulcerative colitis, I think this is a great topic for you, for anybody with digestive issues. So for those listeners who aren't familiar, with ulcerative colitis, it is an inflammatory bowel disease that causes inflammation and ulcers in the large intestine. That large intestine is also called the colon. Ulcerative colitis also causes that inflammation and ulcers in the rectum as well. 

Symptoms can include rectal bleeding, diarrhea, abdominal pain, cramping, fatigue, urgency to have a bowel movement. I've seen a lot of clients over the years with ulcerative colitis, and the main symptom for most of those individuals is frequent diarrhea and urgent diarrhea. And I've had some clients that have had diarrhea as many as 12 times a day. So it really negatively impacts their quality of life and unfortunately keeps them home. But the positive is those individuals have been able to get their ulcerative colitis into remission by figuring out what their food triggers are. And it has varied from person.

I also want to note that ulcerative colitis is considered an autoimmune condition and autoimmune conditions, what that means is your immune system is confused, so your body is actually attacking itself, and in the case of ulcerative colitis, that's causing your body to attack your large intestine, creating those ulcers and and inflammation there.

Determining food triggers

So determining food triggers can be, can be a process. You know, I get a lot of clients that come in and they think that if they're eating a food all of all of the time, that it's not an issue for them. You know, for instance, I might suggest, well, maybe gluten's an issue for you. The response commonly is, “I eat bread all the time. That's not an issue for me.” But I think that when you're eating a food all of the time, it actually can make it more difficult to determine if it's a trigger or not for you. And often the assumption is if you get a symptom that the trigger is the last thing you ate. And although that can definitely be true sometimes. But oftentimes the trigger is something you eat earlier in the day, something you even ate the day before or two days before, or an accumulative effect that then builds up and, and creates that, that diarrhea or whatever, whatever symptom that you might have.

And there's really no way to determine whether a food is a trigger or not unless you just 100% eliminate that food and then reintroduce, and we're going to talk a lot about that. So the most common food triggers I find for ulcerative colitis, and I would say digestive symptoms as a whole would be gluten and dairy.

So let's talk about dairy first. Dairy is a bit more confusing because some individuals are lactose intolerant. Some individuals are dairy sensitive. Hypothetically you could be dairy sensitive and have lactose intolerance. So lactose intolerance means that you lack the enzyme lactase to break down the dairy sugar, lactose, and usually you're going to know right away. You get cramping, diarrhea, gas. It's very uncomfortable. So it's pretty obvious if you’re lactose intolerant.

But when your dairy sensitive, that means that your body is reacting to the proteins in dairy: casein and/or whey. And though that creates more of a delayed response, so it's a lot more difficult to pinpoint if your dairy sensitive and some of the main symptoms of a dairy sensitivity would be diarrhea, constipation, other digestive symptoms, bloating, gas, chronic sinus congestion or postnasal drip, seasonal allergies, skin conditions like acne or eczema. Headaches can also be a symptom of a dairy sensitivity.

And by no means that's not all of of the symptoms of a dairy sensitivity, but those are the most common ones that we see. Now, for me personally, I didn't realize that dairy was an issue for me until I just a hundred percent eliminated it, and then I found certain of my symptoms just went away. So again, that elimination a hundred percent is, is really necessary throughout this process.

Then let's move on to gluten. So a gluten sensitivity means that you're reacting to the gluten, and gluten is found in wheat, barley, rye, spelt and kamut. Common symptoms of a gluten sensitivity include diarrhea, bloating, constipation. It could be other digestive symptoms as well: stomach aches, nausea, reflux, could be some other ones. Joint pain is a common symptom. Headaches, migraines; a lot of people get brain fog from gluten. And then some individuals notice that they feel more anxious or depressed after they eat gluten.

And I think that a lot of people assume if you don't have a digestive response to a food, then it means that you, that you're not negatively reacting. But that's not true. You could have a gluten sensitivity or a dairy sensitivity and not necessarily get any digestive symptoms from dairy or gluten. but it might manifest in other ways, like your mood or headaches, migraines, skin. So that's just something to be aware of. I know the topic today is, is digestive health, but I wanted to mention that.

Food trigger elimination process

So again, as I've been talking about, to determine if a food is a trigger, you need to a hundred percent eliminate that food, and I would recommend for at least three weeks. And I know one piece of bread a week doesn't sound like much, but for some people, one piece of bread is enough to create a lot of inflammation. And during this elimination process, that could be enough to throw off the whole experiment. So, decide, commit to a hundred percent. And I mentioned the word experiment. Sometimes thinking of this as, I'm just going to do an experiment with my body for three weeks. Let's see what happens. And I have so many clients that at the end of this experiment or this elimination trial, they feel so much better. They don't even want to reintroduce the food.

So you can decide to eliminate gluten or dairy separately, or you can decide to just do it altogether. You know, when we see clients one-on-one, sometimes it's really obvious what their food trigger might be. Sometimes it's not so obvious, you know, maybe me listing off those common symptoms, you're thinking, oh wow, I probably have a dairy sensitivity. So then I would prioritize eliminating that first. But again, some people feel really motivated to just eliminate the gluten and dairy at the same time.

And then at the end of that three week time, if you do want to reintroduce, then you would just want to decide, am I going to reintroduce gluten first, or am I going to reintroduce dairy? And when you reintroduce a food, eat it. You know, you can even eat it a few times that day. And then I would wait a few days to see what your reaction might be. Then you can move on to reintroducing the next thing.

With the dairy, while you're reintroducing dairy, it, it needs to be a little bit more methodical. I'd really recommend reintroducing each dairy product separately because each dairy product has a little bit different makeup as far as the amount of lactose, casein, whey. So for instance, some people, many people tolerate butter when they don't tolerate other dairy products, you know, some people might tolerate yogurt but not cheese or milk or or cream cheese. So by introducing the dairy products one by one, you might determine that you tolerate some of them, but not others during that process. And again, between introducing each item, just wait a few days because you might have that delayed response as well.

Eating gluten and dairy free

So I want to talk more about when you do eat gluten and dairy free, because it's, it's really overwhelming. I know for most people, your mind goes to, well, that means I can't eat this or that or that, but instead I want you to focus on all of the things that are naturally gluten and dairy free. So with the gluten, so gluten is in anything, any baked good, any flour product, pasta, things like that. You know, dairy is more obvious, although I would say in packaged foods, dairy sneaks into so many different products. So that means looking at the label of every food that you're purchasing. And then, you know, when you're buying real foods, you know, most of those foods don't even have labels, so you know exactly what you're getting just looking at it.

When we're thinking about the foods that are naturally gluten and dairy free, you know, meats, fish, seafood, eggs are all naturally dairy, gluten free. Healthy fats like avocados, nuts, olive oil, avocado oil, olives, seeds, and then all of the real food carbohydrates, you know, fruits, vegetables, potatoes, sweet potatoes, squashes, carrots; all of those things would be naturally dairy and gluten free.

And when I'm working with clients and we're coming up with food ideas, meal ideas that are going to work for them, I, I encourage my clients to think of what are foods that you love or meals that you really love that are naturally dairy and gluten free? And if you think about it that way, again, I think it feels a lot less restrictive. And believe me, if this gets, if eliminating these foods gets rid of your ulcerative colitis symptoms or your digestive symptoms as a whole, then it's totally worth it. I mean, imagine being symptom free. Again, people feel so motivated once, once they feel better.

For myself, like I love Asian flavors, and generally speaking, those dishes don't ever include dairy. And then the only tweak that you really need to make is traditional soy sauce does usually contain wheat, so you would want to purchase a gluten-free soy sauce alternative. Bragg’s Liquid Aminos is a great option. Or coconut aminos, and you can find those usually at any grocery store. And then you just substitute that for the soy sauce in the recipe, and then it's, it's gluten free. Making a list of all of those foods that you love can really help throughout this process.

If you have ulcerative colitis or if you have a lot of digestive symptoms, a lot of times your intestinal tract is so irritated and inflamed that throughout the healing process, I'd recommend sticking to just soft cooked meats, cooked vegetables, and then those healthy fats. And specifically the cooked vegetables can be really key because it's a lot of work for your body to break down raw vegetables. And if everything is already so irritated and inflamed and then you're breaking down the raw vegetables, that can just exacerbate the irritation. So it's not like you're necessarily reacting to the carrot. You're just having a problem digesting them raw.

So the cooked veggies are really, really helpful during this healing process. And then down the road when your symptoms are gone, you can reintroduce and, and try some of those raw vegetables. Again, I kind of take the same idea of the reintroduction process as I mentioned earlier, because if some people might tolerate a cucumber better than raw broccoli, for instance. When you're just starting to reintroduce those raw vegetables, sometimes peeling them like peeling the cucumber might help you digest some a little bit better.

Other possible food triggers

Some people with ulcerative colitis do need to explore other food triggers if the gluten and dairy doesn't completely eliminate their symptoms. So some individuals do need to eliminate all grains. So rice and, and quinoa and wild rice. Those are naturally gluten free, but some individuals do need to eliminate those as well. Nuts can be problematic. Eggs, nightshades can be problematic for some individuals, but I would start with the gluten and dairy free, and then, working with a nutritionist can be a really great way to determine what your other food triggers might be.

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Maybe you determine that nuts might be an issue, and a lot of times just eating a handful of nuts can be really difficult. So it, it can be that same idea as the raw vegetables, so your body's just having a hard time breaking it down, so you might be able to tolerate that, that down the road during that process. Just be patient. You know, it takes a lot of time to heal the digestive tract.

But I will say I've had many clients have dramatic improvement in their symptoms in even a couple weeks or a month. So it's totally possible to be symptom free. Just be patient during the process. You know, a lot of times supplements can be really helpful during this healing process. Probiotics specifically. I often recommend a glutamine product, which helps to heal the lining of the intestinal tract. So if you've never taken a probiotic before, I would start with a powdered Bifido and start small, like even an 1/8th of a teaspoon. And then as tolerated, you can work your way up. And then down the road, you could switch to like a more multi strain probiotic.

Again, if you're working with a nutritionist, we can help to determine what might be the best probiotic for you. Would it be helpful to add in a glutamine product to the probiotics and, and the Bifido specifically that I was talking about that can be found on nutrikey.net website. We have lots of articles and other podcasts that talk about digestive symptoms on our website at weightandwellness.com. All of our recipes on our website are naturally gluten-free. Many of them are naturally dairy free, and if they're not, oftentimes we offer a way to substitute an ingredient in the recipe to make it dairy free. So we have lots of wonderful resources on our website that will help you through this process.

And if you want to schedule an appointment with a nutritionist to help you a little bit more throughout this process, you can do that online, again at weightandwellness.com, or you can call us at (651) 699-3438.

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