Therapeutic diets

All systems of medicine use diet in one form or another. Conventional doctors are concerned about patients both being overweight and underweight, as well as the quality and type of food that forms part of the modern diet. There are, however, a number of diets that are part of a complementary medical approach.

DIETS AS PART OF TREATMENT

A traditional Chinese doctor may not only recommend acupuncture and various herbs, but also a specific dietary regimen tailored to the individual’s constitution. Other complementary therapies, including naturopathy (see page 90), use fasts to clear out ‘toxins’ before beginning a more specific treatment regimen.

DISEASE-SPECIFIC DIETS

Particular diets to treat arthritis are not uncommon – for example, avoiding ‘acidic’ foods such as tomatoes and citrus fruits or introducing specific foods such as cider vinegar. People with catarrh or other chesty symptoms are often given milk-exclusion or milk-free diets to decrease mucus secretion.

FOOD-AVOIDANCE DIETS

These diets are suggested to treat a specific illness. Childhood eczema or irritable bowel syndrome may sometimes be managed by an individually tailored diet. Specific-food avoidance regimens are a controversial area and one in which there may be conflict between conventionally trained and medically qualified allergists and CAM practitioners.

ALLERGY AND INTOLERANCE

Food allergy is a very clear and unpleasant reaction to food. For example, if somebody is allergic to shrimps or peanuts they will, within a fairly short time of eating them (usually minutes), experience an immediate allergic reaction. This reaction may give rise to unpleasant swellings in the face or throat and, sometimes, acute asthma. Usually these reactions pass within 20 or 30 minutes and can be treated with anti-allergic drugs such as antihistamines. Sometimes, however, they can be potentially life threatening because they progress to anaphylactic shock. Anaphylaxis is a very acute allergic reaction in which the throat and breathing tube become so swollen that they close up for a short period of time. Anaphylaxis is completely reversible with an injection of adrenaline.
Food allergy is usually quite straightforward to diagnose using blood and skin tests. Once the culprit food or foods have been identified, the person concerned must avoid them completely for the rest of their life. If you have a true food allergy, you must seek the advice of a conventional allergist and carry an adrenaline injection with you at all times in case you unknowingly eat the food to which you are allergic.
Food intolerance works through different mechanisms from allergy, although these mechanisms have not yet been clearly defined. From a medical standpoint, various conditions will improve with long-term food avoidance. These include migraine, arthritis, inappropriate or hyperactive behaviour among children, childhood eczema, irritable bowel syndrome and inflammatory bowel disease, such as colitis and Crohn’s disease. All of these conditions have been shown to have a dietary link. There is no particular food for any specific condition – each individual will need to follow their own unique diet to improve their condition.
Although the mechanism of food intolerance is unknown, it is clear that people with these conditions may be ‘addicted’ to the food to which they are intolerant. For example, a child with eczema may be eating mainly milk, yoghurt and cheese, and it may be milk that is aggravating or causing his or her eczema. Food addiction often runs side by side with food intolerance.
Food intolerance is masked. This means that until the susceptible person has avoided the food, often for three or four weeks, there may be no improvement in their symptoms. While the phenomenon of food intolerance is well documented, and there are a number of studies demonstrating the benefit of avoiding ‘culprit’ foods, there is no completely reliable method for diagnosing food intolerance.
• Putting people on diets that are unlikely to contain triggers for allergy or food intolerance is the simplest diagnostic process but takes a long time. For instance, a ‘stone age’ diet of fruit, meat and a few vegetables will often clear the symptoms over a three- or four-week period. Other foods then need to be reintroduced very slowly and the person’s acute reaction carefully monitored over a month or two to identify the foods to which they are intolerant.

• Various unconventional tests have been used to work out ‘safe’ and ‘unsafe’ foods on an individual basis. Some involve unconventional blood tests in which food extracts are placed in a small tube along with red and white blood cells, and the reaction of the blood cells is monitored microscopically. None of these tests is com­pletely reliable and none has been satisfactorily scientifically validated. However, both prac­titioners and patients may find some of these tests useful in sorting out their food intoler­ances while we await further research.

DO DIETS PRODUCE BENEFIT?

Eating less ‘junk food’ would certainly benefit the health of both adults and children. There is also clear evidence that specific food-avoidance diets can help with certain conditions.
The use of dietary intervention in childhood behavioural problems has been discussed in the medical literature for the last 45 years and, although diets are not the only way of managing this condition, the evidence that they may be effective in a significant proportion of children is impressive. People with bowel inflammation have fewer relapses if they avoid the specific foods that upset them.
Although medical experts know that food intolerance does have an effect on some illnesses, there is much confusion about how the principles should be applied by doctors when treating their patients. This is partly because there is no clear explanation for how dietary changes might be working and because of the very uncon­ventional and unreliable nature of the tests that are employed to ‘unmask’ food intolerance.

WHAT DOES TREATMENT INVOLVE?

Before embarking on a long-term diet that you have read about in a book, seek advice from your GP, a relevant specialist or a dietitian. What is likely to happen in a consultation about your diet will, to some extent, depend on the methods used to try to isolate your food intolerance. If this is primarily based on dietary avoidance and food reintroduction then you may need several consultations and it will be quite a long process. If one of the unconventional diagnostic methods is used, the diagnostic process may be quite short and you may simply be asked to follow a specific diet for four to six weeks before returning to discuss your symptoms.
You should never be left on a long-term diet without a follow-up appointment within one to two months. Diets should always be used as part of your overall management plan and you should always be supported with appropriate nutritional advice. This will ensure that any diet you use in the long term to control your symptoms does not result in any vitamin or mineral deficiencies a year or two later.

IS DIETARY AVOIDANCE SAFE?

In general, and in responsible hands, dietary treatment is a particularly safe approach to illness. Such diets are also very em­powering in that you can begin to control your own illness through the foods that you eat.
There are two major potential problems, however, with using food avoidance diets in the long term. The first is the possible risk of developing nutritional deficiencies – this can be avoided with appropriate follow-up appointments and sound nutritional advice.
The second is that long-term diets can be psychologically damaging and can, in effect, become part of a more generalised eating disorder. For example, telling an obsessional young woman to avoid milk or wheat on a long-term basis may actually fuel a pre­existing tendency for her to develop an eating disorder. Diets therefore need to be used in a responsible and conscientious manner.

WHOM SHOULD I SEE?

Nutritional advice is provided by a wide range of complementary and conventional medical practitioners. The British Society for Allergy, Environmental and Nutritional Medicine is open only to doctors, and their members provide advice about both nutritional supplements and food avoidance diets.
Dietitians are qualified registered individuals who work with doctors within the NHS and can provide advice about nutritionally adequate diets, although in general they have limited expertise about food intolerance and food avoidance. Your can contact a dietitian through the British Dietetic Association. Details of these organisations can be found in ‘Useful addresses’ on page 104.
Naturopaths, who use a therapeutic system based on the concept of ‘nature cure’, almost invariably incorporate dietary intervention into their practice as well as exercise, homeopathy, herbal medicine and often some acupuncture as well. There are a relatively small number of naturopaths in the UK – it is a much more popular speciality in certain parts of the USA. To find a naturopath in your area, contact the General Council and Register of Naturopaths.
The British Association of Nutritional Therapists encompasses complementary practitioners who are not medically qualified, but are trained in nutritional medicine, and who recommend a wide variety of different nutritional and dietary approaches.