Following a Vegan Diet. And, a Gluten Free Diet. And, and, and…

Couldn't Resist This Photo Op In Switzerland!

It’s time for some praise for doctors. Surprised? I know you are used to my airing my complaints here, for inappropriate, unconstructive assumptions some doctors make. And, for their misinformation not infrequently conveyed to patients, when it comes to diet and disease management. Just last week, a patient with type 2 diabetes shared her experience about her follow up MD visit. Jane has been eating well, resulting in a significant and appropriate weight loss. She’s moving more, and watching her carbohydrate intake, improving her post meal blood sugars. But given that her morning numbers remained quite high, in spite of her fabulous lifestyle changes, I encouraged her to address this with her doctor, hoping for a shake up in her diabetes medications.

Can you guess what he told her? 

You guessed it. Just lose weight. Yes, he wanted her to continue to stay with sugars almost 100 points too high, potentially causing damage to her blood vessels and her organs. Perhaps continued weight change will improve her sugars—but that takes time, and with the 50 or so pounds she has already lost, the numbers haven’t changed significantly. But it’s easier to pin the responsibility on the patient to change.

Oops! I was planning on praising a doctor today!

The wisdom of Dr. Mars

His patient was not an obvious referral for nutrition counseling. She did not present with any complaints about her health, and her rudimentary labs did not flag any concerns of disease in the works—normal cholesterol, blood sugar, thyroid, to name few. Other, more detailed nutrient assessment is pending. Her blood pressure is fine, low in fact, with that “healthy runner’s pulse”. And her weight? It had dropped from her usual place many years ago, from the normal range, when she had been diagnosed with cancer, now in remission; but it had increased somewhat since then.

“What brings you here?” I asked, as it was not so clear, at first glance. “Dr. Mars suggested I get in to see you”, she replied.  “His concerns?” I continued. “He’d like you to assess my diet and be sure it’s adequate.” Fair enough, I thought.

At least she's left with these--if they're uncooked!

And here’s what I heard. Di moved from a vegetarian diet to a vegan diet some years ago, presumably to be healthier. She then cut out soy products because of inconclusive evidence of a link between soy and some cancer. Only she did not have the type of cancer that might have even been impacted by soy. She then decided that she should cut out gluten, because she thought she might be allergic. She didn’t notice any change, but had heard (from reliable sources, no doubt) that it helps. So she stuck with it. Rumor had it (Hollywood tabloids, perhaps?) that the raw food diet was a means to extend life and stay fit, so she tacked on those rules too. 

I’m not sure I could have created such a patient from my imagination. The only thing she hadn’t reportedly restricted was fats. But judging by her food selection her intake of fat was quite low, unhealthily low. Oh, how wise of Dr. Mars to send her my way!

My confession

We do the craziest things for our cause.

I get it, at least to some extent. If you’ve been handed a diagnosis for which there is no cure, or one which can easily take your life, you feel quite vulnerable. So anything you can do to potentially help your situation makes perfect sense. And so early in my diagnosis with Multiple Sclerosis I embarked on my own gluten free adventure. Armed with anecdotes spread across the Internet, I was determined to take charge of my condition in any way I could. I knew that the science was sketchy, at best, in its infancy in fact. Much had been written about other auto-immune conditions and the benefits of a gluten free diet, but little to no research existed for MS. I had my MD check my labs, which revealed some abnormal levels—so maybe there was a link, I thought. Celiac experts (those that address the autoimmune disease truly caused by consuming gluten) dismissed these labs as inconclusive, but I was determined.

Three months of strict adherence to a gluten-free diet cured my MS!

Don’t I wish! Rather, meticulously following a gluten-free diet was a constant reminder that I lived with this medical condition; kind of like following a meal plan with an eating disorder. But if it worked, I would follow it forever. Only it didn’t work. Sure, I felt I was taking charge, doing my part to control my disease. But in those three months I had more new lesions on my brain and spinal column than perhaps at any other time in my 9 years with MS.

There’s a point you have to ask yourself “Is this strategy working for me?” Is it really meeting the need I intended it to meet?

 Gluten-free failed. But fundraising and riding with my team of friends and
family (almost half of whom are MDs) has helped me enormously.

Did Di’s strategy improve her health with her myriad of diets rules? Hardly! She now had irregular periods (potentially due to a low percent body fat), and she likely will be experiencing muscle wasting, as her total calories and total protein are insufficient for her need. Osteoporosis or osteopenia , its precursor, is inevitable, with her low calcium intake and vitamin D, and with her questionable estrogen levels, given erratic periods. I could go on listing the pitfalls of her diet, but I think you get the point.

Focusing on her food rules may very well work for Di—on some level. But if she allows herself to be honest, she’ll realize that this is not a healthy diet at all.

And you?

Is it time to reexamine your own patterns of eating or food rules? Are your eating behaviors really working for you? And is it in your hands to change?

I’d love to hear from you.

Thanks for reading and for giving me your invaluable feedback!

Healthy Food = A Healthy Diet? Not Necessarily.

My lunch on a hike in Switzerland

Organic, whole grain, natural, unprocessed. These words carry visions of ideal diets, of pure and clean eating, of good health.  US News and World Report’s recent article  summarized the healthiest diets, from The DASH diet at the top of the list to The Paleo near the bottom. A panel of experts reviewed each plan for safety and nutritional value—then ranked the best down to the worst plans for health and weight control.

Here’s a brief summary of a few of their findings—with my interpretation added. You didn’t think I’d let this pass without putting in my two cents, did you?

DASH diet

Never heard of it? Not surprising, unless you, like me, have high blood pressure. DASH, an acronym for Dietary Approaches to Stop Hypertension is shown to be as effective against hypertension as medication, when compared side by side in studies. Its key elements are large quantities of fruits and vegetables, and inclusion of three low fat dairy products daily. It also includes lots of grains, and adequate amounts of lean protein sources. It recommends limiting sodium intake and being physically active as well.

What does this expert think? While it hasn’t normalized my blood pressure, the studies on DASH are quite impressive in demonstrating an improvement in blood pressure. And that’s what it was designed for. And it’s one step you can take to be healthier, if you have high blood pressure. I like its positive focus—on eating more fruits and more vegetables than most individuals consume, and on inclusion of three low fat dairy servings daily. Watching sodium generally necessitates eating less processed foods, which may lead to greater fullness—think apple versus juice.

Paleo diet

The theory, according to US News, is as follows:

Our highly processed, carb-obsessed eating pattern is the culprit behind many of our biggest health ills, so why not go back—way back—to the Paleolithic period of more than 10,000 years ago, when our diet wasn’t full of junk food and pasta? Paleo advocates say we should eat the way we ate when we were hunting and gathering: animal protein and plants.

The diet includes meat, fish, and other protein sources, as well as fruits and veggies, but omits dairy, grains and starchy vegetables, and several oils. Yes, even protein-rich, high fiber, satisfying legumes (think beans and lentils) are out of the question. As are root vegetables, such as sweet potato. (Imagine Thanksgiving at the Paleo family’s home!) Apparently these are omitted because they needed to be cooked. And say goodbye not only to milk, but also to those gut-beneficial probiotics we consume from yogurts with active culture. Never mind the lack of evidence that supports eliminating these foods.

If I have to give something up, there darn well better be a good reason for it. Unless there were some life altering evidence in favor of a Paleo, I say let’s be thankful we’ve evolved since then. And how fortunate we are to be able to consume legumes and grains—those carbohydrate rich foods, full of minerals and energy, as well as rich in fiber—given that we can cook them. Most of you, I suspect have a stovetop?

If you are not living in a year-round warm climate—rich in sunshine used to produce vitamin D, or you choose to prevent skin cancer by using sunscreen—you’ll be missing out on the foods necessary to obtain all the Vitamin D that you need following the Paleo diet. By the way, why use a Paleolithic period diet as some ideal, anyway? Their lifestyle was a bit different, I believe (I haven’t had to chase my dinner), and our lifespan has only increased over the years.

As for Atkins?

The lack of carbohydrate through many stages of this diet, and the saturated fat-rich intake flies in the face of all that we know about disease prevention. Review the 2010 Dietary Guidelines For Americans for an evidence-based review of these recommendations. Is anyone really taking this diet seriously anymore?

And Ornish?

Generally pretty extreme in it’s limitation of fats, which research confirms is not the cause of us getting fat; weight loss at the 12-month mark was no greater with a low fat diet, compared with many other popular diets. And any differences in weight loss between various diets (containing the same calorie level) was obliterated at the later follow up date. No, fats don’t make you fat. And a super low fat diet does not appear to be necessary to improve your lipid profile; very low fat diets may increase triglyceride level, an independent risk factor for heart disease. In the Ornish diet, meat, poultry and fish are not recommended, as well as all oils, nuts, seeds, and refined carbohydrate. It has its merits for reversing heart disease, but his studies showing this reversal focused not solely on dietary changes, but included a comprehensive stress reduction and exercise component.

Mediterranean Diet

My only beef with it is not its lack of meat, but its limited dairy. There’s no support for restricting dairy, particularly low fat varieties, for good health and weight management. I do like their inclusion of moderate amounts of wine, with meals, for those who are able to limit their alcohol. This diet is much higher in fats and carbohydrate than most, but includes, for the most part, less processed varieties. That said, they do not urge extremes, such as no bread or white potatoes.

The U Diet: The best diet you've never heard of

What was unfortunately left off the list of healthy diets was the U diet. Missing is consideration for the individual, because what’s healthy for one person is not necessarily healthy for another. Eating healthy, for many of you, should mean not trying to beat the system and eat less (like the Volumetrics Diet, for instance). Even those 2010 Guidelines for Americans act as if we are all obese and unhealthy and needing to eat less. It’s a challenge, for sure, when the rest of the universe is struggling to drop a few pounds or kilos and you are working, somewhat reluctantly, to gain them, or even to maintain them!

The U diet is truly the answer. It means, first and foremost, including an appropriate intake of calories. Ideally, if you are healthy enough to do so, this is done through better self-regulating (read the 100 or so posts in which I’ve addressed this already. Then re-read them!). It involves more mindful eating, and distinguishing hunger from other eating triggers. You know what I mean. 


But it also means releasing yourself from the rules which prevent you from eating when you are hungry, regardless of whether its only been two hours, or if it’s after 8 PM.

As I’ve mentioned previously, for many of my readers it requires the “just do it approach”—eating in spite of not thinking or feeling you need to eat.  It may defy all the healthy recommendations you’ve read above. Yes, you may be among those that need to decrease your vegetable intake, if they are displacing the calories and nutrients your body desperately needs to function.

Let's take Brian, whose diet was chock full of such wholesome ingredients, as recommended by DASH, Volumetrics, Mediterranean, and some dieticians' model diet.

Breakfast

Old Fashioned rolled oats with soy milk

Snacks

Fresh fruits and vegetables, both orange and green ones

Lunch

Brown rice and veggies

Dinner

Beans and a vegetable soup

Pretty good? Not at all. At 6'1" Brian struggles to function. His determination to select what he considers healthy foods has made him anything but healthy. His energy level is low, as is his testosterone level, impacting a range of quality of life activities. Let's just say, it impacts more than just the frequency of his shaving. His weight, while I will omit mention of numbers, is unhealthily low.

Or let me tell you about Sarah's recent diet. Her move away from "junk" food to a more wholesome diet landed her with a low heart rate and a plummeting weight, now below the 5th percentile. Never one to struggle with her weight in either direction, she now teeters on the need for a hospitalization. Her diet is low sodium, making it more challenging to keep her blood pressure in a healthy range given her unhealthy weight, contributing to her lightheadedness with posture change, from lying, to sitting, to standing.

And then there was Amy, who never intended to lose weight. Really. She gradually moved toward less processed foods, leaving her favorite items behind. Who needs Pop Tarts anyway? Her biggest concern, besides her hair loss, is that she is constantly freezing, even with the record warm temperatures we have had this fall in New England. This is what is motivating her to break from her "healthy" diet.

Diane was also concerned that her daughter wasn't eating healthy enough. Review of her intake revealed the following—she consumed a variety of foods, but would benefit from additional sources of dairy or an alternative. She included meals, but was somewhat picky about what she liked to eat -- pasta was high on her list, as well as several other choices. And for snacks, she responded to her hunger with what appeared to be reasonable quantities of items like Chips Ahoy cookies -- or fruit, or cereal.  She certainly could use to increase her intake of fruit or vegetables, for the variety of nutrients they provide, and for the fiber. But she eats enough to maintain a healthy weight with healthy body function. Her diet supports her need for energy, for fuel, to engage in the activities she enjoys.

Ahh, all butter pump cookies!

The Chips Ahoy? Those processed, refined carbohydrate and sugar containing cookies fit just fine, in the context of her diet. As long as she is getting all the nutrients she needs from a variety of foods, and she needed the calories from the amount of food she consumed, if Chips Ahoy was here snack of choice, why should I try to make it "healthier"?

Healthy eating, to me, is not just about healthy foods. It is about getting enough of what you need--enough calories--from protein, fat and carbohydrate to fuel your body and allow for repair and normal function. It includes a range of vitamins and minerals, as well as all the nutrients, such as phytochemicals, that we are learning contribute to disease prevention (think about selecting colors -- deep orange and yellows as well as deep green, and reds and blues in vegetables and fruits). It includes whole grains, and refined, low fiber foods as well (think French bread or my much photographed challah—white flour and delicious!)—because in our world we also need to balance our need for convenience with our busy lives. And, our interest in eating foods we enjoy.

Follow the U diet, and you, too will rest
peacefully!

Besides needing to meet our physical need, we cannot dismiss food's other benefits. There's the pleasure factor, the enjoyment of the taste and texture, the sensory experience of eating. I'm not saying we should simply eat for pleasure. Rather, that we need to consider these aspects of eating when we are hungry and seeking food. What do we feel like eating? What would we enjoy eating? Not simply what should we be choosing.

Consider the U diet. It may not be a best seller, but it’s a sensible, and healthy diet for your body and your mind.