One of the most common questions I get from patients is what or how they should be eating. The goal may be weight loss, better gut health, energy, or longevity. Spoiler alert: there is no one “right” way to eat for everyone, but there are things I factor in when recommending a nutrition plan to my patients. I believe in testing for food sensitivities and inflammation. I like to know if my patients are insulin resistant or pre-diabetic, have autoimmune disease, high triglycerides, or other lipid metabolism issues. I will often investigate digestive capacity by looking at liver, gallbladder, and pancreatic function. All of this plays a part in dietary recommendations for my patients.
Social media is flooded with people advocating certain diets. Veganism, Paleo/Low-Carb, Keto, and even the Carnivore diet are popular right now. There are several things to consider when deciding if any of these is right for you. Let’s break it down and focus on what you need to know.
Being a Vegan is good for the planet, your microbiome, and is an ethically sound choice when it comes to animal rights. It is also very useful for lowering cholesterol and re-booting gut health. However, certain people are just not genetically cut out for it. For example, let’s take vitamin A, which can be found in meat and other animal products as the readily usable form. The plant form of vitamin A is beta carotene, and is abundant in carrots and other orange-colored foods. However, it is not usable by the human body until it is converted to retinol, which requires an enzyme called BCM01. Genetic variants in this gene can greatly reduce a person’s ability to produce vitamin A from dietary beta-carotene. Over time this may result in signs and symptoms of deficiency, like poor night vision, rough bumps on the backs of your arms, or more frequent infections. If you want to try a Vegan diet, be sure you are supplementing with the usable form of vitamin A (retinyl palmitate) and also B12, which is also not found in plants.
The Keto diet has been widely adopted for many reasons, the most popular being weight loss. Certain medical conditions also respond favorably to an ultra-low carb, high-fat regimen like the Keto diet, including Alzheimer’s disease, cancer, diabetes, and PCOS. Since it is a very high-fat diet, not everyone will do well on it. If you have gallbladder issues or have had your gallbladder removed, you may find it very hard to digest the amount of fat in this diet. It is by nature very low in fiber, so if you suffer from constipation, the Keto diet may exacerbate it. One other interesting side effect I’ve seen as a result of a Keto diet is depression. Your gut microbiome thrives on fiber from grains and vegetables. When you dramatically change what you feed your gut bacteria, the populations change. This can affect serotonin production negatively. In some people, this can present as depression. I recommend supporting your microbiome with prebiotic fiber and probiotics if you adopt the Keto diet for any length of time.
The Carnivore diet consists of meat, fish, eggs, high-fat dairy products, and animal fats only. People choose this diet for weight loss, to solve digestive issues like small intestinal bacterial overgrowth (SIBO), yeast overgrowth, and to reduce sugar and carb cravings. It’s an extreme diet, however, and over time can result in deficiencies in micronutrients like folate as well as electrolyte imbalances. It’s a diet best done for short periods of time. I might recommend it for 30 days to a patient with severe refractory SIBO, or during a gut-healing regimen when someone has many food sensitivities.
The Paleo diet has been popular for about 20 years. It’s based on how our paleolithic ancestors ate prior to the agricultural era. It restricts dairy, grains, legumes, and processed food. It includes vegetables, fruits, nuts, roots, meat, poultry, and fish. Although healthy in that it focuses on whole, unprocessed foods, it has been associated with deficiencies of calcium and fiber. Many people choose this diet because it makes them feel less bloated, and helps control symptoms of some chronic disorders like autoimmune disease, or if they are sensitive to wheat or grains in general.
As a believer in personalized medicine, I don’t think there is one right way to eat for everyone. I do believe, however, that what we do 90% of the time counts. If you do not have food intolerances or sensitivities and just need guidelines for smart and clean eating, these are my recommendations:
- Focus on whole, unprocessed, unpreserved food as close to its natural form as possible.
- Don’t over-do the grain. Even whole grains can be inflammatory.
- Eat ethically sourced animal products and sustainably harvested seafood.
- Dairy should be organic and grass-fed when possible.
- Produce should be organic , especially for highly contaminated crops like strawberries, spinach, apples, grapes, etc (see EWG).
- Limit added sugars to 25 grams or less a day.
- Avoid inflammatory seed oils (safflower, sunflower, canola, corn).
- Get enough protein (1 gram per kilogram of body weight) and make it high-quality.
- Filter your water! Forever chemicals are ubiquitous.
- Give yourself 12 hours after dinner before eating again to maintain insulin sensitivity and intestinal hygiene. Some people may need up to 16 hours.