My gut problems started after my first child was born and made much worse by massive doses of antibiotics 16 years ago. Not been able to touch alcohol for 20 years and now my diet is getting more and more restricted with no successful reintroduction of anything. I am self-controlled so I do the elimination of a food carefully. Gluten was my epiphany 18 months ago (no vomiting, huge fatigue, bloating now and migraine now minimal). But I never manage to successfully reintroduce anything. But I am 4 weeks into taking Symprove and have seen my energy levels soar which is great. I can’t eat a diet full of fruit and veg (although I love both) as it causes me problems. Likewise milk. Nuts cause me terrible stomach pain. But I can’t keep eliminating – I’m like litmus paper though….any advice?

Have you been completing the detailed food and symptom diary (p.187 + p.266-267)? If yes, have you had this analysed by a medical professional (registered dietician/ gastroenterologist/ family doctor)?

Trigger foods or allergies/ intolerances are only one aspect of healthy eating and happy guts. Carefully consider the *balance and variety* of foods you eat, and thus the balance and variety of micronutrients (minerals/ vitamins/ essential fatty acids/ prebiotics). Restrictive diets often lead to insufficiencies or deficiencies. Common ones include magnesium, long chain omega-3s, vitamin D, haem iron. Foods rich in these include oily fish, cocoa, certain seeds, organ meats, oily fish again.

Also carefully consider the amount and form of potentially problematic foods. A splash of cows milk in tea? Live goats milk yoghurt or kefir? A matchbox size chunk of unpasteurised aged ewes milk cheese?

A tablespoon of chia seeds or ground flaxseeds? Ground almonds in home baking? Hazelnuts soaked overnight in water and chewed thoroughly?

Similarly grains … Half a slice of homemade sourdough bread? Steel cut oat porridge? Muesli from raw jumbo oats soaked in apple juice? Pearl barley in a stew or casserole?

If numerous wholefoods seem problematic regardless of amount or form, you may be a candidate for a full blown/ very strict elimination diet. However this *must* be medically supervised for safety.

HTH!

Many thanks for your detailed reply – appreciated. I’ve never had my food diary looked at – I’ve only ever really been sent away from both the GP and the gastroenterologist with a flea in my ear because I “look healthy” and no gastroscopy/endoscopy has ever shown anything other than the starts of diverticulitis. When I said to the GP the other day that with minimal fruit and veg I’d end up getting bowel cancer, she waved her head around and said “Well let’s hope not”…not great. But I think I see what you are saying vis a vis taking in small quantities (they’d have to be very small) of my problem foods. With that in mind, I’ve bought a small bottle of kefir, some apples etc….don’t think I can bring myself to try onions/leeks/wheat just yet even in a tiny amount. Bit by bit. Have been reading about SIBO – didn’t know about it – that was very interesting…all my symptoms and problems. Also – nobody on this site mentions (or maybe I’ve missed it – probably!) about histamine intolerance. I’ve only just noticed that when I have the worst of my symptoms, a piriton (antihistamine) really helps. When you look up food which contains histamine, it’s eye-opening. Brie, blue cheese, tuna…..all these things make me feel very instantly tired and bloated. One antihistamine later and the problem is significantly improved….

The starting point really is maintainance and analysis of your detailed food and symptom diary. As I said consider nutrient imbalances or deficiencies and *whole*foods, not just potential trigger substances (gluten/ histamine) which you cannot consume in isolation.

Use your initial diary analysis to request a referral to a registered dietician and/ or further testing (bloodwork, maybe stool sample). Supply facts – *balance and variety* by food group or type, measured quantities, medical *signs and symptoms*, timing, frequency – not self diagnoses. Contemplating multiple serious, uncommon or faddy diseases leads to gut-unfriendly stress and a medical diagnosis of ‘worried well’

Ask your pharmacist whether your chosen antihistamine would block dietary histamine if taken after the fact. Generally antihistamimines are most effective when taken regularly, and before exposure to an allergen. Also about specificity: IIRC the older antihistamines do not act solely on histamine receptors.

Do post your initial analysis here if you cannot access a more open minded doctor or a registered dietician.