In this episode of Functional Medicine Research, I interview Dr. Liz Lipski in a discussion about how to choose the best therapeutic diet for gut health. We discussed the low FODMAP diet, comprehensive elimination diet, Simple Carbohydrate Diet (SCD), GAPS diet, Paleo diet, histamine, pancreatic elastase and low HCL levels. Liz discussed why we would choose each one of these diets for an individual and what each diet entails. I use all of these diets in my practice so it was nice to have an overview of each diet from one of the top experts in gut health.
Dr. Hedberg: Well, welcome everyone to "Functional Medicine Research." I'm Dr. Hedberg. And I'm really looking forward to my conversation today with Dr. Liz Lipski. And Dr. Lipski, she's a Professor and the Director of Academic Development for the Nutrition Programs at Maryland University of Integrative Health. She has a PhD in Clinical Nutrition, two board certifications in nutrition, one in functional medicine, and she's a fellow of the American College of Nutrition. She's the author of the fantastic book "Digestive Wellness" which I highly recommend. And she's the founder of the Innovative Healing Academy. She's on faculty for the Institute for Functional Medicine and the Metabolic Medicine Fellowship in Integrative Medicine. She's been a pioneer in the field of functional nutrition for four decades. Liz, welcome to the program.
Dr. Lipski: Thanks, Nick. It's so nice to be with you today.
Dr. Hedberg: Yeah. This is gonna be a great talk. We're gonna be talking about how to choose the best diet for gut therapy. And why don't we start by just a general question about, you know, what is the best overall diet for GI health? Do we really know, based on the research at this point, what the vast majority of the population should follow? Do we have any insights on that?
Dr. Lipski: I do. I think a lot about what's different between people who are healthy and wanna work on tweaking their health or preventive health, and then people who are already in a deep hole where already their health is compromised. And hands down, when we look at research, it looks like a whole foods diet based on a Mediterranean-type diet is the very best diet. When we look at it, cancer rates go down and diabetes rates go down and cardiovascular disease rates go down, but we also have some research on GI.
And one of the main issues in the way that we're eating... And I know you see this in your practice, Nick. What we see is, when you ask people, "Well, how do you eat?" And what do they tell us? They say, "I eat pretty well." Right? Don't you hear that all the time?
Dr. Hedberg: Yeah. Yeah.
Dr. Lipski: And then you look at somebody's food diary and maybe they do, but usually they don't. And so for me, steering somebody at first to a whole foods diet is the most important thing because what we know is that according to a recent study based on kind of looking at every food that has a barcode and it represented, you know, any food company that had more than, you know, a tiny share of the market, they looked and they said 70.9% of the foods that we Americans are eating are ultra-processed. Ultra-processed.
And so we now have other studies that say, "Well, if you have more than two servings a day of these ultra-processed foods, we have a 62... For each 10% increase in ultra-processed foods, we increase our risk of cardiovascular disease by 12%, and heart disease by 13%, and strokes by 11%."
So, we also have some research on cancers as well. And so, you know, it's not that we can have a treat. It was just my son's birthday and I made a cake and we all had cake. It's not like, you can't have some treats, but at least I made the cake. I knew every ingredient that was in it. And most of us are just eating, the majority of our food is fast, easy, cheap, and filled with all kinds of additives and highly-processed foods. And so the first step is moving towards a whole foods diet and trying to make at least 80% of what you eat every day as real food and cooking.
And so that's kind of a long answer to, like, what's the best diet for GI? So, for people who are healthy, you know, tons of vegetables and fruits and legumes and nuts and seeds and whole grains and good-quality proteins. That's really what our diet should look like. And for the most part. But then, when we're sick, we have to do different things.
Dr. Hedberg: Right. Right. It's such a confusing topic for the consumer. We're talking about colonizing Mars and we can't even figure out what to eat, you know, on our own planet. But we can wade through some of that, especially when we're talking about specific therapeutic diets. Why don't we jump into this area and go through a few specific therapeutic diets? Why don't we start with the elimination diet? This is a diet that I've used quite a bit over the last 16 years. And so can you tell us, you know, how do you choose the type of patient to use an elimination diet with and what does that diet look like?
Dr. Lipski: Okay. When both of us started, this was pretty much our only therapeutic diet. And so, like you said, you have a lot of experience with it, I have a lot of experience with it. And I've said over and over that if you can take somebody who has inflammation, maybe even somebody with autoimmune disease, and put them on a comprehensive elimination diet, within two weeks they often feel at least 50% better. And so I think that this is one of the greatest reducers of inflammation of all time is dietary change because eating is the most inflammatory thing we do, depending on what we're eating and who we are.
So, the comprehensive elimination diet, I think about it for somebody who has a lot of pain, somebody who has migraines, somebody who has arthritis, somebody, again, maybe if they have autoimmune disease and they're not ready to kind of turn their lives 100% upside down.
And what you can eat on an elimination diet is you can eat poultry, preferably organic. You can eat bison and meats that aren't eaten that often. You can eat fish. You can have fruits and vegetables. You can have non-gluten containing grains like rice and wild rice and buckwheat. You can have seeds like amaranth and quinoa. You can have other seeds like sunflower seeds and pumpkin seeds. And you can use oils like avocado oils and olive oil and walnut oil and sunflower oil. You can use herbs and spices. And that's pretty much what comprises it.
One of the things I like about the diet a lot is you can pretty much walk into most restaurants and be able to find something that you can eat. You could have a salad or you can have grilled chicken with some vegetables and baked potato. What's not on this diet is alcohol, sugar, gluten, dairy, eggs, soy. Unless somebody is a vegetarian, I don't include any legumes because legumes, as people know, can cause a lot of gas and bloating if people aren't used to them. But if they're already part of somebody's diet, we can talk about that. One of the big deals that I typically make is if somebody is a big coffee drinker, we negotiate on that. Do you do that too?
Dr. Hedberg: I do. Yeah. Because cold turkey on coffee can be very, very hard for some people.
Dr. Lipski: Yeah. It's not the most... We know that coffee has, you know, probably a couple of hundred different components to it and some of those are really anti-inflammatory and antioxidant and helpful for us. So, usually, it's not caffeine, is usually not somebody's biggest issue. It's usually, usually, usually in 80% to 90% of cases, it's gluten, dairy or eggs. But I really like to start with a pretty, you know, broad-brush because what I'll ask somebody to do is to do this diet 100% for two weeks and then come back into the office and then we reevaluate where they are.
If they have zero benefit, then it's kind of like, "There is zero benefit? Well, maybe we are barking up the wrong tree." Right? But for most people, I've seen people come in who had arthritis, depression or have mental health stuff. This works so amazingly well for depression, anxiety. And I've seen people come in, they're fatigued, they're not sleeping well, they're depressed and anxious and they have pain. And they come in after a couple of weeks and they go, "Oh, my gosh. I feel like a different person."
And that's when I say, "Do you think you could do this two more weeks?" Because I'd like to give a longer period of time. We know that the half-life of antibodies is about 21 days. So, if we can have somebody stay on this diet for at least three or four weeks 100% then we can kind of tamp down that antibody response. And then when they actually reintroduce foods, they get often a big kind of kick that says, "Uh-oh, my symptoms are coming back."
And how I like to do this, and everybody does it a little bit differently, is I like to have people, for example, if they're gonna add eggs back into their diet, I would like them to have eggs at least a couple of times that first day and a couple of times the next couple of days. And if they have any negative reaction, sometimes people have a negative reaction immediately, then eggs are off their list, and they know that. But if they don't really notice anything, I want them to keep eating eggs for a few days in rather high amount to see what happens. Because often somebody feels fine the first day and it's a second or third day, all of a sudden, their symptoms kick back in. I'm sure you've seen that too.
So, that's kind of the comprehensive elimination diet. And it always used to be my first go-to diet. And it's still one of my main first go-tos and I think it's because people can wrap their heads around it pretty easily and because it works remarkably well so often.
Dr. Hedberg: And you're doing around three weeks to start or do you do it a little longer, a little bit shorter?
Dr. Lipski: Well,
