We all know that food is medicine and that what nourishes an individual can diminish function in another. This is the premise upon which elimination diets were created and I’m all for them - except when they become a source of stress and, therefore, a driver of the very condition a client may have sought help for in the first place. Read on to discover why an abrupt switch from a significantly less rigorous diet to the most stringent version of any elimination protocol may not be appropriate for your unique physiology, personality and circumstances (especially when you have an autoimmune disease) and what you can do to ease the transition.
Food elimination roulette, as I call it, has swept the nation in recent years. Everyone’s at it - from the layperson who is trying to get to the bottom of their symptoms to nutritional therapists and functional medicine practitioners. Please do not get me wrong. There is, of course, a time and a place for strict dietary protocols - albeit temporarily.
If a person’s quality of life is so adversely affected that they are unable to function, the removal of all triggers (dietary and otherwise) to initiate their own innate healing response is paramount but should not end there. This should be followed by attempts to discover - and address - the root cause(s) and a reintroduction of foods that are generally regarded as healthy (from a functional medicine and ancestral point of view) within a minimum of 30 days, depending on the severity of symptoms.
Elimination protocols of any kind are best used as templates and a basis from which experiments can be conducted. Rigidly committing oneself to the elimination of a broad spectrum of potential sensitivities is all too often done at the expense of peace of mind and health. It is easy to see how this can happen, however. Autoimmune diseases are so widely misunderstood by conventional medicine (and the symptoms can be so debilitating) that even an inkling that 30-90 days of following a protocol without any leeway could provide relief can be incredibly alluring, empowering even - at first. Doing something harder or more perfectly to yield faster and better results is a tendency to which many of us are prone in other areas of our lives. In the rather more delicately nuanced arena of health, this ultimately backfires.
Below are just a few important reasons why a myopic focus on the most restrictive dietary protocol possible - without taking individuality into account - is not the best intervention for any disease, let alone autoimmunity.
Isolation: gatherings are so often interwoven with food, that embarking on an elimination diet could potentially hamper one’s social life. The degree to which this may happen tends to be directly proportional to the degree of dietary restriction. Studies show that community and a sense of belonging play a vital role in overall health and these should, therefore, always be encouraged and nurtured. The fact remains that many people still do not pay particular attention to what they eat and how it may affect them in the long run. This is certainly neither good nor bad but merely an acknowledgement that each of us exists on a certain spectrum of awareness with those at one end frequently bewildered by the actions and views of those on the other. Eating in a manner that is at odds with that which is perceived as “the norm” often breeds scorn and defensiveness in others who are neither ready nor willing to make healthier choices. Having supportive friends and family will, of course, make this far less likely. That said, it is worth bearing in mind that the dynamic of one’s default community (close family and friends) can shape one’s experience - for better or worse. Finding a support group of like-minded people can be a great alternative. Because it is not always possible to avoid isolation no matter the circumstances, it can be very freeing to realise that all needs do not have to be met by one person or group. If you find that your quest for health is received with negativity and judgement from a community that was previously supportive, this is valuable data and a sign that this specific need - at least - is best met elsewhere. Surround yourself with people who respect your right to heal in your own way and on your own terms.
Fear: having a chronic illness can sometimes engender vulnerability and a high level of suggestibility. Choose your tribe wisely. The key is to find one that prioritises growth over stagnation and the delicate balancing act of looking within/consulting one’s intuition versus seeking outward authority/”expertise”. It is important to remember that, without an end date in mind, an elimination diet that began with good intentions can soon become fertile ground in which fear of eliminated foods will thrive. There is a fine line between reveling in new found vitality and looking over one’s shoulder for flare-ups or relapses.
Stress: not everyone can cope with the removal of a long list of foods from their diet in one fell swoop. Dietary upgrades of any kind can be so emotionally charged - and financially challenging - that any changes are best made with all aspects of your unique circumstances in mind. Can you change your diet considerably whilst juggling work and family commitments and an autoimmune condition - not to mention other important aspects of health? Are you prepared to cook every single meal from scratch? Even those who have the financial, physical and emotional wherewithal to do so may soon find that they have bitten off more than they can chew. Then again, they may not. Stress can be loosely defined as a discrepancy between an expectation and an actual outcome, particularly when the latter is unpleasant. Whether it is experienced as a result of unmet expectations (diet is not the be all and end all, after all) or misguided ambition, stress is a leading cause and perpetuator of any disease state and is, therefore, best avoided deliberately whenever it can be.
Distraction: isolation, fear and stress are more likely to breed an inability to see the bigger picture. Not getting the results you hoped for is a very real possibility - more so once stress becomes part of the picture - and nothing at all to be ashamed of. Stuck in a cycle of trying to make your diet more and more perfect, you lose sight of the reality that food is not the only medicine. You become blind to the fact that the very thing you placed faith in for healing - possibly to the exclusion of all else - is now keeping you sick. For food to be truly medicinal, it requires other important cofactorial “medicines” like optimal sleep, stress management and movement and play - all of which may receive scant attention when the minutiae of diet take centre stage.
Deficiency: despite advice to the contrary, not everyone is mindful of the unique nutritional profile of each food. Many dietary triggers are often otherwise healthy, the elimination of which warrants replacement with foods containing the nutrients lost as a result. The removal of dairy, for example, must be acknowledged as a loss of an important source of calcium and every effort should be made to include an appropriate substitute like oily fish with edible bones. The immune system (80% of which resides in the gut) cannot possibly hum along nicely without adequate, high-quality fuel. There is also a tendency to lose sight of macronutrient ratios and it is not at all uncommon to eat less protein, carbohydrate or fat than is required for satiety, optimal sleep and energy, thereby decreasing the likelihood of a desirable outcome. Generally speaking, to get the widest range of nutrients in appreciable amounts, the usual rules apply. I recommend offal at least five times a week (especially if choline-rich eggs are not tolerated) and wild-caught oily fish at least three times a week. Gelatinous cuts of meat, bone broth, wild-caught shellfish (if tolerated), fermented foods, fruits and an incredibly diverse range of vegetables and herbs should be eaten as often as possible. That said, there are no guarantees that absorption of nutrients will be optimal for everyone. It is worth noting that, to a large extent, we are what we - and our beneficial bacteria - eat, what we then absorb and what we do or do not detoxify. Testing rather than guessing should - ideally - play an integral role in determining optimal gut health for best results.
Depletion: depending on the autoimmune disease (and/or its severity), fatigue and impaired mobility could make it impossible to keep up with the level of cooking required to adhere strictly to an elimination protocol. In addition, the novelty of adjusting to eating in a radically different fashion in such a short space of time would require an immense amount of willpower (particularly in the beginning) - a resource thought to deplete over time. Elimination and reintroduction is an extensive process and without addressing the deeper issues that led to poor dietary choices in the past (using evidence-based habit formation - and reversal - tools), a strong desire to rebel or “cheat” could emerge. When supported in this way and guided through a less stringent elimination, other more sustainable inner resources could be employed to ensure a greater chance of compliance and success.
If in doubt, remember:
Things change. A regimen that could not fit in with your lifestyle, symptom presentation or outlook may well do so in the future. By the same token, what works now may not do so in the future. You can always scale back on unsustainable aspirations or ramp things up as the situation dictates. Keep an open mind. Health is a lifelong journey, not a destination.
Seek ongoing professional help. Complementary therapy, nutrient-dense food, supplements, functional tests, etc. all add up. Getting to the bottom of autoimmunity can be an expensive - and lengthy - endeavour. It is tempting to go for long stretches without seeking the advice of a nutritional therapist in an attempt to save money but (as is now, hopefully, apparent) elimination diets - and the necessary subsequent reintroductions - are complex and best done under close supervision. Once fatigue, pain and brain fog begin to lift, this can be perceived as the end of the matter. This is only the beginning and should not diminish the importance of finding and addressing root causes.
Customise. Elimination protocols should never be a substitute for your own detective work. If you know that you are unaffected by an otherwise healthy food on the recommended elimination list (eggs, dairy, nightshades, nuts and seeds, for instance), it is perfectly fine - and, in fact, wise - to include it. Eating the narrowest range of foods possible at a time when the immune system requires more nutrients than ever before, can only be counterproductive to healing. It is entirely possible to initiate your body’s innate healing response by eliminating only your most troubling dietary triggers. Adding certain foods is just as important - often more so - than removing others from a nutritional standpoint. Focusing on what you can eat (rather than foods that are off-limits for the time being) will help you proceed with greater ease and a sunnier disposition.
I see clients at my clinics in Oxfordshire and Warwickshire as well as via Skype. Book a free 15-minute discovery session today to see how I can be of help.