“If the patient has been to more than four physicians, nutrition is probably the medical answer.”
—Abram Hoffer, M.D., Ph.D.
If we had a drug that worked as effectively as an elimination diet, it would be the bestselling drug of all time. Food can be inflammatory; food can be healing. An elimination diet is simple: you take away foods that potentially cause inflammation and eat only foods that have a low possibility of provoking a reaction. This is also called a low-antigen diet. You eat this way for a minimum of two weeks to a maximum of three months and then begin adding foods back into your diet to see what provokes symptoms. Often the foods we are sensitive to are the ones that we least want to live without. When I hear someone say “I just couldn’t live without dairy,” then I’m pretty sure that’s one of the foods that may be hurting that person at the moment.
There are many types of elimination diets. The one in this chapter will work for about 80 percent of people. Yet there isn’t one perfect diet for all needs. In Chapter 13, you’ll find information on some of the other diets that work when the elimination diet doesn’t. If you have candidiasis or small intestinal bacterial overgrowth often a low carbohydrate diet will work better for you than the elimination diet. That’s why I recommend that you work with a nutrition professional if you aren’t sure.
To enhance this process, you may also want to have a blood test for food sensitivities. While many foods may be unmasked during the elimination-provocation challenge, others may remain hidden. Upon testing I often find foods that we just didn’t suspect.
If you suspect that chemicals, molds, or pollens are causing problems, you should also be screened for them. (Labs offer these tests either separately or as part of a complete screening package.) Sensitivities are rated from normal to severe reactions. In addition to a detailed readout documenting your personal reactions, most laboratories also include a list of foods that are hidden sources of the offending foods, a rotation menu, and other educational material to help you in the healing process.
Sometimes I recommend using a rice-based medical food while doing this elimination diet. It allows the diet to work more deeply and effectively. It’s not for everyone; read more about it in Chapter 18, “Cleansing and Detoxification.”
This diet is used to determine whether or not you have food allergies that may be causing some or all of your symptoms. During a period of two to three weeks you eliminate foods from your diet that are the most likely culprits. If your symptoms improve during the three-week period, you’ll carefully add foods back into your diet one at a time to see which foods may be triggering symptoms. You may want to keep dairy, eggs, and gluten-containing grains out of your diet for up to three months to get the best result. Make sure to read all labels carefully to find hidden allergens. Eat a wide variety of foods and do not try to restrict your caloric intake. If you find no improvement within three weeks either you do not have any food allergies or you have food allergies but there is yet another factor complicating the picture. There are no magical answers here; this is a journey of self-exploration and discovery. (At http://www.digestivewellnessbook.com you will find shopping lists, recipes, and more.)
Please read all ingredients carefully. You want to eat only those ingredients that are specifically allowed.
Rice: All types of rice are allowed, as are 100 percent rice cakes, 100 percent rice crackers, rice noodles, dry cereals (puffed rice cereal), rice milk (read all ingredients and do not use if it has corn or other prohibited ingredients), Crispy Brown Rice, 100 percent rice bread, and plain rice protein powder.
Additional grains: If desired you can add these specific grains: quinoa, buckwheat, millet, amaranth, teff, tapioca, and potato flour.
Fruits: All fruits are allowed except for citrus fruits. Avoid oranges, lemons, grapefruits, tangerines, tangelos, and any other citrus. Use fresh fruit or canned fruits in their own juices; you can also cook or poach fruits. You can drink diluted fruit juices. You can use a limited amount of dried fruit (unsulfured only). If you suspect candidiasis or small intestinal bacterial overgrowth, limit fruits or avoid them completely during these initial three weeks.
Vegetables: Use a wide variety. All vegetables except corn are allowed. If you have arthritis, you may want to also eliminate the nightshade family foods: tomatoes, peppers (green, red, yellow, chilies, cayenne, chili powder), eggplant, and potatoes. You can use vegetables any way you like: steamed, raw, juiced, roasted, in salads, stir-fried, and grilled.
Fish: All fresh, wild fish are OK. Canned fish is OK; for canned tuna choose a type that is packed in water. Avoid shellfish, swordfish, shark, tile fish, and king mackerel.
Poultry: Use organic chicken, turkey, duck, pheasant, lamb, quail, wild game birds, and so forth.
Nuts and seeds: Coconut, pine nuts, and flaxseeds are allowed.
Oils and fats: Choose sunflower, coconut, olive, flax, ghee. Use cold-pressed or expeller-pressed, or virgin olive oils only.
Sweeteners: Use sparingly; brown rice syrup, honey, agave, stevia, fruit sweetener, blackstrap molasses.
Beverages: Water is the best beverage. Also allowed are carbonated water (no flavorings), mineral water, seltzer, pure fruit juices without sugar or additives (dilute 50 percent with water), and herbal teas without caffeine. (Sometimes if it’s a deal breaker, I’ll allow black coffee, or black or green tea.)
Dairy substitutes: Rice milk and hemp milk are allowed.
Spices and condiments: Use salt in moderation, pepper, all herbs and spices either fresh or dried (without preservatives, citrus, or sugar).
If you are a vegetarian, replace fish with legumes. If not, please eliminate all beans for at least three weeks.
Examples of legumes include lentils, navy beans, black beans, split peas, and string beans. Dried beans should be soaked overnight. Pour off the water and rinse before cooking. Canned beans often contain added sugar or other potential allergens. If you want to use canned beans, look to health-food store brands.
The first two to three days are the hardest. It’s important to go shopping to get all of the foods you are allowed to have. Plan your meals and have a pot of rice available. Make a pot of vegetable soup. Make a large salad. Have planned leftovers.
Keep it simple.
Avoid any foods that you know or believe you may be sensitive to, even if they are on the “allowed” list.
Eat regular meals. You may also want to snack to keep your blood sugar levels normal. It is important to keep blood sugar stable. Carry food with you when you leave the house to avoid straying from the plan.
Try to eat at least five servings of fresh vegetables each day. Choose at least one serving of dark green (for example, broccoli, kale, spinach, collards) or orange (carrot, winter squash) vegetables, and if you can digest it, eat at least one salad daily.
Vary what you eat.
Generally, eat grains as whole grains rather than as flours in breads or crackers.
Don’t eat too many sweets. Replacing regular cookies with gluten-free cookies may not get you the results you are looking for, especially the first couple of weeks.
Buy organic produce when possible.
This is not a weight-loss program. If you need to lose or gain weight, work with your practitioner on a program.
Most people feel better and better each day during the allergy elimination diet. However, if you are used to using caffeine, you may get withdrawal symptoms the first few days, which may include headaches, fatigue, irritability, malaise, or increased hunger. If you find your energy lagging, you may need to eat frequently to stabilize your blood sugar levels (for thinking and energy). Be sure to drink plenty of water. If you lose too much weight on this diet, stop and find a clinician to help you troubleshoot.
Once you have completed two to three weeks on the elimination diet you can begin to add foods back into your diet. Keep a journal of all foods eaten and all symptoms. Be sure to add foods one at a time, one every four days. Be sure to test foods in a pure form: for example, test milk or cheese or wheat, but not macaroni and cheese that contains milk, cheese, and wheat! Eat the test food at least twice a day and in a fairly large amount. Often an offending food will provoke symptoms quickly—from 10 minutes to 12 hours. If this occurs, do not continue to eat the food. Many times you will eat a food one day and feel fine, but the second day you will notice that you are reacting to the food. Signs to look for include headache, itching, bloating, nausea, dizziness, fatigue, diarrhea, indigestion, anal itching, sleepy 30 minutes after a meal, flushing, and rapid heartbeat. If you are unsure, take the food back out of your diet for at least one week and try it again.
When you avoid symptom-provoking foods and take supportive supplements to restore gut integrity, most food allergies or sensitivities will resolve in four to six months. This means that in most cases you will then be able to again eat foods that formerly bothered you. In some cases, you will find that the allergy doesn’t go away. In this case either you must wait longer for it to heal or it is a “fixed” allergy that will remain lifelong.
It is advisable to return to your health practitioner for a follow-up visit to determine next steps. If you find allergies in too many foods, you may want to explore a four-day food rotation diet, described in Chapter 14.
You can find a more complete Elimination Diet with shopping lists and recipes at http://www.digestivewellnessbook.com.