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Why does this registered dietitian (some of his patients) say he should avoid cabbage salad

I've been working as a nutritionist in a gastroenterology practice long enough to see many food trends come and go.

When I started practicing, a strict, sugar-free treatment called the "candida diet" was popular. Among patients of mine who had taken alternative health care before consulting me, I practically got a lash just a few years later the juicing craze hit and suddenly everyone seemed to consume nothing sugar. Juicing, after all, means creating a cocktail of concentrated sugars from the fruits and vegetables from which they are extracted. Soon after, my patients took me through Paleo madness (what I call the Neo-Paleolithic era of 201

3-2014, and I watched as an increasing number of them became gluten-free and since then paleo and paleo-esque diets Like Whole30's mandate, cutting out gluten-containing foods has been called by patients since 2015, who have figured out how to eat "normally" again after so-called clean diets frightened them because they believed dairy, sugar, cereals and pulses are essentially poison. "Soon after, I watched helplessly as the ketogenic diet of some of my patients' diets in favor of bacon, beef and cheese demanded almost everything that was healthy and good Patients helped understand the overwhelming dietary dictates resulting from personalized Bowel Sensitivity Tests and intestinal microbiome .

The details of each new diet sensation vary. But the scenario that I experience with my patients in these programs is remarkably consistent. People arrive at my office after they have recently passed a new program for which they drastically change their habitual eating habits – leaving out certain foods and embracing others – all in search of better health, better energy and better living. Sometimes, at least initially, the weight seems to decrease, much to their delight. They are excited about this new way of eating to help them reach their goals for health and weight. However, diets aimed at the elimination and / or restriction of food and food groups rarely lead to long-term, permanent changes . For example, as SELF reported, the ketogenic diet does not seem to be more or less effective for short-term weight loss than any other type of calorie reduction (and long-term weight loss from keto is unlikely)). Not only are elimination-based diets not necessarily helpful for weight loss but it is simply unhealthy to cultivate a food-related relationship based on restriction and avoidance.

But there is another, somewhat underhand culprit sneaking in these diets. Surely, after a few days or weeks they can bring exciting changes. But luck in the digestive system? Not as much. Sometimes, after moving strongly to a whole new, healthy eating habits, people make an unexpected discovery: the foods they think are good can sometimes make you feel bad.

I've seen vegans freshly squeezed with perpetual gas and flatulence fighting their new herbal diets. I've seen people embrace giant salads for lunch every day just to be rewarded with the telltale small bowel intestine, which requires a graceful but urgent exit from the afternoon sessions.

This is just a small selection of all the healthy eating habits. That was not unpunished in my years of counseling patients with indigestion.

There are countless reasons why objectively nutrient-rich, health-promoting foods with a particular person may not be digestive.

One common problem I see relates to foods that are high in insoluble fiber, or what we commonly refer to as "fiber." It is the crunchy, tough stuff found in leafy vegetables, fruits and vegetables with thick skin or a lot of seeds, popcorn kernels and bran, hard-coated seeds and crispy nuts, stringy celery or woody asparagus stalks. Surprisingly, these coarse, highly structured types of fiber may remain intact even after chewing, making the organs of the digestive system quite tiring to disintegrate into passable particle sizes. For some susceptible people, this means that large portions of such foods run around in the stomach for an extended period of time, leading to acid stomach upset and upper abdominal bloating.

Insoluble fiber also can not absorb or retain water in the digestive tract, which can lead to irregular bowel movements of various kinds. People with a fast digestive system or their gut are hypersensitive to stimuli – such as Irritable Bowel Syndrome (IBS) – can find that eating a load of bulky foods with insoluble fiber triggers urgent, cramped and unformed stools, often within one hour of consumption , Conversely, some people with slow intestinal transit may find that their diets are high in fiber, and they feel completely secure and can only pass through hard, dry stools that lead to incomplete pebbles. As these people learn the hard way, taking a low-carbohydrate diet that excludes grains, root vegetables, and fruits – all foods that contain the moisturizing, shaped stool-promoting soluble fiber – can unexpectedly and undesirably alter your intestinal patterns.

Gas can be another side effect of healthy nutrition because contains certain types of carbohydrates that make our intestinal bacteria particularly delicious. Beans and lentils, soy protein-free meatless foods, brussels sprouts, broccoli, turnips, and cashew nuts are all very nutritious staples of a plant-based diet – and all have one common fiber species, the galacto-oligosachardies (GOS). As with all dietary fiber, humans lack digestive enzymes to break down GOS and gain energy (calories) from it. (That's what makes it fiber!) But the microorganisms in our gut have no such problems. You can ferment this fiber very well and ferment it. Fortunately, feeding high-fiber bacteria seems to promote good gut health. Unfortunately, for us, an important by-product of bacterial fermentation is gas, and the more such fibers we deliver, the more gas is produced. Different people make different amounts of gas, depending on which bacteria they host. While a lot of bowel gas may be a sign of pride that you have gained through a healthy diet, some people find too much of it to be too much, either because of their physical or social well-being.

Like us humans I can not digest a naturally occurring, high fermentable sugar alcohol called mannitol, which happens to be found in #cauliflower (1,000,000 Instagram posts and counting!). This may explain why some people who are looking to reduce the intake of carbohydrates (in general) and highly processed grains (in particular) may experience a sharp increase in gas and gas pain when reliant on novel dishes like cauliflower "rice Cauliflower crackers, cauliflower concentrate gnocchi and cauliflower pizza instead of their grain-based alternatives. To be clear, if you get gaseous from too much cauliflower, that does not mean that you have a digestive disease that needs to be corrected. Gas is only a problem if it is a problem.

Then there is the diarrhea that some people experience as a result of too much fructose or sorbitol – two naturally occurring sugars found in many unrefined sugars and fruits. While you may have heard of lactose intolerance, there is a lesser known disease, fructose intolerance in which a person may not be able to absorb the natural sugar fructose very well. As a result, they get diarrhea several hours after eating high-fructose foods. So, if you make your way to the bathroom a couple of hours after the launch of a cold-pressed juice based on green apples, an agave-sweetened protein drink or a smoothie bowl filled with mango and granola, there is a logical explanation.

The response of most of my patients when I explain why their healthy diet does not agree with them is disbelieving: "But I thought I was so good!"

This is when I find myself explaining that health and tolerability are two separate issues.

Whether a food agrees with you on digestion (or otherwise) does not say anything about whether it's a "good" meal, nor is it a referendum on your character. Unlike popular aphorism, you are not what you eat.

Take note of the following: There are hundreds of objective healthy foods to choose from: vegetables rich in antioxidants of all kinds, fruits rich in potassium and vitamins, nuts and seeds rich in magnesium, fish and vitamins vegetable foods laden with heart-healthy monounsaturated fats and omega-3 fatty acids, leafy green leaves and beans that are rich in folic acid, as well as herbs, spices and teas with known anti-inflammatory compounds.

Let's say you have a friend who has an allergy to one of these healthy foods. we choose nuts for this example. Does your friend's nut allergy mean nuts are not generally objectively healthy food for humans? Should you encourage your friend to have an allergic reaction because the nuts are a "superfood"? Are nuts a healthy food choice for your friend? Of course not. Can your friend get a similar – if not the same – nutritional benefit from other foods that do not endanger his life?

Most people who consider the example of the above food allergy would come to the conclusion that nuts can be both nutritious and food that this person feels "bad". These two things can be true at the same time. We take it for granted that a person with nut allergy should avoid nuts and replace them with something comparable but tolerable – like sunflower oil or roasted pumpkin seeds. It would not occur to us that the person should feel guilty about their allergy, as if the nut allergy was a kind of personal moral failure.

But I am amazed at the guilt that is forcing my patients to push down foods that make them feel digestively ill because they feel they should "should."

There is some dissatisfaction in our wellness culture when people feel so guilty that eating a bagel feels infinitely better than eating a huge cabbage salad that they wrap up

I write this above all a public one Dialogue on nutrition and health, which has paved such a virtuoso language that one can easily see how the feeling of bloated, tangy, and miserable after eating a kale salad, may seem morally misguided to someone looking for better health , If kale salads are part of a "clean" diet and wheat flour is considered "toxic" or "flammable," it is not hard to imagine the impulse to get a waiver from a doctor or dietitian for so-called "bad" food to take. Food that feels – well, good.

Social media messages within the healthy eating and wellbeing community, especially on Instagram, seem to create guilt feelings associated with "failure" to endure the staple foods of "clean life" like kale salad, smoothie, raw Date cocoa energy balls, avocado chocolate mousse and whole roasted cauliflower heads. (Not to mention those of us who are able to tolerate them digestively, but they just do not like them.) A small study published in the European journal Eating and Weight Disorders , surveyed hundreds of social media users who eat healthily. focused accounts. The researchers found that a greater use of Instagram was associated with a person who had more symptoms of an eating disorder called Orthorexia nervosa. Orthorexia describes a fixation with "pure" or "pure" food until it is unhealthily restricted. It can express itself in extreme psychological concern with the origin of the food that one eats; Guilt over perceived indiscretional nutrition; social isolation through rigid, inflexible eating habits; and / or malnutrition due to excessive restriction.

The ever-narrower presentation of "healthy" as defined in diets or social media influences often contradicts the wide variety of dietary habits that true scientific research holds to be healthy. And it can have a number of effects on your emotional wellbeing.

"Find the healthiest diet that you can comfortably tolerate."

The first step to ridding yourself of unhealthy limiting beliefs about what you should do is to expand your mindset, which means eating healthy eating. In the US, we are fortunate enough to live in a country where there is a dizzying array of food available all year round (although food deserts and food swamps mean that we do not all have equal access to all food). That's why not a single food in our diet has to carry as much weight as a single nutrient, nor is there a single "superfood" that we all have to eat. Since many different foods provide similar nutrients, I try to help my patients find nutritious foods they love – and love – to replace others they feel committed to, but they do not feel that way Well.

Green leaf food makes you feel rough I am offering you the 11th commandment "You will eat kale" and suggest your folate from cooked turnips, avocados or peanut butter and your vitamin A from cantaloupe, roasted butternut squash or carrot and ginger soup to acquire.

These big lunchtime salads do not taste that good on the way back? Swap raw vegetables for cooked, steamed, roasted, roasted or soups. (As I tell all my patients, soup is a liquid salad.) Sometimes taming the texture of a vegetable can make all the difference in dealing with your digestive system.

If you eat less animal protein, does beans produce too much gas for your comfort? Instead, try cultured legume forms such as firm tofu or tempeh. Or test your tolerance for small portions of less gassy legumes such as lentils and chickpeas using an enzyme that is used as a bean fiber ripper (alpha galactosidase).

Cold-pressed juices or smoothie bowls at breakfast to give you the afternoon run? Skip apples, dried fruit and mangoes and instead opt for less fructose or sorbitol such as blueberries, strawberries, raspberries, kiwis, bananas, cantaloupe, pineapple and oranges.

You are allowed to eat foods that feel good.

You do not need my permission – or anyone's – to stop eating foods that everyone claims are healthy, but you feel completely unhappy. (However, if you feel better, then you should consider it a given.) Achieving good health is a worthwhile goal, but know that there are many different nutritional paths to this goal. The road signs that guide you on your path to the healthiest diet exist in you – and how your body feels in response to eating certain foods. You will not find it on Instagram or in doubtful lab tests, nor on the diet that your best friend or colleague swears by, and not on people trying to sell you in their unique diet program Just because a meal is "good for you" That does not mean it's good for you.

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