A well-presented man in his late 30s came to the clinic. He was very troubled, as for the last two to three years he was increasingly suffering from bad breath. The smell was noticeable, his friends were commenting on it and it was adversely affecting his personal relationships.
He had read that it might be related to teeth problems, so he had been checked out thoroughly by his dentist, who had determined there were no problems with his teeth although the dentist had noted the bad breath. This gentleman was practising good oral hygiene, cleaning his teeth regularly and scraping his tongue daily — the coating was thick.
On further questioning he had been having increasing digestive problems, was craving carbohydrates and had chronic sinusitis. He had been trying to manage his diet by focusing on high-protein foods but felt he was not digesting these very well, generating recurring symptoms of reflux and heartburn after eating, as well as wind, bloating and constipation. He was also feeling increasingly tired and depressed. He had been to see his GP who had recommended PPIs (protein pump inhibitors) for his reflux and antidepressant medication for his mental state. As he was not totally in favour of long-term medication, he was exploring non-pharmaceutical options first.
He was taking vitamin C and a B vitamin supplement regularly as these helped with energy.
He had never been a big meat eater, but about three years ago he became interested in the keto diet for weight loss, and these days his diet focused mainly on animal foods, eating eggs for breakfast, processed meats and cheeses for lunch and usually meat or chicken for dinner. He was eating some vegetables such as carrots, broccoli and peas and occasional salads with tomato and lettuce with these meals, but small amounts. But because he was craving carbohydrates so strongly he was also snacking daily on biscuits with cheese, cakes, chocolate and dried fruit.
Interestingly, he belonged to the type A blood group, which is more suited to vegetarian diets and can have trouble digesting large amounts of animal foods. While keto diets suit some people very well, they are not as useful in the long term for those with type A blood. This diet had helped him lose 20 kilos in weight, which was positive, but his health was suffering as a result, and on discussion we determined that his symptoms of bad breath and lack of energy had gradually deteriorated along with increasing digestive issues since commencing this diet.
Making changes
My first suggestion was to rebalance his diet, significantly increasing the vegetable component and lowering the animal proteins. This was done over a period of time as we were trying to avoid a rebound effect from suddenly stopping the keto-style diet, despite the snacks he had been consuming to relieve his cravings for carbs.
General dietary suggestions were eggs and salad for breakfast, unfarmed fish and vegetables for lunch and a small piece of free-range chicken and vegetable stir-fry for example for dinner. He could have this with a small amount of basmati rice. Bitter foods are excellent to improve digestion and liver function, so we added rocket, chicory, radicchio and other bitter greens to his salads, which he quite enjoyed as he felt better after eating them regularly.
I suggested bone broth from organic and fish carcasses and vegetable soups. Chickpeas, organic tofu and other well-cooked legumes make good alternative meals, and I supplied various recipes. I recommended snacks of raw or activated nuts, especially walnuts, Brazil nuts and almonds with a couple of dried figs. If he craved chocolate, I allowed a couple of squares of dark chocolate at 70–85 per cent cacao.
Ensuring he was well hydrated with filtered and alkaline water was also important, minimising drinking with meals. I also suggested green tea for a hot drink.
As he was having difficulty digesting protein foods, indicated by the symptoms of reflux, which is a further indication of gut wall inflammation, I suggested that he initially take two protein-digesting enzyme tablets at the end of each protein meal; this was later dropped to one tablet when his symptoms improved. It was important that he took specifically protein-digesting enzymes, not the general broad-spectrum digestive enzymes which are more easily obtained. These made a huge difference in reducing his symptoms of reflux, wind, bloating and constipation. There was also a noticeable improvement in his breath which cheered him up, and the coating on his tongue decreased.
Re-establishing the correct gut microbiome was important, so I suggested a small bowl daily of organic coconut kefir mixed with prebiotics such as slippery elm to repair gut lining and organic berries for antioxidants. He could also add the nuts to this as an alternative breakfast. The bone broth also helped with digestion and elimination.
Despite it being difficult initially to let go of the keto diet, over a few months this gentleman found this regime made a big difference to his overall health. The bad taste in his mouth and his bad breath, which was his main problem, all but disappeared. His digestion improved dramatically with the enzymes and was sustained with the diet, his sinuses cleared and his energy improved. He was also enjoying his meals much more and felt he was getting the nutrients he needed from his food again. Overall he was much happier and very pleased with the outcome.
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