Four Fís Diet
H. Hooshmand, M.D.
Pain: Reflex Sympathetic Dystrophy Prevention and Management
CRC Press, Boca
We devised this method of behavior
modification more than 10 years ago. This diet is not aimed at losing or gaining
weight. It excludes foods that are harmful to your health and aggravate chronic
pain (i.e., Five Cís: cookies, cakes, chocolate, cocktails and candy.
Other foods to avoid are internal organ meats such as Liver, sausage, and hot
dogs). It also emphasizes the intake of foods that help the inhibitory
nerve cells that suppress the pain input (4 Fís: Fresh fruit, fresh
vegetables, fish, and fowl).
By doing so, the patientís weight
normalizes itself automatically: overweight or underweight extremes normalize
close to the patients ideal weight.
1. Fresh Fruit - not canned.
2. Fresh vegetables - Olive oil is the
best cooking oil.
3. Fish - baked or broiled. Use fresh
lemon juice for flavor. Avoid the use of margarine.
4. Fowl - skinned! Not fried - baked,
roasted or grilled is fine. When you are in a hurry, try wrapping a boneless
breast with vegetables (i.e., onions and bell peppers) in aluminum foil and
baking - it is quick and easy.
Avoid the five Cís: cookies, cake,
chocolate, cocktails, and candy.
Foods to be avoided
Soft drinks with
Crisco and other shortenings (replace with olive oil)
Enriched white flour (bleached flour)
|All fried foods
||Bacon and any
packed in syrup
Foods allowed rarely or sparingly
No Coffee (may be replaced with ice
Pulp of potato (may fry in olive oil)
Foods that are allowed
|Diet drinks - no
caffeine, sugar, and low to no sodium
||Nuts - raw and
||Honey - natural
|All fresh fruits
yogurt - flavored has sugar - add your own fresh fruit
Natural fresh - squeezed orange juice and grapefruit juice
||Sweet potato with
|Apple juice - no
added sugar, natural
||Eggs - no more
than two / week
|Chicken and other
fowl - skinned
||Cereals - whole
grain, low sugar
|Lean roast beef (in moderation)
||Fruits - dried
||Drink 6-8 glasses
of water per day
Labels - read them! Be aware of the
word "carbohydrates." Frequently it is a euphemism for sugar. Be aware if the
ratio of fat to calories. Avoid high fat to calories ratios. Also, high
cholesterol and preservatives/chemicals (or flavorings) should be avoided. An
ingredients list that is very long and has many unrecognizable (unpronounceable)
words should also be avoided. Remember very low to no added salt.
Food preparation - Avoid adding
fats (oil, margarine, etc.) and salt during and after preparation. Try to
prepare in ways that do not require oil/fat - such as steam, back, broil, roast.
Definitely do not fry!!! (Olive oil is okay).
Salad Bars - The tendency to eat
free food results in excessive calories! Therefore, it is for this reason that
salad bars can be deceptive. They seem to be more of a high calorie/fat, all you
can eat buffet. When confronted with one, stick to the fresh fruits and
vegetables - avoid the desserts (i.e., puddings, cakes, etc.).
"Cheese is rich in cholesterol".
There are two types of cheese: sharp cheese rich in tyrosine is harmful to RSD
patients; mild cheese (e.g., mozarella, ricotta, muester) contains only 25-30 mg
cholesterol per serving (in contrast to liver, 375 mg, and kielbasa, 400 mg).
"Shell fish has too much cholesterol."
Shellfish contains HDL cholesterol, which is preventive against any form of
"Donít eat food before going to sleep."
Wrong: Donít consume red meat, coffee, or chocolate. Eating fruits and dairy
products before bedtime is quite helpful in chronic pain (such as RSD/CRPS).
Coffee should be avoided altogether in
patients suffering from RSD/CRPS; to consider coffee as a simple conveyor of
caffeine is naive.
1. Coffee has an acid-based oil that is
an irritant to gastric mucosa. It stimulates the secretion of gastric acidity.
Secondarily, the high gastric acidity results in secretion of adrenalin. The
secretion of adrenalin stimulates insulin secretion with resultant secondary
relative hypoglycemia. The end result is tension, a mild rise in blood pressure,
and 2-3 hours later craving sweets because of the relative hypoglycemia.
Obviously none of the above is helpful in RSD/CRPS. The rise in plasma
epinephrine will undo whatever good medications are doing to counteract the
hyperactive dopaminergic system in RSD/CRPS.
2. Coffee is more harmful than
caffeinated soft drinks or tea.
3. Mild tea does not cause reactive
hypoglycemia and a rise in blood pressure.
4. Tea, if prepared in mild form (not
too strong), contains less caffeine. It has no acid-based oil as does coffee. It
contains tannin. Tannin or tannic acid curbs thirst and results in less demand
for further consumption of tea or coffee.
5. Coffee and tea both temporarily
raise the body temperature. A few minutes after drinking coffee, the stimulation
of the dopaminergic system causes colder extremities and a simultaneous rise in
systemic temperature. Tea has a much milder effect in this regard. The cold
extremities aggravate RSD/CRPS.
6. Iced tea seems to be the mildest and
safest of caffeinated drinks.
7. A patient with high fever is harmed
by coffee and helped by tea and lemon juice. As is the case with home-made
chicken soup being helpful to the sick (in contrast with factory-made red meat
type of soup) for unknown reasons, mild tea has a healing effect and coffee has
an aggravating effect in patients suffering from stress and fever, including
stress of complex chronic pain.
Just because tea is less harmful than coffee does not
imply that herbal tea is good or healthy for anyone. Herbal teas are a variety
of different dried vegetable leaves. Some of the herbs contain toxic substances
that are harmful to anyone- including RSD/CRPS patients. Because of the variety
in strength and quality of chemicals in herbs, the use of herbal teas should be
avoided. Some of them contain such high doses of tannins (e.g., sassafras tea)
that can be carcinogenic. Catnip, juniper, nutmeg, and hydrangea may be
hallucinogenic. Chamomile and marigold may be fatally allergenic. Senna leaves,
aloe leaves, and duck roots can be strongly cathartic. Mistletoe leaves and
horsetail grass may cause fatal toxicity. So why bother with such chemicals?