After years of badgering him, this week my partner woke up and said, “Alright, I’m ready to eliminate gluten, dairy, and sugar. Let’s start Wednesday.” My inner righteous self exclaimed, “About dang time!” But my taste buds and sugar-addicted mind yelled, “No!!! Don’t take this away from me!”
I gave up gluten about 4 years ago after completing the elimination diet, something we were forced to do in one of our classes during my Naturopathic medical training at Bastyr. A true elimination diet starts with a small cleansing fast, and proceeds with eating a minimal range of hypoallergenic foods for up to 6 months, adding in a variety of food groups one at a time. During this time, you should notice many mild symptoms improve such as fatigue, headache, sinus congestion, digestive upset, bowel movement regularity and quality, and joint pain. Each food is consumed in its purest form during all three meals of one day. Then, you wait for about three days to see if any of your symptoms return or flare up. If you don’t, Congratulations! You can continue eating that food and add it to your diet as you continue testing other foods. If you do see the return of symptoms, then you have discovered a food that you’re sensitive to, and continuing to eat that food becomes a conscientious choice. This protocol can be modified to be less strict to accommodate the practicalities of one’s life.
I could never have imagined the life-changing results of that assignment. At the risk of sharing too much information, I had incredible stabbing abdominal pains after most meals I ate since junior high school (which I had become so accustomed to I wasn’t even aware of them anymore), lots and lots of gas (just ask my college roommate), and such heavy periods that I quickly became anemic. I realized that gluten was the main culprit. Of course, I had already been eating a pretty healthy Asian diet consisting mainly of vegetables and fruit, rice, and some meat. And the Asian sweets that I’m used to are not nearly as sweet as the decadent desserts that America has to offer. So I hardly ate dessert and hardly had an issue with sugar. But you can’t escape wheat when you’re getting accustomed to a standard American diet.
About a month after giving up gluten, my acne was gone and I realized I didn’t have any more abdominal pains or gas. About a year afterwards, my periods were more regular, and my ferritin (a measure of the liver’s storage of iron) rose from 2 ng/mL to 36 ng/mL. It’s been so empowering to feel better and be able to control my energy and well being just through diet. Since finding my own path through diet to feel the best I can, I’ve seen many patients who have benefited similarly, if not with gluten, then eliminating something else to which they are sensitive. To help figure out what you’re sensitive to and what is the most practical approach to an elimination diet, working with a naturopathic doctor can offer many tools to support the process.
Fast forward to a few months ago, my partner and I were traveling through South Korea and Japan, after I had already been in China for 7 weeks. It was impossible to avoid gluten in China and Japan, specifically. Their soy sauce is all processed with wheat, and the Japanese love to cover food with panko breading and fry it. So I gave in, and enjoyed every cranky, bloated, mind-foggy moment of it. My taste buds definitely thanked me. But my digestive tract is still angry at me. During this trip, a daily sweet also became my favorite way to cope with the stress of graduating and traveling to a new city everyday. I thought, I’ve hopped on the gluten train, might as well ask sugar to join the party. And since coming back to the US and moving to another corner of it, I can still get a sugar fix to cheer me up when I think of leaving my friends back in Seattle. But of course, it’s not free. My energy comes crashing down, I get a teensy bit of brain fog, and more headaches, and more backaches. Yet, the cost seems minimal at first because this sugar fix is now an emotional reward. And to take it away instills a slightly panicked fear inside. In fact, an entire industry benefits from our covert food addictions.
Like any addiction, our attachment to food is complicated. The associations I have to sweets is a reward system that’s embedded in my nervous system. Reflexively, I associate sweets with the relief of something being there for me, like a good friend. I made happy memories with delicious chestnut ice cream and maple syrup ice cream at cute little towns across Japan and associate those flavors with the excitement of exploring a new place. At approximately 2PM, 4PM, and 7PM everyday my brain said, it’s time…you need sugar. And it still does that, even as I am consciously eliminating it from my day. To take it away is like ripping the blanket out of Linus’s hands. But like any crutch, you can’t heal without letting it go–you can’t function at your optimal level.
For me, this practice of letting sugar go, specifically, is just a time of cleansing and renewal. I’m a proponent of moderation. Sometimes restricting food is a form of self-torment, over self-control, and even self-hatred. And I don’t believe that’s healthy. There are some clear foods I try to avoid during this time, but some that are important to include:
- Avoid adding sugar to your own cooking. This includes refined white sugar, powdered sugar, brown sugar, cane sugar, brown rice syrup, honey, agave, maple syrup, sorghum, and molasses. As you can imagine this takes out a lot options for the finer things in life such as cream and sugar in your morning coffee, sweetened tea, and almost all conventional desserts. This calls for a time to reinvent morning rituals, teatime, and dessert.
- Avoid processed foods especially sauces, cereals, and yogurt. Many salad dressings, ketchup and barbecue sauce bottles have enough corn syrup and added sugars in each of them to equal the amount of sugar in a handful of boxed cookies. Most boxed cereals and yogurt are also filled with high fructose corn syrup. You can find many of these products that don’t contain high fructose corn syrup or any added sugar in which case they are free to consume during a no sugar cleanse.
- Avoid eating out or be selective when eating out. Many restaurants use sugar from processed foods. Even restaurants that make food from scratch are adding sugar to their glazes, dressings, sauces, and marinades. Usually ordering soup (that’s not from a can, otherwise you’ll be eating a salt mine), salad with dressing on the side, roasted veggies a la carte, and main entrees without sauces are more likely to not contain added sugars.
- Avoid bottled and canned beverages including even fruit juices. Sodas including diet soda, sweetened teas, frappacinos, energy drinks like red bull and gatorade, fruit juices, both natural and from concentrate like Naked juice and Tropicana or Sunny D, all contain exorbitant amounts of added sugar or corn syrup. I think it’s important to stay away from fruit juices at this time because it’s a large amount of concentrated sugar intake in the form of a beverage especially without the addition of fiber. Other options for beverages are carbonated water and mineral water, coconut water, plant milks that are not sweetened like unsweetened almond milk, hemp milk, and soy milk and fruits that you blend in order to retain the fiber content of the fruit.
- Avoid “natural sweeteners” or artificial sweeteners. This includes aspartame or nutrisweet, acesulfame K, saccharin, sucralose, mannitol, xylitol, sorbitol, and stevia. This list is not comprehensive by any means. Some of these sugars occur naturally and can be used for specific purposes. My reason for eliminating these sweeteners is that they feed into the reward system pathway. The point of a cleanse like this is to break that circuit so that you no longer have that craving. There is controversial speculation whether these sweeteners are actually harmful. For example, it’s clear that sugar contributes to inflammation, and chronic excess consumption of sugar increases the risk of cardiovascular disease (1). But we don’t know if artificial sweeteners carry the same risk. Another example is the association between aspartame and increased brain tumors. Considering the overall research, the American Cancer Society and the FDA approve of its use.
- What to include: Fruit and dried fruit. Though fruit is high in sugars, the other nutrients and constituents that you get from fresh fruit like vitamin C and insoluble fiber help to support the immune system and digestive system. Some fruits have a considerably higher glycemic index such as cantaloupe, honeydew, pineapple and grapes, while others have a lower glycemic index such as blueberries, raspberries, cherries, grapefruit, apricots, apples and pears. This might be something to consider if you’re diabetic. Dried fruit certainly contains even more concentrated sugars. So it becomes more about eating them strategically. Trail mix exists for a good reason. Always either pair dried fruit with protein or fiber or make it less concentrated by using them as sweeteners. Talk about natural sweetener.
- The first thing to integrate slowly back into your diet once your cravings are gone is honey. Honey has so many healing properties. In Chinese medicine, it harmonizes and strengthens the digestive system. It moistens dryness in the respiratory and digestive system. But it is only beneficial in moderation. You’ll notice that you won’t need as much to feel satisfied. It will become a wonderful addition to beloved new desserts you’ve created. And it will be easier to incorporate it moderately into your diet when that sweet tooth has subsided.
These rules may seem severe, but health is dynamic. It’s easy to fall off the horse. And it takes a special strength and effort to get back on the horse. The effort becomes easier. And the rules don’t have to be followed so strictly forever.
Therefore, my partner’s declaration comes at the perfect time for me. I don’t have someone pushing me off the high dive. I have someone to hold my hand as we jump together into a glittering lake. I’m the luckiest lady alive.
The untimeliness of this endeavor is that Valentine’s day is coming up. To pay this supportive hand forward, you’re about to see some treat-yo-self types of desserts and dishes, all without gluten, sugar, or dairy.
(1) Yang Q. Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Internal Medicine 2014; DOI:10.1001/jamainternmed.2013.13563