The Protocol - one source take
Elimination diets constitute a reliable alternative to food sensitivity testing for identifying nonallergic food intolerances at a low cost. Although elimination diets are available, they require more effort and commitment on the part of clients, so dietitians must use their judgment in identifying the best candidates for this approach.
Depending on the practitioner, the protocols used when implementing an elimination diet can vary slightly, but generally they include an elimination and reintroduction phase. During the elimination phase, which should last between four and eight weeks depending on the severity of the client’s symptoms, all potentially problematic foods must be avoided and replaced with safer alternatives.
The approach can be adapted depending on the client, says Kelly Schmidt, RDN, LDN, owner of Paleo Infused Nutrition in Chicago, where she specializes in weight-loss and autoimmune disease nutrition. “Depending on the client’s diet before our meeting and their personality and relationship with food, I typically remove foods in phases and not all at once,” Schmidt says. “Yet, when removing all the foods, it’s just as important to educate clients on how to incorporate certain foods to help repair their digestive tract.” Foods that may help repair the digestive tract include bone broth, fermented vegetables, grass-fed organ meat, and coconut oil.
“Since there’s no universal safe food, there’s no universal elimination diet,” says Susan Linke, MBA, MS, RD, LD, CLT, a certified LEAP therapist and mentor in Dallas specializing in chronic inflammatory conditions related to food sensitivities, allergies, and intolerances. Depending on the client’s condition, a dietitian may eliminate gluten-containing grains; all grains; dairy; legumes; nightshade vegetables, such as tomatoes, eggplant, white potatoes, and most peppers (eg, hot peppers and paprika but not black pepper); soy; monosodium glutamate; and high-FODMAP foods. RDs should encourage clients to keep a journal during this period to ensure compliance and track any changes in symptoms and overall well-being.
Once the elimination phase has resulted in significant health improvements, RDs can assist clients throughout the reintroduction phase, during which eliminated foods are systematically reintroduced into the diet one at a time and every few days to assess tolerance. Any foods that trigger previous symptoms should be considered problematic and avoided. Foods that don’t appear to cause any reaction are deemed safe to reintroduce and can become part of the client’s regular diet, if desired.
“Although there are trigger foods or chemicals that are considered more common allergens and others that are more heavily associated with certain diseases, our individual immune systems still have the final say as to what our personal inflammatory triggers are,” Linke says. “There are no universal anti-inflammatory foods.”
This is why elimination diets can be a great tool for RDs to customize their clients’ nutrition requirements, which depend on their medical condition and individual tolerance.