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Therapies

Food elimination diet

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How to Choose a Practitioner
Cautions
References
Evidence Based Rating Scale 

What Is It? 

A food elimination diet involves eliminating suspected foods from your diet and re-introducing them one at a time to determine what may be causing allergic reactions, which are abnormal responses of the immune system to otherwise harmless substances in food. About two percent of adults and six to eight percent of children under the age of three have food allergies. (1) Eliminating allergenic foods has been shown to be the gold standard for diagnosis and elimination of allergic reactions. If no allergic reactions occur after suspect foods have been eliminated, the foods can be reintroduced one at a time to see if one develops. 

The most common allergenic foods include wheat and other glutinous grains, dairy products, eggs, peanuts, corn, soy and tofu, citrus fruits, yeast, and refined sugars. Other substances such as highly processed foods, chemicals, additives, preservatives, artificial colorings and flavorings, caffeine, and alcohol also can be problematic. During the food elimination diet, the object is to avoid intake of all suspect foods and substances for at least seven to ten days, or long enough to clear all traces of these foods from the digestive tract. The omitted foods can then be reintroduced into the diet one at a time to determine what is causing the allergic reaction. Symptomatic response to certain foods may dissipate with time so, depending on the severity of the initial test response, after three to six months the allergenic foods can be retested and added back into the diet if no reaction occurs. 

Several variations of the food elimination diet may be considered, depending on the patient’s lifestyle, age, weight, general health, food preferences, attitude, or family system. Some variations include a water fast diet, dilute juice fast, fruit and/or vegetable plan, and the caveperson plan. However, all plans follow the same basic procedure of eliminating suspect foods for at least five days, introducing one new food every other day to test for allergic reaction, recording reactions, and avoiding foods that cause allergic reactions.  

How Does It Work? 

Researchers have found most allergic patients have multiple allergies rather than adverse effects from a single allergen, so eliminating only one allergen may not improve symptoms enough to allow identification of the specific problematic food. Eliminating all suspect foods and introducing them back into the diet one at a time allows for rapid clearing of allergens, minimal adverse reactions and accurate test results. 

What You Can Expect 

You may be asked to begin the food elimination diet with one or more of the variation diets. For example, you may start with two days of the dilute juice fast, which involves drinking only diluted juices to clear any allergic substances from your body. The diluted juices – three parts distilled or mineral water to one part fresh, sugar-free, non-citrus juice – provide enough calories while at the same time stabilizing your blood glucose levels and decreasing withdrawal reactions caused by eliminating all common allergens. After two days of the dilute juice fast, you may begin to add the fruit and/or vegetable plan, which allows you to eat unlimited amounts of clean fresh fruit and raw, steamed or baked vegetables. And then the caveperson plan of vegetables, fruits, berries, honey, nuts, seeds, beans, etc. can be added back to your diet. However, if allergic symptoms have not diminished or disappeared after five days, the current diet may be maintained for another five days. 

If allergic reactions have diminished or disappeared during this process, you can begin to introduce foods back into the diet according to your doctor’s advice. Generally, the following order is recommended: vegetables, fruits, melons, beans, nuts and seeds, yeasts, and grains. Next, test goat dairy products such as plain yogurt, cheeses, and then milk. Use the same process for cow’s milk products. Dietary supplements also should be tested one at a time. 

Your physician or allergist may ask you to keep a food and symptom diary during this process to determine if a pattern of symptoms is visible, identifying the allergen and allowing for elimination of the problematic foods.  

Health Benefits

Food allergies and intolerances are common in many chronic diseases such as celiac disease, arthritis, and chronic infections e.g. sinus infections, as well as disorders of the central nervous system (including depression, anxiety and chronic fatigue). Eliminating food allergens may help improve symptoms of these chronic diseases when other treatments have not worked. The diet may also help those suffering from irritable bowel syndrome and attention deficit disorder (ADHD). 

Specifically, food elimination diet may help to: 

Identify food allergens. The primary therapy for food allergy in adults and children is to eliminate the responsible food. (2, 3, 4) Identifying the specific allergen is key to removing the problematic food from your diet while at the same time ensuring you get the proper nutrients from a well-balanced diet. 

Treat irritable bowel syndrome.  Patients diagnosed with IBS may benefit from a food elimination diet. In a 2006 open label pilot study, 20 IBS patients who had not responded to conventional therapies underwent food elimination diets to determine the role of food intolerance in this digestive disorder. Significant improvements were reported in stool frequency and pain, overall well being and IBS quality of life after completing the food elimination diet. (5) A 2005 Finnish review of studies also found that dietary factors contribute to IBS, and food elimination diets offer a viable treatment option for IBS patients. (6)

Treat ADHD. Some nutritionally oriented doctors believe certain food sensitivities may contribute to ADHD. They recommend a food elimination diet to see if symptoms improve. Some preliminary studies also have found potential efficacy of the food elimination diet for ADHD. In a 2002 study of 40 children, parents reported 62 percent of the children showed significant improvement in behavior after two weeks of an elimination diet based on the few foods diet of rice, turkey, pear and lettuce. Researchers concluded the diet may lead to significantly decreased symptoms in children with ADHD. (7) However, more research is needed to confirm these preliminary results.

Treat celiac disease. The only treatment for this autoimmune disorder caused by a gluten protein found primarily in wheat, rye, and barley is a life-long gluten-free diet. But even though the disease is caused by the reaction to the protein found in wheat, it is not the same as a wheat allergy. Some people suffering from celiac disease can tolerate oat products, but there is controversy about including them in a gluten-free diet. A food elimination diet may be the best way to determine whether you can tolerate the oat products, starches and some other grains. (8, 9)

Treat asthma and other respiratory infections. Some allergic reactions can induce respiratory distress and, in some cases, can bring on asthma attacks. A 2001 Colorado Allergy and Asthma Center review of studies found patients who have a current or past history of one or more of the following conditions may have food-related respiratory symptoms: confirmed food allergy, atopic dermatitis, wheezing, or experiencing anaphylactic symptoms after ingesting particular foods. The review recommended a safe elimination diet and an emergency plan for accidental allergen ingestions to treat respiratory symptoms that result from food allergies. (10) However, because asthmatic patients are at an increased risk of developing food sensitivities or allergies, a food elimination diet should only be considered after careful investigation and observation of the patient. (11)    

Treat atopic dermatitis (AD). Researchers believe food allergies play a role in the pathogenesis of atopic dermatitis, a skin disease characterized by red, flaky, inflamed, and/or itchy skin. A 2007 study of 44 infants (under one year old) with symptoms of AD who underwent a food elimination diet found 61 percent of the infants showed sensitization to foods, most frequently to eggs. (12) A 2004 Italian review of studies found an elimination diet is only efficacious in children with AD when a specific diagnosis of food allergy has been made. (13) Nonetheless, an elimination diet if effective for you as a first line treatment for AD may save other expensive tests and treatments.

Treat rheumatoid arthritis (RA). Elimination of allergenic foods has been shown to offer significant benefit to some individuals with RA. Many foods can aggravate RA, but the most common offenders include dairy, egg, corn, wheat, and citrus fruits. One well-designed 13-month study of two groups of patients with RA highlighted the effectiveness of eliminating food allergens as part of a healthy diet and lifestyle program to treat RA. The treatment group began with a modified fast for seven to ten days, drinking only herbal teas, garlic, vegetable broth, a decoction of potatoes and parsley, and juices of carrots, beets and celery. After the fast, the patients reintroduced new foods every second day. If they noticed an increase in pain, stiffness, or joint swelling within 2 to 48 hours, the item was omitted from the diet for at least 7 days before being reintroduced a second time. If the food caused worsening of symptoms after the second introduction, it was permanently omitted from the patient’s diet. The results indicated a therapeutic benefit from eliminating allergens, as well as additional improvements due to changes in dietary fatty acids. (14) In a follow-up study, all of the patients whose RA responded to the diet reported significant benefits and were still following the diet. The control group, which followed an omnivorous diet, did not report any benefits. (15) A recent Italian review concluded that a food elimination diet is more likely to be beneficial in RA patients who have positive skin prick tests for allergies. (16) Nonetheless, for most people without diabetes or other metabolic diseases, there is no contraindication to trying it.

How to Choose a Practitioner 

A food elimination diet also should be managed by a dietitian or other health professional with nutritional expertise to ensure that the exclusion does not lead to a nutritionally-deficient diet. A professional practitioner can help you determine safe alternative foods and supplements that may fill nutritional voids caused by the elimination. Your physician or child’s pediatrician may also recommend you visit an allergist for further testing. 

Cautions 

If you have confirmed your food allergy, you will need to eliminate it from your diet. Reading food labels and restaurant menus carefully will help you avoid allergy triggers.

The food elimination diet is an effective way to sort out the more subtle or chronic reactions to foods ( sometimes called food sensitivities as opposed to food allergies). The elimination-challenge process described in this article is not recommended if someone has had  extremely allergic or severe anaphylactic reactions, such as severe hives and difficulty breathing after a food exposure.  In such cases it is better to go to a physician-allergist for testing. Careful skin testing or use of a blood test (the RAST or the ELISA test of food-specific immunoglobulin E (IgE)) can identify  likely triggers of the more severe and acute allergy reactions.

For  people who are very sensitive to food allergens such as nuts or strawberries and have had a severe or life threatening reaction ( anaphlaxis), it is important to consult with your allergist and to set up an emergency plan.  Be prepared for unintentional exposure, especially if even the smallest amounts of a food allergen (for example, a small portion of a peanut kernel) can prompt an allergic reaction. Wear a medical alert bracelet or necklace describing your food allergy, and carry an antihistamine drug and/or an epinephrine injection for emergencies. 

References 

  1. U.S. National Institutes of Health and the National Institute of Allergy and Infectious Diseases. “Food Allergy: An Overview.” Available at: http://www.niaid.nih.gov/publications/pdf/foodallergy.pdf. (Accessed May 29, 2007)
  2. Grimshaw KE. Dietary management of food allergy in children. Proc Nutr Soc. 2006 Nov;65(4):412-7.
  3. Fiocchi A, Martelli A. Dietary management of food allergy. Pediatr Ann. 2006 Oct;35(10):755-6, 758-63.
  4. Burks W. Current understanding of food allergy. Ann N Y Acad Sci. 2002 May;964:1-12.
  5. Drisko J, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006 Dec;25(6):514-22.
  6. Kalliomaki MA. Food allergy and irritable bowel syndrome. Curr Opin Gstroenterol. 2005 Nov;21(6):708-11.
  7. Pelsser LM, Buitelaar JK. [Favourable effect of a standard elimination diet on the behaviour of young children with attention deficit hyperactivity disorder (ADHD): a pilot study. Ned Tijdschr Geneeskd. 2002 Dec 28;146(52):2543-7.
  8. Kupper C. Dietary guidelines and implementation for celiac disease. Gastroenterology. 2005 Apr;128(4 Suppl 1):S121-7.
  9. Thompson T. Oats and the gluten-free diet. J Am Diet Assoc. 2003 Mar;103(3):376-9.
  10. James JM. Food allergy and the respiratory tract. Curr Allergy Rep. 2001 Jan;1(1):54-60. 
  11.  Aba-Alkhail BA, El-Gamal FM. Prevalence of food allergy in asthmatic patients. Saudi Med J. 2000 Jan;21(1):81-7l.
  12.  Garcia C, El-Qutob D, Martorell A, et al. Sensitization in early age to food allergens in children with atopic dermatitis.
  13.  Fiocchi A, Bouygue GR, Martelli A, et al. Dietary treatment of childhood atopic eczema/dermatitis syndrome (AEDS). Allergy. 2004 Aug;59 Suppl 78:78-85.
  14. Kjeldsen-Kragh J, Hougen M, Borchgrevink CF, et al. Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. Lancet 1991;338:899-902.
  15. Kjeldsen-Kragh J, Hougen M, Borchgrevink CF, et al. Vegetarian diet for patients with rheumatoid arthritis – status: two years after introduction of the diet. Clin Rheumatol. 1994;13: 475-482.
  16. Miggiano GA, Gagliardi L. Diet, nutrition and rheumatoid arthritis. Clin Ter. 2005 May-Jun;156(3):115-23.

 Evidence Based Rating Scale  

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

 

 

  

ADHD

 

 

 

 

 

 

 

A pilot study indicates efficacy, but research is lacking in this area. More research is needed to determine efficacy.

 

 

 

Allergies

 

 

 


Date Published: 02/20/2008
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