Nutrition Counseling for IBS, IBD and SIBO

On the gut side, in my experience people arrive not short of information but full of contradictions. A food banned on one list is allowed on the next; one source suggests extending the elimination, another suggests cutting it short. What follows is not one more list: it is how I separate your own picture, and where this process sits next to your gastroenterology follow-up.

If Your Report Came Back Normal, Where Does the Process Start?

An endoscopy or colonoscopy report coming back clear does not mean your complaint is dismissed. In functional pictures the findings look normal while the symptoms are real, and at that point one concrete piece of data is left: your own record. So the process starts with your report, your medication and supplement list, any lab results your doctor has requested, and a few days of meal and symptom records. Which test is needed is your doctor's decision; I read the result that comes back from a nutrition standpoint.

If the weight of the complaint sits on the stomach side, meaning burning, early satiety and epigastric pain are in front, it is more productive to run the process from stomach-led nutrition. When gas, bloating and bowel habit are in front, the counseling on this page fits. If both are present, we decide the priority together during the intake assessment.

Flare or Calm Period? The Plan Follows That

In Crohn's and ulcerative colitis there is no single plan; the period sets it. In a calm period the work is regaining variety, closing the missing micronutrients from the table, and building a routine that holds long term. In a flare the priority changes: restriction increases, meal frequency shifts, and the aim becomes stopping weight and muscle loss. In a severe flare or during a hospital admission, nutrition is the ward team's work; I do not write an outpatient plan.

There is a similar split on the SIBO side: the breath test and the treatment decision are your doctor's, the table is mine. I have written what the test means and why it can recur in the SIBO guide; the work here is reopening the table after treatment and catching a relapse early.

Who Closes the Elimination Calendar?

The damage I see most often on the gut side is not starting an elimination but failing to close it. Restriction brings relief, so people do not want to let go of it; yet a strict phase that drags on depletes the gut flora and leaves the picture unreadable. How long the strict phase can run, and why it has an upper limit, is set out in the FODMAP guide.

What I sell on this page is not opening that calendar but closing it on time. In the reintroduction phase we decide together which group is tried in which order, how long to wait, and what happens when a reaction shows up; without a record this phase turns into guesswork and usually stops halfway. Where a group needs to stay out for good, we decide that too, but the decision rests on the symptom record rather than on fear.

What the Follow-Up Is Built On

Inside the process: a personalised programme with recipes that are easy to prepare, photo-based meal analysis, a voice call every 2 weeks, WhatsApp messaging support in between, and weight and body measurement tracking. One question runs through every call: what happened after which meal? When the symptom diary and the meal photos are set side by side, the trigger usually turns out to be something other than the one that was suspected.

The first fortnight usually goes on making the current routine visible rather than on restriction. On the gut side the most expensive mistake is guessing the trigger wrong and taking an unnecessary group off the table; without a record that guess is close to unavoidable. So I do not hand over a list in the first voice call; we read it together: which meal gets skipped, when eating is rushed, whether the complaint really follows a meal or clusters on stressful days. The first version of the programme is written after that reading.

The scope is the same in all three packages; only the duration and the fee change, and the call frequency does not. Calls are voice only; video consultations are not offered. The process runs entirely online. Payment is taken by bank transfer and fees are not refunded.

What I Do Not Prescribe

I do not recommend antibiotics, antimicrobial products or medication aimed at gut motility; those sit with your doctor and are not headings a dietitian decides on. I do not write products or doses on the supplement and probiotic side either: I take the scheme you use into the record, place it in the day so it does not collide with meals or medication hours, plan the food-side equivalents, and ask you to raise it with your doctor whenever I see a possible interaction.

I do not diagnose, I do not order tests, and I do not interpret a result medically. Any decision about the dose of a biologic, a corticosteroid or any other medicine belongs entirely to your doctor; I build the table alongside that treatment.

When to See a Doctor Without Waiting

With some signs a change of diet waits: blood or a black tarry appearance in the stool, unintentional and unexplained weight loss, abdominal pain that wakes you at night, diarrhoea together with fever, persistent vomiting, or newly started difficulty swallowing. Where iron deficiency anaemia comes with them, or where there is a family history of colon cancer, a physician assessment takes priority. If I see a picture like that during the intake assessment, I do not open the process; I point you to your doctor first.