# Pimentel's Dietary Recommendations



## Moises (May 20, 2000)

Pimentel has two extended discussions of diet in his book. In Chapter 6, which is called "Help at Last: The Cedars-Sinai Protocol for Treating IBS," he describes his diet for eradicating bacterial overgrowth. In the following chapter, Chapter 7, titled "The Best of Both Worlds: Enhancing Your Results With Alternative Therapies," he devotes another section to diet.The thrust of Chapter 7 is the reduction of the intake of "sugars and other simple carbohydrates." He suggests we test the theory that sugar is the primary food of bacteria by mixing sugar and water in a glass and leaving out overnight. The next morning, he predicts, the sugarwater mixture will have turned cloudy. I did this experiment with my 10-year-old son when I first read the book. It took about a week before we saw anything growing in the sugarwater.But what I would like to stress is not that the experiment failed but that Pimentel is suggesting that white sugar exacerbates SIBO. In the next paragraph he writes that, "People with IBS who regularly eat foods containing sugars and other simple carbohydrates (such as refined flour, another common staple ingredient in fast and process foods) are actually making their IBS symptoms worse" (page 94).The conclusion I draw from reading this is that I, as a person with IBS, will exacerbate my symptoms if I consume sucrose or white flour.Compare this to points 1 and 5 of his 10 dietary commandments in Chapter 6. Point 1: "glucose, sucrose (table sugar), and aspartame (Equal or Nutrasweet) are acceptable. . . Try to limit your sugar intake to no more than 40 grams per day . . ."Point 5: "Potatoes, pasta, rice, bread, and cereals are also acceptable. . . A good rule of thumb is to eat no more than a half cup to one cup of these carbohydrate foods at each meal. Believe it or not, white bread is best in this circumstance."My conclusion is that Pimentel is inconsistent in his dietary recommendations. In Chapter 6 he says that white bread is an acceptable food. White bread's primary ingredient is refined flour. In Chapter 7 he states that consuming refined flour will make one's symptoms worse. In Chapter 6 he says that white sugar is an acceptable food. In Chapter 7 he says that consuming white sugar will make one's symptoms worse.In Pimentel's defense one might argue that Chapter 7 is his presentation of alternative therapies that are adjuncts to his primary protocol as outlined in Chapter 6. To support this reading one need only look at his discussion of acupuncture in Chapter 7. Pimentel argues that there is evidence that acupuncture helps but it is not part of his protocol and he does not prescribe it to his patients. I don't find this argument convincing because dietary intervention _is_ part of his protocol. There is no reasonable explanation as to why his official protocol would recommend the intake of harmful foods and his alternative protocol would forbid that same food.


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## Kathleen M. (Nov 16, 1999)

Two commentsWith the sugar water experiment it really does matter how much sugar you put in.When there are small amounts of sugar bacteria may grow quickly, but if you put too much sugar in then bacteria have a hard time growing.It is a factor of osmosis.If you put enough sugar in the water then when a bacteria lands on it the water tends to get sucked out of the bacteria either killing it or making it not able to grow very well.This is the reason that pre-refrigerator food preservation techniques often use either a lot of salt or a lot of sugar. Put enough salt or sugar into anything and the bacteria either don't grow or grow very very slowly.Comment two.His dietary recommendations may not be completely contridictory.He puts limits on the total amount and that may be the amount a normal human absorbe quickly and completely. After all we are designed to get a certain amount of glucose (either from sugar or starch) into the blood stream quickly. It is why the blood sugar spikes shortly after eating such foods. (Glycemic Index) If you get it out of the GI tract fast enough then there isn't any left over for the bacteria to eat. By limiting the amounts to 1/2 cup of carbs (even if refined) or limiting sugar/day you make sure you are likely under the amount that you totally absorb. Carbs you completely absorb in amounts you completely absorb may be better than high doses of low glycemic index carbs where a heck of a lot of what you eat is not digested by you. Most of the carbs you can't digest and absorb bacteria eat quite well.A lot of people feel really really bad if they reduce carbs below a certain amount. Some people feel great on the Atkins all fat all protein early stages, but others really feel best when they eat at least a little bit of the fuel your body prefers to burn (glucose). The amounts of carbs he recommends are really pretty small portions and probably are not doing a lot to fuel the bacteria because you got the fuel out of the GI tract first.K.


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## Moises (May 20, 2000)

Kathleen,Thanks for the advice on the sugarwater experiment. We actually did it a second time using _more_ sugar. Maybe we should have tried it with less. I will do it again.Your comments about limiting total carbohydrate make sense. I think Pimentel needs a good editor. You'd fit the bill nicely.


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## Kathleen M. (Nov 16, 1999)

When I did a lot of bacterial work I had to make a really concentrated sugar water solution. We'd add a small amount of it to some of the things we used. Even though it probably didn't need it we did sterilize it when we made it, but it was one of the few things that never started growing anything after you had been in and out of it several times. K.


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