"The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and the cause and prevention of disease" Thomas Edison

Always discuss any dietary interventions you make with your regular physician, as changes in diets can affect medications that you are taking. Although, diets benefit many chronic conditions, they are not a replacement for appropriate diagnosis and treatment.

Nutritional Approaches to Chronic Disease

Katarzyna Ferraro MD ABOIM

It has been known for quite some time that nutrition can dramatically improve general health and wellness. We are all aware of the benefits diets for weight loss, management of diabetes and prevention/management of diseases. As with medications, diets are not a one size fits all and each individual has different nutritional needs and resources available to them. These are a few diets that may be recommended after an evaluation at The Center for Holistic Medicine.

Gluten free diets

Gluten is a dietary protein found in wheat, barley, spelt, kamut and rye. It is a ubiquitous protein and is found in the majority of processed foods. Gluten is a peptide(small protein) that can cause inflammation in the gastrointestinal tract and also binds to a receptor on the wall of the gut (1) This opens up the lining of the GI tract for the absorption of larger protein molecules. The body's immune system is very closely associated with the gastrointestinal tract. When it sees large proteins rather than individual amino acids, it can create inflammation. If those proteins look like other parts of the body, autoimmunity(Your immune system thinking that your joints, or your thyroid or your skin are not your own and hence rheumatoid arthritis, hashimotos thyroiditis etc.) can occur. Gluten free diets are a staple for anyone with autoimmune disease, especially celiac disease. Gluten free and Dairy free diets are also associated with improved symptoms of autism spectrum disorder in many cases. (2)

Milk free and Casein free diets

It is estimated that 75% of the world's population is lactose intolerant. This is a deficiency of an enzyme in the gastrointestinal tract that breaks down the disacharride lactose. When the enzyme is not working or is not present it can lead to gas, bloating diarrhea and other digestive discomforts. Beyond lactose problems, there are also conditions in which individuals can be sensitive to the milk protein "casein". This is seen quite commonly in autism spectrum disorder, leading to colicky symptoms as a baby(4), frequent ear infections(3) and also developmental delays(2).

One of the new theories is that many of these children form a molecule called casomorphin which acts like it sounds, like a narcotic in the body.  This can cause these children to have a high pain tolerance and promotes lack of social engagement. Dr. Reichelt in Norway, Dr. Cade at the University of Florida and others have found elevated casomorphin petide in urine samples from people with autism, PDD, celiac disease and schizophrenia.

A second theory for milk intolerance in autism, is the discovery of folate receptor blocking antibodies. (5) When an individual ingests milk, who has a susceptibility to this autoimmune condition they create antibodies to the folate receptor. By removing milk from the diet, many of these individuals can have reversal of some the neurologic symptoms of autism(especially if recognized before the age of 3). The folate receptor is necessary for the B vitamin folic acid to enter the brain. If the brain is deprived of folic acid, neurologic conditions like symptoms of autism can develop.

Specific Carbohydrate diet/GAPS diet

These diets are very good for individuals with inflammatory bowel diseases, such as ulcerative colitis, crohn's disease or autistic colitis. They are restrictive diets, often limiting the amount of carbohydrates that are premitted. The diets, however, are excellent for controlling yeast symptoms and also dysbiosis(abnormal germ overgrowth in the bowels). It is recommended that you read the books "Breaking the Viscious Cycle" by Elaine Gotshall or "The Gut and Psychology Syndrome" by Natasha Campbell McBride if you are considering this nutritional intervention. These books provide the basic foundation for these dietary approaches.

Elimination diets

There are many forms of elimination diets. The simplest ones involve the removal of 1-2 food substances such as gluten and/or dairy from the diet. At the Center for Holistic Medicine we provide a comprehensive elimination diet that removes the top 12 food allergens.  Some of these include eggs, dairy, gluten, soy and peanuts.  The diet focuses on whole and organic real foods.  Elimination diets remove artificial flavors, sweeteners and preservatives.  Many of these compounds are petroleum derived, toxic to the nervous system, destructive to the gut microbiome and also lead to negative metabolic effects.

In addition to the above options, elimination diets can also be individualized.  This is often done by using food sensitivity testing( IgG food reactions and others) to uncover less common but uniquely problematic food substances for an individual. Unlike typical allergies that present with immediate symptoms, these reactions can be delayed, occurring 3-6 days after ingesting a food.  Food intolerances can be difficult to uncover, as they can present days later with symptoms like; fatigue, muscle aches, headaches, nausea and malaise.

Paleo and Autoimmune paleo diets

These ancestral diets can be helpful to individuals with autoimmune conditions including rheumatoid arthritis, hashimotos thyroiditis, psoriasis and others.  The diets involve the removal of grains, legumes and sugars in addition to processed foods. These diets are restrictive, and focus on what you CAN eat reather than what you cannot eat.  They are considered an ancestal approach to diet, which is how they got their name.  Grains are considered inflammatory in nature and were not a part of the traditional diet years ago.  When they were consumed, it was in small quantities and completely unrefined, providing plenty of fiber and plant nutrients. One of theoretical benefits of this style of diet, is that it communicates well with our genetics(These are food substances that have been consumed during evolution). Paleo diets are nootably friendly to the immune system and they frequently are associated with improvements in autoimmunity and inflammation.

There are many renditions of these diets, among them is the autoimmune paleo diet which restricts grains, sugars and legumes, and also certain nuts and eggs.  When you are following these diets, it is important to be aware of nutritional depletions that can be associated with them.  This is especially true in the developing pediatric population as well as the elderly and malnourished population.

Ketogenic Diets

The ketogenic diet is another popular dietary approach.  These diets have been associated with, improvements in blood sugar, decreased systemic yeast, improvement in some cancer treatments and other immune conditions. 70 percent or more of the calories in ketogenic diets come from healthy fats.  This is a low carbohydrate and moderate protein diet.  Ketogenic diets are frequently prescribed to individuals who are having weight loss plateaus, difficulty maintaining blood sugars or history of metabolic conditions.

Fasting and other nutritional interventions

Fasting and intermittent fasting is another nutritional approach for various medical conditions.  Fasting has been around for centuries as part of many cultures and religions as a cleansing process. Similarly, this dietary approach from a medical perspective is considered a good way to help the body detoxify( cleanse) and reset the metabolism.  That being said,  it is encouraged that you discuss this option  with your medical practitioner prior to starting this dietary regime.  It is especially important, if you are taking any medications for diabetes or metabolic syndrome, as the combination of fasting and certain medications can result in low blood sugar levels, which can have severe consequences.

  1. Fasano, Physiol Rev January 1, 2011 vol. 91 no. 1 151-175
  2. Nutr Clin Pract. 2008 Dec-2009 Jan;23(6):583-8.
  3. Acta Otolaryngol. 1999;119(8):867-73.
  4. Paediatr Child Health. 2011 January; 16(1): 47?49.
  5. Molecular Psychiatry advance online publication 10 January 2012; doi: 10.1038/ mp.2011.175.

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