CHAPTER 2
Contemplating the Right Elimination Diet and Support Strategies
One Size Does Not Fit All
When it comes to diet, one size does not fit all. There is no diet that is suitable for all people. Anthropological evidence indicates that the diets of the earliest humans were diverse depending upon where they lived, the season of the year, weather, and availability of food.
This is still true today. The three categories for human food have consistently included protein, fat, and carbohydrate; what has always varied are the specific choices within these categories and the relative percentages of proteins, fats, and carbohydrates.
Natural, Healthy Diets Around the World Are Diverse
There is no “standard” or “ideal” diet that is suitable for all people because natural populations throughout the world differ significantly in diet patterns, food sources, and food choices. The diet styles are based upon geographical location; availability of land and seafood sources; agriculture and aquaculture techniques; genetics and metabolism; cultural and religious customs; and individual food preferences. The outcome includes a wide variation in healthy natural diets with regard to relative intakes of proteins, fats, and carbohydrates. The range varies from carnivorous/paleo style (high animal protein and fat with low carbohydrate and fiber content) to vegetarian (no animal protein and low fat with higher carbohydrate and fiber content). There are numerous versions within this broad range in natural diets.
For all of these reasons, diets need to be flexible and suited to the individual.
The following are examples of how wide the diversity is with regard to diet categories among natural cultures throughout the world:
The intake and type of healthy fats that meet the needs of various cultures can range from 10% in some African countries to 50% t0 75% in Inuit populations and in Uruguay, Poland, Finland, and Denmark, all of which have significantly lower cardiovascular death rates.
• Low fat diets do not necessarily reduce cardio- vascular risk, and healthy fat diets can prevent cardiovascular death rates. France and Italy have a relatively high intake of healthy fats and cholesterol, yet cardiovascular death rates are among the lowest in the world and life expectancy is among the highest.
• The type of fat makes the difference. Instead of hydrogenated oils, deep-fried foods, and high intake of vegetable oils, the healthy fat diets tend to be higher in good fats such as omega-9-rich olive and avocado oils plus coconut oil and animal fats, omega-9, and a higher intake of omega-3 oils from seafood, algae, nuts, and seeds. For these reasons, there is no one standard for all populations with regard to the type of good fat to be consumed.
Carbohydrate intake throughout the world also varies significantly with regard to amount and type. The healthier carbohydrates in legumes (beans, peas, lentils, and peanuts), nuts, seeds, vegetables, fruits, and whole grains tend to be higher in vegetarian style diets and lower in paleo style diets. They keep blood glucose stable as compared to glycemic (sugar-raising) sweets, juices, and refined processed foods and grains—the intakes of which have significantly increased the rates of diabetes and obesity in contemporary populations.
Relative fiber intakes and sources of fiber (legumes, beans, nuts, seeds, vegetables, fruits, and whole grains) also vary throughout the world from 10 to 40 grams/day, the lowest intake being among the more carnivorous/paleo diets. Hence, there is little validity in establishing a dietary fiber intake recommendation for all individuals.
Protein intakes may include a range from paleo style (animal protein) diets to vegetarian style (plant protein) diets. Vegetarian diets may also include varied animal protein choices such as eggs (ovo-vegetarian), milk products (lacto-vegetarian), seafood (pesca-vegetarian), and combinations. The actual adult protein intake may vary from 40 grams/day to 70 to 130 grams/day.
There is no one diet that is suitable for every individual, given the diversity in relative intakes of protein, fat, carbohydrate, and fiber prevalent in ancestral and natural diets throughout the world. The previous USDA pyramids and the current USDA “My Plate” give the impression that grains and cow milk products are essential for humans, but this is not accurate. Although animal milk is one way to obtain protein and fat, and grains are one way to obtain carbohydrates, they are not essential to the diet. They are choices within the categories of protein, fat, and carbohydrate. Legumes, nuts, and seeds provide good protein, fat, carbohydrate, and fiber.
Elimination Diet Choices: How Do I Know Which Diet to Try for My Child?
Diets need to be individualized to the particular child. The underlying causes for reactions to specific foods are related to that child’s unique biochemistry and metabolism, imbalances, nutritional status, digestive ability, gut health, enzyme function, genetic variants, and more. Additional concerns include the common problem of limited food choices due to picky appetites, sensory issues around eating, and the impact of certain medications on appetite.
In selecting an elimination diet, it is important to focus on an organic, healthy, nutrient-dense diet described in detail in Chapter 3. It is glucose stable, and includes pastured animal source foods, while avoiding foods that are refined, processed, genetically modified, reaction provoking and foods that contain artificial additives, preservatives, coloring, flavoring, and contaminants. This “artificial stuff” places a significant burden on the individual’s immunity, metabolism, energy, behavior, and nutritional status. The healthy organic diet includes proteins, fats, and carbohydrates based upon the individual’s uniqueness and reactions to specific foods and food components. Removing the artificial burdens, improving the environment, and cleaning up the diet can result in noticeable improvements and allow for the appropriate elimination diet or diets to succeed.
A diet that works well for your child’s classmate or next-door neighbor may not show any benefits in your child, even if both children have the same outward symptoms or diagnoses. For example, two children with ADHD may have hyperactivity and silliness. The first child does not have sufficient amounts of nutrients to support the clearance of natural phenol chemicals found in a number of fruits and some vegetables. The second child has had frequent ear infections and has taken numerous antibiotics and now has imbalanced bacteria and yeast in his intestine. Both of these conditions can result in hyperactivity and silliness, but the reasons are different and the treatments, including the choice of specific diets and/or supplements, will also be different.
The key to identifying which elimination diet is most likely going to work for an individual is to identify the symptoms that can be addressed by each potential diet. If there are no underlying symptoms suggesting that a given diet will work, then that diet is less likely to be effective. In our experience, the diet that has been helpful for the largest percentage of children, particularly those with autism, is the gluten-free casein-free (GFCF) diet. Soy elimination is also recommended during a GFCF trial. There are numerous other potentially helpful diets, summarized at the end of this chapter.
Diets low in natural salicylates, phenols, and/or chemical additives are also helpful for another significant subset of children who may have behavioral symptoms, red cheeks and ears, and/or irritability. Other diets, such as the Specific Carbohydrate Diet (SCD) focus on avoiding double sugar (disaccharide)foods, with the GAPS version being more restrictive. The anti-yeast diet addresses overgrowth of candida, which can cause rectal and/or vaginal itching and focus and attention problems. The low oxalate diet is helpful in addressing pain and inflammation associated with oxalate foods. The anti-inflammatory diet may be used individually or in combination with other diets. The FODMAP diet is highly restrictive and helpful for those who have symptoms associated with many of the diets. The rotation diet provides more flexibility when there are multiple foods to be limited. For each diet described in this book, we provide symptoms or conditions that suggest that a particular diet may be worth considering for your child in addition to what to avoid and include.
Most of the special diets tend to limit many of the plant-based foods (nuts, seeds, beans/legumes, vegetables, fruits, and grains) because plants contain components that may be irritating, improving the plant’s resilience against pests and reducing the chances of being consumed. Examples include lectins, phytic acids, alkaloids, salicylates, phenols, oxalates, polyols, glutamates, purines, and amines. It is important to note that high-fiber foods can be difficult to digest, especially for those with digestive problems.
Vegetables and fruits may be better tolerated and more easily digested when peeled, steamed, cooked, puréed, juiced, or included in soups and stews.
Nuts, seeds, grains, and legumes/beans are more easily digested when soaked. A pressure cooker is useful in reducing some of the problems produced by legumes/beans.
Grains can be soaked and fermented.
Nuts and seeds can be better digested when made into nuts/seed butters.
These strategies certainly improve digestibility; however, they do not render all the components that trigger reactions less problematic. Meats, poultry, seafood, eggs, and milk products (if tolerated) do not have these natural defense mechanisms and are usually better tolerated. For this reason, most of the elimination diets lean toward animal sources.
Other Potential Culprits
As is the case with all the foods and food components we cover, not every individual reacts poorly to each of the following substances. Although there may be similar patterns in the symptoms from these foods, not all who react to a given category will have the same symptoms.
LECTINS are natural toxins found in high levels in legumes (beans, peas, lentils), grains, peanuts, corn, tomatoes, potatoes, and A1 milk. Plants with seeds also contain lectins (squash, nightshades, and some fruits). Lectins are natural toxins for protecting the plant but are like barnacles to the human gut mucosal lining. They interfere with the gut microbiota, gut cell junctions and functions, and increase inflammation, thus contributing to a leaky gut. They can also attach to insulin receptors, impeding receptor functions and leading to insulin resistance. Lectin effects can be reduced by fermenting and pressure cooking grains and beans and peeling and de-seeding fruits and vegetables.
PHYTIC ACID is a natural substance found in plant seeds, grains, legumes, and nuts. Referred to as an anti-nutrient, it impairs the absorption of zinc, calcium, and iron. Its effects are minimized by the consumption of more anti-inflammatory foods.
SOLANINE, TOMATINE, AND NICOTINE are inflammatory alkaloids found in nightshade foods: tomato, white potato, peppers, eggplant, tobacco, okra, Goji berries, tomatillos, sorrel, gooseberries, ground cherries, pepino melons, paprika, cayenne pepper, and capsicum. They are potential culprits in increased inflammatory and autoimmune conditions
Overview of Elimination Diets: What They Are, Why They Are Needed, and Recommendations
Each of the diets has been summarized in the following grids. Each diet is explained in detail in the corresponding chapters. The following recommendations apply to all of the diets:
Consult with a nutritionist/dietitian or physician with expertise in special diets and nutritional supplementation.
Review the following resources for information on supplements used in ADHD and autism:
• The ADHD and Autism Nutritional Supplement Handbook by Dana Laake and Pamela Compart
• Nutritional Supplement Use for Autistic Spectrum Disorder by Jon Pangborn
• Cure Your Child with Food by Kelly Dorfman
• Cooking to Heal by Julie Matthews
• Nourishing Traditions by Sally Fallon
• The Blood Sugar Solution by Mark Hyman
Overview of Elimination Diets
HEALTHY ENVIRONMENT, LIFESTYLE, AND ORGANIC NUTRIENT-DENSE DIET |
Chapter 3 |
Why Is the Diet Needed? Contaminants, pollutants, toxins, GMO foods, and artificial additives are burdens to the body and deplete nutrients needed for growth and development. Symptoms the Diet May Help: Generalized fatigue; headaches; “brain fog”; mood issues; inflammation; immune problems; and reactions to artificial additives and manufactured chemicals Avoid:
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GFCFSF: GLUTEN-FREE, CASEIN-FREE, AND SOY-FREE |
Chapter 4 |
Why Is the Diet Needed?
Symptoms the Diet May Help: Cravings for opioid food sources (gluten, milk/casein, and/or soy); silly, “dopey” behavior; repetitive behaviors; OCD; self-injury; high pain tolerance; poor eye contact; and digestive symptoms Avoid:
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FEINGOLD/LOW SALICYLATE DIET |
Chapter 5 |
What Are Salicylates and Where Are They Found? Salicylates are a type of phenol found in plants, fruits, vegetables, artificial additives, and in aspirin and other pain-relievers. Why Is the Diet Needed? Insufficient sulfation and detoxification; inadequate gut flora Symptoms the Diet May Help: Hyperactivity; behavior outbursts; irritability; oppositional/defiant behavior; anxiety; and learning problems Avoid: Environmental toxins and manufactured chemicals; artificial additives and preservatives; specific fruits and vegetables (especially brightly colored), and most spices. |
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FAILSAFE/LOW SALICYLATE DIET |
Chapter 5 |
What Is FAILSAFE? (Free of Additives, Low in Salicylates, Amines and Flavor Enhancers) Most rigid diet. Expansion of Feingold Diet by excluding glutamates and biogenic amines. Why Is the Diet Needed? Insufficient sulfation, detoxification, and inadequate gut flora (microbiota); and chemical sensitivity Symptoms the Diet May Help: Red cheeks/ears; hyperactivity; silliness; aggression; regressions; poor sleep; night sweats; headaches; dark circles under eyes; behavior problems (oppositional/defiant); and mood swings. Avoid: Environmental toxins; manufactured chemicals; artificial additives and preservatives (sulfites, nitrates, benzoates, sorbates, and parabens); aromatic chemicals
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LOW PHENOL DIET |
Chapter 5 |
What Are Phenols? Phenols have antioxidant qualities and are beneficial for most, but not for those who are intolerant. Phenols include phenolic salicylates, amines, and glutamates. Why Is The Diet Needed? Defective phenol sulfotransferase (PST) enzyme necessary for sulfation and detoxification; inadequate gut flora; and high sulfur food sources Symptoms the Diet May Help: Red cheeks/ears; hyperactivity; silliness; aggression; regressions; poor sleep; night sweats; headaches; dark circles under eyes; behavior and learning problems; and mood swings. Avoid:
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SCD (SPECIFIC CARBOHYDRATE DIET) AND GAPS (GUT AND PSYCHOLOGY SYNDROME) |
Chapter 6 |
Why Are the Diets Needed?
Symptoms the Diets May Help:
Avoid:
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ANTI-YEAST (ANTI-CANDIDA) DIETS |
Chapter 7 |
What Is Yeast/Candida? Yeast is a normal fungus in the intestine, and Candida albicans is the most common yeast. The problem is the overgrowth of yeast, which produces toxins that cause damage. Why Is the Diet Needed? Yeast overgrowth from intestinal microbiota imbalance, known as dysbiosis. Antibiotics and/or poor fiber increase yeast overgrowth, which damages the intestinal lining. Symptoms the Diet May Help:
Avoid: Consider the SCD diet first. If not sufficient, add this anti-yeast diet.
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LOW OXALATE DIET (LOD) |
Chapter 8 |
What Are Oxalates? Oxalates are in foods, in fungi and yeast, and made by the body. Plants make oxalates to protect against infection and consumption. Why Is the Diet Needed? The problems are caused by insufficient good flora to metabolize oxalates and prevent yeast overgrowth. Inadequate fecal calcium impairs oxalate elimination. Oxalate crystals can damage the GI tract, cross into the bloodstream, and damage tissues, causing inflammation and pain. Symptoms the Diet May Help:
Avoid:
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ANTI-INFLAMMATORY DIET |
Chapter 9 |
What Is Inflammation? Chronic inflammation begins slowly and can last for months to years. Contributors: pathogens; toxins; problem foods and food components; GMO foods; trans-fatty acids and autoimmune antibodies. Nightshades, alkaloids, and lectins are among the most inflammatory components and are the focus in this diet. Other problem foods include oxalates, phenols, salicylates, phytases, FODMAPs and purines. Why Is the Diet Needed? Chronic inflammation of the gut and brain is a hallmark in autism and issues in ADHD. Maternal-fetal antibodies may contribute to autism. An anti-inflammatory diet allows for healing. Symptoms the Diet May Help: Digestive problems including “leaky gut”; brain inflammation; behavior changes; irritability; self-injury; mood disorders; joint and muscle aches/pain; and poor cognition and function Avoid:
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THE FODMAP DIET |
Chapter 9 |
What Are FODMAPs? Fermentable Oligosaccharides, Disaccharides, Monosaccharides, And Polyols. If poorly digested, these short-chain carbohydrates can ferment in the gut to cause digestive distress. FODMAPs are found in many natural foods and food additives. Why Is the Diet Needed? For those sensitive to many foods noted to be culprits in many of the elimination diets. The more reactions and symptoms, the more likely the FODMAPs diet will help. Symptoms the Diet May Help: Multiple digestive conditions and symptoms: irritable bowel syndrome (IBS); inflammatory bowel disease (IBD); and small intestinal bacterial overgrowth (SIBO) Avoid:
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ROTATION DIET |
Chapter 9 |
What Is a Rotation Diet? The diet avoids repetition of foods based upon a four- to seven-day rotation by food families. Families are how biologically related foods are grouped. Rotating by food families provides more options. The diet can reduce reactions to mildly reactive foods and help identify problem foods. Why Is the Diet Needed? When there are multiple food reactions and very limited choices, rotation expands nutrient diversity and allows inclusion of mildly reactive foods and other nonreactive foods. Symptoms the Diet May Help: Persistent digestive problems; autoimmunity; inflammation; skin problems; depression; anxiety; behavioral problems; and inattention Avoid:
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