Dietary Restriction and Healing – Are Restrictive Diets Required for Healing?

Written by: Ryah Nabielski, MS, RDN

The new year is notorious for health-related resolutions that often involve restrictive diets and other extreme measures. Most resolutions, and most (fad, restrictive, weight-loss) diets, fail. But what about the restrictive diets prescribed by your doctor or another healthcare professional? Are they different?

Many clients come to me following a restrictive diet suggested by a functional medicine doctor or online health influencer. These diets often target a specific condition such as an autoimmune disease, digestive disorder, or another diagnosis.

Over time, restricted diets can impede healing because of nutrient deficiencies, food fears, and other side effects of overly restricted plans. You can’t heal when you are under-nourished: recovery requires abundant nutrition – both macro and micronutrients.

That’s not to say there isn’t a place for therapeutic diets if they are personalized, meet nutrient needs, and involve a plan for diet expansion over time.

Keep reading for more of my thoughts on:

·      Red flags to watch out for when prescribed a diet plan

·      Thinking about food as medicine

·      The pros and cons of therapeutic diets

·      How to approach a therapeutic diet and maximize healing (my approach)

Restrictive Diet Red Flags

At some point in the nutrition and functional medicine spheres, food restrictions became the norm. It’s common to seek help from a natural or holistic healthcare provider who prescribes a restrictive diet.

There are many cases where some of these approaches might make sense for an individual, but food restriction is not synonymous with healing.

When you receive a diet plan from your practitioner, here are some red flags to watch for:

• The provider prescribes the same diet to everyone with the same condition, without personalization. For example, you might receive a generic handout about a low FODMAP diet when diagnosed with SIBO.

• There is no discussion of how long to follow the diet or how to reintroduce foods. Are you supposed to follow the plan forever?

• All the focus is on the foods to avoid, which might be demonized or determined to be “bad.”

• There is little or no discussion of what foods to eat and how to implement the diet while meeting the body’s nutrition needs.

• There is no discussion about your relationship with food and what food restrictions might mean for your mental and emotional health.

• The plan doesn’t empower you to connect with your body and discover what works for you.

• You don’t get any pleasure from what you are eating.

• Figuring out what to eat is a source of stress.

• You don’t receive a referral to a knowledgeable dietitian nutritionist for support and implementation. Most doctors have little training in nutrition nor the time to spend on the details with you.

Food As Medicine for Healing

Some doctors tell patients that diet change won’t affect their Crohn’s disease, IBS, PMS, thyroid hormone levels, etc. But what I’ve seen in practice is that food profoundly impacts health.

At the heart of functional medicine is the idea that all body systems are connected. What we eat (and how we eat + our relationship to food) influences our health. Beyond calories and nutrients, food is information that talks to our cells and influences genetic expression.

Shifting what we eat helps to:

·      Lower inflammation

·      Improve digestive function and microbiome balance

·      Cool the autoimmune process

·      Balance hormones (support hormone production, detoxification, and clearance)

·      Balance blood sugar and reverse insulin resistance

·      And so much more!

Diet change is often most helpful along with other interventions, but diet is always foundational.  

The Role Of Therapeutic Diets – Pros and Cons

Sometimes shifting health means restricting certain foods while eating more of others.

Examples of therapeutic diets include:

·      Elimination diet

·      Low FODMAP diet

·      AIP diet (autoimmune protocol diet)

·      Low-carb diet or keto diet

·      Low histamine diet

·      Many others

At their best, these diets are used as short-term interventions to identify inflammatory foods, calm symptoms, and rest the digestive tract. A therapeutic diet is a tool to empower you to connect with your body and understand how specific foods make you feel. And while following the diet, other root causes are identified and addressed.

At their worst, following these diets for long periods without personalization and adjustments might lead to unintended consequences, including:

·      Negative impact on the microbiome due to less diversity in diet

·      Increased fear and obsession with food

·      More food restriction

·      Decreased tolerance to specific foods

·      Decreased quality of life

·      Increased stress

·      Nutrient deficiencies

·      Increased symptoms and poor health

·      Orthorexia - an eating disorder characterized by an obsessive focus on “healthy” food

If you are working to heal a chronic condition by following a restrictive plan and notice you are not improving or getting worse, you may be undernourished. Expanding the diet and using some of the tools below can help.

How To Approach a Therapeutic Diet

I do use therapeutic diets in my practice, but I use them differently, in a different context. Here’s how to get all the benefits of a therapeutic diet without negatively impacting your health over time:

·      Transition to a real food diet. This part is essential and often why you initially feel better on a therapeutic plan. If you do just one thing, I suggest eating real food and ditching packaged, processed, and toxin-laden food products. This will change your health. Then, within this context, work on personalization.

·      Work with a nutritionist for guidance. Everybody is an individual, and there isn’t a one-size-fits-all approach. Even if two people have the same condition, their nutrition plans may differ because they have unique underlying factors. In addition, it’s important to work with a nutritionist who will collaborate with you. I know a lot about nutrition, but you know the most about living in your body, so we work together.

·      Consider a therapeutic diet a short-term intervention. After a period following your therapeutic plan and noticing symptom improvement, systematically work to expand the diet while maintaining the benefits you’ve experienced. (This process can often be confusing; having guidance and support is helpful). The goal is to have the most expansive (real food) diet that supports your health and makes you feel good.

·      Focus on nourishment instead of restriction. It’s easy to focus on what you can’t eat and the challenges of following an elimination diet or other therapeutic plan. Instead, focus on nourishment. Through food reintroductions, you’ll become more connected to your body, understand how different foods make you feel, and how to nourish your body. With this new information, you can make an informed choice whenever you eat.

·      Adopt an inside-out mindset. You may expect an outside-in approach, where you blindly follow a plan that someone gives you, trusting they know what is best for you. An inside-out approach lets you steer the ship. Turn into your curiosity and let your body guide you. It involves experimenting to discover what works for you and what doesn’t. Instead of constantly looking outside yourself to the next diet or fad to follow, you turn inward for guidance.

·      Consider how you are eating. Most focus in nutrition is on what to eat. However, how you are eating impacts digestion, nutrient absorption, stress levels, and more. Consider the state of your nervous system when you eat and what part of you are bringing to the table. Improving your relationship with food will help you succeed in your health goals.  

·      Make room for pleasure. One of the best parts of being human is feeling pleasure from the food we eat. Bringing pleasure into your eating experiences (and your life in other ways) supports healing.

·      Address stress. If stress levels are high, it may not be the right time to add the stress of diet change. Working on stress reduction and stress management helps increase your capacity to make nutrition and lifestyle changes. Consider mindfulness, self-compassion, meditation, breathing exercises, somatic work, yoga, tai chi, therapy, journaling, and other tools.

Bottom Line

Therapeutic diets in a healthy, real food context can promote healing. But you want to make sure they are short-term, personalized, and there is a plan for expansion and moving forward. Let go of the restriction mentality and embrace curiosity, body wisdom, and a mindset of experimentation. For my clients, therapeutic diets often lead to intuitive eating and new confidence in navigating nutrition throughout life.