An elimination diet functions as a test, determining whether patients may have a sensitivity to certain foods. Elimination diets are used to detect food allergies and food intolerances. They are not nutritionally balanced and are intended to be used only for a short time for diagnostic purposes. Initially, patients stop eating foods suspected of causing illness. Then, after a suitable period of time (often 10–14 days), they review their symptoms. If significant improvement has occurred, it is assumed that an allergy or intolerance to one of the restricted foods may be involved. These suspect foods are then reintroduced to the diet, one by one. When symptoms return (usually within three days), the problematic food is identified and removed from the diet.
Elimination diets are potentially useful in identifying hard-to-detect food intolerances that proponents believe are responsible for a wide range of ailments, including constipation; headaches or migraine; infections of the ear or sinuses; frequent colds, post nasal drip, chronic nasal congestion, sore throats or chronic cough; eczema, hives, or acne; asthma; pain or stiffness in the muscles or joints; heart palpitations; indigestion; ulcers of the mouth, stomach, or duodenum; Crohn’s disease; diarrhea; yeast infections; urticaria; edema; depression or anxiety; hyperactivity; weight change; and generalized fatigue.
A true elimination diet is very rigorous and needs to be implemented under the direction of a physician often in consultation with a dietitian or nutritionist. For the elimination diet to be useful, the patient must follow the diet strictly. Cheating invalidates the results. For two to three weeks, a person on the elimination diet eats absolutely none of the following foods (this list may be modified by the physician):
– Additives: monosodium glutamate and artificial preservatives, sweeteners, flavors, or colors
– Alcohol: beer, ale, stout, porter, malt liquors, wine, wine coolers, vodka, gin, rum, whiskey, brandy, liqueurs, and cordials
– Citrus fruits: oranges, calamondins, tangerines, clementines, tangelos, satsumas, owaris, lemons, limes, kumquats, limequats, and grapefruit
– Commonly eaten foods: anything consumed more than three times weekly, as well as foods that are craved or that cause a feeling of weakness
– Corn: as well as corn syrup or sweetener, corn oil, vegetable oil, popcorn, corn chips, and corn tortillas
– Dairy products: milk, milk solids, cheese, butter, sour cream, yogurt, cottage cheese, whey, and ice cream
– Eggs: both yolks and whites
– Gluten: any pasta, breads, cakes, flour, or gravies containing wheat
– Maple syrup
– Sugar: candy, soft drinks, fruit juices with added sugar or sweetener, cakes, cookies, sucrose, fructose, dextrose, or maltose.
Foods that may be allowed include:
– Cereals: puffed rice or millet, oatmeal, or oat bran
– Daily multivitamin: this is especially important during extended dieting to replace missing nutrients
– Fats and oils: soy, soy milk, soy cheese, sunflower oil, safflower oil, flaxseed oil, olive oil, and sesame oil
– Fruits and vegetables: typically anything except corn and citrus fruits though practitioners suggest fruit be consumed in moderation and preferably whole as opposed to juices
– Grain and flour products: rice cakes or crackers, rye or spelt bread (both must be 100% with no added wheat), kasha, rice, amaranth, quinoa, millet, oriental noodles, and other exotic grains
– Legumes: soybeans, string beans, black beans, navy beans, kidney beans, peas, chickpeas, lentils, and tofu. Canned beans should be avoided unless they are free of preservatives and sugar.
– Seeds and nuts: must not contain sugar or salt. Nut butters are allowed if they meet this requirement and are organic.
– Water: two quarts daily, Preferably bottled as tap water contains potential allergens, including fluoride and chlorine
– Other: honey, white vinegar, salt, pepper, garlic, onions, ginger, herbal teas, coffee substitutes, spices or condiments (mustard, ketchup) that are free from sugar, preservatives, and citrus. These products can commonly be found at health food stores.
The individual must avoid all medicines containing aspirin (salicylates) and food colorings. After several weeks on these restricted foods, one new food is introduced in larger than normal amounts. This is the challenge food, and it is eaten for three days in a row. If no symptoms appear, the dieter continues to eat that food in normal amounts and adds another challenge food. If symptoms appear, the challenge food is stopped immediately and no new challenge food is introduced until symptoms disappear. During this time the dieter keeps a food journal, writing down everything that is eaten and any symptoms, either physical or emotional, that appear. It can take two to three months to work through all challenge foods.
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As with all therapies, anyone considering an elimination diet should consider the potential benefits against the risks. The decision, according to some, is comparable to deciding to take a prescribed medication and should be done only under the supervision of a competent medical practitioner.
Anyone suspected of having a moderate to severe food allergy should be under the care of a physician. In this case reintroducing any suspect food must be done in a healthcare setting as severe reactions can cause anaphylactic shock and death. A serious risk of self-administered elimination diets is that people who self-diagnose symptoms as food intolerances using a non-medically supervised elimination diet may be ignoring symptoms of more serious and progressive diseases such as celiac disease, Crohn’s disease, gastroesophageal reflux disease, irritable bowel syndrome, and other health problems that need medical treatment. Patients need to know that following a strict elimination diet is not an easy matter. It is extremely important to read packaged-food labels carefully because many processed foods contain monosodium glutamate, sugar, and other substances that may be prohibited. It is almost impossible for elimination-diet patients to eat in restaurants, at school, or at the homes of friends. The resulting isolation must be considered as part of the decision to undertake an elimination diet. Patients should also consider whether they have sufficient time for the extra planning, shopping, and food preparation involved.
Elimination-diet patients should be vigilant to replace any nutrients missing from their restricted diet. For example, calciumsupplements may be advisable for someone eliminating dairy products from the diet. Also, any prescribed medications should be continued during any diet.
Putting a very young child on an elimination diet may endanger the child’s nutrition and normal growth. A breastfeeding mother may harm both her own health and that of her infant if she undertakes an elimination diet during lactation.
The most significant side effects of an elimination diet are nutritional disorders resulting from a prolonged, highly restrictive diet, and the risk of a serious reaction as suspect foods are reintroduced to the diet. Some proponents also caution that patients consuming a very limited variety of foods risk becoming allergic to those very foods. For these reasons, professional supervision and substitution of missing nutrients are
Research and general acceptance
Elimination diets are widely used by medical doctors, but considerable differences of opinion exist over the range of illnesses that may be caused by food allergies or intolerances. Many physicians and researchers question the role of allergies in migraine, Rheumatoid arthritis, Osteoarthritis, and other conditions.
Some doctors suggest that elimination diets should be used only after other diagnostic methods have been tried, including history-taking, skin tests, blind food challenges, and radioallergosorbent testing.