9

PHASE 3:

Reintroduction—Days 15 and On

You’ve made it to the Reintroduction phase—congratulations! If you’re like most of my clients, the past couple of weeks have probably been transformational for you. Many of my clients tell me that they never knew they could feel so good. They had been living with chronic inflammation and uncomfortable symptoms for so many years that they believed that was normal for them. After two weeks of eating healing foods and avoiding reactive foods, I hope you’re enjoying your new normal, too! Think of the great gifts you’ve given yourself by following this program: a calm, cool immune system and a replenished, balanced intestinal tract. You’ve lost weight, reduced inflammation, and have lessened or eliminated symptoms like bloating, bowel upset, joint pain, fatigue, and perhaps many others.

Now it’s time for the truly exciting part of the Elimination Diet—over the next few weeks, you are going to create a customized diet for yourself. You will learn which foods work for your unique body chemistry, and which don’t. During this phase, you will add foods back in, one by one, to see if you are having a reaction. Reintroduction includes two basic steps—first, you’ll test a food, and then you’ll document any reaction. From there, you’ll move on to the next food. If this sounds complicated, don’t worry; I’ll walk you through the process step by step.

Before you begin phase 3, reintroducing potentially triggering foods, I want you to take an honest inventory of how you’re feeling. Answering these questions will help create an even greater level of customization of the Elimination Diet (it will almost be as though you’ve come into my office for personalized treatment). Ask yourself these questions:

HELP—I’M STILL NOT FEELING BETTER!

If you have not experienced any symptom changes by day 15, it is time to pause and consider what might be behind your lack of success. Using the chart below, find your symptom and the steps you should take to help alleviate it. It’s highly recommended that you follow the steps outlined here until you experience relief from your symptoms (follow them in the order listed). If you reintroduce foods before your system is calm, you won’t know the true source of your reactions.

I am still experiencing: fatigue, joint pain, back pain, headaches, and/or foggy thinking.

Possible culprit: You could have missed a source of irritation or be lacking in key nutrients to decrease your symptoms.

Action steps:

1.  Check for cross contamination. Hidden sources of irritant foods are the prime reason clients don’t experience relief from these symptoms. Gluten, soy, and corn are likely to sneak into your diet unbeknownst to you. Visit our website, WholeLifeNutrition.net, to check out our Hidden Sources of Contamination page.

2.  Check for toxic exposures. Here are three things to consider that may be contributing to your inflammation:

image Nonorganic foods—especially meats.

image Personal care items: lotions, creams, perfumes, cologne, hair products, and so on that have irritant chemicals in them. See Endocrine Disrupting Chemicals (EDCs) here for more details.

image Household products: Dryer sheets, scented cleaning agents, pesticides, laundry and dishwashing detergent, off-gassing from new building materials (paints, furniture, flooring, etc.). Apply your diet detective skills to your environment. If you recall Jimmy’s story from chapter 4 (here), he felt better when he went camping. Has anything changed in your environment? Is there a time when you’ve felt relief from your symptoms?

3.  Look to the supplement section for additional nutrient support. A lack of vitamin D, essential fatty acids, and magnesium can impair the healing process, while supplementing with Meriva can reduce inflammation (see Supplements to Support the Elimination Diet here).

I am still experiencing: gas, nausea, bloating, diarrhea, constipation, and/or skin conditions.

Possible culprit: You may have an underlying deficiency in substances important to digestion, or an unknown intolerance to foods that aren’t eliminated during the first two phases of the diet.

Action steps:

1.  Test your gastric acid to see if you are deficient (see Test Your Stomach Acid here). If you are deficient, take betaine HCL.

2.  Try digestive enzyme supplementation (see here).

3.  Try berberine supplementation (see here).

4.  Eat a low-FODMAP diet (see here).

5.  Consider taking out all grains and beans from your diet.

6.  Get a breath test to identify small intestinal bacterial overgrowth (SIBO; see here).

HOW REINTRODUCTION WORKS

If you’ve determined that you’re ready to begin reintroducing foods, let me explain to you a little more about the process.

After two weeks of phases 1 and 2, your system should be very calm, which will make it very clear to you when you introduce a food that doesn’t agree with your system. When you reintroduce foods, you are challenging or testing trigger foods to see if you have a reaction. You are acting like a diet detective, searching for the source of your symptoms.

To challenge a food, you will eat the food two to three times a day for three days in a row. If at any time during the three-day period you notice a change in the way you feel, then you will remove the food from your diet and wait until your symptoms completely disappear before challenging the next food (this could take a few days or a week or more).

DON’T GIVE IN TO DENIAL

A common mistake is to write off the connection between foods and symptoms, in spite of the evidence. Many of my clients will work hard to convince themselves that it is not the food bringing their symptoms back. They’re so accustomed to thinking that it has to be something else that once made them feel similar symptoms. For example:

  • “My fatigue is probably just because I didn’t sleep well last night.”
  • “This congestion and nasal drip must be from a cold that is coming on.”
  • “I wonder if this joint pain is from all the gardening or exercise yesterday?”

If you have faithfully followed the phases of the program and the reintroduction of a food produces your symptoms, the food is most likely the cause. Here is the tried-and-true rule that has saved many of my clients months of time in doing another elimination diet: “When in doubt… leave it out!” The minute you notice the symptom, stop eating that food.

You must let your system return to a state of calm before testing another food, or you’ll risk inaccurate results. For example, if you have a reaction to dairy and you test gluten too soon after, your conclusion might be that you’re sensitive to both when really it could just be the dairy. If you cut corners here, you will risk landing right back into the same pool of symptoms with no clear answer to the cause. Being patient will prevent unnecessary long-term dietary restrictions.

Even if you don’t have a noticeable reaction, you must challenge only one food at a time to ensure accurate results. If a food does not cause a reaction during reintroduction, it is safe to keep in your diet for the rest of the program.

If a food causes a reaction, it should be kept out of your diet for at least three months before challenging it again. Remember to keep detailed journal entries of the Reintroduction phase, documenting times, dates, and specific physical or emotional responses (see here for more on how to keep a diet journal). Here’s a list of potential reactions to reintroduced foods:

YOUR REINTRODUCTION SCHEDULE

To make it easy to follow this program, here is a proposed schedule you can use to reintroduce foods. This schedule may vary depending on your food choices or known allergens. We recommend that you wait as long as possible to reintroduce dairy, gluten, soy, and corn, as many people react to these foods. They also tend to cause strong reactions, so that it may take a while (possibly weeks) for symptoms to subside before you can continue adding other foods back in. Make sure to track all of your symptoms in your Elimination Diet Journal; see here for an example, or download a free printable PDF from our website, WholeLifeNutrition.net.

You’ll notice specific days listed next to the foods—for example, citrus is suggested to be tested on days 15 to 17. These days are meant to be a guideline only. If you have a reaction to a particular food or foods and need to wait until reintroducing the next food, the calendar will shift. Also, if you see a food listed that isn’t part of your normal diet, don’t feel the need to test it just because it’s listed here. Simply skip that food and move on to the next. And remember that once you’ve tested a food and it’s proven okay for you—that is, it didn’t trigger a reaction—you can leave it in and continue to test other foods.

We’ve included suggested foods and recipes to try when you reintroduce each food. Starting here, you’ll also find suggested sample days with what to eat for each meal.

It’s recommended that you wait to challenge alcohol, coffee, and black tea until all of the previous foods have been reintroduced.

If you decide to add them in earlier, be sure to choose gluten-free alcohols and leave cream and sugar out until they are properly challenged.

1.  Citrus: Add freshly squeezed lemon and lime juice to smoothies and fresh juices for the first day of the citrus challenge; on the second and third day, all citrus is fair game so add items like oranges, tangerines, and mandarins. (It is really important to make sure your citrus is organic; otherwise, there may be chemicals on and in the citrus that will cause reactions.) (Days 15 to 17)

2.  Nightshade Vegetables: Make mashed potatoes; add diced potatoes to chicken soup; add bell peppers to stir-fries and soups; make a tomato-based marinara sauce and serve it over rice noodles or spaghetti squash; add eggplant to stews; snack on goji berries; use curry powder, chili powder, chipotle chile powder, and paprika now in your cooking. (Days 18 to 20)

NIGHTSHADE WATCH

Some people can react to one variety of nightshade vegetable and not another. If you’ve noticed an obvious connection between eating tomatoes, peppers, or eggplant and a flare-up of your symptoms in the past, it would be best to challenge each separately for three days. If you have not observed an obvious connection between nightshades and your symptoms, just test all nightshades as one group.

3.  Beef: Make the Nightshade-Free Beef Stew (here), prepare organic grass-fed steak, add ground beef to sauces or make burgers, make beef bone broths. (Days 21 to 23)

4.  Pork: Avoid bacon, sausages, or ham because of additives that can cause potential reactions; make slow-cooked pulled pork or pork chops, or make homemade sausage patties using ground organic pork and fresh sage. (Days 24 to 26)

5.  Sesame: Use organic tahini in salad dressings; or add sesame seeds to salads or stir-fries. (Days 27 to 29)

6.  Walnuts and Pecans: Toast raw walnuts and pecans in the oven for 15 minutes at 375°F and add them to fresh salads or Coconut-Quinoa Breakfast Porridge (here). (Days 30 to 32)

7.  Almonds: Eat organic almond butter with apple slices; soak raw almonds overnight to make Raw Vanilla Almond Milk (here) or to add to smoothies. (Days 33 to 35)

8.  Cashews: Use raw cashew butter and raw cashews in smoothies and desserts; try the Pumpkin Pie Chia Pudding (here). (Days 36 to 38)

9.  Peanuts: Use organic dry-roasted peanuts or fresh shelled peanuts and eat plain as a snack, or eat apple slices dipped in organic roasted peanut butter. (Days 39 to 41)

10.  Hazelnuts, Pistachios, Brazil Nuts, and Macadamia Nuts: Eat organic nuts as snacks or add to salads or meals. (Days 42 to 44)

11.  Sugar: Use organic cane sugar in baking in place of coconut sugar, or added to herbal tea. (Days 45 to 47)

12. Chocolate: Use raw cacao powder or cacao nibs and add to smoothies or make Chocolate Zucchini Cupcakes (here). (Days 48 to 50)

13. Corn: Use fresh organic corn on the cob or organic frozen corn kernels. (Days 51 to 53)

14. Soy: Use organic wheat-free tamari, tofu, and tempeh. (Days 54 to 56)

15. Yeast: Add nutritional yeast to salads, soups, and sprinkle on main dishes; use baker’s yeast and make gluten-free rice bread (see here); and use other organic vinegars such as balsamic and red wine vinegar. (Days 57 to 59)

16. Eggs: Pastured and organic is ideal—make scrambled, hard-boiled eggs or baked into muffins—try the Sweet Potato Spice Muffins (here). (Days 60 to 62)

When you are ready to test the following foods that are more likely to cause a reaction, wait until at least day 50 and follow these guidelines:

17. Dairy: Use plain organic yogurt, organic raw whole milk or cream, and organic sour cream. (Days 63 to 65)

18. Gluten: Use organic sourdough rye bread (French Meadow Bakery makes one that you can purchase in the frozen section of your local health food store) or pearled barley. (Days 66 to 68)

19. Wheat: Use organic whole wheat berries and flour to test for wheat; add in other gluten-free grains and lentils once you have challenged gluten. (Days 69 to 71)

NOTE: Some people may have reactions to wheat but not to gluten. By testing the gluten reactions with rye and barley first, you can determine if you react to both.

Wait to challenge alcohol, coffee, and black tea until all of the previous foods have been reintroduced.

PHASE 3: REINTRODUCTION MEAL PLANS AND RECIPE LIST

As you prepare to reintroduce foods, use these sample days to plan your meals. Revisit these at least a couple of days before you’re set to test each food. Make sure you’re stocked with all the ingredients you need to make the appropriate recipes for each challenge food. Remember that you will be challenging these foods over a three-day period, so get creative with your menu plans.

Recipes for all meals are found in chapter 11.

Citrus

Breakfast: Very Berry Chia Smoothie, with the juice of 1 to 2 lemons or limes added

Lunch: Raw Kale Salad with Lemon and Garlic with sautéed organic chicken breast or cooked wild salmon

Snack: Avocado-Mint Mini Tarts

Dinner: Black Bean, Yam, and Avocado Tacos, served with lime wedges

Nightshade Vegetables

Breakfast: Sweet Potato–Kale Hash with variation

Lunch: Summer Vegetable Soup

Snack: carrot sticks, red bell pepper slices, sprouted pumpkin seeds

Dinner: Whole Roasted Chicken with Rosemary, baked potatoes, steamed green beans, organic baby green salad greens with Creamy Sunflower Seed–Parsley Dressing

Beef

Breakfast: Turkey, Kale, and Carrot Hash made with ground beef instead of turkey

Lunch: Roasted Delicata Squash Salad with Apples and Toasted Pumpkin Seeds topped with leftover cooked salmon or sliced grilled steak

Snack: Green Cleansing Juice

Dinner: Nightshade-Free Beef Stew

Pork

Breakfast: 2 organic pork breakfast sausages, 2 cups Strawberry-Kale-Mint Smoothie

Lunch: Mung Bean, Zucchini, and Dill Soup

Snack: apple slices and pumpkin seed butter

Dinner: organic pork chops, whipped sweet potatoes, steamed green beans

Sesame

Breakfast: 2 to 3 cups Ginger-Berry Smoothie

Lunch: Adzuki Bean and Rice Salad made with cold-pressed sesame oil and topped with toasted sesame seeds

Snack: Hummus (homemade only) made with tahini and fresh carrots

Dinner: Vegetable Chicken Bake, Raw Kale Salad with Lemon and Garlic sprinkled with toasted sesame seeds, Roasted Root Vegetables

Walnuts and Pecans

Breakfast: Coconut-Quinoa Breakfast Porridge topped with chopped raw pecans

Lunch: Turkey Vegetable Soup

Snack: handful of raw walnuts and a few Medjool dates

Dinner: Herb-Roasted Wild Salmon, Roasted Delicata Squash Salad with Apples and Toasted Pumpkin Seeds topped with lightly roasted raw walnuts or pecans

Almonds

Breakfast: Strawberry-Almond Milkshake, Coconut-Quinoa Breakfast Porridge

Lunch: Mustard-Herb Lamb Burger wrapped in a lettuce leaf with cucumber slices, fresh mint leaves, and a dollop of Coconut Sour Cream

Snack: Almond Butter Cookies or apples dipped in roasted almond butter

Dinner: Turkey Vegetable Soup, salad made of leaf lettuce, grated carrots, roasted almonds, and Fresh Broccoli Sprouts along with your favorite Elimination Diet salad dressing

Cashews

Breakfast: Creamy Rice Cereal topped with fresh berries and Vanilla Cashew Milk

Lunch: Greek Chicken Lettuce Wraps

Snack: handful of raw cashews, fresh organic raspberries

Dinner: Baked Salmon with Cashew-Ginger Sauce served with baked sweet potatoes and sautéed kale

Peanuts

Breakfast: Banana Muffin spread with 2 tablespoons organic peanut butter (only ingredients should be peanuts and sea salt), 2 cups Pineapple Green Smoothie

Lunch: Turkey, Kale, and Carrot Hash

Snack: 2 handfuls of organic dry-roasted peanuts

Dinner: Sautéed organic chicken breasts, baked sweet potatoes, Grated Raw Vegetable Bliss Salad topped with crushed, roasted organic peanuts

Sugar

Breakfast: Creamy Rice Cereal sprinkled with organic cane sugar or organic brown sugar

Lunch: simple green salad with leftover roasted chicken or salmon and your favorite Elimination Diet salad dressing

Snack: Banana Muffin made with organic cane sugar instead of coconut sugar

Dinner: 2 chopped chicken breasts marinated in a sauce made from a few tablespoons coconut aminos, juice of ½ lime, 2 tablespoons organic cane sugar, fresh ginger and garlic, then sautéed in coconut oil. Serve with sautéed broccoli, onions, and bok choy over a bed of white or brown rice.

Chocolate

Breakfast: smoothie made from soaked raw almonds or raw cashews, water, frozen bananas, and raw cacao powder

Lunch: Turkey, Kale, and Carrot Hash

Snack: Chocolate Zucchini Cupcake

Dinner: Chicken Vegetable Soup

Yeast

Breakfast: slice of Chia-Rice Sandwich Bread spread with pumpkin seed butter or almond butter, 1 small banana

Lunch: sandwich made from 2 slices Chia-Rice Sandwich Bread, organic turkey slices, mashed avocado, organic Dijon mustard, and lettuce leaves

Snack: 1 to 2 cups Carrot-Cucumber-Ginger Juice

Dinner: Herb-Roasted Wild Salmon, baked sweet potatoes, large green salad served with a balsamic dressing (¼ cup extra-virgin olive oil, 3 tablespoons organic balsamic vinegar, 2 to 3 teaspoons pure maple syrup, 1 teaspoon organic Dijon mustard, ¼ teaspoon sea salt)

Eggs

Breakfast: Kale, Zucchini, and Egg Scramble, Celeriac-Rutabaga Hash Browns, few spoonfuls of Rainbow Kraut

Lunch: 2 hardboiled eggs with a green salad and your favorite Elimination Diet salad dressing

Snack: 1 Sweet Potato Spice Muffin

Dinner: Mung Bean, Zucchini, and Dill Soup

PHASE 3 RECIPES

In the recipe chapter (here), you’ll find several other recipes that you can try during phase 3. Here’s the complete list:

Ginger-Berry Smoothie

Berry Vanilla Milkshake

Strawberry-Almond Milkshake

Chocolate-Avocado Milkshake

Kale, Zucchini, and Egg Scramble

Mung Bean, Zucchini, and Dill Soup

Summer Vegetable Soup

Nightshade-Free Beef Stew

Almond Flour Tortillas

Carrot Breakfast Muffins

Sweet Potato Spice Muffins

Chia-Rice Sandwich Bread

Grated Raw Vegetable Bliss Salad

Raw Kale Salad with Lemon and Garlic

Raw Cauliflower, Lemon, and Leek Salad

Quinoa-Cucumber-Dill Salad

Chickpea Curry with Potatoes and Kale

Poached Salmon with Summer Vegetables

Baked Salmon with Cashew-Ginger Sauce

Greek Chicken Lettuce Wraps

Hummus

Lemon-Garlic Dressing

Cashew Ranch Dressing

Avocado-Mint Mini Tarts

Almond Butter Cookies

Chocolate Zucchini Cupcakes

Pumpkin Pie Chia Pudding

Raw Vanilla Almond Milk

Vanilla Cashew Milk

WHEN YOUR COMFORT FOOD IS DISCOMFORT FOOD

Some of our favorite comfort foods contain the top trigger foods. Mac and cheese, bread with butter, peanut butter and jelly sandwiches, ice cream, cookies fresh out of the oven, coffee, potato chips, doughnuts, mashed potatoes… they’re all loaded with some of the most common irritants. What do you do if your dietary detective work has revealed these foods are not the source of your comfort, but the cause of your discomfort?

Many of my clients are disappointed when they discover that their favorite foods don’t agree with them, but this is often balanced with the fact that they feel so much better by the time they figure this out. In many ways, it’s a relief to finally know the cause of the weight gain, mind fog, aches, and pains. And this empowering knowledge—that eliminating these foods will give them a new, healthier life—is enough motivation to keep them from truly missing those old, harmful favorites. When faced with the choice, “Do I want the suffering or do I want the foods?” they choose to pass on the foods.

If your reactions aren’t that bad, you might wonder: What’s the harm in indulging in problem foods every so often? I would warn you that even “mild” symptoms of skin flare-ups, bowel changes, mild fatigue, and sinus congestion indicate that your body is under attack by inflammatory signals. This background inflammation will leave you more susceptible for most diseases. The longer you consume foods that irritate your intestines and your body, the more likely you are to promote autoimmune and other diseases.

In people who react to gluten, small exposures can mean big problems. A 2001 article in Lancet authored by researchers with the University of Milano-Bicocca in Italy showed that people who had celiac disease and were not really strict in avoiding gluten were 600 percent more likely to die from a disease over a 30-year period compared to their counterparts who were very strict.

Additional research published in the Journal of the American Medical Association in 2009 by Dr. Jonas Ludvigsson and others echoed this finding, adding concern for those individuals with gluten intolerance as well. They found a:

  • 39 percent increased risk of death in celiacs who cheated on their diet
  • 35 percent increased risk of death in those with gluten sensitivity
  • 72 percent increased risk of death in those who had intestinal inflammation related to gluten consumption

In my personal experience with food reactions, I fought the truth for a while. I would eat burritos with a whole-wheat tortilla and think, “It’s whole wheat; it should be good for me! How could a whole food be bad for me?” Or I would often think: “Maybe I’ve grown out of it by now?” And yet every single time I ate gluten, diarrhea, joint pain, fatigue, and a foul mood would follow within 2 to 24 hours. It was like a hangover after a fun night out. As I got older, the pain and suffering worsened and I began to wonder… is it really worth it? I finally realized that eating the foods that irritated me was like banging my head against the wall and then wondering why my head hurt so much. It had to stop.

If the Elimination Diet reveals that you have food reactions, it’s completely natural to feel trapped and overwhelmed by it at first. But you should know that this feeling is only temporary—there is a brand new world out there for you, one filled with fantastic recipes, restaurants, and experiences.

Be sure to use all the wonderful recipes in this book and visit our community online to exchange ideas and share experiences with others. I used to curse my food sensitivities for limiting me so much socially. Now, I bless them for forcing me to find healthier foods that have brought my life to a completely new and incredible level. And along the way, I have been able to help thousands of other people reduce their suffering.