Precision Based Medicine Offers a New Approach in Treating IBS-by Dr. Richard Firshein

As a physician, one of the greatest senses of accomplishments comes from our patient’s success.  It is a collaboration that takes hard work on both the part of the physician and of the patient. Judy was one such patient.

Judy and Her Rocky Road to Recovery….

Over the past 16 years, Judy had seen numerous specialists whom collectively, represented hundreds of years of medical experience. Yet they could not figure out what the causes of her underlying medical conditions were. In truth, they were looking in the wrong direction. She presented with numerous chronic symptoms which had worsened or progressed.

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Summer Detox: As Featured in DuJour Magazine

Detoxing Done Right

A doctor weighs in

The buzz about detoxifying teas, cold-pressed juices and other trendy products that promise to flush out toxins can truly be deafening. In an attempt to find the perfect plan for a pre-summer detox, DuJour turned to Dr. Richard Firshein of the Firshein Center for Integrative Medicine in New York City. He often recommends detoxes to his patients because of the many benefits of fasting, and says, “When you have all of those allergens and sensitivities, and you have all of these toxins and you eliminate them, you give the liver a chance to recover, and that’s the basic foundational principle of a detox.”

Dr. Richard Firshein

Despite universal benefits, there’s actually no universal way to detox. Each of Dr. Firshein’s patients receives an individualized plan of action based on extensive evaluation. “We use a lot of sophisticated testing—DNA testing, we look at toxins, there are biomes which look at gut flora, allergies, vitamin levels, levels of free radical activity, and with that information we’re able to put together a plan,” he explained. While no two patients—and therefore no two detoxes—are exactly alike, Dr. Firshein outlined some important basic rules to know before embarking on a detox.

Calorie count

Patients typically will ingest one third of the calories they normally would, and Dr. Firshein cautions that patients taking in under 1200 calories per day be medically supervised.

Detox-approved foods

“I use a gluten free, rice-based protein drink that has a number of detoxifying nutrients in it,” says Dr. Firshein. Foods often added on top of this include vegetable or bone broth, a serving of mustard seeds, a yogurt, or even four ounces of steamed salmon with asparagus or broccoli in some cases.


Juice may be seen as the quintessential component of cleansing, but it doesn’t always make an appearance in Dr. Firshein’s plan. Sometimes he will add a green juice to the mix if a patient is sick and needs more nutrition than the typical detox provides, but he always proceeds with caution. “You want to be careful because a lot of commercial juices contain a lot of sugar,” he says. “You want to check the labels, make sure that they’re not getting more than seven or eight grams of sugar per serving. That’s still on the high end—about a teaspoon of sugar—but to make it palatable some people really need a little bit.” To put things in perspective, the popular BluePrint cleanse contains juices with up to 51 grams of sugar in a serving.

Detoxing vs. cleansing

These words are not interchangeable to Dr. Firshein. A detox is the process described above, cutting calories and eating only certain foods for a number of days in order to eliminate toxins. “In the cleanse I add in some things that really clean out the gut to clean out the colon, and that’s why we have things like flax seed, magnesium preparations, or natural supplements like cascara and senna. That really just clears out the gut because for a lot of people they’re toxic not just because of the things they eat and consume, but also because of the gut bacteria,” says Dr. Firshein.

When to detox

“I think a reasonable approach would be every two months,” says Dr. Firshein. “I think that if someone wanted to do it quarterly or twice a year, they’re still going to get enormous benefits from it. It will help them reset the way that their body is functioning and give them the optional nutrition.” It sounds difficult to cut calories so often, but the benefits can make the sacrifice worth it. “People go through a detox and then they suddenly realize—you know that epiphany—that they’re feeling so much better, they have so much more energy, they feel more vital, they think more clearly,” says Dr. Firshein.

The Diet of the Future: As Featured in Town & Country Magazine

The Diet of the Future Will Be Designed Just For You

What you eat will be tailored to your particular allergies and sensitivities, and for a lucky few (which might include you), it could mean less kale and more bacon.


On Sundays I often do a long run. My typical breakfast on such a day used to start with a whole egg omelette made with a dash of milk, green peppers, garlic, scallions, and Swiss cheese, accompanied by a toasted slice of German “fitness bread.” (What can I say? It was a romantic relic of my childhood.) Coffee with a splash of almond milk completed the meal, which would power me through nine or 10 miles on a winter day.

It was deeply satisfying. I remember in a longing way the acrid bite of the garlic, the tang of the green pepper, and the blush of the silky almond milk on my tongue as if I were Proust recalling his madeleine dipped in tea or Brillat-Savarin savoring his postprandial cheese.

It was Brillat-Savarin who said, “Tell me what you eat, and I shall tell you who you are,” and right now he would probably tell me I was quite confused. Because I am no longer allowed to eat any of the above foods. My diet for the last three months has been tailored specifically to me by Dr. Richard N. Firshein, one of New York City’s gurulike food allergy diet doctors.

The list of verboten foods is curious. Yes, I am allowed to eat bacon and drink gluten-free vodka, but, no, I am not allowed to eat eggs, even if they come from my own chickens and, not to sound too Hollywood starlet about it, travel only 50 yards from farm to my table. Nor am I allowed to drink almond milk, a suggestion I glumly vowed to follow despite my recent investment in a Vitamix and a dozen nut bags. Both eggs and almonds—and a flurry of other largely healthful (for most people) foods—it turns out, are allegedly not great for me; they can cause inflammation, were probably making me fat, and could have eventually led to my suffering from the graphically named leaky gut syndrome.

We start with a full physical. I am five-foot-11 and I weigh 153 pounds, which is perfectly healthy. But we’re in new york, and I adjust for geographic weight expectations.

Food allergy dieting sounds as faddish as nutrition can get. Besides, most people think of food allergies and their minds fly to an image of a child with a nut allergy who has accidentally been fed a peanut and must now lunge for his EpiPen. Certainly, serious food allergies are a frightening prospect, and there is no question that they are on the rise in children. In the world of ultra-custom diets and the doctors who design them, however, the more common case is that of an adult with sensitivities or intolerances to certain foods that instead of nourishing the body can cause inflammation and concomitant weight gain along with a host of other symptoms.

Celebrities and their svengalis have introduced the concept to the world at large, via tabloids and Instagram. Gwyneth Paltrow has sensitivities to gluten, dairy, and chicken eggs, but quail eggs are fine. Busy Philipps can’t tolerate gluten or soy. Zooey Deschanel has tweeted about her allergies and can’t eat eggs, dairy, or gluten. Miley Cyrus, when criticized for what people thought was an eating disorder, tweeted about her gluten and lactose allergies. Gluten, she wrote, is “crapppp anyway!”

On my first visit to Dr. Firshein, an osteopathic physician and the director of the Firshein Center for Integrative Medicine in New York City, he broke down for me the difference between food allergies and food sensitivities. Severe food allergies, such as ones to peanuts or shellfish, can be fatal; others can cause vomiting, skin rashes, or runny noses, among other symptoms. Food sensitivities—most often to dairy and gluten, but also to vegetables, fruits, and other seemingly innocuous items—are milder but still unpleasant in their effects. People with a sensitivity to these substances can experience bloating, abdominal discomfort, and a chronic inflammation of the gut, which leads to improper digestion and subsequent weight gain.

“We look at underlying complaints,” said Dr. Firshein, who is so thin and angular it doesn’t look as if he eats much more in a day than the tray of blueberries currently sitting on his desk. “Headaches, rash, intestinal discomfort, constipation, back pain, sinus pain.” He listed several more. “Could all these things be attributable to allergies or sensitivities? Yes. So that’s where we tailor our recommendations to the individual.” The result? Everyone feels better, looks better, and—most often—loses weight.

Take gluten. While only 1 percent of Americans have celiac disease, a potentially serious allergy to wheat that can interfere with nutrient absorption, some doctors estimate that as many as 30 percent of Americans have some sort of intolerance to gluten. The intolerance, according to their research, creates a state of inflammation in the body and the intestines, which leads to damage of the villi, the small fingerlike projections that line the small intestine and promote nutrient absorption. When the villi aren’t working properly, the body can’t absorb nutrition and the gut gets irritated. This is known as leaky gut syndrome, and it’s not pretty, according to Dr. Mark Hyman, who has been studying the effects of food intolerance for 25 years.

“Think of your gut as a second skin,” Hyman told me. “When your skin isn’t intact it can’t prevent infection. When the lining of your gut is not intact, it allows for inflammation.” Which, in turn, he says, can cause arthritis, fatigue, irritable bowel, reflux, chronic allergies, eczema, psoriasis, autoimmune disease, diabetes, migraines, depression, and more.

My husband is incredulous. He eats six to eight slices of buttered toast a day, hasn’t burped or passed gas (that I’ve heard) in 15 years, and has the body fat of a marathoner. “That’s so sad,” he tells me. “I remember when my mother used to take me to the bakery for gluten loaf.”

Gluten loaf is certainly not something I will be eating for the next few months, as I embark on a nutritional investigative journey with Dr. Firshein, whom fitness empress Tracy Anderson relies on for herself and her clients, and whom she describes as “brilliant.” We start with a full physical: blood pressure, bone density, body fat, resting metabolic rate. I am five-foot-11 and I weigh 153 pounds, which is perfectly healthy. But we’re in New York, and I adjust for geographic weight expectations. Dr. Firshein says I could certainly lose a few pounds if I wanted to. His nurse draws 12 vials of blood for tests, the results of which will be returned in a week. I spend 10 minutes spitting into another vial, so Dr. Firshein can run a genetic panel. (“Do you have the gene to process caffeine?” he asks. “We’ll find out.” Fingers crossed.) His nurse administers 83 pricks to my skin, and I wait in a darkened room to see if anything turns red.

You’re staring at me for not eating peaches and you want us to take peruvian hallucinogens and throw up into a bucket for our next girls trip?

Before I leave, Dr. Firshein and I sketch out a list of supplements I should be taking every day. This runs the gamut from probiotics (to promote gut health) to turmeric capsules (to combat inflammation) to L-tyrosine (for low thyroid levels, something my general practitioner and I have been monitoring for the last three years). He also hands me two tubs of “medical food,” detoxifying powders I will substitute for two meals a day for the next two weeks. I refuse a stool sample request, instead opting for a trendy microbiome analysis. It’s far less invasive, and I don’t have to walk down Park Avenue with the “collection device,” a curious oblong plastic hoop that looks like a time travel portal for a Barbie doll.

Food allergy diets have been popular among the glitterati for a few decades. Terri Lawton, an aesthetician in Los Angeles, has treated movie stars and other celebrities since the 1970s, and she encourages most of her clients to have their blood tested for food sensitivities.

“I had a pro basketball player in here for facials to treat his acne,” she told me. “We couldn’t figure out what it was that he was eating that caused the problem.” After learning that he was sensitive to chicken, one of his dietary staples, he eliminated all chicken and his skin cleared up. Ashley Lambert, a voiceover artist in Los Angeles and one of Lawton’s clients, had her bloodwork done after she grew tired of chronic skin problems, gastrointestinal issues, and hoarseness, a career-threatening situation in her profession. Her list of forbidden foods now includes gluten, soy beans, corn, peas, broccoli, cauliflower, and some nuts. “My skin and voice are clear and I don’t have reflux,” she told me.

I received my complete results in 10 days. (Health insurance paid for it all.) According to Dr. Firshein’s lab work, I have some form of food sensitivity to wheat, lactose, egg whites, garlic, almonds, green peppers, and sesame seeds. My results from Lawton’s lab were encouragingly similar but included a few extra surprises, chicken and peaches, to which I might have a moderate reaction. My gut health is actually good, even if I have been eating foods to which I am supposedly intolerant.

The rigorous diet suggested by Dr. Firshein and Lawton at first seems impossible to enact, so I decide to meet a group of friends at the legendary California spa Golden Door for a week and have the staff eliminate all of my allergy foods for me. Suzie, the intake specialist, tells me that lots of Golden Door clients have had their allergen levels tested and show up with lists of forbidden foods. I tell her I don’t think these foods are really causing inflammation. She responds, “Well, maybe they’re why you’re holding on to the five extra pounds you want to lose.” Point taken. Maybe they’re secretly gumming up my gut and making it more difficult to properly digest my food. I have a sudden flashback to a colonic from last year. In a moment of gastrointestinal intimacy, the colonic hydrotherapist told me to chew some of my vegetables, particularly green peppers, more vigorously. Green peppers! They’ve been gumming me up and preventing me from losing weight. I shake my fist at green peppers.

Continue reading “The Diet of the Future: As Featured in Town & Country Magazine”