Are You Trying to Restrict Your Diet? Here's How You Can Navigate Through It Successfully.

Are You Trying to Restrict Your Diet? Here's How You Can Navigate Through It Successfully.

   July 26, 2020       AVisenMD

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Are you allergic to gluten or any other food item? Are you dealing with lactose intolerance? Are you trying to lose weight? Are you gripped by a medical condition? If you answered YES to any of the questions above, you most likely eat a RESTRICTIVE DIET.

The main objectives that I am going to cover in this blog are:

1. How and why restrictive diets can lead to significant nutrient gaps and reduce compliance

2. What is Food Phobia and how it relates to restrictive diets

3. How various milk sensitivities differ from each other and what dietary recommendations can be followed

4. How consumers can reduce their fear and incorporate a more diverse meal plan to tackle their food sensitivities

What are the Health Risks of a Restrictive Diet?

While restrictive diets are necessary in certain conditions such as in food allergies, lactose intolerance, weight loss plans and some medical conditions like diabetes and kidney disease, they do not come without their own health risks.

Restrictive diets can cause nutritional imbalance and  deficiencies, especially in those who are not closely monitoring their eating patterns with a health care professional or a nutritionist. Secondly, eating a restricted diet over long term generates fear, or is called 'FOOD PHOBIA', where a consumer is cautious and very fearful of eating something they have eliminated from their diet with the assumption that it will affect their health negatively. Food phobias very often lead to disordered eating pattern where a consumer will binge eat all the foods they ignored, followed by a strong guilt and reintroduction of the old restrictive diet. The more restricted a diet is the lesser the chances are of sticking with it. Consumers can become very resentful of eating, in general, which leads to poor health outcomes.

Children are at the greatest risk of developing nutritional deficiencies due to restrictive diets because they tend to have more allergies and food sensitivities. For example, if a child is experiencing abdominal discomfort, reflux or eczema, parents begin self-treatment at home by eliminating cow's milk entirely from the diet. Another common example is the weight loss diets that restrict calorie intake along with which many nutrients are excluded as well.

In a study that looked at various restrictive diets, like DASH diet and weight loss diets, where participants followed a 1500-2000 calorie diet, it was concluded that they were falling short on 15+ micronutrients like Vitamin E, Vitamin D, Iodine, Chromium etc.

What is the Impact of Restrictive Diet on Long-term Health?

• Restrictive diets that are not balanced can lead to nutrient gaps over long term
• Restrictive diets are a risk factor for abnormal eating patterns/eating disorders
• Restrictive diets reduce compliance and accelerate the disease process
• Example: A diabetic patient on a restrictive diet since long can all of a sudden binge eat due to craving, which will spike the blood sugar levels, worsening diabetes. 

Who is a Restrictive Eater?

• Someone who experiences pain or discomfort upon eating a food like bloating, fullness, gas, heartburn etc. These can be consumers who have food allergies or intolerances.
  
• Someone who is fearful to experience the symptoms again that have been relieved by eliminating certain foods. This includes those who are fearful of weight gain, who avoid all types of sugars (refined and natural), those with medical conditions.
• Someone who is under medical restrictions (those with high blood pressure, celiac disease, Irritate Bowel Syndrome (IBS), kidney disease etc.)
• Someone who has certain personal beliefs like following vegetarian or vegan diet, religious beliefs that eliminate certain food items, belief in fasting etc.
  

Food Allergies vs. Food Sensitivities:

Food allergy is an immune response by the body where smallest amounts of food items can trigger a severe immune reaction and therefore, these foods must be avoided under all circumstances. On the other hand, food sensitivity/intolerance is a reaction triggered by the digestive system in which small amount of food in a particular range can be eaten safely without uncomfortable symptoms.

What is an Elimination Diet?

Elimination diet is a method by which the exact source of food allergy or intolerance can be identified and successfully eliminated from the diet. The first phase is the 'Elimination Phase' where the consumer eliminates a wide range of food item that they believe could be causing the symptoms of gastrointestinal (GI) discomfort, bloating, reflux, heartburn etc. This leads to resolution of symptoms. The second phase is called the 'Reintroduction Phase' where eliminated food items are gradually added back into the diet over the time of weeks in small amounts while monitoring the recurrence of symptoms. Through this procedure, the exact cause of discomfort and symptoms are identified and only that food item is eliminated from the diet.

Navigating Through Dairy Sensitivities:

It is estimated that 65% of the human population has a reduced ability to digest lactose. However, many of these have just assumed they are lactose intolerant without any such medical diagnosis. Recent research suggests that much of the GI distress is caused by a type of milk protein, called BETA CASEIN, rather than the milk sugar, called LACTOSE. Therefore, eliminating all dairy items will relieve the symptoms but it will not determine whether it was beta casein or lactose that was causing the discomfort.

Understanding Beta Casein in Detail:

Roughly one-third of the protein content in milk is beta casein.This milk protein comes in two forms: A1 beta casein and A2 beta casein. Research suggests that the A2 beta casein protein is easier to digest, which may help minimize the gastric discomfort of dairy products.

               

A1 and A2 proteins differ in their structure at the amino acid position 67, where A1 is cleaved into a product that is harder to digest while A2 does not form this by-product and therefore, is easier to digest.

Is it Necessary to Avoid Dairy Products?

National Institute of Health has stated that dairy products provide us with essential nutrients that are difficult to obtain from low-dairy or dairy-free products. This is the main reason why some consumers do not stop consuming dairy even if it causes digestive discomfort. Before restricting all dairy products, it is important to differentiate whether the discomfort and associated symptoms are caused due to lactose intolerance or the difficulty in digesting the beta casein A1 protein.

How to Differentiate Between the Two Milk Sensitivities?

• Hydrogen Breath Test: Lactose intolerance is diagnosed using the 'Hydrogen Breath Test' in which the amount of hydrogen present in the breath is measured. Presence of higher than normal amount in presence of digestive discomfort is used to diagnose lactose intolerance. Basically, when sugars and carbohydrates are easily digested, they do not reach the distant colon. However, when these reach the colon in largely undigested forms, the bacteria present in the colon use them as their energy source and release hydrogen as a by-product. This hydrogen is then absorbed into the blood, which causes an increase in the hydrogen concentration in the breath.
  
• A2 Tolerance Test: For about a week, the consumer is required to eliminate all dairy products from their diet EXCEPT dairy products made ONLY with the A2 beta casein milk protein. Then, over the course of the next week, consumption of dairy products with A2 beta casein milk protein is gradually increased while tracking the tolerance level and any associated GI discomfort. For example, the consumer may begin with half a cup of milk, gradually increasing to 2 cups over the next week. At the end of the week, if no GI discomfort is noted, it can be concluded that the consumer has sensitivity to the A1 beta casein milk protein instead of being lactose intolerant. 

How Dietary Balance Can Be Achieved:

• When any sort of restrictive diet needs to be followed, a health professional or a nutritionist must be consulted to avoid significant nutrient gaps leading to nutritional deficiencies.
• In case of children, their feeding patterns and dietary habits must be monitored closely to ensure adequate nutritional gain for their level of growth and development.
• Healthcare professionals needs to change the direction of conversation with their clients from 'foods to avoid' toward 'food varieties that can be enjoyed' to avoid food resentment and abnormal eating patterns.
• After a thorough discussion with clients regarding their comfort level and properly addressing their food phobias, healthcare professionals should develop a plan to gradually introduce new food items to maximize variety and monitor and trace food sensitivity and intolerance to judge the necessity of appropriate alternatives to maintain proper nutrition.
  
• In case of food sensitivities, additional food sources must be identified to avoid nutrient deficits. For example, in case of gluten sensitivity, which restricts intake of whole grains and fiber, alternate gluten free food sources must be consumed to maximize fiber consumption. These food items can be fruits and vegetables, beans, lentils, brown rice, etc. In case of dairy insensitivity, which restricts the intake of adequate calcium, dairy products with only A2 milk protein may be an alternative.
  

Having a variety of foods incorporated in the daily diet plan not only ensures adequate nutritional balance but also enhances food enjoyment, promotes healthy eating and improves dietary compliance in cases of restrictive diets. Take time to think whether you are avoiding certain food items and what might be the reason behind it. If you have any dietary restrictions, how does it affect your enjoyment of eating? How likely are you to try new food items without hesitation? Let me know your thoughts and comments below!

References:

1.JaworskiM, Panczyk M, Śliwczyński AM, et al.A ten-year longitudinal study of prevalence of eating disorders in the general Polish type 2 diabetes population.Med Sci Monit. 2018;24:9204-9212.

2.WróblewskaB, Szyc AM, Markiewicz LH, Zakrzewska M, Ramoszko E.Increased prevalence of eating disorders as a biopsychosocial implication of food allergy.PLoS One. 2018;13(6):e0198607.

3.KirbyM, Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin North Am.2009;56(5):1085-1103.

4.CaltonJB. Prevalence of micronutrient deficiency in popular diet plans.J Int Soc Sports Nutr. 2010;7:24.

5.Robbins KA, Uygungil B.Nutritional deficiencies and food allergy. J Allergy Clin Immunol Pract.2017;5(2):528-529.

6.JaworskiM, Panczyk M, Cedro M, Kucharska A.Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator. Patient Prefer Adherence. 2018;12:163-174.

7.Study finds that adherence to diet, not type of diet, more important factor for losing weight. ScienceDailywebsite. https://www.sciencedaily.com/releases/2005/01/050111122137.htm. Published January 14, 2005.

8.NelsonM, Ogden J. An exploration of food intolerance in the primary care setting: the general practitioner's experience. Soc Sci Med.2008;67(6):1038-1045.

9.US Department of Health and Human Services;US Department of Agriculture. Dietary Guidelines for Americans2015–2020: EighthEdition. https://health.gov/dietaryguidelines/2015/guidelines/. Published January 7, 2016.

10.He M,Sun J, Jiang ZQ, Yang YX. Effects of cow’s milk beta-casein variants on symptoms of milk intolerance in Chinese adults: a multicentre, randomised controlled study. Nutr J.2017;16(1):72.

11.Jianqin S, Leiming X, Lu X, Yelland GW, Ni J, Clarke AJ. Effects of milk containing only A2 beta casein versus milk containing both A1 and A2 beta casein proteins on gastrointestinal physiology, symptoms of discomfort, and cognitive behavior of people with self-reported intolerance to traditional cows’ milk. Nutr J.2016;15:35.

12.Asledottir T, Le T, Petrat-Melin B, Devold TG, Larsen LB, Vegarud GE. Identification of bioactive peptides and quantification of β-casomorphin-7 from bovine β-casein A1, A2 and I after ex vivo gastrointestinal digestion. IntDairy J.2017;71.