WHAT IS AN ELIMINATION DIET?

An elimination diet is an eating plan that omits a food or group of foods believed to cause an adverse reaction, often referred to as a “food sensitivity.” By removing certain foods for a period of time and then reintroducing them during a “challenge” period, you can learn which foods are causing symptoms or making them worse.

Quick Fact: It is estimated that over 20% of the US population has a hidden food intolerance that is causing inflammation in their bodies. These are different from food allergies which affect another 10–20% of the population.

WHY TRY AN ELIMINATION DIET?

Adverse Food Reactions: Allergy vs Sensitivity vs Intolerance

Food Allergies

A classic allergy is a rapid defensive immune response to an environmental trigger. Allergic reactions depend on IgE antibodies, and these immune responses cause typical allergy symptoms – rashes, itchy/runny eyes/nose, itching in the mouth or throat, or the potentially life-threatening reaction called anaphylaxis. If you have anaphylactic reactions to something, you should always carry an EpiPen®. Because of the obvious nature and quick onset most people are aware that they have such allergies and if they need help determining what foods may be causing the reaction, they can see an allergist for allergy testing.

Food Sensitivities

Sensitivities are also immune reactions in the body, but they use a very different system (IgG antibodies) that is much slower than the typical allergic response. It takes 3 days for inflammation caused by a food sensitivity to reach its peak, and the half-life of these antibodies is around 3 weeks, which means it can take 3 months or more for this level of inflammation to go away completely. The most well-known food sensitivity is Celiac disease and Non-Celiac Gluten Sensitivity—both of which relate to problems with gluten.

The symptoms of a food sensitivity don’t follow a specific pattern like allergies do. Food sensitivities can cause a wide range of symptoms, including stomach and bowel irritation, headaches, itching, various aches and pains, fatigue/tiredness, brain fog/concentration problems, hair loss, dry skin, rashes, and joint pains. Certain foods can also exacerbate symptoms in people with conditions like autoimmune disorders, migraines, irritable bowel syndrome, gastroesophageal reflux disease, and many others. Because of these wide-ranging symptoms, as well as their slow onset and long-lasting nature, it becomes very difficult to determine if a person has a hidden food sensitivity contributing to their symptoms.

Quick Fact: While studies have shown that 20% of the healthy US population has an unknown food sensitivity, some integrative clinicians feel that the number of patients that they see with a food sensitivity is closer to 80%.from food allergies which affect another 10–20% of the population.

Food Intolerances

Food intolerances are not immune reactions at all – there are no antibodies at play. Rather, food intolerances are problems with physically breaking down foods. An elimination diet is very useful to discover a food intolerance.

The most well-known is lactose intolerance in which a deficient lactase enzyme can’t break down Lactose, the primary sugar found in cow’s milk leading to gastrointestinal symptoms. Food intolerances typically cause localized reactions in the digestive system and play a large role in gastrointestinal disease, but can cause symptoms outside of the digestive tract, as well, that are similar to the above symptoms from food sensitivities.

HOW DOES AN ELIMINATION DIET WORK?

We do an elimination diet to wipe the slate clean of all (or most all) possible food triggers and the inflammation that causes their associated symptoms. Because of the slow onset and long-lasting nature of the inflammation caused by food sensitivities, it can be extremely difficult to determine which foods are causing which symptoms. Eating 1 serving of a food every 2 weeks can be all that is needed to maintain constant chronic symptoms.

The goal of the elimination diet is never to restrict your diet long term, we are simply trying to avoid the foods long enough so that we can identify which foods your body doesn’t agree with. During the food avoidance, the digestive system will heal and the immune system will recalibrate. After the elimination diet, you will sequentially challenge eliminated foods to determine which food(s) might be causing your symptoms. Once you identify the food culprits, you will be encouraged to avoid these foods for at least 3 months. Often times, later, people are able to reintroduce these foods back into their diet with good toleration.

Before

Full Elimination

Challenge Food

Note: While an elimination diet can help discover a hidden food allergy, they are most useful for discovering food intolerances.

WHY CAN’T WE JUST DO A TEST TO SEE WHAT FOODS WE SHOULD AVOID?

Unfortunately, blood testing for food sensitivity is generally inaccurate. The false positive and negative rate is around 50%—so you’re basically flipping a coin to determine which foods you can and can’t eat. Food sensitivity tests often generate a very long list of foods that people are told they can’t eat. This poses significant challenges for most people. The only way to 100% determine if a person has a food sensitivity or intolerance is the gold standard: avoiding that food for 4 weeks and then reintroducing it by itself and monitoring for recurrence of symptoms.

Note for Suspected Celiac Disease (Gluten Intolerance)

Celiac disease is a genetic intolerance to gluten. This is not a typical food sensitivity and there is accurate testing for Celiac disease available. If you suspect Celiac disease, speak with your healthcare provider for testing options as you cannot eliminate gluten-containing foods prior to testing.