Is your loved one a picky eater?

Perhaps your picky eater is histamine intolerant?

Last month, I wrote a piece about a topic that is always popular on social media, the so-called “leaky gut” in autistic people. It was an extension of a talk that I usually end up having with families of newly diagnosed autistic people. In separating facts from fiction, and marketing hype, the usual question becomes - so what does a meal plan look like? I share some possible plans, then the conversation turns again to another hot button topic in autistic spaces - the “picky eater.” Parents often worry that their “selective eater” isn’t getting the proper nutrition on a daily basis. They want to know what to do about “the problem.”

Here’s where the conversation gets difficult. You see, most of what you think you know about how to fuel the human body is marketing hype. Fats are “bad?” Sugar is “OK in moderation?” Some celebrity or another lost 10 kgs on some “miracle diet?” It’s all hype. When you drill down, some special interest paid for studies - the studies that are cited in whatever you’re reading. So what is the truth? How are we supposed to separate fact from fiction?

First, a bit of disclaimer. Among the many certifications that I hold, I am a Certified Exercise Nutrition Coach under Precision Nutrition in Toronto, Ont. It’s part of a suite of certifications around my athletic coaching practice (USATF Level 1 Track / Field Coach, NFHS Accredited / Certified Coach, Systema Instructor under RMA HQ …). For purposes of this article, I am not offering medical advice. I will only present what I do within my own life and coaching practice as well as the science behind my decisions. I am not a medical doctor or a nutritionist as defined anywhere in North America. Thus, do your own homework to verify what I will present to you below. If you need more research help beyond the offered links, drop a note in the discussion below. Also, as someone whose original diagnoses centred around sensory issues, I was / am a “selective eater.” So, I understand a bit of the why around being picky with the foods that I eat.

OK. That’s out of the way, let’s begin.

Most people think that the body deals with energy from foods in a specific order. The common analogy is that carbs are fast burning twigs or paper, protein is a log, and fat is long burning coal, and that you have to burn through them in order. They seem to suggest that you only get to fat burning when you first burn through carbs and protein. This is fundamentally and actually comically wrong. But, it’s out there. Where do people get such ideas? The media, of course.

It’s important to note before going forward that on average, medical students receive 23.9 contact hours of nutrition instruction during medical school (range: 2–70 hours). Only 40 schools in the US required the minimum 25 hours recommended by the National Academy of Sciences (source). Thus, it’s highly likely that your general practitioner might not be the most accurate in guiding you to proper nutritional health. If you want a bit of a laugh, ask them about their nutritional training. I’ve found the replies that I’ve received to be a fascinating array of obfuscations.

Nevertheless, when things go wrong, for whatever reason, people consult Dr. Google, and will find sites like 5 Diets that are Supported by Science over at Healthline.com. There, you will find the low-carb whole-food diet, the mediterranean diet, the paleo diet, the Vegan diet, and the gluten-free diet. They give you the helpful advice that whilst many diets may work for you, the key is finding one you like and can stick to in the long run. Indeed, my HMO’s doctors have recommended all of these when my system was malfunctioning. None of these worked. A few of them made matters worse for me. Parents, upon their initial consult with Dr. Google, try to convince their child to pick one of those five. They may even be using one of those themselves, trying to model the behaviour in the hopes that their child will follow their lead. It doesn’t usually work.

When people find me and my work at The Abbey, they’re often at the end of their rope. They’ve tried it all. Often, they’re worse off (as I was). They start asking friends, and get referred to us. Here’s what I share in our initial talk.

I have sensory issues. I've had them my whole life. Sensory issues can impact bodily functions like digestion. In my case, I've spent most of my life trying to figure out why I seemed to always feel sick and tired. I've spent almost a half a century feeling sick and tired of being sick and tired.

I've had endoscopies. I've had radiological studies. I've had all sorts of pills. I've had all sorts of nutritional advice. I've been fat, sick, and nearly dead. When a pill's side effects are too much to bear, often another pill was prescribed. There were side effects upon side effects.

But, I'm autistic. I'm non-verbal. It has been very difficult communicating just what level of suck I was feeling about a particular pill or diagnostic test. After about a half-million dollars of work, I was done with it all. I was finally in a position in life to be able to change insurance plans from an HMO to a PPO, and thus be able to have more control over my journey to health. This is when I found the right doctor.

I found a clinical nutritionist who understood the autistic body and brain as designed. I was examined from that standpoint. After a few sessions and a few rather non-invasive tests, I discovered that I am histamine intolerant - the root of all of my discomfort and pain. Though science still doesn’t understand precisely why, histamine containing foods can cause inflammation in the body. In my body, it was like having a truck with a flame thrower moving it's way down my digestive path. I was given a new diet to follow - time restricted (to manage my energy / hormone levels and thus sleep better), high-fat / low-carb (to run my body as designed), histamine free diet. Within a few days, I was pain free. Within a few weeks, I was medication free. Within a few months, I had dropped some of the weight that I gained from being on a lot of medication. Now, more than three years later, I have lost all of the extra weight that I gained through my journey with western medicine and weigh about what I weighed at my high school graduation. I feel great - which is the most important.

I share my story with clients in order to begin a conversation about nutrition health. I've been told by doctors to be gluten-free, vegetarian, vegan, and all sorts of other "healthy" options. They all didn't work. Why? Because, again, most doctors have less than 30 hours of nutritional education and are reading from some pamphlet that was sponsored by a group with a financial interest in keeping us in the doctor's office. It turns out that histamine intolerance is actually quite common in people who are from families with less than 5 generations living in western societies, eating western foods. It's also common in people with Rh negative blood types. Having a high level of sensitivity, like sensory processing issues, is also a contributing factor. Thus, it's no wonder I was having problems. All three describe me.

So, what did I do? How and what do I eat? Great questions, but first - how many calories do I need each day to fuel my very large body (remember, I’m still an athlete and a coach)? After all, before planning a day’s meals, we need to know the target in terms of energy requirement.

Your caloric need (kcal in) is based entirely upon your total daily energy expenditure (TDEE) (kcal out). TDEE is the number of calories you burn throughout a 24-hour period. These calories come from the work your body does to keep you alive, including your brain functions, breathing, digestion, and so on as well as all of your physical activity. Overall, TDEE includes everything from fidgeting to your exercise routine.

All of the work your body does at rest is called your resting energy expenditure (REE) or basal metabolic rate (BMR). This component (your BMR) of your TDEE makes up approximately 60% to 70% of the average person's total expenditure. Your non-resting energy expenditure (NREE) is a mix of three components which include non-exercise thermogenesis (NEAT), thermic effect of food (TEF), and exercise activity thermogenesis (EAT).

Here’s a handy TDEE calculator. It’s the one I use to calculate my macros and TDEE.

But wait, I thought that most people should eat about 1200 calories per day from a healthy mix of foods. Isn’t that right? Wrong. 1200 kcal is barely enough. It’s considered the floor to sustain one’s life. It’s certainly not the average or the max. For me, this calculator says that I should have 3525 kcal per day to maintain my weight. My favourite TDEE calculator says 3533 kcal / day should do the trick. With this in mind, I now have to plan the foods that will make up my daily meal plan.

Protein / Carbs = 4kcal / g | Fat = 9kcal / g

(Note: if you’re changing diet for the purposes of weight loss, read this on why “calories in = calories out” is not true)

The minimum TDEE for me is 3000 calories. The macros look like this:

Notice that only the fats were adjusted. The protein and carbs are the same.

I’m guessing that you’re wondering why I’m eating so much fat and so little carbs. Remember, I noted that I’m use a high fat / low carb method. Some people ask if what I’m doing considered a “keto” diet. My answer: yes and no.

Remember, doctors are generally shying away from “keto” diets. They’re suggesting plans like the low-carb whole-food diet, the mediterranean diet, the paleo diet, the Vegan diet, and the gluten-free diet. But, hidden within each of these diets are foods that are histamine-rich. For example, one of the most histamine-rich foods is avocado. So is spinach. But, when people are examining those five meal plans recommended as “healthy,” you’ll find avocado listed as a “healthy fat” and spinach listed as a “healthy” leafy green vegetable. If it’s healthy, why does it make you feel so bad.

In fact, being histamine free is tricky. How do I get proper nutrition and over 3000 kcals / day when so many “healthy” foods trigger a histamine response in my body?

For me, my basic building block is good old butter. I end up consuming about a stick of butter per day in various way. I also eat six eggs per day. I either boil them or fry them up in butter. My carbs generally come from a small mix of almonds and walnuts. For my protein, I like baked chicken. Oh, and I need to supplement electrolytes.

How does this all work together? In the morning (03:30), I have a 750ml glass of water with a dash of lemon juice and 6 grams of salt (one US teaspoon). Next (05:00), I make a tea of turmeric and butter - about half a stick. I drink this with my almonds and walnuts. That’s breakfast.

For a snack (08:00), I have two slices of Havarti cheese. I like the texture, flavour, and the higher fat content.

For lunch (10:30), I have 6 eggs and two slices of Havarti cheese cooked in about a quarter stick of butter. I add pepper and about 6g of salt.

For dinner (12:00), I have about 225g of baked chicken breast. I add pepper and about 6g of salt.

The timing of my eating has to do with managing my energy, not with my histamine intolerance. I do the time restriction so that my autistic brain runs out of energy by about 20:00 each night.

I supplement with vitamins / minerals to make sure I get what I need.

And … that’s it.

It’s boring and repetitive. I’ll grant that. It took about three months to break the psychological addiction to sugars. That was rough. But, in my following an elimination protocol, this is what I came up with. So I stuck with it. When you go through an elimination protocol, you may find that you can tolerate a wider variety of foods. If you can, great. I can’t, unfortunately.

For adults reading this, you’ll notice that this plan does not lend it self to social situations. What about dinner in the evenings, when it’s supposed to take place? Again, this is my plan. Offered as an example. If you don’t need / want to follow a time restriction regime, you can space your calorie consumption over whatever time frame best fits your lifestyle. You also likely noticed that I did not list acceptable adult beverages. They’re generally produce a pretty high histamine response in the body.

I have found that I can tolerate distilled spirits like Scotch, Vodka, and Gin, but not the more sugary ones like Rum and Tequila. Wine is out for me. So is beer. But, I have to be very careful with adult beverages as they are usually consumed later in the day. This is when there are fewer things in my system to absorb the alcohol. So, I find that my tolerance is considerably lower than it was when I was eating whatever / whenever I wanted.

Now, when you ask your medical doctor about switching to such a radical meal plan as mine, they’ll advise you to not be so extreme. They might note that eating so much animal fats is bad for you, that you’ll clog your pipes and have a heart attack not soon after beginning. Because everyone hates maths and stats, they don’t understand the difference between “risk” and “odds,” which often get conflated. “Risk” refers to the probability of occurrence of an event or outcome. Statistically, risk = chance of the outcome of interest/all possible outcomes. The term “odds” is often used instead of risk. “Odds” refers to the probability of occurrence of an event/probability of the event not occurring. At first glance, though these two concepts seem similar and interchangeable, there are important differences that dictate where the use of either of these is appropriate. Again, most people get this wrong. Here’s a good primer if you’d like more info.

My doctor predicted my early demise when he asked about my diet. I told him that I was working with a clinical nutritionist (CN). He didn’t seem to care. My CN monitored my labs, taken at regular intervals. All of my bad numbers trended down to normal. Within a year of being on my plan, all of my numbers were within the normal range. Yet, my LDL was “high.” This was to be expected. Sadly, the role of LDL cholesterol is misunderstood. There is currently no statistically significant study that proves an elevation in LDL-C resulting from the switch to ketogenesis will increase cardiovascular risks (source). This case study demonstrated how the manner in which lipid panels are often reported and reviewed can lead to misleading conclusions and highlighted that, at least in the care of those on a ketogenic diet, more nuanced analyses of lipid subfractionations should be conducted in order for physicians to provide optimal care and clinical recommendations.

Wait. What are lipid subfractionations? Essentially, cholesterol particles come in difference sizes. It turns out that LDL particles are not all created equal. Smaller, more tightly packed LDL has an easier time getting into arteries. Larger, fluffier particles may be less dangerous. Does your lipid panel differentiate the LDL count by particle size? Most health plans pay for the lower-cost cholesterol screening that gives the least amount of useful information. There are calls for this test to be retired.

As it turns out, I’ve got plenty of the good particles of cholesterol and very few of the bad particles floating around in my body. The more advanced tests clearly demonstrate this for me. Be sure to check your results, to monitor how your plan works for you. The point, however, “the experts” predicted my immediate death. Years later, my bloodwork is fine, I feel great, and I’m off all meds. A great outcome for me. A bad outcome for the pharma-industrial complex.

I hope that you find this information helpful. Histamine intolerance is notoriously hard to diagnose. Finding out that you are intolerant to histamines leads to some uncomfortable decisions relative to your preferred lifestyle. Yet, finding out that you or a loved one has this issue may be the key to the remediation of many behavioural issues. After all, it’s hard to be happy and on task when there’s a flame thrower moving down your digestive track.

Thank you for reading today and for your continued support. I invite you to join the conversation. Let me know if this was helpful, or if your experience was different in discovering how your system works.