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It's been a roller coaster ride since I started eating paleo back in November of last year. Mostly down. The good part is that I've lost weight. The bad part is that I've had some sort of GI issue since January.

I just wrote about this last week:

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Last week I thought the reason for my recent stomach pains was that I've been re-introducing occasional wheat into my diet since late March. I had a few weekends the past few months with severe pain in my stomach. While I did notice some severe pain occasionally it was usually a mild discomfort on my right side...about 6 inches to the right of my belly button. During this "re-introduction to wheat" period, I did have more regular bowel movements. Less constipation. Less diarrhea. Things appeared to look normal..but the stomach/side pain was annoying.

Saw a GI doc last week. Took a blood test to see if I may have celiac (which there was a definitive test if the blood test came back positive). Of course my blood was normal, so no celiac.

Came to the conclusion that maybe eating occasional wheat/rice/corn was causing my the abdominal pain. So for the last week I've been strict paleo...even cutting out dairy which I did not consume much anyway.

Stomach pain is pretty much gone..and definitely no severe pain. But now its like flip a coin whether I will be constipated of have diarrhea. This is what I was experiencing off and on Jan - March. I usually feel fine all day until I get home from work. From there its either a normal bowel movement or constipation...then diarrhea at night. After dinner, it sounds and feels like a volcano or thunderstorm going on in my digestive system. I hear rumbling...gurgling..I can feeling liquids sloshing around..and then diarrhea.

I'm trying to determine if I need to completely eliminate dairy, coffee, alcohol, etc.

My GI doc last week just encouraged me to take a fiber supplement daily and I have a follow up in September. From there it will probably be more tests ($$$$$$$) and potentially drugs. I have no confidence anything will be resolved soon.

I know this is diet related somehow. I just need to play health detective to determine what the root cause is.

Here is a list of what I consume (not everything):

Eggs, cheese/half&half, ghee/butter/coconut oil, pickles/kimchi/sauerkraut/kombucha, coffee/water/booze, grass and grain fed beef/chicken/pork/fish, fruit/steamed veggies, avocados, dark chocolate, honey

Multi-vitamin, Omega 3 supplement, pro-biotic, Vitamin D

I have not tried fermented grains, haven't had nuts in weeks, and do not eat too many starchy veggies.

Sorry for the rant! I'm completely stumped and frustrated. Any thoughts would be appreciated.

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Fruits may cause troubles en.wikipedia.org/wiki/Fructose_malabsorption – Eugene K Aug 16 at 6:52
NO FERMENTED GRAINS!!! NO WAY!!! You have autoimmune for sure, forget about grains. No fruit, no nuts, no dairy for you!!! – VB Aug 16 at 13:45
I don't even know what fermented grains are. Someone mentioned it in a previous question I asked. – tonytk Aug 16 at 15:49
I think you're on the right track with eliminating the grains, dairy, coffee, and alcohol. Coffee, alcohol, vinegar and gluten are linked to IBS. And when I first started paleo, I used to eat dairy too. But I feel much better now that I cut that out as well. Eat LOTS of unprocessed fruits and veggies. Over time, this will improve your gut flora. – Jess D. Aug 22 at 19:35
I'm definitely on a trek but probably not the right track. I'm basically at the point where I'm extremely restrictive in my diet and nothing is helping. Maybe I am not strict enough...dedicated enough. I have no idea. Maybe I'll find out I can only eat meat, butter, and carrots. Or perhaps this is just my new "normal". – tonytk Sep 5 at 2:30
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10 Answers

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I would try cutting out the cream (lactose), chocolate (lactose and sugar), and honey (and sugary booze like wine, beer, mixers etc opt for straight transparent spirits instead, like whiskey, tequila or vodka)

Basically everything with sugars in them. (Which probably includes some of your fermented too. You might want to trial a period without them as well as well as without the probiotic, not everyone responds well to probiotics)

Even with major digestive issues you can usually handle two sugars 1) glucose 2) fructose if its in small amounts (ie small portions of lower sugar fruits consumed on there own). This is because glucose is quick absorbed (no digestion), and fructose is also quick, but only under a certain threshold.

Just make sure if you eliminate loads of stuff that you replace the foods so you get good nutrition. Almond milk makes an okay replacement for milk, and its got just as much calcium (for example).

If you get results doing that, check out the sugar and starch content of everything you eat, and read up on fodmaps.

If not, its probably not bacteria. Then I suppose maybe its a food allergy or something else.

But with my digestive issues, your diet would give me total hell, hence my advice.

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My booze lately has been red wine and clear spirits like vodka. I've also just recently tried Robb Wolf's NorCal Margarita. I do occasional have a beer but not often. I have not had honey in probably 10 days or more. I did not know eating healthy was going to be so technical... – tonytk Aug 16 at 3:38
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Thanks for the advice. – tonytk Aug 16 at 3:38
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^ It can be kinda technical for digestive problem solving. Its taken me several months to work out what I can and cant eat for my issues, including alot of looking on skipthepie.org and reading up on fodmaps, reading forums etc. Sadly its something doctors are often not much help with, nor something that theres solid science on. The constipation could be related to low carb (more meat, less fibre). Most people find a bit of fruit or some magnesium works there. But the diareha is less common with paleo. That suggests IMO a bacterial dysbiosis. That is really a complicated solve. – Jamie Aug 16 at 4:31
Good luck with your journey to working it out! – Jamie Aug 16 at 4:33
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Hi Tonytk,

GI questions are almost always confusing and cause as many headaches as stomachaches, so to speak.

My first question back to you is this: you've had GI issues "since January" -- what happened in January? This seems like a very sudden start to GI issues, and if you've not had them before, you might look for what changed at that time.

A few bullet points to consider, but far from a complete answer:

  1. There are things in your diet that are well known to cause constipation. I know it sounds counter-intuitive, but alcohol, coffee, and dairy are three of these things. I would do an elimination of one of these for 2-4 weeks to see if any of them are causing the problem.

  2. Did they check for appendicitis? This is often localized at first in the area you describe. Gall stones can also cause similar pain.

  3. Just because the doctor says your celiac tests are "normal" doesn't necessarily mean you don't have a wheat sensitivity that can cause the problems you describe. The only way to know for sure is through an elimination of wheat/gluten/gliadin. And it sounds like when you re-introduced it, the pain came back. It can take 1-3 months to completely rid your body of gluten too.

  4. I highly recommend following up with Jordan and Steve's site at SCDLifestyle.com. They have excellent first-hand knowledge and expert research on the kinds of issues you're dealing with.

Good luck on the journey!

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Thanks! "Since January"?...I'm not sure. I know I posted something then with similar symptoms that I have now. Constipation, diarrhea, and the feeling like Hurricane Katrina or a major earthquake is happening in my stomach/digestive zone. I'm sure it was before January and maybe it started to really annoy me in January. Also, it comes and goes. Nothing is ever consistent. I could have 3 days where I am normal. In the last week, I have not been normal. 1. I already cut out dairy. Coffee is next. 2. Reg. Doc checked and didn't think I had appendicitis. 3. Good point. 4. Thanks! – tonytk Aug 16 at 4:43
Yeah actually thats a good point. If its localised pain in your upper right quandrant (the top right just under your ribcage), then it could be gallstones. Ask your doc to do a liver test when u see him next (gallstones end up showing up in your liver enzymes). Could be they formed before you went paleo (not enough fat to keep things flowing in there), and paleo has kicked it up. – Jamie Aug 16 at 12:38
I had some just before I went paleo, and they passed thankfully. – Jamie Aug 16 at 12:39
Id did sadly need ABs for awhile to clear the infection. – Jamie Aug 16 at 12:39
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Great! I would add that if you are really concerned with solving this mystery naturally, and feel this really is a dietary issue, then I would get to know FODMAPS intimately and consult someone with expertise in IBS. Chris Kresser has a nice article, as well as a product called "Personal Paleo Code" that claims to help heal the gut and find FODMAPS that don't sit well with you (I'm not affiliated and have not used the product). chriskresser.com/… – Zachary Taylor MA Aug 16 at 12:51
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I'm kind of in your boat. I've lately been trying a new more potent Probiotic "Biokult" and a bit more fermented foods. It's been a bit promising we'll see how it goes.

Have you try to have LESS fiber? It might be feeding the "bad" bacteria in your gut. I've been trying to do a lower carb paleo while my gut flora recoup.

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I'm confused about fiber. My GI doc wants me (and I do) take a fiber supplement. My regular doc suggested it as well. I eat fruit, veggies..but maybe I'm eating the wrong combination of soluble vs insoluble – tonytk Aug 16 at 3:09
Insoluble is difficult for bacteria to eat. Soluble is the one everyone harps on about, that may be worth avoiding if youve got digestive issues because bacteria eat it freely. – Jamie Aug 16 at 3:11
^ Or rather avoiding foods high in soluble fiber. – Jamie Aug 16 at 3:12
Oh, and cream has lactose which bacteria LOVE. You may want to ditch the cream and use coconut cream instead (or almond milk). Cheese is low lactose, if its hard aged cheese, like ideally 12+ month aged cheddar, and probably parmesan fits into this catergory too. – Jamie Aug 16 at 3:13
I've ditched dairy for the past week...no half/half, no milk, no cheese. No difference. – tonytk Aug 16 at 3:17
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I have had a lot of digestive distress as well, becoming considerable worse about 5 months into paleo. I used to be able to eat a wide variety of foods, but now I've been having problems digesting starches and dairy.

I don't know if this has anything to do with eating "cleaner", but it seems ridiculous to me that I have more problems now than before I began this dietary misadventure. I don't plan on giving up or going back, since I am almost 100% certain that I have a major gluten intolerance.

What has helped me tremendously has been realising that vegetable fiber is quite hard on me. When I first started paleo I was gorging down tons of lightly cooked veggies all the while wondering why I was so constipated. I think paleo puts a lot of stress on the digestive system, because it involves quite a drastic change in the type of fiber consumed.

It's easy to become caught up in everything paleo-related - militant attitude towards following the paleolithic principles of whatever dietary guru one chooses to worship, Intermittent Fasting, general food-obsession/strict avoidance of neolithic agents of disease (and guilt-trips when one slips), etc. But over time, I have come to realise that stress plays a huge impact in overall health, and that it is much much better to relax a little and to take time off the internet to enjoy yourself.

If you already do this, good. Otherwise I'll advise you to cut down on the vegetables, consume more easily digestible fruit and enough protein and fat without overdoing it. Having a balance is important - too much protein or fat can cause problems, even though I know it's the generally accepted dietary stance around these parts. When and if you choose to have more vegetables, cook them thoroughly. Think stews and soups, NOT stir-fries. Treat your stomach gently. And listen to yourself and your body - it really does know what is best for you. Don't force down certain foods just because your diet tells you to.

FODMAPs, SIBO, IBS etc. all those are just symptoms of an underlying imbalance. And you don't have to suffer from all of them or become obsessive about finding a specific diagnosis to pinpoint your symptoms on. Sometimes all that does is create more stress.

Best of luck!

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Not really an answer...just a few more observations.

  1. I'm only having these issues Monday through Friday for some reason. At my apartment.

  2. I'm only having the constipation/diarrhea issues in the evening (7pm - 11pm). The problems don't generally last 4 hours, just a time frame when these things occur.

  3. Friday night/Saturday/Sunday I drank more alcohol and ate bad food (chips...oops). But my crazy digestive problems were not present. I did have the hangover (I don't really have severe hangovers) poop..hard to explain but a lot of movement but not diarrhea. And not constipation either. Saturday night I only had a few drinks (unlike Friday) and Sunday's I was generally fine. No severe pain and no constipation/diarrhea.

  4. Cooked pork chops in coconut oil tonight (Monday) and I had a diarrhea after. Constipation before dinner.

  5. Dill pickles (Bubbies Brand) seem to make my stomach make a lot of noise after eating.

  6. Hardly any dairy the past week. No fruit.

Not sure if I can make any conclusions to any of this.

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Colon cancer, dude. If your body is not meant to be eating gluten, knock it off, and figure out another way to poop. People who are gluten intolerant don't realize that cheating may very well take years off their lives. It sounds like you have a cranky, autoimmune-ish sort of gut like me and many others. Eat clean, eat your probiotics, sleep well, drink water, and if you have to, do a REAL elimination diet. None of this "it's been a week" stuff. A week is nothin', especially if you've got multiple variables going on. Do it the right way so that you can do it once. Do you have a good, modern, paleo friendly nutritionist in your area? Identify what your likely allergens/irritants are, cut them 110%, and then methodically reintroduce them.

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Your conclusion is colon cancer? Thanks for the pep talk! – tonytk Aug 21 at 5:18
Not at all. My bad. I didn't mean it to be taken that way. I'm just trying to drive home that messing around with gluten intolerance is a Serious Business. Probably the best thing my nutritionist ever did for me was to stick a European twin study on gluten consumption under my nose. The mortality differences between the gluten eating and the non gluten eating twin weren't funny. You know this is making you sick. In the grand scheme of things, cutting this one thing out of your diet is easy. I'm just here to say please listen to your body, and to not let the perfect be the enemy of the good. – syrahna Aug 22 at 3:46
(fyi those were twins with a diagnosed gluten issue - not random population) – syrahna Aug 22 at 3:47
Cutting this one thing out of my diet is simply not easy. I just do not know what is EXACTLY causing me these symptoms. Maybe its just a weird die-off? Maybe its not diet related. Maybe its something more serious. Who knows? Cutting grains is relatively easy..cutting the one (or 2 dozen) things that cause my body to have IBS like symptoms is not when it is a mystery. I'm starting to get the feeling that this is my new normal. – tonytk Sep 5 at 2:35
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How much water are you drinking? I had easier poo when I add enough water, usually 70 oz a day.

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Your explanation is just about identical to mine, with one major difference; I have been strict PALEO for 38 days, and I started it after a 15 day master cleanse. The master cleanse was 15 days of only water, lemon juice, cayenne pepper, and coconut nectar, no food or beverage at all.

Since starting, I have been eating only grass fed beef, sugar free, nitrate free bacon (not allot), fruit, veggies, lost of carrots, Steves Paleo Kits are a staple, as are the Paleo Crunch Bars. I eat sunflower seeds, raw, and unsalted, and spaghetti squash, as well as lots of water and some almonds.

My gut has been rumbling since almost day one, so I tried a pro-biotic, that just made the diarrhea more predictable. The pro-biotic was seaweed based, and organic, so not fillers, or non paleo ingredients.

I have not cheated one time, so zero wheat, zero dairy, zero cornstarch, or syrup, or any additives, only pure clean food, yet I feel like crap almost all the time.

I do feel it’s a balance thing, but cant figure out what it is. I have tried knocking out the almonds, the pro-biotic, and went days without tree nuts, yet its the same. For only 2 of the last 38 days, I had constipation, otherwise, I just plain feel like crap. It cant be this uncomfortable to be Paleo.

I read everywhere, every post, answer, theory and the like, yet no one really comes out and says, when you go on Paleo, you ........, so be aware. Maybe that statement does not exist, but I need some help bad.

Thank you.

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The first line of my post should read, "Your explanation is just about identical to mine" – Scott Sep 15 at 21:03
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I was doing fine on Paleo, I don't poop often but that's always been my body even on SAD then I are fresh cheese with butter and bam I got the runs gurgling and then away it goes (mostly water) first 45 min after consumption and again the next morning. I'd say it is the cheese. Cut it out. BTW: why drink booze? Cut that out as well and be healthier. Fruits are not needed, chocolate and honey should perhaps be regulated to cheat days alone? If you can't totally cut them out (I know woman and their strange chocolate addictions) thank goodness im a man and don't suffer from such weaknesses :)

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Sometimes paleo can irritate underlying gut problems. Check out this website, and especially look in the left hand column, near bottom, for FODMAPS, IBS, SIBO, etc. Especially if you are doing everything 100% paleo perfect, and the problems get worse.

http://www.eat-real-food-paleodietitian.com/paleo-diet-and-ibs.html

I had to tweak my diet, and the SIBO protocol worked best for me. No fruit for 30 days let my gut flora get back on track. No onions either - that's a big trigger food for me. I still tend to have a lot of diarrhea when I am strict paleo, but I attribute some of that to the actual fat loss, and the excess waste my body is excreting after metabolizing all that fat! I can't find anyone, anywhere, that says this, but it only makes sense. All that fat doesn't get "burned up." There has to be some waste from cell metabolism.

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