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Beyond “Food Jail” …er… Restrictive Diets

celiac gluten nutrition restrictive diets sibo stress Nov 29, 2017

A lot of my patients are on restrictive diets. I walk them through the process, how to deal with the emotions, how to manage it with their busy chaotic lives, so they can allow their bodies to heal from inflammation, bacterial overgrowth, autoimmune disorders, etc. Most of the time these diets are meant to be temporary and therapeutic during treatment with a slow addition to widen the diet once treatment of the infection/inflammation/autoimmune has been accomplished. This way we can begin to see what the body can and cannot tolerate. It is often a non-linear journey.

Restrictive diets by nature are not very fun. Nobody wants to have a “NO!” in their life. It brings up all sorts of “stuff” for the person undergoing the diet restriction. I have blogged a ton on this and there is a massive amount of information and research out there about WHY the restriction is necessary for a time so I am not going to go into that very much in this particular post. You can look back to:

The Why and How Of Autoimmune Diseases
Hashimoto’s, Thyroid, Gluten and the Gut

and more. But reference any of the above blogposts I have written on Autoimmune, Inflammation, SIBO and you will get the picture.

There is understandably backlash over restrictive diets. There is a “you can eat anything as long as it is organic!” camp. A “go ahead and eat whole wheat bread and ice cream” backlash. Some of it quite vehement and skeptical. After all, who DOESN’T want to have their gluten-y cake and cow dairy ice cream and eat it too? These viewpoints will appeal to a lot of people. They will take what has been written and run with it, or abandon their healing journey entirely because, after all, it is easier to “eat whatever I want and take a pharmaceutical pill.” Because lifestyle changes and restrictive diets can be HARD!!!! The pharmaceutical approach may even manage their symptoms for a while, but will not actually bring them to health. And eventually it fails. Ask my diabetic patients who were told to “eat whatever you want and adjust your insulin” how they actually feel on 45 grams of carbs per MEAL and 75 units of insulin per DAY. They usually feel quite ill. Some people will certainly make that choice, but it is most likely leading them towards an early grave. This is just basic science!

 Wouldn’t you like to know the truth? The truth is that yes, eating a restrictive diet ongoing for years can alter the gut bacteria (the microbiome) in a not so great way, so YES, after the restriction, under the guide of a practitioner, you will want to slowly, methodically add back in SOME of the foods to vary your diet. Depending upon your health condition that you are working to treat this may vary. I am not saying to go crazy and suddenly eat whatever you want. This approach often does not go so well and symptoms may flare, maybe not right away, but eventually. They almost always do. This is basic common sense and science.

You have to be cautious. If you have a gut health or autoimmune issue that you are using a dietary approach to treat, if you haven’t quite healed the gut lining and balanced the microbiome you may trigger a flare by suddenly going all out with whatever your inner child desires. Most of the therapeutic diets out there have a “hard-core” phase where you are, say, killing off the bacteria as in SIBO, where you do need to be a bit restricted in your diet. Once that is accomplished, the idea is to gradually introduce foods again, one by one (but only certain foods). It may be that certain foods, such as gluten in the gluten intolerant or celiac patients, need to be restricted. Some people are also genetically lactose intolerant so will never be able to freely eat dairy, even fermented dairy.

It is important to understand that.

Some of us have the gene which creates the enzymes to break down dairy products and lactose, and some of us do not.

Some of us will eventually be able to tolerate grains again with no ill effects and some of us will not.

We are all not meant to be able to eat everything. We did not evolve that way. Some of us have genetic roots in Scandinavia where they developed higher levels of lactase so they can easily break down cow dairy products. Many of us do not. Some of us carry the HLA DQ genes which predispose us to Celiac Disease. Many of us do not. We are all different. It is important to respect the differences and that someone’s food restrictions are a matter of them being out of pain and cognitively clear enough to function. Respect for others.

With breakthroughs in genomic testing, we are better able to understand who will be able to have some (organic) wheat and gluten and who really should not. We can see who is likely lactose intolerant and who is not. (Glyphosates and added hormones in our food supply are a whole issue unto themselves so always choose organic!)

We can even see who is more sensitive to pollutants, pesticides and herbicides and who is better able to detoxify.

Orthorexia is a real syndrome and I have worked with plenty of orthorexic patients in my practice. Some even consider ANY therapeutic diet which restricts certain foods as contributing to orthorexia, but I beg to differ.

We have compromised our food supply in the United States with toxic agricultural practices. People are getting sicker with chronic, inflammatory, autoimmune conditions not to mention increased rates of diabetes and obesity due to high sugar and carbohydrate intake. The United States has high levels of these conditions, but developing nations are also rapidly catching up due to multinational corporations exploiting these developing nations (easier to sell sugary soda than to supply clean drinking water to a community! With that you have skyrocketing rates of diabetes and obesity. The documentary “Globesity” really illustrates this!)

A return to health requires a return to a healthy diet and for a while, certain foods may need to be restricted.

The problem, I think, happens when someone becomes afraid to eat. When they are so sick, confused, and trying to figure out what is causing their belly to hurt and are trying certain diets. Many different diets.  That fear of food is real because they do not know what is going to make them feel bad! This can be misinterpreted as “Orthorexia”.

I tend to think of it more as “We haven’t nailed down the proper approach yet so I am afraid to eat anything”. That is the case with many people.

The other camp says “Food is meant to be enjoyed. You are missing out on the fullness of life if you aren’t eating bread”

But maybe the person is gaining their health and energy back. Life doesn’t feel very full when you feel terrible in your body.

I will also say that things have gotten better for people on a restricted diet. There are a LOT of tasty options. In the past if someone wanted gluten free muffins, they had to grind the rice into flour in their own kitchen. This was very labor intensive and time consuming, but there were dedicated people willing to do anything for their and their family’s health. If someone who is gluten free wants bread, or someone who is Paleo wants an occasional cheat but needs to avoid gluten, there are some enterprising baking companies that do a pretty good job. In Boulder we are fortunate have “Kim and Jake’s” who make an amazing peasant bread that is completely gluten free because Jake has Celiac Disease. And there are lots of other companies popping up also! If you are wanting “ice cream” for a special treat but can’t have dairy, there are coconut, almond, cashew and rice versions of that frozen dessert that are pretty darned good!

The main thing to understand is that in most cases, except for an anaphylactic allergy or Celiac disease, the restrictive diet is meant to be temporary while the healing of the gut occurs and then there is a slow, careful, conscious reintroduction period with specific guidelines and methodology where the goal is to widen the diet a bit.

Because full on long term restriction can impede the health of the microbiome.  And it can make you want to throw the whole protocol out the window! Let’s just say that never ends well!

Here is an Otthorexia Checklist (from Baltimore Sun)

  • Constant worrying about the quality of food one is eating.
  • Feelings of superiority because of rigid dietary habits.
  • Extreme guilt after eating foods considered to be unhealthy or impure.
  • Feeling very competitive about food or criticizing the eating habits of others.
  • A feeling of being in control of one’s life when adhering strictly to a “pure” diet.

These are the main red flags I look for when considering if a patient of mine is heading into Orthorexia. A lot of what makes it a disorder is the emotional charge around the reasons for adhering to a restricted diet. Most of my patients working with a chronic illness do NOT have orthorexia. Most are trying their hardest to heal. They would much rather be eating an unrestricted diet but are doing so by necessity. It is a therapeutic track. I doubt that most of my patients feel any bit superior to their fellow humans by adhering to their diet. Only that they are working on getting healthier.

I work with many patients near and far with health issues who are following a restricted diet. If you would like to work one on one with me, either in person if you are local, or long distance through video or phone, I am accepting new patients. You can also opt to have a FREE 15 minute phone consult with me to see if you and I are a good fit for each other! To schedule any appointment, you can do this online at or by calling (303) 443-2206 M-F 9AM-5PM Mountain time to speak with my receptionist. I hope to hear from you soon! Be well!