When to Use Therapeutic Diets: Don’t Hop on the Bandwagon
As a clinician, navigating through the muddy waters of digestive health concerns offers a multitude of challenges - even when you are successful in helping your patient. This uphill battle usually begins by dispelling their misconceptions about dietary change: Which diets will or will not work for me? Will the new diet be a life-long restriction? Will restricting certain foods make me more prone to new sensitivities? One would hope that with all the expertise and research taking place that the body of knowledge would help clarify the picture, but really the opposite seems to be happening.
My patients had become increasingly knowledgeable yet increasingly confused. For example, a patient with irritable bowel who also desired to lose some weight was resistant to my advice that they have 3-5 small meals throughout the day to help their digestive process because they were afraid that this would actually cause weight gain. The perception that eating more frequently means eating more calories - thus causing weight gain - is incorrect. Smaller portion-sized meals surely offer more caloric control than approximating the portions in 2-3 larger meals when you are hungry. Also, metabolism and blood sugar regulation (2 of the critical factors in weight management) respond much better to smaller frequent meals. The short of it is - we need to re-educate the population.
More information will make us smarter – but only if we use this information in proper context. Not all diets apply equally to all people. This is a tough one because it leaves patients asking, “It worked for him, why won't it work for me?!” You're different, that's all. Genetically, physiologically, you name it, you are different. That’s not to say that there should be 7 billion different diets, but we now have so many therapeutic diets without a clear understanding of when - if ever - they should be applied.
One thing that I look for in all of this is some commonality or correlation. Many of these therapeutic diets have common goals: Reduce intestinal inflammation, improve gut flora, regulate excretion, reduce pain/bloating/indigestion, etc. A great example of how these many issues typically converge on gut health recently occurred with a patient who was suffering with IBS. On the surface, she had a pretty clean, healthy diet. She ate regularly, good quality prepared foods, nothing unhealthy - yet she felt bloated, had irregular bowel movements and discomfort. Gut support in the form of prebiotics, probiotics, digestive enzymes and l-glutamine seemed to help - but not completely. The patient agreed to do a food sensitivity test to see if there was anything specific that she should avoid. I'm glad she did.
The foods that scored highest on the sensitivity test would be familiar to people who follow the Low FODMAP diet. Almost all her problematic foods are known to be high in FODMAPs. Maybe it's just a correlation or coincidence. Perhaps it is something to pay closer attention to. Ultimately, the goal is to help the patient feel better & have a sustainable diet moving forward. Ideally, as a practitioner, you want your patient to have as few long-term restrictions as possible. Some patients may always have to avoid certain critical foods, but every patient will tell you - if they can enjoy their favourite things some of the time and not feel ill, then they are happy. As a practitioner, that's my measure of success.