“I have Hashimoto’s thyroiditis, Raynaud’s disease, psoriasis, asthma, and allergies. As a Physician’s Assistant, I knew that my autoimmune disorders were progressing. At age 28, my energy was low, my symptoms were horrible, my hair was thinning, I had near-daily headaches, joint aches, frequent rashes, and poor digestion. My inflammatory blood markers were increasing, but I reached a dead end with my rheumatologist. During this time I did my first Whole30. I have since done two more, and have maintained this lifestyle for the past year and a half. I have the energy I never thought I would have again. My digestion is healthy. My hair is thick and my skin clear. My hands no longer look scalded, dry, or cracked. I do not take any prescription medications for the management of my diagnoses. I pass along the message of the Whole30 to patients, friends, and family almost daily. I share it because I know that living this lifestyle supports my health in a way I never could have imagined.”
—Megan M., New York, NY
A brief reminder: We are not doctors, and this section is not an attempt to dispense medical advice. Everyone should always talk to their health care provider before beginning any new diet or supplement regimen. This goes double for those of you with medical conditions, especially if you are taking prescription medications to manage your condition.
We asked Luc Readinger, M.D. to help us answer some of these questions from his perspective, as a physician who has been successfully using the Whole30 to treat his patients’ medical conditions since 2011.
The Whole30 is ideal to help normalize an overactive immune system, decreasing systemic inflammation and reducing or eliminating the symptoms of your autoimmune disease, chronic pain, or immune-related conditions (like Lyme disease). However, there are some Whole30 Approved foods that are healthy for most people, but might exacerbate your symptoms or fire up your immune system. The trouble is there isn’t just one list of foods that negatively impact all chronic diseases.
You are a unique snowflake. That means foods that may be perfectly fine for someone else with your same condition may make your symptoms much worse, and vice-versa. This makes it incredibly hard to create one protocol that works well for everyone with an immune dysfunction. Eggs, tomatoes, peppers, eggplant, potatoes, instant coffee, nuts and seeds, beef, lamb, oranges, grapefruit, lemons, and limes . . . These are all foods that are either known to be commonly problematic for those with autoimmune conditions, or are common food sensitivities for those with increased gut permeability.
And that’s not even the comprehensive list.
Continuing to eat stuff that is problematic for your body will lead to (you guessed it) systemic inflammation and an overactive immune system, which means your symptoms don’t improve as much as you’d like them to.
So how do you know if some of these healthy Whole30 foods aren’t so healthy for you? We wish there were an easy answer. It’s hard to know whether these foods impact you without eliminating them, too, but that makes your Whole30 a ton more restrictive. Plus, simply adding these foods to your Whole30 “off-limits” list is a little like shooting at a target in the dark; you may end up restricting foods that you don’t need to, and including foods that you are, in fact, sensitive to.
If you have an autoimmune disease, or a chronic pain or chronic fatigue condition, you have two options with respect to your Whole30:
Option 1: Complete the general Whole30 protocols exactly as written (optionally eliminating eggs and nightshades as well), then evaluate and make a decision as to where to go from there.
Option 2: Skip the Whole30 and go straight to a medical elimination diet, working with an experienced functional medicine practitioner who creates a specific plan just for you.
Let’s discuss the pros and cons of each approach.
There are a few benefits to this approach. First, compared to a medical elimination diet, the Whole30 requires far fewer changes to your overall diet, which means it’s easier to follow and less stressful. You can also start making these changes immediately, bringing relief and results that much faster. It’s also far cheaper—you could theoretically do the entire Whole30 for free, avoiding expensive fees for doctor visits and lab work.
The downside is that you may not experience all of the benefits you hope to see, because you may still be including some items in your diet that might be problematic for you. The Whole30 isn’t a structured elimination approach based on your health history, symptoms, and lab results, which means it could be less effective in your specific context than it is for most people. You may get all the way through your program and think, “This isn’t working!”
We assure you, it’s working.
We’re positive you’ll experience other benefits from the program, and a calmer immune system is a huge step in the right direction, even if you’re not all the way there. Just like a Whole30 that doesn’t cause any weight loss, it is not a disappointment or a failure when you pay attention to all the changes in more subjective areas of your life. But the expectation of having “miraculous” results and not seeing them on Day 30 can be pretty disheartening, which may prove to be the biggest risk of this approach.
All of that having been said, we still think this is where you should start.
Virtually every medical elimination program is going to exclude refined sugars, gluten, dairy, soy, and alcohol (on top of other specific foods), so you might as well get a head start before you begin working with a doctor. In addition, there’s something to be said for gaining some confidence and feeling healthier before you take on something as rigid and restrictive as a personalized elimination diet. The improvements you see on the Whole30 (because you will see improvements!) will increase your self-efficacy, helping you feel more prepared and motivated to tackle a more restrictive approach, if that’s where you decide to go.
You may improve your results by restricting eggs and nightshades, too. Egg whites contain proteins that can indirectly increase immune activity—a contributing factor in immune-mediated diseases. Nightshades are a group of plants that contain compounds that promote gut irritability, inflammation, joint pain and/or stiffness in sensitive individuals. Nightshades include potatoes (all varieties except sweet potatoes or yams), tomatoes, all sweet and hot peppers, eggplant, tomatillos, tamarios, pepinos, and spices like cayenne, chili powder, curry powder, paprika, pimento, and red pepper flakes. These two groups are the most commonly problematic in those with autoimmune conditions, chronic pain, and other immune-mediated medical conditions, so consider leaving these off your Whole30 if this is your context.
If you choose to start with the Whole30, make sure you follow the standard protocol to the letter, and keep a journal of your autoimmune symptoms day by day. If you see an improvement in your symptoms by Day 30, you’ll know you’re on the right track! If your symptoms are resolved and you’re happy with your progress, proceed with reintroduction as outlined here. If you still aren’t feeling as good as you had hoped, you can either extend your Whole30 for a longer period of time (for 60 or even 90 days, to see if the benefits keep coming), or start working with a functional medicine practitioner (see Resources) to see if you have other triggers in your diet.
There’s something you should know about nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and Celebrex. This class of drugs has been shown to directly disrupt the lining of the gut, leading to intestinal permeability (leaky gut), a contributing factor in autoimmune disease and immune-mediated conditions. If you rely on a doctor-prescribed NSAID for pain control, remember that your doctor’s orders always trump Whole30 recommendations. However, given the impact of these medications on gut integrity and immune function, we encourage you to talk with your health care provider about alternative methods for managing your pain. If you’re unable to discontinue your NSAIDs at this time, that’s okay—keep up with the rest of the Whole30 protocol, and work with your doctor to evaluate your symptoms along the way. You may find you’re able to taper off the anti-inflammatory medication as your inflammatory symptoms start to decrease.
The benefit of working with a doctor is that he or she will create an elimination plan specifically tailored to your health history, medical condition, and goals, which means you’re likely to experience more successful management of symptoms long-term. You’ll also have the benefit of expert guidance along the way, managing your condition with not only diet, but supplementation, medication, and/or other important lifestyle recommendations.
The downside is that this protocol may be considerably harder—you’re left without many of the foods you would consider “staples” on a basic Whole30, and learning to cook without things like tomatoes or ghee may prove challenging. In addition, working with an experienced practitioner can be expensive—office visit fees, consultation fees, lab work, medication, and supplementation adds up fast.
If you decide to take this approach, use one of the resources listed in the appendix to help you find an experienced functional medicine practitioner, naturopath, or progressive medical doctor in your area. Also, feel free to start eliminating the most common dietary triggers now (like gluten, dairy, and soy), because that’s probably the first thing they’ll talk to you about.
Whichever approach you choose, we encourage you to be patient, and remember that when it comes to autoimmune disease, improvements don’t happen overnight. When your immune system is this overworked and confused, it can take six months or more of dedication to a protocol like the Whole30 or a medical elimination diet to see results, so don’t be discouraged if your symptoms aren’t fully resolved in just a month. Focus on the improvements you are seeing, and let those motivate you to continue with your chosen regimen.
A “Paleo Autoimmune Protocol” (Paleo AIP) is somewhere between a Whole30 and a medical elimination plan. It asks that you eliminate some Whole30 foods, plus many others that are commonly problematic for those with autoimmune conditions. This approach may be a good middle ground if you get done with the Whole30 and still haven’t resolved all of your symptoms, but aren’t ready to work full-time with a medical practitioner. Visit The Paleo Mom (www.thepaleomom.com) or Paleo AIP (www.autoimmune-paleo.com).
First, do not get discouraged from trying a Whole30 because you take insulin or diabetes medications. We believe the potential benefits far exceed the hassle of having a discussion with your health care provider and adjusting medication—and we’ve seen full reversal of type 2 diabetes in just 30 days.
That having been said, it is essential to talk with your doctor before doing the Whole30. Although not specifically meant to be low-carb, the Whole30 tends to be lower in carbohydrates than the standard American diet (SAD), and lower than what most people are eating on an otherwise unrestricted diet. If you’re on insulin or insulin-sensitizing drugs and radically decrease the amount of carbohydrates you’re eating without adjusting your insulin dose, your blood sugar could dip too low, with serious medical consequences.
This is especially true of type 1 diabetics—in fact, you and your health care provider might decide to ease into your Whole30 eating plan instead of jumping in cold turkey, so you can better monitor your blood sugar and adjust your long-acting and short-acting insulin dosages.
Discuss how to approach a Whole30 with your health care provider before you begin the plan, and schedule regular follow-ups to ensure blood sugars are staying within a reasonable range.
While the Whole30 is ideal for healing the gut and improving digestive conditions, we highly recommend those with IBS or IBD work with a qualified functional medicine practitioner (see Resources), as your condition may also require targeted lab testing and probiotic supplementation. If you decide to try the Whole30 before seeking out professional help, please consider restricting high-FODMAP foods (see FODMAPs), known to impact gut bacteria and worsen IBS and IBD symptoms, in addition to the standard Whole30 eliminations.
Sorry.
We know this looks like a lot to take on. But remember, it’s only 30 days, and you’ll learn so much about yourself, your symptoms, and the triggers for your condition thanks to your short-term sacrifice—all information which will prove invaluable if you do choose to work with a professional during or after your Whole30. Here are some other recommendations to ensure your Whole30 is as healthy as possible, given your context.
Fiber-rich vegetables are good for your digestion, but they can also be hard for your body to process, especially if your gut is impaired. You can ease their trip through your digestive tract by cooking them thoroughly, and/or first breaking them down into smaller pieces manually. Try slow-cooking them as part of a stew, or using a food processor to turn your veggies into a soup or puree. Minimize your consumption of raw vegetables or big salads, especially if following the Whole30 means you are radically increasing your vegetable consumption.
Be careful with even low-FODMAP fruit, too, as there are strong links between fructose malabsorption and IBS. Make sure you peel all fruit, avoid what you can’t peel (like grapes and cherries), and eat your fruit as ripe as possible, which makes it easier to digest. You should also avoid fruits that have seeds and a rough exterior (like berries), which can be tough on your digestive tract. Although no one knows why for sure, many IBS sufferers report increased symptoms after consuming citrus fruits, so you may want to avoid those as well. Finally, no dried fruits and fruit juices, which pack too much sugar into a small package for folks with serious GI disturbances.
And now the saddest news ever: avoid all forms of coffee, even decaf. We know, and we’re sorry—we’re really not trying to ruin your life. It’s just that coffee is a powerful GI-tract irritant, and even decaffeinated coffee can trigger abdominal spasms and diarrhea in those with IBS or IBD. In addition, caffeinated coffee is a double-whammy, as caffeine speeds up every system in the body (including the colon), which can lead to diarrhea, followed by constipation. (Double the fun!) Coffee can also increase stomach acid, which can contribute to inflammation in the GI tract. Try herbal tea instead, and drink plenty of water throughout the day—but not with your meals, as it can inhibit proper digestion by diluting stomach acid and digestive enzymes.
Giving up coffee cold turkey can be stressful on the system, especially if you’ve historically used your pot as a cup. Dr. Readinger offers his patients two options for giving up coffee as part of an elimination protocol: cold turkey, or a tapered approach. Cold turkey is just that—starting tomorrow morning, no coffee. The withdrawal symptoms may be rough for the first three days, but you get it over with quick. The tapered approach looks like this: limit yourself to one cup of black coffee for a few days. Then, mix half-caffeinated coffee with half decaf for three to five days. After that, go down to one-quarter regular, three-quarters decaf for another three to five days. As your last step, go to decaf only for another three to five days. Then, no more coffee at all. This saves people from the severity of cold turkey withdrawal symptoms. Choose the approach that’s right for your context, coffee consumption, and personality.
Finally, we’ll caution that your digestion may get worse before it gets better. As your GI tract starts to heal, your mucosal layer will adjust, unhealthy gut bacteria will start to die off, healthy bacteria will begin to repopulate, and the intestinal lining will start to rebuild itself, plugging gaps and filling in holes. This can lead to gas, bloating, diarrhea, or constipation. In conditions such as IBD and IBS, it’s not uncommon for digestive issues to continue for three to six months after making such radical dietary changes—but it is a necessary first step in restoring healthy gut integrity, so stick with it.
Download our Whole30 low-FODMAP shopping list at www.whole30.com/pdf-downloads.
If you’ve had your gallbladder removed, you might be intimidated by the idea of taking on a “high-fat” diet like the Whole30. However, let us assure you that the Whole30 may be one of the healthiest things you’ve done for your digestion!
First, a little background. The gallbladder is a holding and concentration tank for bile (a fluid that aids in digestion), which is produced in the liver. The body likes having a concentrated reservoir of this fluid, because the liver produces it quite slowly, so it “trickles” instead of “gushes.” When you eat a meal with a decent amount of fat, your liver can’t send enough bile out into the small intestine fast enough, so it sends a large amount from the reservoir stored in the gallbladder—enough to properly digest the fats you just ate.
When the gallbladder is removed, there is no longer a reservoir available for bile to be stored and called upon during a fatty meal. If you eat too much fat at once (requiring more bile than the liver can send), some of the fat remains undigested and passes through your system quickly, leading to loose, oily stools, diarrhea, and cramping. Thus, you may have been told by your health care provider to eat low-fat and whole grain, or eat only certain kinds of fat (generally avoiding animal fats), and above all, to stay away from “high-fat” diets like Atkins, Paleo, or the Whole30.
However, the Whole30 is not a high-fat diet. You may be eating more fat than you used to, but then again, you used to subsist on nothing but heavily processed, sweetened, low-fat foods, and how well did that work? Our added fat recommendations are actually quite moderate, which means your lack of gallbladder shouldn’t affect your Whole30 strategy much.
First, you may need to switch from three big meals a day to four or five smaller meals, especially if you’re large and active (and require more fat for energy). This will help you eat enough fat during your day without overly taxing your liver. Still, don’t graze like an antelope, especially on high-fat foods like nuts and seeds, as that may tax your liver’s capacity to send enough bile to get the job done.
And don’t even think of intermittent fasting. There is no way you can eat enough calories in a shortened feeding window and still be able to properly digest all that fat without a gallbladder. (If you don’t even know what intermittent fasting is, good. It’s not for you.)
In addition, consume plenty of water during your day, but not during meals. Drinking water with your meal will dilute the small amount of bile available for digestion, making it even less effective.
You also may want to experiment with different kinds of fats. The medium-chain triglycerides found in coconut (oil, flakes, butter, or milk) are easier to digest, and coconut oil in particular digests without a need for bile. You may have an easier time with digestion by eating less animal fat, but adding more coconut oil to your meals or during cooking.
Finally, an ox bile supplement can often provide all the digestive help you need, even if you are eating bigger meals closer to our meal template recommendations. In addition, you may notice your capacity for digesting fats increasing after your surgery—the body has a remarkable ability to adapt to new conditions, and you may find a year post-surgery that you can enjoy bigger meals with more fat with little to no issue. As always, talk about doing the Whole30 with your doctor before you begin, and work closely with him or her when making these changes to your diet.
There are other medical conditions and prescription medications that may be affected by the dietary changes you’re making on the Whole30—sometimes within just your first week on the program.
If you’re taking medication for high blood pressure, consult your health care practitioner prior to launching your Whole30. Many have testified they no longer need their blood pressure medication after doing the Whole30, which means you and your doctor will need to monitor your blood pressure and medication dosage throughout the program. If your doctor agrees, you can purchase a blood pressure cuff and monitor your blood pressure twice a day for the duration of the Whole30. If your blood pressures fall below a certain level (as predetermined by your health care provider), or if symptoms of decreased blood pressure occur (light-headedness, especially when going from sitting to standing, generalized fatigue, etc.) then your doctor may decide it’s time to back down on the amount of medication being taken. These changes tend to happen gradually, and not all at once, which makes it easier to monitor and adjust your medication.
As for thyroid conditions—chronic hypothyroidism (low thyroid) responds slowly to medication changes and dietary interventions. Check in with your doctor before embarking on the Whole30, and test thyroid hormone levels before and after the program. This is especially true if you have an autoimmune thyroid condition like Hashimoto’s, which may respond well to this gluten-free, gut-healing diet.
Finally, if you’re taking a statin medication like Lipitor, feel free to continue while on the Whole30. We don’t know of any immediate or long-term dangers with the combination of a statin medication and a whole-foods based diet like the Whole30, but if you haven’t had a discussion with your physician about why you’re on a statin medication, it might be time to do so. We’ve had many testimonials of cholesterol levels and triglycerides dropping far beyond what their doctors told them was possible with dietary changes only, and many people are able to stop using their statins post-Whole30.
We haven’t covered anywhere near the full scope of medical conditions and prescription medications that are affected by the Whole30—that would be impossible, as there appears to be no disease, condition, or symptom that isn’t impacted in a positive way by a gut-healing, anti-inflammatory diet. In general, we encourage you to work closely with your health care provider before taking on the Whole30, and consult them throughout the program, especially if you observe a change in your health or symptoms.
Nervous about talking to your doctor about the Whole30? Follow Dr. Readinger’s helpful tips at www.whole30.com/talktoyourdoc.
We admire your dedication in pursuing a healthy relationship with food, and do believe that eating real, nutrient-dense, unprocessed foods is the healthiest way to nourish your body and break unhealthy cravings and habits. However, if you have a diagnosed eating disorder (or a history of disordered eating), please use caution when taking on a program like the Whole30.
Some people with eating disorders (active or in recovery) have found amazing food freedom with the Whole30. The fact that we don’t count or restrict calories, encourage you to eat healthy foods to satiety, and take the scale and body measurements out of the equation may prove to be the paradigm shift that you need to get back to a healthier relationship with food.
However, there are probably just as many people who have found the rigidity, rules, and structure of the Whole30 program too reminiscent of their disorders. For these people, the Whole30 “as prescribed” is actually a trigger for disordered eating behavior, hurting their progress more than it helps. The restrictions may carry over to calorie or macronutrient restriction in anorectics, or may trigger a binge in those with a history of compulsive overeating.
If you have a history of disordered eating and are wondering if the Whole30 is right for you—we simply can’t answer this question for you. In fact, you shouldn’t try to figure it out on your own, either. If this is your context, you must work with a qualified counselor or mental health professional to determine whether the Whole30 is right for you before you begin the program.
If you and your counselor do decide the Whole30 is appropriate for you, you may also decide together to modify the rules or relax the restrictions. We know—that basically goes against everything we’ve written about the program and the need to follow it to the letter, but this is not your normal scenario. While we insist the Whole30 must be completed exactly as written to obtain the full benefit, we didn’t write the program with eating disorders in mind. That language was written to discourage people from thinking they can have a bite of this here and a glass of that there and it really won’t make a difference. However, in your context, if you and your counselor need to adjust the rules, duration, or structure of the program to make it work for you, by all means do so. If following just a select portion of our healthy eating program helps you make progress in your recovery, we’re happy to have you on board.
However, even if you’re working with a trusted counselor, it’s possible your commitment to the Whole30 will cross into dangerous psychological territory. The signs are different for everyone, but you can use these simple questions to help determine if your Whole30 is going to an unhealthy place:
If you answer yes to any one of these questions, take some time to seriously think about your motivation for doing this program and whether you want to proceed. If you answer yes to more than one, take a time-out from the program, and speak with a trusted counselor before returning to the Whole30.
For more information on the Whole30 and eating disorders, including reader stories and testimonials, visit www.w30.co/w30ed.