Dietary Advice as a Toolbox
Diet can both make you sick and make you well. Hopefully that is not a controversial position.
For certain conditions, dietary guidelines that deviate widely from the usual recommendations are not only common but well-established and recommended. Metabolic state in which the body burns fat rather than glucose for fuel. Characterised by a measurable level of ketone bodies in the blood. → more nutrition, for example, has a remarkably positive effect on epilepsy in many cases - better than all known medications or medical procedures.
For nearly everyone else, though, the direction is predominantly one: there is exactly one flavor of dietary recommendations, and if you want to get (or stay) healthy, there is only one answer: More of the same.
In another article here I have already explained that the dietary guidelines of the Deutsche Gesellschaft für Ernährung - German Nutritional Society, a largely government funded NGO, designated as appointed authority on nutritional matters are made exclusively for healthy people in a specific age group with a specific dietary pattern - yet these guidelines are applied more or less to every nutrition-related situation. And this despite the fact that they are explicitly not intended for sick people.
As I noted: only 30% of the DGE’s dietary guidelines concern the (unspecified) reduction of disease burden - never their minimization or elimination, let alone health itself.
And yet there are plenty of alternative dietary approaches that are rarely even brought up - for example, because patients are assumed to lack the willpower, because the options are simply unknown, or because they are not part of standard treatment protocols - even though many others have had very good results with them.
Craftsmanship
I like to compare this to a toolbox stocked with a lot of tools - most of them still in their original packaging, untouched, while only the hammer gets regular use. Fittingly, the hammer is a tool that always has some effect (1)
In any skilled trade, the standard approach before a repair is to take a close look at what is actually broken - and then choose the right tool for the job at hand. No tradesperson would show up to a job with nothing but a hammer.
Maslow (et al)
The principle behind this is actually well known under its own name, as the Law of the Instrument (also “Maslow’s Hammer”) (2):
If your only tool is a hammer, you see a nail in every problem
Real Alternatives, Different Tools
But there are organisations that have recognised there are often more suitable tools than the hammer, and that publish the corresponding studies and case reports. Ketogenic nutrition in particular has by now been successfully applied to a great many further conditions and symptoms. And there is hardly a dietary approach further removed from current guidelines.
It is no surprise that this kind of research is done on limited budgets: there is no large revenue stream in nutrition that can be tapped the way it can with pharmaceuticals. Study sizes will rarely match those seen in drug trials.
But from those impressive lists alone - covering a large share of the most common non-communicable “lifestyle diseases” - it is clear that there are genuinely promising approaches worth picking up other tools for, at least on a trial basis.
Everyone has to eat, whether sick or well. I think it is important to inform patients that others have already helped themselves significantly through dietary changes - and those familiar with the examples from these two organisations know that we are not only talking about mere partial symptom relief, but about freedom from symptoms in conditions conventionally considered chronic and progressive and partially untreatable.
Whether patients then manage to stick with it is up to them. I suspect that the prospect of a life free of both medication and symptoms (!) is worth at least an attempt for more than a few people.
Conclusion
It turns out: the problem is far from always being just a nail. Adapting from Maslow and the various other attributed authors of the Law of the Instrument:
If all you have is a hammer, make sure that your problem isn’t a thumb
