Food as medicine?

In the summer before starting at Bastyr University, I met a naturopath at a Dave Matthews concert. She recently graduated from Bastyr and was excited to meet someone who was about to embark on their own naturopathic journey.

“One of three things will happen to you while at Bastyr,” she joked. “You will either get pregnant, become a lesbian, or become vegan.”

This turned out to be a known joke among the students, because the learning environment at Bastyr promoted experimentation, and we all took part. We completed medical experiments on ourselves and on each other to learn modalities like IV therapy, chiropractic adjustments, and colon hydrotherapy, and we experimented in our personal lives.

My Bastyr experiment involved food.

I brought The Deegan Diet into the world: a naturopathic perpetual motion machine of psychological distress, guaranteed to make you lose a little weight, become anemic, and break out.

Classroom experiments

First-year naturopathic students at Bastyr University took courses on naturopathic history and philosophy. During the spring quarter, students completed a project called “Cultivating the Conditions of Health and Wellness.”

With a classmate, we were to identify a specific health related behavior or habit that we thought could be adjusted to live healthier. One was supposed to make a positive health-related change in his or her life, like starting meditation or yoga, or cutting back on an unhealthy habit, like smoking, drinking, etc.

My health project was to overhaul my eating. I had previously experimented with my diet to help control my psoriasis, and now that I was a naturopathic student, I thought I should focus on applying this seemingly unique medical approach. I was also suffering from what I considered terrible acne.

As discussed in my ScienceBasedMedicine.org post, first-year naturopathic students were required to seek naturopathic care at Bastyr’s teaching clinic (BCNH). I considered these appointments a perfect opportunity to address my skin problems with the type of doctor I was set to become.

My naturopath was a very nice resident at BCNH. My first appointment was a fairly standard naturopathic appointment: my vital signs were taken, and then we reviewed my health and family history, my complaints, and medications I was taking. We then spent a great deal of time talking about food, especially the use of food as medicine.

I fell in love with the concept of food as medicine. Later, as a practicing naturopath, I used this theory with patients frequently. (I even designed an entire naturopathic detoxification program around the concept that food could be poison or food could be medicine, which is really interesting now when I look at other detox programs.)

It was easy for me to understand that my diet may be causing my acne because of my experiences “controlling” my psoriasis in high school and college. I do not really know if reducing processed foods in my diet improved my skin, but I believed that it did. As a result, this priming effect led to me being able to concede that virtually any food could play a pathological role in any disease. In other words, my perception of cause and effect was set up to positively evaluate dietary changes to my visible health conditions.

When my naturopath suggested severe dietary restrictions, I embraced them wholeheartedly and cultivated them into my own nutritional monster.

I was to avoid all dairy, eat more protein, and eliminate refined sugars. I was warned about the high sugar content of hemp milk and hidden sugar in condiments like ketchup. I was sent home with numerous handouts on eating healthy, eating mindfully, and avoiding sugar. I dutifully followed the recommendations without complaint–I wanted to be a good naturopathic patient!

At my follow-up appointment weeks later, the ND noted I had lost a few pounds. I remember her exuberant compliments about following the restrictions so well that I had lost weight. I remember standing on the scale and feeling like I was doing a good job!

To this day, her comment about my weight sticks with me. I was not heavy, and I was not trying to lose weight. I wonder if she just misspoke, as inexperienced clinicians do, but I also wonder if she wanted me to lose weight or even for me to be more aware of my weight. I took her comment to mean, “Good job, you’re losing those extra pounds!”

The Deegan Diet

Over the next months, I began setting up facades to make my progressively restrictive diet socially and clinically acceptable. I had used the ideas of detoxification and food elimination diets to make sense of what I was doing to myself in the context of diving deeper into my naturopathic training. Under the guise of healthy eating, I made my pernicious relationship to food socially reinforced by my naturopathic peers. The real purpose of my naturopathic diet plan, though, was to lose as much weight as possible.

By the time spring quarter rolled around, I was fully submerged in naturopathic dietary chaos. I had made the Deegan Diet, which was actually quite impossible to describe because it was constantly evolving. I actively searched for more naturopathic diet advice, and my skin was not improving.

It was just a matter of willpower. Right?

With that intention in mind, I also decided to eliminate all forms of sugar including honey, agave syrup, fructose, dextrose, maltodextrin, and sugar derivatives. I came up with this idea after listening to a naturopath describe acne as “diabetes of the skin.” The theory was that acne was a form of glucose dysregulation.

Inflammation was involved, of course. So, most pro-inflammatory foods needed to go.

The Deegan Diet restricted:

  • all dairy including yogurt, cheese, and milk
  • all sugar including honey and agave syrup,
  • all red meat and poultry,
  • most grains (quinoa and brown rice allowed)
  • most “inflammatory” nightshades including white potatoes, bell peppers, and eggplant

I continued to eat tomatoes, eggs, and fish occasionally. Sometimes I made exceptions for the perceived “anti-inflammatory” foods, such as lamb. As you can imagine, I ate a large amount of soy, fruit, nuts, and vegetables, and I was often very very hungry.

I remained “sugar-free” for about three years and continued to follow some version of The Deegan Diet for many years thereafter. To do this, I avoided condiments and salad dressings with unknown ingredients, ambiguously labeled drinks, indulged only sugar-free chocolate bars and coconut bliss gelato. And I certainly never ate candy. Exceptions did occur, but these occasions were rare.

Over time, my friends and peers complimented my dedication to my health. I continued to lose weight and my acne continued to worsen. We started jokingly referring to my future book, The Deegan Diet and all of its health benefits, which so far included iron-deficiency anemia, worsening acne, and weight loss.

The everything-but-the-kitchen-sink naturopathic treatment approach

My attempt to “cure” myself did not end with diet changes. I took digestive enzymes including pepsin and bromelain between meals to help break down dietary amino acids that escaped from my “leaky” digestive tract. I don’t remember if I was diagnosed with “leaky gut” or if I inferred this condition based on my training at Bastyr and perceived sense of my nutrition and health complaints. (It is important to note that “leaky” gut is not a real medical condition. Naturopathic schools teach this condition as increased permeability of the intestines causing food antigens to escape into the bloodstream, which is detectable with IgG allergy testing.)

I took tablespoons of cod liver oil religiously and many probiotic supplements. From time to time, I added in various antioxidants like vitamin E and selenium, milk thistle to help my liver detoxify, dandelion to help my kidneys, and anything else I could get my hands on. I drank protein powders that contained herbs and nutrients for phase 1 and 2 detoxification. I completed many detoxification diets that included water fasting, juicing, eating nothing but quinoa for days, colon hydrotherapy, constitutional hydrotherapy treatments and peat baths. I had intravenous therapy treatments to help detoxify and supply my body with nutrients that I believed I could not absorb from my diet due to my “leaky” gut.

I addressed possible “hormone imbalance” with another set of supplements and herbs to help clear excessive estrogen out of my system. I diligently avoided plastic, microwaves, parabens, sodium lauryl sulfate, and other “toxins.”

I read books about my blood type and wondered if I should stop eating avocados because my blood type is O positive. Yea, right! I read about the importance of detoxifying the liver and did everything I could, including castor oil packs placed onto my abdomen to help my liver conjugate and eliminate toxins.

For my acne, I topically applied bovine colostrum, exfoliated with dry skin brushes, and sometimes used an old Retin-A prescription. I was desperate and willing to try anything, except medical treatment.

I believed that any failure of naturopathic treatments was not a failure of the treatment, but a failure of mine to implement the therapy correctly. Maybe the gluten in that beer I drank last night caused my break out? Maybe I needed to cut out eggs too? Maybe my gut was so “leaky” that the benefits of treatment will take months to years?

These questions were actively discussed in my naturopathic care at BCNH with the residents and considered reasonable explanations about why my acne was not improving.

what to eat?

The skin-gut connection

My naturopath liked to explain the connection between the skin and the gut. I learned about this connection in school as well. A simplified version of the theory is acne is a manifestation of digestive problems, usually a “leaky” gut.

The Deegan Diet actually seemed to cause symptoms consistent with irritable bowel syndrome. My bowels were alternating between constipation and diarrhea and I had consistent abdominal pain, bloating, and gas.

My new IBS symptoms just corroborated the naturopath’s theories about my skin.

My ND would ask, “How are your bowels?”

I would detail every movement, including any bloating, pain, and constipation and anything else that I thought seemed relevant.

Her response seemed to always be some form of the following: “hmmm…. that makes sense given the skin-gut connection.” I was given new supplements and herbs depending on what the resident thought was churning about in my leaking gut.

I was also led to IgG food allergy testing to make sure I was not eating a food that was the “root” cause of my acne.

You can imagine everyone’s surprise when the results showed I had no IgG food allergies. None. Not even any mild to moderate IgG reactions. I became convinced that the results were false negatives and gained new resolve to stay on The Deegan Diet.

There was literally nothing else to be taken out of my diet.

Giving up

It was not until I had virtually exhausted every naturopathic treatment plan (even a constitutional homeopathy appointment!) that I decided to seek real medical care.

It was quickly determined that I had excessive testosterone and dihydrotesterone. The medical doctor explained that these androgens were binding to receptors in my skin, causing cystic acne. Also, the lack of food wasn’t helping my skin either. I was prescribed a low dose of spironolactone, and my acne quickly improved.

What strikes me about my story is how my experiences with naturopathic medicine, as a patient, led me down a road of perpetual failed treatments. Furthermore, not only did the treatments fail, but they also induced IBS symptoms and caused a great deal of stress in my personal life, all under the rouse of “food as medicine.”

I am bothered by many aspects of my story. I am astonished by my own lack of critical thinking throughout my experiences as a patient. As a naturally curious person, I am disappointed in myself for never fact-checking the naturopathic theories that constituted the basis for all my treatments given how utterly inconsistent they were. They quite literally were based on an ideology without any input of new clinical information. I am further surprised, and still somewhat baffled, by how I even tried homeopathy before “giving up” and going to see dermatologist.

The nutritional training of NDs

Even by critics, naturopaths are often acknowledged for having training in nutrition. At Bastyr, students do receive a great deal of nutritional education as part of the naturopathic program. When I was at Bastyr, naturopathic students received 143 hours in didactic nutritional education and even more in clinical science classes where diet is used as a part of disease management.

However, the nutritional training is wrapped up in pseudoscience, which makes it difficult to tease apart what is real and what is fake. For example, naturopaths often make dietary recommendations based on applied kinesiology tests, unvalidated blood tests, or far-fetched medical explanations. A commonly prescribed, but unproven, naturopathic diet theory is the elimination of nightshades to reduce the symptoms of inflammatory diseases, especially arthritis.

One such bogus test I often used in practice was an IgG food allergy test. As a first step in treatment for many conditions, such as asthma, infertility, or migraines, I would order an IgG food allergy panel and then discuss the results with patients in the context of an elimination diet treatment plan. Sometimes I would also recommend supplements such as probiotics and l-glutamine to “heal the gut.”

But as Scott Gavura discusses in his 2012 ScienceBasedMedicine.org post on IgG Food Intolerance Tests: What does the science say? the scientific consensus has concluded that these tests have no clinical value, are not validated, and most importantly, “should not be performed.”

Naturopathic educators are ignoring the scientific consensus, teaching their students to utilize this test anyway and to clinically act on them to the extent permitted by state law. Furthermore, the clinical training is not even good enough for a naturopathic resident to recognize obvious eating disorders.

The harm of naturopathic diet advice

I am also surprised by how no one, including myself at the time, recognized my disordered eating or least openly discussed it with me.

At my thinnest, I weighed 115 lbs. At 5’6’’, I was carefully walking the line making sure I didn’t fall below this number, which for some inexplicable reason represented the boundary between skinny enough and too skinny.

Yet, there were blatant negative health effects of weighing so little that every naturopath I visited failed to observe. I stopped ovulating. My hair fell out. I was moody, depressed, and anemic. I was often hypoglycemic. I suffered from terrible abdominal pain, bloating, and gas. Also, my acne worsened. These are all common signs seen in young women with Anorexia nervosa.

Sadly, I misinterpreted the above symptoms as leaky gut syndrome, and not due to disordered eating. Even worse, my naturopaths corroborated this fallacious thinking. We discussed how I was clearly addicted to sugar, making it that much more essential that I completely eliminate it. We also talked about how certain food reactions come in the form of mental and emotional reactions, such as irritability and depression. I would then discuss this reasoning with my classmates, who invariability all agreed. In hindsight, I was just hangry and malnourished.

I don’t think that naturopathic diet advice caused my eating disorder. I do think, though, these naturopathic diet recommendations helped trigger my predisposition for disordered eating, mainly by clinical suggestions that gave causality to events that have no causal relationship. In this sense, I do not think I am alone. Self-deception is common.

Through naturopathic dietary advice, I started to believe any two events could be causally related.  The fear of breaking out, or any side effects induced by food, became so powerful that I was obsessed with eating foods that I perceived to be healthy.

This “unhealthy obsession with eating only healthy foods” has been coined orthorexia, by Stephen Bratman, MD. In his book Healthfood Junkie, he describes his own obsessions with healthy eating and describes a new, third category of disordered eating called orthorexia nervosa. My disordered eating encompassed a naturopathic triad of anorexia, bulimia, and orthorexia called The Deegan Diet.