Boil it Down (part of the Living With Dietary Restrictions Series)

Boil it Down (part of the Living With Dietary Restrictions Series)
Living with Dietary Restrictions: a.k.a. How to cope with a therapeutic diet.

This is one of the most common issues that surfaces for my patients: how to actually live, day in and day out, on a therapeutic diet. For so many of my patients, it seems like a dream to learn that some chronic, nagging health concern can be addressed simply by changing how they eat. Hallelujah! Until, that is, they realize how challenging it can be to adhere to their dietary prescription in many real-life situations. Allergens, blood sugar issues, detox, whatever…I speak from experience when I say that therapeutic diets can be tough! This series will share the best of what I’ve learned to help make your therapeutic diet a viable long-term option.

Tactic #1: Boil it down.

So you’re eight days out from your last visit with me. Let’s just say that in your workup for oh, let’s say migraines, we learned that you have a RAGING reaction to walnuts, garlic and apples, and it’s not looking so hot for you and dairy, either. Thank god it’s only 4 things! Amazingly, you haven’t had a headache since we figured this out, but now you’re out with your better half for date night. Perusing the menu, you realize that, even though the list of things you can’t eat is pretty short, it’s mental gymnastics to try to figure out what you can eat on the menu of this artisanal, farm-to-table place. The server comes over to ask if you have any questions about the menu; cut to you, frozen in deer-in-headlights position. Questions?! Where do you even start?

Here’s what NOT to do: tempting as it may be, do NOT inflict your overwhelm on this server. It’s the quickest way to convert your lovely evening out into the dining experience from hell. This is how you end up with a drawn out meal where you have to wait from some put-out member of the kitchen staff to come out and list every single ingredient in every single dish and ask if you’re allergic to every single one while your date passes out from hunger. It doesn’t have to be like that! I am definitely going to encourage you to feel OK making requests, including to talk to the chef if you need to. However, clear, simple communication is key for success when eating outside the house. Boil it down to the basics that you can reasonably anticipate to be relevant in that moment.

You’ll generally have the best experience if you don’t make a restaurant employee responsible for understanding the ins and outs of your medical care. They’re just trying to avoid a lawsuit, yo. So don’t come off like someone who would take them to court over a stray nut on a dinner plate. Do not barrage them with a panicky rundown of every detail of your health profile. It’s tedious, it’s boring, and it’s not their job. It’s yours.

Instead, do as much work as you can for yourself. Give the menu a thoughtful perusal. Pick out a few likely candidates you can eat without trouble. If you have dietary requirements that aren’t ubiquitous and aren’t usually stealth ingredients (like allergies to walnuts and apples in this case), I generally advise not to worry about them unless you’re ordering something that specifically might include them. You probably don’t have to worry about your steak coming out sprinkled with walnuts, or your black bean soup having apples snuck in. And if your food comes out and that does happen, it’s completely reasonable to send it back. It’s OK that you didn’t anticipate those culinary moves—you can explain that you didn’t think you’d have to worry about it. That’s not high maintenance, that’s just being human. 

Therapeutic diets that require avoidance of ubiquitous dietary maneuvers are a little trickier. If the issue is that you have an allergy to a commonly used ingredient, a great tactic is to (calmly, rationally) preface your order with something like “I can’t do dairy or garlic, so if you can just tell me if my choices are OK, that’d be great.” The person is so relieved not to have to spend fifteen minutes combing through the entire menu suggesting allergen-free foods, that often, even if you DID inadvertently choose something that has a butter-sauteed garlic finish, they’ll usually be happy to advocate on your behalf to the kitchen staff for an appropriate substitution or deletion.

If the server isn’t sure about your needs, try to anticipate the most common things a chef might do that wouldn’t work for you, rather than list every item on the planet you can’t eat. In the case of the dairy allergy, if you’re ordering salmon and the server isn’t sure, you can briefly elaborate that it wouldn’t work for you if it’s cooked in butter or has a cream sauce, but you can probably skip listing that cottage cheese and milk chocolate aren’t viable options for you. That’s just obnoxious, and tiring to the server. Remember, they’re there to help, they’re just not there to do double-backflips in menu redesign for you. 

The same tactic works if you’re some other kind of therapeutic diet. Let’s say you’re doing a low-glycemic diet. Again, just think in terms of clear, succinct communication. Be calm, and be sure the language you use is simple. In the end, it doesn’t matter if they understand the theory behind a low-glycemic diet, it just matters that you don’t get a plate full of rice, right? You can ask questions like “is the serving of mashed potatoes with this very large?” or “is the sauce on this pretty sweet?” or “I’m not eating a lot of carbs, so can I get sautéed veggies instead of rice?” or “is the chicken soup mostly chicken or mostly noodles?”

Keep your requests as tangible as possible. No restaurant that I know of requires servers to have a nutrition PhD in order to be hired. They usually do happen to have some dietary savvy just by virtue of working with food, but don’t expect them to know the ins and outs of your dietary prescription, and don’t be the obnoxious person who uses your encounter with them to “helpfully” educate them about it (unless they ask). Keep it simple, let them do their job, and keep the end result in mind. All you need is a meal you can eat. Don’t make it a production.


Photo courtesy of Vélocia.