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Elimination Diet: The Final Frontier
August 4, 2014 7:10 AM   Subscribe

I’m finally working on starting an elimination diet, but I need some advice. I’m seeing some conflicting things online. What worked for you? What’s the best way to go about this?

You’re not my doctor; you’re not my nutritionist. My doctor knows I’ve eliminated some foods. I plan to see a nutritionist. I’m looking for elimination diet tips. If you have medical questions, message me.

I have been eating gluten free for about 5 to 6 months, and lactose free for a little less. I noticed a huge difference cutting out gluten. Pretty sure I have become lactose intolerant. I also a few months ago cut out soy and eggs as it seemed that they were making my stomach upset. I now think those may have been a false-positive or that I can at least handle some of it. I definitely think I have an issue with corn. I’ve been mostly corn free for about a week and have felt immensely better. I almost feel like a human.

Questions:

I’m seeing conflicting things on the internet about what all to cut out in an elimination diet. I need a lot of protein in my diet and some recommend basically eating fish and turkey, where others have any meat included. Can I continue to eat closer to paleo with any meat and included/safe veggies/fruits? I don’t like fish, nor do I feel comfortable cooking fish.

How long should I have a reduced diet? I’ve seen anywhere from 21 days to 6 weeks. I was thinking 3 weeks would be enough since I’ve already taken out a lot of allergens.

Do I really need to cut out nuts and citrus fruits? What about potatoes and tomatoes?

On adding things back in, since corn is in everything, should I try something with corn syrup in it first and see how I react? If you have a corn intolerance, can you still have corn syrup? What about the stuff that has less than 2% corn-something?

About how long does the “challenge” portion of this take? I honestly might only try allergens on weekends so I don’t feel sick during work.

Personally, I’d love to eat eggs and soy again. I really doubt I can eat gluten and am scared to even try. The last time I had it I was extremely sick afterward. (Waking up in the middle of the night with severe, nearly unbearable stomach pain and nausea sick.) Should I even attempt it?

What worked for your elimination diet? Any tips, recipes, etc? I don’t eat carb-heavy meals. I will be keeping a strict food journal.
posted by Crystalinne to Health & Fitness (17 answers total) 5 users marked this as a favorite
 
The intersection of people that are lactose-intolerant and gluten-intolerant and soy-intolerant and eggs-intolerant and corn-intolerant is pretty darn small. In other words, either you are a statistical outlier or you have some other underlying medical problems. As a result, I think it's inappropriate to give you advice on diet-based questions here, because your situation is described so specifically as to indicate that any anecdote-based responses here would not be helpful for you.

The thing about elimination diets is you have to be comfortable with the results of eating something you may be intolerant to. If that intolerance involves waking up in the night with extreme stomach pain, then that'll be part of your diet. It seems like your question is, "I feel good eating a very restricted diet, but I don't want to, but I don't want to reintroduce foods I'm intolerant of." If that's the case, then an elimination diet won't help you.

However, if you are willing to take that gamble, I believe you will find that you are not intolerant to as many foods as you think you are. It's just statistics - humans are actually pretty good at eating anything edible and living off of it (note the diverse diets across the world).
posted by saeculorum at 7:28 AM on August 4 [6 favorites]


I did this 21-day elimination list several years ago and was very happy with it. It does cut out nightshades (potatoes and tomatoes), but it does allow chicken. So I'd enjoy a lot of spinach salads topped with vinaigrette, adding some roasted chicken on top. And I'd make a texmex night with shredded chicken and black beans and avocado. Really, between the chicken and the black beans it was pretty satisfying. Oh, and huge smoothies with the fruits listed!

And then after you do your three weeks, introduce new types of food back in one by one in small amounts with time in between so you can focus on it. How does it make you feel: energy, sleeps, digestion, even emotions.

I'd avoid corn syrup altogether, even afterward. That stuff will gunk you right up. IANYN/IANYD, etc.
posted by mochapickle at 7:29 AM on August 4 [1 favorite]


Elimination diets, and their efficacy, vary hugely from person to person. One paleo-style elimination diet is the Whole 30 diet (disclosure: very into selling things). There's also an anti-inflammatory protocol that supplements those types of paleo style elimination diets, which cut out additional things like nightshades, among others (Robb Wolf's website has some specific information on that).

Length: the longer you do the strict elimination, and the more slowly you add foods back in, the more useful the exercise will be. This should depend on what kind of problems you're having and their severity. If you only do it on weekdays, it Will Not Work. You need to do it until you feel better, then add foods back in slowly.

As to specific foods: there's huge variation in the different elimination diets. You may just need to try a couple.

Corn syrup: this could be a corn problem or a sugar problem. You just need to experiment.

Gluten: don't try it until you're feeling good.

One elimination diet I did is laid out here. That list is literally all I ate. Unfortunately, the more restrictive the diet, the more likely you are to figure stuff out.

Memail me if you want more information. I've done this a couple of times; it's hard, but you adjust.
posted by mchorn at 7:30 AM on August 4 [1 favorite]


First, what is the reason you are on the elimination diet? Just for your gut or do you have eczema or some other issue?

This is really important because skin issues can take longer to resolve. Some I've read say 3 weeks or until the symptoms are gone. But then, you have to introduce new foods slowly and carefully - one new food every 2 to 3 days. So that means a still restrictive diet for quite a while later.

A good friend of mine has a corn allergy and that INCLUDES anything with corn syrup in it. I'm not sure if it includes corn-fed animal products, though. Which is something to keep in mind when you are choosing meat. I think this is why turkey and fish might be recommended - but the diets I've read about (and was on) said turkey and lamb, not fish. Because these are both supposedly easier to digest. Beef in the USA tends to be corn-fed unless specifically labelled as grass-fed.

I would recommend going to an allergist and getting a scratch test done for the big 5: eggs, wheat, dairy, soy, peanuts. That can help you identify from that list what you can or can't eat.

Remember to keep up your healthy fat intake. Ghee and safflower oil were main staples while I was on an elimination diet and I quite often just had brown rice and ground turkey sauteed in either ghee or safflower oil and then added peas, carrots or green beans. It wasn't exciting, but it kept me full.
posted by jillithd at 7:30 AM on August 4


Have you looked into the Whole30? It answers a lot of your questions.
posted by Brittanie at 7:59 AM on August 4


If there is something irritating your gut, it's going to make you sensitive to every little thing, and you could end up with some false-positive results. When I was dealing with the worst of it, leafy greens and nuts would make me sick, not because I had a food sensitivity to them, but because they were roughage that was scraping the inside of my already irritated guts.

My advice, especially since you've already been dealing with it for months on end, is to make extra sure that you are eliminating everything that could possibly be irritating you, and make sure you do so for a long enough period of time that you feel "actually human" not just "almost human" for a good, long time. Then start testing what you can add back in.

This thread might be helpful: http://ask.metafilter.com/263128/I-need-a-map-A-FODMAP-map
posted by Bentobox Humperdinck at 8:08 AM on August 4 [1 favorite]


As a clarification, I am working with doctors and have been undergoing multiple tests and peocedures to figure out the medical side of this. Please message me if you'd like further clarification.

I don't think I'm intolerant to all the items I've eliminated. That's why I'm trying a true elimination diet. Also I was saying that it may only add back allergens on the weekend. I'd be doing the diet full time. I also am aware of the fodmap diet.
posted by Crystalinne at 8:54 AM on August 4


I don't know that you need to eliminate all nuts, but peanuts (and even legumes more widely) come up as problems for enough people that I'd avoid them at the start.
posted by acm at 10:14 AM on August 4


Well, when we were trying to pin down a food reaction, we finally just decided to bite the bullet and just go full-on elimination diet. We figured it would just be easier to go full elimination for a while and do the hard leg work as it would be better than having random food flare-ups and just dragging out the whole ordeal longer.

It was REALLY HARD at first. And then it also unexpectedly coincided with our first CSA delivery of the summer, so I definitely whined and pouted and rallied against the whole thing. But that first time we tested a food and got a definite reaction - wow. Did that ever reassure me that what we were doing was the right thing.

We based my diet off of Dr Sears, along with any and every book/web page I could find on the topic.

My main meals were:
breakfast: Rice & Shine gluten free rice cereal with ghee, salt and cut up pears
Snack: a pear, some baked sweet potato or leftovers
lunch and dinner: Usually brown rice or millet, organic turkey or chicken (in various states) with safflower oil or ghee, whatever vegetable was ok. At first, it was just yellow and green summer squash - which got old really fast.

Lunch was usually leftovers from dinner. Roasting a whole chicken or a whole turkey on Sunday was actually kind of a delicious treat for going on the diet. Juicy and delicious, hot out of the oven. A baked sweet potato was really delicious, too.

I decided to try new foods on the weekends, too, as it is just easier to handle feeling crappy when you don't have to make appearances. So that's a good idea.

Good luck. It is a tough thing to do, but very helpful once all of the puzzle pieces start coming together.
posted by jillithd at 10:53 AM on August 4


I found it easiest to eliminate virtually everything for three weeks. I picked a grain (rice), a protein (lentils in my case; you would probably choose a meat), a vegetable (sweet potato), and a fat (canola oil). And that's all I ate, and it sucked, but it was temporary and life went on. After three weeks I added in new foods every three days. (I would often add two not-likely-to-be-allergenic foods at a time to speed things up.)
posted by metasarah at 12:03 PM on August 4


I went to a nutritionist because I wanted to do a supervised FODMAP elimination diet, and she recommended that I buy a book (one that I already owned) and do my own supervising. So, well, that didn't work out as I'd hoped.

I'm on day 29 of the Whole30, and am not having earth-shattering results, but I already had a diet not terribly unlike their elimination diet.

What helped me the most was cutting out caffeine.

Also, I'm planning to do a second Whole30 with the autoimmune protocol (no eggs, nuts/seeds, or nightshades) starting in about a week. If that doesn't have dramatic results then I will do the FODMAP elimination diet now that I'm getting pretty good at elimination diets.

What I'm working with is ulcerative colitis, plus a few other AI disorders, one of the genetic mutations for celiac and a second degree relative with full blown celiac. The last time I started a flare was also the last time I ate gluten, so I've been gluten free for just over a year, and was gluten free for the approximate six months preceding that event. It's very clear that gluten is, for me, a trigger.

Whole30 eliminates sugar and sugar substitutes, all grains, all legumes (so no soy, no tofu, no tamari or soy sauce), dairy, carrageenan, MSG and sulfites, and alcohol.
posted by janey47 at 3:54 PM on August 4


Write down everything you eat after every meal, right down to the herbs & spices. Write down how you feel that day. For most foods, you'll start seeing co-relations pretty soon. For others, such as FODMAPS, if there is an issue, it might take a while to notice.
Food intolerances vary significantly from person to person. There's no one set formula to follow. How extensively you want to go depends on how determined or desperate your health makes you. Or how lucky you are to find the culprits early on.
There are certain things that are allowed in one diet that I can't have, others that aren't allowed that give no me issues. YMMV - a lot!
Good luck. PM me if you have more questions.
posted by Neekee at 4:59 PM on August 4


I did the green smoothie diet for 10 days (without the colon cleanse) which wiped out all dairy and flour...I haven't gone back to dairy and limit the flour products, I have never felt better. My stomach was always bloated and soar but I couldn't put my finger on it well I am now convinced it was dairy.
posted by irish01 at 5:43 PM on August 4


I've done Whole30 (twice), and the tip I'll pass on is that I became more sensitive to foods I had eliminated after swearing off of them for 30 days. I've seen other people complain about the same thing. So, for instance, I never would have called myself allergic to dairy, but after abstaining for 30 days, I was.

I understand this as "something something gut biome changed something something can't digest something any more," and it might discourage me from doing that sort of long-term restrictive diet again.
posted by instamatic at 5:58 PM on August 4


There are certain foods that I react badly to. Those foods I avoid completely. There are other foods that make me feel kind of ick after but I love so, I eat those all in one sitting, a couple of times a year, and suffer the consequences. I was on heavy pain meds after oral surgery and took that as my best chance to enjoy eggs! There are other foods that make me feel a little foggy sometimes but not other times, depending on my stress level and my exposure to other allergens. I just go ahead and eat those. When I am feeling super blah, I take out nearly everything that I react to and dose up on probiotics and detox tea. I'm probably not doing any of this right but it is working for me. Think of your elimination diet as if you were a hippie- if it feels good, do it. After not eating peanut butter for years, I'm now able to enjoy it every once in awhile, in small amounts, without problems, so don't give up on everything forever. And do focus on the foods that you can eat instead of those that you can't. You don't want to get discouraged. The main advice that I can give you is- don't let your diet rule you. Unless you are severely allergic to something, cheating every now and again will not end your world. Enjoy life.
posted by myselfasme at 8:30 PM on August 4


I also did a Whole30. I think it makes a lot more sense than eliminating foods at random intervals and adding them back at random intervals which will take you much longer and make it harder to determine which food caused you to feel which way. As mentioned above, with Whole30 you essentially eliminate everything off the bat, and then add things back at the end using a reintroduction protocol.

Aside from the Whole30 which is a marketing thing, there isn't a right or wrong official way to do an elimination diet for "general allergens" (and although the Whole30's theories have a basis in science, there has not been scientific research to prove that the Whole30 is effective at anything in particular, health wise). Every person's body is different, so we can't tell you whether you need to eliminate food X or Y or not, but I haven't heard of eliminating red meats based on allergies, meats are generally considered safe - the only reason I've seen for cutting some red meats is nitrates and nitrites, which isn't typically an allergy issue but a health and nutrition issue that is controversial.

I am not a nutritionist by any means, but most of the foods you listed don't need to even be cut out for 3 weeks where you should be able to see a difference before that. The only exception I'm aware of is dairy, because cow's milk protein takes longer to get out of your system (still, 2 or 3 weeks is what I've seen recommended to see a result). As far as the Whole30 rules, they operate completely on a person-by-person basis and say that you must follow the diet for the full 30 days to see the results they advertise, but that if you don't see those results, I've seen them recommend extending to a Whole60 etc.
posted by treehorn+bunny at 1:19 AM on August 5


I have a corn sensitivity. I am also sensitive to corn syrup but my reaction is very different. Corn makes me vomit; corn syrup gives me something similar to a hypoglycemic reaction about 45 minutes after I eat it. It was good to test them both separately because the effects are so different. (To be frank, corn syrup made me a crazy person, as many of my friends and my ex-husband will confirm.)

I cannot tolerate any corn whatsoever. I can't have cake because of the corn starch in baking powder. I can't have beer that has fermented in bourbon barrels. (I learned that one in a REALLY unpleasant way. It is an experience I never again care to repeat.) I can't eat egg yolks because chickens are fed corn and something about it gets into the yolks. (I discovered this because I can eat egg yolks in Australia, where chickens are not fed corn. I ate ALL THE EGGS EVERY DAY while I was there.) However, YMMV. I seem to have become more sensitive over the years; on the other hand it could be that I'm just far less used to being sick from corn.

Regarding corn: corn isn't just corn. It is also in, just off the top of my head: baking powder (cornstarch), powdered sugar (cornstarch), distilled vinegar (it's made from corn - and for me, distilled vinegar will make me ill like NOTHING ELSE ON EARTH). It's also in things you don't expect. Corn syrup is in most natto, for example, which is just bonkers. It took a long time before we found all the places that corn stealthily hides itself, and we still have to be vigilant as food reformulations can introduce corn starch where there wasn't any before. (I'm looking at you, Kraft Macaroni and Cheese.)

When I did my elimination diet, I didn't eat seafood (because it's gross like ick) and was just fine.

I did four weeks of cutting out everything before I reintroduced stuff.

I eliminated citrus fruits and nightshades. The nutritionist was positive that citrus was at the root of my problem. I did not turn out to be allergic to either, but it was good to get it confirmed beyond all reasonable doubt. I have a friend who was sure that nightshades weren't the issue, and when she did her elimination check she found nightshades WERE the issue, in a big way.

My elimination diet: I ate a lot of grilled chicken salads without dressing and a lot of risotto. The diet was very boring and I lost several pounds. It was totally worth it.

Tips: You will probably discover things you didn't know. For example: I thought my asthma was induced by cold temperatures (this is not uncommon). It turns out my asthma is induced by cold temperatures only if I have been eating wheat. In the short term I resolved this by cutting wheat out of my diet between October 1 and May 1; in the long term I resolved it by moving somewhere where the temperature rarely drops below 40.

I did my food confrontations during the week because I had ten of them to get through, and because in the one I was on you needed to eat that food morning, lunch and dinner for two days (unless you had a drastic reaction, in which case you could drop it immediately), and if you showed a sensitivity you needed to strip back to the elimination diet for a day or two in order to clear your system and not cloud the results. I had to go home one day due to the corn confrontation but otherwise it was NBD.
posted by rednikki at 7:44 PM on August 5


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