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Navigating an allergen-elimination diet

Contrary to popular belief, food isn’t just fuel. You see, food is also information. Every bite of food you eat sends a message to your body and your body responds accordingly. The gastrointestinal (GI) tract is the interface between food and body. And this huge organ system – the size of a tennis court when stretched end to end – is responsible for converting our food into chemical messages through the processes of digestion and absorption. However, the GI tract doesn’t just digest and absorb food. The GI tract is also rich in neurotransmitters, hormones, chemical messengers, enzymes, and bacteria. Indeed, it’s even home to 70 percent of your body’s entire immune system! Given the amount of resources devoted to the proper function of the GI tract, it seems obvious that a healthy body starts with a healthy GI system. But a whole lot can go wrong.

So what is an elimination diet? Well, it’s all in the title: you eliminate certain foods for a period of time, usually three to four weeks, then slowly reintroduce specific foods and monitor your symptoms for possible reactions. It is used to learn whether or not certain foods may be causing your symptoms or making them worse. If a reaction occurs, the diet can also become a way to treat these symptoms.

Despite the multitude of currently available food allergy tests, the elimination diet still remains the gold standard for identifying food sensitivities. As with all allergy tests, it too has its flaws. But it’s inexpensive, easy to do and you experience the results first hand!

There are four main steps to an elimination diet: Planning, Avoiding, Challenging, and Creating a New, Long-Term Diet. Initially, the healthcare practitioner learns which foods might be causing problems, usually through asking the patient to keep a diet journal for a week, listing the different foods eaten and keeping track of the symptoms experienced throughout the day. It can be helpful to ask the patient a few key questions:

  • What foods to you eat most often?
  • What foods do you crave?
  • What foods do you eat to “feel better”?
  • What foods are hard to give up?

After establishing typical eating patterns, the provider can design an elimination diet suited to rooting out potential problems. The elimination diet must be followed without any exceptions, including checking the ingredients of processed foods. For example, if the patient is avoiding all dairy products, they will need to check labels for whey, casein and lactose to comply with the elimination diet properly. It is important for both the patient and the provider to actively monitor for any severe increases in symptoms. If symptoms don’t improve after the trial period, stop the diet and decide whether to try again with a different combination of foods. However, if symptoms do subside, start “challenging” the patient with the eliminated foods, one at a time, to see if any symptoms return. Based on your results, you plan a long-term diet to prevent your symptoms.

If you decide to try an allergen-elimination diet with your patients, stress that if they have any immediate allergic reactions, such as throat swelling, acute rash, or other severe allergy symptoms, the patient must seek medical attention and avoid any additional food challenges until their primary healthcare provider says otherwise.