Trust Your Gut: How does the elimination diet work?
What is the elimination diet?
Food sensitivities are adverse reactions to foods that are caused by problems with the digestion or metabolism of the triggering foods. There are currently no tests on the market that can accurately identify food sensitivities. Elimination diets are considered the gold standard in identifying these triggering foods. The elimination diet is a dietary method used to isolate and identify food sensitivities in individuals with a variety of symptoms, including headaches, digestive issues, fatigue, and mood swings. It is the gold standard in identifying food sensitivities.
The diet has an elimination phase in which all potential trigger foods are eliminated, followed by a reintroduction phase in which foods are added back in one by one to test for adverse reactions.
Because the diet is so strict, proper planning and preparation is essential to ensure all nutrient and calorie requirements are met.
This is not a diet for weight loss; instead it’s goals are to identify food sensitivities and heal the gut. The diet is meant to be short term.
The elimination diet is a short term dietary protocol that can be used to accurately identify food sensitivities and reduce associated symptoms. It is designed to be used by people who are experiencing chronic, vague symptoms (such as headaches, digestive problems, fatigue, irritability, etc.) without a clear cause. Usually these symptoms have not responded to other treatments and are linked to specific foods.
Reducing gut inflammation:
The overarching goal of the elimination diet is to heal the gut, identify food sensitivities, and establish a personalized, whole foods based dietary protocol. Any adverse food reaction causes low-grade inflammation in the gut, resulting in a breakdown of the gut wall. When the gut wall is weakened, undigested food particles can pass through the gut into the bloodstream (this is referred to as leaky gut syndrome). Leaky gut syndrome not only allows undigested food particles to get out, but it also allows bacteria and other chemicals into the gut, worsening inflammation1. Luckily, leaky gut syndrome can be reversed. The cells of the gut wall are replaced every 2-4 weeks, on average. Eliminating inflammatory foods and replacing them with nutrient dense, whole foods can strengthen the gut wall and eliminate leaky gut.
Nutrition is highly personalized, and what causes inflammation in one person may not impact another person in the same way. The elimination diet allows you to isolate and identify potential trigger foods so you can remove them from the diet, leading to a reduction in symptoms. Food sensitivity symptoms can be pervasive and interfere with your mental health and ability to live a fulfilling life. While it is a strict protocol to follow, it is only temporary and will get you feeling your best!
General diet protocol:
The elimination diet consists of two phases- the elimination phase and the reintroduction phase. In the elimination phase, the following foods are completely eliminated from the diet for 2-4 weeks: alcohol, beef, chocolate, caffeinated beverages (such as coffee, some teas, and soft drinks), corn, dairy products, eggs, gluten, peanuts, pork, processed meats, shellfish, soy and soy products, and sugar. These foods are common triggering foods. They are eliminated for 2-4 weeks to allow the body to reset, reduce inflammation, and eliminate symptoms. In the first 4-7 days, you may experience a resurgence of symptoms, such as fatigue, headaches, or irritability. These will pass.
Once all foods have been eliminated for 2-4 weeks, the reintroduction phase begins. Every three days, you will add one food category back into your diet. This is called testing the food, to see if it gives any reactions. Eat the food 2-3 times a day and track any reactions you may have. Reactions may include headaches, gastrointestinal distress (such as flatulence, bloating, constipation, or diarrhea), irritability, fatigue, rashes, or acne. If you have a reaction on the first day, do not eat the food again and continue on schedule. It is imperative that you isolate the food you are testing. For example, if you are testing dairy, it is better to drink a glass of milk than eat a slice of pizza. The milk isolates dairy, whereas the pizza also contains gluten. If the food being tested is not isolated, it is hard to know what the reaction is from. If the food being tested does not give you a reaction over the course of 3 days, you can add that food back into your diet and continue on with your testing schedule. It may be helpful to create a schedule on a calendar so you are prepared with the foods you will need for testing.
Food journaling:
Food journaling is an important part of the elimination diet. Keeping a detailed log of your experience is the only way to get accurate data about how specific foods impact you. Your food log should include the type and amount of food eaten (precise measurements are preferred over guesses), the time it was eaten, any symptoms, the time the symptoms appear, and beverages consumed. Don’t forget to track condiments, creamers, sweeteners, and dressings as well. While not necessary, it is helpful to include notes about sleep and stress patterns a well. Poor sleep and elevated stress can cause symptoms similar to food sensitivities (such as fatigue and irritability), so it is important to distinguish the two.
The best method of food journaling is whatever method you will stick with for the duration of the diet. Some options include a physical notebook or a digital copy on your phone. Be sure to track food as you are eating it, as opposed to at the end of the day. Tracking as you eat and as you experience symptoms allows for more accurate data collection. At the end of the day, review your log to ensure everything looks accurate and complete.
How to be successful:
Be prepared. The elimination diet is an intense, fairly restrictive diet (and only meant to be completed in a short time frame). While on this diet, it can be difficult to travel, eat at restaurants, or get takeout meals. If possible, try to complete the diet in a time frame where you have no travel, vacations, etc. If you do need to travel, prepare and bring your own meals and snacks when possible and call restaurants to confirm that they can cater to your needs. Let friends and family know about the elimination diet and explain why you are completing it. Offer to bring an elimination friendly dish to any parties or gatherings for everyone to share!
Before starting the diet, stock your kitchen with basic staples you will need. These include gluten free grains, legumes, nuts and seeds, frozen or fresh fruits and vegetables, spices, herbs, lean meat and fish, and herbal tea. It may be helpful to meal prep full meals or staples that you can quickly grab and reheat in a pinch. Cooked gluten free grains and legumes freeze well and can easily be reheated when needed. Frozen fruits and vegetables are a great source of nutrients with minimal prep time. Finding recipes ahead of time that work with the diet will ensure that you have plenty of food options.
Covering nutrient bases:
This is a strict diet, so you need to be mindful of eating a wide variety of the foods that are allowed so ensure you get all the micro and macro nutrients that you need. Micronutrients are vitamins and minerals and macronutrients are carbohydrates, protein, and fat. Include a protein source (legumes, fish, or meat), a fat source (avocado, nuts, seeds, olive oil), and a colorful fruit or vegetable with every meal. Fruits and vegetables contain phytonutrients, important compounds that help our bodies reduce inflammation, improve brain health, and prevent chronic disease2. Different colored foods contain different phytonutrients so it is important to eat the rainbow everyday. Because the elimination diet is a short frame, it is unlikely that you will develop any major nutritional deficiencies. It is still wise, however, to consult with a professional to discuss any potential supplementation needs.
Keep in mind that this diet is not meant for weight loss, but to identify food sensitivities (although weight loss is possible). Do not restrict calories on this diet in an attempt to lose weight. The approved foods on the elimination diet tend to be naturally low in calories and there is no need to further restrict calories. Keep snacks with you at all times so you have something to eat in case you get hungry while out (sugar free dried fruits, nuts, and seeds are great options). The diet may be a big change for you, and you may find yourself fatigued at first. Do not attempt any vigorous exercise while in this stage. Gentle yoga and walking are the preferred methods of movement until you start to get energy back. The best way to limit (and prevent) fatigue is to eat a wide variety of nutrients and an adequate amount of calories based on your height, weight, and activity level. A simple calorie needs calculator online can help you determine your individual needs.
Positive and healthy mindset:
A positive and healthy mindset is crucial to successfully completing the elimination diet. Know that despite the fact that it is hard, it will help you improve your mental and physical health and clear any symptoms you may be experiencing. It may help to remind yourself that it is a short term diet that will provide you with long term solutions to symptoms. Self-care while on this journey is important and can look different for everyone. Options for self-care include journaling, practicing meditation, implementing a sleep routine, doing gentle yoga, going to therapy, setting aside time to read, etc- the possibilities are endless. Working through symptoms can be a difficult process. Acknowledge your symptoms while practicing gratitude for the things your body can do for you. You can even practice gratitude for your ability to complete the diet and improve your health! Recruiting support from family, friends, and others who have done the elimination diet gives you a strong support system to lean on for comfort and help.
Next Steps:
If you think you may have a food sensitivity, the elimination diet is worth exploring. Modyfi has a network of professionals to support you through lifestyle changes, such as fitness, nutrition, sleep, and more. Reach out today for more information.
References:
Camilleri M. (2019). Leaky gut: mechanisms, measurement and clinical implications in humans. Gut, 68(8), 1516–1526. https://doi.org/10.1136/gutjnl-2019-318427
Institute for Functional Medicine. (2021). Phytonutrient Spectrum: Comprehensive Guide.
