Figuring Out Food Sensitivities
In the health and wellness space, you’ll undoubtedly hear that certain foods are inherently “bad” for everyone – gluten, dairy, and lectins are examples. Maybe you’ve wondered if you should avoid any of these foods because they are might be causing your acne, stomach aches, or other troubling symptoms.
However, the real deal is that when it comes to “real” food (meaning unprocessed whole foods) – there isn’t any single food group that is “bad” for every single person – unless it’s spoiled or rotten! Everyone is different when it comes to their body’s response to food. There’s no reason to restrict a food group based on theory alone.
So are food sensitivities a real thing?
Absolutely! There are many different ways that individuals can have an inflammatory or challenging response to foods. And for certain people, it is a health game-changer to figure out if food sensitivities are contributing to inflammation, skin conditions, autoimmunity, aches and pains, digestive distress, or other conditions.
It’s important to note that food sensitivities are not considered allergies. True allergies are those that involve an immediate antibody (IgE) response such as hives, swelling, or anaphylactic shock. These show up on the classic skin-prick test that an allergist performs. Food sensitivities are also called “intolerances.” and sometimes these create an antibody response, but these antibodies (IgG) are delayed rather than immediate.
There are blood tests you can do to check different immune markers, such as antibodies and complement antigens, but these do not identify all the possible ways your immune system can get riled up in response to foods. For example, these tests don’t measure reactions to high-histamine foods, or high-FODMAP foods, or nightshades.
The tried and true method of identifying food sensitivities is by doing an elimination-provocation diet. This is to systematically eliminate a group of suspected foods for a period of time, then to bring them back in one by one and track your response. But this is hard to do without a concrete plan of which foods to eliminate and for how long, and then exactly how to reintroduce them back in and figure out what any potential reactions mean.
How to do an elimination diet, and who is it for
There are different types of structured elimination diets, and they all share the same principles: first eliminate a targeted group of foods suspected to be problematic, then provoke a potential response by reintroducing the eliminated foods, one by one.
These diets can range in the severity of foods restricted. Below I present four different approaches that I use with my patients, starting with the least severe and moving to the most restricted. The folks I recommend this to are those with these symptoms:
- Headaches including migraine
- Skin conditions like acne and eczema.
- Congestion, mucus, or phlegm in your nose, sinuses, or lungs
- Pain or bloating in your stomach or intestines, loose stools
- Histamine-driven reactions like hives or wheezing
- Brain fog, anxiety, depression, perhaps other neurological conditions
- Joint or muscle pain
- Generalized inflammation
- Any autoimmune process or condition
Certain groups of people should not attempt an elimination diet, mainly because food restriction, even for a limited period of time, could be more risky than helpful. This includes anyone with current or past eating disorders. I also don’t recommend a severe elimination diet for kids and teens, because we don’t know how the process will affect their mental health or views toward food.
Let’s dive into the types of elimination diets that I recommend, starting with the least restrictive.
1. The IFM approach
The Institute for Functional Medicine (IFM) has an elimination-provocation approach that is highly useful for most people. For three weeks you eat a clean, whole-foods, low-allergen diet, and then reintroduce foods from the “avoid” list. Here’s what the elimination part includes and does not include:
This IFM approach is a great start for most folks and it includes easy-to-understand guidelines, meal plans, and recipes. However, for those with significant inflammatory conditions, it may not be enough, as there may be foods in the included category that are actually a problem. For example, there are foods that cross-react with gluten in this category, and nightshades* are a problem for many. That being said, this is still an excellent place to start, especially for:
- People who are relatively healthy, with inflammation but not autoimmunity
- Kids and teens
- Vegetarians and vegans (as protein sources include legumes, nuts and seeds)
- Those who eat a conventional diet that includes fried, processed, and fast foods with a low vegetable intake (“Standard American Diet”)
2. The Whole30 as an elimination-provocation approach
Whole30 is essentially “clean Paleo.” The Paleo part is the elimination of all grains, dairy, and most legumes. The clean part is that you also eliminate added sugars, even natural ones like maple syrup and honey. In addition, you eat foods in whole forms as much as possible, rather than making “Paleo” versions of baked goods and processed foods.
When doing a Whole30 you eat real food: Eat meat, seafood, and eggs; vegetables and fruit; natural fats; and herbs, spices, and seasonings. Eat foods with a simple or recognizable list of ingredients, or no ingredients at all because they’re whole and unprocessed.The Whole30 Program Rules
How is this different than the IFM approach?
- Whole30 includes beef, pork, eggs, ghee, coffee, and tea
- IFM includes all gluten-free grains with the exception of corn, and legumes
I prefer the Whole30 approach for those with autoimmune conditions. I often recommend eliminating eggs as well as ghee from the Whole30 as these can be problematic for autoimmunity.
Whole30 Coach Kirsten Redding and I team up once a year to lead a group through a Whole30 experience with a lot of support, education, and coaching. It’s a great way to do an elimination diet with guidance and community. We encourage whole families to do it together, but kids and teens should be able to do it with flexibility, as this may be too restricted for them mentally.
3. Autoimmune Paleo Protocol (AIP)
AIP is a more restricted version of Whole30, as it also eliminates nuts, seeds, eggs, and nightshades. AIP works very well as a temporary elimination-provocation approach, for 10-30 days, followed by reintroducing foods. It’s a fantastic elimination template for those with autoimmunity, and it’s a step up (more restrictive in the right ways for autoimmunity) from Whole30.
Many people I work with follow the most restricted version of AIP as a long-term diet, and there can be problems with this:
- It’s too restrictive for most people
- People are likely eliminating foods long-term that are fine for them, and food diversity is important
- There could, in theory, be foods on the AIP that a person could be sensitive to
4. The old-school elimination-provocation approach.
Allergists in the 1930s came up with medical elimination diets that consisted of a small group of low allergenic foods. A classic example is white fish, pears, parsnips, turnips, rutabaga, sweet potatoes, yams, celery, zucchini, carrots and peaches. It’s very restrictive but compared to IFM (3 weeks) and Whole30 (30 days), it’s only for 6-10 days before reintroducing foods. This is the one I did that most accurately identified my food intolerances.
For the hard-core, I wrote an ebook guiding you through the steps to this:
Provocation (testing) is the most important part
Many people miss the benefits of the elimination-provocation approaches because they don’t go through the proper steps to reintroduce food. They may do the IFM version, Whole30, or another approach, and feel great, then let the eliminated foods come back in a disorganized fashion.
It’s essential to bring back the foods in a systematic, deliberate manner in which you can pay attention to how you feel when you do this. Interestingly, some reactions are low-grade symptoms you may think are normal, like brain fog, a stuffy nose, or constipation. If you’ve picked the right elimination diet, meaning you actually eliminate your problem foods, then you will feel significantly free of these symptoms within just seven to ten days! When you bring problem foods back in to test, your reaction will be clear.
For all types of elimination approaches, here is my guide to reintroducing or testing foods:
Questions about this topic? Please let me know in the comments below.
*Nightshades – eggplant, potatoes, tobacco, peppers, tomatoes (some folks are very sensitive, the symptom is usually pain, so think any type of chronic pain)