An elimination diet functions as a test, determining whether patients may have a sensitivity to certain foods. Initially, patients stop eating foods suspected of causing illness. Then, after a suitable period of time (often 10–14 days), they review the patients' symptoms. If significant improvement has occurred, it is assumed that an allergy or intolerance to certain foods may be involved. These suspect foods are then reintroduced into 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. These include constipation , headaches, migraine, infections of the ear or sinuses, frequent colds, post nasal drip, chronic nasal congestion, sore throats, chronic cough, eczema, hives, 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, anxiety , hyperactivity, weight change, and generalized fatigue .
The following lists of appropriate and inappropriate foods for an elimination diet represent general guidelines. Elimination diets vary according to practitioner and the specific symptoms or allergy.
Foods that may be prohibited in an elimination diet include those containing:
- Additives: monosodium glutamate, artificial preservatives, sweeteners, flavors, or colors.
- Alcohol: beer, ale, stout, porter, malt liquors, 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, 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. Some 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, other exotic grains.
- Legumes: soybeans, string beans, black beans, navy beans, kidney beans, peas, chickpeas, lentils, 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.
An important complement to any elimination diet is a food diary, in which all dietary consumption is recorded, along with any subsequent symptoms. Patterns should be evident after about one month of record keeping.
As with all therapies, anyone considering an elimination diet should weigh 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.
Elimination diets should never be used by individuals with severe food allergies , as reintroducing a suspect food may provoke an asthma attack, anaphylactic shock, or other dangerous reaction. Generally, an elimination diet will only be used when symptoms are believed to be related to just one or two suspect foods.
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, calcium supplements may be advisable for someone eliminating dairy products from the diet. Needless to say, 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 re-introduced 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, both professional supervision and substitution of missing nutrients both essential.
Research & 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.
Training & certification
Because of the risks involved, elimination diets should be undertaken only under competent medical supervision. Some patients may wish to consult an allergy specialist.
Brostoff, Jonathan, and Linda Gamlin. Food Allergies and Food Intolerance: The Complete Guide to Their Identification and Treatment. Rochester, Vt.: Inner Traditions Intl. Ltd., 2000.
"Elimination Diet." Gale Encyclopedia of Alternative Medicine. . Encyclopedia.com. (June 27, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/elimination-diet-0
"Elimination Diet." Gale Encyclopedia of Alternative Medicine. . Retrieved June 27, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/elimination-diet-0
An elimination diet is the systematic elimination of foods or group of foods from the diet suspected in causing a food allergy. It is used as a means to diagnose an allergic reaction to foods.
While people of all ages can develop an allergic sensitivity to certain foods, such allergies are especially common among children. In the United States, one child in six develops an allergic reaction to certain substances, and foods are among the prime offenders. (Many food allergies are outgrown during adolescence.) Food elimination is considered only when no other cause can be found for the symptoms the child is experiencing. Common symptoms of food allergies include hives , angioedema (swelling), rashes , respiratory congestion, and gastrointestinal problems such as constipation , diarrhea , and/or gas. Food allergies are also known to play a secondary role in many chronic conditions, such as asthma , acne , ear infections, eczema, headaches, and hay fever. The most effective means of treating food allergies is to avoid the foods that produce allergic reactions.
There are two main ways of diagnosing food allergies by the elimination method. A casual approach involves eliminating, one at a time, foods from the diet suspected of causing allergic reactions and observing the person to see if there is a reduction in symptoms in the absence of particular foods. This method is often recommended for children, as it is easier to follow than the standard elimination diet. The more rigorous method (which is a true elimination diet) reverses this strategy by eliminating many foods at the outset and then reintroducing suspected allergens (allergy-producing substances) one at a time. Elimination diets often include a rotation component, by which even the limited foods allowed at the beginning are allocated in such a way that no single food is eaten more than once within a three-day period. This feature has two purposes. First, it alleviates the monotony of a limited diet. Second, it allows for the possibility that some persons may even be allergic to the relatively safe foods allowed initially. If there is an allergic reaction at this stage, rotating foods makes it possible to identify the cause of the problem.
An elimination diet is divided into two parts: the elimination phase and the reintroduction (or food challenge) phase. During the elimination phase, which generally lasts between one and two weeks, as many known allergy-producing foods as possible are eliminated from the diet. Foods commonly known to cause allergies include: citrus fruits, strawberries, corn, peas, tomatoes, peanuts, nuts, legumes, soy products, wheat, oats, chicken, shellfish, eggs, dairy products, cow's milk, vinegar and other products of fermentation, coffee and tea, cane sugar, chocolate, and food additives. The elimination diet can be very strict or more liberalized depending on the severity of the symptoms. It is important to personalize the diet whenever possible.
During the elimination phase of the diet, which clears the body of allergens, ingredient labels for all processed foods should be carefully scrutinized to make sure that none of the proscribed foods makes its way into the diet. Different diets handle the reintroduction phase differently. In some cases, the "test" foods are introduced at three-day intervals while in others, a new food is reintroduced every day for 15 days. Foods should be reintroduced in as pure a form as possible (for example, cream of wheat rather than bread) for maximum certainty that the resulting effects are produced by the substance in question rather than by some other ingredient added during the manufacturing process.
A strict elimination diet should not be undertaken without the supervision of a physician and/or dietitian.
Another way to identify food allergies is to keep a food diary, recording everything eaten for a period of three or four weeks and noting any allergic reactions during that period.
The elimination phase of the diet should not last more than two weeks, since this restricted regimen will lack some essential nutrients. Also, a child's growth may be affected if placed on an elimination diet for an extended period. For example, a child with a cow's milk allergy must obtain his calcium, vitamin D, and other essential nutrients found in milk from other sources. Children with food allergies need to be followed by a physician and or dietitian to ensure they are not at risk for growth problems or inadequate intake of nutrients.
Persons with chronic food allergies should see their symptoms subside during the elimination period. Sometimes they may experience withdrawal, an episode in which symptoms may actually worsen before they subside. These include: bloating, food cravings, headache , fatigue, and general aches and pains. This condition may last for a few days. Upon reintroduction of the offending food, these symptoms should return and are often worse than previously reported.
In order to effectively eliminate the offending foods, a parent should be educated on label reading, cross-contact, and selecting alternate foods for an allergic child.
Kleinman, Ronald E., and the American Academy of Pediatrics Committee on Nutrition. Pediatric Nutrition Handbook, 5th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2003.
Mahan, L. Kathleen, and Sylvia Escott-Stump. Krause's Food, Nutrition, & Diet Therapy, 10th ed. Philadelphia: Saunders, 2000.
Physicians Committee for Responsible Medicine. Healthy Eating for Life for Children. Hoboken, NJ: Wiley, 2002.
Willett, Walter C., and P. J. Skerrett. Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating. New York: Simon & Schuster Source, 2002.
Christie, Lynn, et al. "Food Allergies in Children Affect Nutrient Intake and Growth." Journal of the American Dietetic Association 102, no. 11 (November 2002): 1648–51.
Mofidi, Shideh. "Nutritional Management of Pediatric Food Hypersensitivity." Pediatrics 111, no. 6 (June 2003): 1645–53.
Schiltz, Barbara. "Elimination Diet: Food Challenge Tools for Patients with Allergies." Journal of the American Dietetic Association 103, no. 4 (April 2003).
American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007–1098. Web site: <www.aap.org>.
American Dietetic Association. 120 South Riverside Plaza, Suite 2000, Chicago, IL 60606–6995. (Web site: <www.eatright.org>.
Laura Kim Saltel Allan, R.D.
"Elimination Diet." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Encyclopedia.com. (June 27, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/elimination-diet
"Elimination Diet." Gale Encyclopedia of Children's Health: Infancy through Adolescence. . Retrieved June 27, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/elimination-diet