Should you try an Elimination Diet?

By Sharon Puello MA, RD, CDN

Bloating, weight gain, skin rashes, fatigue, whatever the ailment is, more and more people are turning to foods as a causative factor in their poor health versus seeing foods as the ultimate healer. Part of this is attributable to the great number of highly processed foods on the market, causing an upheaval in the digestive processes of many around the world. As a result, the popularity of elimination diets continues to increase. While an elimination diet can bring relief to some, if done improperly they can leave the body in a malnourished state, which will in the long-run worsen the person’s health. Before starting an elimination diet it is recommended that you take the following steps:

  1. Make a detailed log of when and what you eat daily, how you feel after eating, when your symptoms seem to strike, what types of exercise you’ve been doing, and how much screen time using electronic devices you’re engaging in daily. This can help you make some simple connections which can save you the time of going through an elimination diet. For example, perhaps you suffer from stomach pain shortly after consuming a meat-containing meal, you have chronic constipation but notice that your diet is very low in fiber and your day is very sedentary, or you’re chronically fatigued but spend hours using electronic devices. If you share your log with a Registered Dietitian they can also help analyze your diet for vitamins and minerals that you may be lacking which could be contributing to your complaints. Many people underestimate the power of a vitamin / mineral deficiency in wreaking havoc in the body. For example, a B-12 deficiency can lead to symptoms of extreme fatigue, brain fog, neurological symptoms, balance problems, etc., which may be mistakenly attributed to a possible gluten intolerance if a thorough look at the initial diet is not done first.
  2. Make a list of all medications that you are taking (if any) along with any potential side effects the meds can cause and whether they can either delete or interfere with the absorption of certain vitamins and minerals. One resource often used by dietitians and other healthcare practitioners is the book “Food Medication Interactions” by Zaneta Pronsky which I feel should be a standard home reference material for anyone taking a large number of medications. It’s very important to know how your medications can impact your digestion and nutritional state. For example, birth control pills can deplete a variety of B-vitamins, magnesium, zinc, and vitamin C. If taken over long periods of time (which birth control pills typically are) these depletions can lead to significant deficiencies, which can affect your digestion.
  3. Cut out all of the “junk” from your diet. Yes, highly processed foods can really mess with your digestive tract. The goal is to follow a clean eating plan, which simply means consuming a diet based on whole or minimally-processed foods. This also means eliminating any artificially sweetened product (those containing names like sucralose, acesulfame potassium, aspartame, saccharin, etc. in the ingredients section of the nutrition label) from your diet as these can alter the gut microbiome.
  4. Maximize the functioning of your digestive tract. If you’re suffering from stomach pains after eating, one cause may be decreased stomach acid. Some will suffer from just stomach pain, while others may also or alternatively suffer from reflux. While most associate reflux with excess acid it can by a symptom of low stomach acid levels.
    • One simple test that can be done at home is to take a spoon of apple cider vinegar (look for one that contains “the mother” such as Braggs) after eating when pain or reflux is present. If this resolves the problem you may be suffering from inadequate stomach acid. If this makes it worse, you may have too much acid and can simply take baking soda mixed in water to help resolve the issue.
    • For those with not enough stomach acid, consuming meats can be particularly troublesome due to their high protein content which makes them more difficult to digest. Betaine HCL supplements or daily intake of apple cider vinegar 30 min before eating can help work wonders at bringing digestive comfort. Other supplements which may help improve your digestion include: probiotics and beef or swine gelatin supplements such as those marketed by Great Lakes. Gelatin has been as noted for its ability to help heal those with leaky gut syndrome.

If after all these steps and adequate time has passed (at least 1-2 months) there is no relief seen, an elimination diet can be considered. There are a variety of methods for going about this, including:

  1. removing one food thought to be a potential trigger
  2. eliminating all of the most common allergens simultaneously or one at a time until symptoms resolve (i.e. wheat, soy, cow’s milk and cow’s milk products, eggs, seafood, and peanuts)
  3. starting with a diet based only on foods LEAST known to be allergenic such as: meats (excluding chicken), certain veggies (i.e. broccoli or carrots), starches (i.e. white potatoes), and fruits (i.e. apples or bananas).

In my opinion and practice the second and third methods above which begin with multiple food eliminations or starting with only a few select foods and adding from there are unadvised based on:

  1. Eliminating multiple foods at once leaves the individual unsure of which was the food(s) truly causing the problem. Though an elimination diet requires the individual to add foods back one by one until the same symptoms return, human nature often is to avoid discomfort. This can lead to individuals feeling so good that they don’t want to challenge their bodies, and so remain on an unnecessarily highly-restricted diet.
  2. Starting with just a few generally non-allergenic foods may not be right for all. Certain foods in this category (i.e apples, broccoli, etc.) can actually cause gas and bloating for a portion of the population. Elimination diets are extremely individualized processes to which there is no cookie cutter plan that works for everyone. Additionally, this method takes an extreme amount of time to complete as foods must be added very gradually given it can be days after a food is eaten before a reaction is seen.

If you still want to test out the elimination diet theory my recommendations are:

  1. Go back to your initial food log and start your exclusion from there. As you remove foods one by one, look for an improvement in symptoms. Remove only 1 food every 2 weeks, and always replace with a food with similar nutrients. For example, if you remove a protein such as eggs, and this was part of your daily breakfast, you need to replace the eggs with another protein high in vitamin D such as sardines; or if you remove milk, whole almonds (NOT almond milk) can substitute for the protein and calcium you’ll be missing. You must be aware of what you’re removing from your diet in order to prevent deficiencies from arising.
  2. If you get no relief from removing that food after 2 weeks, add it back and remove another. You don’t want to unnecessarily keep foods out of your diet which are not proven to be hurting you.
  3. Once you have found the food or foods which you believe to be causing the problem, they will need to be removed until the underlying problems have been resolved.

As you can see the process for trying an elimination diet and successfully determining which foods are causing you trouble (without sacrificing your body of nutrients and unnecessarily restricting yourself) is complicated. The process can be made more simple if you allow a registered dietitian to work with you and evaluate your food log over a period of time.

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