Therapeutic diets have hit the mainstream and there are numerous options to choose from, many of which can seem overwhelming or restrictive. I use therapeutic diets regularly in my functional nutrition practice and they can be immensely helpful to clients when used strategically. Let’s discuss what you need to know about therapeutic diets and how to choose the best one for your health and well-being.
What Are Therapeutic Diets?
A therapeutic diet is a targeted nutrition plan imposed for a short period of time to address a specific health issue and encourage healing. Most therapeutic diets focus on consuming very specific foods or nutrients and strictly avoiding others. Then, once you bring your body back to balance and good health, you can begin to re-introduce restricted foods back into your diet.
Some therapeutic diets – including a few discussed below – have mutated from short-term plans into permanent lifestyle changes. Most therapeutic diets, due to their restrictive nature, were originally intended to be temporary. Once the health problem was resolved, normal eating would resume. Nowadays, given the tremendous number of burdens our bodies deal with sometimes it takes months or even years to bring our health back into balance and to be able to build resilience. While there are those of us who may benefit from a long-term therapeutic diet, for the most part these diets are more effective when they aren’t followed forever. The reason? Our bodies change and evolve over time and our dietary protocols must change, too. What may have worked 10 years ago may not remain effective now or 10 years in the future.
People often ask me what diet I follow and the answer is always the same: I’m a Josh-a-tarian. During the last couple of decades I have explored many different diets that supply my body with a variety of nutrients for optimal health, whether I’m training for exercise performance, building immunity, bolstering brain health, focusing on preconception planning, and everything in between.
Key Therapeutic Diets and How They Work
Therapeutic diets rise and fall in popularity. During my last decade in nutrition practice, these are the therapeutic diets I’ve used regularly with the most success with clients. There are some common threads throughout these diets: they involve cutting out heavily processed foods and sugar, are plant-based, and focus on including fresh, whole ingredients that are often cooked from scratch.
Paleolithic Diet (Paleo)
What Is It?
The Paleo diet follows what our ancestors likely ate during the Paleolithic period, before the rise of agriculture. Also called the stone age, hunter-gatherer or caveman diet, Paleo eating includes plants, eggs, sustainable meat, fish, herbs, spices, nuts and seeds, and eschews grains, beans, legumes and dairy products.
The Paleolithic diet is commonly used for weight loss, and evidence indicates it can help improve satiety by secreting hormones that make us feel full and amend metabolic syndrome, a cluster of conditions that include obesity, cardiovascular disease and insulin resistance.
Paleo eating is effective for blood sugar control and reducing cardiovascular risk factors, as well as lowering inflammation, and improving dental health. It can also foster gut health: a study of modern hunter-gatherers found that their diet, which is similar to what Paleolithic humans ate, produced a richer and more diverse microbial community in the digestive tract compared to controls eating a more Mediterranean-style regime. Paleo diets are rich in fiber, too, which is essential for digestive health and eliminating wastes.
Cons: Paleo dieting can be very challenging for vegans and vegetarians, and may be pricey if you eat a lot of expensive nuts, seeds and animal products.
Autoimmune Protocol Diet (AIP)
What Is It?
Also referred to as the Autoimmune Paleo Diet, AIP is a variation of the Paleo diet with stricter guidelines. The AIP diet is designed for those dealing with autoimmune diseases and it removes foods that stimulate the immune system and worsen intestinal permeability, or leaky gut. The earlier phases of the diet banish grains, dairy, legumes, eggs, nightshade vegetables, nuts, seeds (including seed-based spices), alcohol, food additives, and some natural sweeteners like stevia. As you heal, you add in foods one by one in a set order.
The AIP diet is a nutrient-dense protocol and patients report improved digestion and a reduction in symptoms. Scientists are only beginning to study the specifics of the AIP diet, but so far there have been promising studies about its ability to help patients with inflammatory bowel diseases, Hashimoto’s and rheumatoid arthritis.
Cons: The prohibited list of foods can be daunting, and this is not a diet for vegans or vegetarians.
Low FODMAP Diet
What Is It?
FODMAP stands for fermentable oligosaccharides, disaccharides, monosacchardies and polyols. These are specific short-chain carbohydrates that aren’t broken down in the digestive tract and once they reach the colon, they are fermented by bacteria leading to bloating, gas, cramps, diarrhea or constipation. A low FODMAP diet starves these carb-hungry organisms and changes our gut ecology, as well as reduces the amount of water drawn into the gut. Many foods contain FODMAPs – you can find a FODMAP foods list here.
Low FODMAP diets are primarily used for people with irritable bowel syndrome (IBS). Studies have shown that low FODMAP diets can provide symptom relief for IBS patients, decreasing gas, bloating and pain.
Cons: It can be tricky to keep track of all of the low FODMAP foods, and challenging to dine out or consume pre-prepared foods (which isn’t necessarily a bad thing!). Some research indicates that in the long-term, a low FODMAP diet may negatively alter gut bacteria by reducing beneficial microbes and increasing the unfavorable organisms, which may cause the very symptoms that led to trying the diet in the first place.
Specific Carbohydrate Diet (SCD)
What Is It?
The Specific Carbohydrate Diet was developed by a pediatrician in the 1920s to treat celiac disease, but is now primarily used as a diet therapy for inflammatory bowel diseases. It’s a grain-free diet and similar to the low FODMAP plan, SCD limits certain carbohydrates. SCD allows simple sugars and monosaccharides that are less work to break down, and prohibits more complex carbohydrate and sugar chains such as disaccharides, polysacchardies, lactose and sucrose. You can find the full list of SCD foods here. The reasoning behind this diet is it will help reduce inflammation, encourage mucosal healing, boost immunity and create a diverse community of microbes in the gut.
Some evidence has shown that the Specific Carbohydrate Diet can improve symptoms in IBD patients, alter their gut microbiome and even induce remission in some cases. It can also be an effective diet for children with IBD, alleviating symptoms and healing mucosal tissue.
Cons: This diet requires strict adherence and can be tough for some to follow. As with the low FODMAP diet, there are some indications that SCD may alter the gut microbiome and not always for the better.
Ketogenic Diet (Keto)
What Is It?
The ketogenic diet was first implemented in the early 1920s as a treatment for epilepsy, and today it’s still used as an option to manage and prevent seizures in adults and children. The keto diet is a high fat and very low carb diet, with low to moderate amounts of protein depending on which expert you consult with. Normally, our bodies use the glucose from carbohydrates as our main source of energy. In the absence of carbs our body will launch into ketosis, drawing upon stored fat for energy. Staples of the keto diet include oils like coconut and olive, avocados, meat, eggs, dairy, fish, poultry, nuts, seeds and non-starchy vegetables. Similar to the Paleo diet, keto prohibits beans, legumes, refined sugars, and grains, and also vetos starchy fruits and starchy vegetables like potatoes and root veggies.
Ketosis produces some rapid changes in the body, including increased fat burning, blood sugar balance and accelerated weight loss. It can promote weight loss and improve body composition, and reduce cardiovascular risk factors.
As our brains are about 60% fat and ketones can cross the blood-brain barrier (the layer of cells that protect the brain), keto diets have been studied for their effects on the brain and nervous system. Ketogenic eating may improve cognition, lower the risk of brain diseases such as Alzheimer’s, fight brain inflammation and brain aging, and improve recovery after brain injury.
Cons: There is an adjustment period to the keto diet and you may experience some negative side effects like nausea, vomiting, dizziness, insomnia, cramping, constipation, diarrhea or weakness, also known as the ‘keto flu’. It can be very difficult to follow the ketogenic diet in both the short and long term, and it’s nearly impossible to follow this diet as a vegan.
What Is It?
The elemental diet is a liquid formula of vitamins, minerals, amino acids, carbohydrates, electrolytes and fats. It is most often used in gastrointestinal disorders and inflammatory bowel diseases to give the digestive tract a rest through nutrition that is easy to assimilate and digest. Sometimes the elemental diet is administered though a feeding tube, or it is consumed through a liquid meal replacement beverage.
Elemental diets are usually well tolerated and can give the digestive tract a rest from breaking down foods, especially those that are fibrous. They can improve symptoms and nutrient concentrations in patients with inflammatory bowel diseases like Crohn’s, benefit patients with pancreatitis, HIV, cerebral palsy, and cystic fibrosis, and help malnourished seniors and children.
Cons: It can be an emotional hurdle to stop eating food and solely consume liquids, even if it’s only for a couple of weeks. Some of the meal replacement beverages can be very sweet, taste chalky and contain the forms of vitamins and minerals that are less bioavailable for our bodies to use.
Which of These Therapeutic Diets Is Right for You?
Dietary protocols must be unique to the person following it. In my practice, each diet is customized to each patient based on their symptoms, blood work and other tests, lifestyle, supplements required and perhaps most importantly, commitment level. Therapeutic diets are strict for a reason and compliance is much more likely to yield positive results. I recommend patients follow a therapeutic diet for at least 8 to 12 weeks in order to determine whether it is working and what needs to be adjusted for better results.
Following a therapeutic diet may result in some nutrient deficiencies or additional health problems if they’re not followed in a planned, careful and thoughtful manner. Working with a health practitioner, doctor or nutrition expert is immensely helpful, as is using a printed or online resource guide (many of the therapeutic diets I’ve discussed have detailed step-by-step guides that can be found online or at your local library).
Therapeutic diets are an important tool in your health toolbox and may be a missing link that can help you build your health!