CHAPTER 5

Food Allergies, Sensitivities,
and Special Diets

Diet Essential: Mental illness is affected significantly
by diet and exposure to food toxins and allergies.

People make food choices based on family experience, religious and cultural belief systems, and the conditioning of their sense of taste and satisfaction. Spiritual and religious faith also influences dietary choices, such as beliefs that prohibit eating of pork (Judaism and Islam), that include the drinking of human and bovine urine (Jainism, Buddhism), or that call for periodic fasting (Islam and Christianity).

People may also make choices or feel driven to eat certain foods due to allergies and sensitivities. What people choose to eat can be a response to cravings and the effects of food chemicals on the brain/mind. People are frequently unaware of their allergies or sensitivities even as their body reacts to various foods they consume, because the effects may not be immediate but delayed for hours or days. Indeed, someone who is allergic to shellfish may break out in hives in a matter of moments, whereas the signs of gluten sensitivity build over months.

Mental and physical reactions to foods and to food additives can go undetected for many years. Some people experience minor or major reactions while others do not experience any reaction. Eliminating certain foods and additives greatly reduces sensitivities. Symptoms can improve and frequently the adverse reactions resolve.

The saying “If your food can go bad, it is good for you. If your food can’t go bad, leave it alone” refers to the detrimental effects of preservatives in foods that prevent spoilage.

In this chapter, I first show what is known about how food allergies and sensitivities affect mental health and then review some dietary concepts that are beneficial (or detrimental) for mental health. Diets provide a roadmap for clients to follow. Some people like a map laid out for them, while others prefer to use their inner “homing device,” their gut. As a mental health clinician, you need not be a nutritional expert on all diets to help and advise your client. Knowing the types of diets clients are using or what diets are available as a roadmap for their health will enable you to have a dialogue about their choices, free of bias, and thus enhance your partnership model of care. Review Table 5.1 to match the optimal food ratios for each nutritional type .

TABLE 5.1

Nutritional Types and Best Foods

Type	Metabolism	Blood pH	Best Foods
Fast metabolizer	Burns carbohydrates fast	Acidic	Carnivore and purines, fats, low carbohydrates
Slow metabolizer	Burns carbohydrates more slowly	Alkaline	Vegetarian, carbohydrate rich (lacto-ovo and lean animal products)
Mixed metabolizer	Burns balanced	Balanced	Mixed animal and plant proteins/carbs

The first step to identifying an appropriate diet is to further explore the client’s nutritional type (Carnivore, Mixed, Lacto/Ovo Vegetarian, Pesca-Vegetarian) and the ideal range of food types and ratios that will benefit her or him. The next step is to discover whether the client has food sensitivities or allergies and, if so, their effect on the client’s mental health. Sometimes eliminating certain foods may be the easier first step for certain clients. Identifying allergies and sensitivities may be painstaking. Some may do well eating larger amounts of protein but may also experience milk sensitivities. As a basic first step, I encourage clients to eliminate all the packaged foods with additives and preservatives, regardless of whether they are sensitive to them, while advising them to choose fresh whole foods.

Another common challenge to dietary changes may involve working with a vegan or vegetarian who eats a lot of grains. Such clients may indeed be sensitive or allergic to grains containing glutens, or she or he may be a biological carnivore or mixed oxidizer and is resistant to incorporating animal proteins. This individual may then be willing to try a gluten-free diet as a pathway to improved well-being before she is willing to incorporate more animal proteins. Using diets to explain desired outcomes can be helpful, but understanding personality needs and the stage of change that I discuss in Chapter 9 is crucial to success .

FOOD ALLERGIES AND SENSITIVITIES

Food allergies and sensitivities are common in people who experience poor mental health. Inflammatory reactions caused by diet fall into three categories: Food Allergy, Food-Induced Autoimmune Disease, and Food Sensitivities. Some of the more common food allergies that affect mental health are glutinous grains and dairy products, but they are not limited to these major categories of food.

Food Allergies: Definitions

Food allergies involve reactivity of the immune system. Allergies are often genetic and hereditary. Allergies can be present in childhood through adulthood and are more likely if a parent has an allergy. They can also develop in response to foods that are eaten often. Allergies can also develop in adulthood and may be linked to chronic stress disrupting immune function. Allergies can also develop as a result of chronic infections, eating poor quality or pro-inflammatory foods, toxic exposure, nutritional deficits, and chronic stress.

Food allergies are serious, sometimes life-threatening reactions of the body and immune system to certain foods. An allergic reaction occurs when the immune system overreacts, attacking a normally harmless food protein. This is why food allergies are sometimes referred to as “body paranoia.” The body may be overreacting to a threat that normally should not be threatening. Food allergies occur when the body produces large amounts of the antibody immunoglobin E (IgE) to neutralize the offending food protein. IgE then stimulates the immune system to release histamine and other chemicals, resulting in an allergic reaction.

Symptoms of food allergy can occur immediately after ingesting the food or up to several hours later. Symptoms may be mild or severe. Mild symptoms of food allergy include itching in the nose, mouth, eyes, and throat; hives; or gastrointestinal problems like vomiting and diarrhea. More severe reactions include angioedema or anaphylaxis.

Common Allergens

While common allergens include milk, eggs, wheat, soy, tree nuts, peanuts, fish, strawberries, and shellfish, nearly any food can cause an allergic reaction.

Pollen-food allergy syndrome occurs when certain vegetables, fruits, nuts, or other foods cause an allergic reaction in people who have hay fever due to a similarity in the proteins in the pollens and the foods. For example, a ragweed allergy can cause a food allergy to bananas, tomatoes, or melons. Cooking food usually prevents this cross-reactivity from occurring .

Testing and Treatment

Food allergies can be tested by a skin prick test, blood test, oral food challenge, the pulse test, or elimination diets. The best approach to treatment is elimination of the allergen.

Box 5.1

The Pulse Test

One way to begin to test for food allergy or sensitivity is the pulse test, a simple, do-it-yourself method for determining negative reactions to foods. It is not recommended in cases of severe allergic reactions like anaphylaxis.

Pulse Test Directions

1.  Begin the day by taking your pulse before you get out of bed. Count your pulse beats for 1 minute and record them.

2.  Take your pulse 1 minute before each meal.

3.  Take your pulse 30 minutes after each meal, then again in another 30 minutes, and a third time 30 minutes after that.

4.  Take your pulse just before going to bed.

5.  Record each pulse that you take along with the foods eaten at each meal.

6.  Continue the pulse taking and recording of meals eaten for 2–3 days.

7.  Take note of meals that caused pulse increases of more than 6 to 8 beats per minute, and identify foods within those meals that could be the cause.

8.  Foods that are suspected of causing pulse increases can then be tested individually. Take your pulse before eating the suspected food item and again 30 minutes afterward.

9.  Eliminate foods that cause pulse increases of more than 6 to 8 beats per minute from your diet.

Food Sensitivities/Intolerance

Food sensitivities are the most common type of diet-induced inflammatory reaction. These sensitivities contribute to poor mental health and yet may be disguised in their presentation. Thus, it may take many years to realize that food sensitivities can be a cause or contributing factor to any diagnosis or symptom .

Definitions

Food and food-chemical sensitivities or intolerances, also called nonallergic (non-IgE) food hypersensitivities or nonceliac inflammatory reactions, differ from food allergies. Food and food-chemical sensitivities play a role in the inflammation and symptoms of many chronic conditions. It can be very difficult to identify trigger foods because the symptoms may not manifest directly after consuming the offending food, and the amount of food eaten can greatly affect the presentation of symptoms.

Symptoms of food intolerances vary widely and can manifest quickly after eating the food or may require up to several days to appear. Sometimes the skin shows signs of food intolerance, like eczema, acne dermatitis, rashes, or hives. The digestive system can be affected with symptoms such as gas, bloating, cramping, diarrhea, constipation, irritable bowel syndrome, nausea, and ulcers in the mouth. The respiratory tract can also be affected.

There are many mental health and physical conditions that may be related to food and food-chemical sensitivities, such as fibromyalgia, GERD, inflammatory bowel syndrome, obesity, migraines, ADHD, autism spectrum disorders, depression, insomnia, and chronic fatigue syndrome (Oxford Biomedical Technologies, 2013). Food intolerances and sensitivities can also have a psychological component when foods are associated with traumatizing events in state-dependent learning memory and behavior. This occurs when an offending food is associated with a negative event in one’s life and the body associates the pain of the event and the symptoms with the food or even the time of year the event occurred. This can make teasing out cause and effect very challenging. Then the symptoms can become conditioned and no longer require the food or environmental trigger; they just continue. Juana’s experience, which is described in Box 5.2, reflects how allergic reactions and sensitivities can combine with state-dependent memory and learning and behavior.

Box 5.2

Juana’s Story

Juana came for treatment for depression and anxiety due to disability associated with unremitting hives and life-threatening angioedema. She experienced ongoing swelling around her neck and shoulders and around her clavicle. Her breathing was also affected, and she was on several medications, including antihistamines and sedatives. She was emotionally and physically hyperreactive. Together we worked on her diet for several months. She closely followed her overall health program and made some improvements. Still she suffered terribly with the angioedema. I explored during her assessment her history of the events leading up to the start of her symptoms. When she was on her way home from shopping, she picked up some take-out food and then sustained a car accident. During the accident the seat belt caused bruising across her neck and upper body, and the air bag had activated while her arms were crossed, forcing her hands against her neck and injuring her. She developed PTSD from the accident, and her body/mind memory associated the grocery bags in the car at the time of the accident—which went flying throughout the car—with fear and the bruising and swelling across her upper body. Years later, as she sat in my office, what remained was the state-dependent memory of fear and swelling associated with food. We then integrated a series of hypnotherapeutic sessions to decondition this state-dependent memory as an adjunct to the dietary improvements she was making. Together with her dietary changes, she experienced improvement over time.

Common Foods That Cause Allergies and Sensitivities

Lactose

Lactose is a sugar that is present in dairy products. Lactose intolerance is an impaired ability of the body to digest lactose due to lactase deficiency—an enzyme needed to break down lactose. Lactose intolerance is different than a milk allergy, in which the immune system reacts to protein(s) in milk. Milk allergies are more common in infancy, whereas lactose intolerance is more common in adulthood.

Lactose intolerance is commonly undiagnosed. Humans lose the ability to synthesize lactase by about age 5, and by adulthood 70% of people in the world are lactose intolerant. They do not produce sufficient quantities of this enzyme. Lactose intolerance is genetically based and occurs at high rates among people genetically associated with cultures where dairy animals are not native to the environment. Lactose intolerance varies among ethnicities. African natives and peoples from Asia have the highest rates (80%–100%), followed by African Americans and Mexican natives (70%–80%), Mediterraneans and those of Jewish descent (60%–90%), and Northern Europeans (1%–5%). However, in keeping with our understanding of culture and biochemical individuality, understanding the genetic influences is what counts. For example, the Maasai of northeastern Africa are herding peoples and indeed drink raw milk mixed with bovine blood. This is in contrast to peoples of the west coast of Africa who do not drink milk. Hence, the origins of one’s ancestors, coupled with the admixtures with Europeans, African Americans, and other peoples, will ultimately determine these types of food allergies and intolerances. This will be true with everyone .

Some people are able to handle small amounts of lactose without triggering a reaction. Some people with lactose intolerance may be able to tolerate dairy products that have a higher fat content, such as pure cream or butter, since the lactose content is lower in these products. Yogurt and other fermented dairy with live cultures can generally be consumed due to bacteria converting lactose to lactic acid. However, note that most commercially available fermented products are not truly fermented nor have live cultures.

Many processed foods contain lactose (see Appendix I for a list of Foods Containing Lactose). It is important to read food labels and check for milk, lactose, whey, curds, dry milk solids, nonfat dry milk powder, and milk by-products. As a rule, I discourage all children and adults from drinking cow’s milk or eating cow’s cheese. There are better options for their health.

Casein

Casein is a protein found in milk and milk products. Products with higher protein content, such as yogurt, cheese, kefir, milk, and ice cream, tend to be higher in casein. Butter and cream contain only small amounts of casein. Casein is often added to nondairy cheeses to give them the melting quality of real cheese (see Appendix J for a list of Foods Containing Casein and Dairy Alternatives).

Casein has been implicated in schizophrenia, depression, and the autism spectrum disorders. Casein is the major ingredient in the anxiolytics that have the generic term Lactium or brand name De-Stress. However, this is a specially prepared peptide derived from casein and does not appear to contribute to allergic or sensitive reactions.

Gluten

Gluten (think “glue”) is comprised of the proteins gliadin (a prolamin protein) and glutenin that can cause immune system reactions. Approximately 50% of those who are sensitive to dairy are also gluten intolerant. Gluten reactions occur along a spectrum; type 1 is celiac disease, an autoimmune reaction, and type 2 is non-celiac gluten sensitivity (GS). Celiac disease is a genetic autoimmune reaction to gluten that causes damage to the small intestines, preventing the absorption of important nutrients. I have been examining throughout this book the contribution of gluten and its various proteins to poor mental health and suggesting its elimination from the diet as a priority.

GS is more common than celiac disease. In GS, gluten does not always cause intestinal damage, and it does not trigger tissue transglutaminase antibodies. Undiagnosed GS should be suspected and ruled out in depression, dementia, ADHD, skin disorders, joint pain, headaches, schizophrenia, and autism spectrum.

Many foods cross-react with gluten. This means that the proteins in these foods are similar enough to cause a reaction. Among these are casein, yeast, oats, sesame, and instant coffee (Kharrazian, 2013).

GLUTEN-FREE DIET

The easiest way to withdraw from gluten is to follow a 7-day high-protein diet. Generally the physiological craving for gluten and carbohydrates has diminished significantly after 7 days, but the diet can be continued longer if necessary. A modification of this diet involves incorporating root vegetables such as sweet potatoes, yucca (manioc or cassava), parsnips, carrots, and squash. These foods satisfy the need for fiber and for something sweet. Unlike other sweets, they raise the blood sugar level slowly and they contain nourishing vitamins and minerals. Sometimes people who are addicted to carbohydrates like the sensation of fullness that these foods bring. This can be produced with root vegetables or by taking some fiber in a drink—for example, a gluten-free source such as psyllium.

There are many gluten-free carbohydrate substitutes such as milled flours: rice, potato, coconut, almond, buckwheat, sorghum, sweet potato, bean/cassava/rice mixtures, and tapioca. Gluten sensitivity may also be tied to glucose dysregulation and thus mood lability. It is very effective to eat a hypoglycemic type of diet (see Appendix A for Guidelines for a Hypoglycemic Diet), ensuring the intake of proteins every 3 to 4 hours. This will generally stabilize mood. It is very helpful during this time, once the client is through the first initial 3 days of withdrawal, to keep a food diary. It takes 3 months, in general, for the intestinal inflammation associated with gluten sensitivity to heal. However, changes in mood, a reduction in joint stiffness, and the lifting of depression will be apparent sooner. In severe cases of sensitivity, it is always wise to eliminate all gluten products. In mild cases of carbohydrate addiction, it is possible to reintegrate the use of carbohydrates with gluten on some special occasions without adverse effects. However, as in the case of alcohol addiction, some people do better than others with total abstinence. Total abstinence is better for some, and others appear to manage limited quantities.

Since glutinous carbohydrates are considered comfort foods, applying the principle of substituting a less addictive substance for another could be used here—for example, making a non-sugar-based cup of hot cocoa or chocolate to which a natural sweetener such as stevia has been added can help one through tough times and will raise energy levels and endorphins.

Gluten/gliadins are found in wheat, wheat germ, wheat grass, bulgur, couscous, farina, graham flour, kamut, matzo, seitan, semolina, triticale, barley, rye, buckwheat, pearl barley, oats (unless they specify gluten-free), oat bran, oat fiber, and spelt. Some people who are gluten intolerant are able to handle small amounts of gluten (see Appendix E for a list of Foods That Often Contain Gluten).

The digestive enzyme called dipeptidyl peptidase-IV (DPP-IV) helps to break down gluten protein fragments (Kharrazian, 2013). While this enzyme should not be used as a supplement in order to eat gluten, it can assist in the case of accidental exposure to gluten. DPP-IV also helps to break down the allergenic protein casein found in dairy products. Both gluten and casein contain proline. The intestines normally produce DPP-IV to break down proline. Researchers commonly hold the view that these prolyl peptides act like opiates in the brain and may cause a worsening of symptoms in depression, schizophrenia, and autism spectrum disorders. Simply removing gluten, along with reducing carbohydrates and increasing healthy fats in the diet may improve conditions such as ADHD, depression, and dementia (Perlmutter, 2014). There are many satisfying options for gluten-free foods, as shown in Box 5.3.

Box 5.3

Gluten-Free and Casein-Free Pancakes Topped
With Fruit Sauce

Children and adults alike love pancakes, but ordinarily they contain poor-quality flours and sugars. However, these pancakes are ideal for everyone. They are light and fluffy, sweet and satisfying, and make a wonderful Sunday morning meal. Place one or two poached eggs on the side with some organic bacon or sausage for an antihypoglycemic meal.

Dry Ingredients

1¾ cups rice flour

¼ cup buckwheat flour

¼ cup almond flour

1 tablespoon chia seeds (for fiber)

1½ teaspoons baking powder

¼ cup tapioca flour

pinch of sea salt

Wet Ingredients

1 cup almond milk or coconut milk

1 cup water (or as needed)

1 tablespoon vinegar

2 eggs, beaten

4 tablespoons coconut oil, melted

4 drops of liquid stevia

1 teaspoon vanilla extract

Sauce Ingredients

1 cup defrosted organic berries or other fruits like mango or pineapple chopped

1 tablespoon organic Butter

1–4 drops stevia liquid, to taste

Serving Suggestions

Top pancakes with butter, fresh berries, almond butter, yogurt, and/or nuts.

Directions

1.  Whisk together the dry ingredients in a large mixing bowl. In a separate bowl, whisk together the wet ingredients. Add the wet ingredients to the dry ingredients and mix until almost smooth. The consistency should be pourable; if it is too thick, add a little more water or milk. Let sit for about 10 minutes to blend and hydrate the chia seeds. It should show signs of little gas bubbles due to the vinegar/baking powder reaction.

2.  Lightly grease your pan or griddle with coconut oil and heat over medium-high heat.

3.  When the pan is hot, use a ladle to pour the pancake batter into the pan. (Turn heat down a bit if the first cakes are a bit scorched.)

4.  Wait until you see bubbles forming in the pancake and the edges look cooked, then flip the pancake with a spatula. Cook for another minute or two until firm, then serve. Repeat with the rest of the batter.

Making the Sauce

1.  Defrost frozen berries or other fruits like mango and pineapple and lightly heat in a pan with added butter and stevia. Bring to a near boil, simmer for a few minutes, and decant into a syrup bowl with a spoon.

2.  Pour over the top of the pancakes .

Tip: Pancakes are best when eaten immediately, but if you need to keep the pancakes warm, use a large, shallow serving bowl and place a towel inside of it. Wrap the pancakes in the towel. This will keep them warm and prevent them from drying out.

Always Read the Label

The key to understanding the gluten-free diet and the additive-free diet is to become a good ingredient label reader. Gluten is everywhere now and even used as an additive, so there is a lot of hidden gluten in prepared and packages foods. Just because it is not listed does not mean it is not there. There are many gluten-free foods and bread/grain substitutes. Choose from many fresh, healthy foods like fruits, vegetables, beans, dairy, nuts and nut flours, sweet potatoes, buckwheat, amaranth, potato flour, and gluten-free grains like sorghum, quinoa, or rice. Millet along with quinoa is highly nutritious, versatile, and easy to prepare (see Appendix K for a recipe for Curried Quinoa). It is rich in iron, B vitamins, and calcium, and it can be used as a breakfast cereal with butter and sweet juice added, mixed with cheese, or used with vegetables or animal proteins as desired (see Appendix K for instructions on how to cook millet). The best options are the natural flours made with nuts and seeds and flours made from coconut, almond, and rice, potato, and tapioca.

Gluten and Alcohols

Beer is made from grains and thereby contains gluten. Most other alcohols such as scotch, rye, and vodkas, while made from grains that are glutinous, are distilled, which removes the gluten, thereby making them safe to consume. Do keep in mind that alcohol, when mixed with gluten in food, magnifies the reaction in sensitive individuals and therefore should be avoided. Further, many patients who have celiac disease or who are gluten sensitive have a poor reaction to alcohol. All commercial oats are contaminated with gluten. To be sure about the quality of the oats, obtain certified gluten-free oats.

Corn

Corn is one of the more difficult food allergies to have inasmuch as corn is so prevalent in foods produced in the United States. From cornstarch and corn syrup to ingredients like dextrose, it is very difficult to find packaged foods that do not contain some form of corn (see Appendix L for a list of Foods That Commonly Contain Corn). While not considered one of the top eight food allergens, corn allergy is becoming more common in the United States and corn-producing countries in Asia and Africa. Perhaps due to how ever-present corn is in our diets, allergic reactions to corn are increasing. The symptoms of corn allergy are similar to other food allergies and can range from mild to severe.

Another aspect of what makes corn an allergen is that most corn in the United States is now genetically modified. Genetically modified organisms (GMOs) are plants or animals that have been genetically engineered with DNA from bacteria, viruses, or other plants and animals. More than 60 countries, including those of the European Union, have placed restrictions or bans on the production and sale of GMO foods. GMO foods should be avoided.

Histamine

Histamine is a neurotransmitter released from mast cells. While necessary for our immune system function, at high levels histamine causes allergic reaction and influences mood and psychosis. For example, the treatment of schizophrenia with high-dose antihistamines has shown some success (Meskanen et al., 2013). High levels of systemic histamine are also associated with OCD, oppositional defiant disorder, and seasonal affective disorder. People who are histamine sensitive may experience anxiety, headaches, migraines, mood lability, itchiness, and have hives and asthma. Histamine is found especially in fermented foods like red wine, aged cheese, and sauerkraut (see Appendix M for a list of Foods Containing Histamines). A low-histamine diet may lead to improvement. This means eating only fresh food, not leftovers, and avoiding the following foods: fruits and vegetables that are overripe; additives and fermented foods (probiotic powders should be used instead); cultured, processed, smoked, and fermented meats; eggs in large amounts; citrus fruits; tea; chocolate; and alcohol.

Salicylates

Symptoms of salicylate intolerance are associated with anxiety and depression, and they are found in people who experience multiple-chemical sensitivity. Sensitivity to foods containing salicylates has been shown to contribute to ADHD in some children (Stevens, Kuczek, Burgess, Hurt, & Arnold, 2010).

Salicylates Derive from Salicylic Acid

Many plants like willow bark naturally contain salicylates, which act as an immune hormone and preservative that protects the plants from harmful bacteria, fungi, insects, and diseases. There are also synthetic salicylates found in medications (like aspirin), perfumes, and preservatives (see Appendix N for Foods and Products That Are High in Salicylates). Most people can handle moderate amounts of salicylates in food; some people are intolerant of even small amounts of salicylates and experience adverse reactions. This is called “salicylate sensitivity” or “salicylate intolerance.” Adverse effects may be seen when a certain amount of salicylates are consumed, or if salicylates accumulate in the body over time. Both the natural and the synthetic forms of salicylates are harmful to everyone in large amounts. Symptoms of salicylate sensitivity may include depression and anxiety; asthma and breathing problems; headaches; nasal congestion; itching, skin rash, or hives; swelling of the hands, feet, and face; and stomach pain.

Sulfites

Sulfites, or sulfur dioxide (SO2), are chemicals used as a preservative and food additive. Sulfites are commonly added to wine to stop the fermentation process and to preserve the wine. Organic wines tend to have a lower content of sulfites. Generally, white wines and sweeter wines contain more sulfites. Sulfites are added to dried fruits as a preservative. They may be a hidden ingredient added to frozen shrimp and also in some beverages and medications.

Sensitivity to sulfites may cause symptoms such as mood lability, headaches, sneezing, asthma, throat swelling, and hives. People with asthma tend to be more at risk of having sulfite sensitivity.

Reading food labels is important when trying to avoid sulfites. Things to look for include sulfur dioxide, potassium bisulfite or potassium metabisulfite, sodium bisulfite, sodium metabisulfite, or sodium sulfite (see Appendix O for Foods Containing Sulfites).

Nightshades

Nightshade foods are an important factor in mental health. They can cause intestinal permeability and inflammation, leading to the use of pain medications and antacids. Consuming these medications causes nutritional deficits and adversely affects gut function.

Members of the large plant family known as Solanaceae, nightshades comprise a wide variety of plants and foods, including tomatoes, potatoes (excluding sweet potatoes and yams), eggplant, and peppers (excluding black pepper). Peppers include all peppers, both spicy and mild, from habanero and jalapeno chilies to cayenne and paprika. Additionally, ashwagandha, goji berries, cape gooseberries, ground cherries, and garden huckleberries are in the nightshade family. Symptoms of nightshade sensitivity include muscle pain and tightness, arthritis, sensitivity to weather changes, morning stiffness, slow healing, gallbladder problems, heartburn, and GERD.

Test for Nightshade Sensitivity

Begin by conducting a self-inventory of pain and swelling of joints. Rate how you feel on a scale of 1 to 10 with 10 being in terrible joint pain with stiffness. Eliminate all nightshade foods during 4 weeks, and at the end of the period conduct another self-inventory. If you are sensitive to nightshades, you will feel better after 4 weeks without them. You can test this by returning to the use of nightshades for 1–2 weeks and observe that the pain and stiffness will return. Some people can sharply reduce their intake of nightshades and still tolerate them on occasion. If you enjoy barbecue sauce, look for a nightshade-free recipe called Papaya Barbecue Sauce in Appendix P .

General Treatment of Food Intolerances

•  Reduce exposure to one food one at a time to test reactivity.

•  Identify healthy substitutes where possible.

•  Increase supplemental digestive enzymes.

•  Address linkages to traumatic events and use hypnotherapy to decondition reactivity.

Assessment Essentials and Elimination Diets

Tests

The Mediator Release Test (MRT) is a blood test that identifies up to 150 foods and chemicals, which provoke the release of immune mediators that cause pain and inflammation (Pasula, 2014).

Conduct Specific Food Elimination Diet

The elimination diet is an effective and safe way to assess and treat food intolerances. Eliminating a food or food group for 3 or 4 weeks while monitoring symptoms allows sufficient time to observe symptom changes. If symptoms improve during this time, the food is reintroduced to see if it causes the symptoms to worsen. If symptoms improve when the food is eliminated and return when the food is reintroduced, the food should be excluded from the diet for at least 6 months. Strict adherence to the diet is necessary for accuracy. Allow sufficient time for inflammation caused by the food to heal. Once an offending food is identified, it may be possible to eat it once in a while without symptoms, but only on special occasions, and this must be assessed individually (see Appendix Q for a Guide to Foods on the Elimination Diet).

After 3 weeks on the elimination diet, one food at a time is reintroduced for 1 day. For example, if you decide to end the elimination diet by reintroducing corn, you would add corn or a corn product to a couple of meals for 1 day. Then for the next 2 days you would not eat corn, but you would monitor to see if any reactions occur. If not, you can continue to eat corn, and after those 2 days you can add another food back into your diet and follow the same process of 1 day with the new food and 2 days without while monitoring for symptoms. The elimination diet and reintroduction phase should take about 5–6 weeks total.

Among the first foods to start eliminating are grains containing gluten (wheat, bulgur, barley, rye, couscous, kamut, semolina, spelt, triticale, and oats), cow’s milk (milk and cheese products), and soy, but any food or food group (salicylates, nightshades, additives) that can cause reactions can be eliminated.

Modified Elimination Diet

1. Begin by eliminating dairy products like milk, cheese, butter, ice cream, and so on. It may be okay to continue eating small amounts of plain, unsweetened yogurt with probiotics.

2. Eliminate gluten and other grains that may cause reactions.

3. Drink a minimum of 2 quarts of water daily.

4. Avoid alcohol and products containing alcohol, as well as all caffeinated drinks, decaffeinated coffee, and herbal coffee (see Appendix Q for a Guide to Foods on the Modified Elimination Diet).

CHEMICAL SENSITIVITIES

Multiple-Chemical Sensitivity

Multiple-chemical sensitivity (MCS) is also known as “environmental illness” or “multiple allergy” and environmental intolerance. It refers to a range of severe symptoms that are related to chemical, biologic, or physical irritants, or pollutants. Understanding MCS is important to mental health treatment because people with unexplained symptoms can suffer from debilitating symptoms and as a result have significant mental health problems. Because there is no widespread or agreed-upon consensus about this syndrome, people are commonly misdiagnosed with somatic symptom disorder and illness anxiety disorder. While they may indeed benefit from psychological treatment, these individuals are often difficult to diagnose. The causes of their symptoms are wide ranging and invisible. There are several theories as to how MCS is possible, including (1) enzyme depletion, (2) immune system disorder including systemic inflammation, (3) nervous system sensitization, (4) HPA axis dysregulation, and (5) challenges in phase 2 liver detoxification.

In my own practice, every person suffering from MCS has experienced many years of chronic stress prior to diagnosis. Early-life events and high allostatic load affect the ability of their adrenal and immune systems to withstand significant environmental exposures. MCS sufferers are the proverbial canary in the coal mine for all of us. Many people are exposed to significant toxins at work and at war that cause multisystem health reactions. Symptoms include fatigue, dizziness, headaches, chest pain, skin rashes, nausea, sleep problems, digestive problems, sore throat, coughing, wheezing, muscle pain and stiffness, itching, heartbeat irregularities, difficulty concentrating, memory problems, bloating, confusion, and mood lability.

Some of the common triggers reported in MCS include solvents, exhaust, volatile organic compounds (VOCs), chlorine, perfume, tobacco smoke, insecticide, new carpet, paint, pollen, pet fur, and dust mites.

Neurotoxins

Neurotoxins and excitotoxins are substances added to foods that prevent nerves from functioning normally by interfering with their electrical activities. They are found in most packaged foods and include ingredients like dough conditioners; seasonings; yeast extract; carrageenan; maltodextrin; hydrolyzed vegetable protein; sodium fluoride; sodium caseinate; calcium caseinate; chicken, pork, or beef flavoring; disodium anything; smoke flavoring and anything called autolyzed; whey protein concentrate; natural flavors or spices; and additives such as glutamate and aspartate. Researchers and clinicians associate neurotoxins with the development of Alzheimer’s and Parkinson’s disease. Neurotoxic food additives are mostly derived from proteins in the form of free glutamic acids. Next I list the most prevalent neurotoxins to be avoided .

Monosodium Glutamate

Monosodium glutamate (MSG) is a flavor enhancer added to many processed foods, especially of Asian origin. It is a natural sodium salt of glutamic acid. It is usually made from fermented corn, rice, or potatoes. Animal studies repeatedly show that refined MSG causes depression and anxiety (Quinesa, et.al., 2014). Individually and together with aspartame, MSG disrupts cognitive function and increases oxidative stress in animals (Abu-Taweela, Zyadah, Ajarem, & Ahmad, 2014). Magnesium (Bland, 2004) and vitamins C and E are protective against the oxidative stress effects of MSG (Tawfik & Al-Badr, 2012).

Natural Flavors

While natural flavors are derived from natural foods like fruits and vegetables, they are also isolates of those foods and can become toxic. When consumed as part of the whole fruit or vegetable, the other compounds present balance them. In addition to “natural flavors,” which sounds harmless, many companies use the term “spices” to refer to ingredients that are actually neurotoxic substances. Foods with natural flavors added are to be avoided.

Soda Pop

Sodas with sugar and diet sodas are one of the first substances to eliminate from the diet. Diet sodas have excitotoxins like aspartame. Ironically they have been shown to cause weight gain and diabetes. Artificial sweeteners (saccharin, sucralose, or aspartame) disrupt intestinal gut microbiota and alter metabolism of glucose (Suez et al., 2014). Caffeine-rich sodas contribute to anxiety and insomnia, and there is some evidence that regular consumption of sugar-sweetened soda alters DNA and shortens life span (Leung et al., 2014). Withdrawal involves withdrawal from sugar (or artificial sweeteners) and often caffeine. Soda drinking is a common habit, linked to work.

Beverage Sweetener Alternatives

I encourage people to make their own sodas by purchasing mineral water and flavoring with frozen fruit and stevia. See the recipe in Box 5.4 for a Raspberry Lime Rickey.

Box 5.4

Raspberry Lime Rickey

Ingredients

Crushed ice

Juice from 1 lime

½ cup frozen raspberries

1 glass of sparkling mineral water

1 to 5 drops liquid stevia, to taste

Directions

Fill glass with ice. Add lime juice, raspberries, sparkling water, and stevia; stir to combine.

Aspartame®

Manufactured by a Japanese company called Ajinomoto, Aspartame has many other names, including Equal® , NutraSweet® , Benevia® , Spoonful® , and more recently AminoSweet® . Aspartame is an artificial sweetener used in sugar-free products like gum and drinks. It is most often made from the feces of genetically modified bacteria. Aspartame breaks down into methanol, which is then converted into formaldehyde. At low levels with long-term exposure, formaldehyde damages the nervous system and immune system, and causes irreversible genetic damage. Research links aspartame to serious illnesses, including depression and irritability (Lindseth, Coolahan, Petros, & Lindseth, 2014), migraines, oxidative stress, diabetes, seizures, blindness, obesity, and neurological disorders, (Soffritti et al., 2014). A significant body of research has shown that aspartame, along with other food additives, causes neurological, psychiatric, and behavioral disorders and is associated with headaches and panic. People with a history of depression, pregnant women and lactating mothers, and young children appear to be especially vulnerable. Individuals with mood disorders are particularly sensitive to aspartame, and aspartame makes depression worse (Walton, Hudak, & Green-Waite, 1993). The use of artificial sweeteners is associated with higher rates of depression in the elderly (Guo et al. 2014) .

Sucralose®

Sucralose, or Splenda® , is an artificial sweetener used in sugar-free products. Sucralose is a chlorinated compound that is a cousin to the chemical DDT. The body breaks down chlorinated compounds like sucralose and toxic chemicals are released.

Hydrolyzed Vegetable Protein

Found in junk foods, hydrolyzed vegetable protein is high in glutamate and aspartate, which overstimulates nerve cells and leads to cell death.

ELIMINATION OF DIETARY FOOD ADDITIVES

The Feingold Diet

The Feingold diet was developed especially for ADHD and behavioral disorders by Dr. Ben F. Feingold, who was a pediatric physician specializing in allergies. This is a food elimination program designed to identify food additives in the diet that may be causing symptoms like hyperactivity. Foods containing artificial dyes, preservatives, and flavors are eliminated permanently from the diet, while some fruits and vegetables are eliminated but later reintroduced based on tolerance. Food dyes are petroleum based and are contaminated with mercury, lead, and arsenic. Food additives include dyes (Red 3, Red 40, Blue 1, Blue 2, Green 3, etc.) and artificial flavors, artificial sweeteners (Equal® /aspartame, Splenda® /sucralose), and preservatives (BHA, BHT, TBHQ). Salicylates are eliminated. The Feingold program provides lists of foods that are to be eliminated.

Benefits

The Feingold diet benefits children and adults with symptoms of hyperactivity, impulsiveness, compulsive behaviors, and mood lability; learning problems, such as short attention span, neuromuscular problems, and cognitive and perceptual problems; and health problems, like asthma, bedwetting, ear infections, eczema, hives, seizures, and sleep problems.

Cautions/Deficiencies

There are no problems incorporating this approach alongside other diets. Elimination of all these additives is beneficial for everyone .

The Leap Diet

The Leap diet is also called “ImmunoCalm Nutrition” designed for people with food sensitivities and allergies. It emphasizes foods that are beneficial for the individual, rather than focusing on what the individual is sensitive to. Water is essential to flushing out toxins. In Box 5.5 learn how to calculate your specific needs for water.

Box 5.5

Calculate Your Requirements for Water

We are made up of water. Think of a big balloon filled with water and a big fat globule called the brain at the top. That’s our body. Dehydration contributes to fatigue, depression, and toxicity. I suggest to my clients to fill water glasses and place them in every room they visit during the day so they will drink their requisite daily fluid. (Coffee and black teas do not count toward the total, but herbal tea and broths do.) As a general rule, we need to drink 30%–50% of our body weight in ounces of water daily. Calculate your body weight and divide it in half. These are the number of ounces of water to drink daily. For example, 150 pounds equals 50–75 ounces of water daily.

HEAVY METALS

Heavy metals are well-established causes of mental illness, in particular learning disorders (lead, molybdenum) and cognitive decline (arsenic, mercury, aluminum, lead). With the use of mercury in dental amalgam and ongoing increases in air pollution and the widespread use of chemicals in the food supply, it is impossible to avoid exposure. One hopes to reduce exposure and eat foods that aid the body to eliminate what has been stored.

Aluminum

Exposure to aluminum occurs at higher rates than any other known metal neurotoxin. Aluminum exposure and high levels in brain tissue are correlated with cognitive decline and Alzheimer’s disease (Bhattacharjee, Zhao, Hill, Percy, & Lukiw, 2014), in large part because of the inflammation and oxidation it causes. It is found throughout the environment—in the air, water, and soil; in medicines; and in foods. Aluminum is naturally found in all foods; however, additives like coloring agents, preservatives, and leavening agents contribute a much larger amount of aluminum compounds. Aluminum is also found in larger amounts in processed cheeses, spices, pickles, and baked goods. It is also commonly present in drinking water, antacid medications, and vaccines, the latter of which contributes to the majority of aluminum toxicity cases since frequently it is injected into the body. Maintaining higher levels of magnesium can be protective against aluminum absorption. Percy, Kruck, Pogue, and Lukiw (2011) describe the use of the intramuscular antioxidant agent desferrioxamine to reduce levels of aluminum and iron in the brains of Alzheimer’s patients and to slow down the disease process.

Methods to Avoid Aluminum Exposure

•  Do not take antacids that contain aluminum hydroxide.

•  Avoid using aluminum cookware

•  Do not use aluminum foil.

•  Do not use antiperspirant spray, especially if it contains aluminum chlorohydrate.

Mercury

Mercury is a toxic metal that easily destroys brain tissue and can cause memory loss, ataxia, fatigue, depression, and neurological disturbance. Most mercury in the diet is obtained through seafood and fish products, which tend to contain high concentrations of mercury. Other sources of mercury in the body can derive from bleaching skin creams, calomel laxatives, some cosmetics, hemorrhoid suppositories, photographic supplies, some vaccines, and contact lens solution containing thimerosal.

Elimination of Heavy Metals With Nutrition

When protein is deficient in the diet, then toxic metals like cadmium, lead, and mercury are more easily absorbed and retained. The sulfur compounds in proteins protect the cells from heavy metal toxicity. Sulfur is necessary for the methylation process of detoxification. Sulfur is rich in animal proteins, fish, and garlic and onions. Supplemental niacin also works to detoxify the liver. The cruciferous vegetables—like cabbage, broccoli, and brussels sprouts—enhance detoxification enzymes, and sulfur-containing onions and garlic, both raw and cooked, are most beneficial when used daily (see Appendix R for a selection of recipes using raw, cooked, and fermented cruciferous vegetables). Seaweeds are a significant detoxifying food source (particularly kelp with its natural sodium alginate compound built in). Sea plants with sodium alginate bind toxins in the intestinal tract, drawing them from the body’s cells. Adding seaweed to soups or bean dishes or as a snack is healthy for the thyroid. Alginates from the brown seaweeds bind toxic metals to the digestive tract (Eliaz, Weil, & Wilk, 2007); capsules combining sodium alginate from brown seaweeds and modified citrus pectin can be used every 3 months to reduce heavy metals. Coriander is also known as cilantro or Chinese parsley. It is a powerful antioxidant that has been demonstrated to remove heavy metals from the body. Incorporate cilantro in your recipes like the one shown in Box 5.6.

Box 5.6

Cilantro/Parsley Pesto Heavy Metal Detox

This is a healthy and delicious pesto that can be used on gluten-free pasta or rice, or as a dipping sauce for vegetables. The added benefit is that it chelates (removes) heavy metals from the body. Double the recipe and freeze it in small containers so it can be pulled out for a quick healthy meal.

Ingredients

2 cups of firmly packed organic cilantro leaves and stems

2 cups of firmly packed organic Italian, flat leaf parsley leaves and stems

½ cup of chopped organic walnuts

½ cup of organic olive oil

1 teaspoon of kelp powder

¼ teaspoon of sea salt

2 garlic cloves

Directions

Using a food processor or blender, mix all ingredients together until smooth.

ELIMINATING TOXINS IN THE HOME

Environmental toxins are linked to a variety of mental health problems. Exposure is especially dangerous in pregnant women and during the first years of life, but exposure at any stage is harmful. Although we cannot eliminate all exposures, we can reduce risk where we have control. This starts in the home with cleaning products and outside the home with pesticides or fertilizers, as well as detoxifying fruits and vegetables prior to consumption. To eliminate pesticides and fertilizers from produce, fill a sink with water and add ½ cup of either hydrogen peroxide or bleach. Let the vegetables and fruits soak for 5 minutes, then wash, rinse, and dry thoroughly. Look underneath your sink and in your garage for toxic cleaning supplies, as well as drain and oven cleaners. If you have bought cleaning supplies in the store, they will be toxic. Throw out any toxic cleaning supplies. Replace them with a mixture of white or apple cider vinegar and water. Vinegar is a powerful antibacterial, antimold, and antifungal cleanser and it is less expensive than cleaners. If you like, add a little essential oil with your favorite fragrance. This mixture can be used to clean dishes, counters, floors, toilets, and tubs. If you need to scrub, just add some baking soda and salt. Also avoid dry cleaning.

FOOD ADDICTIONS, CRAVINGS, AND ORTHOREXIA

When people are addicted to fast foods, such as those containing high levels of sugar and salt, they become inured to taste and lose the ability to taste foods in their natural state. Our work is to educate clients that they are in a process of learning to perceive these tastes. Processed food tastes are much more potent, so they blunt the capacity to taste and appreciate the authentic flavors of foods. People may be unaware of this, which leads them to say they do not like certain foods or simple foods “don’t taste like much.” Someone who salts heavily with table salt may not be able to taste the saltiness of sodium in celery and may feel the need to salt celery and other foods. This is an example of how people have overwhelmed and excited their own taste buds and inner chemistry. Part of the whole process of changing food and dietary patterns and addictive processes is to slowly eliminate these high-stress excitotoxins as they are replaced with their natural counterparts.

There are several factors that contribute to food cravings:

•  Nutrient deficits may cause people to crave food with nutrients they need. This is “cravings as self-medication.”

•  Specific foods are formulated to be addictive and lead to cravings, especially processed foods. This is “cravings as addiction.”

•  Foods that people are allergic to can cause cravings for those foods; this is “cravings as allergy/sensitivity.”

Cravings

Mood affects food cravings, and food cravings also affect mood. Cravings are complex and may derive from several causes. Understanding the foods, the time of day, the food-as-self-medication factor, food allergies, and mood prior to cravings is essential and can be reviewed during the assessment process. Hormones contribute to cravings. Ghrelin is the hormone that cues hunger and responds to chrononutrition. Sleep and ghrelin interact; the less one sleeps, the more one is hungry, and this also leads to obesity. Gastric bypass decreases ghrelin levels, though over time they rise again. Cholecystokinin and peptide YY cue satiety by slowing the emptying of food by the stomach and peptide YY signals satiety in response to protein, supporting the idea that protein provides more satiety than carbohydrates. People have different levels of each hormone, which can account for the ranges in appetite and cravings. Certain foods dysregulate these hormones, and boredom and anxiety can precede food cravings. People who are tense and distressed may crave sweet carbohydrates and then feel more relaxed after eating, while protein craving is often related to anxiety and hunger and then followed by more energy.

Nutritional deficiencies also contribute to food cravings as part of the self-medication response. Women tend to crave carbohydrates and sweet goods during the luteal phase (around midway through the menstrual cycle), which is suggestive of the need to increase dietary tryptophan and serotonin.

The elaborated intrusion theory of desires (May, Andrade, Kavanagh, & Hetherington, 2012) is a cognitive-emotional approach to understanding the role of imagery and intrusive thoughts on cravings, positing that alternative visual/spatial tasks such as mindfulness meditation, the computer game Tetris, and exercises that engage working memory can compete successfully for attention for cravings.

Decreasing the negative effects of cravings on health requires a multifaceted approach to understanding the types of foods being craved and how they alter mood, and identifying nutritional substitutes along with cognitive-behavioral management methods that decrease craving behaviors.

Nutritional and Behavioral Tips for Dealing
With Food Cravings

•  Reduce stress to help avoid the tendency to reach for addictive substances as a coping mechanism.

•  Keeping addictive foods out of sight can help keep them off of your mind.

•  Identify foods that precede or trigger your cravings and avoid them.

•  Engage in alternative strategies for attention such as computer games, relaxation, and exercise.

•  Drink water throughout the day.

•  When a craving is for a comfort food not in alignment with your diet goals, substitute something healthy instead.

•  Just rinsing the mouth with starchy carbohydrates triggers brain response and increases energy .

•  Plan “snacks ahead” so if you grab something, it is healthier but satisfying.

•  Allow some compassion with your cravings, but in small portions; for example allow craving responses twice a week and not every night.

Nutrient Supplementation for Reducing Cravings

•  Vitamin B complex is useful in raising serotonin levels, improving mood and the body’s ability to metabolize carbohydrates.

•  Chromium and L-glutamine both help to regulate blood sugar levels and can reduce cravings for carbohydrates and sugars.

•  Fish oil helps to reduce cravings for sugar by enhancing insulin sensitivity.

•  L-tyrosine supports the production of dopamine that contributes to improving mood.

•  Magnesium is useful in reducing stress, balancing blood sugar, and improving sleep.

•  DL-phenylalanine increases endorphin levels, and tryptophan raises serotonin levels and reduces cravings for carbohydrates.

Orthorexia Nervosa

Orthorexia, from the Greek orthos , meaning “correct or right,” and orexis , meaning “appetite,” refers to a fixation on a way of eating that is characterized by an unhealthy obsession with what is considered healthy. There may be a feeling of superiority over others with less healthy eating habits, and there is an obsession with how much to eat, what types of food, the quality and purity of the food, as well as a tendency toward self-punishment if the diet is not strictly followed. A sense of self-righteousness is common. Social isolation may result from orthorexic tendencies, or people with similar dietary inclinations and philosophy may form together in communities. It may include self-abnegation and take the form of increased dietary restrictions, fasting, and exercise. Health may suffer if orthorexia becomes severe and as foods become so restricted that calories and the variety of nutrients are reduced.

Orthorexia can be related to a need for control, a fear of poor health, a desire to be thin, spiritual purity or other spiritual reasons, asserting identity through food choices, and self-esteem. There are some similarities between the symptoms of orthorexia nervosa and obsessive-compulsive disorder (Donini, Marsili, Graziani, Imbriale, & Cannella, 2004). Assessing whether or not healthy eating choices have become obsessive is the role of the practitioner.

One might also mistake orthorexia for rigid dietary practices that are required as a process to regain health. This can occur if clinicians are not familiar with the role of diet and supplementation in mental health. It may be misdiagnosed in people who have chronic illnesses such as gluten sensitivities, multiple chemical sensitivities, or specific needs that appear obsessive. Any of these may lead others to assess that they are being neurotic or obsessive. Thus, the overall picture requires assessment. In my own practice I have observed orthorexia, especially in addiction recovery clients, in persons practicing veganism, raw food diets, and vegetarian diets. Young people can also show symptoms as a result of group bonding, and others who are survivors of various cults may also show symptoms. These diet choices often reflect stage-of-life developmental processes associated with identity development and often change over time. In Box 5.7, I review an example of this process with the case of Suzanne.

Box 5.7

Suzanne’s Story

Suzanne came to see me at the age of 24 complaining of depression, fatigue, low energy, and lots of bloating that caused discomfort. Suzanne had been a vegan for 7 years. She was in a relationship with a partner who introduced her to veganism. It became clear after a series of tests that while she was a vegan for spiritual and environmental reasons, her body and mind were suffering from this diet. First, we did some testing. We discovered that she had gluten and soy intolerances (two foods that had made up the majority of protein and calories in her diet). This was important for Suzanne to know. She was an intellectual, and it provided her with some answers to things she had wondered about. She made slow, consistent changes to her diet, beginning with the addition of certain foods and the exclusion of others. She began by reducing soy and gluten, and she began to eat eggs as her first animal protein. Almost immediately Suzanne noticed an increase in her energy. Exercise that normally left her feeling fatigued became easier and more enjoyable. After a couple months of including eggs in her diet, she also began to incorporate fish. She continued on this diet for a while but still experienced symptoms of low mood and fatigue. I encouraged her to try some other animal proteins, but Suzanne said, “I feel uncomfortable chewing flesh. Also, Brad, my boyfriend, is upset with me about making these changes.” We spent a few sessions discussing her relationship. She invited Brad in for a meeting with us to explore these issues.

Suzanne felt better with the changes she had made, but her improvements stalled. It took several months to make this next shift, but when she did she noticed improvements in her overall energy and mood, and she began to feel more efficient in her life. We worked together over many years to make these changes. Like many spiritually minded vegetarians, Suzanne had the belief that it was impure to eat animal flesh, and this sense of maintaining strict control over what went into her body reflected the need for her to stay sober after an adolescence of heavy drug and alcohol abuse. It was also a reaction to gain control over what had been a chaotic early-life experience with her family. This is not uncommon in people experiencing orthorexia and reflects a stage in their recovery.

I continued to work with Suzanne off and on for several years as she sought support. I focused on helping her pay attention to how her nutritional behaviors made her feel physically and emotionally as I suggested refinements in her dietary practices.

If I were to become too “heavy handed,” then I would be repeating the patterns she had been in with other people who were often “making decisions” for her. Thus, my approach was to appeal to her intellectual understanding of dietary needs and then ask her to follow her intuition and what her “gut” told her that she needed.

DIETS AND THEIR VALUE FOR MENTAL HEALTH

There are nearly as many different diets as there are people. And there are as many diets as there are psychotherapies. Our clients frequently say to us that they follow certain dietary practices. Diet names come and go. But the basics of all diets are the same—the ratios of proteins, fats, and carbohydrates and the effects they purport to achieve. We know from our own experiences that a diet that does miraculous things for our neighbor or even a client may not have that effect at all in someone else. Thus, we return to the concept of biochemical individuality. If I suggested that my client who is an Inuit from Greenland become a vegetarian, I would be challenging her innate biochemistry; to return to our car analogy, I would be suggesting the car (her body/mind) could run on 89 octane when in fact it could run only on diesel. My client would likely become ill. Thus, the balance we seek for our clients is to help them identify what diets, or maps, might serve them, and like maps, there are several ways to get to the intended location, though some may be faster and others easier. In many ways the best approach for following a food system is to find one that feels “right” in the gut. Dietary needs shift over the life cycle as well. For example, orthorexia is common in young people who join groups based on belief systems, but they evolve out of the groups and beliefs or modify them, as I explored in the story of Suzanne.

Understanding the benefits and deficits of particular diets enables us to provide counsel for our clients. Let’s remember our essential principle: There is no one right diet for everyone. The question we should ask: Is this diet right for my client ?

People go through stages when it comes to making dietary changes. We reviewed during our assessment all the vagaries that affect one’s dietary and food preparation choices. People’s ability to taste subtle flavors improves as they explore new foods preparation methods and textures. It is unrealistic to think that most people will go from a SAD, fast food diet to a Paleo diet in a few months, though some are able to. More often, people make incremental changes. We often think that our clients will jump at the chance to feel better, faster, and some will, but many who have felt badly for a while need time to learn how to tolerate feeling good.

Identify which dietary changes are essential:

•  Prioritize nutritional requirements.

•  List health goals and link them to the dietary changes required.

•  Identify where the fastest improvements will be experienced.

•  Clarify which changes the client is willing to make and in what order.

•  Identify appropriate substitutions for substances to be relinquished or reduced.

Next I describe some effective diets that provide a spectrum of approaches that address biochemical individuality; they range from carnivore to mixed types to vegetarian. I have organized them according to what I believe are best adapted for mental health and then additional specialty diets for health problems that intersect with mental wellness.

I previously suggested that one goal during the assessment process is to help clients consciously communicate between their second brain and their first brain, to identify how they feel when they eat certain foods and food combinations. When discussing dietary approaches with clients, I always ask them to pay attention to how the changes make them feel and to not to rely on what “the experts” say.

Gut and Psychology Syndrome Diet

Dr. Natasha Campbell-McBride, the neurologist and nutritionist, developed the Gut and Psychology Syndrome (GAPS) diet. The diet was developed to treat children (and adults) with the autism spectrum disorders, ADD/ADHD, dyspraxia, dyslexia, and schizophrenia in particular, but it may be beneficial for everyone who is reactive to dairy and gluten. It focuses on reducing inflammation of gut walls to reduce permeability and entry of toxins into the bloodstream. There are three main principles of the GAPS diet: (1) healing the gut, (2) restoring beneficial bacteria to the gut, and (3) detoxification.

The GAPS diet is undertaken in a series of stages beginning with a very restrictive introduction phase, which includes only easily digestible vegetables and homemade broths, fats, boiled meats, and fermented vegetable juices. All grains, starches, and sugars are eliminated from the diet. As digestive symptoms subside, more foods can be slowly added to the diet, such as raw vegetables, eggs, fruits, juices, and nuts. The diet emphasizes a range of whole foods in their natural and fermented states; especially healthy fat-rich butter, fermented foods, and eggs.

As emotional and mental health improves, one incorporates the full GAPS diet, which allows many whole foods but excludes grains, starchy root vegetables, sugars, and (unfermented) milk products. Some individuals can incorporate grains and dairy again, but others who are sensitive or allergic will not.

Benefits

The GAPS diet will help detoxify the body and repopulate the gut with healthy bacteria. It may reduce inflammation in the body and also improve mental health and overall well-being.

Cautions/Deficiencies

This diet is safe and effective for mental health disorders.

Carnivore Diets

Carnivore diets emphasize eating animal proteins, in particular raw or cooked meat and flesh. They vary by the amount of other food categories that are included. Cultures as diverse as those indigenous to the Arctic as well as East Africa are primarily flesh eating cultures. The Atkins and the Paleo diets represent two valuable approaches to a meat/flesh emphasis.

Atkin’s Diet (Carnivore)

The Atkins diet is a low-carbohydrate diet often used for weight loss. This diet is very effective to eliminate carbohydrate cravings. By lowering carbohydrate consumption, the body switches from using glucose for energy to using stored body fat in a process called ketosis. Proteins and healthy fats are increased in the diet. Carbohydrates, like fruits, starchy vegetables, grains, breakfast cereals, flour, and sugars, are restricted. The diet can then be used as a healthy weight management diet for life if your metabolism requires heavy proteins and low carbohydrates. It does not work for people who require more carbohydrates. It is possible to become deficient in vitamins B5, C, D, E, and K. Fiber, selenium, potassium, magnesium, and B-complex vitamins and minerals should be supplemented .

Benefits

People who are eliminating carbohydrate addiction can be successful with this diet: carnivore/high protein metabolism weight loss.

Paleolithic (Paleo) Diet

The Paleo diet, also called the primal diet or cave person diet, is based on foods similar to the food groups eaten by hunter-gatherers in the preagricultural Paleolithic era. The diet is based on the belief that our Paleolithic ancestors did not have the current array of chronic diseases. The diet includes grass-fed meats, fish and seafood, nuts and seeds, vegetables, fruits, roots, eggs, and healthy oils, while excluding dairy, carbohydrates like potatoes and refined flour and sugar, grains, legumes, refined salt, and refined vegetable oils. It is higher in protein and fat while reducing the intake of carbohydrates.

Benefits

It is high in protein, fat, fiber, and nutrients, and low in carbohydrates and sodium. The diet is a superior diet for hypoglycemia and diabetes and is a beneficial diet for mental illness, including depression and anxiety and psychotic disorders.

Cautions/Deficiencies

It is important to ensure sufficient fiber in vegetables and fruits, and calcium and vitamin D sources.

Modified Carnivore

This diet is similar to the Paleo diet, but it allows dairy for people who are not sensitive to lactose or casein. This diet is also recommended for withdrawing from alcohol and sugar addiction.

Benefits

The diet is an excellent transitional diet off of fast food, allowing for animal proteins and fats that are satisfying. I recommend this diet to individuals who have a fast food and poor-quality protein and fat diet, and I ask them to substitute the fast food meats and fats for free-range steak, hamburger, eggs, and good-quality cheeses in lettuce wraps as they detoxify from fast foods.

Cautions/Deficiencies

People with kidney disease and women who are pregnant or breastfeeding should check with their health care practitioner before undertaking this diet. Low fiber intake can lead to constipation.

The Perfect Health Diet

P. Jaminet and S-C. Jaminet (2013) provide a valuable refinement of the Paleo diet. The diet consists of 20%–30% carbohydrates from starches like potatoes, sweet potatoes, and rice, beets, carrots, fruits, and berries; 15% animal protein, including some organ meat, derived mostly from beef, lamb, goat, wild bird and duck meat, and shellfish or freshwater fish; 55%–65% healthy fats like butter, sour cream, duck fat, beef tallow, coconut milk and oil, palm oil, avocado oil, macadamia nut butter, almond butter, cashew butter, and olive oil. Fats should ideally be combined with acids such as vinegar, lemon juice, or fermented vegetables. The diet also emphasizes the use of bone broths and soups, and it recommends small amounts of desserts from “pleasure foods” like chocolate, fruits and nuts, alcohol, cream, and fructose-free sweeteners like dextrose or rice syrup. Other foods are emphasized for their micronutrient content, such as egg yolks, liver, kidney, shellfish, seaweed, and fermented vegetables.

Certain foods are not consumed such as cereal grains (wheat, barley, oats, and corn) and products made from cereal grains (bread, pasta, cereal, oatmeal). White rice and white rice products (rice noodles, crackers, etc.), as well as gluten-free products made from rice flour and potato or tapioca starch, are considered “safe starches.” Beans, soy, and peanuts are not recommended. Foods with added sugar or high-fructose corn syrup are not consumed on the diet, and sugary drinks are eliminated, while water, tea, and coffee are allowed.

Polyunsaturated fats (vegetable oils) should only be about 4% of the diet, so it is recommended to eliminate the consumption of soybean oil, corn oil, safflower oil, and canola oil. The basic principles of this approach are excellent and small increases in proteins and fewer fats may suit some clients better.

Ketogenic Diet

Primarily used to treat epilepsy in children, a ketogenic diet is high in fat and moderate protein, and low in carbohydrates. Between 50% and 80% of the calories on this diet come from fat, mostly high-quality butter, heavy cream, coconut oil, eggs, avocado, and raw nuts, with carbohydrates and protein making up the remaining 20%–50% of the calories. The diet is used to reduce the frequency of epileptic seizures by inducing ketosis in which ketone bodies are elevated in the blood. The ketones enter the brain as an energy source replacing glucose, normally obtained from carbohydrates. When glucose is eliminated in the diet, the body is forced to burn fat for energy instead. High-carbohydrate foods are avoided on this diet, such as starchy foods, sugar, and grains.

Benefits

The ketogenic diet can be an effective therapy for reducing seizures in epileptic children and youth, and it has also shown some benefit for adults with epilepsy.

Cautions/Deficiencies

Constipation, dehydration, and kidney stones or gallstones are the most common side effects of the ketogenic diet, and they may only affect some children. Drinking plenty of water and incorporating fiber into the diet are important to minimize these side effects. Qualified nutritionists, dieticians, or medical doctors and nurses should oversee administration of the diet.

Recommendations/Supplementation

Supplementation is necessary on this diet, as several important vitamins and minerals are deficient, including carnitine, calcium, magnesium, iron, and vitamins B, C, and D.

Diets That Focus on Reducing Inflammation

Anti-Inflammatory Diet (Mixed/Balanced Metabolism and Lacto Ovo Pescatarian)

The anti-inflammatory diet is designed to reduce the intake of inflammatory foods. It emphasizes eating a variety of fresh fruits and vegetables while eliminating the intake of processed and fast foods. The diet consists of 40%–50% carbohydrates, 30% fat, and 20%–30% protein. Carbohydrates are low-glycemic such as brown rice and bulgur wheat, beans, sweet potatoes, and winter squash. Animal proteins from fish and natural cheese and yogurt are emphasized, as well as vegetable protein.

Other aspects of the diet include drinking tea instead of coffee, drinking red wine in favor of other alcohols, and eating dark (sugarless) chocolate in moderation.

Benefits

This diet is an excellent first step approach for people in the process of changing their diets. It should be used for 2–4 weeks at a time. It is helpful for people with pain and depression. If it feels too restrictive, some of the inflammatory foods can be eliminated one at a time as beneficial foods are added. The diet is higher in carbohydrates than some people need so that people can still gain benefits by eliminating the inflammatory foods such as wheat, corn, soy, dairy, nightshade vegetables, sugar, margarine, partially hydrogenated oils, alcohol, and peanuts.

Cautions/Deficiencies

Over time people will need to add in saturated fats and people who are more naturally carnivore will benefit from adding in more animal-based proteins.

Recommendations/Supplementation

Can be done short term and periodically if eliminating all animal proteins and fats. This diet mistakenly suggests that saturated fats and animal proteins (meats) cause inflammation. Nevertheless, this is a cleansing diet that can be beneficial for almost anyone for short periods.

Dr. Sears Zone Diet

The Zone diet is a low-glycemic-index diet developed by Dr. Barry Sears as a way to reduce excess cellular inflammation, thereby leading to a balanced hormonal state, supporting a healthy inflammatory response. It comprises 30% lean protein, 40% carbohydrates (such as fruit and vegetables), and 30% “good” fats, including supplements with Omega-3 fatty acids from fish oil and purified polyphenol extracts.

Balanced/Mixed Diets

Mediterranean Diet

The Mediterranean diet is based on the traditional foods of the Mediterranean region. The diet emphasizes lots of plant-based foods and whole grains, healthy fats like olive oil, fish and poultry 2–3 times a week, red wine in moderation, and fresh fruit. Salt and red meat are reduced in the diet. Nuts are also an important part of the diet as they are high in healthy fats. Butter, saturated fats, and hydrogenated or trans fats are discouraged in favor of monounsaturated fats (found in olive oil) and fatty fish, which are rich in Omega-3 fatty acids. Exercise and eating with family and friends are other components of the diet. Herbs and spices are used to flavor food and to help reduce the need for salt and fat. Low-fat dairy products are also encouraged over the full-fat varieties.

Benefits

The Mediterranean diet is best for the mixed-oxidizer and vegetarian-type diet. It has been shown to reduce the risk of Parkinson’s disease, Alzheimer’s disease, cognitive decline, and diabetes.

Cautions/Deficiencie s

The diet is very general in its requirements, which may make it easy or difficult, depending upon the personality of the client.

Raw Diet

A raw foods diet consists of fresh, uncooked, and unprocessed foods that can range from raw vegan and vegetarian diets to raw omnivorous diets. A raw foods diet may include raw fruits and vegetables, nuts, seeds, and sprouted legumes and grains, and sometimes raw eggs, meat, fish, dairy products, and fermented foods. Foods may be either completely unheated or heated only at very low temperatures (below 104 or 118 degrees Fahrenheit or 40–42 degrees Centigrade) or prepared using a dehydrator. Other raw food preparation techniques include sprouting, blending, pickling, fermenting, and juicing. A common reason for consuming a raw diet is that raw foods contain beneficial enzymes that are necessary for digestion, and cooking foods destroys these enzymes. Raw foods also contain beneficial bacteria and microorganisms that improve digestion and immunity and neurotransmitter production.

Benefits

Most people will benefit from the inclusion of raw foods in the diet, but few require or will benefit from a totally raw foods diet. Most people will benefit from including a range of raw food ranging from 25% to 50% of total daily intake. Another way to work with raw food is to undertake brief cleansing diets of raw foods that range from 3 to 10 days. Proponents of a raw foods diet believe that it increases energy, decreases the risk of disease, and promotes weight loss. Raw vegan and raw vegetarian diets are lower in saturated fats and cholesterol, and high in fiber, vitamins, minerals, and antioxidants. They are typically low in processed foods, and hence low in trans fats, sodium, and sugar.

Cautions/Deficiencies

A raw foods diet is not right for everyone, and I do not recommend a totally raw diet for clients with mental health challenges. People who are underweight, suffer from diabetes or hypoglycemia, or who have a history of eating disorders may not be candidates for a raw foods diet. The consumption of fruit juices can intensify hypoglycemia and diabetes. Low calorie intake can be a problem as well for people with difficulty gaining weight or who are prone to eating disorders. The rigorous nature of a raw foods diet can trigger an obsession for eating healthy foods. For some people a totally raw foods diet can lead to dissociated states. A raw foods diet requires a lot of preparation time, especially when a diversity of foods and menus is necessary to alleviate “food boredom.”

Raw diets that do not include animal proteins are deficient in B12, vitamin D, Omega-3 fatty acids, zinc, and calories. Nutritional supplementation is recommended if undertaking a raw foods diet. When eating raw foods like meat, dairy and eggs, they should be organic and from a local, non-industrial farming source to ensure cleanliness. Even organic foods grown in large commercial operations are more subject to pathenogenic bacteria. Meat and fish can also be frozen for two weeks and then thawed prior to consumption.

Vegetarian Diets

While there is a wide range of vegetarian diets, from vegan to lacto-ovo vegetarian, the basic vegetarian diet excludes meat of any kind, including seafood, poultry, and red meat. One of the primary reasons people choose a vegetarian diet is generally due to the belief that it is unethical to kill animals for food. This diet is also chosen for health, religious, economic, environmental, political, or personal reasons. Frances Moore Lappé’s book, Diet for a Small Planet , was one of the first books to describe the environmental and social impacts of large-scale meat production, and ongoing research confirms the inhumanity and toxicity of mass-produced animal foods. Lacto-ovo vegetarians eat eggs and dairy, ovo vegetarians eat eggs but not dairy, and lacto vegetarians eat dairy but not eggs.

Semivegetarian diets are primarily vegetarian but may include some animal flesh, such as pescatarianism in which seafood is the only meat consumed or a pollotarian diet in which poultry is allowed. Macrobiotic diets include whole grains and legumes, and they may also include some seafood. Semivegetarian diets are sometimes used when transitioning into or out of a completely vegetarian diet, or for other reasons such as a dislike for certain types of meat or to simply reduce meat consumption.

Benefits

Vegetarian diets are high in fiber, vitamins, minerals, antioxidants, and carbohydrates.

Cautions/Deficiencies

Animal protein is low in a vegetarian diet, but lacto-ovo vegetarians who consume animal by-products, such as cheese, milk, and eggs, are usually able to consume enough protein and the necessary amino acids. A vegetarian diet can provide adequate protein, but it is important to eat a wide variety of foods and proteins to ensure proper nutrition. B12 deficiency is a risk for vegetarians, as this vitamin comes primarily from meat. Vegetarians can obtain some B12 from dairy and eggs, and other fortified packaged foods.

A deficiency of dietary sulfur can occur in those following a strict vegetarian or vegan diet, as they are not consuming the dietary protein that provides the sulfur-containing amino acids. A recent study shows that strict vegetarians may be susceptible to subclinical protein malnutrition that can lead to hyperhomocysteinemia and an increased risk of cardiovascular diseases (Ingenbleek & McCully, 2012). This protein deficiency also causes a concurrent sulfur deficiency, leading to problems with protein and enzyme activity in the body, as well as problems with bones, joints, metabolism, and connective tissues. Sulfur is important for the proper functioning of insulin, detoxification, carbohydrate metabolism, electron transport, and the synthesis of metabolic intermediates like glutathione.

Ayurvedic Diet—Vegetarian

Ayurveda is an ancient Indian system of medicine that is thousands of years old. The diet derived from this system is based on the principle of body types and a person’s predominant constitution, referred to as “doshas.” There are three doshas, Vata, Pitta, and Kapha, corresponding to the elements of air, fire, water and earth.

Ayurvedic diets vary based on one’s constitution, but they are all vegetarian with an emphasis on wholesome, freshly cooked, or raw foods that are in season. Additionally, the diets incorporate a lot of spices, such as turmeric, ginger, coriander, fenugreek, and cumin. Meat may be prescribed as a medicine in cases of blood sugar issues or protein deficiency. Foods are divided into six tastes: sweet, sour, salty, bitter, pungent, and astringent, and each of these should ideally be present at every meal.

Benefits

The Ayurvedic diet aims to bring balance to specific constitutional types, so it is very personalized. It can increase energy levels, improve immunity, resolve digestive disorders, improve sleeping patterns, reduce toxicity, and improve overall health.

Cautions/Deficiencies

Using Ayurvedic dietary prescriptions and herbs could be problematic if not properly understood. Undertaking an Ayurvedic diet should be done under the care of a qualified Ayurvedic practitioner. Since this diet is mostly vegetarian, it may be deficient in vitamin B12 and it may be low in protein.

Five-Element Die t

The five-element diet comes from traditional Chinese medicine and is based on the five elements of water, wood, fire, earth, and metal, which correspond to the internal organs of the kidneys, liver, heart, stomach, and lungs. This diet incorporates fresh, local, plant-based foods and minimizes the use of animal proteins. The elements are also divided according to five tastes: salty, sour, bitter, sweet, and savory or pungent. Foods are chosen depending on the seasons, which correspond to the elements as well: Winter is water, spring is wood, early summer is fire, late summer is earth, and fall is metal. Light cooking techniques such as steaming and poaching are emphasized.

Benefits

A Chinese medicine practitioner familiar with the constitutional needs of the client may prescribe this diet. It is especially useful when a client is in recovery from illness and digestion is weak. It will be important to ensure adequate intake of fats and fat-soluble vitamins when on this diet.

Macrobiotic Diet

The macrobiotic diet is high in whole grains (40%–60%), fresh and cooked vegetables (20%–30%), beans, sprouts, nuts and seeds, seaweed, and small amounts of fish and seafood (5%–10%). High-quality, fresh, local foods are emphasized, whereas processed and packaged foods, dairy, eggs, meat, coffee, stimulants, and sugar are avoided. Nightshades are also avoided in this diet due to their tendency to cause inflammation in the body. Foods eaten vary based on the time of year, with lighter foods in spring and summer and heavier, denser foods in the winter. The macrobiotic diet differs from a vegetarian diet in that it includes fish and seafood, as well as other naturally raised meats, according to individual needs. The macrobiotic diet also dictates the role of food preparation—food is prepared in a peaceful environment, using pots and dishware made from glass, ceramics, stainless steel, and wood. Food is thoroughly chewed until it is a liquid to aid in digestion.

Benefits

The macrobiotic diet is both a way of eating and a way of life. Foods are eaten to balance yin and yang. The diet is also low in fat and high in fiber. The behavioral aspects of macrobiotics can be useful, such as food preparation and good food-chewing practice .

Cautions/Deficiencies

Not recommended for children, pregnant women, or nursing women; because it is low in dietary fats, supplemental fats would be necessary. Deficiencies could develop if one undertakes a strict vegetarian or vegan macrobiotic diet. Poor nutrition could result from a macrobiotic diet if it is not properly planned.

Vegan Diet

A vegan diet is a category of vegetarian diet. It is strictly plant based without the use of any animal products or by-products. This means that vegans do not eat anything that has been derived from an animal, including meat, fish, poultry, eggs, dairy, honey, or even gelatin. Vegans also believe that all sentient creatures have rights, and it is unethical to exploit animals as though they were commodities. Some people who follow a vegan diet also follow a vegan lifestyle, which eschews all clothing and personal products made from animals (leather, fur, wool, some cosmetics).

There are many reasons that people choose to adopt a vegan diet. Some approach it from an ethical standpoint and as a statement for animal rights. Vegans are against killing animals, and they also believe it is unethical to raise animals for their milk and eggs and keep them in cages. Many vegans are also concerned about the environmental effects of pollution from factory farms, large-scale deforestation for grazing land, and the use of fossil fuels in the meat industry. People also believe that being vegan is healthier and a more natural diet for human beings, claiming that cultures consuming a primarily plant-based diet live longer and have healthier lives. However, while there is good evidence for the health benefits of a diet rich in plants, there is no evidence of any indigenous culture or Paleolithic culture practicing veganism, suggesting that veganism is a relatively recent innovation in dietary practices among humans.

Benefits

Vegan diets are rich in carbohydrates, Omega-6 fatty acids, dietary fiber, carotenoids, folic acid, vitamin C, vitamin E, and magnesium.

Cautions/Deficiencies

It is common for people who are not well suited to veganism (or vegetarianism) to become depressed, anxious, and fatigued due to low protein levels, as well as develop neurological and mental health problems associated with vitamin B12 deficiencies. Veganism is especially dangerous for pregnant women and their fetuses due to the high amounts of essential fatty acids required for brain and nervous system development, available only from grass-fed animals. Omega-3s and the fat-soluble vitamins are required especially for neurological development and the brain. A vegan diet has low cholesterol and is low in saturated fats. The major drawback of a vegan diet is that it requires care and attention to ensure that essential nutrients are being included in the diet, as it is easy to become deficient in vitamins and nutrients essential to health. Protein in a vegan diet is limited to plant proteins, found in foods like legumes, nuts, seeds, and whole grains; however, only a few contain complete proteins. This results in deficits in obtaining all the essential amino acids, which are required for proper health. Vegan diets often include large amounts of soy and soy protein isolates, which can have negative effects on thyroid hormones and digestive enzymes. Other vitamins that are commonly missing, or very low in a vegan diet, are vitamin D, vitamin B12, calcium, and iron. The fat-soluble vitamins, A, E, D, and K, require saturated fats for absorption. Eating products fortified with these vitamins and minerals, and making sure that one’s diet includes complete proteins as well as varied protein sources, is essential to maintaining a healthy vegan diet. However, it is questionable whether this type of diet is a match to human physiology.

Vegans are especially susceptible to vitamin B12 deficiency, a condition that, if left untreated, can cause serious health problems like depression, dementia, and Alzheimer’s disease. Vitamin B12 is mainly found in animal products, and while it is found in some plant foods, such as spirulina algae, tempeh, and sea vegetables, the B12 found in these foods is an analog of B12 that actually blocks the absorption of vitamin B12. In effect, eating these foods can cause an increase in the body’s B12 requirement. This deficiency can also cause the artery-damaging hormone, homocysteine, to increase. Even though the body’s intestinal bacteria produces vitamin B12, it is not in a form that is readily absorbed and used by the body (Lam, Schneider, Zhao, & Corley, 2013).

Healthy nonmeat sources of B12 include organic free-range eggs, raw milk, and wild-caught Alaskan salmon. In terms of B12 supplements, the sublingual sprays are superior to other forms of consumption (Lam et al., 2013). Inasmuch as the diet is low in protein, saturated fat, Omega-3 fatty acids, retinol, vitamin B12, and zinc, vegans may have particularly low intakes of vitamin B12 and low intakes of calcium.

Recommendations/Supplementation

People who wish to adhere to a vegan diet should be encouraged to do so for very short periods of time. Because veganism is frequently linked to a strong belief system, it is important to inquire about the meaning of veganism: Is it about animals, the environment, and/or spiritual beliefs? In my practice with vegans, I discuss whether there are ways to balance out personal concerns for animal well-being with the need of the animal-human body for animal-based protein by ritually giving thanks to the animal who has shared its flesh.

Fasting and Detoxification Diets

Fasting is the voluntary act of abstaining from food and/or liquid for a given amount of time for health-related, spiritual, or political reasons. Fasts may include the consumption of only liquids. Mono diets may be used for elimination purposes.

Water fasts eliminate all food and liquids other than water from the diet. They are generally ill advised for mental or physical health, and people should be discouraged from water fasting. Many benefits can be obtained from juice or vegetable fasts, which include only fruit and vegetable juices and water but no other foods. Juice or vegetable fasts provide more nutrients and can be used for short periods of 1–3 days for detoxification.

Fruit and vegetable fasts restrict all foods except for fruits and vegetables, which are high in nutrients and allow digestion to rest and detoxification to occur. Mono diets are fasts in which only one food is consumed for a given period of time to give the digestive system a rest while supplying necessary nutrition, such as a rice fast or a diet of only one type of vegetable. For example, Khichadi (also Khichari or Khichdi ) is an Indian dish made from split mung beans and rice, and sometimes other spices and vegetables; it is eaten as an Ayurvedic cleansing mono diet. This dish is easily digested and can be used after a period of intemperance or to eliminate allergens from the diet. It can also be used to transition into and out of other more extreme liquid fasts, as a recovery diet after surgery or other illnesses, or during times of emotional stress when digestion is taxed.

Fasts and detoxifications, like diets, follow “fad” periods. This does not necessarily mean they are without merit, just that they are promoted at the social level, often considered the latest “cure,” and attract people via social contagion and may or may not be beneficial for individual mental health. When discussing fasts during the assessment, understanding the value of the fast and the duration along with its effect on mental health will be important.

One example is The Master Cleanse, a juice fast that was popular in the 1970s and returned to popularity recently. It is a 1- to 40-day fast in which the only liquid consumed is a mixture of freshly squeezed lemon juice, maple syrup, and cayenne pepper, which is added to pure water. It provides a sufficient amount of calories and nutrients (for a few days) while allowing the body to cleanse itself of toxins. The cleanse is undertaken in three phases, beginning with a 3-day period of slowly eliminating processed foods, then 10 days on the lemon juice mixture, and 3 days of slowly reincorporating solid foods back into the diet. The “cleanse” may include the use of nightly laxatives and a morning salt-water flush. The fast is very alkalizing, which might benefit people who are natural vegetarians/high carbohydrate/slow oxidizer metabolism types. But for carnivores it would be too alkalizing and could exacerbate anxiety and fatigue. The sugar content is high, so it would not be suitable for people with either hypoglycemia or diabetes. It would not be appropriate for adolescents either. Undertaking this fast for 1–2 days would be the limit for safety as there are many other fasts that can achieve better results.

Urine fasting is the practice of drinking one’s own urine and water for cleansing. The Jain people practice urine drinking each morning, and this practice has spread worldwide among non-Jain people. The benefit of this fast is in the nutrients and NT metabolites available in urine that include a mixture of minerals, salts, enzymes, and hormones, which cleanse the blood. Urea is also put back into the body and acts to cleanse the body of excess mucus.

Benefits

Fasting for a day or two can have positive effects, such as increasing immune health, disease prevention, mental clarity, and improving digestive health. Fasting gives the digestive system a break and allows toxins to be eliminated. The energy that is normally used for digestion can be used for healing and repairing damaged tissues.

Cautions/Deficiencies

Side effects of fasting include headaches, nausea, foul body odor and bad breath, and intense hunger. Nutrient deficiencies can be a problem if fasts are done for long periods of time. Other possible side effects are constipation, dizziness, fatigue, dehydration, and gallstones. Fasting is contraindicated during pregnancy and nursing, and for those on medications or with diabetes, heart disease, cancer, and fevers. Starvation may be induced by strict fasting and could lead to electrolyte imbalances, renal failure, cardiac arrhythmias, and death. People with anorexia nervosa should not fast.

Recommendations/Supplementation

It is important to transition slowly into the fast and out of the fast. Limit fasts to 3 days. Do not use water-only fasts .

Essential Next Steps

Recall that food is to our bodies like fuel is to a car. Some cars can run on any fuel, but others won’t unless the mixture is exactly right, and still others do best on one octane while they might limp along on others. Once the basic requirements mentioned earlier are met, diets will differ by their ratios of foods.

•  Identify the role of allergies and sensitivities in client mental health.

•  Prepare fresh food and avoid packaged foods with preservatives and additives.

•  Conduct elimination diets and other tests to assess for sensitivities.

•  Work with the client to identify diet types that are optimal.

•  Identify the ratio of proteins, carbohydrates, and fats that suits a specific biochemically individual metabolism: fast (carnivore), moderate (mixed foods), or slow (vegetarian-based).

•  Minimize exposure to toxic heavy metals.

•  Undertake periodic cleanses to detoxify.

•  Explore the intersection of belief systems and dietary choices, differentiating between close adherence to a specific dietary system for health and orthorexia.