Nutrition in Clinical Practice

http://ncp.sagepub.com/ Popular Diets Prescribed by Alternative PractitionersPart 1

Gerard E. Mullin Nutr Clin Pract 2010 25: 212 DOI: 10.1177/0884533610361912

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CAM Corner

Popular Diets Prescribed by Alternative PractitionersPart 1

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

Nutrition in Clinical Practice Volume 25 Number 2 April 2010 212-214 2010 American Society for Parenteral and Enteral Nutrition 10.1177/0884533610361912 http://ncp.sagepub.com hosted at http://online.sagepub.com

his April 2010 issue of Nutrition in Clinical Practice highlights several articles dealing with feeding issues and eating disorders. As nutrition practitioners, many of us have seen patients who have been placed on unconventional diets as prescriptive strategies for health. Popular alternative strategies for dietary intervention can include the alkaline diet, Candida diet, detox and cleansing diet, gluten-free diet, macrobiotic diet, Makers diet, Mediterranean diet, Paleo diet, raw food diet, specific carbohydrate diet (including variations) and vegetarian/vegan diet.

those taking medications that affect potassium levels in the body should consult with their doctor first.3

Anti-inflammatory Diet
The theory behind the anti-inflammatory diet is that proinflammatory foods increase inflammation throughout the body. Foods that are considered to be proinflammatory are high in trans fats and saturated fats. Junk foods (ie, high-fat meats, sugar, and fast foods) tend to contain high amounts of arachidonic acid, which is a precursor of proinflammatory eicosanoids (ie, prostaglandin E2). Diets high in sugar have also been associated with inflammation, obesity, and chronic disease such as diabetes mellitus. The anti-inflammatory diet eliminates the nightshade family of plants (ie, potatoes, tomatoes, and eggplant), which contain a chemical alkaloid called solanine. Solanine can trigger pain in some people and is thought to have proinflammatory actions. Although the anti-inflammatory diet promotes the elimination of proinflammatory foods, it fosters the selection of foods that combat inflammation. -3 Essential fatty acids (oily fish, walnuts, flax seeds, canola oil, and pumpkin seeds) have anti-inflammatory actions via their antagonism of -6 essential fatty acids, which are proinflammatory. Olive oil is another type of oil that will reduce inflammation.4 Like -3 fatty acids, olive oil has been shown to reduce the risk of cardiovascular disease.5 Other healthy oils recommended by the anti-inflammatory diet include rice bran oil, grape seed oil, and walnut oil. According to the diet, anti-inflammatory protein sources include fish and seafood, nuts, legumes, and seeds. Safe substitutions that are less proinflammatory include soybeans, tofu, and soy milk. Because red meats are thought to trigger inflammation, the anti-inflammatory diet restricts fatty red meats while advocating lean cuts of bison, venison, and other game meats or the lowest fat cuts of beef, preferably grass-fed beef. According to the anti-inflammatory diet, most dietary carbohydrates should come from whole grains rich in
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Alkaline Diet
The theory behind the alkaline diet is that our diet should reflect the bloods normal pH level (7.35-7.45) and be slightly alkaline. Proponents of alkaline diets believe that a diet high in acid-producing foods disrupts this balance and promotes the loss of essential minerals, such as potassium, magnesium, calcium, and sodium, as the body tries to restore equilibrium. This imbalance is thought to make people prone to illness.1 An alkaline diet emphasizesto varying degreesfresh fruit, vegetables, roots and tubers, nuts, and legumes. Grains, fish, meat, poultry, shellfish, cheese, milk, and salt all produce acid, so the introduction and dramatic increase in our consumption of these foods led to the typical Western diet becoming more acid-producing.2 Consumption of fresh fruit and vegetables decreased, which further made the Western diet acid-producing. Large, well-designed clinical trials on the effectiveness of the alkaline diet for general health are lacking. The alkaline diet should not be used by people with acute or chronic kidney failure unless under a doctors supervision. People with preexisting heart disease and

From the Johns Hopkins University School of Medicine, Baltimore, Maryland. Address correspondence to: Gerard E. Mullin, 600 N. Wolfe St, Baltimore, MD, 21205; e-mail: gmullin1@jhmi.edu.

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Popular Diets / Mullin 213

fiber, vegetables, and fruits. The bread, cereal, and pasta in your diet should be mostly 100% whole-grain products. Whole grains are excellent sources of fiber, and a highfiber diet will reduce inflammation. Green vegetables and whole fruits are important as sources of dietary fiber. Berries contain many phytochemicals that have antiinflammatory properties as well.

mushrooms; peanuts; peanut butter; pistachios; coffee; black tea; cider; fermented beverages; aged and processed cheeses; processed, dried, smoked, and pickled meats; and packaged, processed, and refined foods.10 Large, well-designed clinical trials on the effectiveness of the Candida diet for digestive health are lacking.

Ayurvedic Diet
Ayurveda is a vast and ancient medical science. Unlike other medical sciences, which focus on treatment of any particular disease,6 Ayurveda focuses on healthy living and general well-being, which include consuming a healthy and nutritious diet. In Ayurveda, food is considered not only a mixture of basic ingredients, like proteins, vitamins, fats, and carbohydrates, but also a source of energy for mind and soul. Although different kinds of diet are suggested in Ayurveda, no specific diet can be said to be ideal for every human body, because every human being has a different body structure and digestive system. Some general principles of the Ayurvedic diets include the following: Skipping meals and eating in excess and before the normal time are unhealthy. Drinking water between meals should be avoided. Body types (pitta, vata, kapha) play a role in determining the choice of foods. The places and climatic condition where the food is grown, prepared, and consumed are important in determining the diet of the individual. The effect of consuming food in a particular season plays a role in diet selection. The Ayurvedic diet has been suggested as effective for diabetes mellitus, cardiovascular health, and arthritis.7-8

Detox and Cleansing Diet

A number of detoxification and cleansing diets are marketed by practitioners and nutraceutical firms. The premise of this approach is to eliminate accumulated toxins and revive the enzymatic and biochemical machinery to more efficiently purify the body. The various programs (Candida cleanse, Colon cleanse, Liver Detox, Kidney Detox) eliminate and flush toxins in a fast-and-flush phase that can include juice fasting with freshly processed vegetables that facilitate the livers phase I and phase II detoxification pathways (ie, cruciferous vegetables, green leafy vegetables), inducing diuresis (ie, cucumber, parsley, asparagus), or using bowel-purging laxatives (senna, aloe-based) either alone or in combination. Generally, these diets withdraw patients from foods and place patients on a supplement of medical foods containing predigested proteins (hypoallergenic base such as rice) that are dissolved in rice milk and mixed with whole berries to provide wholesome carbohydrates and antioxidants. Large, well-designed clinical trials on the effectiveness of detoxification and cleansing diets for general health and digestive conditions are lacking. 11 Part 2 of Popular Diets Prescribed by Alternative Practitioners, coming in the June 2010 issue of NCP, will discuss the gluten-free diet, macrobiotics diet, Makers diet, Mediterranean diet, Paleo diet, raw food diet, specific carbohydrate diet (including variations), and vegetarian/vegan diets.

References
1. Wynn E, Krieg MA, Lanham-New SA, Burckhardt P. Postgraduate symposium: positive influence of nutritional alkalinity on bone health. Proc Nutr Soc. 2009;3:1-8. 2. Welch AA, Mulligan A, Bingham SA, Khaw KT. Urine pH is an indicator of dietary acid-base load, fruit and vegetables and meat intakes: results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study. Br J Nutr. 2008;99:1335-1343. 3. Minich DM, Bland JS. Acid-alkaline balance: role in chronic disease and detoxification. Altern Ther Health Med. 2007;13:62-65. 4. Ros E. Nuts and novel biomarkers of cardiovascular disease. Am J Clin Nutr. 2009;89:1649S-1656S. 5. Colussi G, Catena C, Baroselli S, et al. Omega-3 fatty acids: from biochemistry to their clinical use in the prevention of cardiovascular disease. Recent Pat Cardiovasc Drug Discov. 2007;2:13-21.

Candida Diet
Overgrowth of yeast (Candida) in the digestive tract or mucous membranes, called candidiasis, was popularized by William Crook, MD, in his 1983 book, The Yeast Connection.9 The Candida diet is designed to stop the growth of Candida yeast. Foods that have been thought to encourage the growth of Candida in the gut include white sugar; brown sugar; honey; maple syrup; corn syrup; maple sugar; molasses; date sugar; turbinado; raw sugar; demerrara; amasake; rice syrup; sorghum; fruits; yeast-containing foods; gluten-containing foods; vinegar;

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6. Chopra A, Doiphode VV. Ayurvedic medicine: core concept, therapeutic principles, and current relevance. Med Clin North Am. 2002;86:75-89, vii. 7. Mamtani R, Mamtani R. Ayurveda and yoga in cardiovascular diseases. Cardiol Rev. 2004;12:155-162. 8. Chopra A. Ayurvedic medicine and arthritis. Rheum Dis Clin North Am. 2000;26:133-144, x. 9. Crook WG. Caveman diet and Candida worthy of attention. Nurse Pract. 1989;14:8-9. 10. Santelmann H, Howard JM. Yeast metabolic products, yeast antigens and yeasts as possible triggers for irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2005;17:21-26. 11. Jeffery EH. Detoxification basics. Altern Ther Health Med. 2007;13:S96-S97.

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Erratum

Nutrition in Clinical Practice Volume 25 Number 3 June 2010 315 2010 American Society for Parenteral and Enteral Nutrition 10.1177/0884533610374593 http://ncp.sagepub.com hosted at http://online.sagepub.com

Rollins MD, Scaife E, Jackson W, Mulroy C, Book L, Meyers R. Elimination of Soybean Lipid Emulsion in Parenteral Nutrition and Supplementation With Enteral Fish Oil Improve Cholestasis in Infants With Short Bowel Syndrome. Nutr Clin Pract. 2010;25:199-204. (Original DOI: 10.1177/0884533610361477) In the above article, on page 202, 2 amounts in Table 2 appear incorrectly. Under 20% soybean lipid emulsion, in the linoleic line, the amount should be 0.1 g/mL instead of 1.1 g/mL. In the total fat(kcal/ml) line, the amount should be 2.0 g/mL instead of 0.2 g/mL.

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