The Elimination Diet: a Path to Bounty
You may have heard through friends and social media that an elimination diet can help identify dietary culprits of ill health, but what exactly does this diet entail? A diet is planned by a clinician, certain foods are eliminated over the course of 2-4 weeks, then reintroduced one at a time every 3-4 days to help someone identify foods that may be causing health problems.(1) However, it is important to understand that this is not the simple, straightforward diet it may appear to be, and careful considerations need to be taken before initiating it. In fact, it can be dangerous in certain situations. For some people, this diet is life altering and a short term inconvenience for long term health.
Letting Go
There are common allergens that are avoided in this diet, including tree nuts, peanuts, shellfish, fish, eggs, dairy, gluten, soy, and perhaps surprisingly, citrus.(1) People may be intolerant of these foods if not allergic.(1) Other common culprits of food intolerance include corn, beef, refined sugar, lactose, food additives like nitrates, MSG, and aspartame, and preservatives such as benzoates.(1) I myself am intolerant of nightshades, but am not a fan of the common notion that nightshades like tomatoes cause inflammation in the general population. It is important to note that research supporting this is extremely lacking, and giving up such nutritious foods is not usually warranted.
The elimination diet may help those who have symptoms but no clear diagnoses, those who are known to have an intolerance, and for those who suspect they may react to certain foods.(1) The diet has been associated with long term relief to adults with eosinophilic oesophagitis,(2) remission of IBD,(3) reduced ADHD symptoms,(4) and reduced frequency of migraines triggered by food.(5) Foods can also be triggers of skin conditions like acne, atopic dermatitis, and psoriasis.(6) Elimination diets can vary greatly and be very specific, such as the gluten contamination elimination diet designed to help bring relief of persistent symptoms in those with celiac disease.(7)
If there is a known or suspected allergy (which is different from an intolerance, as it is IgE mediated and can be accurately tested for), an elimination diet should never be done without the supervision of a doctor or allergist as the reintroduction of allergens could potentially cause anaphylaxis.(1) The diet could also be a trigger for disordered eating, and may need to be avoided in those with a history of an eating disorder.(1)
Elimination of foods can contribute to specific nutritional deficiencies which is why this diet should be short term, and if you find you are intolerant or allergic to a food, your nutritionist can help ensure you consume replacements. For instance, those who do not eat dairy have been found to have lower intake of calcium, zinc, and B2, and people who do not eat wheat or soybeans have lower intake of many nutrients like B6, niacin, potassium, and iron.(8)
Key Takeaways
An elimination diet could potentially help you determine foods that cause adverse effects. However, due to the specificities of dietary protocols and potential nutritional deficiencies, it should be done under supervision and with guidance. If there are known allergies, a doctors supervision is needed.(1)
This diet may seem straightforward (elimination, reintroduction, and watch for symptoms), but it is anything but. There are various foods that could cause a reaction, a timeline needs to be adhered to, and symptoms may be aberrant and exist at varying degrees.(1)
It can be difficult to suddenly exclude staples of our diets, especially comfort foods and those you crave (which, tragically, may be the culprit, like at the height of my symptoms when I craved tomato sauce on potatoes), but there is an extensive selection of foods that can be eaten during the elimination period. Printing up my personalized grocery list of approved foods and visiting recipe websites that cater to allergies can help provide variety. It is okay to ask for support from friends and family, and making home cooked meals together can help prevent eliminated foods from making their way onto your plate. Remember, this is a short term diet and the potential results may be very much worth the physical and emotional investment. In some instances, elimination can lead to a bounty of health.
References:
1.Rakel D. Integrative Medicine. 4th ed. Philadelphia: Elsevier Health Science; 2018.
2. Reed CC, Fan C, Koutlas NT, Shaheen NJ, Dellon ES. Food elimination diets are effective for long-term treatment of adults with eosinophilic oesophagitis. Aliment Pharmacol Ther. 2017;46(9):836-844. doi:10.1111/apt.14290
3. Forbes A, Escher J, Hébuterne X, et al. ESPEN guideline: Clinical nutrition in inflammatory bowel disease [published correction appears in Clin Nutr. 2019 Jun;38(3):1486] [published correction appears in Clin Nutr. 2019 Jun;38(3):1485]. Clin Nutr. 2017;36(2):321-347. doi:10.1016/j.clnu.2016.12.027
4. Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004;53(10):1459-1464. doi:10.1136/gut.2003.037697
5. Özön AÖ, Karadaş Ö, Özge A. Efficacy of Diet Restriction on Migraines. Noro Psikiyatr Ars. 2016;55(3):233-237. Published 2016 Sep 20. doi:10.5152/npa.2016.15961
6. Katta R, Kramer MJ. Skin and Diet: An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease. Skin Therapy Lett. 2018 Jan;23(1):1-5. PMID: 29357214.
7. Leonard MM, Cureton P, Fasano A. Indications and Use of the Gluten Contamination Elimination Diet for Patients with Non-Responsive Celiac Disease. Nutrients. 2017;9(10):1129. Published 2017 Oct 18. doi:10.3390/nu9101129
8.Kim J, Kwon J, Noh G, Lee SS. The effects of elimination diet on nutritional status in subjects with atopic dermatitis. Nutr Res Pract. 2013;7(6):488-494. doi:10.4162/nrp.2013.7.6.488
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