Diet

It takes a lot of work to recover from C Diff, and guess who is going to do the work? You are :)

My philosophy was:

starve the C Diff
overwhelm the C Diff with an army of good bacteria

Starving the C Diff means not eating things that C Diff likes.

In terms of food, this was my protocol:

no sugar, fat, salt, or spice
no caffeine or alcohol*
eat probiotic foods
⁠get a dietician
consider joining a food support group
manage diarrhea
high nutritional value
stay hydrated as possible (helps digestion)

*Alcohol use disorder increases C. diff risk, particularly during withdrawal (article: Alcohol use as a risk factor for Clostridioides difficile). If you need support to quit, reach out to AA.org. If you choose to drink, weigh the risks carefully.

Re: the risk of sugars/sweeteners - https://pmc.ncbi.nlm.nih.gov/articles/PMC12530488/#s0004

Re: Trehalose (found in some processed foods in Canada since the 2000s, for example certain ice cream products) - https://pmc.ncbi.nlm.nih.gov/articles/PMC5984069/

Foods I Avoided

Sugar, fat, salt, and spicy foods—believing C Diff thrives on these.
Used cooking spray rather than oil and gradually reintroduced healthier fats.
Processed foods, even healthy options like hummus, are often high in salt.
Spicy foods may increase inflammation, making them unhelpful during recovery.

Consider Eliminating or Reducing Caffeine and Alcohol

Caffeine may be a diuretic and upset the stomach, especially during CDI, possibly causing further dehydration. I did not drink coffee before CDI, but online sources suggest avoiding it, as well as black teas during CDI.

Alcohol use disorder increases C. diff risk, particularly during withdrawal. If you need support to quit, reach out to AA.org. If you choose to drink, weigh the risks carefully.

After recovery, I can enjoy a beer socially, though I usually avoid coffee and alcohol.

Eat Probiotic Foods

I tried different yoghurts and researched probiotic foods until I found ones that worked for me. Here are some of the foods that I had.*

*Please note that Miso paste is not eaten with a spoon, but was added to soups AFTER boiling; boiling probiotics will kill them. That explains why the traditional sauerkraut that my family makes is simmered, not boiled.

Manage Diarrhea effectively

Avoid insoluble fibre (e.g., salads, legumes, raw vegetables, apples’ peel) as it may worsen diarrhea.
Eat soluble fibre, which absorbs water and may aid hydration. Miso paste can add probiotics, but boiling destroys their effectiveness.
Oatmeal is often recommended for diarrhea, but was a trigger for me.
Probiotics, such as kefir and plain yoghurt, normalized gut behaviour for me. Try different kefirs/yoghurts until you find the one that is least bothersome. My dietician recommended yoghurt options.
Some use the BRAT diet.

Thoughts on the BRAT Diet

The BRAT diet is high in natural sugars and flour.
My “rich” BRAT alternative was sweet potatoes, oat bran, and plain kefir—the “SPOK” diet.
Refer to the appendix for recipes.

Stay Hydrated

Replenish water and nutrients lost from diarrhea. I used electrolyte drinks with low sugar/sweetener content during severe symptoms and drank water throughout the day, not all at once.

Tap water usually contains chlorine; I purchased large jugs of water for home use and recommend delivery services for those unwell. Drinking water can assist both weight retention and loss, though it may increase urination, especially after vancomycin.

Eat Foods That Soothe Your Gut and Are Easily Digested

Trust your gut. The principles I followed—avoiding sugar, fat, salt, and spicy foods—worked for me, but your needs may differ. If you find something beneficial, continue it.

Work with a Dietician Experienced in C Diff or Gut Issues

Not all dieticians are familiar with CDI recovery. I worked with Leigh Merotto, Registered Dietician and Owner of GutFit Nutrition, and later a local clinic dietician.

Avoid Personal “Trigger” Foods

Identify foods that bother your stomach over time. For me, salads, oatmeal, bread, raw vegetables, peanut butter, and excessive almond milk were problematic, though some may work for you. Many people develop dairy intolerance during CDI. The BRAT diet (Bananas, Rice, Applesauce, Toast) helps some people, but I tended to be cautious and avoided many items. Insoluble fibre also bothered my stomach, but I was gradually able to reintroduce insoluble fibre and salads.

Develop “Recovery” and “Flare-up” Protocols

Eventually you will reach a point in your recovery where you can begin to reintroduce/challenge foods. My dietician recommended the following recovery protocol:

Introduce a half serving of the “challenge” food on day 1.
If symptoms are not bad, have a full serving of the challenge food on day 2.
Have none of the challenge food on day 3.
Do not reintroduce other foods during days 1-3.

If your symptoms flare-up, return to eating only the foods that are least likely to cause you symptoms. This is your “flare-up” protocol.

During my recovery I first reintroduced proteins, such as black beans by gradually increasing the amounts I could eat. I also tried eating 3 or 4 meals per day depending on how big of meals I could eat and if my sleep schedule permitted a 4th meal. It took a long time to be able to eat salad again, and only after five years did I eat my first burger. This was in Tobago, and it was delicious! Travelling when you are recovering by eating healthy is difficult, but by this time I was recovered.

Eat Nutritious Foods

I relied on non-sugary kefir, sweet potatoes, oat bran, and homemade soup with non-salt broth as my “flare-up” protocol. Basmati rice, cooked in non-chlorinated water, is nutritious and easy to digest. Refer to the appendix for soup recipes, including “Jewish penicillin,” which was recommended for gut healing. I tolerated eggs, cooked spinach, and cooked vegetables, but avoided salad for a period post-CDI. Additional sources about nutrition through a CDI are in an Appendix.

I used probiotics including HFM Replete, then HMF Forté as prescribed by my naturopath. Prebiotic food increase the effectiveness of probiotics. Foods that include probiotics include kefir, yoghurt, kim chi (though this includes salt), tempeh, sauerkraut (though this includes salt), and other foods.

Join a Support Group (if Appropriate)

During infection, I ate less to starve the bacteria but eventually had to overcome my fear of eating. Support groups for food addiction provided valuable structure, tips, and community. For example:

Avoid processed foods with sugar/sweeteners among the first four ingredients.
Shop the perimeter of grocery stores for healthier options.
Use support calls or techniques to avoid tempting foods.

While support groups offer help, always prioritize your doctor’s advice. I treated my sugar addiction and mental illness as severe diseases, finding support from sponsors and fellow members. The program provided a framework for addressing fears and emotional challenges.

During COVID-19, I joined an online support group and learned from others with food addiction, anorexia, or bulimia. The support network helped me maintain healthy habits and provided encouragement.

Tips on Food Support Groups

Some sponsors understand the need for individualized approaches, but don’t use health reasons as an excuse to eat indiscriminately.
Work with your doctor and sponsor to find a balance.

Nutrition resources

“Clostridioides difficile Infection: Is There a Role for Diet and Probiotics?” (Nutrition Issues in Gastroenterology, Series #202) (https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2020/09/September-2020-CDiff-Diet-Probiotics.pdf)
Nancy Caralla’s “Nutrition; Managing Meals through a C.difficile Infection” (Published by “The Book Patch”) (https://app.thebookpatch.com/BookStore/nutrition;-managing-meals-through-a-c-difficile-infection/f8fa5082-f073-42d1-a065-e33a8b9a62fd?isbn=9781947519565 or available on Amazon or Audible)
https://microbiome.ferring.com/patient-c-diff-infection/#info-center
https://cdiff.org/nutrition-guide-form/ (by the Peggy Lillis Foundation)

Naturopathic treatment

This is excerpted from the draft book I am working on, C. diff Survival Guide. (Copyright, Karl Mikelsons, 2026)

Because I felt I could not survive more antibiotic treatments, I decided to stop taking them. On February 21, 2020, I sought alternative treatments and strict healthy living. I followed a weed and seed protocol under Dr. Jeyantus Philip, ND:

• Weed out the bad organisms.

• Feed the good organisms.

Dietary changes were recommended, including the addition of
more fermented foods. But, I had difficulty tolerating fermented foods.

On February 28, 2020, Dr. Philip emailed me a copy of my person-

alized Advanced GI Flora Balance Program which I could use to create

a good balance of bacteria in my gut. It provided for a six week protocol. On weekends, I would take berberine and garlic (allicin) only as per dosage in
the handout. On weekdays, I would take slippery elm to soothe digestion and as a nutritive to the gut.

I would also use probiotics recommended to me. Along with S. Boulardii that I was already taking, I took HMF replete, 1/2 sachet per day until I finished the container, and might have started and finished another container at 1/2 sachet per day. Then I reduced to HMF forté until I no longer needed HMF forté in consultation with my naturopath.

Post-infection, or even while infected, I had what I called acute and challenge phases of recovery

Acute phase - This is when I felt that I was actively infected. I became afraid when I sensed a burning sensation when I used the toilet, had blood in my stool, or was otherwise having a digestive flare-up.

When I had a digestive flare-up, I ate what I knew was safe for me - baked sweet potatoes, plain kefir, and oat bran.

Where possible, I would add nutrition and protein, like cooked spinach and miso paste in the oat bran, eggs, or chick soup with home made broth so that it had little salt.

Cleanse - Before challenging myself to gain weight, I did a 3-day soup cleanse using a particular soup. More information is available in my book, or will be posted here as I have time. This does not mean everyone has to do the same thing I did, and in fact this soup resulted in my dropping to my lowest recorded weight. At this time, I decided that my low weight was a bigger risk than whatever stomach problems I had.

Challenge phase - When I felt well, I would "challenge" myself to east something that I could not before. Plan to only introduce one new thing. Have a half serving of the food that you need/want to reintroduce. On the next day, if you noticed no significant issues, try a full serving. On the third day, have none of that new food. Record your results in your symptoms tracker spreadsheet, app, or notebook.

Work with a dietician if possible, when introducing new foods and rebuilding your gut and microbiome.

C Diff diet is a big topic and changes in different phases of your recovery

To manage diahrea, I used sweet potatoes, plain kefir and oat bran. Sweet potatoes are soothing on the gut and a prebiotic. A prebiotic enhances the effectiveness of a probiotic. Oat bran has both soluble and insoluble fibre. Soluble fibre is what you want. Insoluble fibre is rough and will contribute to diarrhea. Apples have soluble fibre which can be helpful (without the skin), but I found they were too sweet for me. I avoided applesauce for the same reason.

Highlights of the food I ate - Find what is soothing for your gut and put the work in to obtain and prepare that food. Cooked spinach (high nutritional value), chicken soup made from homemade vegetable broth (no salt), a little eggs, a little salmon, and a traditionally cultural food (beets) were all foods that helped me along the way. I am grateful for my dad who also found frozen beets for me – during Covid some foods were hard to find!