Elimination diets may promise to improve bloating, brain fog, and breakouts, but do they really live up to the hype? Before trying a diet of this type, it is important to know what they are, how they work and why you should only do them under the supervision of a doctor.
What are elimination diets?
They are meal plans that eliminate specific foods or food groups from the diet to determine the source of a person's food intolerances . They can be quite useful when you consider that 15-20 percent of the population suffers from food intolerances, according to a December 2014 review in Alimentary Pharmacology & Therapeutics.
The goal of this type of diet is to identify foods that can trigger a variety of unwanted symptoms. It is often recommended for acne , migraines or abdominal inflammation among others. Chronic pain and fatigue can also lead people to try this diet.
But gastrointestinal problems are among the most common reasons people try elimination diets. The low- FODMAP diet , for example, is designed to help people with irritable bowel syndrome (IBS) identify specific carbohydrates that they cannot tolerate. Another example is eliminating dairy to see if gastrointestinal symptoms like bloating, gas, and diarrhea resolve when lactose sugar is removed.
You could even say that Paleo , Whole30, and gluten-free diets are all elimination diets. After all, they are meal plans that eliminate food groups from the diet.
Unlike diets designed for people with food allergies that require long-term adherence, elimination diets must be temporary . They also reintroduce potential trigger foods as a means of testing whether or not they cause symptoms.
How do elimination diets work?
Phase 1: Elimination
The goals of the elimination phase are to eliminate all harmful foods from the diet and to see complete or near complete resolution of symptoms. Typically this is done for about four to six weeks , but most people will begin to see an improvement in symptoms within the first two weeks.
It is not yet known exactly why some people respond and others do not, although it is probably because irritable bowel syndrome itself is quite variable. For some people, diet can cause symptoms, while for others it can be stress or medication.
The general rule of thumb is that if you do not experience improvement in symptoms within two to six weeks after the elimination phase, there is no reason to continue the diet.
Remember that symptom relief is not linear or immediate. Nerves and bacteria in the gastrointestinal tract take time to adjust to changes in diet.
Phase 2: Reintroduction
The second phase of elimination diets consists of the slow and steady reintroduction of food . This phase is the most important.
If done incorrectly, the removal will be useless and all symptoms may return without information being provided to us. The goal here is to carefully reintroduce one food at a time in order to assess whether that food is a trigger.
Reintroducing foods one by one is essential. For the low-FODMAP diet, for example, the best approach is to eat a new food from a certain FODMAP group every three days (with a three-day "washout period", in which you go back to the elimination phase, between each new acquisition).
If a reintroduced food does not produce symptoms, it can remain on the diet for the long term. However, if consumption causes adverse reactions, the complete elimination diet should be restored until all symptoms resolve.
When working through phase two, it's important to make sure that the foods you reintroduce only contain one of the possible triggers that you are controlling. For example, try watermelon (a high-FODMAP food) instead of a piece of bread, which may also contain wheat, gluten, dairy, and / or eggs.
It is also helpful to keep a food diary to document the severity and duration of symptoms during the reintroduction phase. Sometimes we will have a symptom and will be so distracted or 'used' that we lose it until we are asked to take a journal and document it.
Phase 3: Individualization
The final phase of an elimination diet is all about personalization.
Once we complete the reintroduction and identify food triggers, you should work with a professional to create a nutrition plan that limits or eliminates certain food triggers, but still has variety and is balanced.
The need to eliminate food for life depends on the person and the condition. When you are allergic to a food, there is no option to "taste" it. Food should be avoided completely. However, if you are dealing with an intolerance or irritable bowel syndrome, there may be room for maneuver.
Pros and cons of elimination diets
As long as elimination diets are done correctly, they shouldn't carry major health risks. That being said, it is critical to follow the strict protocols surrounding meal plans.
Elimination diets should not be done without the guidance of a healthcare professional. You need to do a comprehensive assessment to determine a person's food preferences, dietary patterns, and medical history before starting such a diet.
It is also important to remember that elimination diets are temporary and should not be followed for long periods or to lose weight . Potential risks can also arise with nutritional deficiencies or negative changes in the gut microbiota if someone sticks to such a diet for a long time.
Low fiber intake (in the case of the low FODMAP diet) and unwanted weight loss can occur if an elimination diet is followed for a long period of time or if it is completed incorrectly.
Also, they are not recommended for people struggling with disordered eating patterns , as eating plans can be extremely restrictive and therefore can contribute to unhealthy relationships with food.
Foods You Can't Eat on Elimination Diets
There is no single elimination diet, but foods that are commonly eliminated include:
1. Common allergens : These include wheat, soy, dairy, eggs, peanuts, tree nuts, fish, shellfish, and sesame.
2. FODMAP Foods : This stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. Here's what these are:
Oligosaccharides: wheat, rye, onions, garlic and legumes.
Disaccharides: Lactose in milk, yogurt and cheese.
Monosaccharides: fructose in honey, apples, watermelon, mango, pears, and plums.
Polyols: Sorbitol and mannitol found in some fruits and vegetables; polyalcohols and artificial sweeteners.
3. Gluten
4. Alcohol
5. Caffeine
6. Added sugars
