After using the Elimination Diet for more than a decade to help people of all ages, backgrounds, and symptoms, I’ve encountered just about every question and issue there is. Hopefully, the answers provided here will help you make modifications or resolve any issues. If you’re still stumped, reach out to our website, WholeLifeNutrition.net, for our Elimination Diet resources.
Is it normal to have intense cravings for cheese, bread, sugar, and caffeine that border on drug-like addiction?
Yes, especially if you have a history of addiction in your family. There are compounds found in these foods or produced after consuming these foods that can have drug-like effects on your body. Cheese, interestingly enough, appears to be the worst offender. I have had clients dream about cheese, draw pictures of cheese, get anxious without cheese, get the shakes without cheese… it is really surprising how powerful cheese cravings can be.
But you don’t have to white-knuckle it along. Having a high concentration of antioxidant- and detoxification-supporting foods like broccoli sprouts, kale, and radishes can help. So can Epsom salt baths and supplementing with a high-quality multivitamin.
My best advice if you’re having cravings is to hang in there. Symptoms are usually worse in the first four to six days and get better soon after that. If your caffeine headaches are unbearable, you may want to wean yourself off with green tea (see here).
Yes, this is normal for some people. As the gut detoxes, gut microflora changes. Your body may take some time to adjust.
For some people, especially those with severely damaged guts, the gas and bloating could be caused by bacterial imbalances, fructose intolerance, gastric acid insufficiency, or a pancreatic enzyme deficiency. We recommend removing apples, pears, dates, beans, cherries, watermelon, asparagus, avocados, garlic, onions, and cauliflower for a period of time to see if your symptoms improve. If your symptoms persist, see the recommendations below.
When it comes to fruits and gas, FODMAP avoidance is key. See the next question for more on FODMAPs.
What is the FODMAP diet and do I need to follow it?
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polylols. These are all forms of carbohydrates that are more readily fermented by bacteria. Easily fermented carbohydrates have been shown to contribute to SIBO.
If you have gas, bloating, diarrhea, or “gooey poops” after you eat pears or drink apple juice, you can first try to reduce the quantity of fruit smoothies you are drinking at any given time. If you are drinking 16 ounces now, cut that amount in half to 8 ounces and see if that helps. The next step is to take out foods high in FODMAPs for a while and see how you feel.
FODMAP reactions are most often temporary and will go away once your intestinal flora have been balanced out. Reactions usually occur when you eat too many foods rich in fermentable carbohydrates at one sitting. For example, you might tolerate a quarter of an apple before having a reaction, whereas half of an apple might bring back the bloating.
Here is a list of common foods on our program that have FODMAPs in them. These are to be avoided if you have symptoms of bloating, gas, nausea, diarrhea, and/or constipation that are persisting. (Note: You will have already eliminated some of these foods during the Elimination Diet):
Vegetables: onions, cauliflower, beets (root), asparagus, garlic, sweet potatoes, mushrooms
Fruits: apples, avocados, mangoes, pears, watermelon, nectarines, apricots, blackberries, cherries
Grains: quinoa, brown rice and rice flour, white jasmine rice, rice noodles, and quinoa pasta (corn-free) are okay to eat. The highest FODMAP grain is wheat. Other grains that include high levels of FODMAPs are rye, barley, and spelt. Note that none of the grains used in this Elimination Diet program contain FODMAPs, so they are okay to eat if you suspect a FODMAP sensitivity.
Legumes: garbanzo beans, black beans, adzuki beans, more than ½ cup lima beans
Nuts: almonds, cashews, pistachios
Dairy: Lactose from dairy products is a high-FODMAP food.
You can also download the FODMAP app from researchers at Monash University in Australia, where the FODMAP diet was created. It’s available online at www.med.monash.edu/cecs/gastro/fodmap.
What is Starch Maldigestion and what can I do about it?
Foods such as potatoes, whole grains, and legumes contain long chains of sugars in them called starches. Our intestinal cells can only absorb single sugars so our bodies have to break these chains apart before we can absorb and use them. Proteins called enzymes secreted from our saliva and pancreas break the bonds in the chains of sugars until small pairs of two sugar molecules called disaccharides are left. The last and possibly most important step of breaking these into single sugars is left to enzymes located in the wall of the intestines. Problems arise when these intestinal enzymes can’t do their job. Many things that irritate the intestines or leave it susceptible to damage, such as food sensitivity reactions, toxins, bacteria, parasites, stress, and poor nutrition can impede the activity of these enzymes. Interestingly, there are some populations that have less production of these disaccharidase enzymes to begin with. For example, a 2011 article in the journal PLoS One demonstrated that autistic children were more likely to have lower disaccharidase levels in the intestines and an imbalance in bacteria as well. Without this enzyme activity that frees up the sugars for absorption into the body, these pairs of sugars (dissacharides) get digested and consumed by local bacteria. The bacteria can then overgrow, leading to further irritation of the intestinal wall. These undigested particles can also cause a release of fluid from the intestines as an attempt to flush them out. The resulting symptoms people can experience include gas, nausea, bloating, cramping, and diarrhea. Starch maldigestion may eventually then lead to SIBO (see below).
If you experience these symptoms, or have the diagnosis of inflammatory bowel disease (Crohn’s and ulcerative colitis) or irritable bowel syndrome, you may benefit from doing an elimination diet that excludes all complex starches.
To modify the elimination diet for starch maldigestion, remove all whole grains (brown rice, white rice, wild rice, quinoa, whole grain flours) and all legumes. Additionally, you must remove other complex starches such as sweet potatoes and yams, maple syrup, tapioca flour, arrowroot powder, seaweeds, flaxseeds, and chia seeds. Your diet will consist of animal proteins, fats, vegetables, fruits, seeds (pumpkin and sunflower), and small amounts of raw honey and dates to allow the intestines to fully heal. After the gut is totally calm you can enter Phase 3 and begin to challenge foods. Keep out sugar, corn, soy, yeast, dairy, and gluten until the very end of the Phase 3. All other challenge foods are safe for someone following the starch maldigestion variation.
What is SIBO (Small Intestinal Bacterial Overgrowth) and what can I do about it?
More and more people are suffering from distention and bloating after eating. This can be a sign of having an overgrowth of bacteria in your small intestines. Partner those symptoms with nausea, cramping, diarrhea, constipation, or alternating diarrhea and constipation that persists for over three months, and chances are quite high that you may have SIBO.
Normally, the upper intestinal tract has very little bacteria in it compared to the lower intestines. While the colon is a cauldron of bacteria teaming with trillions upon trillions of organisms, the upper intestinal tract is relatively vacant in comparison. There are multiple things that assure that this area is kept clear of too many organisms.
Adequate digestion of food by stomach acid, pancreatic enzymes, and intestinal “brush border” enzymes allow food to be in small particles that are easily absorbed by the body. If the foods are not digested properly, they can be consumed by bacteria and contribute to their colonization and growth in the upper intestinal tract.
Muscle contractions called the migrating motor complex squeeze the contents of the upper intestines and force them to travel along toward the lower intestines. This sweeps out undigested food and bacteria in the upper intestines approximately 4 hours after food is eaten.
Vitamin D assists intestinal cells in secreting their own version of antibiotics called antimicrobial peptides that kill off harmful bacteria that try to colonize along the intestinal surface. Healthy intestinal cells also secrete immunoglobulins (immune system antibodies) that attach to bacteria and stop them from causing harm.
When a person has low stomach acid, low pancreatic enzyme and bile secretions, poor secretion of protective immunoglobulins from intestinal cells, low migrating motor complex function, and low vitamin D, they are more likely to have undigested food in the upper intestinal tract and SIBO. Add in damage to the intestinal tract by toxins, a poor diet, stress, and nutrient deficiencies, and SIBO can become severe.
There are a few things you can do to help you turn the corner and most of them have already been mentioned in this book.
1. Find the foods that are irritating your intestines by doing the elimination diet.
2. Check your gastric acid secretion and use a betaine HCL supplement with meals if it is low.
3. Look for signs of fat malabsorption and take digestive enzymes if necessary.
4. Leave adequate time between meals (approximately 4 hours) unless you have been diagnosed with hypoglycemia.
5. Check your vitamin D levels and start supplementation if necessary.
6. Eating recipes rich in mushrooms appears to increase immunoglobulin A (IgA) from the intestinal cells, which has been shown to keep bacteria from entering the intestinal lining, thereby protecting the gut wall from damage.
To modify the elimination diet for SIBO, follow the starch maldigestion and low-FODMAP variations mentioned previously. When severe, SIBO can require intense interventions. Treatment options for SIBO include antimicrobial herbs (high dose garlic and berberine), elemental diets, and antibiotics. For proper testing and treatments for SIBO, go to SIBOinfo.com.
I’m afraid not. No coffee is allowed, only herbal teas. Try chamomile, mint, ginger, raspberry leaf, and nettle teas. You can add back coffee and other teas at the end of Phase 3: Reintroduction. Caffeine is a stimulant and affects liver detoxification.
Some people get terrible caffeine headaches, cravings, and irritability that are so bad they discontinue the diet. If you are finding your caffeine withdrawal to be unbearable, have a cup of green or white tea. You can add a little honey if you like for an extra antioxidant and immune-boosting combination.
If you reuse the tea bag for a second cup, you will get even more antioxidants and less caffeine. Make sure you drink plenty of fluids, eat broccoli sprouts, take Epsom salt baths, and have some activated charcoal on hand to lessen these symptoms.
What about herbs and spices—can I have those?
Yes, you can have dried herbs and spices that are gluten-free, additive-free, and preservative-free. Please check with the manufacturer to make sure they are processed in a gluten-free facility. As was mentioned earlier, we highly recommend organic spices. Of course, all fresh herbs are in.
When can I add regular vinegar? I don’t see it on the list.
Keep all vinegars, except for raw organic apple cider vinegar and coconut vinegar, out of your diet until after you challenge yeast in Phase 3: Reintroduction. Vinegar contains yeast and this is why we keep it out until the end of the diet. Raw organic cider vinegar and coconut vinegar seem to be tolerated by most.
Fermented foods like vinegar may contribute to headaches and/or anxiety in some people with sensitivities to amines.
When can I add vanilla?
Add alcohol-extracted vanilla during the reintroduction phase when you challenge alcohol. Non-alcoholic vanilla can be used during all phases. We prefer to use raw organic vanilla powder in many recipes, which is suitable for all phases.
Fermented foods are high in histamine, which can contribute to headaches, anxiety, or even aggression in some susceptible individuals. If you notice a pattern in your food journal with some of these symptoms and fermented vegetable consumption or vinegars, then omit them from your diet.
I find that sometimes I can tolerate a certain food while other times I cannot. Can you explain?
Sometimes we are able to tolerate only a small amount of a particular food with no reaction. Other times you consume that food you may eat more than your body can handle and so you will have a reaction. Another reason for varying responses to food has to do with what’s going on in the intestines at the time of eating the food. If your intestines are calm, your microbes are balanced, and you have plenty nutrients around to lessen your immune response (vitamin D, essential fatty acids, Meriva, etc.…), a food may be less troublesome. If any of those factors are out of balance in that moment, you are more likely to have a reaction. As you read in Part 1 of this book, environmental toxins may throw off many of these factors.
Is this an anti-candida diet?
No. Although this Elimination Diet will assist in lowering the growth of the troublesome yeast known as Candida albicans, it was not designed with that intention in mind. Candida albicans thrives in an intestinal environment lacking in beneficial microbes and vegetables and full of junk food. The Elimination Diet is far from that.
Can I drink kombucha on the diet?
No, although kombucha may be well tolerated and beneficial to health for most people, some individuals may not react well to the yeasts. Additionally, depending on many factors, some of the sugar and caffeine may still be present in the brew. Wait to add kombucha back into your diet until after you have challenged yeast and cane sugar.
Cheating will drastically affect your results. I had the privilege to interview world-renowned gastroenterologist Alessio Fasano in 2013. During the interview, he said “100 percent effort equals 100 percent results. Ninety-nine percent effort equals 0 percent results!” Unfortunately for would-be cheaters, the tiniest bit of irritating food can set off your immune system for weeks. And this makes perfect sense. Your immune system is designed to react to minute bacteria and viruses. Once you are exposed to them, your immune cells will stay excited in case they need to continue battling them. This will make it impossible to pinpoint the full list of foods that works and doesn’t work for your unique body chemistry. Long story short: Cheating will completely change your results of the Elimination Diet.
Why do you leave out agave?
When fructose is eaten with a similar amount of glucose as is common in most natural foods, both of the sugars are fairly well absorbed. When the ratio of fructose is much higher, the fructose is not well absorbed and can lead to symptoms of gas, bloating, and diarrhea. Agave is very high in fructose (between 60 and 90 percent of the sugar in agave is fructose), unlike other sugars that have a more balanced ratio of fructose to glucose.
Can I put my child on the Elimination Diet?
Children who are having problems with attention disorders, eczema, stomach upset, asthma, ear infections, and keeping weight on can benefit greatly from this program. The most important aspect of making this diet work for children is to make sure they are eating enough.
To do this, skip phase 1—the two-day detox—and move right into phase 2. Foods featured in the Detox Phase can still be consumed, but should be eaten in balance with other foods. For example, your child can still enjoy the green smoothies from phase 1; I just do not advise that they fast on them. Follow phase 2 for a full fourteen days.
For children with less severe issues, such as mild cases of eczema, asthma, or bowel problems, it is possible to modify the diet further to make it simpler and easier to follow. Since you’ll be starting with the Elimination Phase, you’ll want to focus on getting all the processed foods out of the diet as well as removing all sources of gluten, dairy, eggs, corn, soy, and yeast. You can keep in nightshade vegetables, nuts, and some citrus (only lemons and limes), as well as sesame, beef, and pork (make sure it is pastured/organic).
If your child does not respond to this and is still having gut-related issues, then remove all grains, legumes, and starchy vegetables from the diet (potatoes, sweet potatoes, yams). Make sure you are supplementing with digestive enzymes and a high-quality probiotic (see Resources here for recommendations).
Can I do the diet while pregnant?
Yes, absolutely. The key to following the Elimination Diet during pregnancy is to make sure you are consuming enough calories. As a result, you may want to do a less restrictive version of the Elimination Diet that allows you to keep in some common calorie-dense foods. Keeping in access to all nuts, seeds, pork, beef, nightshade vegetables, and citrus will assist you in meeting these needs.
Doing the Elimination Diet during pregnancy can have a tremendous benefit for your unborn baby. If your gut is being affected by an unknown food sensitivity, then you might not be able to absorb all of the key nutrients needed for growing a healthy baby. Both calming the gut and discovering your food sensitivities are key.
To modify the Elimination Diet for pregnancy, we recommend skipping the restrictive two-day detox (phase 1) and jumping right into phase 2. But since the phase 1 recipes are incredibly healing and nutritionally dense, include all of the phase 1 recipes in your diet during the entire program.
All of the recipes in this book are full of the key nutrients needed for a healthy pregnancy, so know that by going on this diet you are giving your unborn baby a tremendous gift of health right from the start.
Please note that it can be extremely difficult to follow the Elimination Diet during pregnancy if you are vegan or vegetarian—this is likely to limit dietary choices too much and may put your baby at risk for not getting adequate nutrients. If you are vegetarian or vegan, you may want to try a gluten-free and dairy-free (if you are not already vegan) diet during this time instead, and supplement with calcium and vitamin D.
Can I do the diet during lactation?
Many lactating mothers choose to follow an elimination diet if their breastfed baby is experiencing chronic colic, reflux, skin irritations like eczema, as well as ear infections. If a mother’s gut is out of balance and leaky, large food proteins can pass through undigested into her breast milk.
To modify the Elimination Diet for lactation, skip the first two-day detox (phase 1) and jump right into phase 2. Incorporate phase 1 recipes into your daily meals. Keeping in access to all nuts, seeds, pork, beef, and nightshade vegetables while breast-feeding will help you meet the extra calorie demands while on the Elimination Diet.
However, you may need to modify our diet even further and avoid things like raw garlic in salad dressings and raw kale and other cruciferous vegetables if your baby is very gassy.
All babies are different—some thrive off breast milk from moms who consume raw garlic, broccoli, and dairy products while other babies can get very irritated. Here are some foods that can irritate a newborn baby and cause colic:
The best way to determine what’s upsetting your baby is to follow an elimination diet with the modifications listed. Be sure to journal or document how your baby responds to foods as you reintroduce them to your diet.
I’m an athlete—will this diet provide enough nutrients and calories?
Absolutely. Ultramarathon runners, Crossfit competitors, and other extreme athletes have completed the Elimination Diet. Just make sure you are eating an adequate amount of calories while on the program. This may mean eating lots of extra snacks, and larger meals to accommodate your needs.