Diet Challenges, Diets for IBD, Gut Feelings, Life With My Illness

How I Figured Out the Right Diet for My Sensitive Gut

An empty white plate holding a fork and knife, set on a wooden table with decorative nuts scattered around it.

I’m Offering a Diet-Discovery Method, Not a Specific Diet

Every time I meet someone else with inflammatory bowel disease, the conversation eventually turns to diet. We’re so curious what each other can and can’t eat! Although doctors routinely deny that diet affects Crohn’s disease and ulcerative colitis, most IBD patients find that diet dramatically affects our symptoms.

The tricky thing, though—and the thing I believe is keeping doctors and science from embracing this reality—is that different patients respond differently to different diets. While diet consistently matters, which diet works is inconsistent. My hunch is that this inconsistency relates to differences in our microbiomes, although the scientific jury is still out.

Whatever the reason, until science finds more consistent patterns, patients will have to keep muddling through by trial and error. That requires enormous perseverance, and a whole IBD-diet industry has blossomed, with dozens—hundreds?—of books and websites directing us to various diets and supplements. Most of these resources are well-meaning and can be very helpful, but some are predatory and harmful.

This post is my own resource. But it’s not a specific diet I’m suggesting you follow; rather, it’s the method by which I discovered what diet works for my body. I want to help you discover what works for your body.

Thanks to this method, I’ve now been in remission for nearly five years. That’s also largely due to Remicade, but I’m convinced that diet plays a crucial role in my remission too. Even on Remicade, whenever I’ve deviated from my diet, my symptoms have begun to reappear. Knowing what diet to follow is, I believe, helping Remicade work its magic and keep me healthy. (As I said in my last post, both diet and meds are usually needed to manage IBD.)

I also believe that, had I discovered my body’s dietary needs earlier, my disease may not have progressed to the point where I needed Remicade in the first place. It’s possible I could have stayed on milder meds if I’d just known what foods to consistently avoid—I might have kept myself out of severe flares.

My hope is that by sharing my method with you, I can help you arrive at your own ideal diet sooner than I did.


The Contents of This Post

My method is ultimately quite simple, but it takes some explaining. I’ve designed this post like a short course on the method. Here are the course contents, with links to the sections:


The basic idea: this is the Mother of All Elimination Diets

My diet-discovery method is essentially a very long elimination diet, coupled with a method for tracking progress that I’ve found especially helpful. The key to my success has been in the details.

Elimination diets are pretty straightforward, and you likely know the basics. First, you remove any foods you think might be doing you harm, going off them for a few weeks to let your body “detox.” Then you slowly add them back in one at a time, noticing whether any symptoms develop with each one.

My method differs from most others in its extraordinarily slow pace. When I first started, I thought it would take two or three months, which seemed like a long time back then. If I’d known how long the diet would really last, I wonder if I would have done it. The truth was, by the time I figured out my ideal diet, it had been more like two years.

But this elimination diet gave me the answers that had eluded me in all my previous diet attempts. If I’d known this long method would work so well, and that ultimately, I’d finally reach the freedom of remission, I think I would have started it even sooner.

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Why I developed my own charting method

Along with the slow pace, the other key to my success has been my method of documentation.

It’s useful to document diet and symptoms rather than just noting them in your mind, to avoid getting confused. It’s impossible to control your whole environment—not only foods, but other factors like stress, exercise, sleep, meds, and menstruation can also affect your gut. But the problem I initially ran into was exactly how to document my symptoms.

There are various popular methods of charting, including apps designed specifically for IBD. I tried both MySymptoms and GI Buddy, but I found them both lacking in a couple ways. While both allowed me to record stool frequency and appearance, foods I was eating, and symptoms like gut pain and stress level, I couldn’t make sense out of the charts they produced. What good was tracking my symptoms if the data I collected was hard to decipher?

Using apps, I also discovered I disliked being so chained to my phone, having to enter data every time I ate, used the bathroom, or experienced stress. I’m a Gen-X/Yer who grew up without the internet and smartphones. For me, something will always feel stressful and overstimulating about screens, plus it was anxiety-producing to be tracking everything so meticulously. And my colitis responds to stress.

So I developed a charting method that doesn’t require as much detail or screen time. It’s a chart I can fill in just once a day, either on a screen or on a handwritten printout (my preference). My chart, which I describe below, is simpler than the apps. And perhaps because of its simplicity, I’ve found it far easier to find patterns in the data.

The printed chart I’ve created fits about a month’s worth of data on it. It does benefit from being plugged into a spreadsheet at some point, so once a month, I would go to the computer and enter all the past month’s data into Microsoft Excel. The data entry took around a half hour. I would then spend another thirty to sixty minutes poring over it, so my screen time for this method was around ninety minutes per month. Not bad!

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My chart’s basic format

My chart’s concept is simple. Each day’s data is recorded on a single row, with columns representing either “inputs” or “outputs.” Inputs are things that might affect your IBD symptoms: diet, stress, exercise, etc. Outputs are your symptoms: stool frequency, diarrhea, pain, etc.

Here’s a simplified version of my chart. (If it looks funny in your browser, try experimenting with the size of your font; zooming out might make it better.)

Date#BMsAvg Pain (1-10)Gluten? (y/n)Dairy? (y/n)Stress (1-10)
1/1/2021
1/2/2021
1/3/2021

In this example, the second and third columns (#BMs and Average Pain) are outputs, while the final three columns (Gluten, Dairy, and Stress) are inputs.

Like I said, the chart above is a very simplified version of the one I’ve actually used. For now I’m just introducing concepts, but later I’ll get into more detail.

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Step 1: Creating a patient-specific chart

Once you’re familiar with my method, you can create your own version of the chart above. (If you’d like to skip to that step, click here.) But first, I’ll walk you through the method and all its steps.

Let’s look at an example UC patient, Jennifer, who suspects that either gluten or dairy, or both, are affecting her symptoms. She also wonders if stress is another trigger. For our simplified purposes, these are the only inputs Jennifer is tracking. Her chart will thus look like the example above.

Here is Jennifer’s data for the beginning of 2021:

Date#BMsAvg Pain (1-10)Gluten? (y/n)Dairy? (y/n)Stress (1-10)
1/1/202142ny3
1/2/202165ny3
1/3/202164nn5

As you can see, Jennifer had 4 bowel movements on the first of the year, with an average pain level of 2 that day. She didn’t eat gluten that day, but she did eat dairy, and she had average stress around 3 on a scale from 1 to 10, with 10 being worst. 

On the next day (1/2/2021), Jennifer’s BM total increased to 6. Poor Jennifer! She also had more pain that day, ate dairy again, and had the same level of stress.

And on the third day (1/3/2021), her BM frequency remained higher and her pain lessened slightly. She stopped eating dairy that day, probably realizing that it might be worsening her symptoms. Her stress also increased—possibly because by now she was more worried about her flare!

Along with familiarizing you with the chart, this simplified example shows how gathering data over time is essential. Circumstances change, and symptoms change with them.

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Step 2: Getting to a steady baseline

Once you’ve created your health chart and begun tracking your symptoms, you might start to notice useful things in your chart right away. You may immediately start adjusting your diet and lifestyle, as Jennifer did with dairy, and that’s great! Just keep tracking your symptoms.

But for many people, a deeper dive will be necessary. To fully take advantage of my method, I recommend doing more methodical experiments in which few variables are changing at once. To experiment, it helps to reach a steady baseline, in which your symptoms aren’t changing too much over the course of several days.

To establish a baseline, minimize your changes in inputs like diet, stress, sleep, and exercise. Some inputs are harder to control than others—we only have so much influence on factors like stress and sleep. But others, like diet and exercise, are more straightforward. Be as consistent as possible and document everything.

Note that baseline health does not have to mean excellent health. It might still mean you’re flaring—you can still be experiencing pain, diarrhea, and fatigue. The key is to achieve stability: consistent enough symptoms that you’ll notice when changes occur. Your baseline can still involve flare symptoms, though ideally not severe ones.

After tracking her health for a couple weeks, Jennifer’s baseline might look like the last few rows here:

Date#BMsAvg Pain (1-10)Gluten? (y/n)Dairy? (y/n)Stress (1-10)
1/4/202154nn3
1/5/202154nn3
1/6/202153nn2
1/7/202143nn3
1/8/202143nn4
1/9/202132nn4
1/10/202152nn6
1/11/202142nn4
1/12/202141nn3
1/13/202142nn3
1/14/202132nn3
1/15/202142nn4

You can see that her number of BMs per day is now holding steady around 4, give or take 1. Her pain is also holding steady, around 2. She’s not in remission, but she’s stable enough that an experiment might yield noticeable results.

Also note that Jennifer has been doing her best to control inputs as she prepares for her experiment. She’s stopped eating both gluten and dairy, her suspected trigger foods. Her stress generally hovers around 3, although it sometimes spikes upward.

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Step 3: Being a good scientist (conducting experiments)

Once you’ve established a baseline, you can try experimenting with inputs. Here it helps to think of yourself as a scientist. 

Like a scientist, try to change only one variable at a time. If both dairy and sugar are suspects, eating ice cream—which has both—will muddy the data. Instead, try just sugar, or just dairy. And if you’re experimenting with food, try to avoid changing other inputs, such as stress, meds, or exercise. If a med change is coming up, wait a week or two to do a diet experiment. If you’re already experimenting with adding dairy, don’t suddenly begin lifting weights or taking a new zumba class.

We can’t always control all the variables, of course. There’ll be times when multiple inputs will change at once. That’s why charting is so helpful—if the experiment was muddied by multiple changes, repeat it and see if you get the same results.

Menstruating women have an additional input that men, non-menstruating women, and girls don’t have to deal with. Monthly hormonal shifts can have huge impacts on our gut function, energy levels, abdominal pain, and mood. All of these symptoms can be confused for IBD symptoms, which makes experiments more confusing for this demographic than for others. For this reason, getting good data may take much longer for many women than for men, due to the need to repeat experiments at different times of the hormonal cycle.

Along with changing one variable at a time, aim for small increments when it comes to diet changes. Add foods little by little. Not only the foods’ presence but their quantity may matter, unless you have a true allergy or a severe intolerance.

With each change, wait a few days before making another. This is one reason my method takes so much longer than other elimination diets. Others often recommend adding a new food each day, but in my experience, one day is not always enough time to learn how your body reacts to a food. With gluten, for instance, I usually have symptoms two days after eating it.

And finally, because it’s so hard to control all the inputs, I always repeat experiments. This is the other main reason this method takes so long.

If I think I’ve noticed a pattern, I wait a couple weeks, get back to my baseline, then start over. I also try to make sure experiments happen at different phases in my monthly hormonal cycle, so that I can see whether that cycle has affected my results.

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Step 4: Finding patterns in your data with the Ruler Method

Once you’ve got a few weeks of data, you can begin looking for hidden patterns. Here’s where the beauty of my simple chart emerges.

I’ve found the best way to see patterns is low-tech. First, I look at my symptom columns to find days when symptoms significantly changed. If my symptoms have held steady, then it’s not time to look for patterns yet—I’m still in my baseline. But if there are big changes, I take a ruler (or a sheet of paper, or a book) and place it over the day the symptoms changed, covering that day so its row is hidden. 

Now I can easily examine the inputs on the days just before my symptoms changed, the days when I most likely made the changes that led to my new symptoms. I look at the “input” columns for those days. Did I change anything I was doing or eating?

Let’s look at the example again. Jennifer decides to experiment with dairy, and her resulting data look like this:

Date#BMsAvg Pain (1-10)Gluten?Dairy?Stress (1-10)
1/13/202142nn3
1/14/202132nn3
1/15/202142nn4
1/16/202142ny3
1/17/202163nn4
1/18/202153nn4

On 1/17, she notices that her symptoms—the BM number and the pain level—both increased. It’s clear in this simple example that this probably happened because she ate dairy on 1/16, but just for the sake of learning the method, she places a ruler across the chart on 1/17, the day her symptoms changed:

With the ruler, it’s easy to see what changed on the day before the symptoms’ change: she added dairy!

This method is helpful because the data are never this simple. When you build your own chart, it will have far more columns, and with so much data, it can be hard to see patterns. My own chart really looks like this: 

With a chart so complex, I love being able to highlight an entire row so I can easily see patterns. On a printout, I do this with a ruler. On Microsoft Excel, I do it by clicking a row to highlight it. Either way, there’s a clear visual.

If you’re a whiz with spreadsheets, you can go a step further. Microsoft Excel’s conditional formatting allows you to program automatic color patterns into your spreadsheet. I’ve done this for mine: green means good, yellow means so-so, and red means bad. When my number of BMs, or their consistency, is good or bad, the program knows to color them green or red, and the colors help me to quickly see patterns.

But you don’t really need all that fancy formatting; the Ruler Method works just fine! When I’m feeling lazy and haven’t yet bothered to enter my data into Excel, that’s the method I use.

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Step 5: Why it’s still great if you see no patterns

Say you go to the trouble of an elimination diet and a health chart, only to find that you can’t see patterns in the data. If that happens, never fear. All your work has actually still given you some very useful information.

A basic tenet of science is that no pattern is not the same as no results. Finding no pattern is still a finding: your data are showing you what inputs do not consistently affect your gut.

For example, let’s return once more to Jennifer’s chart. Now she does an experiment with corn, and the data look like this:

Date#BMsAvg Pain (1-10)Gluten?Dairy?Corn?Stress (1-10)
2/1/202142nny2
2/2/202153nnn3
2/3/202143nnn3
2/4/202153nny3
2/5/202123nnn4
2/6/202142nnn6
2/7/202133nny4
2/8/202142nnn3
2/9/202141nnn3
2/10/202152nny3
2/11/202143nnn3
2/12/202142nnn4

She keeps adding corn every few days, and her symptoms are fluctuating—but they’re not consistently getting better or worse after eating the corn. Sometimes they go up, sometimes down, and sometimes neither. Her stress has been fluctuating, too, which is why it’s helpful to keep repeating the corn experiment. But in general, she’s staying around her baseline and nothing much is changing with the corn.

This is not no results. In fact, it’s great news! If it keeps happening as she adds more and more corn, what she has found is that corn does not have a significant impact on her IBD. That’s what happened with me and corn (although sadly, it’s not what happened with gluten, lactose, sugar, or soy!).

No pattern can also mean you’re not tracking the right things yet. Again, that’s still helpful, too. It can be your cue to adjust what you’re tracking on your chart. Knowing what doesn’t affect your gut, you can keep looking for what does.

I’ve met one person so far who says she’s never found any patterns with diet and IBD. She was once the head doctor in the emergency ward of a prestigious hospital, so she is quite sharp and scientifically minded. I believe her. It’s possible she never undertook a meticulous charting method like mine, but it’s also possible that in some cases, IBD really isn’t influenced much by diet. That means it must be managed by other means—and she’s found good meds that keep her in remission, so that she still lives an active, healthy lifestyle.

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Taking this show on the road: build your own health chart

Now that I’ve explained my method, if you’d like to try it yourself, you can start building your own health chart!

In case you’re handy with spreadsheets, here’s a downloadable template of my own chart in Microsoft Excel. This can also be uploaded and used in Google Sheets:

You might find it helpful to start with my chart, adding and editing the columns to suit your own needs. I think most people will prefer to start from scratch and create their own charts—but examining mine might still help you see what I’ve done.

If you’re not familiar with spreadsheet programs, it might be worth finding a friend or relative who can show you the basics. But you could also ditch screens entirely and hand-draw a chart, using the simple Ruler Method to find patterns!

Regardless, in building your chart, simply list what “inputs” and “outputs” you suspect are most important to track and arrange them in columns across the top of the page, with each row representing a date. In deciding what to record, the trick is to balance between capturing important data and preventing overwhelm. If you’re anything like me, you’ll want something you can easily fill out in just a few minutes each evening.

As a rule of thumb, I limit my data to what I can fit on one single, landscape-oriented printout page—at most, twenty to twenty-five columns’ worth of data. I’ve found that I can fill out that many columns in just a few minutes each day. 

In my printed chart, I shorten column headings as much as possible and/or angle them, so that each column can be as small as possible and I can fit more columns on the page. On a separate tab of the electronic spreadsheet, I keep a key to my columns, so I can remember what my abbreviations stand for. I’ve set up my chart so that most columns can be filled in with either a “y/n” or a number. Especially once I got used to the chart, I could fill it out quite quickly this way.

Because I don’t have space to record everything I eat each day on my chart, I also keep a small notebook nearby and take a few notes each day. If I have questions later, I can refer to this notebook for more detail on what I ate and other factors that might have impacted my IBD. 

My handwritten notes capture things like what I was stressed about, what kind of exercise I did, and quick descriptions of my meals. A typical note might look something like this:

Bfast = buckwheat porridge
Lunch = coconut dal w/ rice & kale
Dinner = same, with orange juice
Exercise: moderate 20-minute walk
Stress: stressful vet visit in afternoon

I also periodically change what I’m tracking. Once I learn a food I react to, I stop eating it and no longer track it, since I know I’m not eating it. (If I cheat, I make a note of it.) I delete its column from the printout, leaving space for other things to be tracked. 

I never delete data from my electronic spreadsheet, though. It’s too useful to return to.

Finally, I also leave a wider column or two for quick notes, if possible. If there isn’t enough space on the printout, then I put an asterisk next to each item for which I have notes, and I write notes for those items in my little notebook. For example, if I experience unusual abdominal pain but there’s no room for notes, I put an asterisk next to that day’s ab pain number and write something in my little notebook, such as:

* ab pain was on lower left, came after breakfast, and lasted ~2 hours. From eating peanuts??

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Conclusion: The surprising comfort of my chart

In my first several years of illness, nothing could throw me into despair more than unexplained symptoms. I would begin flaring, seemingly out of the blue, and would spiral into desperation. The mystery of the flare was the hardest part of all, because it left me with no sense of control.

At times like that, I discovered that nothing could calm me down like spending some time with my health chart. I would enter the latest data into Microsoft Excel and pore over the details, coming up with hypotheses I could test. Almost invariably, looking at the chart would make me see things I had missed before, and I’d come up with possible explanations for my mysterious symptoms. This was an enormous relief. It empowered me and gave me direction.

There was an answer to my questions, always. I just needed to find it. My health chart and its wealth of data were how I found it. Over time, the more data I collected, the more I learned about my body. Within a couple of years, I was free of unexpected flares.

Now that I know what to eat, my diet is strict and restricted, so I often need to bring my own food when I go out or weigh in on picking the restaurant. It can be a hassle, and it sometimes makes me feel frustrated. But at the same time, I recognize that my limited diet also liberates me.

I am free of pain and flares. I can spend time with the people I love, and do the things I love to do, in comfort and security. There were years when all that was stolen from me by my illness. In the end, these freedoms are well worth the trouble, and I am living again in joy.

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5 thoughts on “How I Figured Out the Right Diet for My Sensitive Gut

  1. This is so so helpful!!!!! Thank you so much for such an informative/educational/descriptive post! I’ve downloaded your spreadsheet and can’t wait to start tracking.

    I don’t have IBS but am tracking my food sensitivities to try and improve my inflammation and hormones to hopefully impact/cure/reverse(?) my infertility. Exercise, stress, and sleep also matter so I’ll track those too with this. I already made some major changes to my diet last year and noticed a huge increase in energy at the time, but am feeling lower energy and lethargic again, and have been wondering how to track that and figure out whether it’s diet, exercise (not enough), stress, sleep, or what. And then this post came up and is so perfect for what I need!!!!!! Thank you so much!

    (BTW I’ve been a fairly long-time reader but don’t believe I’ve commented before, but I really appreciate both your informative health posts as well as your nuanced discussions about racism and other current topics.)

  2. Hi katers (Kate?), that is so wonderful to hear! I’m thrilled that you got so much out of this post, and I really hope this method helps you find some answers. As someone who wanted to have kids but was thwarted by illness, I can relate to the struggle of infertility, and I know it’s an emotional roller coaster. All the best to you as you explore your options.

    If you wind up sticking with my “diet-discovery method” and have the time, I’d also love to hear feedback (from you or anyone else, positive or negative) about how it went for you! It works for me, but this is the first time I’ve attempted to teach it to others.

    Regardless, good luck and thanks so much for reading! 🙂

  3. Thank you Katie for this. It is difficult to know where to start to try to improve situation with IBD and its symptoms, feel like a headless chicken sometimes and panicky, can be scarey, so many different food variables and anecdotal writing about the condition, but this article is very helpful. I find your writing about the disease to be well-considered and I will try your tracking method. It is something to focus on and hopefully will provide some insight.
    I was wondering if you have ever worked with none-health-service people such as private nutritional therapists or functional medicine practitioners, etc, and what has been your experience if you have? I am in UK and interested in exploring non-nhs support (alongside nhs input) but it can be expensive and no guarantee of its efficacy. Any thoughts on this? Many thanks

  4. Hi Katie – after writing above comment I found your article about naturopaths which answered my question. I’ve only just come across your website – which I am finding very useful – so thank you. I would be interested to know your daily or weekly menu plan – to help with ideas about what to eat/try – I know it is different for each person but when avoiding/eliminating foods it’s sometimes difficult to think of alternatives. Best wishes Dee

  5. Hi Dee! I’m so glad you’re finding all this helpful. As with katers above, if you do wind up trying my method, I’d love to hear how it goes and what might need improving/clarifying. I really hope it gives you some insight!

    For my personal menu plan, I started off pretty simple when I began my elimination diet. I had already tried both the Specific Carbohydrate Diet (paleo) and macrobiotics (vegan, gluten-free) in the past—if you’re interested, you can find my blog posts on those. I knew, going into my long elimination diet, that my gut had done best with macrobiotics—so I knew I did well with a diet that cut out gluten, dairy, and sugar; and that I could tolerate non-gluten grains and legumes if they were pre-soaked and well-cooked; and that I did okay with well-cooked (over-cooked, steamed) kale.

    Based on all that, at the beginning of my diet-discovery process, my “baseline” diet was a rotation of a few simple legume-based recipes: kitchari and 3 dal recipes I had found in a Yoga Journal. These were all Ayurvedic, which is similar to macrobiotics. I still eat those dals frequently. They use a variety of legumes, all of which need to be presoaked; plus veggies like carrots and kale; sometimes onions and garlic (which are inflammatory for some people); Indian spices like turmeric, cumin, and coriander; ghee; and sometimes coconut. Some of these ingredients, like ghee, coconut, onions, and garlic, are especially worth experimenting with and possibly eliminating if not tolerated. And some folks can’t easily tolerate grains and legumes—although it can really pay off to do a long pre-soak, make sure they’re very well-cooked, and possibly even puree them if starting out.

    I also tend toward low iron, so along with legume-based recipes, once or twice a week I eat beef or organ meats. When flaring, fat and grease are harder to digest, so at those times, I often eat broiled, lean ground beef. (I don’t bother with buns; I just slather on the sugar-free mustard and eat it with a fork!)

    Another go-to recipe I’ve often used as a “safety meal” is rice (or rice noodles), a protein like red lentils or canned fish, steamed kale, tamari (for yummy flavor), and toasted sesame or some other well-tolerated oil for fat. All mixed together, I find this very tasty!

    I also had to experiment with breakfasts, but nowadays, my go-to breakfast is a cold “cereal” I make every day: toasted buckwheat groats (I buy them pre-toasted/brown), chia seeds, flax oil, almond butter, almond milk, apples, and blueberries. This is something I only began eating once I was in remission; when flaring, I was eating a warm, cooked, pureed version of it.

    Does that help? I hope so!! I know it can be overwhelming to find recipe ideas that feel safe. If you do tolerate legumes and grains, Virginia Harper has great recipe ideas in her book: https://www.amazon.com/Controlling-Crohns-Disease-Natural-Way/dp/1575668319. (She’s heavy on the soy, though, which I don’t tolerate well.)

    As for your question about alternative medicine, I’m glad you found my naturopathy post! I’m not as familiar with private nutritional therapists or functional medicine, nor with the NHS. But as you can see, I’m open to and cautious about alternative med—I generally think it’s worth trying if you do have the money and time, it’s most useful as an adjunct (while still seeing a conventional doctor), and I prefer practitioners who respect science even if their own methods aren’t science-based.

    All the best to you! 🙂
    Katie

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