A Brief Guide To Therapeutic Diets and How Not to Get Caught in The Diet Trap

It’s time for New Year’s Resolutions, so let’s talk diets! No, I don’t mean your Atkins diet, juice cleanse, Weight Watchers diet, or any other trendy diet. I want to talk about therapeutic diet restrictions. Have you ever had a doctor or other practitioner tell you to “watch what you eat” or to “eat less” of something? Did they walk you through what diet they actually wanted you to follow? Did they ask you how you felt about it? Did they make suggestions that would actually fit into your lifestyle? Not likely. That’s why Registered Dietitian Nutritionists are so important!

Any time you restrict, you’re setting yourself up for potential psychological and physical harm. Yup, you read that right. Just by cutting one item or food group out of your diet, you mess with your mental and physical health. And anyone who already has disordered eating behaviors is especially at risk to take a practitioner’s well-intentioned suggestion and turn it into an all-out restriction, binge, self-hatred, repeat. Basically, there’s the risk of taking a suggestion for health and wellness and turning it into a traditional diet.

The key to following a therapeutic diet restriction, and I’ve only outlined the very basic ones, is to remember that it is for your health. It is because there are some nutrients which your body simply cannot utilize or process right now. Following these dietary restrictions is an act of self-care. When it becomes anything other than that, it’s time to step back and reassess what you’re doing and why you’re doing it.

So let’s make sense of a few therapeutic diet restrictions. When your practitioner says to “eat less…”:

Why?:  Following a low fat (25-35% of total calories) diet is indicated in conditions such as cardiac disease including disorders of lipid metabolism, history of coronary artery disease and cerebrovascular disease.
A low fat diet is also indicated for people with pancreatitis, gall bladder disease, diarrhea, steatorrhea, and abdominal pain associated with intolerance to high intakes of dietary fat.

How?: Did you know there are different types of fat? A low fat diet is often just limiting saturated and trans fats found in foods like meat, dairy, coconut and palm oil, baked goods, and some packaged foods. It is super important that you do not cut out all fat from your diet unless clinically indicated. Fat has important functions in the body including for energy, vitamin absorption, and insulation. Fat is also important in helping you realize you’re full. And, sorry to tell you, simply avoiding fat will not instantly make you lose stored fat on your body.

Why?: A low cholesterol (less than 200mg per day) diet is indicated in cardiac disease, and for people with high LDL (bad) cholesterol which increases the risk of heart disease.

How?: Cholesterol is found in your animal products like butter, milk, and meat. Saturated and trans fats can also raise your blood cholesterol levels. Cholesterol is important and functions in the body to make hormones, vitamin D, and other substances that help you digest foods.

Why?: If someone told you to eat less carbohydrates because you’ve been diagnosed with pre-diabetes or type 2 diabetes, this person is setting you up for failure. When you develop insulin resistance, as is what happens in pre-diabetes and type 2 diabetes, your body becomes very inefficient in processing glucose from carbohydrates. Thus, it might make sense to eliminate carbohydrates altogether. However, carbohydrates are the most important source of energy for our bodies and by eliminating something that comprises 45-65% of a typical diet, you are setting yourself up for frustration when you find you simply can’t eliminate carbs from your diet. Not to mention, you will likely feel guilty when you do eat carbs.

How?: The goal is not to eliminate all carbs (did you know most fruits and some vegetables are considered carbohydrates?), but simply to choose smarter carbs and eat them consistently throughout the day. Whole grain products, fruits, and vegetables are your best bet for the increased fiber which slows the glucose absorption in your body. Pairing carbohydrates with a protein or a fat also helps blunt the rapid rise in glucose. For example, rather than simply eating an apple as a snack, dip the apple slices in peanut butter.

Why?: A reduced sodium (3000mg or less per day) diet is indicated for people with mild to moderate congestive heart failure, hypertension, or end stage renal disease. Consuming an excess of salt can cause fluid retention which raises your blood pressure. The higher your blood pressure, the greater the strain on your heart, arteries, kidney, and brain. You might feel bloated or swollen with edema after eating high sodium foods, which may need to be treated with medication. Eating foods high in potassium can counteract mild bloating.

How?: Salt is added to foods for flavor and preservation. For this reason, may packaged foods contain high amounts of sodium. Any sauces, gravies, soups, cheese, and cured meats will likely have the most sodium. Read labels to see if salt has been added to a product; you might be surprised by some of the foods that have high sodium.

Why?: A low fiber diet is not recommended often for healthy individuals, but would be necessary for someone recovering from GI surgery or with certain GI disorders like Crohn’s disease during a flare.
On the other hand, a high fiber diet is a useful recommendation for almost all individuals. A high fiber diet helps promote regular bowel movements and maintain bowel health, can lower cholesterol levels, control blood sugar, and help you stay fuller longer.

How?: Foods highest in fiber are fruits, vegetables, whole grains, and legumes. There are plenty of products with added fiber, but getting it in the most natural form is your best bet. Eating too much synthetic fiber additives can cause abdominal discomfort and gas in some individuals.

“Just Eat Less”
Why?: This one might be the most common suggestion heard from practitioners. If your BMI is above the “normal” range, your practitioner might just say, “well why don’t you eat less”. Of course, if it was that simple… This suggestion is the only one on the list that would not necessarily be a form of self care. This would be just another diet.

How?: Here’s the thing, take a look at what you’re currently eating. Ask yourself if someone else would think it was “too much”. If someone else would say you were eating a normal amount, feel free to brush the practitioner’s comment off and continue as you were. However, if you realize that you are eating in excess, it’s time to figure out why. Are you overly hungry? Are you bored? Sad? Lonely? Stressed? Busy? Once you figure out what is causing you to overeat, it’s time to do some work. This will be covered in a future blog post.

Finally, it’s important to note that for all therapeutic diets discussed, there are also medications and medical interventions that can help with the associated diseases/disorders. Therapeutic diets can treat and manage different conditions, but sometimes your mental health must come first, and a therapeutic diet may not be feasible for you. That’s okay too.


Struggling to figure out what to eat? In search of an experienced registered dietitian in the Centerport, New York area or virtually? Send Christina an email to learn more about 1:1 nutrition therapy sessions!

Published by Christina Frangione, MS, RD, CDN, RYT

Christina Frangione, MS, RD, CDN, RYT is a Registered Dietitian Nutritionist serving the Long Island, New York City, and New York State areas helping clients with eating disorders and disordered eating recover their relationship with food and their body. She utilizes a Health at Every Size® approach and supports Intuitive Eating and knows that while she is the food and nutrition expert, you are the expert of your body and life.

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