How To Complete An Elimination Diet Suited To You

What is an elimination diet?

Elimination diets are commonly used tools in functional medicine. The food we eat is the foundation of our wellness yet, some foods, even seemingly healthy ones, may triggers unwanted symptoms in some people. It is estimated that between 2–20% of people worldwide may suffer from some form of a food intolerance. An elimination diet is the process of removing a food or group of foods from a person’s diet for a set period of time. The absence of the food(s) and then careful reintroduction of the item(s) helps determine whether specific foods or ingredients in foods contribute to unwanted symptoms. Elimination diets are individualized based on each patient’s history, eating patterns, and overall symptom picture.

Why complete an elimination diet?

Food sensitivities can be responsible for a variety of symptoms. You may benefit from completing an elimination diet if you struggled with any of the following symptoms:

Bloating
Heartburn
Distention
Constipation
Diarrhea

Fatigue
Difficulty sleeping
Skin rashes
Headaches
Low mood

Common types of elimination diets:

• FODMAP Diet: This diet eliminates foods high in certain carbohydrates (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) that can be difficult to digest and may cause digestive symptoms such as bloating, gas, and diarrhea. It is often used to manage irritable bowel syndrome (IBS) or other functional gastrointestinal disorders.

• Gluten-Free Diet: This diet eliminates all sources of gluten, a protein found in wheat, barley, rye, and some other grains. It is necessary for individuals with celiac disease, an autoimmune disorder triggered by gluten, and may also be followed by those with non-celiac gluten sensitivity.

• Dairy-Free Diet: This diet eliminates all dairy products, including milk, cheese, yogurt, and butter. It is commonly followed by individuals with lactose intolerance, a condition in which the body has difficulty digesting lactose, the sugar found in dairy products. It may also be followed by individuals with milk protein allergies.

• Specific Carbohydrate Diet (SCD): This diet eliminates complex carbohydrates, disaccharides, and certain grains. It is often used to manage digestive disorders such as Crohn's disease, ulcerative colitis, and celiac disease.

• Low-Histamine Diet: This diet restricts foods that are high in histamine or release histamine in the body. It is followed by individuals with histamine intolerance, a condition characterized by an inability to properly break down histamine, leading to symptoms such as headaches, flushing, hives, nasal congestion and digestive issues.

• Whole30: Whole30 is a 30-day elimination diet that removes grains, legumes, dairy, added sugars, processed foods, and certain food additives. It is designed to reset eating habits, identify food sensitivities, and promote overall health and well-being. It is not specifically designed for a particular health condition.

• Autoimmune Protocol (AIP) Diet: The AIP diet eliminates foods that may trigger inflammation and exacerbate autoimmune conditions. It eliminates grains, legumes, dairy, eggs, nightshade vegetables, nuts, seeds, refined sugars, and processed foods. The AIP diet is often recommended for individuals with autoimmune diseases who are looking to manage their symptoms and reduce inflammation. It eliminates potential trigger foods to support immune system regulation.

• Six Food Elimination Diet: This diet is often used in the diagnosis of food allergies in children. It helps identify specific allergenic foods that may be causing symptoms such as skin rashes, digestive issues, or respiratory problems. It eliminates the most common allergenic foods, including milk, eggs, peanuts/tree nuts, soy, and wheat.

These are just a few examples of elimination diets, and there may be variations or combinations of these diets based on individual needs and specific health conditions. It's important to consult with a healthcare professional or registered dietitian before starting an elimination diet to ensure proper guidance and monitoring throughout the process.

What to expect on an elimination diet:

• Duration of the Diet: During the elimination phase, you will remove certain foods from your diet based on the specific type of elimination diet you are following. This phase typically lasts for a few weeks to several months, depending on the diet and your individual needs.

• Potential Withdrawal Symptoms: Some people may experience withdrawal symptoms when cutting out certain foods, particularly those containing caffeine or sugar. These symptoms can include headaches, irritability, and fatigue. These effects should subside after a few days as your body adjusts.

• Improved Symptoms: If you have food sensitivities or intolerances, you may notice a reduction in symptoms during the elimination phase. For example, digestive issues, skin problems, or respiratory symptoms may improve as you remove trigger foods.

• Food Reintroduction: After the elimination phase, you will start reintroducing the eliminated foods one at a time in a systematic manner. This is usually done over several weeks, and each food is reintroduced individually, allowing you to observe any reactions.

• Identification of Food Sensitivities: The primary goal of an elimination diet is to identify any food sensitivities or intolerances. By reintroducing foods one by one, you can pinpoint which ones are causing adverse reactions.

• Increased Awareness of Eating Habits: Elimination diets often require careful reading of food labels and increased awareness of ingredients. This can lead to improved knowledge about the foods you consume and better eating habits.

• Emotional Challenges: Elimination diets can be challenging, especially if you have to give up favorite foods or make significant dietary changes. This might cause some emotional ups and downs during the process.

• Support and Guidance: Having a healthcare professional or registered dietitian guide you through the elimination diet can be highly beneficial. They can help you plan your meals, monitor your progress, and provide support throughout the process.

• Reintroduction Reactions: Some individuals may experience reactions when reintroducing certain foods. These reactions could be mild or more severe, depending on the level of sensitivity. If you experience severe reactions, it's essential to stop consuming the food and consult with a healthcare professional.

Is there a blood test to use instead of completing an elimination diet?

There are many lab tests availalve that measure certain antibodies or biomarkers in the blood that are associated with an immune response to specific foods. They claim to identify which foods might be triggering adverse reactions in individuals. However, food sensitivity tests have many challenges including lack of standardization, difficulty interpreting the significance of IgG antibodies and potential cross-reactions between foods. Food sensitivities are complex and can involve various immune mechanisms. Blood tests often oversimplify the process by focusing on just a few markers, potentially missing other important factors.

Due to these limitations, many healthcare professionals and experts still consider elimination diets as the gold standard for identifying food sensitivities or intolerances. Elimination diets allow for a more comprehensive and personalized approach, and they are more likely to provide accurate results in identifying specific trigger foods.

If you are considering food sensitivity testing, it's crucial to consult with a qualified healthcare professional who can help you understand the limitations and implications of the test results. They can also guide you on the most appropriate approach to identifying and managing potential food sensitivities based on your unique health needs and history.

Relish Health offers a Whole30-style, physician-guided elimination diet. The 50-day program guides you through removal of specific foods from your diet for 30 days. This 30-day period is proceeded by 10-days of preparation and followed by 10 days of careful food reintroduction. The course provides step-by-step instructions, meal plans, and resource guides. During the months of January and September, Dr. Leazenby is available to answer questions and provide encouragement through facebook and live zoom classes.

A PRIMER ON HISTAMINE INTOLERANCE

IS A LOW FODMAP DIET RIGHT FOR YOU?

Is your bloating caused by SIBO?

Small intestine. Image courtesy S Bhimji MD

You have probably heard that we are what we eat. I believe we are more accurately “what we absorb.” Much of our health and wellbeing hinges on a well-functioning gastrointestinal tract to absorb the nutrients that support the rest of the body. Pesky symptoms like constipation, diarrhea or frequent bloating and gas suggest that the GI tract may be compromised. These symptoms can be associated with small intestinal bowel overgrowth.

What is Small Intestinal Bowel Overgrowth (SIBO)?

Before we look at how the bowels can become overgrown with organisms, it is important to understand how the digestive system works. The intestines are comprised of the esophagus, stomach, small intestine and large intestines (also called the colon). Gastric acid produced in the stomach initiates the digestive process but also acts to suppresses the growth of ingested bacteria and control bacterial counts in the upper small intestines. The small intestines are where the majority of food is digested, and nutrients absorbed. The small intestines have an impressive length of approximately 10-15’ and are home to a large network of immune cells that help fight infection and regulate our immune system. The small intestines have a normal muscular activity which creates waves that move the intestinal contents, like food, through the gut. Our entire digestive tract is populated with trillions of organisms that make up our microbiome. The bulk of these bacteria live in our large intestines. The small intestines have relatively few bacteria in comparison to the large intestine. The normal (beneficial) bacteria are an essential part of the healthy small bowel. They help protect against bad (i.e. pathogenic) bacteria and yeast that are ingested. They also help the body absorb nutrients, and produce several vitamins like folate and vitamin K. Any disruption in the quantity of organisms, or balance of species, in the microbiome can be diagnosed as SIBO.   

What causes SIBO?

An overgrowth of organisms in the microbiome can occur when the stomach has inadequate gastric acid or the motility of the small intestines is slow. Food that nourishes us also feeds the microbiome and is subject to fermentation in the small intestines, especially if it spends prolonged time in the small intestines. This fermentation can produce gas (hydrogen or methane) that can be felt as bloating, belching, flatulence, reflux or the gas can trigger symptoms such as diarrhea or constipation. 

The conditions below are risk factors for SIBO and slow motility:

• Anatomic changes due to surgeries, scaring or small intestine diverticula

• Slow motility due to gastroparesis, celiac disease, scleroderma or pseudo-obstruction

• Metabolic changes such as those associated with diabetes or low gastric acid

• Advanced age

• Organ dysfunction like kidney failure, pancreatitis or liver failure

• Frequent medications use with antibiotics or gastric acid suppressers

How do you test for SIBO?

SIBO is most often diagnosed with a breath test. The test measures how much hydrogen or methane gas are in your breath. Both gasses are a byproducts of bacteria breaking down sugar in your gut. There are no blood or stool tests for SIBO. However, anemia, low B12 levels and markers of malabsorption may be seen on blood testing. 

How do you treat SIBO?

SIBO treatment includes 4 goals:

1. Correct the cause: SIBO is notoriously challenging to treat with a high recurrence rate. If possible, identifying and resolving the condition that initially predisposed one to the overgrowth increases the success rate of treatment. 

2. Provide nutritional support: Adopting a nutrient dense diet, supporting digestion/absorption and occasionally using targeted supplements can support gut healing. There are multiple dietary approaches for SIBO that also help relieve symptoms.

3. Treat the overgrowth: Although some antibiotics can predispose users to SIBO, there are other specific antibiotics and anti-microbial herbs that are useful in treating the overgrowth.

4. Prevent relapse: Sometimes it is difficult to completely resolve the predisposing risk(s) for SIBO. Using targeted pro-kinetics supplements of medications to promote small bowel motility can help prevent SIBO recurrence. 

Need help treating bloating, gas or abnormal stool patterns? Relish Health is here to help. 

Learn more about optimizing your gut health:

7 Steps to Fight Reflux and Bloating

Natural Foods for Gut Health

Promote Digestion and Gain Nutrients with Delicious Bitter Greens

Advice for Staying Regular When You Travel

Is a Low FODMAP diet right for you?

References:

• Collins JT, Nguyen A, Badireddy M. Anatomy, Abdomen and Pelvis, Small Intestine. [Updated 2020 Apr 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459366/

• Dukowicz AC, Lacy, BE and Levine, GM.  Small Intestinal Bacterial Overgrowth: A Comprehensive Review Gastroenterology & Hepatology Volume 3, Issue 2 February 2007 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/pdf/GH-03-112.pdf

• Bures J, Cyrany J, Kohoutova D, et al. Small intestinal bacterial overgrowth syndrome. World J Gastroenterol. 2010;16(24):2978‐2990. doi:10.3748/wjg.v16.i24.2978

Is a Low FODMAP diet right for you?

Our gut is the unsung hero of our health and well-being. This hard-working organ is responsible for not only nourishing our body, but also housing much of our immune system and playing a significant role in our brain and mood health. When this organ is impaired, our health can suffer. Without a well-functioning digestive system, the body struggles to pass along nutrients to our cells. Unfortunately, having an unhappy gut is very common. It is estimated that approximately 10-20% of adults in Western countries have irritable bowel symptoms (IBS) (1). These include gas, bloating, diarrhea, cramping and constipation— symptoms that indicate our digestion is less than optimal. Fortunately, eating the right food can reverse and improve these symptoms. By healing your gut you are on the path of healing the rest of your body.

A common approach for treating IBS is the Low FODMAP diet. This diet was initially developed by Monash University in Melbourne, Australia. It is well documented and used throughout the world for IBS and other GI disorders (2). FODMAP stands for Fermented Oligosaccharides, Dissaccarides, Monosaccharides and Polyols. This is a group of small and medium-chain carbohydrates and sugar alcohols found either naturally or artificially in food. Examples of these include: wheat (oligosaccharide), dairy (dissaccharide), high fructose corn syrup (monosaccharide) and sorbitol (polyol). For a more complete list, please see this FODMAP guide.

These FODMAP carbohydrates can ferment in the gut and cause the gas, bloating and distention symptoms that are characteristic of IBS. Additionally, these carbohydrates are highly osmotic and pull water into the digestive tract changing the way your gut moves. As a result IBS sufferers may experience diarrhea or constipation. To initiate the diet, you remove all FODMAPs for a short period of time. Eventually the FODMAP foods are reintroduced in a slow and methodic manner to keep GI symptoms at bay.

Do you wonder if a Low FODMAP diet is right for you? Generally speaking, nearly all healing starts with your diet, lifestyle changes and restoring any deficient nutrients. However, for any treatment its important to evaluate your total health, risk factors, mood and emotions. At Relish Health Dr. Erica Leazenby will discuss your individual digestive symptoms and help determine the best approach for you.

Similar articles:

7 Steps to Prevent Reflux and Bloating

Is your bloating caused by SIBO?

1. Ann Gastroenterol. 2015 Apr-Jun; 28(2): 158–159.

2. Gastroenterology. 2014 Jan;146(1):67-75.e5. doi: 10.1053/j.gastro.2013.09.046. Epub 2013 Sep 25.

Traveling with Special Diets

For many people with chronic illness, major dietary changes are part of the healing process. Changing one’s lifestyle is never easy, but travel can be especially stressful. I’ve learned through years of experience that following a strict diets is possible on the go. Below are a few strategies that have served me well over the years. 

Travel prepared

Ok this one is not new, but it bears repeating. You will reap dividends by doing some prep at home. This may simply mean packing a brown bag for the plane or may be as complex as packing groceries for the entire get-away.  The last thing you want is to feel ill or constantly worry about your food source while trying to enjoy some R&R. 

Stay in hotels with kitchenettes or use Airbnb to score an entire kitchen set up

Everybody’s idea of a vacation is different, but for me cooking and having my own kitchen is preferred while away from home. I’ve collected a few go-to recipes that are fast, easy and require little equipment. For our family, reducing the number of meals eaten out makes our dining experience special and helps us minimize the search for the next diet friendly location. 

Use a meal kit services

Consider buying meal kits from companies like Plated, Blue Apron, Sun Basket and others for vacations when you have access to a kitchen. Depending on your travel destination, the pre-portioned meal kits could even be delivered to the location of your choice or transported with you. The convenience of the kit and the curated menu items may make cooking while on vacation a little more palatable. 

Order groceries online at your final destination

Flying to a beach condo but need a week’s worth of supplies? Search the groceries in the vicinity of your final destination and look for one that has curbside grocery pick up. On your way to the condo simply swing by and fill the trunk without roaming the isle of an unfamiliar grocery. 

Eat at the grocery

Most stores have a deli, salad bar and hot food counter as well as tables for lingering. I like Whole Foods as the smaller size allows a quicker meal on the road or in a city on a business trip. Eating at the grocery may not be glamorous, but it allows you the ultimate flexibility with quantities and ingredients. This is a lifesaver for avoiding fast food restaurants during road trips. 

Do some local research with Yelp

Yelp rarely lets you down. I rely heavily on Yelp when I enter a new city. Look for restaurants that list allergens on their menus. The restaurants that are savvy enough to call out items like gluten can also likely handle other requests. 

Be “That guy”

While nobody wants to be difficult or stand out as needy and demanding at a restaurant, the truth is food sensitivities are real. You are not alone in making requests to the kitchen. Chances are high they already have a solution for the sensitivity you are addressing. 

Make your own Entree

Often components of different meals will meet your dietary needs but the entree as a whole doesn't. Don't be afraid to mix and match sides and entrees from different dishes. Many kitchens can easily accommodate this request. 

Enjoy!

Food is a great connecter of people and culture. Do your best to get out and taste the unique cuisine of your destination. Don’t be afraid to politely ask questions about ingredients and cooking methods. Having a food sensitivity may allow you to learn more about the food culture than you otherwise might have. You may come home with new inspiration and recipes!

7 Steps to Fight Reflux and Bloating

Reflux and bloating are common complaints that I hear frequently in the office. If you struggle with these symptoms as well, know you are not alone. It is estimated that 44% of Americans have heartburn once a month and as many as 10 million people have daily symptoms. 

Food is medicine and can be part of the trigger or the healing of these common complaints. Food plays many roles in our lives. It is delicious, comforting and linked to our identity and social connectedness, but is also the fuel and building blocks for health. It is information for your cells and gene expression. You eat approximately one ton of food each year and can change your body chemistry every time you eat.

Listed below are seven steps that may help you identify and address potential triggers for reflux and bloating. At a recent workshop event, we discussed these in more detail and sampled foods that can aid digestion. Look for future sessions like this on the Event page. 

1: Eat mindfully at the table (and your desk and steering wheel are not tables). Mindfulness can promote the parasympathetic nervous system responsible for the “rest and digest” function of the body. Eating slowly and paying attention to your food and how your body is responding can improve your overall digestion.

2: Get your digestive juices going. Bitter flavors can promote digestive juices. Consider adding bitter greens (eg. arugula, endive, radicchio, mustard greens, chard, parsley, cilantro, broccoli rabe or vinegars, etc.) to your plate.

3: Tend your inner garden. Our gut is home to a host of bacteria. Add fermented foods or probiotics to your diet to encouraged friendly flora. Make sauerkraut, kimchi, sour pickles and/or kefir regular condiments on your plate. Consume adequate fiber to keep the good bacteria happy and thriving and avoid processed, refined foods. 

4: Some foods can actually aid digestion. Consider adding ginger, fennel seeds and bitter flavors to your diet. Be aware of foods that may trigger reflux symptoms. They may include: fried and fatty foods, spicy foods, citrus, tomato-based foods, processed foods, alcohol, caffeine and tobacco. 

5: Consider eliminating and re-introducing foods that commonly trigger sensitivities. Start with eliminating gluten and dairy for 2-4 weeks then reintroducing and monitoring for symptoms. If bloating is still an issue, there are other diets to consider that are known to improve symptoms, including the FODMAP diet. 

6: Stay active and get your beauty rest. Movement promotes gastrointestinal motility and helps maintain ideal weight while sleep is important for overall health. Avoid going to bed with a full stomach by eating at least 2-3 hours prior to going to bed. Elevate the head of the bed to minimized night time reflux.

7: Seek help. While these interventions are generally safe for everyone, frequent or daily gastroentestinal symptoms, weight loss, blood in your stool, black tarry stools or a family history of gastrointestinal problems may siginfy more significant problems and need to be further evaluated. If you need more help identifying your particular triggers, come see me at Relish Health and we'll work on an individual treatment program designed for you.