Nutrition in Clinical Practice

http://ncp.sagepub.com/ Popular Diets Prescribed by Alternative PractitionersPart 2

Gerard E. Mullin Nutr Clin Pract 2010 25: 308 DOI: 10.1177/0884533610368713

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CAM Corner

Popular Diets Prescribed by Alternative PractitionersPart 2

Gerard E. Mullin, MD
Financial disclosure: none declared.

Nutrition in Clinical Practice Volume 25 Number 3 June 2010 308-309 2010 American Society for Parenteral and Enteral Nutrition 10.1177/0884533610368713 http://ncp.sagepub.com hosted at http://online.sagepub.com

he April 2010 issue of Nutrition in Clinical Practice highlighted several articles dealing with feeding issues and eating disorders. Additionally, we reviewed unconventional diets such as the alkaline diet, Candida diet, and detox and cleansing diet. In the June 2010 issue, we review common diets that are prescribed by alternative practitioners as therapeutic strategies, such as the gluten-free diet, macrobiotic diet, Paleo diet, raw food diet, specific carbohydrate diet (including variations), and vegetarian/vegan diet.

Feingold diet4 and specific carbohydrate diet5) are based on the gluten-free diet.

Macrobiotic Diet
The macrobiotic diet is part of the far eastern philosophy of macrobiotics. The basic diet is rich in whole grains and vegetables. The diet allows for protein sources such as fish, legumes, nuts, and seeds. Fruits are restricted, as are sugar, spices, alcohol, eggs, meats, and cheeses. The diet is low in saturated fats. A number of claims are made about the healing properties of the macrobiotic diet, the most notable of which is its possible anticancer benefit.6 Concerns about lowering bone mass have been raised in the literature.7

Gluten-Free Diet
Gluten-free diets have traditionally been restricted to individuals with a known hypersensitivity to gluten. Individuals with celiac disease (with or without dermatitis herpetiformis), as proven by antibody, genetic, and microscopic pathology testing, continue to be the population most at risk for the consequences of gluten-induced enteropathy. A gluten-free diet eliminates all foods containing wheat (including spelt, triticale, and khorasan), rye, barley (malt), and in some instances oats. Adherence to a gluten-free diet can be challenging and can affect an individuals quality of life.1 Thus, nutrition professionals should carefully scrutinize the indications for such a diet given the possible stress imposed to the patient. Alternative practitioners commonly recommend the restriction of gluten as a first-line therapy in the management of many disorders that are believed to be triggered or worsened by sensitivity to gluten. These conditions include but are not limited to attention deficit disorder, autism, chronic fatigue syndrome, Crohns disease, depression, diabetes, eczema, fibromyalgia, irritable bowel syndrome, leaky gut syndrome, multiple sclerosis, obesity, psoriasis, rheumatoid arthritis, schizophrenia, systemic lupus erythematosus, thyroiditis, Tourettes syndrome, and ulcerative colitis.2,3 Many other diets (eg,

Paleo Diet
This diet is a nutrition plan based on the diet of the hunter gatherer prior to the development of agriculture, which is believed to have occurred around 10,000 B.C. The Paleo diet consists of lean meats, lean poultry, eggs, game meat, fish, fruit, vegetables, nuts, and seeds. The diet discourages oils, soft drinks, alcohol, sweets, dairy, processed foods, grains, legumes, starchy vegetables, salt-enriched foods, and fatty meats.8 The diet claims to facilitate weight loss, but there are no published studies in the scientific literature available at the time of writing this review.

Raw Food Diet

The raw food diet is a diet based on unprocessed and uncooked foods. The foods that are permitted include fresh fruit and vegetables, sprouts, seeds, nuts, grains, beans, nuts, dried fruit, and seaweed. According to the theory behind the raw food diet, eating raw foods preserves vital enzymes that facilitate the digestion and absorption of nutrients. Typically, at least 75% of the diet must be living or raw.9 The proven benefits of the raw food diet are unclear. One study found that serum lipids

Address correspondence to: Gerard E. Mullin, 600 N. Wolfe St, Baltimore, MD, 21205; e-mail: gmullin1@jhmi.edu.

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were affected in both a favorable manner (lower serum cholesterol level) and an unfavorable manner (high serum low-density lipoprotein and homocysteine levels).10 People at risk for osteoporosis should exercise caution in following a raw food diet. Individuals following a raw foods diet vs the standard American diet for 3.6 years were reported to have a lower bone mass.11

processed foods and refined carbohydrates. Well-designed research into the potential benefits of these diets in the prevention and treatment of disease is welcomed.

Acknowledgment
The author acknowledges the contribution by Laura K. Turnbull, BA, BSN, Johns Hopkins University School of Nursing.

Specific Carbohydrate Diet

The specific carbohydrate diet is a strict grain-free, lactose-free, and sucrose-free dietary regimen intended for those with Crohns disease, ulcerative colitis, celiac disease, and irritable bowel syndrome.5 The specific carbohydrate diet is based on the principle that unabsorbed carbohydrate residue feeds pathogenic intestinal microbes that disrupt gut integrity. The specific carbohydrate diet is purported to permit the proper absorption of nutrients by restoring intestinal barrier function.12,13

References
1. Hall NJ, Rubin G, Charnock A. Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Aliment Pharmacol Ther. 2009;30:315-330. 2. Lieberman S. The Gluten Connection: How Gluten Sensitivity May Be Sabotaging Your Health-and What You Can Do to Take Control Now. Emmaus, PA: Rodale Books; 2006. 3. Petersen V, Petersen R. The Gluten Effect. Hueytown, AL: True Health; 2009. 4. www.feingold.org. Accessed April 18, 2010. 5. www.scdiet.org. Accessed April 18, 2010. 6. Kushi LH, Cunningham JE, Hebert JR, Lerman RH, Bandera EV, Teas J. The macrobiotic diet in cancer. J Nutr. 2001;131(11 suppl):3056S-3064S. 7. Parsons TJ, van Dusseldorp M, Seibel MJ, van Staveren WA. Are levels of bone turnover related to lower bone mass of adolescents previously fed a macrobiotic diet? Exp Clin Endocrinol Diabetes. 2001;109:288-293. 8. Cordain L. The Paleo Diet. New York, NY: John Wiley; 2002. 9. www.webmd.com/diet/guide/raw-food-diet. Accessed April 18, 2010. 10. Koebnick C, Garcia AL, Dagnelie PC, et al. Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low 135:2372-2378. serum HDL cholesterol in humans. J Nutr. 2005; 11. Fontana L, Shew JL, Holloszy JO, Villareal DT. Low bone mass in subjects on a long-term raw vegetarian diet. Arch Intern Med. 2005;165:684-689. 12. Haas SV, Haas MP. The Management of Celiac Disease. New York, NY: Lippincott; 1951. 13. Gotshall E. Breaking the Vicious Cycle: Intestinal Health Through Diet. Baltimore, ON: Kirkton Press; 1994. 14. Ferdowsian HR, Barnard ND. Effects of plant-based diets on plasma lipids. Am J Cardiol. 2009;104:947-956. 15. Barnard ND, Katcher HI, Jenkins DJ, Cohen J, Turner-McGrievy G. Vegetarian and vegan diets in type 2 diabetes management. Nutr Rev. 2009;67:255-263. 16. Hagen KB, Byfuglien MG, Falzon L, Olsen SU, Smedslund G. Dietary interventions for rheumatoid arthritis. Cochrane Database Syst Rev. 2009;(1):CD006400. 17. Kirby M, Danner E. Nutritional deficiencies in children on restricted diets. Pediatr Clin North Am. 2009;56:1085-1103.

Vegetarian/Vegan Diet
A healthy vegetarian diet consists primarily of plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts, and seeds but still incorporates animal products such as eggs, milk, and cheese. Vegan diets eliminate all animal-derived products and strictly consist of plantbased foods. There is evidence that vegan diets impart a favorable impact on cardiovascular risk factors, diabetes, and plasma lipids.14,15 Because of inadequate data reporting, the effects of a vegan diet on rheumatoid arthritis are uncertain.16 Long-term vegan diets can be complicated by nutrient deficiencies such as protein, vitamin B12, calcium, zinc, and iron.17

Summary
Alternative practitioners prescribe a number of diets from which patients report deriving benefit. There is scant evidence in the medical literature to support the incorporation of these diets on a condition-specific basis. They all favor consuming fresh whole foods and limiting

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