There is a really, really short answer to the title of this article: DON’T.
WAIT! For those of you about to jump off the page because you think you ‘need’ to follow all of these diets for your ‘health conditions’ and to ‘fix’ your ‘[gut/thyroid/inflammation/SIBO/dysbiosis/IBS]’ (seriously, fill in the blank…) please read the rest of this article and hopefully it will help you understand how your myriad diet sheets that you’re trying to follow are probably not necessary and may be (OK, I’ll go out on a limb and say ‘are’) doing you more harm than good.
The Science Behind Paleo
Rather than debate for hours about whether there is actually any ‘real’ science behind Paleo (if you want that debate, my previous article on Paleo myths is linked here, with my other article on how I eat, and why linked to here) here I want to explain what each of the diets you’re trying to combine are attempting to achieve.
Remember my mantra – that beyond the basics, nutritional interventions are specific tools for specific circumstances. If you are attempting to combine a multitude of diets then you have more than likely approached your health (more specifically, your illnesses) in a reductionist manner – splitting off each ‘condition’ and attempting to eat according to its needs. If you really do have multiple different conditions, the likelihood is that you need the 30,000 foot view approach, not the microscopic food-analysis mentality which multiple diet combining demands.
OK – so Paleo, as Jimmy Moore on his Instagram recently pointed out, has multiple origins and there is much conjecture as to what it really means – but basically, at its simplest, it is a ‘real, whole foods, nutrient-dense diet’. (Before people get soap-boxy and yell about which foods aren‘t real – remember than anyone judging the terms ‘real food’, ‘unprocessed food’ and even ‘whole food’ are willingly misrepresenting the argument, choosing to play with semantics rather than address the very real fact that Turkey Twizzlers are much further from whole foods than roasted turkey.)
The purpose of Paleo – and the removal of non-nutritive and inflammatory foods – is to reduce both inflammation and oxidative stress within the body. It removes refined products which create metabolic shifts in the human physiology and preferentially promotes whole foods that contain many nutrients per calorie: high quality animal and plant proteins and fats, broad arrays of vegetables and fruits, organ meats, seafood, shellfish and bone broths.
This shifts the biology into a less taxing space and can – for many – create real and permanent health improvements by removing foods which are inherently draining and aggravating to the body.
The Science Beyond Paleo
Once you move to Autoimmune Paleo, Low-FODMAP, low histamine, low salicylate, oxalate or sulphur diets, these are all working from a slightly different basis. In all of these diets it is whole foods themselves which are eliminated or included based on their nutrient profile, anti-nutrient profile and/or interaction with a specific person’s biology.
The Autoimmune Paleo diet chooses to eliminate some otherwise perfectly heathy whole foods (eggs, nuts and seeds, nightshade vegetables) because of the way these whole sources of good nutrition actually interact with the biology of someone with autoimmunity. The anti-nutrients contained within these foods are specifically activating to the immune system – and in someone with autoimmune tendencies this activation is not desirable.
The Low-FODMAP diet focuses again on eliminating nutrient-dense vegetables (amongst other foods such as dairy, grains and non-nutritive sweeteners and sugar alcohols). With the exception perhaps of the artificial sweeteners, all of these foods can form part of a whole foods, real food diet. Yet those avoiding FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are choosing to eliminate otherwise healthy, whole foods due to the way they interact with their gastrointestinal system.
The same is true of low histamine, salicylate and oxalate diets – again it is the perfectly healthy whole foods that are being selectively eliminated due to their interaction with a specific person’s digestive tract, immune system and overall wellbeing.
This basically means that if you are choosing whole foods, then eliminating the majority of foods due to the suspicion that you may not be ‘tolerating’ them well, there is high likelihood that you are actually causing more problems than you’re solving.
Healing Through Food
So often, clients come to me saying, “I’m eating really well because I don’t eat……”
Their list normally includes gluten, dairy, soy, sugar, processed food, sometimes they even say ‘fruit’. They’re often really confused when I say, “But what are you eating?” They’re frequently bewildered when I say, “But why?”
Nutritional tools like specific diets are designed, much like medication, to resolve and remove symptoms in the short term. They are, in no way, a lifelong sentence. Moreover, if you are following nutrient-dense whole food diets and feel the need to further remove some of those whole foods, to me that’s a clear indicator that there is something physically going on that we need to get to the bottom of.
Rather than make enemies of food – and therefore see eliminating all potential symptom-causing foods as evil – we need to focus instead on what it is inside us that is making those foods hard to tolerate.
This is especially true in the case of histamine intolerance, salicylate and oxalates – an inability to process these foods typically has more to do with imbalances of gut flora, nutritional deficiencies and detoxification issues. If you are giving yourself a headache trying to remember all of the things you have to avoid, the likelihood is that you’re thinking about this from the outside in – rather than focusing on healing from the inside out.
Using food as medicine does not mean religiously dancing around the foods you ‘can’t have’.
And much like prescription drugs, if you are combining diets you have to be aware of the side-effects that come when you take too many ‘medicines’ at once:
Side Effect 1: Nutrient Deficiencies
Most of these nuanced symptom-specific diets are eliminating vegetables. Whether due to their fibre, phytates, lectins or histamine, normally well-regarded fresh veg is removed, along with a lot of fruit. Whilst vegetables aren’t calorie-dense, they are very nutrient-dense, as are fruits. Removing so many foods leaves you at risk of actually leaving yourself definitively short on nutrition, particularly in terms of fibre, vitamins and minerals, carbohydrate and also variety (see Side Effects 2 & 3).
Nutritional deficiencies are a problem because if you’re attempting something like diet combining there is no doubt you are suffering from some form of illness. That means that nutritional intake, and a plentiful supply of a broad array of beneficial vitamins and minerals, is absolutely vital to halting the illness and to recovery. A diet of 10 foods, even if judiciously supplemented, is simply not nutrient-dense. In an attempt to conform to all the add-on rules, you are negating the very first rule of healthy nutrition: nutrients.
This is actually less of a “side effect” and more a guarantee that no matter how carefully you ‘diet’, your protocols will fail.
Side Effect 2: Creating Food Intolerances
The science on this is not so clear cut, but it is perfectly possible to create intolerances to or issues with foods that you eat habitually, particularly if you’re doing this in a nutritionally unvaried, nutrient-lacking diet. Intestinal permeability is one of the lead dominos in having antibodies created against certain foodstuffs. As the foods that you eat pass into the blood surrounding the GI tract it is absolutely necessary for the immune system to attack those displaced particles. The issue with eating the same foods over and over again is that this is repeatedly showing this food to your immune system. Your immune system will learn soon enough that this food is a real enemy and mount stronger and stronger immune responses.
But more than this, the gut microbiome is a wondrous mass of bacteria that we know are highly responsible for overall health. They allow us to digest, detoxify, absorb and maintain health. However, it is directly ‘seeded’ by our food supply. Narrowing the fuel for your gut to just a few things, largely excluding vegetables fibres which are essential for bacterial growth, might feel good in the short term. In reality, however, you are pruning your gut bacteria – good and bad – and limiting growth to only a couple of strains that thrive on the foods you are eating.
The effects of this are not yet fully articulated in the scientific literature (there’s a lot of hypotheses which are interesting, but I’m in the camp that views the data thus far as interesting but not yet clinically useful). However, the suggestion is that limited strains of gut bacteria can have systemic health impacts. More important to me, however, is that because histamine, FODMAP and salicylate/oxalate digestion issues are normally created due to gut dysbiosis in the first place, avoiding foods that feed diversity in the large intestine is not a way to ‘right’ this dysbiotic situation. In fact, it seems precisely the opposite of what we are seeking to do.
Side Effect 3: Not Eating Enough
This is an area of real interest to me. Hypocaloric diets (i.e. calorically insufficient diets) are interesting because they are perhaps one of the least healthy things you can do to your body and are yet repeatedly recommended by doctors in practice as a means of ‘healthy weight loss’.
As with everything in the body, there are always levels at which certain behaviours are healthy – and levels to which the same behaviour becomes a negative, or unhealthy. So too with hypocaloric diets (i.e. diets too low in calories). Crossing a certain line will result in a down regulation of metabolism, and yet crossing an even further down line you become at risk of completely deregulating all systems within the body. Once this line is crossed, the net effect on health outcomes are catastrophic. The main problem with diet combining is that in choosing this nutritional approach, the line where under-eating becomes intensely problematic is incredibly easy to cross.
I am actually working separately on a pretty science-y, detailed blog post about all of the interesting things about under-eating and autoimmune conditions, under-eating and gastrointestinal conditions and the whole web of issues that crop up when chronically under-consuming calories. Trust me, hunger is the least of your worries…
When you are juggling all of the diets sheets you remove most of the carbohydrate sources. But you also struggle mentally and physically to consume the amount of fat and protein you need to replace those carbohydrates – and in those with impaired digestion (pretty much a given if you’re thinking you need to do all of these diets) you are likely to have a reduced ability to break down and assimilate nutrients from these denser sources of calories (proteins and fats). This means that you end up woefully under-nourished from a sheer quantity perspective.
For now, to keep this more brief than my longer article will detail, the net effects of chronically under-consuming calories are as broad as you can think of: from mental fatigue and brain fog to physical lethargy and lack of energy, through to mass hormonal dysregulation – everything from sex hormones to appetite and fullness hormones, the regulation of insulin, sleep hormones, the adrenal hormones and everything in between. Additionally, to add insult to injury, many of those hormones play key roles in immune system regulation and inflammation.
That means that by attempting to control inflammation and immune system dysregulation by combining a heap of diets together, the under-eating that results will actually directly increase inflammation and aggravate the immune system. Not the desired effect, huh?
Side Effect 4: Psychological Stress
Much like the stress of caloric insufficiency above, stress of any kind will negate efforts you go to to heal. Psychological stress is an important factor in that – especially if that psychological stress is directly associated with your healing attempts and your body.
Juggling dietary specificity is a nightmare. Even being gluten free is challenging, so being AIP, FODMAP, histamine and everything else free is literally impossible to maintain for any length of time. This has direct impact on social relationships, being able to have fun and interact with others outside of the home. Cooking and preparing, thinking about food, it all becomes a deep chore and a necessary realm of anxiety and excessive care.
You are not truly following an AIP protocol if you are not also looking into lifestyle and mental/emotional stressors. Like with Side Effect 1 – in attempting to bolt additions on to the AIP template you are literally flouting a part of the original protocol. Not only is this not a healthy exercise because of the reasons stated above, but the whole act of trying to be so careful creates a stress which instigates a lack of health within your life.
Side Effect 5: Psychological Food Issues
Most of the autoimmune conditions that I see in practice and in life are the result of, in part, genetics – aggravated or ‘switched on’ by lifestyle, layered over with anxieties. Anxieties can come in the form of fears, threats to our safety, early childhood or even adult experiences where securities and survival was threatened – whether literally, or just socially, or in terms of our identities.
This foundational anxiety and stress is a big reason why Autoimmune Protocols work. They are removing a whole pile of stressors and allowing us to see the wood for the trees – both in terms of our body’s inflammation and stressors, but also in terms of our lives, attitudes and the way we live. The Autoimmune (and even Paleo) approaches ask us to stop panicking for a moment and connect deeply with our bodies and the way they respond to certain elements of food, life, relationships etc.
I have witnessed that if people are seeking more dietary restrictiveness in order to ‘tackle’ their ‘issues’, the reality is that there are deeper problems than whether spinach is too histamine-y for them. The bigger issues revolve around attempting to derive ‘safety’ from a rule book, rather than find a safety internally and within their own skin. Don’t get me wrong – the spinach is probably causing them symptoms, for now. But the symptoms arise out of a seriously dysregulated stress response – the root of which is not in histamine, salicylates, oxalates or FODMAPs, but in other areas – some examples of which are mentioned above.
I can state this as someone for whom this was an actual, real and long-lived issue. My health crises were so alarming that being able to hold onto foods as ‘enemies’ and lists as ‘bibles’ was very reassuring for a long period during my healing process. I also witnessed how self worth can be crushed by illness, particularly mysterious or poorly understood illnesses. In this situation, desperate to prove we are attempting to be well (and not ‘making it all up’, as is often the accusation), self worth can become tied to how well we are performing according to our rule books and diet sheets.
As I’ve mentioned above, those numerous rules are practically impossible to stick to because they’re so damn unhealthy. Nutrient deficiencies alone will cause cravings for stuff that’s ‘off-plan’. Caloric restriction will do the same.
But more importantly, if you are ‘diet combining’ you are reinforcing the subtle message that your healing is about avoiding certain foods, rather than about nourishing your body with the food, love, respect, relationships and trust it needs in order to feel safe and secure.
To be really, really clear, it is my belief that the symptoms we are all experiencing are very real. You are experiencing reactivity to histamine, salicylate, oxalates, sulphur-containing foods. But the real reason for the reactivity is emerging from somewhere else – a metabolic, physical, emotional, mental and sometimes even ‘soul’-based sense of a lack of safety, increased threat, physical disconnectedness or excess trauma.
Somewhere in this nutritional world we have to recognise that eating is a two-way process. The food quality, quantity and nutrient-density is absolutely vital – because it’s the building blocks of your biology. But it’s not the fundamental deal breaker. The environment into which the food is going is just as key – and that doesn’t just mean your microbiome and GI tract… it means your attitude, your trust of yourself, your ability to surrender the lists and learn to respect, honour, make time for, and ultimately listen to your own body.
If your system is riddled with multiple sensitivities and you are viewing restriction as a route to wellness then I would caution you strongly that you are creating more problems – both physical and psychological. If you genuinely have gut issues, please work with a practitioner rather than finding yet another food list on the internet that ‘might work’.
If you are eating only a handful of foods, please ask someone for help. You aren’t going to heal with time or by restricting harder, being ‘better’ or staying ‘on plan’ longer. You are only delaying your true healing.
So Diet Combining, and those Facebook posts where you gleefully tell everyone that you’re AIP, Low-FODMAP, Low-Histamine and you also can’t tolerate x, y and z… (and gosh isn’t it hard, and aren’t you hard-done-by) please don’t. You aren’t being ‘good’ by following all of these diets, and you certainly aren’t healing. Instead, you are perpetuating stress, prolonging misery and more than likely not getting to the root of any of your issues because you’re so caught up in attempting to avoid everything that you think is the problem. Lists and rules aren’t the solution to your health journey. Creating your personalised health template is. And that goes way beyond Paleo, but never just to bolt on more restrictive avoidance regimens.
If you’d like to contact me to see if I can help you work through your issues to get to a place where the world of nutrition isn’t such a stress and you are nourishing yourself rather than locking yourself in avoidance – please know that this is a place I have been personally and know how to move through and out of. Contact me and ask for help creating your Personalised Health Template today.