Nutritional Detoxification: Analyzing and Changing a Patient's Diet

In previous articles, we have discussed the importance of identifying any definite or possible sources of external toxins for those patients who seek nutritional detoxification. My point with this article is to simply remind you to consider external contributing factors, rule them out and/or address them prior to tackling a patient's diet.

Diet Analysis

Before you change a patient's diet, you must know their diet. The goal of a diet analysis is to get an idea of the foods primarily consumed, enjoyed, disliked and avoided. Most people derive the majority of their energy from less than 15 different sources. I will analyze the diet in the following order: breakfast, morning snack, lunch, afternoon snack, dinner and dessert/bedtime snack.

Using breakfast as an example, a typical exchange would be as follows: "Do you eat breakfast? If so, how many days a week? What do you eat?" The patient typically will answer such as, "I have cereal most days, eggs sometimes, occasionally a muffin or pastry, and, if I'm late, I skip." I then ask how many days a week they skip breakfast. If they have an unsure answer, I will then ask, "Is it fair to say you skip breakfast four days a month?" If the answer is yes, then the average is once a week even though the occurrences are not regular. If the answer is no, I will continue to probe until I determine how often breakfast is skipped. I would then address their other statements about breakfast.

"You said you have cereal on most days. Is 'most days' four to five, or..." The patient normally interjects with a number. I would follow that question by asking what kind(s) and quantities of cereal, milk, side dishes and beverages are consumed. Using this same approach for the other days, I boil down a typical week and then repeat my findings to the patient for confirmation. It would sound like this:

"So, is it fair to say you eat corn flakes with low-fat milk two to three times a week and Raisin Bran one to two days a week? Non-fat yogurt accompanies your cereal two days a week. Once a week, you eat a second bowl. On Sundays, you have a big breakfast out and usually have two fried eggs, three sausage links, either two pancakes or hash browns, and a piece of toast with butter and jelly. You always have one cup of coffee with cream and sugar, and only drink juice on weekends."

If the patient confirms my summary, questioning is repeated in the same fashion for the rest of the day. You will find as the day gets later, the variety of food increases. That is, lunch varies more than breakfast and dinner varies more than lunch. Therefore, it normally takes more time to determine those meal patterns. The good news is, once completed, your chances for success increase because this data is much more accurate than what is obtained by questionnaires or computer programs.

Food Allergies

Next, I ask about food allergies. If they have identified food allergies, I take a detailed history. This includes when they were diagnosed, how they were diagnosed and what happens if the food(s) are intentionally or inadvertently consumed. It's not uncommon for those who have had previous professional nutritional intervention to discover that some allergic foods actually are safe. Normally, these are the foods that were identified by some type of test other than elimination-provocation (E-P). Whenever I hear, "They told me I was allergic to so-and-so, but it never bothered me," I will E-P test because of the wide margin of error seen in various food allergy tests. If a person doesn't react following E-P challenges, I don't withhold the food.

If they are unaware of food allergies, I will question them in detail about their presenting complaints and look for any possible food-symptom connections. Most patients are surprised to learn we often will crave reactive foods, especially when the reaction is delayed. If we identify any potentially irritating foods, they are eliminated for three-week periods. Many times provocation is unnecessary because the patient will begin to feel better when the food is discontinued. Sometimes food sensitivities aren't noticed until provocation (reintroduction). I only eliminate one food type at a time to ensure the information obtained (whether it's positive or negative) accurately relates to the specific food.

Bad Foods Are More Harmful Than Good Foods Are Helpful

This concept is not hip, trendy, fun, cool or politically correct for those who market cleansing/detox kits, products and programs. It does not generate product sales. But it does address the root cause of why the patient is in your office. And the application is not complicated - stop eating all the ____! Unfortunately, it's a 24/7 challenge of willpower and discipline for most people to follow. Why? Because bad food is not only easily available, it tastes great. Think about the following:

• Lack of omega-3 or an excess of saturated fat?
• Lack of broccoli and apples or an excess of cookies and candy?
• Lack of dietary fiber or an excess of dietary sugar?
• Lack of water or an excess of soda?
• Lack of raw food or an excess of junk food?
• Lack of nutritional supplements or an excess of medications?

Detoxification Equals Stopping the Pollution

I have suggested in previous articles that we make sure to identify and either eliminate or reduce external sources of pollution. To complete the task of cleansing, we must stop the ingestion of bad foods and reactive/allergic foods, which also are pollutants. I define bad foods as foods that include rich sugars, sodium, saturated fat, trans-fat, preservatives, colorings, stabilizers and other polysyllabic additives. Refined grains, along with processed, high-calorie, low-nutrient foods are also quarantined. Some examples of specific foods requiring elimination include: candy, potato and corn chips, crackers, pretzels, cookies, cake, pie, donuts and danish, pizza, burgers, hot dogs, wings, sausage, bacon, pepperoni, salami, bologna, ice cream, french fries, onion rings, fried chicken, fatty cuts of beef, pork and fowl, white bread, white pasta, and foods high in sodium, such as most canned, frozen and restaurant food. Prohibited beverages for a dietary cleanse would include beer, wine, mixed drinks, diet soda, regular soda, blended coffee drinks, sugary aids, teas and energy drinks. I am personally not a coffee drinker and normally eliminate it. I will make an occasional exception of one cup of black coffee in the morning for those cases where complete removal will risk loss of the patient. (Going from one pot to one cup is much harder than stopping a single serving.) I also eliminate fruit juices, unless a patient wants to fast for a day or two. That leaves pure water or mild, unsweetened herbal teas for beverages.

A typical detoxification diet would be as follows:

Breakfast: A fiber-rich, whole, unprocessed grain that does not cause a hypersensitivity or allergic reaction.

Midmorning snack: Fresh fruit.

Lunch: Salad. I define salad with the mnemonic one green, one bean and three colors. This means one type of a dark green leafy vegetable, 1 kind of bean (canned beans are allowed, provided they are thoroughly rinsed and drained) and at least three different colors of vegetables. This is accompanied by a lean protein source (skinless chicken or turkey, wild game, fish, non-fat cottage cheese [if dairy is tolerated] or a low-fat, low-sodium soy product [if soy is tolerated]).

Afternoon snack: Raw nuts or seeds.

Dinner: Four to five different types of cooked or raw vegetables, including at least three that were not consumed at lunch, with a vegetable or animal protein source different from lunch.

Snack/Dessert: Fruit (again, something different than previously consumed).

Fluid: Plenty of fresh, pure water should be consumed throughout the day.

I recommend patients follow this diet for a minimum of 14 consecutive days, and preferably for 28 days. Patients do not start counting days until they have completed the transition from their former diet to their new diet. The amount of time I allow for this depends on the degree of change required. I realize this flies in the face of many cleanses, which validate their potency by the significant bowel changes that occur with their introduction. I have occasionally skipped the transition period for those patients who are dismayed or concerned at the absence of products which promote sudden bowel changes.

Once the strict phase is complete (and almost all who comply feel better), the hard part begins. Simply stated, 21 meals + 21 snacks = 42 chances a week to ingest bad foods. In many cases, the "badder" the food, the better the taste. I usually recommend a patient limit "bad" food to three servings a week if they only eat 21 times. For those who eat 35-42 times a week, I allow their willpower to take one break a day.

Occasionally good food isn't good enough (but NOT very often). It's then, and only then, that I turn to pills and powders (and in most cases, after aggressive testing and referrals to ensure nothing has been missed) if I'm convinced they didn't cheat with their eats. Ironically, excess sugar, saturated fat, junk food, sweets and sodas will, over time, often lead to problems requiring medications which, in turn, can lead to additional problems requiring other medications. If patients want to begin their cleanse/detox, I make sure they understand why they do not feel well (again, after ruling out serious pathology and/or if appropriate co-management is underway).