Diet plays an important role in human health, so functional medicine healthcare providers often consider diet as a primary approach when supporting patients with various health concerns, especially those related to the gut. There are ten times as many microorganisms within the human gastrointestinal tract as human cells within the body. Diet significantly influences the composition and activity of this microbial population. Many diets have been developed over the years to help manage digestive discomfort and support gut health. This article will discuss the Cedars-Sinai diet and how it may help support digestive well-being.
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What Is the Cedars-Sinai Diet?
The Cedars-Sinai diet, also known as the low fermentation diet, was originally developed by Dr. Mark Pimentel of Cedars-Sinai Hospital in Los Angeles, California. It is a structured eating plan designed to limit fermentable carbohydrates that feed intestinal bacteria and to modify the timing of mealtimes to help manage symptoms associated with small intestinal bacterial overgrowth (SIBO). Through selective eating, the Cedars-Sinai diet aims to reduce the food supply for bacteria in the gut.
Who Could Benefit from the Cedars-Sinai Diet?
The Cedars-Sinai diet was designed for individuals with SIBO. SIBO is characterized by an overgrowth of bacteria within the small intestine. When SIBO occurs, the resident bacteria in the small intestine are exposed to easily digestible "bacteria food" (fermentable carbohydrates and fiber). As the bacteria digest these foods, in a process called fermentation, excess gases are produced, which may contribute to symptoms associated with SIBO. Common symptoms associated with SIBO include abdominal discomfort, bloating, gas, and changes in bowel habits.
Individuals diagnosed with irritable bowel syndrome (IBS) may also find a low fermentation diet helpful. It is now understood that up to 80% of individuals with IBS may have an underlying SIBO contributing to their symptoms. This is likely why dietary modifications aimed at reducing fermentable carbohydrates may result in symptom improvement for many IBS patients. The low-FODMAP diet, similar to the Cedars-Sinai diet, is commonly recommended for individuals with IBS and SIBO and may result in symptom improvement for many people.
What Foods Are Allowed on the Cedars-Sinai Diet?
The Cedars-Sinai diet emphasizes the inclusion of foods that are low in fermentable carbohydrates. Low-fermentable carbohydrates are sugars that are more easily digested in the human gastrointestinal tract. Consuming foods with little or no fermentable carbohydrates may help reduce the predominant food source for small intestinal bacteria and limit the amount of gas produced in the digestive tract after eating.
The following are foods individuals may be encouraged to eat while following the Cedars-Sinai diet:
- Refined carbohydrates: white bread (e.g., sourdough, French bread, potato bread), white rice
- Protein: beef, chicken, eggs, fish, pork
- Noncruciferous vegetables: peppers, tomatoes, carrots, cucumber, zucchini, squash, eggplant, peas, mushrooms, potatoes, sweet potatoes
- Fruits, but limit apples, pears, and bananas
- Lactose-free dairy: if eating cheese, choose a hard, aged cheese that has a much lower lactose content
- Nuts and seeds
- Oils
- Sugars: sucrose (table sugar), glucose
Another important aspect of the Cedars-Sinai diet is the emphasis on the timing of meals. Avoiding snacking and designating distinct meal times may help promote small intestinal motility and cleansing of the small intestine. Individuals may be advised to space meals during the day by 4-5 hours and to eat their last meal at least two hours before bedtime.
What Foods Are Discouraged on the Cedars-Sinai Diet?
Fermentable carbohydrates are limited from the diet because these are more poorly absorbed, pull water into the intestine, and are quickly fermented by bacteria, which may lead to digestive symptoms such as gas, bloating, burping, abdominal discomfort, and changes in bowel habits. Short-chain, fermentable carbohydrates are often referred to as FODMAPs, standing for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.
These are the following foods that may be avoided on a Cedars-Sinai diet:
- Beans and legumes
- Cruciferous Vegetables: cabbage, brussels sprouts, broccoli, cauliflower, kale
- Lactose-Containing Dairy: milk, yogurt, and cheeses
- Whole wheat and multigrain breads
- Sugars and Sweeteners: sucralose (Splenda™), sorbitol, xylitol
- Gums: Arabic, xanthan, carrageenan
Functional Medicine Labs That Can Help Individualize the Cedars-Sinai Diet for Patients
Functional medicine providers may order functional medicine tests to better understand the root cause of a patient's digestive symptoms. The goal of functional doctors and nutritionists is to help their patients regain dietary freedom by identifying and addressing factors that may contribute to digestive discomfort. Popular labs that may aid this process are discussed below.
SIBO Breath Test
SIBO may be suspected in a patient whose digestive symptoms improve by removing fermentable carbohydrates from the diet. SIBO can be confirmed and subtyped by using a diagnostic breath test. Addressing SIBO by managing bacteria in the small intestine may help patients achieve improved clinical outcomes and food tolerance.
Comprehensive Stool Test
Large intestinal dysbiosis, intestinal infections, digestive enzyme insufficiencies, and intestinal inflammation are also common contributing factors to digestive symptoms and can be assessed and monitored with a comprehensive stool test. Reintroducing foods into the diet may be more successful after addressing these factors.
Food Sensitivity Testing
Foods other than fermentable carbohydrates may contribute to a patient's digestive symptoms. A food sensitivity panel can help identify immune-mediated responses to food proteins. These results can assist doctors and patients in customizing dietary plans for enhanced patient outcomes.
Nutritional Assessment
Given the structured nature of the Cedars-Sinai diet, nutritional deficiencies may occur when a patient begins the elimination diet. A nutritional assessment screens for nutrient imbalances and can be ordered before, during, or after the patient follows the Cedars-Sinai diet. When addressing deficiencies with Cedars-Sinai-compliant foods is not possible, a doctor may suggest a dietary supplement to help fill nutritional gaps.
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Summary
The Cedars-Sinai diet is a structured dietary meal plan developed by SIBO specialist Dr. Mark Pimentel to help manage SIBO-related symptoms. By modifying meal timing and the types of carbohydrates in the diet, this low-fermentation diet may be used to support digestive health. Various functional medicine tests can be utilized during a holistic patient evaluation to gather information that helps doctors personalize gut-supportive plans.
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