Avoid Ultra-Processed Food

One way to help keep your gut healthy is to avoid ultra-processed foods. These include items like instant noodles, deli meats, chips, frozen meals, packaged baked goods, and sugary beverages like sodas.

These foods often contain additives (ingredients added during processing) that can affect your gut in harmful ways. Some common additives—such as CMC, P80, and GML—can change the types of bacteria in your gut and may cause undesirable symptoms.¹⁷ 

Reduce Sugar Intake

Eating a lot of added sugar has been shown to lower the number of good gut bacteria. It also might lead to increased inflammation and other health problems, including obesity and metabolic disease.³

Try an Elimination Diet

An elimination diet is a tool that helps identify foods that may be causing symptoms like bloating, cramping, or fatigue.² To begin this process, you stop eating foods that you and your doctor think might be causing problems. Then, one by one, you slowly add these foods back into your diet over time. As each food is reintroduced, you keep a diary of how you feel, whether good or bad. 

This helps you determine which foods may be causing symptoms. This process should always be done under the guidance of a healthcare provider to make sure you’re still getting the nutrients your body needs.

One well-known elimination plan is called the low FODMAP diet. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are certain types of carbohydrates (sugars) that are not well absorbed in the small intestine. In some people, they can cause uncomfortable symptoms like gas, bloating, diarrhea, constipation, and stomach cramps.⁴ 

Examples of high FODMAP foods include:

• Dairy products like milk, yogurt, and ice cream
• Wheat-based foods such as bread, crackers, and cereal
• Beans and lentils
• Certain vegetables like onions, garlic, asparagus, and artichokes
• Fruits such as apples, pears, peaches, and cherries

It’s worthwhile to note that how food is prepared can affect how well you tolerate it. Many people living with scleroderma cannot tolerate foods high in FODMAPs when they are eaten raw. However, cooking these foods can sometimes make them easier to digest.

The low FODMAP diet is not meant to be a permanent part of your lifestyle. Instead, it’s a short-term tool to help identify food sensitivities. For people who don’t experience symptom relief with the FODMAP diet, there are other elimination diets, such as AIP, that you can try.

If you have scleroderma, it’s important to ask your doctor or pharmacist if any of your medicines might interact with certain foods, to better inform your diet choices. One food to watch out for is grapefruit or grapefruit juice. Grapefruit can change how some medicines work in your body by letting too much of the drug into your bloodstream.¹⁵ This can make the medicine stronger than it’s supposed to be. For example, people with scleroderma who take calcium channel blockers (a medicine often used to help with Raynaud’s) should know that these drugs don’t mix well with grapefruit.^{14 13}

Vitamin Supplements

For people with significant GI involvement in scleroderma, getting enough nutrients can be challenging. Even if you’re eating enough food, your body might not be absorbing vitamins and minerals properly.¹¹ In these cases, vitamin supplements might be necessary if you’re found to be deficient.

Ask your doctor to check your vitamin levels before starting any supplement. It’s just as important to avoid over-supplementing as taking too much of certain vitamins can be harmful.

Omega-3 Fatty Acids

Omega-3s may help reduce inflammation in people with scleroderma, which makes them a potentially helpful addition to your diet.¹¹ You can get omega-3 fatty acids from whole foods like fatty fish (such as salmon), flaxseeds, chia seeds, hemp seeds, pumpkin seeds, olives, and walnuts. Supplements are also available, but speak with your doctor about the right source and dosage for you.

Probiotics

While probiotics are often marketed for gut health, their benefit in scleroderma is still unclear. Two studies looked at whether probiotics helped improve GI symptoms in people with SSc, and both found no meaningful difference between those who took probiotics and those who didn’t after two months.^{8 6}

There are many ways to eat well when you’re living with scleroderma. In the end, the most important thing is finding what works best for you. Everyone’s body and experiences with this disease are different, and what helps one person might not help another. Your doctor can work with you to figure out the best plan for your health and needs.