Friday, December 9, 2011

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!


  1. Oh my...I am relating in a big way to this post. I have used, for years, the subterfuge of being gluten intolerant (so "disappointed" was I when I tested negative for Celiac I strongly felt I no longer had a "socially acceptable" malady..and was simply eating-disordered/weird/crazy)..

    I have jumped on the Paleo bandwagon..conveniently cutting out entire food groups...grains, legumes,dairy,most fruit (G.I./"Fructose Makes Us Fat" fears) most carbs,..but have "neglected" to include the increased fat required to sufficiently fuel the body.. My ED team has, rightly noted that I have effectively fabricated or "cherry-picked" my own "magic formula" diet..which, becomes more and more restricted with the elimination of more and more "off-limits" foods. Spot-on recognition and analysis Laurie...that we use these new eating guidelines and "lifestyles" as excuses and justification for more restriction and, for me, anorexia...Less food choice equals less stress..less terror of food. The irony is that this effacement of allowed foods tends to pull one to obsession/ideation of it (for me personally,bookmarking hundreds of recipes which will probably never be made.

    All of this food evasion/obsession seems to "occupy" those with restrictive anorexia, such as myself, as it allows us to escape, albeit momentarily from what is truly bugging us...

    This is why I am starting to see the importance of the entire team approach to eating disorders..the psychiatrist/counselor/psychologist component as well as the sage nutritionist component...

    Excuse the lengthy comment..but this struck such a chord of "verité" within myself..and thank you for such a consistently well-reflected post.

  2. I have followed so many different diets, each a proponent of a unique way of eating. Never did get to the gluten free or vegan diet, though. It wasn't until I began to work with Lori that I actually realized it is possible to lose weight, and most important for me, to keep it off, and to feel healthier by eating a more well rounded selection of foods and in smaller portions. And, of course, starting to exercise. It sounds simple, and at times is just the opposite, but I am certainly in a better place as a result of following her advise. I have been lucky to have a doctor that gets it about dieting and she is actually the one who suggested that I seek out Lori's help. I hear such horror stories from some of my friends that I am grateful to have these connections. I have been battling my weight since I was a baby and I finally feel like I am doing the right things.
    Thank you, Lori.

  3. Very much relate to this post - just wish there were more sensible and balanced info and advice on "diet" out there (this website is an all-too rare gem of an exception.) I'm a restricting anorexic desperately wanting to recover; but don't know what to eat to be the "normal" I so much long to be, as I haven't got a clue any more what a "normal" diet is, and none of the supposedly normal eaters seem to have any more of a clue either. It's like the whole of society has become eating disordered - but maybe I'm just looking to make excuses, I don't know. I just wish, though, when I ask what I need to eat, I didn't always just get the same old Healthy Eating mantra of low fat, low fat, low fat and anything nice is naughty by default.

  4. Great responses--thank you! Clearly the first step is acknowledging that there's a problem with maintaining things as they are. As for moving forward? Jan, there are no "bad foods", in my book. Even low fat is a fad of the past. Sounds like some solid and intelligent supports are needed. FInd an RD near you, if possible.
    Sally, so glad to hear you appreciate your progress. And your MD.

    Really, I am so thankful for the fabulous doctors whom I work with professionally and personally. There is mutual respect, and a willingness to discuss differing viewpoints. My frustration comes from the MDs in the minority, who confuse and misinform patients, making change an even greater challenge.

    Donna G, so glad you've also found a great team. Thanks for your very articulate comments!

  5. Gluten Free diets are also considered a good alternative for those who suffer with "Friedreich’s Ataxia".
    Found this article as there doesn't seem to be alot out there about diets that may help this condition.

    Hope it will help someone.

  6. Hi Lori,

    Just wanted to let you know that this was a great post!

  7. After years of trying unsuccessfully to lose weight and control my migraines with everything from weight watchers to vegetarianism to a modified sort of paleo based on the "eat for your blood type" diet (there was a book out that promoted that), I finally managed at one point to lose 85 pounds - although that only put me in the merely "obese" range - by eating only 1000-1200 calories a day for a year and a half on a nearly vegetarian, extremely low fat diet high in raw foods, becoming anemic and developing a heart murmur in the process.
    I have PCOS. Dieting does not cure PCOS, even the internet craze for "low carb diets are 'proven' to help PCOS!" - they aren't "proven" to help it, there's some evidence they might help some women take off a few pounds but the evidence isn't firm. I actually do not have insulin resistance with my PCOS, I just cannot lose weight, and no amount of weight I lost or dietary changes helped with my migraines. Proper medication did, however.
    I had to stop the low fat, meatless diet before it killed me. It was very hard because everyone and everything in society supports me losing weight because t is "good for me" because I am fat and "everyone knows" I should lose weight and "everyone knows" if I just eat less and exercise more I will lose weight. Except I won't, and I don't know how many more times I have to try this to prove it to everyone else and myself. I rarely eat out, make healthy homecooked meals for myself and my family all the time, don't indulge in fried foods often, don't stuff my face at meals, and I have been obese or morbidly obese my entire adult life even though I walk and bike several miles a week and always have. My blood pressure and cholesterol are fine, my blood sugar is fine. But the abuse I get for simply leaving my house and existing in the world, walking down the street, sitting on the bus, existing in public, is horrific. Every day I feel the urge to go back to days of starving myself with fat free or extremely low fat meals in an attempt to start losing weight again even though I know it wont really work in the long run, because of the short term drop that I know it will provide. Nothing else provides any short term drop at all other than total cessation of food. After the short term drop that comes from total cessation of food, all weight loss stops. I suppose I should be grateful to my body for being so good at preventing me from starvation.

  8. @Anonymous Good for you for airing this frustration here! No, you should NOT be fighting your body to lose weight--from your description, it is both pointless and unhealthy to fight against your body's natural and healthy state. You are likely meant to be a larger size--and can still be (and apparently are) quite healthy at that larger weight (in spite of the stupidity that you might hear all around you!)

    For added support, check out Health At Every Size, and see Dances With Fat's blog, too!

  9. Great post... thank you! I always enjoy reading your posts :)

    I had a quick question that doesn't completely fit under this post but wanted your opinion... I know typically all 'diets' really don't work, but there seems to be this regeneration of an older diet (the HCG diet - either oral or injections) amongst the healthcare workers that I work with, and I was curious your thoughts on it and if you'd seen much use of it?

    Thanks so much for all your wonderful posts, they are incredibly helpful!

  10. Actually, I would like it if you would "go on listing the pitfalls of her diet," because the way Di is eating is the EXACT same "program" I am doing. First I went vegetarian, then low-fat, low-glycemic vegan, then I eliminated all grains including those containing gluten, then I eliminated soy, and finally went mostly raw. I was using Agave as a sweetener until I read some unfavorable things about it, so now I only use Stevia.

    I am not overweight. I am 5' 11" and my BMI is 20.4, and I do not have an eating disorder. I WOULD like to be thinner though. I work out 5 days per week and watch every single thing I put in my mouth. I have been frustrated by all the mixed messages, much of which comes from doctors, promoting one way of eating over another, or one diet more than another. It seems to me that NOBODY can agree on what constitutes a healthy lifestyle, so I decided to make up my own. Hence the low-fat, low-glycemic, raw-vegan regime.

    I thought I was the only person in the world doing it, and so I was quite surprised when you described Di's eating habits. I am curious as to what some potential pitfalls of this manner of eating could be, and I would be most interested to hear what you think.

    You have an excellent blog, btw. I really enjoy reading it.

  11. @ Heather While you may be neither over nor under weight, I question your quality of life when so much thought goes into what you can't eat. Sure , you can be physically healthy, carefully meeting all nutrient needs for your active lifestyle. But the mental energy? The striving to be better than you are? Thinner than you already are? To spend what I suspect is a high percentage of our thoughts thinking about what, when, and how much you can eat, while trying to restrain your eating to achieve a further weight loss? I'm suspect.

    Also consider--are your periods regular? How's your energy level? Irritability? Concentration? Are you cold all the time? If all is well, perhaps you are doing a great job with your food choices. If not, you've just heard some of the pitfalls, beyond those listed above.

    Hope that helps.

  12. I actually have a diagnosed condition called fructose malabsorption. When I was diagnosed they just gave me a list of foods to eat and not eat with no other directions or follow up. Then the dr told me he didn't think I would get better with it and insisted I had Crohn's Disease despite all tests coming back negative. Since then none of the doctor's I've seen have really addressed how I handle the disease despite my blood tests showing low levels of iron and vitamin b-12. I try not to restrict any other foods, but just the restrictions from the fructose list are enough sometimes to induce binging behavior. There also doesn't seem to be any set list of foods to follow. I did see a nutritionist a few times and while she helped with appropriate foods, she wanted me to restrict other foods (meat) in order to lose some weight.
    I have since had drs suggest WW and medicine that blocks fat absorption as weight loss strategies. It can be very frustrating, especially when they don't seem to factor in my past health issues.

    1. Melissa, I have the same thing, but with a few other foods added in. I follow FODMAPs diet. There is a heap about it online now and lots of blogs popping up with food and recipe ideas. Also Monash University who did all the initial research into it has just released an excellent app with a great list of all the things you can and can't eat. It also has recipes. It's fantastic. I'd recommend you get it. I know it's hard to find info on it in the US as it's relatively new but there is a bunch of good stuff if you search under FODMAPs. I know it's hard, I have issues with binging on the very foods that make me sick too. I don't know what to do about it (hint! hint! Lori, blog post idea?) but I'm seeing a good dietician and that helps. Oh, also, I'm going to hire a chef to create a bunch of meals for me to learn how to cook that fit my diet perfectly. Also, go to they also sell cookbooks and all kinds of helpful things. Good luck!!

  13. After hours upon hours of searching and reading about food and behavior and binging and restricting and eating "midnfully" (whatever that is), all I really know is that I should and shouldn't eat an apple.

  14. All I know after hours and hours and hours of reading, talking to friends, fellow bingers, RD's, and all manner of human on the subject of food in general, I have realized: I should eat an apple - and I should not eat an apple. And either should be done "mindfully" whatever that means.