Inflammatory Bowel Disease (IBD) is a chronic, debilitating inflammation of the gastrointestinal tract. It is characterized by abdominal pain, diarrhea, bleeding, cramps, and weight loss. The two major forms are Crohn's Disease and ulcerative colitis. It is estimated that 1.4 million Americans have IBD. It is understood to be incurable; and treatment involves managing symptoms through dangerous drugs, such as sulfasalazine; really dangerous drugs, such as prednisone (a corticosteroid); and, when those fail, surgery – cutting out some or much of the GI tract. Sufferers, well, really suffer.
Irritable Bowel Syndrome (IBS) is a much milder gastrointestinal complaint, characterized by abdominal pain, discomfort, bloating, and diarrhea and/or constipation. IBS is thought to affect 25-55 million people in the U.S.
I personally believe – and can give my reasons why – that much or most of this suffering is unnecessary; and that in many cases these conditions can be reversed through diet. Here's how. [N.B. Consult your doctor about any serious health conditions. Even if your doctor turns out to be, as mine did, clueless.]
- Read this book. Make the dietary changes recommended (i.e. cutting out the sugary, starchy, carb-y crap). Get better.
- Here's a longer explanation online.
- Here's the complete list of allowed and disallowed foods.
Theory: IBD (and a lot of IBS) is caused by a "floral imbalance" in the gut, resulting from poor diet. Specifically, it is caused by eating a ton of sugary, starchy, carb-y foods – which, being dense energy sources, massively overfeed the batcteria in your GI tract. The bacteria then overmultiply, irritating the lining of your gut, which inflames (an auto-immune reaction) to protect itself. The inflammation and the bacteria promote each other, and the condition gets worse and worse.
Solution: Go on something called the "specific carbohydrate diet." This cuts out all the sugary, starchy crap. (Stuff that, not incidentally, wasn't in the human diet until very recently.) It also cuts out all grains, and several other food types that intestinal bacteria love. Instead, you eat fruits, vegetables, meat, nuts – all kinds of fats, protein, and complex (not simple) carbohydrates that feed you, and starve the bacteria.
If this also sounds like a diet for coeliac or gluten-intolerant people, it should. If this also sounds like the paleo diet – eating as humans did in the 99% of our evolution before agriculture – it also should.
Action:
- Buy the book and check the links above.
- Get on the diet – fascistly strictly – until your symptoms are gone. This might take 6-12 months, if you were very sick. Hang in.
- Stay on diet – still fascistly strictly – several months after your symptoms are gone. After a flare-up, you're much more vulnerable to relapse, and can't screw around.
- Slowly work back in some of the forbidden foods. Take it very easy with them. Stay on a version of the diet that works for you.
Full Version, with My Story™
In late 1998, I discovered I was passing blood. I went to my GP. He immediately sent me to get "scoped out" – i.e. have a "flexible sigmoidoscopy", which is sort of little brother to the colonoscopy. (*) This is because the immediate concern is: colon cancer. I didn't, it was determined, have colon cancer. Phew.
I was referred to a gastroenterologist. (My own private gastroenterologist. Albeit not my cousin. I'd actually read that book, funnily enough.) A Stanford gastroenterologist. (This was back when I worked at Stanford Medical Center, and basically enjoyed the friends and family treatment, healthcare-wise.) This is important to note: my specialist was a professor of gastroenterology at one of the very top medical centers in the world. I was in perfect hands. Right?
Well, under her care, and with my condition worsening rapidly, she diagnosed me with ulcerative colitis. I'd never heard of it. Here's how the conversation went from there.
Her: <totally deadpan> Nothing. Nothing caused it. It just happens to some people.
Me: <pause for heavy beat> Ooo-kay. Now – I've never been to medical school. My training is in philosophy. But pretty much the very first thing they teach you in metaphysics is: There are no uncaused effects. Things don't "just happen" – like a virgin birth outside of the world causal chain.
Her: <silence>
Me: Like, okay, just for instance: for the past few months, every morning I have a huge flagon of dark, hot coffee – seriously topped off with a big pour of General Foods International sweetened creamer. Not, to my mind, incidentally, this shortly, and invariably, results in sort of a complete hot wash of my insides. Couldn't that be related?
Her: No. Diet can have nothing to do with it.
Me: You're telling me that I have a massive inflammation of my GI tract – and nothing I'm putting in there could conceivably be related to it?
Her: Yes. That's right.
Okay, if you have brain function, you'll likely conclude what I did: That was absurd, on the face of it. But, she was (still, in my mind), the expert. And moreover, we weren't making any progress, so I decided to table that for the moment.
Her: We can't. You will have this condition for the rest of your life. All we can do is try to manage the symptoms.
You can probably see where this was deeply unsatisfactory, on both counts.
She prescribed drugs – sulfasalazine. I took them. I had terrible side effects. I also got worse. Much worse. I lost weight. I was weak and dizzy. I was bleeding all the time. I was out of the office full-time. I was, briefly, hospitalised.
I intentionally didn't pay attention when she weighed me on my visits. But I will tell you that, later, when I finally started to get better, she did exclaim, "Terrific! You're back up to 138!" I've generally been around 155-160 most of my life. So now I was back up to 138. Yowzers. [Oh – here ya go.]
She prescribed stronger drugs – ones everyone agrees are just no good whatsoever for you long-term, namely corticosteroids, specifically prednisone. She quietly explained that if we couldn't get control of the inflammation and bleeding with the drugs, we would have to resort to surgery – removing the afflicted part of the colon.
Her: <discreetly touching her hip> A bag.
As you will imagine, I didn't like the way this was going, not one bit. I decided to do some research on my own. I found, among other things, this Elaine Gottschall woman. She had, I believe, a daughter with terrible IBD. And it can be terrible – I mean, there are guys who haven't been able to be more than 10 seconds away from a toilet, for years. They're house-bound. I could relate all too easily.
Anyway, I found Gottschall, who with others had been working on a diet-related theory and cure for decades, and I found her book Breaking the Vicious Cycle, and this "specific carbohydrate diet," and the web site for that, scdiet.org, as well as one for the book, breakingtheviciouscycle.info.
And so I took all this stuff to my gastroenterologist. And she was just having none of it. She said, "Dietary changes have never been shown to have any therapeutic effect on ulcerative colitis." (I now know that's because they've never tried – that is, no one has ever tried to demonstrate an effect by actually conducting clinical trials to test, under controlled conditions, the god%*&%ed theory.) "If you want to go on this diet," she said, "I will allow it. It probably won't do any harm, though we really have to monitor your weight."
And so that right there was the party line – i.e. the stated, formal, unyielding position of gastroenterological medicine: Nothing causes this. We can't cure you. We can only treat you with dangerous drugs and deforming surgery. Diet is unrelated to your massive GI inflammation. And – implicitly, but most infamously – we're not going to bother to test your little pet theory about diet.
This is a theory that, anecdotally, is successful in ameliorating or totally eliminating symptoms in upwards of 75% of people who try the diet. (*) It's the theory that fixed me. I got better on it. (Full disclosure – I started the diet at the same time I started the prednisone, which almost certainly accounted for some of the initial, quick retreat of the inflammation.) And it's the theory, and practice, which have kept me totally well since then.
Basically, in the 12 years since, I have only (and very nearly always) had minor relapses (or "flare-ups") after episodes of long, intense binging on sugary, starchy crap. (Generally over Christmas, when I don't control my food environment. And will power ain't one of my strong suits.) In every case of relapse, I've fixed it again by rigorously adhering to the diet. And, after getting well, I've been able to stay well, while still eating occasional grains, sugars, and starches, but being very careful not to overdo it.
I was horrified when I realised they had never deigned even to test any of this. I've been really horrified to go back and discover that, 12 years later, they still can't be bothered to test it! (The best explanation I've seen for this baffling fact is from Dr. Seth Roberts whose quote opens the dispatch.)
I'm also probably personally going to Hell for not writing this dispatch any sooner than now. I have had conversations with a handful of sufferers over the years, and told them this exact story. None of them had heard of the theory. All of them embraced it when I explained it. I personally firmly believe that most likely they, and millions of others like them, have been suffering unnecessarily. And I hope they will all read this dispatch, and try the diet, and that it will work for them, and their situations will be improved as a result.
You don't want to meet the big brother. I don't, anyway. I had two sigmoidoscopies during that period – one without general anaesthetic, and one with. I'd seriously recommend "with," if this comes up for you. My then-girlfriend Elizabeth asked me about the experience of having a small robot launched up my bottom. "Not so small," was my reply. The experience of watching the approach on live video – of, essentially, going up my own bottom – was one of the most horrifying of my life, and haunts me to this day.
Check the Amazon reviews on the book – 228 people (out of 280) don't give 5-star reviews to a crank.
