Elimination Diet

Elimination Diet

Many of the chronic health problems that plague Americans today are the result of poor dietary and lifestyle choices. Illnesses such as diabetes, cardiovascular disease, hypertension, cancer, and gastrointestinal problems develop as a consequence of the foods we choose. Nutrition is the backbone of naturopathic medicine. By changing our diets and adopting a healthy lifestyle, we can often change or reverse the course of an illness and restore health. 

What we eat impacts every cell in our body: you are what you eat. Unfortunately, the importance of nutrition is downplayed in our society. Foods can and do have a positive and negative impact on our health. One way food can have a negative impact on the body is from food sensitivities (also known as food intolerances), which are often incorrectly referred to as food allergies. A food allergy is an immune response to a food that is eaten. People who have a true allergy to a food (common examples are peanuts or strawberries) are usually aware of it and avoid the food due to the immediate and strong immunologic reaction that occurs (e.g., swelling, hives). A food sensitivity is a physiological reaction (e.g., headache, diarrhea) to a food that is eaten. However, no immune response is initiated.

Often people refer to a food allergy when they mean food sensitivity. Food allergies are generally easy to determine through allergy testing or history of immune response. Food sensitivities can be more difficult to determine because reactions can be delayed (up to 48 hours) or more subtle. Also, it can be difficult to determine which food is actually causing a symptom, or if the symptom is caused by food or another pathological condition. Food sensitivity symptoms are many and varied. They include headache, diarrhea, constipation, sinus congestion, sore throat, and joint pain. But food sensitivities are more complex than just a symptom. When a food is eaten that the body does not tolerate, the stomach and intestines can become inflamed. Because of the inflammation, the gut walls develop little openings that bits of undigested or partially digested food can pass through. This is referred to as leaky gut syndrome. When these particles enter the bloodstream, the body’s immune system recognizes them as foreign and attacks them. Thus, an immune response is initiated at this point, but it is still not identified as a true food allergy.

Eliminating food sensitivities from the diet is important. Determining which foods one is sensitive to can be a challenge. One of the most effective ways of finding out which foods cause problems is by eliminating the most common food sensitivities from the diet and then reintroducing foods one at a time to see how the body reacts. A negative reaction means that the person is sensitive to that food and should remove it from their diet. This process is called an elimination and challenge diet: the food is eliminated from the diet then reintroduced to challenge the body. It is also referred to as a hypoallergenic diet. Licensed naturopathic physicians are trained to monitor elimination and challenge diets and can provide guidance during the process.

Common Food Sensitivities

  • wheat products (pasta, breads, processed foods)
  • glutenous grains (rye, barley, oats, spelt, kamut, seitan, hops)
  • dairy products (milk, cheese, yogurt, cream)
  • corn products (tortilla, chips, polenta, cornstarch, thickeners)
  • peanuts (peanut butter, peanut oil)
  • soy products (tofu, tempeh, soy milk, soy protein powder, soy oil)
  • red meat (usually more a problem with additives than with the protein itself)
  • caffeine (coffee, tea, colas)
  • chocolate
  • sugar substitutes (aspartame, saccharine)
  • food colorings, dyes
  • pesticides and chemical spoilage retardants
  • sulfites (canned vegetables, tuna, albacore, fruits, wines)
Read labels
Vegetable protein, thickening agents, and stabilizers are either wheat, corn, or soy. It is much easier simply to avoid processed food than to determine all the additives in prepared foods.

Elimination and Challenge Diet
An elimination and challenge diet is an effective way to determine a food sensitivity. Some possible symptoms that can occur on a food challenge include the following:

Symptoms associated with food challenges may not be the same symptoms experienced before the elimination process. For example, before the elimination and challenge diet began, a patient's symptom was chronic sinus pain, but a stomachache occurred during the challenge. This does not mean that the food group being challenged was not causing the sinus pain. It is just that the body and immune system react differently when the offending agent is removed and then reintroduced.

Option 1
For 2 to 6 weeks, eliminate all suspect foods and focus diet on fresh fruits, vegetables, potatoes, yams, animal protein (fish, poultry, lamb), and nonglutenous grains (rice, buckwheat) . Eat organic foods whenever possible.

After 2 to 6 weeks of maintaining a strict elimination diet, there should be relief from symptoms. Weight may also be lost. Now begin the challenge. Start with the food group that is least problematic. Challenge a specific food group for one day only. Eat several servings of that food group throughout the day. Then do not eat that food again for at least 48 hours while continuing to eat only elimination diet foods. If symptoms do not return after 48 hours, go on to the next suspected food group. However, feel free to wait more than 48 hours. Waiting a week between food group challenges is optimal. This increases the accuracy of the diagnosis. Remember to challenge only one food group at a time.

Continue this process until the problematic food group is determined. In most cases, reactions occur within 48 hours. Rarely do symptoms appear several days or weeks later.

Option 2
Maintain a regular diet and eliminate only the food group that is believed to be causing the symptoms. Eliminate all items in that food group for at least 1 month. If the symptoms disappear before the end of the month, continue to abstain from that food group for another week before starting the challenge.

To do the challenge, eat several servings of the suspect food group during a 24-hour period. Then return to the elimination diet and do not eat the suspect food group for at least 48 hours. More often than not, immediate reactions occur if there is a sensitivity.