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Let's Talk About Diet

We seem to be obsessed with diets in the United States.  Obsessed.  A new fad diet emerges every few months that quickly becomes the greatest, most revolutionary, easiest, quickest way to weight loss you've ever seen!!!  Yet our obesity rates are at epidemic levels, having spread to our youngest citizens, producing a massive public health crisis that will take decades to undo.  But that's a whole other topic, and not what I want to get into today.  Today I want to talk about the role of diet in physical symptoms, which is a question I get asked quite frequently.

What is the relationship between certain foods and chronic medical symptoms?  This is a tricky area that can feel a bit like navigating a mine field.  Many people that I've worked with have identified foods that make their symptoms worse.  For some, it's a few foods that aren't very difficult to cut from their diet; for others, it involves entire classes of foods such as gluten for Celiac disease, dairy for lactose intolerance, or soy for a severe food allergy.  Unfortunately, some people I've seen have cut so many foods from their diet that eating becomes unpleasant, even stressful, and severely limits their social interactions.  Even more unfortunate in these situations is most of the time the severity of the dietary restrictions are unnecessary and they remain symptomatic.

So how does this happen?  There are many things at play, but I want to revisit the fad diet trend that we have for general weight loss as it applies to medical illness.  So I asked The Google and there are hundreds of pages dedicated to "Food Cures" for everything from Autism to GERD to ulcerative colitis.  Do diets work for some people?  YES!  So I don't want to come across as some sort of Negative Nancy here.  But, those who are most successful in using diet to "cure" their chronic medical condition do so by working closely with their medical team which includes a registered dietitian and a health psychologist.  "Diet" not only involves what you eat but how you eat it, so there's a large behavioral piece to all of this.  Unfortunately, integrated care isn't the norm so most people find themselves flying a bit blind and running the risk of restricting foods that they don't need to restrict.

When food is no longer fun.
The term "Food Cure" is a bit of a problem, in my opinion.  It preys on the worries of those who have a chronic condition whose medications may not be working,  or who have a child with a condition that is poorly understood and lacks good treatment.  It makes it sound like "if you just cut out these foods, your symptoms will vanish!"  Sure, not all people are gullible and take that promise at face value.  But it can create a mindset of "maybe it's this food" when the diet doesn't work like it should, leading to a pattern of disordered eating.   Another food is eliminated...and another...and the person ends up like one of my former clients who only ate white foods yet her IBS remained symptomatic.  She felt like a failure on top of being truly obsessed with what she ate, thereby taking no pleasure in eating, and slipping into depression.

So what can you do?  My #1 tip for anyone considering using diet to help with a medical problem is to consult with a registered dietitian.  Unfortunately many insurance companies don't cover this service, but it is worth the money spent to get an informed, expert opinion on how to approach your diet.  If you can't do this, be very systematic and patient.  Keep a food diary with a column for symptoms and eliminate only 1 food at a time.  Wait at least a week before you decide if it was helpful or not.  If you feel like your symptoms have improved, you have to test your hypothesis and reintroduce that food to see if your symptoms come back.  Wait at least a week and eat the food more than once before you decide if it's on the "gotta go" list.  Remove the food again and see if your symptoms improve.  Only then should you decide to eliminate that food from your diet.  This is a very time consuming process, but if done right you're more likely to accurately identify your trigger foods and not erroneously deprive yourself of foods you love.

This is a complicated topic that I'll spend more time on in future posts.  Have you tried a diet to manage your condition?  What has that been like for you?  We'd love to hear your stories.

Best ~ Dr. T

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