Bring Back the Big Four over Four Weeks (If You Want To)
As many allowances as there are on the 4×4, it still requires you to eliminate a lot of foods you might have really enjoyed throughout your life. You may be itching to have some nice, rich, fatty yogurt again. Or maybe you really miss the occasional sorbet, or a slice of sourdough bread with your morning coffee.
Thankfully, the 4×4 isn’t a way of eating you must implement for the rest of your life. The purpose of the 4×4 isn’t to get you used to doing it forever. Instead, it’s to reset. It’s to start fresh. It’s to show you how your body functions when you remove potentially problematic foods. Once you experience this, you can play around with bringing the Big Four back into your diet (if you want to).
To figure out which foods might be causing specific symptoms for you, we’ve created a step-by-step protocol for bringing back the Big Four. Over the course of four weeks, you’ll reintroduce each of the Big Four individually, independent of one another, in specific amounts. Doing so will allow you to see exactly which foods are problematic for you, and if your reactions are dose-dependent. We get you started with dairy, as it is the most complex of the Big Four and can be an incredibly healthful food for some people. Then we have you reintroduce grains, refined sugars, and vegetable oils to see how you feel with those foods back in your diet.
To help you keep track of everything, we’ve included a Reintroduction Worksheet for you to use throughout the reintroduction phase (see here). To download a printable form, go to coconutsandkettlebells.com/book downloads.
BEFORE YOU REINTRODUCE THE BIG FOUR
Before reintroducing the Big Four, it’s important to recognize how you are feeling and understand the changes that happened during your 4×4. On the last day of your 4×4, answer the three questions here again. Because you answered these questions at the end of each week, you should have some solid information about the improvements that occurred throughout your 4×4. Take special note of any symptoms you listed in question 2, and make a list of any symptoms that improved or completely resolved at the top of your Reintroduction Worksheet.
THE BASICS OF REINTRODUCTION
To reintroduce each of the Big Four, you’ll simply bring one category back into your diet for one day only, then monitor your body for any symptoms for two days afterward. We recommend adding one serving of the category you’re testing to each meal on day 1. For example, if you are reintroducing dairy, you could put cream in your coffee with breakfast, have some full-fat yogurt with lunch, and top your cooked vegetables with butter at dinner. If all goes well and you don’t have any major reactions during your two days of monitoring, you’ll bring back dairy (or whichever of the Big Four you’re testing) on day 4, except this time you’ll include two servings at each meal, then monitor your symptoms for the next three days. This process will take exactly one week. After week 1 is complete, you’ll move on to the next Big Four category.
Reintroduction Day by Day
DAY 1: Reintroduce Big Four category #1 (1 serving at each meal)
DAY 2: Monitor your symptoms
DAY 3: Monitor your symptoms
DAY 4: Reintroduce Big Four category #1 (2 servings at each meal)
DAY 5: Monitor your symptoms
DAY 6: Monitor your symptoms
DAY 7: Monitor your symptoms
If you didn’t have any reactions to the foods you introduced during week 1 and you’re certain they don’t cause any problems for you, you can include those foods intermittently (if you want to) throughout the rest of the reintroduction phase. However, if a food feels problematic at all, or if you are uncertain, it’s best to remove it for the rest of the reintroduction phase so you can accurately gauge your reaction to the other Big Four categories.
If you react negatively to a specific food or your symptoms return after the first reintroduction day, you are not required to eat it again on day 4. You have just learned what its effect is on you—there’s no need to subject yourself to more unless you think it could be helpful for gathering more information. To let your body heal and come back to the baseline you established during your 4×4, simply leave that Big Four category out for the rest of the week, and the following week, begin reintroducing the next category as planned.
Your second reintroduction day (on day 4) is meant to help you determine if you develop any symptoms with a larger quantity of that Big Four category. If this happens, you know your reactions are dose-dependent. If you develop symptoms, remove that category from your diet for the rest of your reintroduction phase. Begin reintroducing the next category the following week as planned.
When your reactions to a food or Big Four category are dose-dependent, we recommend eating it very selectively or removing it from your diet completely, because your body has clearly demonstrated an intolerance to it. While you may not feel the effects when you eat it in smaller doses, it could still cause inflammation. The good news is, you can handle that food in smaller doses without experiencing an immediate reaction. This is especially nice when you want a small indulgence or are exposed to a food unknowingly when dining out.
MONITORING YOUR SYMPTOMS
During the reintroduction phase, look for any negative physical, mental, or emotional reactions. These reactions can occur immediately after eating a food, but may take up to seventy-two hours to appear. A good place to start is the list you wrote down on your Reintroduction Worksheet of the symptoms that improved and those that completely resolved during the 4×4. If you didn’t have any health conditions or symptoms to note prior to your 4×4, it is possible for new reactions to occur. This is because removing the Big Four allows chronic inflammation to subside, and your immune system is then able to react more strongly to what it perceives to be a problem. Possible negative reactions include:
Anything that is different from what you felt during your 4×4 could be a symptom. Use your Reintroduction Worksheet to keep track of any negative reactions you experience as you reintroduce the Big Four week by week.
Reintroduction Worksheet
Start of Reintroduction (Date):
During the 4×4
| Symptoms that improved:
|
Symptoms that completely resolved:
|
Week #1: Dairy
| Reintroduction Day #1 | Reintroduction Day #2 |
| Negative reactions?
|
Negative reactions?
|
Week #2: Grains
| Reintroduction Day #1 | Reintroduction Day#2 |
| Negative reactions?
|
Negative reactions?
|
Week #3: Refined Sugar
| Reintroduction Day #1 | Reintroduction Day #2 |
| Negative reactions?
|
Negative reactions?
|
Week #4: Vegetable Oils
| Reintroduction Day #1 | Reintroduction Day #2 |
| Negative reactions?
|
Negative reactions?
|
WEEK 1: DAIRY
To kick off your reintroduction of the Big Four, you’ll test your reaction to dairy. Dairy is the first category you’ll reintroduce because it is the most complex of the Big Four. For some people, it can be a very healthful addition to their diet. For others, it can be harmful. The type and quality you consume can also greatly impact how your body reacts, and for this reason, it’s important for you to experiment with different dairy products to make sure you are covering all your bases. On each reintroduction day, you should consume a few different types of dairy. We recommend starting with the most innocent of dairy products—butter, yogurt, and/or cream—during reintroduction day 1 and moving on to the more problematic ones, such as cheese and milk, on your second reintroduction day. Each type of dairy is listed in the following pages in order of most innocent to most problematic, along with more insight into each food.
Symptoms to look out for when reintroducing dairy include digestive problems such as bloating, gas, and diarrhea; acne; postnasal drip and other allergy-like symptoms; and joint pain. Of course, this is not an exhaustive list. In fact, since the proteins in dairy have been linked to inflammation and intestinal permeability, consuming dairy could cause any symptom related to any autoimmune disease to flare up. Be on the lookout for any symptom that arises or comes back.
BUTTER
When full-fat cream is churned or agitated, it separates into a solid (butterfat) and a liquid (buttermilk)—butter is the solid. It is about 80 percent fat, and the rest is mostly water. For this reason, it is typically well tolerated by most people because it contains only trace amounts of protein (the dairy proteins are casein and whey) and lactose (the dairy form of sugar). We recommend consuming grass-fed butter on reintroduction day 1, as it’s great for testing the waters. If you notice any symptoms after consuming butter, it’s best to back off and not move on to more problematic types of dairy.
FULL-FAT (HEAVY) CREAM
Much like butter, cream is composed of mostly fat and water, with small amounts of protein and lactose. We recommend including grass-fed unhomogenized heavy cream on reintroduction day 1, as many people can tolerate it well. If cream bothers you but butter does not, it may be either because of the higher lactose content (this would most likely cause only a digestive reaction) or the higher percentage of proteins (which could cause all kinds of symptoms, not just digestive distress).
FULL-FAT YOGURT
Yogurt can be an incredibly healthful food. Since it is bacteria-fermented milk, it contains live bacterial cultures, otherwise know as probiotics. Live bacterial cultures can be great for your gut health. The more probiotics you consume, the more “good” bacteria you have in your gut. These bacteria help protect your intestinal lining from damage, help break down food particles, and facilitate the absorption of nutrients into the bloodstream. Probiotic foods are incredibly healthy, so yogurt may merit some testing for you. It’s another great option to try out on reintroduction day 1.
If you decide to reintroduce yogurt, go with a grass-fed, full-fat yogurt that doesn’t have added sugar. Yogurt is much easier to digest than other dairy because its probiotics help to break down the lactose, so if you are sensitive to lactose, you may be able to tolerate small amounts of yogurt without issues. Yogurt contains a reasonably significant amount of dairy protein, as much as 10 grams in a typical 100-gram serving. If you struggle with yogurt, then dairy proteins are likely a problem for you.
If you happen to not tolerate yogurt, don’t despair about the state of your gut bacteria. There are plenty of nondairy fermented alternatives you could consume instead. Any kind of fermented vegetable, coconut yogurt or kefir, and kombucha tea are all commonly available alternatives (read more about probiotic foods here).
CHEESE
Cheese has lactose in it, but like yogurt, cheese, especially those aged for longer periods, doesn’t have as much lactose as milk. Aged cheeses are generally handled quite well by people with lactose intolerance, though this varies from person to person and cheese to cheese. If you choose to reintroduce cheese, we recommend going with grass-fed, raw cheese. Cheese is a great food to bring back on your second reintroduction day (if you did fine with the foods you ate on reintroduction day 1).
If you can tolerate cheese but you can’t tolerate milk, whey is likely the issue: While cheese is quite high in casein, the whey from the milk from which it’s made is largely filtered or strained out during the cheesemaking process. If your symptoms are primarily digestive, the issue could be the lactose in the cheese.
FULL-FAT (WHOLE) MILK
Milk is the most potentially problematic of all dairy options, since it contains a whopping dose of both casein and whey, as well as lactose. For this reason, we recommend bringing milk back in on your second reintroduction day (if you choose to) and including only one serving of it. Quality can make a huge difference when it comes to how your body responds, so try to find grass-fed, nonhomogenized whole milk. This will be the most nutrient-dense option that has undergone the least amount of processing. You can often find high-quality milk from local farms and creameries at farmers’ markets and natural grocery stores.
RAW MILK
If you have access to it, you can experiment with raw (unpasteurized) milk during your dairy reintroduction week to see how your body responds. Many people who suffer from lactose intolerance digest raw milk without any problems, as it contains probiotic bacteria and antimicrobial enzymes (which are removed with pasteurization). Pasteurization also destroys some of the nutrients in milk, so unpasteurized milk is much more nutrient-dense. Some people (including the FDA) deem raw milk unsafe. However, consider that while almost 10 million people are now consuming it regularly, there hasn’t been a single death attributed to raw milk since the mid-1980s (peanuts, eggs, and cantaloupe—which are far more readily available—are the worst offenders when it comes to foodborne illnesses). Grass-fed raw milk can be purchased in stores in some states (check sites such as realmilk.com to see if your state is one of them), but you’ll likely need to buy it directly from a local farm or at the farmers’ market.
Noelle’s Experience
While gluten generally makes me feel terrible, dairy is actually what triggers my IBS symptoms. This was a bit tricky to figure out, as I originally only reintroduced more innocent forms of dairy, including grass-fed butter and yogurt, which didn’t cause me any issues in small doses. A few weeks later, I had some ice cream on vacation, thinking that it wouldn’t be a big deal. Unfortunately, I had a major gut reaction that lasted all night and continued on the plane ride home. Needless to say, it’s the last time I ever consumed ice cream or milk. To keep from making a similar mistake, make sure to follow our tips regarding how to reintroduce different types of dairy. Don’t assume that dairy doesn’t cause you any issue unless you’ve consumed all the different types during your reintroduction and observed the effects.
WEEK 2: GRAINS
Grains—specifically grains that contain gluten—are the most likely of the Big Four to cause negative reactions. For this reason, we recommend bringing back non-gluten-containing grains on reintroduction day 1, and including one or two servings of gluten-containing grains on your second reintroduction day if you didn’t experience any negative reactions after the first day. If you experience negative reactions after the first day, remove grains from your diet for the rest of the week and continue with week 3 as planned.
NON-GLUTEN-CONTAINING GRAINS
Gluten-free grains include amaranth, buckwheat, corn, rice, millet, quinoa, sorghum, gluten-free oats, and teff. We suggest prioritizing whole, unrefined grains during your reintroduction. For example, you can make oatmeal (with rolled oats labeled “gluten-free”) for breakfast, have some rice with lunch, and eat corn with dinner. While including grain products such as rice crackers or tortilla chips is fine, it can be hard to find brands that do not contain added refined sugar or vegetable oils, and those are the only ones that will work for your reintroduction. Some of our favorite brands (like Jackson’s Honest, which makes tortilla chips with coconut oil) can be found here.
GLUTEN-CONTAINING GRAINS
Gluten is the term used to refer to a combination of proteins—glutenin and gliadin—found in certain grains. Grains that are gluten-free have similar proteins, but they are made up of different amino acid chains that do not cause the same disruption as gluten does. Grains that contain gluten include wheat, barley, and rye, and related grains including spelt, Kamut, farro, durum, bulgur, semolina, triticale, and oats (unless labeled as gluten-free oats).
Until recently, doctors and scientists have thought of gluten consumption as a problem only for those suffering from celiac disease, an autoimmune condition. When people with celiac disease eat gluten, it triggers a cascade of inflammation both outside and inside the intestinal wall, and a loosening of the tight junctions that hold the cells of the gut together. When this loosening occurs, undigested gluten proteins “leak” through the gut barrier and interact with tissue transglutaminase (tTG), an enzyme the body releases in the gut to help repair damage. Because the invaders (gluten) are now crosslinked with the body’s own tissue, the immune system creates antibodies to attack both gluten and gut cells. This can result in nutrient deficiencies, and a wide range of digestive problems.
In the past few years, research has shown that celiac disease is only one of many expressions of gluten intolerance. A general sensitivity to gluten, which many people experience, is now recognized as non-celiac gluten sensitivity (NCGS). Those with NCGS experience the same symptoms as those with celiac disease or a wheat allergy, but they don’t produce antibodies to their body’s own tissue, or have the same severe intestinal atrophy. Unfortunately, if you are sensitive to gluten, it can still trigger inflammation and leaky gut. Because inflammation and leaky gut are associated with a large number of diseases, symptoms to look out for when reintroducing grains include just about all of them. The most common symptoms of gluten sensitivity include IBS-like symptoms (abdominal pain, bloating, diarrhea, and constipation), brain fog, headaches, migraines, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, anxiety, and anemia. Gluten sensitivity has also been associated with thyroid issues and hormonal imbalances.
If you already know you have celiac disease or NCGS, you should not reintroduce gluten-containing grains. However, you may want to exclusively test non-gluten-containing grains on both reintroduction days. Many people who have celiac disease or NCGS think that consuming grains without gluten is fine. Unfortunately, even relatively innocent grain proteins such as those found in amaranth or corn can trigger inflammation in those who suffer from celiac disease and NCGS, so it’s important to test them.
Properly Preparing Grains
Most traditional cultures soak, sprout, or ferment grains prior to cooking and consuming them. These preparation methods break down the antinutrients in grains, which makes them much easier to digest. It also means the nutrients in the grains are better absorbed.
To soak grains—which is the easiest preparation method—all you need are filtered water, an acidic medium like apple cider vinegar, and time. This is a super-easy process! Simply place grains in a glass bowl and cover with warm filtered water. (The water needs to be slightly warmer than room temperature in order to break down the phytic acid.) Add 1 tablespoon apple cider vinegar for every 1 cup water. Then cover the bowl with a paper towel and let it sit in a warm area in your kitchen. Most grains should be soaked for 12 to 24 hours; buckwheat, brown rice, and millet have less phytic acid than other grains and only need to be soaked for 7 to 8 hours. Before cooking, drain the grains in a fine-mesh strainer and rinse them. (Note: Grains that were soaked will typically cook faster than grains that weren’t.)
WEEK 3: REFINED SUGAR
If you consumed high quantities of sugar before, you probably noticed some huge changes during your 4×4. Once your blood sugar levels stabilized, your cravings may have decreased, your mental health improved, and your energy level increased (though sometimes this comes after a short period of fogginess, moodiness, and/or dizziness while the body adjusts). If you noticed significant changes and as a result have no interest in reintroducing refined sugar, that is A-OK! Simply skip this week and move right on to week 4. Long-term, you can continue to use natural sweeteners, such as those here, to sweeten foods.
If you do choose to add sugar back into your diet, you may notice subtler symptoms during your reintroduction. Dairy and grains largely impact gut health and inflammation. Sugar can impact those, too, but its most potent effects are on your metabolism, mental health, and general feelings of energy and wellness.
There is no real need to distinguish between different kinds of sugar during your reintroduction. If it is “refined” or “processed” sugar, it’s going to impact your body the same way. On reintroduction day 1, we recommend incorporating more isolated sources of sugar, such as adding coconut sugar to your morning coffee. On your second reintroduction day, you can include foods that contain added sugar, such as coconut milk ice cream or sweetened grass-fed yogurt (if you didn’t react to dairy during week 1).
WEEK 4: VEGETABLE OILS
In order to test this last category, we don’t invite you to bring a large container of soybean oil into your home. That would be unwise, to say the least. Instead, we want you to experiment with dining out however many times you want to on both reintroduction days. Go to a restaurant and get whatever you feel comfortable ordering, including foods that you’ve already reintroduced (but not ones you’ve decided are problematic). Or if you’d rather, get a premade meal at the supermarket. The point here isn’t necessarily to pinpoint the effects of vegetable oils, but rather for you to experience the difference between days that include dining out and days that don’t. We also want you to do your vegetable oil introduction at a restaurant because we really do not recommend bringing vegetable oils into your home. If you tolerate them, vegetable oils can be included in your diet sporadically but should never be reintroduced for use on a regular basis.
While reactions to vegetable oils typically aren’t pronounced, you may experience symptoms associated with inflammation, such as digestive distress, joint pain, acne, or anxiety. Long-term, we recommend cooking with and consuming stable, high-quality fats and oils, such as those listed here.
KNOWLEDGE IS POWER
The purpose of reintroduction is to teach you about the effects different foods have on your body. That way, going forward, you can make educated decisions about how you want to engage with certain foods. When faced with the option of dessert while dining out, for example, you could ask for a sorbet, which is dairy-free, if you know that dairy is a problem. Or, if dairy doesn’t bother you as much, you could go ahead and get the ice cream. You could also decide to abstain entirely, because you might hate how tired you feel after you eat a large dose of sugar. It is entirely up to you. Remember: All foods are available to you, and you get to make the choice about how and what you want to eat based on what you know works best for you.
After going through the 4×4 and reintroduction phase, you are equipped with knowledge about your body. Now you can go forth and utilize it as you see fit. We have provided you with the empowerment of familiarity with your body.
TROUBLESHOOTING
If you find that some of your symptoms still remain after the 4×4, there are a few other foods that may be at the root of your reactions. Depending on your symptoms, you may wish to experiment with eliminating the following:
SOY
Many different products are soy-based: tofu, soy milk, tempeh, edamame, and miso, to name a few, and soy is also a component in many prepared foods in the form of soybean oil. Soy may contribute to hormone imbalance in the body for both men and women. Men may experience low libido, mood swings, low energy, and even the development of breast tissue if they consume too much soy. Women may suffer from a wide variety of symptoms based on their personal physiology. Soy increases estrogenic activity in some tissues and decreases it in others. This can lead to menstrual cramps, ovarian cysts, fibroids, PMS, mood swings, acne, hot flashes, and disrupted sleep. (In some cases, if you have low estrogen, some soy may help. It’s best to work with a functional medicine practitioner if you are interested in using soy or other estrogenic compounds medicinally.)
Importantly, flaxseeds also have a high amount of estrogen-like compounds in them. They should be handled as carefully as soy.
Stefani’s Experience
I have a super-sensitive endocrine system. One of the results of this is that I am quite sensitive to the effects of soy and flax. One time I used a soy-based lotion and I became so depressed I cried for days. Now I regularly avoid soy and flax, and I have a much better grip on all the systems they affect in my body. My periods are so regular I can time them to the hour, my skin is so clear I often don’t wear foundation, and my mental health is no longer subject to dramatic swings.
NIGHTSHADES
Nightshades are fruits and vegetables that belong to the botanical family Solanaceae. These include tomatoes, potatoes, eggplants, sweet and hot peppers (but not black pepper), and chile-based spices (including paprika). Nightshades contain compounds (specifically lectin, saponin, and/or capsaicin) that can cause problems for some people. Those who are suffering from an autoimmune disease typically are the most sensitive to nightshades. If you find removing nightshades improves your symptoms, you may wish to consider following a diet plan tailored to people with autoimmune disease. We highly recommend The Paleo Approach by Dr. Sarah Ballantyne and The Autoimmune Wellness Handbook by Mickey Trescott and Angie Alt for managing autoimmunity.
FODMAPS
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The first word, fermentable, simply means what follows has the ability to ferment (specifically, in the gut). The rest of the words in the acronym are names of specific types of short-chain carbohydrates that aren’t completely digested in the small intestine. While that may sound like a bad thing, short-chain carbohydrates that aren’t entirely absorbed act as food for our resident gut flora. For some people, however, these short-chain carbohydrates ferment in excess in both the small and large intestines, causing gas, bloating, and abdominal pain. They also draw water into the large intestine, producing symptoms like bloating and diarrhea.
Foods that are high in FODMAPs include onions, garlic, asparagus, cauliflower, apples, cherries, peaches, pears, watermelon, gluten-containing grains, and dairy (to name a few). For a complete list of foods that are high in FODMAPs, go to http://coconutsandkettlebells.com/what-are-fodmaps.
If removing foods that are high in FODMAPs drastically reduces your symptoms, you likely have a FODMAP intolerance. While the causes of FODMAP intolerance can vary, it’s often because of dysbiosis (an imbalance of bacteria in the gut), or a condition known as SIBO (small intestinal bacterial overgrowth). Treating the root cause will often result in a reduction of symptoms.
EGGS
While eggs are an incredibly healthful food, egg whites are packed with allergenic proteins because they are responsible for protecting the yolk from pathogens while the embryo grows. This means that some people can develop an egg allergy, which can cause skin inflammation or hives, nasal congestion, and digestive symptoms such as cramps and diarrhea.
People with autoimmune conditions can also be sensitive to eggs. Egg whites contain a proteolytic enzyme called lysozyme, which has the unique ability to pass through the gut barrier. When this happens, lysozymes can “leak” other allergenic proteins found in egg whites into the bloodstream at the same time. For healthy individuals, lysozymes usually have little to no effect. Those with autoimmune conditions, however, tend to have exaggerated immune and inflammatory responses to eggs. This could mean a flare-up of any symptom associated with autoimmune diseases.
FREQUENTLY ASKED QUESTIONS
Naturally, many questions arise when you’re following an elimination diet like the 4×4. In order to smooth your transition and get you up and running on our plan as joyfully as possible, we’ve covered the most popular questions below.
WHAT DO I DO IF I STILL HAVE SYMPTOMS AFTER THE 4×4?
It is entirely possible that you will go through the 4×4 and reintroduction and still have unexplained symptoms. That’s okay—even normal. All it means is that you have an underlying condition that either needs more time or a more specific intervention to heal.
First, it may be that you simply need to eliminate the Big Four beyond four weeks. While four weeks is sufficient time for most people’s symptoms to subside, if you are dealing with a more chronic condition, it may take longer. We recommend trying the 4×4 for an additional one to three months to see if things resolve.
Second, there could be other foods that are causing your symptoms. Begin with the foods mentioned in the Troubleshooting section starting here. If you suspect one of those foods may be at the root of your symptoms, eliminate it for four weeks, then reintroduce it using the guidelines here. If your symptoms are associated with an autoimmune disease, two great resources for understanding food sensitivities are The Paleo Approach by Dr. Sarah Ballantyne and The Autoimmune Wellness Handbook by Mickey Trescott and Angie Alt.
Lastly, we recommend talking to a trusted medical practitioner (we are partial to functional medicine doctors because of their emphasis on identifying the root cause of symptoms) about your symptoms. You might be dealing with a specific nutrient deficiency or gut infection that needs a more targeted approach. It may take time to learn what’s happening in your body, but with careful research (and teaming up with a practitioner who is willing to help), you will be able to figure out what your body needs to be its healthiest.
WHAT DO I DO IF THE REINTRODUCTION PHASE IS INCONCLUSIVE?
If you have more questions after your reintroduction phase, the first thing to do is reset: Go back to what you knew felt good and right. Stay there, eating foods that you are certain feel good for you (or as good as you can manage), for at least two weeks.
Then try reintroduction again. But this time, depending on where things started to become inconclusive, reintroduce each food from a Big Four category one at a time. For example, if you reintroduced a few different types of dairy on reintroduction day 1 during week 1, only test one dairy product (for example, butter) on day 1, and eat one serving at each meal. Monitor your symptoms for two days, then try another dairy product (such as yogurt), and monitor your symptoms for two days again. Keep doing this until you are able to pinpoint exactly which type of dairy (or grain) bothers you.
During this time, hold as many variables as possible constant, from how many hours you sleep each night to how many grains of rice you have with dinner (a slight exaggeration)—everything counts. The steadier you hold the rest of your life, the better your results will be.
WHAT HAPPENS IF I EAT ONE OF THE BIG FOUR DURING MY 4×4?
Whether it was an accidental exposure or a decision made out of desperation, if you end up eating one of the Big Four during your 4×4, we have one very specific recommendation for you: keep going. The whole experiment hasn’t been derailed, we promise. Take this as a learning experience. Ask yourself, what caused you to deviate from the plan? Are there ways you can change your environment or your mind-set to help prevent that from happening in the future?
Also, take note of how you feel. Did you experience any symptoms after your slip? If so, that may feel unfortunate, but it also provides you with good information! This information could be so good and motivating that it could help you avoid the food you ate even more in the future (like if eating dairy gave you horrible diarrhea, for example).
WHAT IF I TRAVEL OR DINE OUT DURING THE 4×4?
While traveling and dining out may require some additional preparation, they’re not nearly as intimidating as they may seem at first glance.
When you travel, there are two things you can do: pack your own food in advance, or try to get food when you arrive at your destination. Which you choose depends a lot upon where you are going. If you’re going to be somewhere where a large grocery store will be hard to find, then it might be wise to pack your own nonperishable snacks beforehand. If you’re going to be traveling to a major U.S. city, however, you will probably have access to some great options once you get there.
If you’re traveling by car, you can simply pack a bag with nonperishable items (dried fruit, jerky, nut butters, canned wild salmon, Cinnamon-Toasted Coconut “Chips”, and nuts and seeds are all great options), and pack a cooler with whatever foods you’d like to eat for meals. If you are traveling by plane, you can pack nonperishable items in your suitcase and take a cooler bag with meals to eat on the plane as a carry-on (gel ice packs are allowed through security in the United States). Bring fresh fruit, some peeled hard-boiled eggs, or a salad with some meat on top, depending on how long your flight is. (Note: Food that is packaged with liquid (like canned salmon) will not be allowed through security.) Once you get to your destination, you can swing by the grocery store to get some additional snacks or food for meals before going to your hotel. Make sure your hotel room comes equipped with a small fridge to store any perishable food you purchase.
When traveling, don’t be shy about bringing things that make you feel your best. Bring a small jar of olive oil or travel packets of coconut oil. Bring your own salt. Bring your own treats, such as Almond Shortbread Cookies. Pack enough dried fruit to last you a week. We like to pack enough snacks to get us through our trip. Then, when we arrive at our destination, we find the nearest grocery store and stock up on nonperishables. (For packaged snack and meal bars that we love, check out the list here.) It’s pretty much like eating at home, but in a hotel room without a stove.
For dining out, you have two options: First, if you have control over where you will be going, do a quick Internet search for “farm-to-table restaurants” or “gluten-free friendly restaurants” plus the name of the city you are in. These buzzwords will typically yield search results that include restaurants that have high-quality food and offer options for those with food sensitivities. Once you’re at the restaurant, work with your server to figure out what the best option is for you. Second, you can’t go wrong with vegetables and meat. Sides like salads (ask for olive oil for dressing) and steamed vegetables, and entrées that are broiled or baked are a great place to start.
CAN I DRINK ALCOHOL DURING MY 4×4?
During your 4×4 and your reintroduction phase, it’s best to completely avoid alcohol. Alcohol can cause inflammation and disrupt gut flora, which can interfere with your reintroduction results. After your 4×4 and reintroduction period, reintroduce alcohol carefully and intentionally, as many forms of alcohol are made from grains. For example, beer is made from gluten-containing grains, so if you find you are sensitive to gluten, beer will also cause negative reactions. Some liquors, such as vodka and whiskey, are also typically made from grains (including gluten-containing grains). You may want to start with a gluten-free beer or a vodka made from grapes or potatoes.
WHAT IF I’M FEEDING A FAMILY?
Stefani lives alone, but Noelle’s got a husband and a child to feed. This makes Noelle’s situation more complicated than Stefani’s. While Noelle’s husband is completely on board with their food choices as a family, if he wants to eat something that Noelle is sensitive to (like dairy), he simply purchases enough for himself and eats it at his own will. Your family can operate the same way.
Before beginning the 4×4, we recommend proposing your plan to your family members—spouse and children alike. Tell them what you’re going to be doing and ask if they want to join. It’s possible they may want to try it too. Then all you have to do is start stocking your pantry for a full house and help whoever is responsible for the cooking (including you!) get the support they need.
If your family doesn’t want to get on board, that’s okay. It’s important to communicate why you are doing it, and to let them know you need their support. The better you feel, the better you will operate as a family. Many of the meals in this book are so good, your family won’t care whether they are free of the Big Four or not. So get them involved in choosing meals, snacks, and treats to cook while you’re doing your 4×4.
I’M ON A TIGHT BUDGET! WHAT DO I DO?
If you’re on a limited budget, you first need to figure out what your priorities are. We personally believe it’s best to prioritize eating high-quality animal products. This is important not just for the environment but also for the sake of your health. The most affordable way to do this is to buy meat directly from local farms or at farmers’ markets (see here for detailed information and resources regarding purchasing from local farmers). There are unique health benefits that come from consuming grass-fed meat as opposed to industrialized meat, such as a preponderance of vitamin K, which we discuss at length here.
If farmers’ market prices are still out of your budget, that’s okay. You can put local meat on a future wishlist, and in the meantime, simply buy conventional meat that has a very low percentage of fat. Toxins are stored in the animal’s fat, which can be problematic if the meat comes from animals raised in concentrated animal feeding operations (CAFOs).
If you can afford it, purchase organic produce—and if you can’t go all organic, try to buy a few fruits and vegetables from the organic section. When prioritizing which fruits and vegetables to purchase organic, use the Environmental Working Group’s “Dirty Dozen” list as a guide (see here). In general, buying organic becomes more important when you eat the peel or skin of a fruit or vegetable. It is worth noting, too, that frozen fruits and vegetables tend to be less expensive than fresh, and also have a greater nutrient content since they are flash frozen right after harvest. Frozen organic produce can be a great way to maximize savings while choosing healthful foods.
It also helps to buy produce and other plant-based products in bulk. Purchasing large containers of spinach, big bags of apples and onions, coconut oils and butters, and nuts and nut flours, for example, in bulk from wholesale clubs is astoundingly cheaper than purchasing individual items at the grocery store. Larger containers of oils and spices tend to be more cost-effective than smaller ones, no matter what kind of store you purchase them from.
More recently, online-based retailers like Thrive Market (thrivemarket.com) and Vitacost (vitacost.com) have exploded because they offer many natural products at reduced costs. Purchasing from these sites in bulk when additional discounts are offered (during holidays, for example) can get you all kinds of different products, such as sauces, nuts and seeds, nut butters and flours, and snack and meal bars, for relatively cheap.
CAN I FOLLOW THE 4×4 IF I AM PREGNANT OR BREASTFEEDING?
It is perfectly safe to do the 4×4 if you are pregnant or breastfeeding. Removing the Big Four only cuts potentially problematic foods from your diet for a set period of time. As long as you are eating sufficient calories and maintaining a macronutrient ratio that works for you during your 4×4 (see here for more information on this), your body will be well nourished. During your 4×4, we encourage you to track your calories and macronutrients to make sure you are eating enough. It’s easy to unintentionally eat less—especially when you are busy—because you are no longer consuming hyperpalatable foods. Of course, because pregnancy and breastfeeding often make life more stressful and complicated, we encourage you to always prioritize your mental and emotional health. If at any time during your 4×4 you start to feel fatigued or drained (outside of the norm), discontinue the 4×4 and go back to eating however is most convenient for you.
IS IT OKAY TO EAT DESSERTS AND TREATS?
In short: absolutely. As long as a food is free of the Big Four, you can incorporate it into your 4×4. We are both fans of treats—and have no intention of depriving you of them. While you may be able to find some “paleo” treats at natural grocery stores, we recommend making your own treats using the recipes starting here. We’ve included everything from Salted Dark Chocolate Almond Butter Cups to Watermelon-Lime Gummies. All the recipes include nourishing ingredients and are free of the Big Four.
WHAT IF I AM A VEGETARIAN?
If you are a vegetarian, you can still do the 4×4. All the vegetarian recipes in this book are labeled as such; however, there are only a few main dishes that do not include meat. For this reason, we recommend having a few other vegetarian dinner recipes on hand when completing your 4×4. The best way to find vegetarian recipes that are 4×4-friendly is to search “paleo + vegetarian recipes” online.
Both of us spent many years (almost twenty between the two of us) as vegetarians because we believed it was healthier. But when looking at the research, we realized almost all the research that shows red meat is “bad” comes from observational studies, which do not prove causation. Additionally, these studies have absolutely no regard for the quality of the meat, and almost all the people who participate in these studies are consuming red meat sourced from CAFOs. (See here for more information about meat quality.)
We believe the most healthful way to eat is to include high-quality animal products such as meat, fish, and eggs in your diet. Important nutrients, such as EPA and DHA, found in fatty fish; heme iron (which is more absorbable than the iron found in plants), found in beef and other ruminants; choline, an important B vitamin found mostly in eggs; and notably vitamin B12, which is crucial for survival, are not found in plant products.
If you are passionate about the environment, sustainability, and the humane treatment of animals, as we are, consider getting involved in the world of what esteemed sustainability farmer Joel Salatin calls “grass farming.” While CAFOs absolutely have a negative impact on the environment, grass farming has the opposite effect. Grass farming is based on the tenet that the diet of all the animals on a farm should be based on grass. When a farm is run as a grass farm, cows eat the grass, then the herd is rotated. Chickens come in behind the cows and peck through the manure, eating the fly larva, sanitizing the manure, and spreading it around. The grass is then able to rest, rejuvenate, and grow strong again. This type of farming not only results in the animals living a protected and productive life exactly how they were supposed to (birds follow omnivores in nature); it also doubles and triples the amount of biomass that grows. The more biomass that grows, the more carbon is moved from the atmosphere safely into the earth, since plants consume carbon dioxide as food. (For more information on this process, we recommend visiting Joel Salatin’s website, polyfacefarms.com, and our friend Diana Rodgers’s website, sustainabledish.com, where you can listen to her podcast.)
If you do choose to be vegetarian, we completely respect that. Long-term, in order to make sure you do not develop nutrient deficiencies, we suggest you supplement with vitamin B12 or a high-quality B-complex vitamin, as well as algal DHA (or better yet, if you are willing, a high-quality extra-virgin cod liver oil supplement). Be sure to also get enough protein. You can do so by consuming eggs, dairy (if you tolerate it well post-4×4), and/or high quantities of legumes.
WHAT IF I FEEL TOO FULL ON 2,000 CALORIES A DAY?
For most women, 2,000 calories a day is a great place to start. But if it’s not right for you, that’s okay. We understand that all bodies are different, and you may need fewer calories due to your build, height, and current lifestyle, for example. If you feel overfed or overstuffed eating 2,000 calories a day, you can slowly ramp down your caloric intake until you no longer feel too full, but also don’t feel hungry. When doing this, we invite you to err on the side of eating more rather than less. Your caloric need may shift down and up at different points in your life according to your individual needs, so don’t get hung up on the idea that you need “only” 1,800 or 1,500 calories a day because that’s what you’ve always eaten or that’s what some diet said to do. If you find that your appetite and needs are definitely for fewer than 2,000 calories a day—and not because you are lying to yourself and actually just trying to get lean the quick and unsustainable way—then listen to your body and give it what you think it needs.
WHAT ABOUT MEAL TIMING?
Eating three square meals, six small meals, or most of your calories in the morning are all ways you can eat food and be healthy.
That’s right—there is literally no research that shows you cannot eat at whatever time you like and still be healthy. In fact, while many experts say to eat less at night or stop eating by a certain time, there are no studies that show eating at night is more likely to make you gain weight when compared to eating the exact same food earlier in the day.
Yes, we know that studies have demonstrated, for example, that people who eat breakfast are leaner and have more robust circadian rhythms. But there are so many confounding variables: people who eat breakfast may be leaner simply because they are more conscientious eaters, or because they get more sleep, or because they eat more calories (and nutrients) overall. There is not much reason to really believe that you must eat breakfast in order to be healthy. It may help, but you can be healthy with alternative eating patterns, too.
The key to being healthy is taking care of your own needs. Everybody’s “cure” is different. Many people’s “cures” are complete opposites. Some people may be helped by cutting back on carbohydrates, but other people might really need to add them to their diet. The same thing goes for the way in which you eat. Some people might feel really great and suffer no adverse symptoms when they fast intermittently. Others really suffer. Women who are recovering from hypothalamic amenorrhea (a condition that occurs when the body feels over-stressed or under-fed) or who are trying to get pregnant are great examples of those who should never regiment their meal times and should simply eat when they want to.
Personally, we both have tried various eating schedules. These days, Noelle is a big-time snacker. She carries snacks with her literally wherever she goes. She refuses to be hungry and therefore always keeps good fuel on hand. Stefani likes to work long hours, so she’ll often eat two to three square meals a day or go a long time without eating (though not always).
So go ahead and eat on the schedule that works for you. Three meals with an occasional snack is a good place to start. But don’t worry at all about deviating—you know what’s best for your body.