Elimination Diets- Who Should Follow Them
I think we all know someone who claims following a gluten free diet increased their quality of life; a work colleague who feels more energized on the Atkins Diet, by minimizing the consumption of carbohydrates; or my personal favorite when fitness bloggers say how great they feel after removing toxins from the diet during a cleanse. Every single one of you has a different gastrointestinal (GI) tract and can tolerate different foods. Therefore, no one food will fix every persons problems. Elimination diets are beneficial in individuals who are experiencing chronic GI distress and are suffering from very unpleasant symptoms such as diarrhea, bloating, or constipation. In some individuals, the removal of a certain food can be very beneficial in removing gastrointestinal distress. However, the majority of the population lives symptom free and elimination diets are not necessary for improving their health. If you are unsure what specific foods are causing your symptoms to arise, a temporary elimination diet might be what you need to take control over your dietary practices.
An elimination diet is a short term eating plan where you eliminate certain “suspect” foods, that may be causing an allergic reaction or other unpleasant digestive reaction, for 4 to 12 weeks. It is critical that you keep a food and symptom diary during the elimination phase to be able to pin point exactly how you feel before and after you consume various foods. After a minimum of 4 weeks, you can start reintroducing the “suspect” foods, one at a time, to determine which foods are, or are not, well-tolerated. During the reintroduction phase, you should continue maintaining your food and symptom diary to provide a detailed look into how your body digests, and tolerates, certain foods. If you experience unpleasant symptoms after the consumption of a certain food, you should remove it from the diet. 1
Food and Symptom Diary
So, what are considered suspect foods that should be removed during an elimination diet? It is recommended to eliminate the top 8 allergens: milk, egg, wheat, fish, shellfish, soybeans, peanuts, and tree nuts. As stated above, once these foods have been avoided from the diet, add them back in one-by-one each week to see which foods are trigger foods.1
What’s the big deal about the FODMAP diet? Consuming low amounts of Fermentable oligo-, di-, monosaccharides and polyols (FODMAP) has been found to decrease symptoms in 50-86% of patients presenting with irritable bowel disease.2 The FODMAP diet follows a similar pattern to an elimination diet as stated above. Recommendations include limiting the amount of high FODMAP foods including 3:
Fructose– fruits, honey, high fructose corn syrup, etc
Lactose– Dairy products, such as milk, ice cream, and soft cheeses
Oligosaccharides (Fructans or Galactans)- wheat, onion, garlic, beans, lentils, legumes, soy
Polyols- Sorbitol, Mannitol (sugars ending in- ol), avocado, appricots, cherries, nectarines, peaches plums
Ok, I know… that’s super restrictive..! If you are serious about relieving your IBS symptoms adding these foods back into your diet, slowly over time, and maintaining a detailed food and symptom log will help you regain control over your body and feel empowered about knowing which foods cause distress. Individuals who are not presenting with IBS do not need to follow a low FODMAP diet, if the elemental diet, that was first discussed, is successful.
Elimination diets aren’t for everyone, and should only be considered in individuals who have chronic GI distress or IBS. As with anything, if your symptoms are uncontrollable or you feel like you are in over your head, I highly recommend working with a Registered Dietitian. He or she will be able to address your concerns or perceptions, and go over your food and symptom diary to assist you in reducing symptoms and regaining control.
Feel free to comment below on nutrition or wellness questions you would like answered.
Until next week.
- K. Mahan SE-S, J. Raymond. Krause’s Food and the Nutrition Care Process. Vol 13. 2012.
- Hill P, Muir JG, Gibson PR. Controversies and Recent Developments of the Low-FODMAP Diet. Gastroenterology & Hepatology. 2017;13(1):36-45.
- Gibson PR, Shepherd SJ: Evidence-based dietary management of functional gastrointestinal symptoms: the FODMAP approach, J Gastroenterol Hepatol. 25:252, 2010.