Have you heard the term “elimination diet?” Do you suspect that certain foods don’t agree with you, but aren’t sure how to figure out which ones? If so, this post is for you. I am a firm believer in not restricting foods for no valid reason. In the wellness space, you’ll hear theories that certain foods are inherently “bad” for everyone (think gluten, dairy, and lectins). News flash: the only “bad” foods are the ones that are spoiled or rotten. Let’s get away from judging foods for everyone folks.
My mission is to help people figure this stuff out on their own, with tried-and-true methods. I became an expert on this topic – not by choice but by necessity. When I came down with an aggressive form of rheumatoid arthritis at age 33, I proceeded to learn everything possible about how to calm down my immune system so I could stop my crippling joint pain. Cleaning up my gut health, which included identifying food sensitivities, was the #1 factor in getting my RA into remission.
Did you know that the majority of your immune surveillance takes place in your small intestine? This is because this long ” hollow tube” deals with a constant influx of food proteins, microbes, and chemicals to sort out. In Chinese medicine, the small intestine is considered the organ that sorts the pure from the impure. All autoimmune conditions involve the small intestine and its lining, which is meant to be a semi-permeable barrier between what comes in from the external environment and your inner body. Food sensitivities are a sign that your gut immune system is ramped up and your small intestine barrier is extra permeable, or “leaky.”
The story behind food sensitivities
If you have an immediate reaction to a food, such as hives, swelling, or wheezing, it’s likely to be a “true food allergy.” These are mediated by an IgE antibody response and can be tested with a skin prick at an allergist’s office. Most immune reactions to food are not true allergies, rather they are a “sensitivity” (sometimes called intolerance or delayed allergy). Blood tests can detect some of these, but not all.
A food sensitivity means your immune system gets inflamed when exposed to that food. This could cause symptoms in your digestive tract, such as bloating or diarrhea. However, with a leaky gut, food proteins pass through your small intestine lining and cause inflammation in other parts of your body, including your brain (think brain fog). Common symptoms of inflammation from food reactions include:
- 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
If you have symptoms from this list, they may stem from food sensitivities and leaky gut. The best way to figure this out is by doing an elimination-provocation trial.
What is an elimination-provocation trial?
Classicly known as “elimination-provocation” diets, this is a period of time during which you:
- Eliminate: Cut out certain foods
- Provoke: Bring back these foods one at a time to test your response
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. 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
- 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 can eat all vegetables, fruits, nuts, seeds, fresh corn and peas, cashews, coffee and tea, ghee, animal protein like meat and eggs, and seafood.
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.
3. Autoimmune Paleo Protocol (AIP)
AIP is a more restricted version of Whole30, as it also eliminates nuts, seeds, eggs, and nightshades. Many people I work with follow the AIP as a long-term diet, and there are problems with this:
- It’s too restrictive for most people
- People are likely eliminating foods long-term that are fine for them
- There could, in theory, be foods on the AIP that a person could be sensitive to
The 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 a smart way) from Whole30.
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.
I’ts 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. For all types of elimination approaches, here is my guide to reintroducing or testing foods:
*Nightshades – eggplant, potatoes, tobacco, peppers, tomatoes (some folks are very sensitive, the symptom is usually pain, so think any type of chronic pain)