Food for Thought: An Examination of Diet & Digestion

Even an acute poison can become an excellent drug if it is properly administered. On the other hand even a drug, if not properly administered, becomes an acute poison. — Charaka Samhita

In the above quote from the classical Ayurvedic medical text Charaka Samhita, the word "drug" can easily be changed to "food." One of the most common questions encountered in the clinical setting is, "What is the ideal healthy diet?" I personally do not believe there is a one single diet which is "the best" or "most healthy." A multitude of factors come into play when the concept of diet is considered—genetics, lifestyle, and cost, to name a few.

One of the key factors I target when asked this question is to evaluate the digestive capacity and digestive health of the patient. From a TCM perspective, this would be primarily the Spleen Qi / Yang (although many organs are involved) while from an Ayurvedic perspective this would be primarily the Agni. When patients ask me for the mythological perfect diet, I steer the conversation on to the topic of ideal digestion. An ideal diet is a diet that is digested well.

The Diet Craze

We can use the latest diet craze as an example. I see many patients who are now interested in trying, or are currently using a Keto themed style diet. The overall standard breakdown for such a diet is 70-80 percent of calories from healthy fats, 20-25 percent of calories from high-quality protein, and 5-10 percent of calories from fiber-rich carbohydrates. The subject of a Keto diet is a large topic and will note be covered here, however the basic nutritional structure of this diet can be used as an example of using digestive efficiency to determine the type of diet which may be best for a particular patient.

There are several standard ways to evaluate the health of the digestive system in Ayurveda and TCM, and these evaluations should be used with every patient's respective dietary approach. This is one of the most unique and important ways a TCM practitioner can help a patient above and beyond generic approaches to diet or to avoid falling prey to "diet cults" espousing a one-size-fits-all myopic approach.

The basic foundational ideas of TCM must not be forgotten, abandoned, or replaced by novel clinical "tricks." To quickly and effectively evaluate the health of the digestive system in both TCM and Ayurveda, the tongue must be examined closely for color, shape, and coating. I will use the Keto dietary paradigm as an example. As mentioned earlier, the strength and efficiency of the digestive system must always be examined when a patient begins a new diet or is considering implementing a new dietary approach. Most patients turn to a Keto diet in an attempt to lose weight quickly and are usually switching to the Keto diet from a high carbohydrate-based diet. We know from TCM that the strength and vitality of the Spleen plays a fundamental role in the metabolism and digestion of carbohydrates. The sweet taste can potentially strengthen the Spleen or damage the Spleen depending upon the quality and quantity of the source of the sweetness—keep in mind there is a large difference between a sweet potato and a soft drink when the health of the TCM Spleen is considered.

The Keto Diet

Most often, in my clinical experience, individuals who are turning to a Keto dietary approach are most often consuming large amounts of sugars and/or suffer from blood sugar issues. The attractiveness of the Keto diet is the promise of a lower carbohydrate diet correcting such blood sugar issues resulting in weight loss, hormonal balancing, and insulin regulation. However, for this to occur, the patient must be able to digest the larger amount of healthy fats and high-quality proteins.

In other words, the patient must possess strong Spleen Qi / Spleen Yang or Agni. To evaluate this, the tongue examination is crucial. Does the tongue have deep teeth-marks? Is the tongue body swollen? Is there a thick sticky coating on the tongue? Is the tongue body scarlet red? All of these factors should be considered when I patient is considering switching to a higher fat / higher protein diet.

If any of these issues are occurring with the tongue body / tongue coating, the clinician should council the patient on methods of foods, acupuncture, and herbal options to boost the Spleen Qi / Spleen Yang, clear Dampness, or clear Damp Heat and/or Liver Depression Qi Stagnation. This same evaluation of the tongue can be done as the patient follows the Keto dietary approach over a longer period of time as well.

If after weeks or months on the respective Keto diet, the patient's tongue begins to show teeth-marks, become swollen and/or have a sticky thick coating with a scarlet body, the patient should shift back to an easier to digest bland Spleen friendly diet. Attempting to treat these pattern presentations by herbal medicine or acupuncture alone are often not as effective as shifting the diet back to an easier to digest Spleen friendly diet. Clinicians can also use this approach for a patient on a higher carbohydrate diet as well. If the aforementioned tongue presentations appear on a higher carbohydrate diet, the clinician may counsel the patient to shift to a lower carbohydrate / higher protein diet until the tongue presentations shift back to a state of digestive balance.

Raw Foods

Clinicians can also use this method to evaluate patients following or considering following raw food diets. Raw foods can be very hard for the Spleen to digest and if any of the aforementioned tongue signs begin to appear in a patient on a raw food diet, the clinician should counsel the patient on an appropriate Spleen friendly diet shifting away from a raw foods diet until the tongue returned to a more normal presentation. By monitoring the health of the tongue before and during a significant dietary change, the clinician can help the patient avoid long-term problems or acute / future Spleen Qi issue.

We must remember in TCM that the Spleen is the root of a large array of health issues, acute and chronic. By monitoring the quality of the tongue body and tongue coating, the clinician can help the patient stay one step ahead of disease and discomfort and more effectively counsel patients nutritional questions while staying safely within the scope of practice for TCM practitioners.