Westminster Refsum’s Diet Principles
The Westminster Refsum’s Diet has been shown to be effective at lowering the amount of phytanic acid in the blood. The diet works in two ways:
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It restricts the intake of foods which are rich in phytanic acid and the foods which the body can convert to phytanic acid to a level that the body can process.
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It supports general metabolism so that the body does not release phytanic acid from body stores in amounts that are greater than the body can process.
The Westminster Refsum’s Diet includes the following principles:
1. Eat regular meals and snacks
This means having breakfast, lunch, evening meal and a bedtime snack. If you have a long break between meals (4 hours or more), have a snack. It is particularly important to eat breakfast, so that you break your overnight fast. It is also important that you do not exercise hard in the morning unless you have eaten breakfast.
Dieting to lose weight is not recommended unless your phytanic acid is in the target range of less than 200µmol/L. If weight loss is desired and your phytanic acid is low, it is important that you work closely with your dietitian to develop a weight loss plan and regularly monitor your phytanic acid levels. Any time you lose weight phytanic acid is released from your fat stores; therefore, very slow weight loss would be recommended.
2. Eat carbohydrate rich foods at each meal
The brain needs a regular supply of glucose to function. Without a regular supply of glucose, your body will break down its carbohydrate stores and once it has used those, it will break down your fat stores and release phytanic acid from your body fat. It is very important not to follow a low carbohydrate diet. Carbohydrates can come from starchy foods (bread, potatoes, rice, pasta, breakfast cereal) and sugary foods (fruit, sweets, fruit juice).
If you have other health conditions such as diabetes, it is important to talk with a Dietitian for specific advice.
3. Avoid foods that contain a lot of phytanic acid
See STOP section for foods to avoid.
4. Limit foods that contain a moderate amount of phytanic acid, free phytol, and phytyl fatty acid esters
See CAUTION section for foods to limit.
5. Avoid high intakes of caffeine
Consuming large amounts of caffeine from energy drinks, sports drinks or high intake of coffee is not recommended. If consuming products with caffeine, a moderate caffeine intake is advised. For an adult woman (not intending to become pregnant) this would be 200-350mg a day and for an adult man, 300-450mg a day.
6. Ensure you are getting your essential fatty acids
Omega 3 and omega 6 are essential fatty acids that the body cannot synthesise and therefore need to be consumed in the diet. Omega 3 and 6 are found in vegetable oils and walnut oil, and can be a source of essential fatty acids on a low phytanic acid diet. In addition, omega 6 can also be found in chicken, eggs and wholegrain breads. It is important to discuss with your dietitian about ensuring you are getting omega 3 and 6 from your diet.
7. Ensure adequate vitamins and minerals
With all specialist diets it is important to regularly monitor nutritional bloods. These should be monitored annually and vitamin / mineral replacement provided as needed.
8. Ensuring adequate carbohydrates when exercising
It is important to fuel your body with carbohydrates prior to exercise. This could include eating a carbohydrate containing meal or snack before exercising. If exercise lasts longer than 45 minutes, you should take a carbohydrate snack during exercise. For example, if you go on a 90-minute walk you should bring a small snack to eat at 45 minutes (e.g. banana, a couple of dates). If you exercise without adequate carbohydrates, your body will start to break down fat and release phytanic acid. If you are starting a new exercise plan or wanting to increase the amount of exercise you do, it is important to talk with your dietitian.
9. Getting enough glucose when unwell
If you are feeling unwell and unable to manage all your usual meals, you will need to consume glucose at regular intervals in order to stop the breakdown of your fat stores and release of phytanic acid into your body. This is called an emergency regime, and an example of one used at Guy’s and St Thomas’ Hospital, London, is included (see Emergency Regimen). This regimen is specific for those who do not have diabetes. If you have diabetes, it is important to contact your medical team and dietitian for specific advice.
10. Medical Procedures or Surgery that requires fasting
Fasting for a surgical or medical procedures can result in increasing phytanic acid levels. To prevent the increase in phytanic acid levels, glucose solutions (oral and IV) will need to be provided prior, during and post procedure. If you are having a surgery or medical procedure, please contact your medical/dietetic team to make them aware.