Elimination Diets: The Gold Standard for Food Sensitivities?

Have you ever gone through the rigor of an elimination diet to see if there are foods in your diet that are causing unpleasant symptoms? Many of us have, or at the very least thought about it. The classic Elimination Diet is still the gold standard for uncovering food sensitivities. It was originally invented and popularized by Dr. Albert Rowe in his book Elimination Diets and Patient's Allergies, written in 1941. We are still using his concept to this day. Many healthcare practitioners, even medical doctors, recommend these diets on a routine basis. They too know that IgG tests, as I wrote about previously (insert link), are fraught with errors and are frankly unreliable.

So what does an Elimination Diet entail exactly? As aptly named, this type of diet seeks to eliminate many of the known common allergens (or as they should be more appropriately called, sensitivities) from the diet for a set period of time, usually 3 or 4 weeks. This gives the immune system enough time to calm down, so to speak, and ample time to see a reduction in symptoms. When foods are reintroduced, the symptoms they provoke are typically obvious and more severe than previously experienced. This makes it much easier to pinpoint the culprit foods.

Here are the foods typically eliminated on a basic elimination diet:

Wheat

Gluten

Co
Soy

Dairy

Nightshades

Eggs

Peanuts

Alcohol

Caffeine

Cane Sugar

Artificial Sweeteners

Other foods eliminated on stricter plans:

Beans, peas, lentils

All seeds and nuts

ALL sugar (including maple syrup, honey, etc)

Beef

Chicken

Pork

Shellfish

Certain chemicals (tyramine, phenylethylamine, nitrates, MSG, etc)

As you can imagine, these diets are clearly no walk in the park. They are typically only suggested for patients that are willing and able to follow the protocol with the strong suggestion that the diet be guided by a trained practitioner. The rigor of the diet can be a hurdle for some, but this can be overcome with proper education, advice, and support. Most of us Dietitians have had training and practice during our schooling and are well qualified to walk patients through the process.

While you know now that elimination diets have been around for some time, you may have noticed they have started to become re-popularized lately, almost faddish in nature. Nowadays there seems to be countless books hitting the shelves talking about anti-inflammatory diet plans and specialized eating plans that claim they will help you shed weight, increase your energy, and even make you look years younger. What do all these diets have in common? They are based on the classic elimination diet!

As noted previously, these diets can be moderately restrictive or very restrictive based on what criteria you follow. That criteria is usually decided upon by you and your practitioner and what foods they seem to think are likely problematic in your particular case. While guided, informed and well-meaning, it's essentially a guessing game. Similarly when you follow the plan put out by some author who has never met you and certainly doesn't know your history or symptoms, it is an even greater guessing game.

And there you have the number one problem with our "gold standard." How in the world do we know what to eliminate and what to leave in? Why are we never recommending someone take out apples, for example, or quinoa, or other "healthy" foods that could be equally problematic. If you are one of the lucky few that reacts to only one or two of the common allergens, then this diet works great for you. Problem solved! I've met these people and the elimination diet has been a miracle. For others, however, it ends up being just another plan that didn't work. Clearly elimination diets can be helpful, but they just aren't the answer for everyone. I know this first hand because elimination diets never worked for me.

As I mentioned previously, there are several authors and experts that are now recommending different elimination diets as the miracle plan to cure your ailments and help you shed stubborn weight. Even Dr. Oz has an elimination diet plan! Knowing what you know now, you can immediately ascertain that this may hold true for a select few. For many, these diets won't address all of the problematic foods and you just spent money on yet another book or wasted weeks of hard work for little reward.

All that being said, I do think elimination diets have their place. I have had clients who were unable or unwilling to spend money on food sensitivity blood testing (the only one I recommend is Mediator Release Testing by Oxford Biomedical) and we successfully found an elimination diet plan that worked for them. This is the minority, however. We guessed and won. That doesn't always happen. Most clients who have already tried everything typically come to find out, through blood testing, that no one figured out they were reacting to random healthy foods (ie fruits, vegetables, gluten-free grains, etc) and therefore they fell through the cracks. There is where elimination diets show their limitations and knowing the right blood test to use is crucial.

The best use of an elimination diet is with a trained medical practitioner, particularly one that knows your entire health history and can help you devise the best diet plan. A book, a TV show, or an online guide is not the way to go. Sure, those avenues have obviously helped some, but a carefully tailored plan is the best option, especially for those with more severe and chronic conditions. Of course blood testing is even better and more targeted if you can find a practitioner, such as myself, offering Mediator Release Testing. Educate yourself on all the options before starting or otherwise all that hard work may be for naught.