Which therapeutic diet is best for you?
By Sue Kira, Naturopath & Clinical Nutritionist
In my busy practice as a naturopath and clinical nutritionist working with more than 16,000 clients over 28+ years, I found that prescribing specific therapeutic diets, along with nutritionals and herbs, achieved much better results than prescribing supplements alone.
For most clients the appropriate diet, when followed, was transformational.
So what is the most appropriate diet, or progression of diets, that suits you best? Sometimes the answer is obvious and the solution simple. Whereas other cases are complex when the real sleuthing starts as I ‘Sherlock Nutritional Holmes’ unravel the clues.
For example, during the first consultation I often find my client suffers from digestive problems. It may be a FODMAP intolerance, SIBO, leaky gut, parasites, or candida. But many symptoms of these conditions are similar, and there could be two or more co-existing conditions, making it difficult to determine the appropriate diet.
Stool and breath testing can help to differentiate these conditions, although some clients may not desire tests or want to make changes while waiting for their results.
So let’s investigate some practical clues to determine dietary options for various health conditions…
The Questionnaire
Before a new client’s first consultation, I ask (insist) that the client completes a comprehensive questionnaire about symptoms, current diet, and lifestyle choices. I ask him/her to rate the severity of each symptom (out of ten). The more information I receive, the better for the client as I thoroughly check the details – which is why I need the info at least 24 hours before the consultation. By the time I see the client I’ve already gathered a huge amount of valuable data.
Lethargy
A client presents as tired or run down, with no apparent digestive symptoms. The issue is still likely to relate to an unhealthy gut.
If a client’s diet is loaded with sugar, breads, pasta, heavy carbs, frequent use of takeaways and processed foods, then a simple gluten and dairy free, low sugar diet can make a huge difference. If they already appear to have a healthy diet, then further clues need to be considered.
FODMAPs
FODMAPs (Fermentable, Oligosaccharides, Disaccharides, Monosaccharaides and Polyols) are found naturally in fruits, vegetables, legumes and grains. In other words, carbohydrate foods.
Common symptoms of FODMAPs sensitivity include abdominal pain and discomfort, bloating, wind/gas (usually smelly), abdominal distension and altered bowel habits, ranging from diarrhoea to constipation.
Clue: If the client’s digestive system symptoms only occur after eating foods such as onions, garlic, brassica vegetables or legumes, this could indicate FODMAPs sensitivity.
A Low FODMAP diet is the least challenging of the gut healing type diets and a good place to start if unsure of which diet to use, or the client is reluctant to make radical changes until results come back.
Less compliant clients may initially only want to drop gluten, dairy and sugar, which is a good place to start to help their immune and digestive systems. But if there is little change, they may be willing to go the next step, which in this case would be a low FODMAP diet.
SIBO
There is now more awareness about SIBO (small intestine bacterial overgrowth) as many conditions are linked with bacterial overgrowths in the small intestine. There’s LIBO, related to bacterial overgrowth in the large intestine, and the newly labelled FIBO for fungal infections in the intestine.
Irrespective of the type of overgrowth, there needs to be balance in the microbiome, with the right bugs in the right places in the right proportions. Even so called ‘bad’ bugs are commensal i.e. fine to co-exist. All bugs have their role in our digestive systems and increasing research reveals the many roles that a healthy microbiome has in our body.
It’s fascinating to know we have more ‘bug’ DNA than human DNA in our bodies. So how do I differentiate between a bacterial or fungal overgrowth from a simple FODMAPs intolerance?
In most situations, an issue with FODMAPs means there is also SIBO or similar, but there are cases where these are independent. I usually won’t know until the client tries a low FODMAP diet and improves to a degree, but not completely. Let’s look at some other clues.
Clues: Digestive system symptoms such as bloating occur between half an hour to two hours after eating but may be resolved after four hours of no food, a good bowel movement or overnight fast. However, some with SIBO for a long period of time may have their symptoms all day, but it’s usually worse after eating and slightly better after overnight fasting.
If SIBO has been ongoing for some time, there may also be skin rashes, depression, anxiety, mood swings, hormonal imbalances, food or sugar cravings, food sensitivities, headaches, restless legs, weight issues, sleep issues, nutritional deficiencies, or other symptoms.
Parasites
How do I tell if someone has a parasitic infection and not SIBO? It’s hard to tell the difference as many symptoms are the same. Tests and other clues often provide the answer.
Clues: Digestive symptoms are random and can occur irregularly throughout the day, irrespective of the time of eating or with different types of foods – although usually worse after alcohol or binging on sugary foods.
Digestive system symptoms may occur after stress, illness, or infection, especially if they had a tummy bug, antibiotic use, or diarrhoea, although constipation can be present with parasitic infections.
It’s common for clients to say they haven’t been well since a specific occurrence, and they often have random symptoms that come and go, such as headaches one month, aches and pains the next month, then good for a month and sick the following month.
While some clients have a regular pattern of symptoms, many with parasites seem to be all over the place and up and down with their symptoms. That’s my biggest clue to check for parasites.
Oxalates
What about clients who appear to have a healthy diet, yet have health issues? They enjoy loads of green vegetables, green smoothies and salads, love berries, nuts and seeds and some dark chocolate on the side.
Clues: Since going ‘healthy’ they’ve had all sorts of joint aches and pains, especially in their feet and some may even experience tingling in the bladder.
These foods are high in oxalates, although poor break down of oxalates is common with conditions like SIBO and other types of dysbiosis. A low oxalate diet for a few weeks can help to quickly relieve symptoms, then gradually reintroduce high oxalate foods in small doses to see how they respond.
If symptoms persist during the low oxalate diet, or symptoms return with the reintroduction of high oxalate foods, that’s my clue to consider if it’s a SIBO issue, because with SIBO it’s difficult to break down oxalates in food.
Inflammation
There are clients who struggle with inflammation who are already on a gluten, dairy and sugar free diet. So what do I do next to reduce their inflammation? Probiotics, omega fats, minerals, and anti-oxidants can help along with closer attention to diet. Consider inflammatory compounds in the diet as they may react to salicylates, histamines or oxalate rich foods.
Clue: Investigate their current diet for clues to recommend a suitable diet to trial. If they eat foods rich in either salicylates, histamines, or oxalates, consider a ‘low in’ diet e.g. a Low Salicylates Diet, Low Histamines Diet, Low Oxalates Diet etc. Select the one which affects them the most.
Histamine
Various health conditions are linked to intestinal permeability or ‘leaky gut’. Prebiotic rich foods are often recommended to feed the good bacteria and support healing of the gut wall.
The Leaky Gut Diet is very popular, but many people find the foods in this diet make their symptoms worse because they have a histamine overload or intolerance, thus their gut may not be ready for these foods and drinks.
Clues: Symptoms become worse, or new symptoms occur, from fermented foods like sauerkraut, kim-chi, drinks like Kombucha and long cooked bone broth. If so, consider histamine overload and see if they respond to a low histamine diet.
Apart from fermented foods high in histamine, also look out for high consumption of foods like tomatoes, potatoes, eggplant, avocados, nuts, legumes, spinach, coffee, spices of the chilli (nightshade) family, egg white, vinegars and chocolate.
It could be only one of these foods in excess, such as chocolate and/or coffee. If histamine is the issue, just one week on a low histamine diet can produce a significant improvement, which provides a very good clue.
Another clue is that someone who has histamine issues will always have more altered bowel habits and gas. It is common to also have reflux, heartburn or GERD, as histamine tends to drive up stomach acid. They are also likely to have other symptoms such as irritability, restlessness, depression, brain fog, behavioural issues, mood swings, aches and pains, rashes/hives/prickly or itchy skin, runny nose, insomnia and fatigue.
I would recommend the Low Histamine diet and check their response for clues. They may only need to be on a Low Histamine diet for two or three weeks and if responding well, happily convert to a Low FODMAPs diet which is less restrictive.
Salicylates
Sometimes you find clients who react to some histamine foods but not others.
Clues: They may be fine with bone broth but react to other high histamine foods like chilli and tomatoes. Consider a low salicylate diet.
One of my clients had severe blistering of the lips when she ate tomatoes yet was fine with potatoes (another nightshade food). She stopped eating tomatoes and her lips did not react, then had itchy hives but didn’t think the two were connected. Some might think histamines were the issue, but in her case, it was salicylate sensitivity.
And what about a kid’s crazy behaviour from eating otherwise healthy foods like red apples, strawberries, or tomatoes? This is a clue of salicylate sensitivity. I would suggest a Low Salicylate diet for a couple of weeks to see if there’s a change.
Glutamates
Many of my clients had problems because they ate instant two-minute noodles with MSG or a similar substance with a different name, such as ‘textured vegetable protein’. Might sound ‘healthy’ but the glutamate in these foods can really stimulate brains, especially in children.
Many become addicted to these foods, particularly impoverished Uni students, and behavioural issues continue until they changed their diets.
Clues: behaviour issues, or hyperactivity of the nervous system, which can also cause insomnia, restlessness, depression, or anxiety. Investigate their diet, particularly for glutamates and food additives.
For example, a family eliminates dairy due to respiratory symptoms, substitutes lots of coconut products and the child becomes hyperactive. This could be a glutamate issue. These kids often have sleeping and bedwetting problems. Consider a Low Glutamate diet.
Food additives/colours and flavours
Teachers commonly report children with behavioural issues. whereas other times they are angels. A glance into a lunchbox may reveal a packet of yellow-coloured cheesy flavoured snacks like ‘Cheezels’ or ‘Twisties’ which are full of additives and other undesirable compounds. I believe they should be banned.
Clues: I check what the kids (or adults) are eating to see if there are potential trigger foods and relate this to their symptoms. If uncertain, I recommend removing all suspicious foods and see if they improve. If not, an Elimination Diet can help.
Sometimes it’s like peeling an onion where more clues surface as you take away the layers. Consider starting with the removal of additives and heavily processed foods and check for a change in symptoms.
Diet progression
Many clients present me with a complex array of multi-symptomatic conditions that need careful consideration, which could involve a progression of dietary protocols to regain vitality.
For example, I may start a client on the SIBO 1 diet for a few weeks, with a follow up consultation to review and supply necessary supplements. All going well, they may progress onto the less restrictive SIBO 2 diet for a further few weeks, followed by a review, then onto the Leaky Gut 1 diet, followed later by the Leaky Gut 2 diet. Then all being well, a Low FODMAPs diet, if needed, followed by a Mediterranean, Paleo, or a simple gluten and dairy free lifestyle, depending on what suits them best.
This an example of dietary progression to help my clients regain vitality. A progressive course of specialised diets can improve compliance, in turn leading to better results.
Keep it simple
The bottom line is the right diet can accelerate healing while the wrong diet can be harmful.
Simplicity is the key to improved compliance. Sometimes, removing one or two foods from a client’s diet at the beginning can make a huge difference.
I avoid recommending a combination of diet types, otherwise my clients will be confused and give up. One diet type at a time is best unless we need to allow for allergies or intolerances.
When I work with clients, I use the words ‘short term’ and ‘detox’ so they understand that’s what their body needs, but it’s not forever. Some love the idea of a three month detox, while others may only commit until they see me at the next visit and then take the next step.
Many people intuitively, or from experience, know what foods they shouldn’t eat, but look to me for qualified guidance. I listen to their comments for clues, or ask questions such as, “Are there any foods you feel or have noticed that don’t suit your body?” A typical comment, “I get so bloated when I eat bread, milk makes me feel nauseous and I have trouble sleeping after eating mushrooms”. Bingo! Three foods to avoid in a trial.
There are many other specialised diet types depending on your needs…which of course will require my sleuthing skills to unravel the clues. 😊