Elimination Diets

What is an elimination diet?

Dictionary.com Definition: "A procedure used to identify foods that may be causing an adverse effect in a person, in which all suspected foods are excluded from the diet and then reintroduced one at a time."

https://www.eatright.org/health/allergies-and-intolerances/food-intolerances-and-sensitivities/what-is-an-elimination-diet

There is no one "elimination diet", this term captures the process of eliminating specific items and monitoring symptoms, following a thought out plan.

Can feel like a "fact finding" mission at many time- requires dedication and persistence.

"Elimination diets require motivation.  It can be tough to make the needed dietary changes even though it is only on a short-term basis. Also, if you’re taking any medicines, discuss them with your physician before making changes to your diet and consult with an RDN."

From <https://www.eatright.org/health/allergies-and-intolerances/food-intolerances-and-sensitivities/what-is-an-elimination-diet>

IMPORTANT DIFFERENTIATION BETWEEN INTOLERANCE AND ALLERGY

1. Elimination diet can assist with both or either
2. A food allergy should be much more apparent and easy to diagnose
3. Food allergy can often be detected with blood test- Iga antibodies
4. Mail away hair tests, and self administered blood tests are not acceptable forms of diagnosis for either allergy or intolerance
5. Allergy response occurs in the immune system (hives, immediate swelling, anaphylaxis)
6. Intolerance response occurs in the gut (GI symptoms, chronic or long term systemic effects r/t malabsorption- ie deficiencies, chronic diarrhea and fat malabsorption, wt loss)

More here:https://www.mayoclinic.org/diseases-conditions/food-allergy/expert-answers/food-allergy/faq-20058538

How an Elimination Diet Can Help You

What conditions can an elimination treat?

1. IBS > reference the elimination diet content from the IBS page. We will link to it
2. Suspected food intolerances
3. Autoimmune conditions (sometimes- main example from this article is gluten)
   1. Rheumatoid arthritis, more on RA- (https://www.eatrightpro.org/news-center/nutrition-trends/diseases-and-conditions/rheumatoid-arthritis-and-diet)
   2. Type 1 DM ( only in relation to autoimmune- overall gluten and autoimmune is still considered skeptical, but should definitely be an option for someone who is out of options)
   3. Migraines
   (https://www.todaysdietitian.com/newarchives/070113p10.shtml)
4. Throughout the treatment of an elimination diet, use symptoms and your medical professionals expertise to help you rule out other, underlying conditions

Symptoms that may be treated by exploring an elimination diet:

1. GI: bloating, diarrhea, gas, constipation
2. Nutrient deficiencies showing up on bloodwork (malabsorption or maldigestion occurring in gut r/t damage)
3. Non GI: headaches, persistent seasonal allergy symptoms, rashes, joint pain, low energy

How do you practice an elimination diet

1. You can start with your PCP to get a referral
2. With a registered dietitian or qualified health care professional;RD, GI specialist
3. Elimination phase, reintro phase, determination of long term maintenance
4. Can take 3-12 weeks or so
5. Food and symptom tracking and journaling
6. Do one thing at a time, one elimination at a time or one treatment or augmentation at a time
7. Short term solution, needs to be liberalized as soon as able

Why not do an elimination diet myself?

1. Specialist or practitioner will make sure you are not suffering big "holes" in your nutrition
2. Significant eliminations can cause or exacerbate deficiencies
3. It takes a lot of thought and planning, and requires a detailed eye
4. You may have misconceptions around what is causing your symptoms
5. Long term limitations (especially unexplored or unnecessarily stringent) can contribute to disordered eating
6. You will need help with "healthy substitutions based on your individual preferences" related to what you may be omitting

From <https://www.eatright.org/health/allergies-and-intolerances/food-intolerances-and-sensitivities/what-is-an-elimination-diet

What types of foods are typically excluded during an elimination diet? I.e. food list

1. Needs to be tailored to individuals
2. Examples could include specific food groups such as dairy, wheat, fruit (fructose)
3. Can start with common offenders: alcohol, caffeine, high sulfur/cruciferous veggies - cauliflower, broccoli, brussels sprouts, raw roughage/fruit and veg
4. 7 biggest/main allergens: cows milk, peanuts, tree nuts, fish, shellfish, soy, wheat
5. FODMAP is one form of an elimination diet

The Protocol - one source take

The Protocol

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.

Elimination Phase

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.

Reintroduction Phase

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.

From <https://www.todaysdietitian.com/newarchives/070113p10.shtml>