It’s very unlikely you will be asked to give up your most loved habits. (Hello morning latte and treat-yourself croissant!)
As a general rule, I aim to limit restriction and allow maximal variety (in diet and lifestyle) as much as possible in my treatment plans, especially in diet and lifestyle, to:
allow for optimal quality of life
prevent nutrient deficiencies or difficulty obtaining sufficient calories
reduce higher costs associated with “special” diets
eliminate social isolation caused by dietary restriction
and prevent fear of foods and/or disordered nutritional habits or beliefs that can be more harmful than helpful in the long-run
In specific situations, caffeine or certain foods can be aggravating factors that are best reduced (and, rarely, avoided all-together); usually this is a temporary approach to obtain symptom control while more impactful and sustainable changes are implemented.
Examples of situations where temporary or permanent eliminations are indicated include:
Anxiety, insomnia, palpitations: If these symptoms are present and improve with caffeine reduction, consideration of continued reduction and/or a trial of strict elimination is warranted. However, for people who do not experience these symptoms or do not have an aggravation of these symptoms with caffeine, there is no strong evidence that caffeine should be reduced or eliminated.
Overactive bladder symptoms: Reducing caffeine intake can improve urgency and incontinence. There isn’t a clear consensus in the research as to an exact maximum intake, but limiting intake to no more than 100mg/day is recommended in some studies.
Pregnancy: Caffeine doesn’t need to be eliminated during pregnancy, but Health Canada suggests limiting caffeine consumption to 300mg/day (the amount in 500ml of drip coffee, 4 espresso shots, or 1.2L of strong tea) since increased caffeine consumption during pregnancy may be associated with higher rates of spontaneous abortion, and is associated with an increased risk of low birth weight and small for gestational age (SGA) babies. A dose-response relationship has been observed, where each 100 mg/day increment in maternal caffeine intake (about one cup of coffee) was associated with a 13% higher risk for low birth weight compared with very low or no caffeine intake.
Celiac disease: This is a unique situation in which strict and complete gluten elimination is required to allow for symptom management and prevention of negative health outcomes in this autoimmune condition which occurs in only 1% of Canadians.
Food allergy: Just like patients with Celiac disease, patients with a true, confirmed food allergy should strictly avoid that food in all forms.
IBS: In the short-term, a Low FODMAP diet can provide significant symptom relief for patients with IBS (which is up to 1 in 5 Canadians). This typically looks like a 3 week elimination of foods containing these poorly digestible carbohydrates (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) to reduce fermentation in the large intestine that contributes to many IBS symptoms. The temporary elimination is followed by a few weeks of strategic reintroduction under the guidance of a practitioner. Even if symptoms completely resolve while following the Low FODMAP diet, it’s too restrictive to be maintained in the long-term.
Lactose-intolerance: Patients who lack the enzyme lactase which allows the body to digest the lactose sugars found in dairy products are diagnosed (via breath test) with lactose intolerance. Limitation of dietary lactose by reducing higher lactose dairy products (eg. milk, fresh and soft cheeses (like ricotta, cottage cheese, and mozzarella), and ice cream) can help prevent the common and uncomfortable digestive symptoms of bloating, gas, abdominal pain, and loose stools.
In nearly all other cases, dietary or caffeine restriction is not indicated and will not be recommended. Cue sigh of relief.