By Brooke Lee Keefer
Quite often I am asked whether there is a special diet for Sphincter of Oddi Dysfunction (SOD). My answer is always the same, “no.” There is no perfect SOD diet because each SOD patient is different. Some foods triggering one person’s symptoms may be a safe food for someone else. There also exists a uniqueness between people with biliary and pancreatic issues and their tolerance of certain foods. Keep in mind, there are three sphincters that can dysfunction, the biliary and pancreatic sphincters and main sphincter of oddi. Some people have an issue with one sphincter while others have a problem with all three. That is why some experience biliary symptoms while others lean to pancreatic symptoms and yet others experience both biliary and pancreatic symptoms.
All that being said, this does not mean there aren’t dietary guidelines or practices that could benefit a person with SOD. It is well documented food plays a role in pain attacks and the severity and frequency of other symptoms. There are also varying degrees of SOD. Some patients can eat anything and experience only occasional pain. Others have trouble with everything they ingest, leaving them with severe unrelenting pain, nausea, vomiting, unintended weight loss, diarrhea, and/or constipation.
Food Diary and Elimination Diet
The first step to finding the nutritional plan best suited for you is with a food and symptom diary. Food diaries are easy tools to identify trigger and safe foods. There is no hard rule of what this diary should look like but a good food and symptom diary is broken down by daily time intervals like morning, mid-morning, noon, afternoon, evening, and late evening. You may keep notes in a notebook, on your computer, or in your phone. In fact, there are a variety of free or affordable food diary apps you can download. Whatever form of a food diary you decide upon doesn’t matter as long as you are diligent in recording everything you put in your mouth, i.e. food, beverages, supplements, and medications; and the symptoms you feel throughout the day. This will help you identify what is safe and not safe to consume. Activities like exercise should also be included.
The food diary doesn’t just isolate foods as they affect you. Absolutely anything you ingest is fair game to affect your SOD. Seemingly innocent vitamins, minerals, herbal supplements, and medications can be triggers. I have allergies and found if I ingested certain herbal teas like chamomile I’d get stomach cramps and headaches. This made sense for if I was allergic to breathing in a plant, then of course my body would react to ingesting it. Beverages could also be an issue. I would develop severe SOD pain after drinking carbonated drinks like soda or seltzer. I tried changing soda brands and flavors, thinking it was the artificial flavorings, colorings, or sweeteners of a particular brand. I soon discovered soda, even sparkling water and my beloved kombucha tea, caused pain and concluded it was the carbonation not the ingredients which caused the problem. My theory was the air from the carbonation got “stuck” in the ducts as the sphincters spasmed open and shut, causing pressure and pain.
Deducing the origin of SOD triggers takes investigative work and patience. Some food reactions may be instant while others are delayed. You may experience a symptom from a food several hours after ingesting and confuse the reaction with a food you ate later on. For this reason, I recommend starting your food diary with a strict food elimination plan then slowly reintroduce the foods and treats you like. Foods with multiple ingredients should be kept to a minimum. For example, I know many SOD patients who react to mashed potatoes. The problem with mashed potatoes is there are several ingredients which could cause the problem, i.e. potatoes, milk, butter, seasonings, etc. If you had a plain potato and it didn’t bother you but mashed potatoes did, then undoubtedly you are sensitive to the dairy or the fat content of the added ingredients. Even an otherwise innocent seasoning could be to blame.
Most elimination diets are meant to identify allergies or food sensitivities. SOD triggers are not allergies per se, but SOD may lead to food sensitivities or intolerances especially if bile and pancreatic enzyme output is impeded. A good overview of a simple elimination plan can be found here: http://www.uccs.edu/Documents/healthcircle/pnc/health-topics/Allergy%20Elimination%20Diet.pdf. At the very least, eliminate the most commonly reported SOD triggers. Some of these are:
• Coffee and anything with caffeine
• Red meat and pork, even lean cuts
• Fried foods
• Spicy foods
• Fatty and oily foods
• Some fruits especially acidic fruits
• Difficult to digest raw vegetables
Juicing and Blending
Many SOD patients report feeling better when they juice or eat a blended diet. You may want to stick to juicing and blending during your elimination stage. Juicing and blending are different but similar. Both make it easier for your body to absorb nutrients as they are in the form of micronutrients. A juiced vegetable may take less than 30 minutes to digest while its raw whole counterpart could take 6 hours or more. Juicing vegetables and fruits with a juicer (not to be confused with an extractor) squeezes juice from the food. None of the fibers or proteins are included in the juice extract and nutrients are more easily and quickly absorbed. Blending or extracting (think Ninja or Vitamix appliance) emulsifies the vegetable or fruit, leaving the juice and fibers intact. For some people this can be an issue as it is very high in fiber. A high fiber diet is contraindicated for people with certain intestinal conditions and those with post-gallbladder diarrhea. If you are someone who does better with extra fiber, then this may be the way to go but for those sensitive to high fiber diets you may want to stick with juicing.
I recommend homemade blended smoothies before drinking preservative- and artificial ingredient-laden drinks like Ensure or Muscle Milk. You can make smoothies with any kind of pure protein powder. Whey is a popular protein powder. I buy undenatured organic whey as it is more pure and less processed. Rice, pea, or hemp protein powder are good choices as well but may be grittier. The only protein I don’t recommend is soy protein. It is one of my trigger foods and can be inflammatory. Also, the majority of soy is a “genetically modified organism” aka GMO food product, which I’ll talk about in the next paragraph. Once you have selected a protein powder, put a few scoops in a blender and add vegetables and fruits and/or their juice, yogurt or kefir if you want, and a healthy fat like flax or olive oil (warning: even healthy oils/fats can cause an SOD flare). It isn’t fun to live on a liquid diet but can be useful during severe flare ups as a meal replacement. There is also a good medical food replacement supplement called GI Sustain by Metagenics. I don’t have a stake in the company or product. I just know some people with unintended weight loss and malabsorption issues who benefited from it. It is one of the cleanest most gut friendly supplemental medical foods I’ve seen.
Good Diet Habits
Eat organic and non-processed foods. Ideally, shop in the outer aisles of the grocery store. I particularly steer clear of GMO foods, which are engineered to withstand large applications of Roundup, a toxic fertilizer. GMO foods aren’t the same foods our ancestors ate, which could mean they are harder to digest. I also advocate consuming only antibiotic free meat. The antibiotics injected into these animals are often powerful and can be neurotoxic. Quite often the meat industry uses fluoroquinolone antibiotics which were invented to kill Anthrax! These antibiotics end up in our bodies, disrupting our precious microbiome. Your liver will love you for keeping your diet clean as it has to work overtime to detoxify foods containing pesticides, preservatives, artificial flavorings and coloring, and other toxins.
The liver experiences a great deal of strain already when the sphincter continuously spasms shut, causing bile to backup. When we flood our bodies with toxic substances, our liver, pancreas and intestines have to work extra hard to remove them from the body. Ideally, bile acts as a detergent to break down fats and carry toxins out of the body. However, not all bile is excreted and instead is reabsorbed by the intestine and sent back to the liver. These toxins can end up back in the liver where it joins more toxins accumulated from the present. The more work the liver has to do the more stress to the biliary system and possibly the sphincters. Stay away from high fructose corn syrup too as it is the leading contributor to fatty liver disease. Many SOD patients report having a fatty liver show up on their scans.
Some report benefiting from specific diets, the most common being anything low fat. I have several low fat cookbooks on my Kindle so meals don’t get boring and I don’t feel deprived. I don’t think anyone with SOD can go wrong with a low fat diet. Some find it helpful to count fat grams and keep it under a certain amount as determined by their food diary. One popular diet my gastroenterologists and dieticians recommended was the FODMAP diet. It is usually reserved for irritable bowel syndrome but some with SOD and chronic pancreatitis say it helped them. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These foods contain difficult-to-digest sugars and fibers that can cause bowel problems like excess gas, painful bloating, and constipation or diarrhea. Here is a good overview of it: http://ibs.about.com/od/FODMAPsInformation/ss/Foods-on-the-FODMAP-Diet.htm. FODMAPs is restrictive but for my pancreatic symptoms it is very helpful. I believe when I eat FODMAPs, the resulting excess gas gets trapped in the biliary or pancreatic duct due to the faulty sphincters, causing pain. When I do eat a FODMAP item I am sure to take an activated charcoal capsule after the meal to “mop up” the gas.
Another diet strategy many people with SOD employ is to go gluten free. Gluten is a protein present in many grains, particularly wheat, that is linked to a serious intestinal disease called celiac disease. It is also linked to leaky gut, which is another way of saying the small intestine’s lining is damaged. Gluten free is a big craze now but I am yet to meet anyone whose SOD symptoms were completely relieved by going gluten free. Some do report feeling better having gone gluten free but it is likely these people have celiac disease or a gluten sensitivity. Going gluten free is not a panacea for curing your SOD. In fact, there are a lot of gluten free items with nasty ingredients that could trigger SOD symptoms. When my SOD was at its worst I went gluten free for a whole year. I was strict about it and felt no better or worse. I personally do not believe gluten is entirely evil, but I do make an effort to limit the amount of gluten I eat in a week. If I do eat something with gluten in it, I focus more on staying away from GMO wheat/grains. There is certainly no harm in trying a gluten free lifestyle. Just stick with whole foods and not gluten free items loaded with ingredients you can’t pronounce.
With SOD we want to make digestion as easy a process as possible. Food combining can accomplish this. Eating some food groups together can be a disaster for your digestive system. Food combining enthusiasts recommended never eating a heavy protein with a heavy carbohydrate or starch. In other words, eating meat and a potato is a no no. Same goes for meat with pasta or bread. Instead, eat meats, beans, or tofu with a non-starchy vegetable. The same goes for eating a heavy carbohydrate. Pair it with a non-starchy vegetable. Avoid large amounts of fat with protein, like the extra mayonnaise in a chicken salad or olive oil drizzled on a chicken breast, because it slows digestion. This is one of the reasons pizza is an SOD nightmare food. You’ve got all of the big offenders: heavy fatty protein (cheese) and heavy carbohydrate high FODMAP (wheat pizza dough). The tomato sauce is likely ok, unless it has a high amount of onions and garlic which are high in FODMAPs. I love pizza but it never failed. If I took even a few bites I’d have a pain attack. As for fruit, eat fruit alone, on an empty stomach. Here is a great article on food combining: http://articles.mercola.com/sites/articles/archive/2013/10/27/food-combining.aspx.
In closing, I think it is fitting I mention that one of my worst triggers was going too long without eating. Yes, NOT eating triggered SOD pain. I thought I was alone with this issue until others agreed this happened to them too. It was like the stress of being hungry caused pain. The other extreme, overeating, was a trigger too. Overeating puts stress on all of the organs and the sphincters. It’s best to eat small frequent meals. Chewing thoroughly and slowly will benefit your entire digestive tract and organs so they don’t have to work as hard. Your digestive system starts in your mouth where enzymes are released to start the digestion process. Finally, I recommend taking a good probiotic supplement or eat plenty of fermented or cultured foods like yogurt, kefir, kombucha tea, sauerkraut, or other foods containing good bacteria. Our gut bacteria are like little mini engines controlling hormones, enzymes, metabolism, and who knows, maybe even our sphincters. I have tried numerous probiotics and find VSL 3 to be the best for me. It is the most studied probiotic and can be ordered online or prescribed by a doctor. The downside is it is expensive, which is the case for anything worthy of our health.
Note: I could not begin to cover all the co-occurring issues people with SOD could have, i.e. acid/bile reflux, bile diarrhea, gastroparesis, chronic pancreatitis, small intestinal bacterial overgrowth, etc. This article was written solely to address SOD symptoms.