What is an elimination diet. How does it work. Who should consider trying it. What are the potential benefits and risks. How to implement an elimination diet effectively.

Understanding the Elimination Diet: A Powerful Tool for Identifying Food Sensitivities

An elimination diet is a structured approach to identifying food sensitivities or intolerances by temporarily removing certain foods from one’s diet and then systematically reintroducing them. This method allows individuals to pinpoint specific foods that may be causing uncomfortable symptoms or health issues.

The primary goal of an elimination diet is not weight loss or fitness improvement, but rather to uncover potential food triggers for various health concerns. By eliminating suspect foods for a period of time and then carefully reintroducing them, individuals can gain valuable insights into how their bodies react to specific foods.

How does an elimination diet work?

The process typically involves two main phases:

1. Elimination phase: Removing potentially problematic foods from the diet for a set period (usually 2-3 weeks)
2. Reintroduction phase: Gradually reintroducing eliminated foods one at a time while monitoring for any adverse reactions

This methodical approach allows individuals to isolate and identify specific food triggers that may be contributing to their symptoms.

Who Should Consider an Elimination Diet?

Elimination diets are particularly beneficial for individuals experiencing unexplained symptoms that may be related to food sensitivities or intolerances. These symptoms can include:

• Digestive issues (bloating, gas, diarrhea)
• Skin problems (rashes, eczema)
• Headaches or migraines
• Joint pain or inflammation
• Fatigue or low energy levels
• Mood swings or cognitive issues

It’s important to note that elimination diets should be undertaken under the guidance of a healthcare professional, particularly a doctor or registered dietitian. These experts can help identify potential trigger foods based on your symptoms and ensure that you maintain proper nutrition throughout the process.

Is an elimination diet suitable for everyone?

While elimination diets can be beneficial for many individuals, they may not be appropriate for everyone. Children, pregnant women, and those with certain medical conditions should exercise caution and consult with a healthcare provider before starting an elimination diet. Additionally, individuals with a history of eating disorders should approach elimination diets with care, as they may trigger restrictive eating behaviors.

The Benefits of an Elimination Diet: Uncovering Root Causes and Improving Health

One of the most significant advantages of an elimination diet is its ability to help individuals identify the root causes of their health issues. Rather than simply treating symptoms, this approach allows people to pinpoint specific food triggers and make informed decisions about their long-term dietary choices.

What are the potential health improvements from an elimination diet?

Many individuals who successfully complete an elimination diet report a range of health improvements, including:

• Reduced digestive discomfort
• Improved skin clarity
• Decreased frequency of headaches
• Reduced joint pain and inflammation
• Increased energy levels
• Enhanced mood and cognitive function

By identifying and eliminating problematic foods, individuals can often experience significant relief from chronic symptoms that may have been plaguing them for years.

How does an elimination diet differ from other approaches to managing food sensitivities?

Unlike medications or symptomatic treatments, an elimination diet addresses the underlying cause of health issues related to food sensitivities. This approach can lead to long-lasting improvements in health and well-being without the need for ongoing medication or interventions.

Potential Risks and Considerations: Navigating the Challenges of an Elimination Diet

While elimination diets can be highly effective, it’s important to be aware of potential risks and challenges associated with this approach.

What are the main risks of an elimination diet?

The primary concerns associated with elimination diets include:

• Nutrient deficiencies: Eliminating multiple food groups can potentially lead to inadequate intake of essential nutrients
• Overly restrictive eating: Some individuals may become overly cautious about food, leading to unnecessary dietary restrictions
• Misinterpretation of results: Without proper guidance, it’s possible to misattribute symptoms or draw incorrect conclusions about food sensitivities

To mitigate these risks, it’s crucial to work with a healthcare professional throughout the elimination diet process. They can help ensure that you’re meeting your nutritional needs and provide guidance on interpreting your results accurately.

Are there any specific considerations for children on elimination diets?

Children require special consideration when it comes to elimination diets. Due to their rapid growth and development, ensuring adequate nutrient intake is particularly important. Parents should always consult with a pediatrician or pediatric dietitian before implementing an elimination diet for their child. These professionals can provide guidance on maintaining proper nutrition and monitoring for any potential side effects.

Implementing an Elimination Diet: A Step-by-Step Guide

Successfully implementing an elimination diet requires careful planning and execution. Here’s a general outline of the process:

What foods are typically eliminated during an elimination diet?

Common foods and food groups often removed during the elimination phase include:

• Dairy products
• Gluten-containing grains
• Eggs
• Soy
• Nuts and seeds
• Citrus fruits
• Nightshade vegetables (e.g., tomatoes, peppers, eggplants)
• Processed meats
• Caffeine and alcohol
• Added sugars and artificial sweeteners

The specific foods eliminated may vary depending on your individual symptoms and suspected triggers.

How long does the elimination phase typically last?

The elimination phase usually lasts for 2-3 weeks. This duration allows sufficient time for potentially problematic foods to be cleared from your system and for symptoms to improve.

What should you eat during the elimination phase?

During the elimination phase, focus on consuming a variety of nutrient-dense, whole foods that are not commonly associated with sensitivities. This may include:

• Fresh fruits and vegetables (excluding those being eliminated)
• Lean proteins (e.g., chicken, turkey, fish)
• Gluten-free grains (e.g., rice, quinoa, buckwheat)
• Legumes
• Healthy fats (e.g., olive oil, avocado)
• Herbs and spices

It’s important to maintain a balanced diet during this phase to ensure you’re meeting your nutritional needs.

The Reintroduction Phase: Identifying Food Triggers and Tolerances

The reintroduction phase is a critical component of the elimination diet, allowing you to systematically test your body’s response to previously eliminated foods.

How should foods be reintroduced?

Follow these steps when reintroducing foods:

1. Choose one food group to reintroduce
2. Eat a small amount of the food and wait 2-3 days, monitoring for any symptoms
3. If no symptoms occur, gradually increase the amount and continue to monitor
4. If symptoms do occur, remove the food and wait until symptoms subside before trying the next food
5. Move on to the next food group and repeat the process

What symptoms should you watch for during reintroduction?

Pay attention to any changes in your body, including:

• Digestive discomfort (bloating, gas, diarrhea, constipation)
• Skin reactions (rashes, itching, acne)
• Headaches or migraines
• Joint pain or inflammation
• Fatigue or changes in energy levels
• Mood changes or brain fog
• Sleep disturbances

Keeping a detailed food and symptom journal during this phase can help you identify patterns and correlations between specific foods and your symptoms.

Interpreting Results and Long-Term Dietary Adjustments

Once you’ve completed the reintroduction phase, it’s time to analyze your results and make informed decisions about your long-term diet.

How do you determine which foods are problematic?

Foods that consistently trigger symptoms during the reintroduction phase are likely to be problematic for you. However, it’s important to consider the following factors:

• Severity of symptoms
• Consistency of reactions
• Dose-dependence (whether symptoms occur only with larger amounts)
• Overall impact on quality of life

Consult with your healthcare provider to interpret your results and determine the best course of action.

Should you permanently eliminate trigger foods?

The decision to permanently eliminate certain foods should be made in consultation with a healthcare professional. In some cases, complete avoidance may be necessary, while in others, you may be able to tolerate small amounts or occasional consumption. Your provider can help you develop a personalized long-term dietary plan that balances symptom management with overall nutritional adequacy.

Beyond the Elimination Diet: Maintaining Gut Health and Overall Wellness

While an elimination diet can be a powerful tool for identifying food sensitivities, it’s just one aspect of maintaining optimal gut health and overall wellness.

How can you support gut health after completing an elimination diet?

Consider incorporating the following strategies to promote ongoing gut health:

• Consume a diverse range of plant-based foods to support a healthy gut microbiome
• Include probiotic-rich foods like yogurt, kefir, and fermented vegetables
• Stay hydrated by drinking plenty of water throughout the day
• Manage stress through relaxation techniques, exercise, and adequate sleep
• Limit processed foods, artificial additives, and excessive sugar intake

When should you consider retesting eliminated foods?

In some cases, food sensitivities may improve over time as gut health improves. Discuss with your healthcare provider the possibility of retesting eliminated foods after a period of strict avoidance, typically 3-6 months or longer. This process should be approached cautiously and under professional guidance to minimize the risk of severe reactions.

By leveraging the insights gained from an elimination diet and adopting a holistic approach to gut health, you can work towards long-term improvements in your overall health and well-being. Remember that every individual is unique, and what works for one person may not work for another. Patience, persistence, and professional guidance are key to successfully navigating the journey towards optimal health through dietary modifications.

Fact vs. Fiction: Everything to Know About Elimination Diets

Is the elimination diet just another trend, or could it change your life?

Going on an elimination diet means you avoid eating certain foods for a short period of time. By doing this, you can identify foods you’re allergic or sensitive to. When you stop eating some foods, you might get rid of uncomfortable symptoms, such as rashes, stomach pains or headaches. You slowly reintroduce the foods back into your diet over several weeks to see how you react to them. Learn more about elimination diets before jumping in.

Who should do an elimination diet?

Elimination diets aren’t about losing weight or reaching fitness goals. Elimination diets are for people who have food intolerances or uncomfortable health symptoms that might be related to their diets. The goal of an elimination diet is to figure out which foods are causing problems. Then, you remove them from your diet for the long term.

If you’re doing an elimination diet, you should do so under your doctor’s care. Doctors can help you identify which foods might be causing your problems based on your symptoms. They can also monitor your progress and keep an eye out for any nutrient deficiencies during the process. Your doctor can run tests to make a diagnosis if necessary.

Benefits of an elimination diet

The biggest advantage of an elimination diet is that it helps you get to the root of your health problems. Rather than trying several treatments in an attempt to control your symptoms, you can figure out what causes the symptoms. During an elimination diet, you’ll hopefully experience less bloating, gas, diarrhea, headaches, inflammation or other issues. That’s because the problem foods are no longer part of your diet.

The results of an elimination diet can be long lasting. Unlike medications that lose their effectiveness or cause unwanted side effects, an elimination diet helps your body heal without causing long-term harm.

Things to watch out for on an elimination diet

Elimination diets don’t have many risks or side effects. However, there are a couple of things to look out for and consider when you’re starting this diet. First, you should only follow an elimination diet for the short term. Your overall health needs a varied diet filled with nutrient-rich foods. Avoiding these foods for months or years doesn’t help, especially if they’re not the cause of your problems. This can also lead to nutrient deficiencies down the line.

Children are more likely to suffer side effects of an elimination diet. Because they’re growing at a faster rate, it’s important that they get all of the necessary nutrients in their diets. Before starting your child on an elimination diet, be sure to consult with their doctor about how to proceed.

Starting the elimination diet

During the first three weeks of an elimination diet, you avoid eating foods that you think are causing problems. You should also avoid other foods that you know can trigger symptoms. It takes about three weeks to completely eliminate certain proteins from these foods from your body. That’s why it’s important to stay away from them entirely during this phase. Some of the most common foods to eliminate are:

• Fatty foods
• Citrus fruits
• Nuts and seeds
• Sugar and sweets
• Caffeine and alcohol
• Nightshade vegetables
• Condiments and spices
• Gluten-containing foods
• Processed meat, fish and dairy foods

During this phase, focus on eating simply. Eat lots of fruits, vegetables, rice and legumes. Drink dairy alternatives, like unsweetened coconut or rice milks. Stay hydrated with water and herbal teas.

Adding foods back into your diet

During the next phase, you slowly reintroduce foods back into your diet. Add foods back individually with two to three days in between. Keep a journal of the foods you eat each day. Note any symptoms you experience. Some things to look out for are:

• Stomach pain
• Gas and bloating
• Drop in energy levels
• Inflammation in joints
• Changes in bowel habits
• Migraines and headaches
• Changes in sleeping patterns

If you add a new food and don’t have symptoms, move on to the next one. If you do experience symptoms, remove it from your diet. The entire process takes about five or six weeks, depending on how many foods you’re eliminating. In the end, you should have a list of foods that trigger symptoms and notes on how they affect you.

Elimination diets can help heal your gut and make you feel better overall. If you feel like the foods you eat are causing symptoms, an elimination diet can help you pinpoint the cause. Find a doctor near you and we can show you more about how an elimination diet can help you.

Healing Your Brain by Healing Your Gut — Beata Lewis MD

The Gut and the Brain

When it comes to nutrition and our health, there is good news and bad news. The bad news is that with the changes in the Standard American Diet the rates of chronic diseases, such as diabetes, and mental health problems such as depression, attention problems, anxiety, and autism are on the rise. The good news is that you can protect and improve your health by improving your diet. In fact, by changing your diet, you can take control over your wellbeing.

While conventional medicine has become reliant on using medications to treat symptoms rather than root causes, new movements in medicine, known as integrative medicine and functional medicine look below the surface to address the root causes of disease.  Surprisingly, the root cause of a brain problem may be in the gut.  Research evidence is accumulating for the connection between gut bacteria, gut inflammation, digestive functions and the brain.  A number of books, such as Bugs, Bowels and Behavior, a new scientific journal called Brain and Gut, and a whole new field called neuropsychoimmunology have appeared in recent years documenting the links between the gut and the brain.

Our guts have the increasingly complex job of sorting out the good from the bad as our food is changing rapidly with industrialization of agriculture and processed food production.  We are exposed to numerous chemicals synthesized by chemists to make our food taste and smell a certain way.  Since these chemicals did not exist in the past, we don’t know what effects they may have on our bodies in the long term.  We are also exposed to antibiotics, which can kill the good bacteria in the gut.  It is not surprising that our digestive tracts may be stressed.

An unhealthy diet, and even an apparently healthy diet, may cause inflammation and damage to the digestive tract, which then can manifest through a multitude of symptoms.  Since we absorb nutrients, vitamins, and minerals through our digestive tract, a disruption to our digestion can result in nutrient deficiencies. Nutrient deficiencies can cause symptoms in many body systems.

The specific foods that cause trouble vary between individuals. It depends on the person, and their particular genetic predispositions and life experiences.  Food sensitivities and allergies may be quite difficult to pin down, and allergy testing is less reliable than an elimination diet for finding food allergies.  In many cases the food that is craved the most may be the food that is causing problems.

Symptoms of food intolerance may look different from person to person. Below are just some of the symptoms that have been linked to food allergies or intolerances .

• mood disorders

• ADD/ADHD

• Migraines and headaches

• autoimmune disorders

• allergies

• diabetes

• gastrointestinal problems such as diarrhea, constipation, gas, bloating, nausea and pain

Gluten and the Brain

By now, everyone has heard of gluten.  Gluten is a protein found in wheat, barley, and rye and is the first item eliminated in many elimination diets.  Maybe you know someone who eliminated gluten from their diet and, like magic: they lost weight, their acne cleared up, they experienced better digestion, better sleep, and better sex.  Some people experience a dramatic change, while others do not notice a difference when they eliminate gluten. Those who feel the strongest effects of eliminating gluten may have celiac disease, or the less severe problem of gluten sensitivity.

When someone has celiac disease their immune system reacts to gluten and damages the lining of the small intestine.  A healthy digestive tract lining has many finger like projections called villi that increase the surface area of the gut to help to absorb food.  In celiac disease the intestinal lining flattens out, and with decreased surface area plus inflammation food cannot be absorbed effectively.  This can lead to a variety of problems either immediately or later in life.  In individuals without celiac disease, gluten may cause inflammation of the intestinal lining and “leaky gut. ”  In leaky gut, the cells lining the intestines lose their ability to keep out partially digested food particles from crossing into the bloodstream, and causing a variety of immune reactions.

Gluten is just one of many foods that may cause sensitivities and leaky gut.  While it can be challenging to pin down what food is causing symptoms, the benefits of discovering food sensitivities can be profound for physical and mental health.

Elimination Diets

You can have control over the diagnosis and treatment of your health conditions through using an elimination diet!  There are many types of elimination diets, and you can pick the right elimination diet for you.  The diet described here is based on the Institute for Functional Medicine elimination diet guide.  Having the support of a doctor, a friend, or a group may be helpful in making the commitment and sticking to the elimination diet.

Elimination diets require effort, motivation, and a dash of creativity in the kitchen.  To begin an elimination diet you should stop eating the most common offenders for at least three weeks. Children often respond more quickly and can see results in 7-10 days.  Make an effort to stick to at least 21 days because it takes approximately that long for the immune system to stop reacting to the a food that caused a sensitivity.  Prepare for the elimination diet by slowly lowering your caffeine intake to avoid caffeine withdrawal headaches.

Foods to Eliminate:

• gluten grains (barley, rye, spelt, wheat)

• dairy

• corn

• eggs

• white sugar and added sugars

• shellfish

• soy

• beef

• pork

• processed meats

• coffee, tea, and chocolate

• alcohol

This can be an overwhelming list, and it is certainly a lot to eliminate in one go.  If you would rather take things slowly then start by only eliminating gluten and dairy.

However, it is worth embarking on the full elimination diet for at least 21 days.  If you are motivated consider a three-month elimination diet, as effects of some foods, including gluten, can take three months to fully wear off.  Remember that it is all for a reason!  Symptoms may resolve (even symptoms you weren’t aware of), and you will experience the benefits first-hand.  Seeing the benefits my inspire you to make lasting changes.

So what can you eat during this detox period?

Foods to eat during the elimination diet:

• Vegetables

• Fruits in moderation

• Healthy Oils (Olive oil, coconut oil, ghee, avocado, flax seeds)

• Meats (grass fed, hormone free) in moderation

• Fish (small fish is lower in contaminants)

• Nuts

• Seeds

Foods To Consider Eliminating:

• Non-gluten grains

• Legumes (may cause gas and bloating)

• Night shade vegetables (white and yellow potatoes, tomatoes, peppers, eggplant)

If you eliminate grains and legumes, this will result in the Paleo Diet. The Paleo Diet may have the additional benefits of reducing the carbohydrate and sugar load on the body.

Some people may be sensitive to nightshade vegetables and cannot digest them fully.  People with a sensitivity to nightshades may experience diarrhea, gas, bloating, nausea, joint pains, headaches and depression.

Since an elimination diet is also a detox, eat the best quality food that you can access.  Aim to eat organic vegetables and fruits, and grass fed, hormone free meat.

Maintain good hydration and daily bowel movements to aid in the detoxification of the body. It is a good idea to add a probiotic supplement and a multivitamin to aid in the healing of the gut.

Dr. Oz’s website has a great printable version of an elimination diet plan you can hang on your fridge for reference.

Everything that happens during an elimination diet is good information as you become a detective about your own health. Notice if you experience detox symptoms such as headaches, runny nose, or mood swings during the first week of your elimination diet.  You may want to keep a journal to record physical and emotional changes on the elimination diet.

After three weeks on the elimination diet, you may start to reintroduce the foods which you eliminated.  It is important to reintroduce foods one at a time.  That way, if you have symptoms you can easily pinpoint the offending food.  You may want to first reintroduce the foods which you craved the most during the detox period. When you reintroduce a food, in addition to eating the elimination diet food, add two or three portions of the new food for two days and observe your body’s reaction to the food.  Keep a written record of any changes in mood, energy levels, pain, sleep, concentration, stomach issues, congestion or any other symptoms you notice.  If you experience discomfort or a return of symptoms during the reintroduction period, you can be fairly certain that the food you have just reintroduced has something to do with the discomfort you are feeling.  If you do, in fact, experience symptoms when you reintroduce a food, stop eating the offending food and let the symptoms resolve completely before you reintroduce another new food. Keep reintroducing new foods one at a time until you test all the foods you eliminated.

The Institute for Functional Medicine  offers a variety of resources for planning an elimination diet.  While elimination diets do clearly take time, effort, and creativity, the results can be very useful. You may come away with a diet especially tailored for your body to help you feel healthier by the day.

No Gluten, No Sugar, No Thanks: The Pitfalls of Elimination Diets

The latest trend in health appears to be watching what you don’t eat, as highlighted in a Wall Street Journal article this week. People looking to resolve digestive problems and other medical issues are cutting out any number of food groups in their quest for a cure – everything from gluten and grains to sugar, alcohol, soy, and dairy.

In some cases, elimination diets can be very helpful for identifying food intolerances and relieving symptoms. In fact, allergists and registered dietitians have been using this approach for decades to help patients methodically pinpoint –  or rule out –  foods that may be contributing to gastrointestinal upset, irritable bowel syndrome, headaches, and other conditions potentially influenced by diet.

But it’s concerning when people start cutting out any number of food groups on their own for long periods of time, without medical supervision. While giving up certain categories of food for a few weeks or months isn’t likely to cause ill effects, over the long-term, avoiding a long list of ingredients could contribute to nutritional deficiencies or a whole new list of symptoms.

Can ‘Free’ Diets Make Things Worse?

“Free-from” diets can sometimes backfire and make patients feel even worse, according to Tamara Duker Freuman, a registered dietitian who specializes in gastrointestinal disorders and recently shared her clinical experience with elimination diets in her U.S. News & World Report blog. Gluten-free diets can lead to diarrhea, Paleo and other low-carb eating styles can contribute to constipation, and broad, multi-food elimination diets can trigger uncomfortable bloat.

Sometimes, free-from diets are an absolute and life-long requirement. Following a gluten-free diet is a medical necessity if you have celiac disease, and avoiding certain foods can be a life-or-death matter if you have diagnosed food allergies. Of course, the first step is getting a proper diagnosis from an appropriate medical professional before cutting out anything. In the case of food allergies, make sure you’re working with a board-certified allergist who is using the proper diagnostic tests. There are many unproven diagnostic methods, including IgG blood tests and hair analysis, that are unfortunately still used inappropriately by health care providers. If dietary changes are warranted, working with a registered dietitian can help you adjust your eating plan so you’re still getting all the nutrients you need.

However, people following self-made elimination-style diets on their own – especially those that exclude multiple ingredients – should think twice about the potential consequences. The best way to get all of the vitamins, minerals, and other ingredients your body needs to function at its best (without relying on supplements or fortified products) is to eat a variety of whole foods, and restrictive diets, by definition, interfere with your ability to do that. Give these downsides some real consideration before making sweeping cuts to your diet, particularly if these changes are completely voluntary, not a medical necessity.

For instance, there’s no question that the Paleo diet can help people lose weight and feel better as a result, but (heavy animal protein content aside), this eating style typically prohibits a laundry list of food groups, including extremely nutrient-dense choices like beans, lentils, and most if not all whole grains. These ingredients are some of the most concentrated sources of fiber and other essential nutrients, and they have well-established, long-term health benefits.

The Health Halo of ‘Free’ Labeling

Further, as I’ve mentioned before, splashing “gluten-free” or “sugar-free” on a packaged food label can create a health halo effect by masking the downsides of a less-than-stellar product. Just because a product is dairy-free, or cholesterol-free, or casein-free, doesn’t mean it’s good for you; what’s actually in the food counts, too. We all snicker about Snackwell’s cookies, the poster child for the low-fat movement, because we now understand that even though they were fat-free, they were loaded with sugar and junky refined carbs…certainly not a health food. Well, the same is true for today’s line of “almost-everything-free” products. Gluten-free snack foods and dairy-free desserts may still be loaded with sugar and unhealthy fats. We need to learn from our mistakes and always look at the whole picture.

If you’ve found that cutting out certain foods improves your comfort and quality of life, that’s certainly nothing to make light of. However, you also need to look carefully at the foods you’ve eliminated and how these omissions affect your overall diet. If you’re worried about the impact dietary restrictions may be having on your health, I strongly advise working with a registered dietitian to develop a personalized eating plan that meets your individual nutrition needs.

Elimination diets: How and why to do them

Reviewed by Okoro Ezinne K. MD, MSc, Jennifer Broxterman, MS, RD, and Ryan Maciel, RD

Definition | Basics | Benefits | Symptom list | How they work | Types | Food List | Recipes

Maybe you’ve heard a lot about elimination diets—and you’re wondering, “What the heck is one, and should I try it?” Or perhaps a health care provider has suggested you go on one and your first thought was, “I dunno. That sounds like a lot of work. But I’m willing to read more.”

Or, maybe you’re already sold, but you need help getting started.

In this article, we hope to answer all of your questions about elimination diets. You’ll learn the basics, how elimination diets work, the symptoms they address, and the common types. You’ll also find a list of removal foods, recipes, and more, as well as the answers to the questions below.

What is an elimination diet?

Why would you go on an elimination diet?

What is a food sensitivity or food intolerance?

What symptoms can be addressed by an elimination diet?

What are the benefits of an elimination diet?

What are the side effects of an elimination diet?

What are the most common food sensitivities?

What are the types of elimination diets?

How does an elimination diet work?

Can you do an elimination diet if you’re pregnant or breastfeeding?

What can you expect on an elimination diet?

What foods do you remove during an elimination diet?

What recipes work for an elimination diet?

Become an Expert on Elimination Diets

Learn everything you need to know with our FREE e-book, The Ultimate Guide to Elimination Diets. It shows you how to create an elimination diet plan that’s customized for each individual client. Plus, it includes extensive food lists, recipes, and instruction sheets you can share directly with your clients (or use for yourself). All so you have everything you need to confidently (and expertly) coach anyone through an elimination diet. Download it today—for free.

What is an elimination diet?

Elimination diets pretty much do exactly what the name suggests: exclude certain foods for a short period of time—usually 3 weeks. Then you slowly reintroduce specific foods and monitor your symptoms for possible reactions.

Why do an elimination diet?

Elimination diets are used to identify food sensitivities and intolerances. (Wondering what food sensitivities and intolerances are? See the next section.)

Elimination diets work a lot like a science experiment to help you identify foods that lead to a wide range of bothersome symptoms. (You’ll find a list of common symptoms a little later in this article.)

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What’s a food sensitivity? What’s a food intolerance?

According to the American Academy of Allergy Asthma & Immunology, “A food intolerance or a food sensitivity occurs when a person has difficulty digesting a particular food.” For simplicity, we’ll use the word “sensitivity” throughout this article.

Unlike food allergies—which involve the immune system—food sensitivities occur when the gut reacts poorly to specific foods and ingredients. These reactions generally unfold in a couple ways:

• Inflammation: Certain foods irritate gut tissues, leading to symptoms throughout the body. For example, the amines naturally present in red wine can expand blood vessels, triggering migraines in some people.
• Indigestion: Other times, the digestive tract fails to properly break down certain foods. For example, you’ve probably heard of lactose intolerance. Some people’s intestines don’t produce enough of the enzyme lactase to digest lactose, a sugar present in dairy. The result: gas, bloating, and diarrhea.

(Learn more about food sensitivities.)

What symptoms can be addressed by an elimination diet?

A growing body of evidence shows that food sensitivities can lead to a wide range of unwanted symptoms.^1,2 For example, food sensitivities have been linked to:

• ADD/ADHD^3,4
• Bloating
• Brain fog
• Depression
• Diarrhea
• Fatigue⁵
• Headaches^6,7,8
• Obesity⁹
• Pain¹⁰
• Rashes
• Stomach aches

And much more.

Wow, that’s a big list! You may wonder: If food sensitivities involve the gut, how do symptoms show up all over the body—in the skin (rashes), brain (headaches), or joints (pain)?

Here’s why. Our gastrointestinal (GI) tract does a lot more than just digest and absorb food. Surprisingly, the GI tract also has its own independently working nervous system (aka the enteric nervous system).

Therefore, the GI tract is rich in neurotransmitters, hormones, chemical messengers, enzymes, and bacteria. Indeed, it’s even home to 70 percent of your body’s entire immune system!

Food sensitivities may also contribute, directly or indirectly, to many other problematic aspects of digestion: microbial imbalances, motility issues, detoxification abnormalities, and intestinal permeability.

This explains why problems in the gut can show up all over—in the form of migraines, chronic pain, eczema and other rashes, and brain fog, among many other symptoms and health problems.

So it makes sense that, if you’re suffering from food sensitivities, following an elimination diet for a few weeks could be the most profound dietary change you’ll ever make. For some people, the results can feel nothing short of miraculous.

(Read more on how food sensitivities affect the whole body.)

What about food sensitivity testing? Does it work?

Why do an elimination diet when you could just undergo food sensitivity testing?  IgG food sensitivity tests (a blood test for food sensitivities) are unproven as well as expensive.¹¹ The Canadian Society of Allergy and Clinical Immunology, American Academy of Allergy Asthma and Immunology, and The European Academy of Allergy and Clinical Immunology have all issued position statements against their use.^12,13,14

For this reason, the elimination diet remains the gold standard for identifying food sensitivities.

As with all sensitivity tests, it too has its flaws. There’s no universal diet for all people, and  findings are unique to each person, too. But elimination diets are inexpensive, relatively easy to do, and empowering (you do it, not a lab). Plus you experience the results first-hand, which can be a more powerful stimulus for dietary changes than a lab test.

What are the benefits of an elimination diet?

Elimination diets help you to collect and analyze empirical evidence, using experimentation and observation based on what happens in your body as you change what you eat. If your headaches disappear after you’ve removed certain foods only to suddenly resurface when you reintroduce chocolate, that’s a powerful clue.

Without an elimination diet, you can only guess about causes and their effects. 

Are you bloated because of the onions you ate at lunch? Or was it the beer? Or is the bloat from something non-food related, such as eating too quickly?

This guesswork gets even more difficult when:

• Symptoms show up outside of the gut. Did you wake with a migraine because of the wine you had with dinner? Or are you just dehydrated? Or maybe you didn’t sleep well? Similarly, was that skin rash caused by something you ate—or was it caused by contact with a perfume, detergent, or some other irritating substance?
• You can eat small amounts of certain foods without symptoms. For example, one square of chocolate might not cause problems, but when you eat half a bar? Your body rebels.
• Symptoms are delayed. You eat some red pepper and feel fine. Then days later, your joints are achy and swollen. Yep, it’s possible.

An elimination diet helps you pinpoint the true source of such problems, once and for all.

Is it a food sensitivity? Or just normal digestion?

Occasionally people assume they’re sensitive to certain foods when, in reality, they’re merely having a quite normal bodily-response to foods that tend to result in gas-production during digestion.

These include Brassica vegetables—such as cabbage, cauliflower, broccoli and kale—as well as beans, legumes, raw onion, and raw garlic. Rather than eliminate these foods, you may only need to prepare them differently and/or introduce them slowly to allow enough time for your digestive tract to adjust. You may also want to take a probiotic supplement that contains Lactobacillus rhamnosus GG, which is one of the most studied gut bacteria strains. Look for a supplement that contains at least 1 billion live cultures.¹⁵

What are the side effects of an elimination diet?

Whenever you dramatically change your diet, your body is likely to have a few things to say about it—and this can be especially true with elimination diets.

Though some people truly feel amazing pretty quickly, other people feel worse before they feel better.

Why? An elimination diet involves a rapid and dramatic change. It’s like jumping into high-intensity-interval-training after being out of shape for years.

This is especially true if you go from a heavy intake of caffeine, sugar, and highly-processed foods to a zero intake of these foods and beverages.

As a result, you may initially notice withdrawal symptoms like headaches, fatigue, irritability, or skin flare-ups for a few days to a week.

What are the most common food sensitivities?

Based on data we’ve gathered from the thousands of clients we’ve coached, we can say pretty confidently that the following categories tend to cause the most problems:

• Gluten
• Dairy
• Eggs
• Sweeteners (example: sugar)
• Soy

Types of elimination diets

In this article, we’ve included a food list for one type of elimination diet, but many other elimination diets exist. They include:

The whole foods elimination diet

Highly-processed foods house a wide range of additives that can trigger gut irritation and sensitivities in many people. These include food colorings, sugar alcohols, monosodium glutamate (MSG), and sulfites, among others.

By shifting to a diet rich in minimally-processed whole foods, you can naturally reduce or eliminate those food chemicals while boosting your overall health. As an added bonus, minimally-processed whole foods tend to contain fiber and other nutrients that nourish the digestive tract.

Eliminate just 1 food or food category

If you’re pretty sure you already know which food causes your problems, this is a great option. Let’s say, for example, from past experience, you know that you feel pretty horrid whenever you eat dairy. Then, on this type of elimination diet, you’d eliminate just dairy for 3 weeks. Then you’d reintroduce it to see how you feel.

Eliminate up to 4 foods

This is another great option if you’re pretty sure you know what foods bother you. To do it, only eliminate 1-4 foods that you think might cause problems for you.

The Precision Nutrition Elimination Diet

We usually refer to this as the “elimination diet medium” because it offers a middle way between hardly removing anything at all and removing so many foods that you think you can’t last another day.

You’ll find a food list a little later in this story that shows you, in detail, which foods to eat and which foods to remove.

The full elimination diet

This much more extensive type of elimination diet excludes a wide range of foods, including many types of meat, legumes, grains, nuts, and seeds—even a wide variety of fruits and veggies.

Because of the highly-restrictive nature of this elimination diet, however, you should only try it with the guidance of a professional who specializes in integrative medicine and/or medical nutrition therapy.

The FODMAP elimination diet

FODMAP stands for:

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols

These carbohydrate fibers are not fully absorbed in the small intestine. For many people, that’s not an issue. But in people with Irritable Bowel Syndrome (IBS), this incomplete digestion can trigger a range of bothersome symptoms: gas, distension, pain, diarrhea, and/or constipation.¹⁶

Over several years, researchers at Monash University in Australia have developed and extensively studied a low-FODMAP elimination diet for people with IBS, showing that it can help to alleviate these symptoms.¹⁷

Unlike other types of elimination diets, however, the FODMAP diet is a highly specialized form of medical nutrition therapy. The reintroduction phase of this diet is much more complex than the reintroduction phase of a typical elimination diet.

As a result, if you’ve been diagnosed with IBS and suspect you might have a FODMAP issue, you’ll need the expertise of someone qualified to offer medical nutrition therapy, such as a FODMAP-trained nutritionist. 

Check out the Find an Expert page of the Academy of Nutrition and Dietetics and/or the FODMAP dietitian directory from Monash University.^18,19

Can you do an elimination diet if you’re pregnant or breastfeeding?

As it turns out, you need a lot of nutrients to grow and feed a baby, which is why rapid changes in dietary consumption are not recommended.

That said, when you’re pregnant or nursing, you can experience a range of uncomfortable problems, such as gas, bloating, and acid reflux.

If you suspect something you are eating may be worsening your symptoms, mention it to your physician or nurse midwife.

Under the direction of a specialist in integrative medicine and/or medical nutrition therapy, you may be able to safely remove and reintroduce a small number of foods—such as dairy, gluten-containing grains, or soy—thought to be behind the vast majority of food sensitivity issues.

How does an elimination diet work?

Elimination diets are organized into three phases: A prep phase, removal phase, and reintroduction phase.

Prep phase (7-9 days)

During the prep phase, you’ll… prepare for the removal phase.

This may be the most important part of the diet—so don’t skip it. People who spend a week getting prepared do far better than people that jump right into it.

Some of your prep work involves keeping a food journal to help identify trigger foods as well as deciding which foods to stop eating during the removal phase. This will help to personalize the elimination diet.

This prep time also involves planning what you will eat: finding recipes, finding groceries, organizing your kitchen, and so on.

Removal phase (3 weeks)

This is when you stop eating a variety of common trigger foods, such as gluten, dairy, and eggs.

Phase 3: Reintroduction phase (3+ weeks)

Now it’s time to systematically reintroduce the eliminated foods—testing them one at a time while monitoring for possible reactions.

The removal phase: What to expect

During the removal phase of an elimination diet, you stop eating 1 or more foods.

Depending on how many foods you eliminate, you might begin to feel better pretty quickly. Within days to weeks, you might notice clearer skin, heightened energy, more regular bowel movements, improved sleep, and other improvements.

Though this is an encouraging outcome, it’s not always evidence that the removal phase is working. For example, more whole foods, fewer highly processed foods, and smaller portions can also lead to improved energy, fewer GI symptoms, and an overall sense of well being.

You won’t know for sure whether you have a food sensitivity until you get to the reintroduction phase.

Also, it’s important to note that not everyone feels better right away.

Some people feel worse before they start to feel better as they withdraw from caffeine, sugar, and other foods.

Foods to eliminate during the removal phase

The following table gives an example of what to include and exclude during a typical elimination diet.

You’ll of course find other lists available on the Internet allowing more, and sometimes fewer, foods in the diet. The key here is to not get too dogmatic.  Self-experimentation rules the day. Try different things and see what works for you.

Removal phase meal ideas

An easy way to adapt to an elimination diet? Make a list of the foods and meals you eat regularly—and then look for ways to adapt them. For example, if you plan to follow our Elimination Diet Medium food list above, perhaps you could…

• Make tacos or burritos in a bowl or lettuce wrap with turkey or tilapia, brown rice, and guac.
• Try homemade 100% salmon, lamb, chicken, or bison burgers, either wrapped in lettuce or with sweet potato toast, or eaten on their own.
• Have pasta made from zucchini noodles or brown rice pasta, mixed with a sauce made from lemon, salt, pepper, and olive oil. Top with roasted salmon.
• Add avocado to a smoothie to replace the creaminess of yogurt.

Another great strategy is to make a list of all of the foods you can eat, and organize them into these categories: Proteins, vegetables, carbs, healthy fats.

Then, whenever you want to assemble a quick meal, just pick one option from each of those four categories.

In other words, you might choose salmon for your protein, broccoli for your veggie, brown rice for your carb, and avocado oil for your fat. Then you might use the oil to roast the broccoli and salmon, serving both with the brown rice. Add herbs and spices as needed.

(Find an extensive Create-a-Meal template, along with additional recipes and food lists, see our new Elimination Diet ebook for nutrition coaches. Download it here. It’s free.)

Removal phase packaged food list

Elimination diets can feel pretty restrictive, mostly because so many packaged foods contain gluten, dairy, soy, and corn. To make this easy, we read label after label, searching for packaged foods that work well with a typical elimination diet removal phase. You’ll find a complete packaged food list in our free Elimination Diet ebook for coaches.

Removal phase recipes

The following recipes all work with the Elimination Diet food list presented in this story.

Simple Fruit Smoothie

Blend (in this order): 2 cups coconut or rice milk, 2-4 thumbs of avocado, 2 cupped hands of fruit chunks (use frozen for a thicker smoothie), 2 scoops rice protein powder.  (Makes 2 servings.)

Sweet Potato Toast

Slice a large sweet potato in half lengthwise. Then slice 2 pieces from that center cut on each side, 1/4 “ to ⅓” thick. Toast until fork tender. (This may take several rounds in a toaster). Alternatively, lightly brush both sides with oil and bake at 350°F for 15-20 minutes, until fork tender, but not soft. Serve topped with ½ mashed avocado, 2 sliced radishes, and sea salt. (Makes 2 servings.)

Basic energy balls

Blend 10-12 pitted, coarsely chopped dates, 1 cup unsweetened shredded coconut (or any variety of finely chopped nuts, except peanuts), and ½ teaspoon cinnamon in the food processor. Then roll into balls. (Makes about 8 balls, 2 per serving.)

Avocado cakes

Mash ½ avocado. Spread on 8 Lundberg “Thin Stackers” brown rice cakes. Sprinkle with sea salt. Top each with 1-2 cucumber slices and a small sprig of dill, parsley, or cilantro. (Makes 2 servings.)

Banana “nice” cream

Coarsely slice 4 ripe bananas into small chunks, set on a plate or baking sheet, and freeze 1-2 hours. Once frozen, add banana chunks to a food processor and blend until creamy, scraping down the sides as necessary. Freeze for 1-2 hours for scoopable ice cream—or eat right away for “soft serve.” Top as desired. (Makes 4 servings.)

Baked Salmon with Brussels Sprouts

On a foil-lined or nonstick baking sheet, combine 1 pound (4 cups) trimmed and halved Brussels sprouts, 2 Tbsp melted coconut oil, 1 cup fresh cranberries, ½ tsp sea salt, and ¼ tsp apple cider vinegar. Scoot to one side of the sheet, then add six 4-oz salmon fillets, seasoned with salt and pepper. Bake at 400°F for 20 minutes, or until the salmon flakes with a fork and the sprouts are golden. (Makes 4 servings.)

(Find more recipes in our comprehensive elimination diet ebook for nutrition coaches. Download it for free.)

The reintroduction phase: What to expect

Of course, it’s not the purpose of the elimination diet to get rid of all the foods above forever. That would be awful. Rather, the point is to eliminate the foods and then slowly reintroduce them, one at a time, so you can monitor yourself for symptoms.

During the entire reintroduction phase, pay attention to how you’re feeling.  For example, you’ll want to monitor your sleep, mood, energy, digestion, bowel habits, and so on.

Reintroduce foods using a 3-day cycle:

Day 1: Reintroduce one food, eating at least two servings of it at different times of the day. For example, clients might reintroduce eggs on a Monday by having two scrambled eggs at breakfast and two hard boiled eggs at lunch.

Days 2 & 3: Stop eating the new food. For example, if you reintroduce eggs on day 1, you’ll stop eating eggs.

Day 4 and beyond: What happens after day 4 will depend on how things went on days 2 and 3.

• If you feel great, you’ll reintroduce a different food (say wheat) for one day, repeating the three day cycle.
• If you’re still experiencing reactions, you’ll wait until those symptoms subside before reintroducing another food.

What to do next

By now you should realize that the elimination diet isn’t necessarily easy.  But it’s not that hard either. It just requires that you have a plan and you pay attention.

To get started on an elimination diet, you might want to:

• Download our comprehensive Elimination Diet book for nutrition coaches, which includes food lists, recipes, and all of the resources you or a client would need to get started and be successful.
• Keep a food journal for a few weeks. Jot down what you eat and drink, along with how you feel. Then examine it for clues to see if you can get a sense of the foods leading to your symptoms.
• Try to see this journey as an experiment that helps you learn more about yourself, your body, and your eating choices.
• Consult with your health care provider to learn how such a diet might interact with any health conditions or medicines you might be taking.

If you decide to give an elimination diet a try, we hope it helps you get to the bottom of your symptoms, learn more about the foods that do and don’t work for you, and feel a whole lot better.

References

Click here to view the information sources referenced in this article.

1. Hart GR. Food-specific IgG guided elimination diet; a role in mental health. BAOJ Nutr. 2017;3:045.

2. Chey WD. Diet and Irritable Bowel Syndrome. Gastroenterol Hepatol. 2018 May;14(5):309–12.

3. Nigg JT, Holton K. Restriction and elimination diets in ADHD treatment. Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):937–53.

4. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011 Feb 5;377(9764):494–503.

5. Rowe PC, Marden CL, Jasion SE, Cranston EM, Flaherty MAK, Kelly KJ. Cow’s milk protein intolerance in adolescents and young adults with chronic fatigue syndrome. Acta Paediatr. 2016 Sep;105(9):e412–8.

6. Zaeem Z, Zhou L, Dilli E. Headaches: a Review of the Role of Dietary Factors. Curr Neurol Neurosci Rep. 2016 Nov;16(11):101.

7. Xie Y, Zhou G, Xu Y, He B, Wang Y, Ma R, et al. Effects of Diet Based on IgG Elimination Combined with Probiotics on Migraine Plus Irritable Bowel Syndrome. Pain Res Manag. 2019 Aug 21;2019:7890461.

8. Martin VT, Vij B. Diet and Headache: Part 1. Headache. 2016 Oct;56(9):1543–52.

9. Onmus MY, Avcu EC, Saklamaz A. The Effect of Elimination Diet on Weight and Metabolic Parameters of Overweight or Obese Patients Who Have Food Intolerance. Journal of Food and Nutrition Research. 2016;4(1):1–5.

10. Marum AP, Moreira C, Saraiva F, Tomas-Carus P, Sousa-Guerreiro C. A low fermentable oligo-di-mono saccharides and polyols (FODMAP) diet reduced pain and improved daily life in fibromyalgia patients. Scand J Pain. 2016 Oct;13:166–72.

11. Kelso JM. Unproven Diagnostic Tests for Adverse Reactions to Foods. J Allergy Clin Immunol Pract. 2018 Mar;6(2):362–5.

12. Carr S, Chan E, Lavine E, Moote W. CSACI Position statement on the testing of food-specific IgG. Allergy Asthma Clin Immunol. 2012 Jul 26;8(1):12.

13. Bock SA: AAAAI support of the EAACI Position Paper on IgG4. J Allergy Clin Immunol. 2010, 125: 1410-

14. Stapel SO, Asero R, Ballmer-Weber BK: Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy. 2008, 63: 793-796. 10.1111/j.1398-9995.2008.01705.x.

15. Agamennone V, Krul CAM, Rijkers G, Kort R. A practical guide for probiotics applied to the case of antibiotic-associated diarrhea in The Netherlands. BMC Gastroenterol. 2018 Aug 6;18(1):103.

16. Nanayakkara WS, Skidmore PM, O’Brien L, Wilkinson TJ, Gearry RB. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol. 2016 Jun 17;9:131–42.

17. De Giorgio R, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut. 2016 Jan;65(1):169–78.

18. Find an Expert [Internet]. [cited 2020 Jul 7]. Available from: https://www.eatright.org/find-an-expert

19. FODMAP Dietitians Directory – Monash Fodmap [Internet]. [cited 2020 Jul 7]. Available from: https://www.monashfodmap.com/online-training/fodmap-dietitians-directory/

If you’re a coach, or you want to be…

Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in a way that’s personalized for their unique body, preferences, and circumstances—is both an art and a science.

If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification.

Elimination Diet and Food Challenge Test for Diagnosing Allergies

What Is an Elimination Diet?

An elimination diet is a meal plan that avoids or removes certain foods or ingredients so you can find out what you might be sensitive to or allergic to. 

It isn’t about weight loss. You aren’t out to delete unneeded calories or drop some extra pounds. 

The most common reason for an elimination diet is because you and your doctor think certain foods may be the reason for your allergy symptoms. You’ll need to partner with your doctor on this and make sure that you still get all the nutrients you need.

Don’t do it if you have a serious food allergy or have had a severe allergic reaction called anaphylaxis. If you have, you need to know your trigger food as soon as possible so you can avoid it. Talk with your doctor about that. Blood and skin tests can identify some food allergies. You may need them before you can safely try an elimination diet on your own.

How Does an Elimination Diet Work?

There are two parts to an elimination diet: 

• The elimination (avoidance) phase
• The reintroduction (challenge) phase

Elimination phase

The first step is to stop eating the suspicious foods. You’ll need to read food labels carefully and ask how foods are prepared at restaurants. Keep a food diary and write down everything you eat, and note how you feel after you eat them. Your doctor will watch you for a few weeks while you try this.

Foods to consider avoiding while on an elimination diet: 

• Citrus
• Milk
• Eggs
• Wheat and gluten, which includes rye, barley, and malt vinegar
• Shellfish
• Soy

Remember to consider food additives. Some are known to trigger allergy symptoms in some people: 

• Things that end in -amine (histamine, tyramine, octopamine, and phenylethylamine)
• Artificial food colors (tartrazine and dyes derived from coal tar)
• Aspartame (artificial sweetener)
• Butylated hydroxyanisole and butylated hydroxytoluene (preservatives)
• Lactose and other disaccharides
• Monosodium glutamate (flavor enhancer)
• Nitrate and nitrites (preservatives)
• Sulfites, benzoates, and sorbates (preservatives)
• Tragacanth or agar-agar (thickeners or stabilizers) 

You may not need to avoid all these foods at the same time. If you suspect you feel bad after eating dairy products, you might just start with avoiding those. 

Continued

Make sure you eat other foods that provide the same nutrients as the food you need to avoid. For example, if you’re supposed to eliminate dairy products temporarily, you’ll want to look for foods that are fortified with calcium. (Soy can be a good source, but check to see if it’s allowed on your plan.) A dietitian can help you make your shopping list.​​​​​​​

Reintroduction (challenge) phase

After you’ve eliminated possible food allergy triggers, you’ll slowly add back suspicious foods, one at a time. This process helps you know exactly which foods are a problem.

In your food diary, note any symptoms that you get as you add each food back in.

If you bring back a food and you have any of the following symptoms, get emergency medical help and stop the elimination diet until your doctor says it’s safe to resume: 

• Throat swelling
• Immediate rash or hives
• Trouble breathing

The last step is to once again stop eating the problem foods, one at a time. The list should be smaller this time. The goal is to see if your symptoms clear up for good.

Continued

Keep in mind that you could be sensitive to a food but not allergic to it. Still, the elimination diet can help you know which foods you’re better off avoiding.

If your symptoms disappear after you stop eating a specific food or ingredient, your doctor should order blood or skin tests to confirm the food allergy diagnosis.  Some, but not all, food allergies can be diagnosed this way. 

Types of Elimination Diets

There are several types of elimination diets. Your doctor can design one that’s right for you. 

Some common types are: 

Simple (modified) diet. This basic elimination diet involves avoiding just one food or, sometimes, the two most common food allergy triggers: wheat (including gluten items) and dairy. Instead, eat gluten-free foods and brown rice, millet, buckwheat, or quinoa. 

Moderate intensity diet. You’ll avoid several groups of food all at one. On this diet, you stop eating or drinking:

• Alcohol
• All animal and vegetable fats
• Certain fruits and veggies
• Chocolate
• Coffee, tea, soft drinks
• Dairy
• Eggs
• Legumes
• Nuts
• Wheat
• Yeast products

Continued

Ask your doctor what foods you need to stay healthy. If you don’t want to skip animal protein entirely, try lamb or poultry, which are considered low-allergy risk. 

Strict, few foods diet. This is the strictest type of elimination diet. You can only eat a selected group of foods. It isn’t a nutritious diet, so you don’t want to follow this plan for long. The only foods allowed on this level 3 strict elimination diet are: 

• Apples or apple juice
• Apricots 
• Asparagus 
• Beets 
• Cane or beet sugar 
• Carrots 
• Chicken 
• Cranberries 
• Honey 
• Lamb 
• Lettuce 
• Olive oil 
• Peaches 
• Pears
• Pineapple
• Rice (including rice cakes and cereal)
• Safflower oil
• Salt
• Sweet potatoes
• White vinegar

No matter what type of elimination you choose, remember to drink lots of water to stay hydrated. 

Benefits of an Elimination Diet

An elimination diet can make you aware of your specific food allergens — the ingredients you’re sensitive to — and may help identify a specific food allergy. 

Continued

Elimination diets can help uncover the cause of symptoms such as persistently dry, itchy, skin (dermatitis) and stomach discomfort.

Knowing your food triggers and staying away from them is the safest way to manage a food intolerance or allergy. Carefully following an elimination diet with your doctor’s help can allow you to create a healthy, safe, personal meal plan. 

Risks of an Elimination Diet

Adding foods back to your diet might be risky if you are allergic to them. Sometimes, small amounts of a food might be OK but larger portions could cause problems. You might have a severe food allergy reaction. If you eat a type of food and immediately get a rash or have throat swelling or breathing trouble, seek medical help right away. 

How To Do An Elimination Diet​

“Food is fuel.” On the surface, that’s a statement you can get behind. After all, food does fuel your workouts and your daily life. But for some people, certain foods may drag them down rather than pump them up.

In cases of food allergies, intolerances, or sensitivities, they may provoke unpleasant symptoms such as bloating, gas, severe diarrhea, constipation, unexplained changes in weight, or nutritional deficiencies, says registered dietitian Maxine Yeung, MS, RD, CPT, founder of The Wellness Whisk. And sometimes, they may also cause non-GI woes such as headaches, migraines, skin rashes, acne, joint pains, mood changes, low energy levels, runny noses, hives, and itchy eyes, says registered dietitian Kerry Clifford, MS, RD, LDN, with Fresh Thyme Farmers Market.

“Everybody’s body responds to foods differently,” Clifford says. “Sometimes, our body doesn’t necessarily love every food we eat or our immune system might recognize something as a ‘foreign invader.'” While it’s possible to have a food allergy, sensitivity, or intolerance to any given food, the most common culprits include alcohol, coffee, corn, dairy, eggs, peanuts and tree nuts, shellfish, soy, and wheat. (Yes, even incredibly healthy foods can cause issues for some people!)

Since there are so many possibilities that could be to blame for your body’s distress, figuring out which food (or foods) that are actually at fault can be a little tricky. One common way to ID the problem? Performing an elimination diet, which, yes, involves eliminating certain foods from your diet only to gradually reintroduce them to identify the specific trouble makers. But those are just the nuts and bolts.

If you’ve been suffering from any, if not many, of the above symptoms (bloating and gas and diarrhea, oh my!) an elimination diet probably sounds like a total saving grace. But walk, don’t run. Unfortunately, it’s not as simple as ditching ice cream for a few days and, if you feel less bloated, assuming you’re lactose intolerant. Instead, done right, an elimination diet requires precise planning and monitoring (and the help of a professional).

Before you start slashing food from your repertoire on your won, there’s quite a bit of info you should know. So, pull up a chair and get comfortable—elimination diet 101 is in session.

What is an elimination diet?

Despite being called a “diet,” it has nothing to do with weight loss or dieting in the traditional sense. Rather, an elimination diet is a two-part process lasting anywhere from three to eight weeks.

First you remove potential food triggers and then carefully add them back into your diet to determine whether they’re to blame for your reactions, says WH advisor Samantha Nazareth, MD, a gastroenterologist who practices in New York City. “Sometimes symptoms, which range from belly pain to nasal congestion, can be delayed, therefore reintroduction of each food group has to be for at least three days.”

Yeung adds, “Once [triggering] foods are identified, we can modify an individual’s diet to help improve their symptoms and other body functions such as digestion, absorption, microbial balance, and inflammation.”

In addition to just a general elimination diet that Dr. Nazareth and Yeung describe, there are also specific types of elimination diets such as a low FODMAP diet, which is used for patients suffering from irritable bowel syndrome (IBS).

“The low FODMAP diet eliminates certain short chain carbohydrates—gluten, lactose, fructose, and sugar alcohols—that ferment in our gut and can cause bloating, abdominal pain, diarrhea and/or constipation,” says Liz McMahon, MPH, RDN, a gut health-focused dietitian in Philadelphia.

According to studies, patients with IBS don’t absorb short-chain carbs, which can be a reason why they experience gas, severe bloating, and altered bowel habits (think: diarrhea, constipation, or both). “Eliminating the FODMAPs allows them to first of all, feel better, but then add them back in slowly to figure out what specific carbs/foods are causing their issue,” McMahon adds.

Can I do an elimination alone or do I need help from a pro?

Before undertaking an elimination diet, consult a professional so they can ensure that you’re conducting the diet effectively and that you’re still able to meet your nutritional needs, Clifford says. After all, if you decide to try cutting out gluten, it’s easy to not get the fiber you need. And if you eliminate dairy, you could be putting yourself at risk of too-low vitamin D and calcium levels. Your RD won’t let those issues happen.

And the same goes for more specific elimination diets such as a low FODMAP diet—best to do so under the care of a physician and/or nutritionist.

It’s also important to talk to your doctor about any issues that you’ve had in the past (or currently have!) with disordered eating or anxiety, Yeung says. Especially in those with a tendency to control their eating, an elimination diet may trigger food restriction or a hype-focus on “good” and “bad” foods, and your health professional can help you to ensure that you follow your elimination diet in the healthiest way possible, both physically and emotionally.

How should I begin an elimination diet?

“Before starting an elimination diet, keep a food and symptom diary to help identify patterns between eating habits and symptoms,” says Yeung. This will help you and your healthcare professional figure out which food or foods you should try to eliminate.

For example, if you notice that you regularly get itchy after eating walnuts and almonds, you might decide that you want to try eliminating tree nuts. It’s totally possible that you will decide to eliminate multiple foods or types of foods.

The important thing is to eat normally and thoroughly document both everything you eat and how you feel after eating it. Track for at least a couple of weeks before making any decisions about what you’ll try cutting.

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The second you spot a potential link in your log, it can be tempting to jump right into your elimination diet. Don’t. Instead, keep eating normally, track your symptoms, and start planning. On day one of your diet, you should feel knowledgeable about the exact foods you’ll need to avoid, prepared with lots of well-rounded recipes, and ready to read food labels with confidence, says Meghan Sedivy, RD, LDN, a registered dietitian with Fresh Thyme Farmers Market.

Okay, so I’ve kept a food journal for a few weeks—now what?

When it comes to picking an actual day to start, choose a time when you know that you will easily have complete control over what you do (and don’t) eat. So, no, vacation isn’t the best time to try out something like this.

Once you do choose a time to press play on this program, make sure to avoid making simultaneous lifestyle changes. “I’ve often seen people make many other lifestyle and medication changes [at the same time that they start an elimination diet],” says Yeung. “This makes it much more challenging to determine dietary sources of the symptoms.”

For example, if you start taking probiotics at the same time you eliminate soy, it will be hard to know if you’re feeling differently because of the supplement or because of the elimination, she says. During your elimination diet, it should be your only lifestyle change in progress.

And when this kick-off day finally arrives, go ahead and eliminate all food and food groups at once. Again, it’s important to do this with a doctor or RD’s supervision. After all, if you’re cutting dairy, gluten, shellfish, and nuts…getting the nutrients you need is going to require some help, says Sedivy.

Umm, how can I make sure to get all my nutrients if I’m not eating so many things?

Hey, you—breathe! It’s a lot. But keeping up your intake of essential nutrients while on an elimination diet really isn’t as hard as it might seem.

In addition to working with a pro like a dietitian or doc, start (if not continue!) taking a standard multivitamin that doesn’t have an added “‘superfoods’ or food powders,” as they may actually have the ingredients you’re trying to avoid, McMahon says. Depending on what food(s) you’re eliminating, it’s not a bad idea to go for a vitamin that has calcium with vitamin D if you’re ditching dairy or one with B-vitamins if you’re eliminating wheat and gluten.

McMahon also encourages elimination dieters to keep it as simple as possible, to helps de-stress the whole process by making sure each meal has three basic components: protein—lean options like chicken or fish—healthy fats—avocado or EVOO—and carbohydrates—veggies like spinach or broccoli or grains like brown rice or quinoa. Together, these components will keep you energized and feeling satisfied, which is a must especially when you’re eliminating foods.

How long does an elimination diet last?

There’s no hard-and-fast rule as to the exact length of an elimination diet. It can technically last anywhere from three to eight weeks, which “gives the body time to adjust to a new diet and also allows the gut lining—the barrier from what we put into our mouths and the rest of the body—to regenerate,” Dr. Nazareth says.

Irritants like food allergens can damage the lining, weakening the “security system” so that things that shouldn’t enter the body (think: bugs) can now do just that and cause inflammation, bloating, gas, diarrhea, Dr. Nazareth explains.

That being said, your doctor or dietitian can help you determine the appropriate time period for your elimination diet, which will largely depend on the food(s) you’re cutting out. However, your body requires a good week or two to recoup from any potentially triggering foods.

It will be tempting to quit the process early, but Yeung says it’s important to stick it out. “Many people stop the elimination diet early because they are feeling better shortly after starting, but by doing this, you risk eliminating foods that you do not necessarily need to because you didn’t go through the reintroduction phase,” she says. “This could cause imbalanced diets and stop you from eating foods that you may really enjoy and can tolerate.”

When can I start reintroducing foods—and how?

After eliminating everything that’s a potential trigger for you, begin the challenge phase of reintroducing one food group at a time. I repeat: one. at. a. time. You do this with the intention of provoking symptoms, Yeung says. But if you find that the food that you reintroduced has caused issues, then best to hold off eating it and seek medical advice.

While you’re at it (read: throughout the entire process of elimination and reintroduction), remember to log everything.

Hey, hey, I know what you’re thinking: again with the logging?! But take it from the pros like Clifford who emphasizes the importance of tracking, tracking, tracking. “Write down what foods you ate, how much, and where you got it,” she says.

Also take time to reflect on how you feel after eating, whether there are any changes to your digestion or energy levels, and whether you can tolerate certain serving sizes, but not others. You could keep this record in a journal or on your phone or download a food tracking app.

What about the foods that still bother me? Should I keep eating them?

It’s important to know if you have a food allergy, intolerance, or sensitivity—but it’s even more important to know how to respond to that information.

For example, she says, if you’re lactose intolerant you won’t cause harm to yourself if you eat lactose. (Although you might experience some uncomfortable side effects like gas or diarrhea.) But if you have celiac disease (confirmed by a intestinal biopsy) and eat gluten, you could harm your gut’s ability to properly take in the nutrients your body needs, thereby putting you at risk for thereby putting you at risk for vitamin deficiencies, Dr. Nazareth explains. Your MD or RD can help you fully understand your condition so that you can keep your body safe and healthy.

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Dietary Restrictions and Weight Loss

Why do people assume elimination diets promote weight loss?

Rothberg: People read about some new fad or craze — and they’ve usually tried something else and haven’t succeeded. I think some of it may have arisen just from the popularity of the gluten-free diet. That probably translated into many other things.

People with allergies or sensitivities who have felt better by consequence [on various elimination diets] may have had some weight loss. So other people then say, “If that worked for you, it’ll work for me.”

There have always been elimination diets, we just haven’t called them that. Certainly, vegetarian diets are a type of elimination diet.

How might such diets backfire or pose a risk?

Rothberg: People on gluten-free diets often gain weight. Many of the foods are actually calorie-dense.

SEE ALSO: What Happens to Your Body When You Stop Exercising?

People on vegetarian diets with the hopes of losing weight often replace what they have eliminated with high-calorie [junk] foods. In a way, there’s some psychology there: If I’ve taken away something high in fat and calories [such as meat], I can replace it with this.

Vegan diets are, frankly, very restrictive. The worry about vitamin B12 deficiency in vegans, for example, is well-known. They do have to have supplementation.

Should people consult a doctor before trying one?

Rothberg: It depends how comfortable your primary care physician is talking about nutrition. There are physicians interested and have expertise, but they also can refer you to a registered dietitian who can provide supervision and counseling.

If someone cuts a food from his or her diet, is reintroduction dangerous?

Rothberg: I’m not sure we know the answer whether that will cause harm. People stop eating something — pizza, for instance. You might feel ill (after eating it again), but the truth is that people do this all the time. I don’t think it’s analogous to, say, discontinuing medications.

What diet do you most often recommend?

Rothberg: There is no magic to weight loss. It really is calorie restriction and eating things that are less calorie-dense — lean proteins, whole grains and vegetables.

Cut out the processed and packaged foods and refined sugars. I say this over and over, like a broken record.

Elimination Diet – what it is and an expert’s comment

 It's time to get acquainted with another interesting diet!
 

Your friend Anya refused carbohydrates, the other half excluded milk from the menu, and a colleague said that a raw food diet is the way to nirvana? Perhaps this is a sign that you, too, need to choose some special diet for yourself? We have collected some information about the elimination diet that will surely help you decide “to be or not to be.”

What is an elimination diet?

We must warn those who come here looking for an easy way to lose five kilograms in two days: the elimination diet is not about that.It is designed to identify foods that your body is particularly sensitive to and may even respond with allergies, and eliminate * (hence the name) from your diet for weeks or months.

Read also: DASH DIET: WHAT IS IT AND WHAT IT IS EATED WITH

How does it work?

Together with your doctor, you will need to make a list of foods that may be causing the unpleasant symptoms. Often this list includes:

• milk

• eggs

• nuts

• wheat

• corn

• shellfish

• 4 alcohol
  

After you create an individual "black list", you will have to completely eliminate all of these foods from your diet and observe how your body reacts to this.To do this, experts recommend keeping a food diary and writing down not only what was sent to your stomach, but also what your body responded to you (for example, after a salad with cucumber and cabbage, you felt bloated). This is followed by a reintroductive phase, when you are allowed to gradually return prohibited foods to your menu. One product at a time. But at the same time, you should not forget to write down all your feelings in a diary. If you can make a causal relationship between the product and the reaction of the body, then be ready to forever delete it from your menu and life.

Should you try the elimination diet?

If you suffer from certain allergic reactions when taking certain foods (choking, sore throat, rash), then the van needs not an elimination diet, but a visit to the doctor. But if we are now talking about milder reactions (bloating, headache, fatigue, digestive problems), the cause of which remains a mystery to you, then you should try this diet.

Read also: PALEO DIET: WHAT IS IT AND WHAT IT IS EATED WITH

Are there any side effects?

You will need patience, a lot of patience: in order to understand which particular product is causing the body to malfunction, you need at least a couple of weeks to experiment with the most "suspicious" inhabitants of the refrigerator and carefully write everything down.For this to work, you will also have to be very careful in the store (read the labels) and in the restaurant (interrogate the waiter). Do not forget that you will have to go all this way hand in hand with a professional - only he will tell you how to get all the useful substances in addition to giving up some products. Something else? Oh, yes, if the elimination diet has helped someone, then this does not mean that it will help you.

Expert verdict

It is important to understand that the elimination diet is not a diet for weight loss, but nutrition in order to exclude allergic reactions and other adverse effects of foods on the body.

Chocolate, milk, cereals, mushrooms, seafood, tomatoes, strawberries, citrus fruits and other exotic fruits are often included in the allergenic list. How to understand that this particular product should be excluded? We'll have to get confused and keep a diary detailing all the symptoms. You will need to eat the product at least twice a day and in fairly large quantities. The reaction time to a problematic product can vary from 10 minutes to 12 hours.

Look for the following signs: headache, itching, bloating, nausea, dizziness, fatigue, diarrhea, indigestion, drowsiness 30 minutes after eating, skin redness, heart palpitations.

Be aware of the possibility of cross-reacting. That is, if you have a food allergy, for example, to cow's milk, you should also exclude goat's milk, and veal, and beef from the diet. And with an allergy to chicken protein, not only chicken, but also quail eggs, mayonnaise based on them, as well as some medications are contraindicated. If, after stopping the use of probable allergens, the disease regresses, then the allergenic product has been correctly identified.

For those planning to try an elimination diet, I highly recommend doing it under the supervision of a doctor,

- advises Olga Sukhova, a wellness coach, founder of the Beautycamp fitness program.

If you are exhausted by an unpleasant feeling in the stomach after eating and you have a suspicion that the culprit is not a disease of the gastrointestinal tract, but “not your” product, you should talk to your doctor or nutritionist. A specialist will tell you whether to try your luck with an elimination diet or not.

Eliminate - (book) delete, exclude, eliminate something.

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Allergy Elimination Diet: How To Calculate Allergen

Elimination Diet

If you have chronic diarrhea, constipation, stomach pain, excess gas, or a rash after eating certain foods, an elimination or elimination diet can help determine if your symptoms are caused by a particular food sensitivity.In addition, such a diet helps in diagnosing allergies, identifying the causative product in the case of latent allergies, and in overcoming irritable bowel syndrome.

According to one of the variations [1] of the elimination diet, it is proposed to give up gluten, dairy products, eggs, soy, alcohol and fast food for 23 days. This is how long it takes to neutralize the influence of allergens. During this period, it is also not recommended to eat fish, a lot of fiber and vegetable oils. The use of "health bars" is not a good idea either: because of the large amount of sugar, they should also be discarded.As well as from special gluten-free cereals and breads. In them, refined carbohydrates from one plant species are replaced by similar carbohydrates from another plant. Also, be careful about oats as they can often be contaminated with gluten.

On the 24th day, one of the products is returned to the menu and the reaction to it is studied within 48 hours. If after these two days there is no reaction, the product remains in the diet, and the reaction is recorded in a paper version of the food diary or in a smartphone application that allows you to record the meals eaten.If after the next consumption there is no reaction to the product, it remains completely, and the next "temporary exile" returns to the diet ...

If a reaction appears to a product, it is recommended to confirm it a second time and also write it down in the food diary. If symptoms recur, it is possible that this particular product is an allergen and should be excluded from the menu. Thus, you can protect yourself from unpleasant symptoms in the future.

At the same time, although the elimination diet has several advantages, it can also lead to negative consequences.Indeed, substances necessary for the normal functioning of the body can be excluded from the diet.

A diet is especially dangerous when it is developed by the patient independently, without consulting a doctor. First of all, a family doctor can help you, who will determine what kind of general pathology (problems with the stomach and / or intestines, allergies) you suspect. He may refer you to an allergist, gastrologist, or nutritionist who can provide an accurate diagnosis and the right diet for you.

Does not improve diet and skin condition. For example, a review of nine studies [2] found that diet did not improve symptoms in people with atopic dermatitis. In addition, prolonged elimination can exacerbate an allergic reaction to food.

For example, a study conducted at Johns Hopkins University showed that children who outgrew peanut allergy, but continued to exclude it from their diet, experienced relapses of severe allergies. A strong reaction is also reported by those who excluded gluten from their diet, and then inadvertently ate a product with its content.However, another study found that children with atopic dermatitis and concurrent egg allergy improved their condition on egg-free diets. In any case, the elimination of the allergen from the diet is, so far, the best method for eliminating the symptoms of allergy. However, we repeat, only a doctor can compose a specific menu without allergens after he has established an accurate diagnosis of your sensitivity to a particular product.

Meanwhile, the scientific literature suggests that some dietary diversity can relieve some of the symptoms of seasonal allergies and even asthma.There are a number of [3] foods that can help reduce inflammation and increase the immune system's defenses. For example, ginger can help reduce swelling and irritation in the nose, eyes, and throat. It contains phytochemicals with antioxidant and anti-inflammatory properties.

Turmeric is another product that helps reduce inflammation and swelling. But in order for it to better reveal its properties, it should be added to food along with black pepper. If you don't have food allergies, don't forget about red and other oily fish.It can reduce the risk of allergic sensitivities or hay fever and even make asthma easier. This is likely due to the anti-inflammatory properties of omega-3 acids found in fish, especially fatty ones. Regular onions, peppers and parsley can also be useful. They are a natural source of quercetin, which acts as a natural antihistamine to reduce seasonal allergy symptoms.

Pineapple, thanks to an enzyme called bromelain, can reduce irritation in allergic diseases, including asthma.Regular consumption of natural probiotic kefir and yogurt can also improve the body's health [4].

Talk to your doctor about which of the following products may be helpful in your case.

Sources of information:

1. https://www.mindbodygreen.com/0-12540/the-simple-elimination-diet-that-could-change-your-life-forever.html
2. https://www.verywellhealth.com/food-making-you-sick-allergy-elimination-diet-may-help-1324053
3. https: // www.healthline.com/health/seasonal-allergies-best-foods#1

https://www.webmd.com/allergies/features/foods-fight-allergies

90,000 What is an elimination diet? | TipTar

Elimination diets may promise to improve bloating, brain fog and breakouts, but do they really live up to the hype? Before trying this type of diet, it is important to know what they are, how they work and why you should only perform them under the supervision of a doctor.

What are elimination diets?

These are meal plans that eliminate certain foods or food groups from the diet to identify the source of a person's food intolerances . They can be quite beneficial when you consider that 15-20 percent of the population suffers from food intolerances, according to a review published in the December 2014 journal Alimentary Pharmacology & Therapeutics.

The purpose of this diet is to identify foods that can cause various unwanted symptoms.Often recommended for acne , migraine or abdominal inflammation among others. Chronic pain and fatigue can also motivate people to try this diet.

But gastrointestinal problems are one of 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 certain carbohydrates that they cannot tolerate.Another example is avoiding dairy products to see if gastrointestinal symptoms such as bloating, gas and diarrhea go away when sugar is removed lactose .

You could even say it Paleo , Total 30, and gluten free diets are all exception diets. After all, these are meal plans that exclude food groups from the diet.

Unlike diets designed for people with food allergies requiring long-term adherence, elimination diets should be temporary .They also reintroduce foods that can be triggers into the diet as a means of testing whether they are causing symptoms.

How do elimination diets work?

Phase 1: Elimination

Objectives of the elimination phase: Eliminate all harmful foods from the diet and see the complete or almost complete disappearance of symptoms. This is usually done around for four to six weeks , but most people will notice an improvement in symptoms within the first two weeks.

It is not yet known exactly why some people react and others do not, although this is probably due to the fact that irritable bowel syndrome itself is very diverse. For some people, diet can cause symptoms, while for others it can be stressful or medication.

As a general rule of thumb, if you do not feel an 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. It takes time for the nerves and bacteria in the gastrointestinal tract to adjust to changes in diet.

Phase 2: Reintroduction

The second phase of elimination diets consists of slow and steady reintroduction of food . This stage is the most important.

If done incorrectly, deletion will be useless and all symptoms may return without providing us with information. The goal here is to carefully re-introduce one product at a time to assess if it is a trigger.

Reintroducing foods one at a time is very important. For example, for a low FODMAP diet, the best approach is to consume a new food from a specific FODMAP group every three days (with a three day “washout period” where you return to the elimination phase between each new purchase).

If the reintroduced food does not cause symptoms, it can be continued for a long time. However, if consumption causes adverse reactions, a completely elimination diet should be reinstated until all symptoms disappear.

When working on the second phase, it is important to ensure that the foods you reintroduce contain only one of the possible triggers that you control. For example, try watermelon (a high FODMAP food) instead of a slice 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 be so distracted or "used" that we lose it until we are asked to take a diary and document it.

Phase 3: Personalization

The final step in the elimination diet is personalization.

After we complete the reintroduction and identify food triggers, you should work with a professional to create a meal plan that limits or eliminates certain food triggers, yet is varied and balanced.

The need to eliminate food for life depends on the person and condition. When you are allergic to any food, there is no way to "taste" it.Food should be completely avoided. However, if you are dealing with an intolerance or irritable bowel syndrome, you may have some wiggle room.

Pros and cons of elimination diets

If performed correctly, the elimination diet does not pose a serious health risk. That said, it is very important to adhere to strict protocols regarding meal plans.

Elimination diets should not be carried out without medical advice. Before starting such a diet, you need to conduct a comprehensive assessment to determine a person's dietary preferences, dietary patterns, and medical history.

It is also important to remember that the elimination diets are temporary and should not be followed for a long time or to lose weight . Potential risks can also arise from nutrient deficiencies or negative changes in the gut microbiota if someone is following such a diet for a long time.

Low fiber intake (in the case of a low FODMAP diet) and unwanted weight loss can occur if the elimination diet is followed for an extended period of time or if it is not properly followed.

In addition, they are not recommended for people suffering from disordered eating patterns as meal plans can be extremely restrictive and therefore can contribute to unhealthy eating habits.

Foods that should not be eaten on the elimination diet

There is no one-time diet, but foods that are usually avoided include:

1. Common allergens : These include wheat, soy, dairy products, eggs, peanuts, nuts , fish, shellfish and sesame seeds.

2. FODMAP Foods : This means fermentable oligosaccharides, disaccharides, monosaccharides and polyols. This is what it is:

Oligosaccharides: wheat, rye, onion, 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 certain fruits and vegetables; polyester alcohols and artificial sweeteners.

3.Gluten

4. Alcohol

5. Caffeine

6. Added sugar.

Elimination diet: how to eat, features, indications and contraindications ~ SLOVESA

To begin with, determine the purpose for which you are planning to use any diet.

If you want to choose a diet for weight loss - pay attention to the keto diet or just resort to intermittent or short-term fasting.

The Emilination Diet is designed not to lose weight, but to treat you - to show which foods are intolerant and which foods are allergic.

Elimination - exclude, delete, replace.

What is the essence of the elimination diet for recovery

Identifying food allergies is not difficult for an allergist or nutritionist. Food allergy usually has characteristic symptoms:

• feeling of suffocation after eating - swelling of the face, neck, lips, tongue,
• severe eruptions on the body to ulcers,
• cough and shortness of breath,

90,021 runny nose and lacrimation.

Food intolerance or sensitivity of the body to certain food products is rather difficult to determine, since it is characterized by atypical signs:

• skin redness,
• itching,
• bloating or a certain taste in the mouth,
• constipation or diarrhea,

90,021 and even joint pain and headache.

Foods that contain powerful allergens, such as coffee and tea, citrus fruits and nuts, spices and dairy products, and others, can cause sensitivity.

For example, arthritis sufferers have been found to be sensitive to citrus fruits, pork, corn, oatmeal, coffee, cheeses, tomatoes, sugar, chocolate, wheat, and migraine sufferers have added food additives, preservatives, tea, potatoes and salt to this list. (source sektascience.com).

The elimination diet usually lasts up to 6 weeks and is supervised by an allergist or nutritionist. To begin with, a list of foods is compiled that can potentially cause discomfort in the body.These foods completely eliminate and stick to this diet for up to 3-4 weeks. This will be the first step in the diet.

After the characteristic symptoms are gone - you can proceed to the second stage of the diet - returning a product or group of products 1 at a time.

Important! In order to fix the cause of the unpleasant symptoms in the body and to identify which product is causing the allergy, it is recommended to write down all your feelings in a so-called food diary.

It is recommended that you strictly adhere to the list of excluded foods for the period of time that the doctor indicated and only eat permitted foods.To clearly understand - study labels in stores and conduct interviews with staff in restaurants.

How to Eat an Elimination Diet

As already mentioned, the elimination diet, in order to identify an allergen product, consists of 2 stages: a period of excluding products and a period of adding these products.

Stages of the elimination diet

Step 1 - Eliminate potential food allergens

At this stage, a list of foods that should be removed from your diet and a list of what foods are allowed is clearly formed.

Potentially hazardous products generally include:

• Products containing gluten: bread, pasta (pasta), muesli, beer, wheat, rye, barley, bulgur, semolina, couscous, sauces.
• Milk and dairy products, seafood, eggs, beef, pork, lamb.
• Fruit: citrus, melon, cherry, grape, dried fruit.
• Drinks: alcohol, coffee, tea.
• Vegetables: tomatoes, eggplants, corn, potatoes, cabbage.
• Legumes: All legumes, including lentils, soybeans.
• Saha, honey and syrups.
• Nuts and Seeds.

Follow an elimination diet for 3-4-5 weeks. All menus and body reactions should be recorded in a diary.

Stage 2 - return of those products that have been eliminated

Products that were excluded - return to your diet 1 at a time and also write down your feelings in detail and how the body behaves. And when the alarming symptoms return with the introduction of a certain product, it means that it should be excluded from the diet forever.

Important: lists of prohibited and permitted foods are compiled individually, we have provided only a recommendatory list - those foods that most often fall under the category of allergens.

Elimination food - Tasteful

Satisfying hunger and getting pleasure should not be the main motives in cooking. We spend 30 minutes to an hour for breakfast or lunch, but we feel the effect on ourselves throughout the day. If we consider food not only as a means of survival, it becomes clear that what lies on the plate controls our weight, health, well-being and, finally, mood.

If you experience troubling symptoms such as frequent migraines, excess weight, acne, loss of energy, nausea and poor sleep, it may be worth learning more about the Elimination Diet . And yes, it is not only needed for effective weight loss .

What is the elimination diet

Food allergy is fairly common, but we are not talking about a true allergy to specific irritants (for example, to citrus fruits), but about the so-called pseudo-allergy - food intolerance .

Each person is different, and everyone's taste preferences are very different. Someone hates olives, and someone even eats strawberries with difficulty, although there is no obvious negative reaction. Someone needs a large steak to feel full, and someone will feel after it only heaviness in the stomach.

Elimination Diet is a course during which you first gradually eliminate food from your diet, and then re-enable it and observe the reaction of your body.After such a break, it can be very pronounced, and you will clearly understand which foods are causing imbalances in your body.

This is important, because unsuitable diet slows down metabolism, creates additional stress, side effects and often leads to excess weight. By the way, if the weight is gone, and the condition has not improved, it is quite possible that the matter is not only in calories.

First stage: reboot

So, in the first three weeks, you need to completely abandon the most aggressive products : sweet, fried, most of the flour, spicy, meat and too fatty.Here is a list of foods to avoid:

• gluten-containing products (most of cereals and products from them)
• dairy products
• pork
• beef
• soybean
• eggs
• corn
• peanuts
• sugar
• caffeine
• alcohol

Nutritionists recommend excluding these particular food groups due to their high allergenicity .When three weeks have passed, many of the symptoms associated with poor absorption have disappeared. At this time, your diet should consist mostly of fish, vegetables, fruits, chicken, as well as gluten-free cereals (millet, rice and buckwheat). Cold pressed oils and avocado are allowed to maintain the balance of fatty acids in the body.

Second step: formulation of the diet

The hardest part is over, and it's time to return the food to the diet one by one. Try starting with dairy products such as cheeses and yoghurts.Enter them and for a day or two observe the reaction of your body: if fatigue, discomfort, rashes on the skin of the face or pain return, it means that you are poorly assimilating this group of products.

Keep a journal and include different groups in your diet one at a time, while continuing to closely monitor your body's reactions. As a result, your list will be ready in a couple of weeks. Feel free to use favorable products in cooking, but all precautions must be followed with problem points.

1. It would be better if unsuitable foods were excluded from the menu for a period of 3 to 6 months. Yes, it’s not easy, but perhaps after six months, due to the absence of the stimulus, your body will be able to absorb them well again.
2. Make sure that unwanted foods end up on your plate no more than 1-2 times a week. And to make them easier to digest, it is necessary to detox the body more often in order to reduce the load on the immune system and the gastrointestinal tract.
3. Cook red-listed vegetables, legumes, and meats to reduce side effects. For example, germinate and soak grains and legumes before eating; ferment vegetables and milk; ferment foods; bake, not fry the meat. In general, resort to those processing methods that neutralize the negative effect as much as possible.

Weight loss is just a nice bonus. The biggest reward for those who decide to try this popular diet is health that works like a Swiss watch.And no discomfort or unexplained loss of strength.

By the way, if you have long suspected that your body does not perceive a certain type of food well, it will be enough to exclude only it and observe the reaction (this, of course, is half measures, but it will also work). We hope you find this technique useful!

The use of enzyme-linked immunosorbent assay (ELISA) in the diagnosis of allergic diseases in dogs and cats

Authors: VV Ruppel, Ph.D., veterinary dermatologist of the Clinic of Neurology, Traumatology and Intensive Care, Dr. Sotnikov; Svetlana Belova, DVM, DiplECVD, Estonian Agrarian University.

A few words about the ethics of a veterinarian

One of the founders of ethics in the art of healing, Hippocrates (lived about 500 BC), gave the following definition to medicine: "a doctor is a philosopher, because there is not much difference between wisdom and medicine." The ancient physician Hippocrates, wishing to protect his colleagues from some pernicious mistakes that interfere with healing, formulated another famous saying: “Everything that is sought for wisdom, all this is in medicine, namely contempt for money, conscientiousness, modesty, simplicity in dress... ". Many ethical considerations of this ancient medical scientist were fundamental to the modern subject of deontology, which teaches the fundamentals of ethics so necessary for the doctor in his daily practice.
Undoubtedly, for the activities of a veterinarian who treats beloved family members, the same moral rules that are inherent in human medicine can and should be fundamental. Hippocrates equated medicine with wisdom. The path to wisdom lies through knowledge.Difficulties in cognition in modern conditions give rise to medical errors Russia is experiencing another crisis in culture, science, education. If we talk about the educational system, then, alas, having failed to properly adapt for a number of reasons, today it turned out to be of little use for people who want to get an education or improve their qualifications in the field of treating small pets.
On the one hand, this generates a number of misconceptions based on erroneous stereotypes of thinking that are formed due to the lack of proper schools and / or directions in veterinary medicine of small animals.On the other hand, it gives impetus to study the undoubtedly valuable experience that was formed during the life and work of more than one generation of doctors abroad. This experience has already made it possible to develop “there” the necessary algorithms for action, based on a deep understanding of various aspects in small animal medicine. To make sure of this, it is enough to look through some of the textbooks offered to the attention of students and doctors, to familiarize yourself with some of the many scientific publications on various topics.Unfortunately, only the awareness of objective reality can lead to the creative process of cognition of the already open and understood “not with us”. Probably only then will many of the erroneous stereotypes cease to exist forever.

Briefly about the algorithms of action for itching

Small animal dermatology is a whole structure of knowledge. This knowledge is systematized and logical. Basically, there are two large groups of causes that can form itching in cats and dogs: the presence of skin parasites and allergies.Of course, itching can also occur with skin infections, such as pyoderma or dermatophytosis, and in a number of other cases, such as pemphigus, dermatomyositis, zinc-dependent dermatosis and others. But since parasites and allergies are most often the cause of itching, then, based on these ideas, we build the entire sequence of actions. We collect anamnesis, conduct a physical examination and initial examinations. Anamnesis is very important, as it often helps to understand the cause-and-effect relationship of the development of the disease and to imagine your further actions.Physical examination allows you to determine the area of ​​the lesions, assess their nature, and also suggest which dermatological tests will be used at the moment.
Dermatological studies already at the initial stage can help establish a diagnosis (for example: with demodicosis, notoedrosis, cheiletiellosis, dermatophytosis, less often with sarcoptic mange, or determine which microflora acts as a secondary infection (coccal bacteria, bacilli, yeast).Whereas most pruritic diagnoses are related to either parasites or allergies, we usually prescribe trial treatments against parasites and often, at the same time, allergy diagnostic tests. In the event that trial treatments are unsuccessful, confidence is strengthened that we are most likely to have an allergy.
It is generally accepted that after the exclusion of parasites, including flea allergies, there are two groups of possible causes that can form an allergy. First - food factors, second - non-food factors. Allergy diagnostics is built in accordance with these ideas.

Allergy diagnostics in dogs and cats

The "gold standard" for the diagnosis of food allergies - elimination (exclusion) diets, which are based on the introduction of two new (previously not included in the diet) foods - protein and carbohydrate - into the animal's diet for 6–8 weeks. This is followed by provocative tests based on a recurrent diet over a period of 14 days.These tests are then evaluated. If, against the background of elimination diets, the patient's clinical condition improves, and against the background of provocation, on the contrary, it worsens, then in this case it is concluded that the animal has a food allergy. In the event that, against the background of elimination diets, the clinical situation does not change or when food provocations do not deteriorate, the conclusion suggests itself that a probable cause of itching and secondary skin infections is a non-food allergy, i.e.e. allergy to airborne allergens.
In dogs, for the final diagnosis of non-food allergy and the selection of allergens for further immunotherapy, intradermal testing (skin allergy test) is usually used to determine the reaction in response to the intradermal injection of allergens. In that case, if the reaction turns out to be positive (the appearance of erythema and a blister, indicating the presence of allergen-specific IgE in the skin), the diagnosis is made - non-food allergy. Intradermal testing has also been used in cats until recently.Recently, however, more and more people began to resort to diagnostic ELISA tests, used to determine the concentration of allergen-specific IgE in the blood, due to the difficulties encountered in interpreting the results of intradermal testing. In dogs, ELISA can also be used to determine the concentration of allergen-specific IgE. But, as a rule, this happens infrequently and only in those cases when it is technically impossible to carry out intradermal tests (with severe dermatitis in the testing area, with absolute contraindications to sedation, with refusal of the test owners).

Predictive value - an important criterion in the diagnosis of allergies, which is relied on in dermatological practice, is the relationship between the results obtained in a particular laboratory test and clinical data. And if the determination of the level of allergen-specific immunoglobulins of class E (AC IgE) in the diagnosis of allergies caused by aeroallergens in dogs and cats is a significant test for choosing further therapy (allergic vaccines or immunotherapy), then this is not the case in the case of determining the level of specific immunoglobulins in the diagnosis of food allergies.
In this case, a high concentration of specific immunoglobulins of both class E and class G may mean absolutely nothing for a particular patient. That is, suppose a blood is taken from an animal, an ELISA serological study is carried out, a high concentration of specific immunoglobulins (class E and / or G) is determined, which are assumed to be produced in an increased amount as a result of an immune response to the antigenic effect of specific foods.At the same time, it is logical to assume that it is these products that can cause allergies. In the future, these food products are introduced into the diet (food provocation), and nothing happens in response - the situation does not change clinically. That is, the predictive value of a positive test is absent in this case.
Many studies support the fact that food allergies cannot be diagnosed by measuring serum IgE and IgG levels. Jackson et al. (Evaluation of the clinical and allergen specific serum immunoglobulin E responses to oral challenge with cornstarch, corn, soy and a soy hydrolysate diet in dogs with spontaneous food allergy H.A. Jackson, M. W. Jackson, L. Coblentz and B. Hammerberg. Veterinary Dermatology 2003, 14, 181-187) set out in their article the data that were obtained in their experiment. The subjects of the study were maltigili (a cross between bigley and maltese dogs) with an allergy to corn and soy. The aim of the studies was, on the one hand, to test the hypothesis that dogs with confirmed hypersensitivity to a particular protein do not develop sensitization to its hydrolyzate. On the other hand, in these studies, the authors characterized the low diagnostic value of ELISA and intradermal tests in dogs with food allergies.Careful planning of the experiment, the use of meaningful clinical tests, the processing of the data obtained, and much more collectively indicate the adequacy of the conclusions reached by the researchers. Since our goals do not include the desire to convey all the nuances of this experiment, we will not dwell on this in detail. But in order to be able to verify this, in our opinion, it is highly desirable to refer to the original source.

With regard to the determination of the level of food antigen-specific immunoglobulins of class E by the ELISA method, a number of interesting data were obtained:
1), it was noted that, against the background of food provocations, there was an obvious rapid effect of increasing the concentration in serum of AC IgE, but this did not carry prognostic value with respect to the possible development of clinical signs of hypersensitivity in the future, since in some dogs, against the background of food an increase in the level of AC IgE not only for corn, but also for soybeans.As the authors point out, it is unlikely that there is a cross-reaction between soybeans (legumes) and corn (cereals). Therefore, they suggested that when an antigen is obtained at the time of food provocation, the immune memory T cells are stimulated, in connection with which the production of several types of IgE is initiated at once, which have a specific difference;
2) the authors note that in human medicine, the elimination of an allergen from the diet leads to a decrease in serum IgE AS and to an improvement in clinical signs, in this regard, the determination of the level of food AS IgE was adopted as monitoring in the diagnosis of food allergies in humans.In contrast, in this experiment, an increase in AC and total IgE levels was noted with a diet free of soy and corn. The reason for this is not completely clear, and one of the explanations for this may be, according to the researchers, a decrease in the formation of complexes of IgE with IgG and anti-IgE, which, in turn, leads to an increase in the total level of IgE in dogs that do not have signs of allergic manifestations. This hypothesis, presented by researchers as a possible scenario for the development of such events, requires confirmation.
3), the researchers found that after the first food provocation with corn starch, a significant increase in the total concentration of serum IgE was determined. Despite this increase in total IgE levels, no predictive value has been established for the development of allergic disease in dogs. In this connection, it was concluded that the study population of dogs predisposed to allergies could be susceptible to cumulative and chronic exposure to the allergen.

And so, summarizing the data of the researchers, we can offer some summary and draw brief conclusions regarding the value of the method in a specific ELISA study to determine allergen-specific IgE in food allergies:

1. When a significant allergen is introduced into the diet, the level of total IgE, and AC IgE.But at the same time, the level of other AC IgE can also increase, even despite the fact that the allergens to which these immunoglobulins should be produced were not introduced into the diet.
2. Instead of the AC IgE level decreasing upon elimination of the food allergen, the opposite happened - the AC IgE level increased.
3. The total IgE production can be high for a long time, after the end of the food challenge. Thus, an increase in the total level of IgE can hardly indicate the presence of an allergic process in dogs, in contrast to the way it is accepted in human medicine.

Instead of conclusions, I would like to suggest that if a clinical practitioner, taking into account the data obtained in the study, holds in his hands a form with the results of blood serum tests for the presence of food AS IgE, then instead of answering his questions, he will most likely have new ones. questions:

1. Is this animal allergic to food?
2. In connection with what increased the level of AC IgE (due to exacerbation or remission)?
3. Is the total IgE level elevated because some allergen is stimulated? How exactly?

Ralf Müller et al. (Food allergen-specific serum IgG and IgE before and after elimination diets in allergic dogs.Anja Zimmer, Jennifer Bexley, Richard E. W. Halliwel, l Ralf S. Muller. Veterinary Immunology and Immunopathology, 144 (2011) 442–447) conducted a study aimed at measuring the level of food AC IgE and AC IgG to 16 food antigens before and after the elimination diet. These antigens are believed to be the most common cause of food allergy in dogs and are therefore used in ELISA test systems. Careful experimental approaches, such as those used in the Jackson et al. Study (which we mentioned above), also indicate the adequacy of the conclusions reached by the researchers.In order to verify this, we recommend that you refer to the original source.

The authors found the following:

1. When determining the production of IgE: IgE against duck, egg and white fish were not detected and only one dog was determined IgE against chicken and turkey, respectively. Only two blood samples contained IgE against wheat, soybeans, barley, rice, potatoes, oats, and corn; which were determined after the diet in the same two dogs. None of these allergens were included in the statistical evaluation due to the small number of reactions.There were no significant differences between serum containing specific antibodies before and after the diet for either of the individual allergens or for the group IgE concentration of all antigens (P = 0.55). In addition, there was no difference between the IgE concentrations of dogs on a commercial diet versus those on cooked food at home.
2. When determining the production of IgG: , only one dog had IgG against potatoes and eggs, respectively.Only two blood samples contained IgG against wheat and barley, and four dogs responded to soy. None of these allergens were included in the statistical evaluation due to the small number of reactions. No significant differences were found between serum food specific antibodies before and after the elimination diet for either of the individual allergens or for the grouped IgG concentrations for all antigens (P = 0.53). In addition, there was no difference between the IgG concentrations of dogs fed a commercial diet versus those fed a home-cooked food.

That is, the determination of the level of immunoglobulins of various classes does not carry any information about the clinical condition of the patient. Elimination diets improved this condition, and prior to their implementation there were clear clinical signs of allergy. But the level of immunoglobulins did not change at all.

From which it can be concluded that a test such as determining the concentration of AC IgE and AC IgG is unlikely to be useful in order to answer the following questions:

1. Which of the antigens is allergic to?
2. Does the patient have an exacerbation of allergy or remission?

In this connection, the lack of diagnostic value of these tests is again confirmed.Analyzing the results of the experiment, Ralf Müller and co-authors compare them with others and refer to other researchers (data on the links in the bibliography of the original source): “Many authors point out that the determination of the level of serum IgE and IgG for detecting adverse reactions to food is unacceptable. Test results using polyclonal IgE antibodies are also not considered reproducible (reproducibility - the degree of closeness to each other of independent measurement results obtained by the same method, on identical test objects, in different laboratories, by different operators, using different equipment) (Wilhelm and Favrot, 2005), and measurement of serum allergen-specific IgE to food allergens with monoclonal ELISA is also unreliable (Mueller and Tsohalis, 1998) ... Many food ingredients elicit the production of antibodies (IgE and IgG) in patients who have no signs of dermatitis or gastrointestinal -intestinal disorders (Foster et al., 2003) ... There are several studies that have evaluated changes in serum concentration of dietary specific antibodies depending on the proposed diet (Jackson and Hammerberg, 2002; Jackson et al., 2003). In these studies, no clinically significant parameters were found in relation to changes in serum specific serum antibodies, and therefore their concentration cannot be used to predict clinical hypersensitivity.

Although we saw significant clinical improvements with elimination diets and could detect specific food allergens IgE and IgG in serum concentrations, these antibodies did not change during the diet despite exposure to significant allergens at that time. ”

Also, as the authors note: “Dogs with atopic dermatitis associated with environmental allergens have higher levels of serum food-specific IgE than healthy dogs and dogs with gastrointestinal diseases (Foster et al., 2003; Halliwell et al. ., 2005) ... Currently, the role of IgE-mediated hypersensitivity in terms of the development of clinical signs of adverse reactions to food in dogs has not been clearly established (Hillier and Griffin, 2001).In addition, changes in serum concentration of food-specific IgE and IgG can be observed even in clinically healthy dogs, regardless of the diet used (Foster et al., 2003). In human medicine, the production of antibodies in response to food intake is ubiquitous in both children and adults and is not generally associated with increased sensitivity against antigen intrusion (Johanson et al., 1984).
In this study, some dogs showed very high levels of specific antibodies before and / or after the diet, while other dogs did not.However, the results of serum concentrations of dietary specific antibodies did not correlate with changes in diet. A number of factors can affect the production of antigen-specific IgE. These include possible genetic changes within and between breeds, type of antigens, as well as doses, routes of entry, frequency and interval of exposure, and the presence of concomitant hypersensitivity (Foster et al., 2003). The immune response can be influenced by previous or concurrent microbial or parasitic infections of the gastrointestinal tract (Olsen et al., 2000).

In addition, vaccine adjuvants or vaccines themselves can influence serological responses (Hogen Esch et al., 2002; Tater and KC, 2005). Unfortunately, the vaccination period for the dogs participating in this study was not included. In conclusion, it should be noted that the concentration of food specific antibodies in serum does not change during the elimination diet, that is, the elimination diet does not affect the results of testing serum for the presence of food antigens. The conclusion that ELISA is not the method of choice in the diagnosis of food allergies has been arrived at for a long time.Thus, Jeffers et al., Trying to use intradermal tests and ELISA as diagnostic methods in dogs, conclude that these methods cannot replace elimination diets, which are the "gold standard" for diagnosing food allergies (Diagnostic testing of dogs for food hypersensitivity. JG Jeffers , KJ Shanley, EK Meyer J Am Vet Med Assoc. 1991 Jan 15; 198 (2): 245-50). Ralph Müller et al. (Evaluation of serum allergen-specific IgE for the diagnosis of food adverse reactions in the dog.Mueller, Tsohalis. Article first published online: 5 JAN 2002. DOI: 10.1046 / j.1365-3164.1998) used a monoclonal enzyme-linked immunosorbent assay (ELISA; CMG IMMUNODOT, Friborg, Switzerland) to measure dietary serum antigen-specific IgE in an attempt to assay AS IgE in dogs. Serum was collected from eight dogs with clinically proven adverse reactions to specific proteins. The serum was tested for antigens of beef, cow's milk, pork, lamb, chicken eggs, soybeans, a mixture of fish (cod + sole), peanuts, corn, wheat flour.In the control group, the authors included three healthy dogs, three dogs with non-allergic skin diseases, and two dogs with atopy. The tests revealed only three moderately positive reactions to beef, lamb and peanuts, respectively. At the same time, which is undoubtedly very indicative, an increase in the level of these antibodies was not found in the serum of dogs with allergies, but in sera taken from two control dogs with such clinical diagnoses as dermatophytosis and atopy. None of the animals with confirmed adverse food reactions showed positive reactions.This study shows, in the opinion of the authors, that the diagnosis of food-borne adverse reactions in dogs by measuring AC IgE with the monoclonal antibodies used for ELISA is not reliable. We subscribe to this conclusion and are unlikely to speculate further on this topic, considering it exhausted.

Do food allergies occur frequently?

Although food allergy has received a lot of medical attention, it is actually not a common problem. Thus, in one study, out of 55 surveyed dogs with signs of allergy, after excluding flea allergy, only 5% had food allergies.The rest were diagnosed with atopic dermatitis (ie food allergy) (Food hypersensitivity dermatitis in the dog: diagnostic possibilities. S. Wilhelm, C. Favrot. Schweiz Arch Tierheilkd. 2005 Apr; 147 (4): 165–71).

The use of ELISA in the diagnosis of non-food allergies

It has been proven that ELISA can be used as one of the methods for diagnosing non-food allergies in dogs and cats. In particular, a number of serious studies have been carried out in which a high degree of comparability of the results obtained during intradermal testing and ELISA (Comparison of intradermal testing and serum testing for allergen-specific IgE using monoclonal IgE antibodies in 84 atopic dogs.R. S. Mueller, A. Burrows, J. Tsohalis. Australian Veterinary Journal Volume 77, Issue 5, pages 290-294, May 1999; Comparison of intradermal and serum testing for allergen-specific IgE using a FceRIa-based assay in atopic dogs in the UK. A. P. Foster, J. D. Littlewood, P. Webb, J. L. N. Wood, K. Rogers, S. E. Shaw. Veterinary Immunology and Immunopathology 93 (2003) 51-60).
Today, there are several companies in the world that produce high-quality test systems for these purposes.These are HESKA (USA), GREER (USA) and ARTU (Holland). We used the services of the ARTU laboratory in order to select allergens for vaccination (that is, for allergen-specific immunotherapy).

Conclusions:

1. Determination of the level of immunoglobulins of various classes (IgE, IgG) in the blood does not represent any diagnostic value in determining food allergies.
2. "Gold Standard" for the diagnosis of food allergies - elimination diets followed by food provocation.
3. ELISA can be used only as one of the methods for diagnosing non-food allergies in cats and dogs at its final stage, mainly for the purpose of selecting airborne allergens for immunotherapy or choosing measures to limit patient contact with an allergen.

Diagnostics and treatment of various allergic diseases - Allergologist-immunologist - Department of general practice with personal supervision - Departments

Diagnostics and treatment of various allergic diseases

DIAGNOSTICS .There are many ways to diagnose allergies. The correct diagnosis can be made only after a comprehensive examination and never after one analysis. A comprehensive allergy examination begins with a conversation with an allergist. The doctor asks about complaints, about the onset of the disease, the peculiarities of its development, about the conditions in which the allergic reaction is most pronounced, about the presence of such diseases in relatives, living and working conditions. After that, the doctor prescribes certain diagnostic methods.

Skin Tests: A prick test (prick test) or scratch test (scarification test) is done to determine which allergens may be important in a person's symptoms. These are completely painless methods. The study, as a rule, is carried out on the skin of the forearm, which is pre-treated with an alcohol solution. Further, drops of allergens are applied to clean skin. In the case of scarification tests, small scratches are applied through the drops of allergens with a disposable scarifier.After a while, slight swelling and redness of the skin may develop, which suggests an allergy to the corresponding substance.

Investigation of specific antibodies Ig E: Such an analysis for antibodies responsible for the development of allergies helps to identify a group of causal allergens. The method is very sensitive, and the information obtained is inherently similar to that obtained as a result of skin testing. To carry out this analysis, you will need to donate blood from a vein.

Provocative Tests: Skin and IgE blood tests indicate allergens that could potentially cause allergic reactions in a given person. If, after skin tests and blood tests, the diagnosis is unclear, the doctor may order provocative tests. Such studies are carried out in allergy hospitals for strict indications. When conducting provocative tests, a small amount of an allergen is injected into the nose, under the tongue or directly into the bronchi, and after a while the reaction is assessed.Such a study can cause a severe allergic reaction in the patient, therefore it should be carried out in the presence of a doctor who can provide immediate medical attention.

Elimination Tests: If contact with an allergen is persistent, elimination tests are used to confirm that this particular allergen is causing the clinical manifestations of the allergy. Elimination is the removal of an allergen. A typical example of an elimination test is the elimination diet. This is a diagnostic technique, which consists in the complete elimination of the alleged allergenic product from the diet.If, after excluding the product within 7-14 days, there is a visible improvement in the course of the disease, then we can say that this product is the cause of allergies.

To diagnose allergies and correct treatment, the doctor may ask you to keep a special diary, in which the patient will note the time of the onset of the allergy, manifestations and possible cause. This will allow prophylactic treatment or avoid contact with the allergen, for example, in the case of pollen allergy or food allergy.

Laboratory methods for diagnosing allergies are just a part of a comprehensive allergy examination. On their basis, the doctor can suggest the cause of the allergy. An accurate diagnosis can be made only with the totality of all the data: interview, examination, laboratory data and response to treatment.

TREATMENT. In addition to the selection of the optimal symptomatic pharmacological therapy for allergic diseases, the allergist-immunologist performs ASIT, which is also called specific immunotherapy, specific desensitization, specific hyposensitization, immunotherapy with allergens, allergy vaccination or allergy vaccination.

An allergist-immunologist prescribes ASIT if there is a history of confirmed IgE-dependent allergic diseases. Treatment is carried out using standardized drugs, the effectiveness and safety of which has been confirmed in practice. ASIT is prescribed in the following cases:

• If it is not possible to stop the patient's contact with the allergen, for example in the case of household dust.
• If the clinical manifestations of the disease have clear evidence of the effect of a particular allergen.
• If analyzes for allergens (prick tests and in vitro antibody tests) have confirmed an IgE-dependent mechanism of sensitization.
• If there are no more than three allergens.
• If elimination of allergens makes it impossible to control the symptoms of the disease or complete elimination of allergens is not possible.
• As an alternative to continuous or long-term administration of drugs, as well as in case pharmacotherapy gives side effects.