Response from Laura Schoenfeld:
That’s a really good question. I would say that that is pretty … it’s going to be individual, depending on the patient. Some people really like that whole 30-day reset, 30-day committing to major lifestyle changes. There are a lot of things like the Whole30, there are 30-day fitness challenges, there are 30-day meditation challenges, there are lots of things where people commit to behavioral change, and it tends to be like a major lifestyle overhaul. Sometimes it’s 30 days, sometimes it’s three weeks, sometimes it’s three months—however long it is. Some people really do well when they have some kind of challenge mentality. It’s one of these things that … sticking to something for 30 days seems a lot more doable than if you say, “Oh, I want you to do a Paleo diet and do it for the rest of your life. Just go!” You know? If you have something that’s like, “Just do it for 30 days to see how it goes,” I feel like anyone can stick to anything for 30 days, so there is some level of more commitment, and there’s more motivation sometimes with a massive overhaul like that.
Now, on the flipside, I will say that there are a lot of people that can’t handle that level of change all at once. Some people like to make small changes, choose a couple of things to focus on. If you’re working with a patient that’s coming from, like, Standard American Diet, has no idea what Paleo is, is just starting from scratch, there may be a few things that you want to focus on first. There’s some level of on-ramping that Chris talks about in his book. He talks about in just a 30-day reset in general, spending a couple of weeks preparing and not just diving straight into it. The 14Four has a two-week on-ramp, so there’s some level of changes that happen during that two weeks to get ready for the two-week challenge.
Some people really do better if they just pick a couple of things to focus on. So maybe you have a patient that, again, is eating a normal American diet and you want to get them moving towards a Paleo approach, but doing it in an overhaul fashion for that particular patient might be a little bit too challenging. You might just want to pick a handful of things that you think are the most important changes for them to focus on. Maybe that’s just that they go gluten free for 30 days. Even for some people, getting rid of things like bread or pasta just sounds incredibly challenging, and that would be hard enough for them to do, whereas if they went straight Paleo, they’d have to get rid of dairy, they’d have to get rid of legumes, they’d have to get rid of soy, they’d have to really massively change their diet. But if you just say, “Listen. Just get rid of gluten for 30 days. Let’s see what happens,” it gives them the chance to kind of ease into things a little bit more and just focus on one more important thing.
Like, if they have an autoimmune disease or if you are suspecting that maybe they have celiac disease but there’s no positive test that you can go on, just doing something simple like that could potentially get them really good benefits that not only would be easier for them to stick to, but it would also give them some level of improvement that would start to build their motivation, and then maybe after that 30 days they’d feel more comfortable getting rid of dairy products or whatever you think is appropriate for them to be removing.
I know that’s kind of not a straight answer necessarily, but when it comes to individual patients, I think knowing the patient and trying to identify what you think their style of change is, if you think they’d be really into just doing a full-on 30-day reset challenge where they eliminate all the things that are on the list and just go for it or if you think they’d be better off picking a couple of things that maybe are a little bit more relevant to their health issues. And there may be things that aren’t diet related. I mean, some of my patients’ issues are really centered around things like stress, not exercising enough, certain things that don’t have to do with diet that you might even get better results if you focused on that as opposed to doing this massive lifestyle overhaul.
Hopefully that helps. Like I said, it’s really going to be individual to the patient. The way that I work with patients, the way that Kelsey Marksteiner works with patients, we spend a lot of time in the first session talking to the person a lot, and we try to figure that out in the beginning to see if we can sort of make a decision clinically if we think that this person is going to do better with a few small changes versus a lifestyle overhaul. You don’t always get it right. Sometimes you assume someone is able to do something, and then they come back to you in three weeks or something and they’re like, “I wasn’t able to do it.” You might change the goal at that point. You might refocus to something that they can do. It might just be that they’re having trouble and they need more resources to help guide them, but generally, I like to start with smaller changes, focusing on things that are more important, and if they have the motivation and ability to make bigger changes, then we’ll add a few on in follow-up appointments.