CHAPTER 21:
FINE-TUNING FOR SPECIAL POPULATIONS
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“I was diagnosed with my first autoimmune disease at 19—autoimmune hepatitis. Then seven years later, I was diagnosed with lupus. I had a rash on the face, mouth sores, fatigue, hair falling out, swollen, painful joints, shortness of breath. Then, my kidneys started to fail, and I was diagnosed with lupus-induced swelling of the brain. I started chemo treatments, reached remission, then came out of remission in 2010. Nothing worked—I was heading toward dialysis and more chemo. During all of these years, I gained weight from the steroids, and my legs were was so full of water my skin would crack. This is when my cousin told me about the Whole30, and how it helped her arthritis. In the first week, my pulse fell from 98 to 78. It only took the Whole30 seven days to get the water out of my legs! I could see and feel the inflammation leaving my body. My BP is now 120/80, and my blood sugar is more regular. I feel great, I have energy to make it through the day and then some, and most importantly, I’m pain-free. Your program has changed my life—if not saved it.”
—Heather B., Stevens Point, Wisconsin
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While we believe that our dietary recommendations, and our Whole30 program, would benefit everyone, there is no one-size-fits-all nutritional plan. There are those with specific medical conditions, lifestyles, or activity levels who may require the modification of our general guidelines to achieve optimal results.
If you fall into one of these categories, feel free to make the adjustments that we’re going to recommend during your Whole30 program and beyond. *
DIABETES
This program is ideal for managing blood sugar and insulin levels, and for preventing (and even reversing!) type 2 diabetes. We have seen firsthand the effects of our Whole30 program and healthy-eating guidelines on those with both type 1 and type 2 diabetes, and the scientific literature also supports our protocol.
However, diabetics must work very closely with their doctors to ensure that the powerful effects of these dietary changes are monitored and medications are properly adjusted. We have seen dramatic results in as little as one week, with one client being able to cut his oral medication in half. Radical improvements, in just seven days—which means that you’ll need to speak with your doctor before making changes in your diet, so that together you can decide how to monitor and adjust your medications.
In addition, those with type 1 diabetes will need to make changes far more gradually than the Whole30 program calls for. Start with small modifications to meals, gradually substituting your “less healthy” foods for high-quality meats, vegetables, fruits, and fats. Working with your doctor, adjust your insulin dose and/or oral medication as necessary to accommodate these new foods, until you’ve successfully replaced all the less-healthy foods on your plate with more-healthy choices.
AUTOIMMUNE DISEASE
Our protocol is ideal for normalizing an overactive immune system, reducing systemic inflammation, and minimizing (or eliminating) symptoms related to an autoimmune disease. There are some additional caveats with respect to our autoimmune guidelines, however, as certain foods that are generally “safe” for many people may provoke inflammation in those with an autoimmune disease. Since your margin of error is that much smaller, you may want to consider removing these additional items from your daily diet.
Eggs (whole eggs and egg whites): Egg whites contain proteins that can adversely stimulate the immune system—a contributing factor in autoimmune diseases. We recommend that those suffering from autoimmune diseases avoid eggs for at least ninety days, to evaluate sensitivity.
Nightshades: Nightshades are a group of plants that contain compounds that promote gut irritability, inflammation, and joint pain or and stiffness in sensitive individuals. Nightshades include white potatoes, tomatoes, sweet and hot peppers, eggplant, tomatillos, tamarios, pepinos, and spices like cayenne, chili powder, curry powder, paprika, pepper sauce, pimento, and crushed red pepper flakes. We recommend avoiding nightshades for at least ninety days, to evaluate sensitivity.
Dairy (including heavy cream, clarified butter, and ghee): Milk solids (proteins), even the trace amounts found in ghee, can be problematic if you have an autoimmune disease. For this reason, you should avoid all dairy products during your Whole30, and potentially indefinitely.
Nuts and Seeds: Nuts and seeds contain compounds that may be inflammatory in those with an autoimmune condition. Consider other sources of dietary fat per our recommendations.
NSAIDs: Nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), and Celebrex disrupt the lining of the gut, leading to intestinal permeability, a contributing factor in autoimmune disease. For pain relief, Tylenol (which is not an NSAID) is a better choice—or ask your doctor about other pain-control strategies.
IBS AND IBD
Medical professionals agree that our general recommendations and Whole30 program are safe, healthy, and effective for those with IBS (irritable bowel syndrome), IBD (inflammatory bowel disease) and similar digestive disorders. However, having a serious digestive disorder does require you to follow some protocols specific to your type of inflammation. These modifications should make your transition easier.
In addition, those with IBD (Crohn’s disease or ulcerative colitis) should also adopt our autoimmune protocol, especially with respect to eggs and nightshades. Only after you have seen symptomatic improvement and, ideally, improvement in inflammatory lab markers, would we recommend reintroducing these foods, starting with eggs first, and then nightshades.
Vegetables: Eat plenty of fiber-rich vegetables, but make sure they are cooked thoroughly, as this makes their fiber content way less likely to cause problems. We also recommend that you prepare veggies by first chopping them into small pieces, which makes it easier to guarantee thorough cooking, or to add them to soups or stew.
Fruit: Be cautious with fruit consumption, as there are strong links between fructose malabsorption and IBS. Make sure you peel all fruit, avoid what you can’t peel (like grapes and cherries), and eat your fruit as ripe as possible. You should also avoid fruits that have seeds and a rough exterior (like berries). Although no one knows why for sure, many IBS sufferers report increased symptoms after consuming citrus fruits, so we recommend avoiding those as well. Finally, dried fruits and fruit juices pack too much sugar into a small package for folks with serious GI disturbances.
Nuts and Seeds: Avoid all nuts and seeds. They can be profoundly inflammatory in the intestinal tract, mostly because of their physical structure. (They can “scrape” the intestinal lining, causing discomfort when inflammation is already present.) This includes nut butters, even the “creamy” kind.
Coffee: Avoid coffee—even decaffeinated. Coffee is a powerful GI-tract irritant, and even decaffeinated coffee can trigger abdominal spasms and diarrhea in IBS/IBD patients. In addition, caffeinated coffee is a double-whammy, as caffeine speeds up every system in the body (including the colon), which can lead to diarrhea, followed by constipation. Coffee can also increase stomach acid, which can contribute to inflammation in the GI tract.
Water: Drink plenty of water throughout the day, but not with your meal, as it can inhibit proper digestion by diluting stomach acid and digestive enzymes.
Fish Oil: Consider taking a high-quality fish oil. (See Chapter 22 for details.) Fish oil supplements containing omega-3 fatty acids have been proven a complementary or alternative treatment for IBD.
Finally, understand that your digestion may get worse before it gets better. As your GI tract starts to heal, your mucosal layer will adjust, unhealthy gut bacteria will start to die off, healthy bacteria will begin to repopulate, and the intestinal lining will start to rebuild itself, plugging gaps and filling in holes. This can lead to gas, bloating, diarrhea, or constipation. In conditions such as IBD and IBS, it’s not uncommon for digestive issues to continue for three to six months after making such radical dietary changes—but it is a necessary first step in restoring normal, healthy gut integrity.
ADDITIONAL FACTORS
Note, there are other food groups that may potentially be inflammatory or digestively disruptive— like FODMAPs (see page 119), high-oxalate foods, or high-histamine foods. If you’ve been following the Whole30 and these special protocols for sixty to ninety days and are still experiencing digestive issues or other autoimmune-related symptoms, consider working with a qualified nutritionist or functional-medicine practitioner to help you arrive at an ongoing protocol that will work for your particular condition and symptoms. A food journal can also help you identify potentially “healthy” foods that may be triggering unpleasant symptoms. Write down all the foods in your meals and snacks for a week, and note the severity and type of symptoms you experience after each to try to pinpoint the culprit(s).
FOOD ALLERGIES
This may seem like a no-brainer, but we get plenty of questions from people asking if they can follow our plan if they are allergic to eggs, seafood, nuts, or avocado.
The answer is, yes, of course! Just don’t eat the foods you are allergic to.
If you suspect that you have an allergy or intolerance to any one food, please don’t test your limits during your Whole30 program.
You want to completely eliminate your exposure to any potentially inflammatory compound during your Whole30, so avoid that food or food group. None of the foods on our shopping list are mandatory—and there are plenty of healthy options in each category (protein, vegetable, good fat), so it should be easy for you to make appropriate choices.
In addition, your “allergy” to certain foods may not be a true allergy—it may just be an intolerance or sensitivity, in which case, it may be reversible. Many have reported the reduction or elimination of food “allergies” after successful completion of their Whole30. Perhaps by eliminating intestinal permeability and restoring normal gut flora and fauna, your body’s immune system will relax enough to permit the reintroduction of certain foods.
However, this process requires at least six months of absolutely no exposure to the problematic food, and may not be safe or feasible for those with long-standing, life-threatening allergies. Work closely with your doctor and test this cautiously, please.
VEGETARIANS AND VEGANS
These particular lifestyle choices do present more of a challenge to our nutritional recommendations and Whole30 program. While our diet is not exclusively carnivorous, we do recommend the inclusion of animal protein for optimal health. However, it is still possible to reap many of the benefits of our healthy-eating plan while still honoring your ethical or religious obligations.
HEALTH-CONSCIOUS
If your primary reason for becoming vegetarian or vegan was for health, we certainly hope we have made you reconsider! We don’t believe you can enjoy optimal health without eating animal protein (dairy doesn’t count), and we think we’ve provided a well-reasoned, well-sourced argument to back up our position. So if this is where you are coming from, give our plan a try! Go back to eating high-quality animal protein for thirty days (while implementing the rest of our recommendations) as a self-experiment. We’d be shocked if your health did not dramatically improve!
If you’ll eat some animal products (eggs, fish, etc.), then we recommend getting the bulk of your protein from these sources and supplementing with plant-based sources as little as possible. If your concerns are largely ethical—animal welfare, sustainability, your local economy, or global economic factors—know that there are ways to responsibly, ethically source meat, seafood, and eggs and supporting those efforts sends a strong message (financial and otherwise) to the large corporations invested in factory farming. We believe it is important to create an alternative food-supply system, but that cannot be done without the support of committed consumers.
If dairy is a viable source of protein, we recommend putting pastured, organic, fermented sources like yogurt or kefir at the top of your list. You could also use whey protein powder from grass-fed, organic sources, which would provide the protein you need with fewer downsides than other dairy products, including all forms of milk and cheese.
If you don’t eat any animal products, or if you find you still need to supplement your diet with plant-based protein sources, your best choices are minimally-processed, fermented soy products like tempeh or natto, or organic edamame (soybeans). You can also include nonfermented soy (like extra-firm tofu) and various legumes in rotation, making sure to soak them for twelve to twenty-four hours, rinse, and boil them for at least fifteen minutes to reduce the anti-nutrient and inflammatory compounds. A hemp- or pea-protein powder is also an option for you.
Avoid all grains and grain products, including seitan (which is made from wheat gluten) and pseudo-cereals like quinoa, as the downsides are too numerous. In addition, vegans will need to eat more carbohydrate and fat, to cover the missing calories from their relatively low protein diet.
VEGETARIAN SHOPPING LIST
You can download a free copy of our shopping list for vegetarians and vegans on our Web site (http://whole9life.com/itstartswithfood). In addition, refer to Appendix B for responsibly-sourced animal and vegetarian protein.
ACTIVE INDIVIDUALS
If you exercise regularly or play a sport, you’ll need to support that activity with extra nutrition and calories. Remember, your energy stores function like gas in your car. The more you drive, the quicker you’ll use up the gas in your tank.
Lower-intensity activity, like casual cycling, walking, hiking, or golf, burns more fat than carbohydrate, so you may not need to load up on starch on a daily basis. However, if you participate in high-intensity activity (like CrossFit, P90X, sprinting, or basketball) or longer-duration activities, like running or biking, you will probably need to include more carbohydrate than the average (less-active) person in your daily meals to maintain adequate glycogen stores. Throw in some carb-dense veggies like sweet potato, butternut squash, acorn squash, beets, pumpkin, or parsnips, and perhaps bump up your protein and fat and/or add an extra meal.
WHAT IS HIGH INTENSITY?
“High intensity” means the exercise is brief and you are close to an “all-out” effort. Often, it’s based on the rate of perceived exertion (RPE), how hard you think you’re working. You could also use heart rate to determine the level of your intensity, especially if you’re new to this of kind of training. If you are working above 75 percent of your max heart rate (conversation is impossible, save for short phrases or one-word bursts), that’s generally considered high-intensity effort. From our perspective, high-intensity training generally lasts less than ten or fifteen minutes—any longer, and you simply cannot continue to sustain near-maximal output. However, some exercise programs include workouts that last longer than that and expect participants to work as hard as possible the entire time. For the purposes of this discussion, we’ll call these training sessions “high intensity” too.
In addition, for those participating in either high-intensity or longer-duration activity, you’ll need to support your training session or athletic event with proper nutrition to help you fuel and recover.
Pre-Workout: Your pre-workout “snack” is not fuel for your workout! You’ve got tens of thousands of calories stored in your body—plenty to support your activity. Your pre-workout food simply sends a signal to your body to prepare it for the activity that is coming. Eat fifteen to seventy-five minutes before your workout, choosing foods that are easily digestible and palatable—the timing is highly variable and depends on what your gastrointestinal tract can tolerate before physical activity. Focus on protein and fat and avoid lots of fruit or carb-dense vegetables. Remember, elevated insulin levels undermine glucagon’s energy-access function—and you need your energy stores during a training session. A pre-workout snack might be: two hard-boiled eggs, some deli turkey and a small handful of macadamia nuts, or a few strips of beef jerky. If you exercise first thing in the morning, a little something is better than nothing, so do the best you can.
Post-Workout: Your post-workout meal is a special “bonus meal” designed to help you start the recovery process faster and more effectively. After you train, your muscles and connective tissue need protein, and your glycogen stores may need replenishing. Eat your post-workout meal as soon as possible—ideally, within fifteen to thirty minutes of training. Bring it to the gym or competition site! Have a meal-size serving of an easily digestible protein and add carbohydrate in the form of starchy vegetables based on your activity level and health status. Fruit is not your best choice here. Fructose-rich fruit will preferentially replenish liver glycogen, but your muscles did all the hard work. A good post-workout meal might be: chicken breast and sweet potato, salmon and butternut squash, or egg whites mixed into mashed pumpkin. Eat a normal meal sixty to ninety minutes after your post-workout meal.
All high-intensity exercisers need protein post-workout, but whether to include carbohydrate depends on the type of activity and metabolic status. If you are lean, muscular, healthy (insulin sensitive), and performance-oriented, you have a totally different context than someone who is overweight, metabolically deranged, and trying to get back on track with his health. For that reason, we recommend following our “post-workout carb curve,” which accounts for both your particular health status and the type and duration of activity.
Duration: On the left side of the chart, find the number that corresponds to the total duration of the high-intensity portion of your exercise session. If you were at the gym for an hour, but spent only twelve minutes actually working hard, then 12 is your number.
Health Status: Identify where your current state of health lies along the spectrum at the bottom of the chart. It’s subjective, but it’s just a conceptual guideline.
Post-Workout Carb Intake: Use those two coordinates to plot the point that determines the approximate amount of carbohydrate you should consume after each high-intensity training session.
If your health status is toward the left end of the continuum, perhaps just starting to exercise and eat healthier, restoring your health takes priority over fueling your athletic performance. In that case, we don’t think you need carbohydrate post-workout, regardless of the duration of your high-intensity activity. You have thousands of calories stored in your body already, and adding a bunch of carbs in any one sitting isn’t the smartest hormonal strategy when you’re already insulin resistant. Therefore, your post-workout meal should include only protein.
THE X FACTOR
Notice how there’s a big “N/A” area on our chart? That’s because we don’t think it’s appropriate for overweight, insulin-resistant, inflamed folks to work out hard for longer than twenty minutes straight. Adding more stress to an already overstressed system is counterproductive to improving health. So keep your workouts either long in duration or high in intensity—but not both. As always, context matters.
If you are closer to the lean, healthy, performance-oriented end of the spectrum, you’ll need to start replenishing calories (and glycogen stores) after even short-duration activity to maintain performance levels and muscle mass. Follow our recommendations and include both protein and varying levels of carbohydrate in your post-workout window.
PREGNANT AND BREASTFEEDING WOMEN
If you are pregnant or breast-feeding, you know how important Mom’s nutrition is to her baby’s health and development, and we believe that the diet that’s healthiest for you is also going to be the healthiest for your baby. The more nutrition Mom receives from her diet, the more she is able to pass along to the little one—and there is no diet more nutritious than one that focuses on healthy protein and fat, vegetables, and fruits.
ASK THE DOCTOR
Dr. Michele Blackwell, OB-GYN, has done our Whole30 program herself and recommends it to her pregnant and breast-feeding patients. Dr. Blackwell says, “I wholeheartedly recommend the Whole30 plan to my patients to optimize a woman’s health during pregnancy and lactation. The nutrient-dense foods recommended provide ample vitamins and minerals without the need for the standard prenatal supplement. Eating in this manner will also help regulate blood sugars, alleviating hypoglycemic spells common in pregnancy.”
However, you’ll want to make some minor tweaks to your healthy-eating plan, as your nutritional needs (and those of your baby) are different during these special times. Recommendations for pregnancy include:
Protein: A very high protein diet isn’t the healthiest thing for your baby, and may contribute to low birth weight, poor feeding, and other longer-term effects. Pregnant women should limit protein consumption to no more than 20 percent of total calories. (Nature usually helps us out here—many women report an aversion to, or loss of appetite for, protein during pregnancy.)
Total Calories: While pregnant, it’s critical for you to consume enough calories. Make sure you are incorporating more starchy vegetables and healthy fats into your diet to make sure you’re not underfeeding yourself or your baby. Sipping on a can of coconut milk throughout the day is a easy way to add calories.
Omega-3 Fatty Acids: EPA and especially DHA provide excellent benefits for your baby’s neurological and early visual development, and may reduce the risk of pregnancy complications like preeclampsia, gestational diabetes, postpartum depression, and pre-term delivery. We recommend shooting for 300 mg of DHA per day while you are pregnant (but do not exceed a total of 1 gram of EPA and DHA combined).
Prenatal Vitamins: The problem with most prenatal vitamins is that they contain too many potentially harmful nutrients (like iron and folic acid) and not enough of what a pregnant woman really needs (like vitamins D3 and K2). It’s best to meet as many of your nutritional needs as possible with food, even while pregnant. That said, the recommended amounts of certain nutrients, like folate, vitamin K2, and vitamin D, during pregnancy may be difficult to obtain solely through diet. For this reason, taking a prenatal vitamin with the appropriate nutrients in the right dosages and forms may be a good insurance policy. You want at least 1,000 IUs of vitamin D3, 500 mcg of vitamin K2 (MK-4 form), and 800 mcg of folate (not folic acid). A good choice is Nutrient 950 with vitamin K from Pure Encapsulations.
While breast-feeding, the same protein restrictions are not necessary. However, breast-feeding mothers need to make sure their hydration and caloric intake are adequate for ongoing lactation. Most women’s appetites are stimulated when they breast-feed, and increasing fat intake is the best way to keep up the calories. Keep coconut milk or individual packets of coconut butter on hand, or snack on olives or avocado—and make sure you always have a bottle of water on standby.
Omega-3 supplementation is just as important while breast-feeding as it is during pregnancy. Continue taking the same daily dose of EPA and DHA while you are lactating.
KIDS
Once again, we believe that the diet that is healthiest for us grown-ups is also healthiest for growing children. There isn’t a single nutrient in cereals, biscuits, or formulas that can’t also be found in healthy meats, vegetables, and fruits!
For infants, breast milk is the perfect food. The scientific literature supports the health benefits of breast milk, reporting that infants who are breast-fed have lower rates of respiratory illness and ear infections as babies, and lower rates of type 1 diabetes, asthma, and allergies as adults. Better yet, babies who are breast-fed longer grow up to have higher IQs than those who are breast-fed for fewer months. Because of the numerous advantages breast milk provides for an infant’s development, we encourage mothers to breast-feed for longer than twelve months, if possible.
Once your infant is weaned, there is no need to supplement his or her real-food diet with cow’s milk! Once a cow starts eating grass, it does not return to suckle—that’s simply not natural, biologically appropriate behavior. And while cow’s milk perfectly supports the needs of a rapidly growing calf, your baby has different nutritional requirements.
Since your kids are working so hard to grow into adults (though we can’t imagine why they want to do that), they need plenty of calories to support growth, activity, and normal cognitive development. But eating well isn’t just about getting adequate protein, fat, and carbohydrates—micronutrients also contribute significantly to our health, and that of our children. One significant reason that fresh, unprocessed foods like meat, vegetables, fruit, and good fats are so healthy is that these foods supply generous amounts of vitamins, minerals, and phytonutrients—the stuff that directly benefits your child’s health. Choosing foods that supply adequate calories and copious amounts of micronutrition is the “best-case scenario” for growing kids, from toddlers to teenagers.
Your child’s diet should comprise nutrient-dense foods that require minimal preparation—beef, chicken, and fish; sweet potato, carrots, and spinach; blueberries, cantaloupe, and plums; avocado, olives, and coconut milk.
Sound familiar?
It should!
As we’ve mentioned once or twice, eating Good Food confers a host of benefits on us adults, including effortless weight management, decreasing systemic inflammation, optimizing hormonal levels, and reducing the risk for a number of lifestyle-related diseases and conditions. And kids are just adults-in-the-making, right? This same food promotes their healthy immune function, supports activity and growth, and contributes a wide variety of micronutrients that have been shown to decrease risk of (and improve) conditions such as asthma, allergies, ADHD, and various autoimmune diseases.
On the opposite end of the spectrum, much in the way foods like sugar, grains, legumes, and dairy negatively affect our health, they also have a negative impact our children’s health—perhaps even more so, as their immature immune system and GI tract can be even more vulnerable than ours. Even in the youngest of us, typical “kid foods” like milk, yogurt, cereal, peanut butter, and bread can promote systemic inflammation, create immune system dysfunction, and increase the risk of diseases like type 1 diabetes.
Lots of parents we’ve talked to say, “But my kids don’t like vegetables …” or, “But my son loves his sugary breakfast cereals.” This is where we often get into trouble, asking, “Does your toddler do his own grocery shopping?” Admittedly, we don’t know how difficult it is to try to take away a child’s Golden Grahams—although we can imagine, knowing how hard it is for our adult Whole30 participants to change their eating habits. But until your children are buying their own food with their own money, you as the parent are the single largest supplier of your child’s nutritional needs. And we believe it’s just as critical to your children’s long-term success to feed them healthy food as it is to make sure they don’t drop out of school after the third grade.
Admittedly, getting kids to love Good Food is easier said than done, especially if they’re accustomed to sweeter, more processed foods. But we think that there are few parental duties more noble than loving your children wholeheartedly, and feeding them as best you can.
Even if you have to fight them on it.
Even if they go to bed hungry for a night or two.
Even if you have to resort to the old standbys:
It’s for your own good. Because I said so.