What exactly is an elimination diet? Could you clarify its medical basis, and that it’s not just cutting out sugar or carbs to lose weight?
An elimination diet is designed to help identify foods that are potential triggers for inflammation, allergens, intolerances and sensitivities. It is used as a tool by practitioners who are attempting to help patients get to the root cause of their condition, symptoms or health concerns. Certain conditions ranging from acne to IBS, may be triggered by unidentified problematic foods. Potential food triggers can also lead to vague symptoms such as gas, bloating, heartburn, abdominal pain, abdominal rigidity, bowel changes, cough, congestion, fatigue, joint pain, feeling swollen, skin problems (acne, rashes, eczema), sleep disturbances, headaches and more.
While testing is available for allergies, sensitivities and intolerances, these tests can be flawed and expensive, which is why I often times prefer using an elimination diet.
For instance, many of the mainstream tests used to identify problematic foods only utilize IgE testing, which identifies a type of reaction that has the potential to cause anaphylaxis. While this is an important thing to know, this type of allergy is only one of several different ways your body may react to a particular food and is often already known by the patient . This is because IgE food reactions cause severe, often life threatening responses (these patients usually have to carry an epi-pen).
Some reactions to food don't involve IgE responses, but are mediated by your digestive tract and other physiological responses. These reactions more so represent your body having difficulty breaking down a food. Symptoms take much longer to appear than an IgE allergy and may be less severe. An example of a food intolerance is lactose intolerance, where your body does not produce enough of an enzyme (lactase in this case) to properly digest a food. These reactions are not often investigated by conventional practitioners and testing.
Food intolerances can also be a temporary problem, caused by a more complex GI issue such as an infection or gut bacteria imbalance. Additives/preservatives, flavorings, certain lectins, histamine rich foods (or histamine producing foods) and other chemicals added to food can also cause these type of reactions. Common foods leading to intolerances include wheat, dairy, processed foods with artificial sweeteners/colorings/chemical additives.
Another issue with food testing is that most companies test using raw food proteins, rather than cooked. The protein structure of a raw food vs cooked is different, resulting in less accurate testing. An example of this would be receiving a test result indicating you have a problem with eggs, but the testing company may have used a raw egg protein rather than cooked to assess this. You may in fact be fine with cooked eggs, but only have a problem with raw eggs, which I'm assuming many of your aren't eating to begin with.
If someone is having medical issues, how can they know if food is the culprit? Why is an elimination diet a good thing to try?
It is sometimes difficult to know whether a food is the cause of certain symptoms. This is why trying an elimination diet with a qualified practitioner is a must. A knowledgable practitioner is going to be informed when it comes to symptoms caused by food issues and will be versed in what conditions may be influenced by certain foods.
How do you assess someone and determine what foods they should start cutting out?
The elimination diet is some what standardized to remove the biggest food offenders for everyone, which are: gluten (wheat, rye, barley, etc), dairy, corn, chemical additives/preservatives, refined sugar, peanuts and soy. Depending on the health condition at hand, your practitioner may choose to add additional foods to the elimination list. Research has demonstrated that certain foods have the potential to cause something called "molecular mimicry", which can cause enhanced autoimmune responses in the body. An example of this is gluten with Hashimoto's disease. Patients with Hashimoto's may actually worsen their autoimmune response to their thyroid by eating gluten, so removing it is essential when it comes to promoting health. Specific conditions may merit eliminating additional foods such as eggs, beef, chicken, legumes, shellfish, nightshades or foods that the person eats more than 3 or 4 times per day. It just depends on the condition and an experienced practitioner will know what is best for your individual case.
What food groups tend to cause the most problems, generally?
Generally speaking gluten, dairy and soy are the biggest offenders.
How do elimination diets work? Is it best to cut out one food at a time or a bunch all and once and slowly reintroduce them?
A true elimination diet works like this:
Step 1: Eliminate all foods on elimination list for 2-3 weeks
(gluten, dairy, corn, chemical additives/preservatives, refined sugar, peanuts and soy). You will likely show improvement in your symptoms. This is because it takes about 2-3 weeks for inflammatory cascades in your body to be reduced. The aim is to resolve these responses completely before testing problematic food and noting responses.
Step 2: At completion of your first 2-3 weeks, start reintroducing problematic food list in its purest form, one at a time. You must consume the food you are reintroducing 2-3 times in one day and wait 24 hours before testing a new food. An example of this is eating wheat berries (gluten) 3 times on Monday, eat no wheat berries on Tuesday and then start testing dairy on Wednesday. Journal symptoms of how you feel after reintroduction.
How long does someone typically need to give up a food to determine its effect? How do you recommend patients keep track of everything?
It is imperative to remove all potential problematic foods for at least 2-3 weeks. This is to give the body time to calm down inflammation and immune responses that may be causing symptoms and gives the patient a "clean slate" to assess foods and symptoms upon reintroduction. I have my patients keep a food journal to jot down symptoms, so it's easy to identify problematic foods.
What conditions/health issues can the elimination diet commonly help with? I know you can’t share patient specifics, but do you have a couple of specific examples of how an elimination diet helped someone?
I've found the most benefit in utilizing an elimination diet with autoimmune patients or with those experiencing gastrointestinal problems. Many times patients with IBS or acid reflux are actually just consuming unidentified foods that their body is reacting to. Foods can be triggers in patients with migraines and chronic acne as well. I've seen the use of an elimination diet be incredibly helpful when it comes to improving acid reflux, arthritis, various skin issues, and autoimmune problems (such as Hashimotos, psoriasis, SLE, rheumatoid arthritis, etc).
Why are treatments like elimination diets sometimes better than medications or other treatments?
Medications are designed to treat symptoms. Elimination diets are aimed to get to the cause of your symptoms, but identifying problematic foods. By finding the root cause of your problem, you can prevent the symptoms from occurring by avoiding the food, rather than putting a bandaid on the symptom once it's there.
For example, the elimination diet may help you realize that eating gluten is what triggers your acid reflux and other gastrointestinal problems. These symptoms may be completely eliminated if you just adhere to a gluten free diet. This dietary change could prevent the need for long term medications with side effects to manage the acid reflux and GI problems. It would also help you avoid the financial burden of continued medical care and medication, along with any side effects the medication may have.
What is often misunderstood about the elimination diet?
I think many patients don't actually understand the basis of the elimination diet or the importance of following the elimination time frames or reintroduction periods. The elimination diet guidelines were actually developed based on your body's physiological responses. So you want to give the body time to calm down inflammatory responses by eliminating all the possible problematic foods for 2-3 weeks and then upon reintroduction, wait for delayed symptoms to show up. If you're not strict with the timeframes, it may alter your results. It can be a tedious process, but it works and is really a small amount of time to commit to in the long run.