Why This Registered Dietitian Tells (Some of) Her Patients to Avoid Kale Salads 

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Why This Registered Dietitian Tells (Some of) Her Patients to Avoid Kale Salads 

In addition to nutritional value, eating healthy is also about knowing the foods your body can tolerate.

I’ve worked as a dietitian in a gastroenterology practice long enough to have seen many food trends come and go.

When I first started practicing, an austere, sugar-free regimen called the “candida diet” was popular among patients of mine who had gone the alternative health route before consulting with me, so I practically got whiplash when just a few years later, the juicing craze hit and suddenly everyone seemed to be consuming nothing but sugar. After all, juicing just means creating a cocktail of concentrated sugars from the fruits and vegetables they derive from. Soon after, my patients ushered me through the paleo craze (what I call the neo-Paleolithic era of 2013-2014), and I’ve watched as increasing numbers of them have gone gluten-free since then as paleo and paleo-esque diets like Whole30 mandate cutting out gluten-containing foods. Starting in 2015, I’ve been called upon by patients figuring out how to eat “normally” again after so-called clean diets scared them into thinking that dairy, sugar, grains, and legumes were basically poison. Soon after, I watched helplessly as the ketogenic diet claimed almost everything that was healthy and good from some of my patients’ diets in favor of bacon, beef, and cheese. Most recently, I’ve been helping patients make sense of the overwhelming dietary dictates emerging from personalized food sensitivity and gut microbiome tests.

The particulars of each new diet sensation vary, but the scenario I encounter with my patients on these programs has been remarkably consistent. People arrive at my office having recently adopted a new regimen for which they drastically change their usual eating habits—eliminating certain foods and wholeheartedly embracing others—all in a quest for better health, better energy, and better living. Sometimes, at least initially, weight seems to be coming off, much to their delight. They’re excited about this new-found way of eating that promises to help them achieve their goals for health and weight. But diets based in eliminating and/or restricting foods and food groups rarely lead to longterm, sustained change. As SELF has reported, the ketogenic diet, for example, doesn’t seem to be any more or less effective for short term weight loss than any other way of restricting calories (and long term weight loss by way of keto is thought to be unlikely). Not only are elimination-based diets not necessarily helpful for weight loss, cultivating a relationship with food that’s based on restriction and avoidance is just unhealthy.

But there’s another, slightly sneakier culprit lurking in these fad diets. They may bring exciting changes after a few days or weeks, sure. But digestive system bliss? Not so much. Sometimes, after pivoting hard to a brand new healthy eating habit, people make an unexpected discovery: the foods they think of as good can sometimes make you feel bad.

I’ve seen newly minted vegans struggle with incessant gas and bloating on their new plant-based diets. I’ve seen people embrace giant salads for lunch every day, only to be rewarded with the telltale lower intestinal churning that requires a graceful but urgent exit from afternoon meetings.

This is but a small sampling of all the healthy-eating deeds that haven’t gone unpunished in my years of counseling patients with digestive disorders.

There are countless reasons why objectively nutrient-dense, health-promoting foods might not agree digestively with a given individual.

One common issue I see pertains to foods high in insoluble fiber, or what we commonly think of as “roughage.” It’s the crunchy, tough stuff found in leafy greens, fruits and veggies with thick skins or lots of seeds, popcorn kernels and bran, tough-coated seeds and crunchy nuts, stringy celery, or woody asparagus stalks. These coarse, highly textured types of fiber can remain surprisingly intact even after chewing, which leaves quite a job for the digestive system organs to break down into passable particle sizes. For some susceptible people, this means that large portions of such foods will spend a prolonged time being churned around in the stomach, provoking acid indigestion and upper stomach bloating.

Insoluble fiber is also unable to absorb or retain water in the digestive tract, which can result in irregular bowel movements of varying types. People with speedy digestive systems or whose intestines are hypersensitive to stimuli—such as those with Irritable Bowel Syndrome (IBS)—can find that eating a load of bulky foods high in insoluble fiber triggers urgent, crampy and unformed stools, often within an hour of consumption. Conversely, some people with slower gut transit may find that diets very high in roughage leave them feeling totally backed up, able only to pass hard, dried out stools that come out in incomplete pebbles. As these people learn the hard way, adopting a low-carb diet that excludes grains, root veggies, and fruits—all foods that contain the moisture-holding, formed-stool-promoting soluble fiber—may change your bowel patterns in unanticipated and unwelcome ways.

 

Read on: Why This Registered Dietitian Tells (Some of) Her Patients to Avoid Kale Salads

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