Veggiephobia: Why limiting your vegetable intake might be slowing down healing

December 4, 2013 in Categories: , , , , , , by

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I get a lot of questions from people who are tackling the autoimmune protocol and are frustrated that they aren’t seeing results.  When we examine diet and lifestyle factors to narrow in on the missing piece, one of the most common culprits is what I now think of as “veggiephobia”.

Veggiphobia

People think “well, I can’t eat legumes or nightshades on the AIP and I can’t have FODMAPS because I have IBS, and I have to do GAPS too for SIBO, and I guess since I have GI symptoms, I should also not eat leafy greens because of the insoluble fiber, and then I can’t have the goitrogenic veggies because of my thryoid, and my friend says I should cut out high histamine foods, and four vegetables came up on my ALCAT testing and…”  there’s nothing “safe” left so people eat almost no vegetables.  This causes deficiencies which slow healing.

You might have noticed that some of the above examples are areas I have specifically researched in order to show you that there is no rationale for avoiding these foods for most people.  I have written very thorough posts addressing these topics:

  • Avoiding insoluble fiber for GI symptoms/conditions is a myth (I busted a lot of fiber myths in my Fiber Manifesto series, see here, here, here, here, and especially here).
  • Avoiding goitrogenic veggies for thyroid diseases is a myth (see here)

One thing I haven’t talked about is avoiding starchy vegetables for SIBO a la GAPS and SCD diets.  It turns out that, as popular as these diets are, these approaches have not been validated in the scientific literature.  Because of this, I have completely pulled away from my previous recommendations to combine GAPS- and SCD-style avoidance of starchy vegetables for gut dysbiosis.  I think annecdotal evidence supports that these approaches can still be very beneficial over the short term (think 2-4 weeks) to quickly correct overgrowths (specifically overgrowths, but not other forms of dysbiosis); but that over longer timescales than that, the low starch and fiber content of these diets doesn’t support the growth of normal gut microorganisms…  you basically trade overgrowth for undergrowth (which also has a variety of negative effects for gut and immune health).  I won’t go so far as to say that these approaches are myths (because they have worked for many people, at least in the short term), but I think there are better, more well-researched approaches to try first.

The strategy that has been very well studied and clinically validated for dealing with SIBO and other GI complaints (like IBS) is removing or dramatically reducing FODMAPs from the diet.  I definitely think that a low-FODMAP diet can be a useful approach in tandem with the autoimmune protocol.  This post gives you more details (and of course, there is even more information coming in my book).

But often, health doesn’t come from what you take away, but rather what you add.

My first focus in The Paleo Approach is on adding nutrient-dense foods, especially organ meat, seafood, and large portions of vegetables.  Many, many vitamins and minerals are required for the immune system to function normally (so deficiencies lead to immune dysfunction).  You need the building blocks of your tissues in order to heal damage to your gut or other organs (so deficiencies slow healing).  A huge variety of nutritional deficiencies increase risk of autoimmune disease and chronic illness in general, and it’s pretty easy to understand why:  if you don’t have all the nutrients your body needs to be healthy, you won’t be healthy.

With regards to gut dysbiosis, the two diet factors with the most powerful corrective influences on gut microorganisms are high intake of long-chain omega-3 fatty acids (that’s DHA and EPA, which you mainly get from seafood but also from grass-fed meat) and insoluble fiber from vegetables.  (Okay, two other diet factors are hugely important too and those are eliminating gluten and eliminating alcohol… but I assume you’re doing those on the autoimmune protocol.)  If you are severely restricting your vegetable intake, you are hindering your gut microbiome from normalizing in diversity, numbers and location–i.e., you are slowing down your healing process.  Also recall that my research into soluble versus insoluble fiber showed that the insoluble fiber from vegetables is more antiinflammatory than soluble and can actually help speed the healing of your gut (see here and here).  Plus correcting your gut bacteria is one of the most important aspects of properly regulating the immune system–eating lots of fish and vegetables is the most expedient way to do that.

The other thing you are missing if you don’t eat enough vegetables is the tremendous diversity of vitamins, minerals and antioxidant phytochemicals within them.  Research shows that chlorophyll (the green pigment in vegetables) completely inhibits the production of potentially cancer-causing byproducts from the digestion and metabolism of heme (an iron-containing molecule that is particularly rich in red meat). This is why all research showing that red meat causes cancer has the correlation completely disappear once you include vegetable intake in the calculations:  it’s not high meat consumption that increases your risk of cancer, it’s low vegetable consumption.  In addition, a variety of vitamins, minerals and antioxidants abundantly found in vegetables are required by the immune system for it to function normally–if you are deficient in these micronutrients, your immune system will stay in overdrive.

Vegetables are nutrient-dense foods that should be a large part of your diet.

Dr. Terry Wahls‘ original protocol for reversing multiple sclerosis with diet focused on eating 9 cups of vegetables per day; and, as defined in her initial clinical trials, this was far more important than cutting anything out. The newest version of her protocol being used in her current clinical trials and which Dr. Wahls explained beautifully in her upcoming book The Wahls Protocol (I had the pleasure of previewing this book and I highly recommend it!) includes 9 cups of vegetables plus a focus on nutrient-dense protein sources like seafood and organ meat (anecdotally, these are the other two most commonly omitted foods in the diets of people who are not seeing results on the autoimmune protocol).

Overlimiting vegetables, especially if you are also limiting your fruit intake can lead to a very low carbohydrate diet. Let’s just follow this tangent for a minute, because fruitphobia is related to veggiephobia.  Recall that one aspect of the autoimmune protocol is to keep fructose intake between 10g and 20g per day.  Many people try to err on the safe side, which means they avoid fruit completely, but some fructose actually has health benefits.  Not to mention that fruit are also rich in vitamins, minerals, antioxidants, and fiber.  To stay between 10g and 20g, you can eat 2-5 servings of fruit per day depending on which fruit you choose.  Another reason people tend to avoid fruit is concern that the sugars in fruit will cause problems, but really, as long as your blood sugar levels are well regulated (which they will be if you eat fruit in moderation with meals), fruit shouldn’t be a problem.  It’s helpful to familiarize yourself with which fruits are lowest fructose and relatively low sugar (berries, citrus, melons) and which pack a fructose punch (apple family, tropical fruits).  Okay, so the low carb thing:  eating too low carb can be very hard on your thyroid and on your adrenal glands.  Clinical trials in rheumatoid arthritis patients following a ketogenic diet showed worsening of symptoms and increased cortisol (see this post).  Some people do great on very low carb diets (and it that’s you, you probably aren’t emailing me to find out why the autoimmune protocol isn’t working for you–if something is working for you, stick with it).

Eating large portions of a wide variety of vegetables is an important aspect of The Paleo Approach and the autoimmune protocol.  You may heal faster by increasing your vegetable intake.

There are certainly additional food sensitivities that might be complicating your particular situation, including:

  • FODMAP sensitivity (or a subset of FODMAPs like just sugar alcohols or just fructan fibers; see here)
  • Histamine sensitivity (see here)
  • Salicylate sensitivity (see here)
  • Sulfate sensitivity
  • Food intolerances or allergies

These are all discussed in the troubleshooting chapter of The Paleo Approach (along with a ton of other topics).  But, I think that all of these (unless explicitly diagnosed by a healthcare professional) shouldn’t be assumed, and certainly shouldn’t be where you start.  These are for troubleshooting, 3-4 months down the road.  And, I would far rather see you try digestive support supplements first (plant enzymes are particularly helpful for digestive issues associated with eating vegetables and fruit, and I recommend either Enriching Gifts or Thorne Research) before you start severely limiting your vegetable variety. (Other digestive support supplements are discussed in great detail in my book but also more generally on my autoimmune protocol page.)

Also important to note: other than food allergies, all of the above sensitivities are caused by a damaged gut and/or gut dysbiosis, meaning they should go away when your gut heals, your gut bacteria normalize and your immune system is properly regulated.  And including those foods in your diet, unless you have severe overt symptoms, may actually speed up your healing.  If you aren’t sure, you should be working through this with a qualified healthcare professional.

If you do have a real food sensitivity that does limit your vegetable intake, then it’s important to work even harder within your restrictions to increase variety.  You can do this by buying vegetables you aren’t familiar with when you see them in the store, shopping at Farmer’s Markets, natural/health food stores,  cultural grocery stores and by checking out your local garden center for what unusual vegetables might grow in your backyard, or in a pot on your patio or in your kitchen window (you’d be surprised!).

Even when extra restrictions due to sensitivities constrain your choices, you can still eat variety (you just have to work a little harder and be a little more creative to source it).

Also, even if your choices are limited, your portions should still be large.  Dr. Wahls’ 9 cups of vegetables per day (3 cups of greens, 3 cups colorful, and 3 cups cruciferous) has been shown to be therapeutic in clinical trials for multiple sclerosis (with gluten-free, dairy-free diets and no other diet changes).  I personally aim for this as a bare minimum.

I delved into all of these issues in great detail in The Paleo Approach (complete with tons of references, which I apologize for not including in this post), but I thought this topic was important to discuss here.  The important message is this: eating lots of veggies is an important part of the diet recommendations of The Paleo Approach and the autoimmune protocol.  The only veggies you should be avoiding are legumes and nightshades (unless you have a diagnosed sensitivity, intolerance or allergy to other vegetables or fruit).  It’s actually quite simply an important thing to do for health in general.  And, the more variety you eat the better.

Comments

this post is just what I needed. Thank you Sarah.
Concerning the fruit, I am thinking about adding some but was wondering if you (or any others that read this) have some recommendations besides the citrus fruits (grapefruits, limes etc.)

Berries tend to be the highest in antioxidants. Bananas, figs, apricots, grapes tend to be lower fructose (apricots are a FODMAP though because of polyols). Melons are awesome too (even watermelon which often gets a bad rap because of its high glycemic index, it actually has a low glycemic load).

Thanks for this post! I have been feeling like I can´t eat anything by doing exactly what you talked about….trying to combine scd gaps aip and low fodmap….AAAAHHH!!!! I am going to go an buy a bunch of veggies after work and dig in. It turns out that maybe AIP hasn´t been working as well as I hoped for my Crohn´s Disease because I had C-diff complicating things (thank god my Dr. finally decided to test me for it!) now with treatment and AIP I am hoping to get this all under control! Thanks so much for your help and I am counting down the days to get the book :)

While I recognize the value in the recommendations Wahl’s provides, am I the only one who can’t eat that much?? To eat 3 cups of veggies per meal (to get 9 cups per day) plus some protein (4 oz, I’m small) and fat is a TON of food! I have tried, and eating that much makes me ill. Should this amount be worked up to? How you do you make yourself eat MORE food? Thanks

Yes, it’s totally something to work toward gradually. I personally find it really easy to eat that much food (but remember I have a history of obesity and binge eating disorder!). Also, there’s other tricks, like braising spinach or kale. 3 cups raw becomes about 1/4 cup cooked, depending on the leaf, and that’s much easier to eat for a lot of people.

I have a question based on something that Tara said in the latest podcast. She mentioned yeast being an issue in her healing and said once she removed that component she healed much faster. She referenced grapes and berries as being problematic for som, and on Robb Wolfs latest podcast she also said vinegars and fermented foods were an issue. You didnt agree or disagree with this comment so I wanted to get your opinion. Can that be an issue for those of us with skin problems? I do eat strawberries, blueberries, ACV, kraut and coconut aminos.

Excellent post. I’m trying to create a plan for dealing with AIP and possible FODMAP sensitivity. Until I can read your new book, could you elaborate on how to approach this? Are there any previous posts covering this I missed?

It seems like a lot, but you don’t have to eat 9 cups of raw veggies. When you take3 cups of leafy greens and cook them, it turns into 1/4 cup. When you make a green juice or smoothie, you can easily get 2 or 3 cups there. In 1/4 cup cooked kale and spinach and a green smoothie, yyou’ve reached over 50% of your goal! It’s a good idea to just start slow and gradually introduce more veg if you’re not used to it!

I have been eating low carb for over a year now. First, on the Kaufman diet, and then SCD (when it became clear it was not a fungal infection but SIBO). Every time I try to introduce starchier foods, my stomach aches/reflux increase markedly. I haven’t noticed a pattern with FODMAPS. However, I am not a veggie-phobe, I just avoid the starchiest ones (potato, sweet potato, plantain). Do I need to worry about undermining my healing? Btw, I am on my 2nd course of Xifaxam for the SIBO.

I have been on AIP for 5 months. Paleo for 5 months before AIP. I get hives and loads of itchiness when I eat most fruits and veggies and/ or get horrible GI pain from cruciferous veggies. Would digestive enzymes help relieve these symptoms? I do have a doctor that is helping me. I have had treatment for h pylori, parasites, and ameba. I have corrected vitamin imbalance(vit d, methylcobalamin B12) . I take 40 billion in probiotics. And take 10,000 mg of L-glutamine. I would love to eat more veggies!!!!

It should help with the cruciferous… hives and itchiness sound like IgE reactions though, and it’s not as likely to help with that (at least until your gut has healed)

I agree that veggies are majorly imporyant. However my reasoning for avoiding leafy vegetables is because it agitates my ulcerative colitis. Most others I know with the feel the samenway

Hi Sarah, awesome post! My healing plateaued for months and only turned around after increasing offal and vegetable quantity and variety.
What are your thoughts on resistant starch? The AIP limits many soures of resistant starch (namely legumes/lentils, and rice) though more and more it is being shown as critical to building a healthy microbiome. Chris Kresser did a great podcast with Jeff Leach from the American Gut Project on the microbiome and resistant starch. (http://chriskresser.com/you-are-what-your-bacteria-eat-the-importance-of-feeding-your-microbiome-with-jeff-leach)

It’s interesting. I think the research is still very preliminary on resistant starch itself. It binds bile salts and cholesterol similarly to soluble fiber, so I think supplementing with large amounts could potentially lead to the same problems as supplementing with soluble fibers (discussed in the Fiber Manifesto linked from this article). There’s some interesting anti-inflammatory effects, but no one has looked at this head-to-head with other fiber types and all fiber is anti-inflammatory. It’s been shown to provide no benefit to cancer risk (whereas other fiber types have) but benefit in IBD (both soluble and insoluble do too). I think that the research showing insoluble fiber in general is very important (resistant starch is a type of insoluble fiber) and an essential corrective influence on the gut microbiome is very convincing. I just feel uncomfortable will all fiber supplements… as soon as you isolate one type of fiber, you preferentially feed certain types of bacteria. I think that especially when you’re talking about supplements geared at the microbiome, eating real whole foods is the safest strategy. The AIP includes many foods that have resistant starch though, like bananas, plantains, and all root vegetables.

Does it mean we should consume some chlorophyll every time we eat some animal products ? Should we eat vegetables or fruit together with every animal product we consume ? Does every vegetable and fruit contain enough chlorophyll ?
I consume some plant with antioxidants and fiber with every animal product I consume but I’m not sure if it’s necessary. Maybe eating them seperately is ok or with every animal product we should consume some plant with a high chlorophyll content…

I do try, but also don’t get too worried if I have a meal without something green on the side. You mainly find chlorophyll in the parts of plants that grow above ground. In fruit, many of the antioxidants are derived from chlorophyll and there’s no studies evaluating whether they act similarly (although I suspect they do).

Normally your articles have lots links to studies at the bottom but this one doesn’t. I didn’t really seem to be the focus of this article but I was wondering if you have any study links regarding the information you mentioned on the correlation between red meat and cancer disappearing once you include vegetables. I’d love to see those.

This is a great post! Sarah, can you please, please tell what to do if I can’t eat fish? I developed a reaction to it after supplementing with fish oil and now I am super sensitive to fish – other seafood is also a problem as it is often contaminated with fish. Is there anything else I can do to get the Omega 3′s besides eating grassfed beef?

Well, you could find a source of brain (scrambled brain is similar to scrambled eggs). Other than that, limiting poultry and trying to get mostly grass-fed and pasture-raised or wild beef, bison, lamb, pork, boar, venison, etc.

Thank you. Excellent article as usual. I do notice that if I eat too much fruit and/or treats, I can’t eat cruciferous anymore without digestion problems. Then I need to restrict for a few days (FODMAPS/sugar detox) and I can reintroduce all veggies. I see why my N.D. said this can take 1 to 2 to 3 (!!!) years for healing to occur. I also have to eat veggies for breakfast to get 9 cups in and I’ve slowly, but almost imperceptibly, started to crave and eat a lot more fish. I find I usually want it more than land animal meat these days. After 1 year I’m finally seeing my own patterns and needs and really embracing the organic flow of it (no pun).

Sarah – You briefly mentioned ALCAT testing and I imagine you go into that in more depth in your book I’m anxiously awaiting, but in the meantime…
As I wasn’t seeing improvement with my Raynaud’s, I went ahead and did the food sensitivity testing. The doctor tested me on my first visit (for just 100 foods) and after receiving the results, I read online false negatives are common. Wouldn’t you know I tested with ‘mild’ intolerance for beef, lamb and coconut?!?! Then I was told to follow this crazy rotation diet based on the foods I was not sensitive to and only had ONE leafy green vegetable! (I was surprised that many AIP avoidance foods came up as ‘okay’ including gluten, cow’s milk, eggs, nuts, bell peppers. Can I believe this?) I’m also underweight and with so few foods to choose from based on the testing, I shelled out more money to add more testing and hopefully more foods to choose from. Needless to say, between AIP and this rotation diet, I’m borderline schizophrenic! I thought I would just remove the ‘sensitive’ foods from my AIP diet and move forward. Admittedly, I’ve tried some of the foods like eggs and although I didn’t have stomach issues, I felt a dramatic change in my mood which had become very stable. I can’t say if it was the food or the anxiety over eating something I ‘shouldn’t’. SO, my question is, should I follow the rotation plan that only allows beef & lamb on the same day every four days or chuck it out the window and go back to my AIP roots removing the ‘moderate’ intolerances. I know a lot of people say Raynaud’s isn’t worth all this trouble but mine is bad. Kids are running around in shorts and t-shirts and I have thick gloves on and my hands are still frozen :(
Thanks for any insight! Can’t wait for Christmas and your book!!!

You could look into MRT (mediator release testing). It looks at the mediators released like histamine and cytokines that cause symptoms rather than IgG and is more accurate and sensitive compared to ALCAT. When they tested all these food sensitivity testing like ALCAT, they split up the same sample and got different results. MRT testing is much more accurate, and you work with a certified leap therapist on the diet. http://nowleap.com/

I’ll just chime in and mention that there’s no science supporting validity of MRT (but it is true that ALCAT has variability and results should be taken with a large grain of salt).

I want to say that a tablespoon of hemp seeds a day almost alleviated my too disproportionately cold hands, I keep using it but consider switching to borage oil when the hemp seeds sun out. What works must be the gamma-linolenic acid, it increases prostacyclins and they improve circulation in hands. This dose is close to the recommended supplement form dosage and very far from Robb Wolf’s general recommendations.

I’m looking forward to buy your book, Sarah. I have the feeling that it’s just what I need to customize the diet to my needs. So far, I’m only on the “standard” paleo diet (dairy free) and I really hope I don’t need the AIP.
I have a question for you: do you consider PCOS and/or endometriosis to be autoimmune?
Thank you.

No, but there’s clearly an immune component to those conditions, meaning that aspects of the AIP are still useful (most notably avoiding nightshades and increasing nutrient density).

I wouldn’t call myself veggiephobic persay, because I do eat vegetables at every meal, but I have been one of those who has tried to follow GAPS for the past year. While my symptoms are a little more manageable, currently I can only eat lean meat and a few vegetables (green beans, peeled zucchini/yellow squash, and winter squash–the last in limited quantities). Any attempts to increase fat, fiber intake, sugar (like with fruit or winter squash) causes me a lot of bloating, stomach pain, and a worsening in my already present constipation. I have tried using digestive enzymes, which seem to help only slightly with digesting the vegetables listed previously, ox bile for fat (which didn’t help at all and just caused extreme gas), and hcl (which seemed to just overload my stomach and not doing anything). I’ve also tried fermented veggies, building slowly but those caused me acid reflux too.

I have leaky gut, a lot of food allergies, gastroparesis, and what I suspect to be SIBO because of the gas, severe constipation, and inability to really eat anything without problems.

It’s already a given that I am buying your book. It’s on Pinterest Christmas 2013 board! But I was wondering if you had any other suggestions that I could try until then. I’m going to be seeing yet another doctor next week who hopefully will have some more insight, but I feel like a lost cause. Thanks.

I may have missed it but don’t see where you addressed folks with IC, that is a very limiting diet, as is the kidney stone diet. I have found that eating small amounts of some of the “forbidden” vegies with other foods works for me. I think you have to listen to your body for sure. IC is so painful I am careful with things that flare that up. It can be daunting to sort this all out and figure out what is really OK to eat. I appreciate this article.

Check out my info on the autoimmune protocol and the fiber series (there’s also some info about the kidney stone diet in my recent almond flour versus coconut flour rebuttal post).

Hello – I just wanted to say thank you very much for your website and all the information you provide, which you have really explained in a way that I can understand. I have Psoriasis and hoping to implement AIP very soon, but in the last year or so I have been reading as much as I can, and I have to say your website is just outstanding.
I just had a question about this article – is it okay to get these “9 cups of veggies” from juicing? It wasn’t addressed whether these 9 cups have to be raw, uncooked vegetables (salads) or is it okay if the majority is cooked? Thanks.

Cooked or raw are both good, and ideally you should get a mix. Many of the benefits of vegetables comes from the fiber in them, which you lose when you juice, so a smoothie would be better.

Great stuff here.. Now I have new ammo to when I force my kids to eat the veggies that I drop on their plate each evening!!

As for me, I didn’t eat veggies at all as a kid, but have learned to love them. These days, I am even sure to have a side of veggies with my breakfast. I can just tell a major difference in my energy levels and overall health on days that I don’t get my veggie servings.

I’ve twiced the amount of the raw and mostly cruciferous vegetable salad I eat everyday a while ago and I had mild digestive pain from it before but today I’ve had just too much digestive pain to go on the same way. I’m almost sure cooking would make it much easier to digest but are there other ways to be able to eat it without problem ? What about pulverizing it ? What about using probiotics or prebiotics or fermenting it ? Fermenting without dairy ? Fermenting with only salt and water ? Any other way ?

How can this be causing the pain ?

Fermentation does make vegetables much easier to digest (you can do wild fermentation with just unrefined salt or salt and water), and many people do find that blending with a high powered blender into a smoothie helps (although some others find it’s even worse, so caution is advised). Have you tried plant enzymes?

I am new to the whole Paleo way of eating and found it really hard to cook when I first started. Things are getting easier now and I’m really feeling more energized and healthy. I’ve started eating different seeds in smoothies to get my omegas and a serving of fruit in the morning. It’s a great way to start my busy day! I like to use flax seed, hemp seed, and chia seeds. I recommend this to every mother that has a busy day ahead of her. In my search to make my life a little easier I also found a Paleo cookbook with 1000 different recipes. This cookbook has made it so much easier to feed my family and I during our busy life. I will leave the link to this amazing cookbook I have found just click on my name. I hope this helps someone I know I could’ve used this when I first started.

Have you talked any about your binge eating disorder on your website? If so where can I look for it? I’m interested in learning about how you helped that problem.

Thank you for the great post, Sarah! This is exactly what I needed! I had previously pre-ordered your book. Then, upon finding out that this isn’t a recipe book, I cancelled my order. I’m about to order this book (again!). Thanks for debunking these myths. I guess moderation is, as always, the key. I’m looking forward to reading all of the well-researched and balanced information. I guess I’m guilty of over-thinking the Paleo diet.

I had an ALCAT done last year and attempted to follow it for about two months before I gave up. My heart wasn’t in it because there were so many mixed reviews about it online. What I have noticed as I gear up to do the AIP, is that several of the same foods that are restricted on the AIP are on my ALCAT intolerance sheet. But MANY more restricted foods are on the ALCAT. My question is, should I attempt to combine the two programs? AIP says I can have squash and sweet potatoes which are not allowed on ALCAT for example. Dairy is allowed but not on AIP. I overwhelmed thinking of everything that I cannot have, but I’m not getting better and I’m wondering if I missed the boat on ALCAT and should have stuck with it. I’m starting AIP as soon as I’m finished reading your book this weekend.

Sarah recommends starting with the AIP first, and only making additional restrictions if it does not yield results and you strongly suspect you are sensitive to additional foods. – Christina, Sarah’s assistant

Your timing is impeccable! I have been struggling with this very issue lately and feeling so confused about what I should and shouldn’t eat. Thank you!

I read it until you say that cruciferous arn’t goitrogenic. You just can’t say that what i sproved scientifically and in practice is a lie. You lie by disregarding scince !

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