Managing a High Protein Diet
One of the most common clinical presentations in today's clinic is patients following a high protein diet. It seems that every year a new version of a high protein diet appears promising weight loss and physical transformation. In this article, we will examine effective ways to manage a patient following a high protein diet via TCM pattern differentiation and ameliorate potential side effects which some patients may experience following this diet. We will also discuss some important nutritional supplements which can improve digestion in a high protein diet and help patients avoid any secondary gastric irritation which may occur while transitioning to such a diet.
From a TCM perspective, we always want to assess the health and vitality of the Spleen Qi and Liver Qi in patients who are following a high protein diet. We want to be sure that the Spleen Qi is strong and can work in a synergistic fashion with the stomach to receive, digest, transform and distribute food substances and also work in harmony with the Qi mechanism to prevent any type of stagnation. If the Liver and Spleen are working in harmony, then most of the potential complications of consuming large amounts of protein can be avoided. The main TCM formulas which can be used to harmonize the Spleen/Liver dynamic are Xiao Yao San, Si Ni San, Xiao Chai Hu Tang and Bu Zhong Yi Qi Tang. Each one of these standard formulas can be modified ad infinitum to address individual patient's needs and can easily be used on a fairly long-term basis in order to keep the Spleen/Liver working in harmony.
If the Spleen and Liver are not working in harmony, the most common patterns which typically appear are Damp Heat, Phlegm, Depressive Heat, Food Stagnation and Blood Stasis. These are just the most basic typical patterns and we should always keep in mind that in good clinical medicine, nothing is typical or "standard" and patients can always present with much more complex pattern presentations.
However, if one can grasp the pathological mechanisms of the aforementioned patterns, it will be all the more simple to solve any unique pattern combinations which may appear as a result of a high protein diet. The following TCM formulas are some important ones to study to target these potential pattern complications which arise from Spleen/Liver disharmony: Wu Ling San, Wu Pi San, Ping Wei San, Huo Xiang Zheng Qi San, Ban Xia Hou Po Tang, San Ren Tang, Yin Chen Hao Tang, Ba Zheng San, Er Miao San, Er Chen Tang, Xiao Luo Wan, Ban Xia Bai Zhu Tian Ma Tang, Qing qi Hua Tan Wan, Wen Dan Tang, Jia Wei Xiao Yao Wan, Yue Ju Wan, Bao He Wan, Wu Mei Wan, Xue Fu Zhu Yu Tang, Bu Yang Huan Wu Tang. This list is far from exhaustive and the clinician should modify or combine as needed to address each patient's specific needs. The formulas Yue Ju Wan and Bao He Wan are particularly important as the issue of the "five stagnations" of Qi, Blood, Damp, Phlegm, Heat and Food are all common complications of a high protein diet and Yu Ju Wan can be modified to address these issues and works wonderfully in combination with Bao He Wan to avoid potential gastric issues. In cases of the "five stagnations," I also use a good quality bitters formula which can be used short term to help clear the stagnations and strengthen the digestion. I typically avoid using bitters which contain stimulant laxatives as this can often injure the Spleen mechanism which should be strengthened in cases of stagnation.
Outside of the use of TCM medicinals, there are some important nutritional supplements which can be used to strengthen digestion. The most common ones to consider initially are assessing the HCL secretion of the patient to be sure their digestion is strong enough to start the important initial digestion process of protein.
If the patient is experiencing gas, bloating and belching after starting a high protein diet, it's very important to evaluate if they may need supplementation with Betaine HCL (hydrochloric acid). It's best to start out with a small dose of 100-200mg taken with meals and then access if symptoms improve. I typically prefer to use balanced herbal bitters to improve HCL secretion however, in some cases, the use of HCL supplements can be extremely useful. It's important to have patients take this with meals and when symptoms improve, the patient can typically start to lower the dose and eventually stop supplementation. Digestive enzymes can also be used in cases of gas and bloating and can be sourced from vegetarian or animal sources to suit the needs of each unique patient. These enzymes are typically taken with meals as needed. I typically prefer to use TCM medicinals to boost the Spleen Qi over enzymes however, in many cases, enzymes provide quick relief and the patient can use them concurrently with Spleen tonics without any concerns. It is also important to assess whether the patient needs probiotic supplementation as well in cases of gas, belching or bloating, particularly if the patient has experienced long term gastric issues or use of antibiotics.
One of the most common side effects of a high protein diet besides potential gas and bloating is constipation. This is actually the most common issue of a high protein diet which I encounter in clinical practice. In these cases, it is important to evaluate the fiber intake of patients and be sure they are consuming enough vegetables in cases where the patient is avoiding whole grains.
I typically have patients who are experiencing constipation on a high protein diet to consume 3 to 4 organic apples daily in conjunction with a quality probiotic. This approach typically resolves with complication of constipation and is particularly germane in cases in which the patient is following a "paleo" diet and is avoiding whole grains. In some cases, the patient may not be consuming enough oil and is experiencing constipation due to dry stool; in these cases the simple addition of fish oil, flax oil, hemp oil or olive oil along with the aforementioned protocol typically resolves the issues with two weeks.
In cases where constipation is coupled with excess flatulence, enteric coated peppermint pills can be used along with appropriate fiber/probiotic use to aggressively resolve the gastric complications. In some cases, I recommend the use of Magnesium Citrate to help move sluggish bowels, however it is important to asses if the patient is truly consuming enough fiber before one turns to supplements to stimulate bowel movements.
I hope some of these simple suggestion help stimulate clinicians to explore and research potential ways to manage patients following a high protein diet. Acupuncture is also an extremely effective choice for targeting all the complications we discussed in this short article and should always be integrated into the clinical protocol when patients are open to this option.