How to do an Elimination Diet

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Food Allergies, Food Sensitivities, and Food Intolerances

  The body responds to substances it sees as foreign by producing antibodies. There are several different types of antibodies including IgE, IgG, and IgM.  IgE antibodies produced after eating food produce an immediate allergic reaction. IgG and IgM reactions are delayed and symptoms may take hours to days to appear.

  According to the CDC ‘Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.’ These allergens can be deadly if the allergy is severe enough to cause an anaphylactic reaction. These are all IgE – mediated allergies.

  Medically speaking, only these IgE – mediated immediate response allergies are true food allergies. Delayed reactions to food are considered sensitivities, and these can be produced by any type of food, including the ones in the list above. There are also food intolerances which include food additive reactions and lactose intolerance and gluten intolerance (celiac disease) which are caused by a lack of enzymes.

  Because of the delayed reaction caused by IgG and IgM antibodies, it can be difficult to link the symptom you are experiencing with the food you ate days ago. There are tests that your doctor can run to test the antibodies in your blood, but there is also a way you can test at home to find your food sensitivities, get your symptoms under control and start healing.

 

Symptoms of Food Sensitivities

  Delayed food sensitivity symptoms can show up in any tissue in the body and can include migraines, headaches, joint pain, irritable bowel syndrome, eczema, or wheezing.

  An elimination diet removes the offending foods from the body so it can reduce inflammation throughout your body and begin to heal. During the elimination diet, you will remove allergy producing foods for 3 weeks and track symptoms. If your symptoms improve during this time, you will then start to reintroduce foods one at a time. If you don’t see improvement, it could be that you have not eliminated all of the foods you are allergic too or it could mean that there is another factor complicating the picture.

 

Results of an Elimination Diet

  The results to expect go beyond just a reduction of the symptoms that you are experiencing but you should also have increased energy, mental alertness, decrease in muscle or joint pain and a general sense of improved well-being.

  There may be a period of adjustment to the new diet and some cleansing and withdrawal symptoms such as changes in sleep patterns, lightheadedness, headaches, joint or muscle stiffness and changes in gastrointestinal function. Such symptoms rarely last for more than a few days.

 

The Elimination Diet

  Foods to Include Foods to Exclude
Fruit All whole, fresh fruit except citrus Canned fruit, fruit juice, all citrus fruits (oranges, grapefruits, lemons, limes, tangerines) and any foods or juices containing citrus
Milk Rice milk, coconut milk Dairy milk, cheese, cottage cheese, cream, yogurt, butter, ice cream, non-dairy creamer, casein, sodium caseinate, calcium caseinate
Grains Rice, millet, quinoa, amaranth, teff, tapioca, buckwheat Wheat, corn, barley, spelt, kamut, rye, triticale, oats; this includes most breads, spaghetti, other pasta, most flour, baked goods, durum semolina, and many graviesAvoid any product with corn, corn starch, corn oil, vegetable oil from an unspecified source, corn syrup, dextrose, glucose, corn chips, tortillas and popcorn
Meat Fresh or water-packed canned fish, wild game, lamb, duck, organic chicken and turkey Pork, beef/veal, sausage, cold cuts, canned meats, frankfurters, shellfishBe aware that many canned tunas contain textured vegetable protein which is soy
Legumes If you are vegetarian you can add split peas and lentils, if not then avoid Soybean products (soy sauce, soybean oil in processed foods, tempeh, tofu, soy milk, soy yogurt, textured vegetable protein, miso, etc)If not vegetarian, avoid all beans, peas and lentils
Nuts and Seeds Coconut, pine nuts, flax seeds Peanuts, peanut butter, walnuts, sesame seeds, pumpkin seeds, sunflower seeds, hazelnuts, pecans, almonds, cashews, nut butters
Vegetables All except corn, tomatoes and white potatoesEat veggies fresh or frozen Canned veggies, corn, tomatoes, white potatoes
Oils Cold pressed olive, grape seed oil Butter, margarine, shortening, processed oils, salad dressings, mayonnaise, and spreads, safflower, sesame, almond, sunflower, walnut, canola
Drinks Filtered or distilled water, decaffeinated herbal tea as long as they don’t contain citrus Alcohol, coffee, any caffeinated beverages such as soda, tea or energy drinks
Condiments Apple Cider Vinegar, all spices, salt, fresh herbs Chocolate, ketchup, relish, chutney, soy sauce, barbecue sauce, teriyaki, and other condiments (vinegar in ketchup, mayo and mustard is usually from wheat or corn)
Sweeteners Organically grown dried fruits, eaten sparingly. Blackstrap molasses can be used sparingly. Table sugar and any foods that contain it (candy, soda, pie, cake cookies, etc). Other names for sugar include sucrose, glucose, dextrose, corn syrup, corn sweetener, fructose, maltose, and levulose.Brown sugar, honey, maple syrup, corn syrup, high fructose corn syrup
Food additives   Artificial colors, flavors, preservatives, texturing agents, artificial sweeteners, etc
Known allergens   Avoid any food you know or suspect you are allergic to, even if it is allowed on this diet. If there are foods that are a frequent part of your current diet, it is likely they are an allergen and should be avoided.

 

Tips:

  • Eat simply. Cook simply. This can be a big change so make it as easy as possible.
    • Make a pot of chicken-vegetable-rice soup. Make a large salad. Have prepared food on hand so you can grab something quickly.
  • Plan your meals for the week. For ideas, look through cookbooks that specialize in hypoallergenic diets. Most meals can be modified easily to meet the requirements of the diet.
  • Eat regular meals and do not restrict your calories. If you do not eat enough you may experience symptoms of low blood sugar such as fatigue, irritability, headache, and too-rapid weight loss. To ensure adequate fiber, eat beans, permitted whole grains, whole fruits and vegetables.
    • Try to eat at least three servings of fresh vegetables a day. Choose at least one serving of dark green or orange vegetables (carrot, broccoli, winter squash) and one raw vegetable each day. Vary your selections.
    • Buy organic produce when possible to eliminate pesticide and chemical residue consumption. Wash fruits and vegetables thoroughly.
  • Be sure to chew thoroughly in order to enhance digestion.
  • A good general rule for water intake is to divide your weight in half and drink that much water in ounces every day.
  • Dine out as little as possible while completing your elimination diet. It is much harder to control what is in your foods at restaurants. When you do go out, do not hesitate to ask questions or make requests. Use salad bars that do not use sulfites as a preservative, and bring your own dressing (olive oil and cider vinegar with fresh herbs).
  • If you select to eat animal protein, look for free-range or organically raised meat and prepare by broiling, baking, stewing, grilling or stir-frying. Cold-water fish (salmon, mackerel, and halibut) is another excellent source of protein and the omega-3 essential fatty acids are important nutrients.
  • Get into the habit of carrying pure water, snacks, seasonings, etc, wherever you go to supplement your meals or to have something on hand if you start to get hungry.
  • About one in four patients develop mild ‘withdrawal’ symptoms within a few days after starting the diet. Withdrawal symptoms may include fatigue, irritability, headaches, malaise, or increased hunger. These symptoms generally disappear within 2-5 days and are usually followed by an improvement in your original symptoms.
  • If you regularly drink coffee or other caffeine-containing beverages, it is wise to slowly reduce your caffeine rather than stop abruptly; this will prevent caffeine-withdrawal headaches. If possible, begin to reduce your caffeine consumption prior to beginning your elimination diet.
  • The elimination diet should last at least 3 weeks for symptoms to improve enough to allow you to retest foods. Most people do improve. If reintroducing certain foods causes a recurrence of symptoms, you are probably allergic to those foods.
  • Reintroduce one food at a time. For example, test milk, cheese, and wheat individually not in a combination like macaroni and cheese. Organic sources are best to use for testing, as you will not experience interference from pesticides, hormones or other additives that may be used in commercial preparations.
  • Test one new food at a time by eating it twice a day in fairly large amounts for three days. If no symptoms appear then you are not allergic to that food and you can add it back to your diet and then move on to the next food to reintroduce. If you do experience symptoms, you will need to remove that food permanently. Wait until those symptoms subside before moving on to the next reintroduction.
    • Symptoms to watch for include headache, itching, bloating, nausea, dizziness, fatigue, diarrhea, indigestion, anal itching, sleepiness 30 minutes after a meal, flushing, and rapid heartbeat.
  • Foods may be reintroduced in any order. Begin testing on a day you are feeling well (without colds, headache, fatigue, etc). Keep a journal of the foods that you eat and any symptoms that you experience.
  • Reintroduce different dairy products at different times. Test milk and cheese separately. You may also want to test each type of cheese individually.
  • To test corn, use fresh or frozen (without sauces or preservatives).
  • When reintroducing eggs, test whites and yolks separately.
  • When reintroducing coffee or tea, do not add milk, non-dairy creamer or sugar. You may add rice milk.
  • Beer, wine, and hard liquor require testing on different days, as the reaction to each may be different. Have 2 drinks per test day, but only if you can afford not to feel well that day and possibly the next day.
  • If you have an allergic constitution and eat the same foods every day, you may eventually become allergic to them. After you have discovered which foods you can eat safely, make an attempt to rotate your diet. A four-day schedule is necessary for some severely allergic patients, but most people can tolerate foods more frequently than every four days. You may eventually be able to tolerate allergenic foods, after you have avoided them for 6-12 months. However, if you continue to eat these foods more frequently than every fourth day, the allergy may return.

 

 

 

 

Sources:

http://www.cdc.gov/healthyyouth/foodallergies/

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 3rd ed. New York: Atria, 2012.