Our diets are complex puzzles. We eat and drink so many different types of things and a lot of the time we have no clue exactly what we’re ingesting. Most people can tolerate a wide variety of foods, but some bodies are a little extra rebellious - causing bloating, cramping and constipation on a regular basis. Due to our diverse diets it can be hard to pinpoint the exact cause of our digestive woes, but that's where the elimination diet comes in. Listen now for more details!
Want to recommend an episode topic? Send me a message on Instagram @nutritionbitespodcast
Credit to MonoSheep for the theme music.
Our diets are complex puzzles. We eat and drink so many different types of things and a lot of the time we have no clue exactly what we’re ingesting. Most people can tolerate a wide variety of foods, but some bodies are a little extra rebellious - causing bloating, cramping and constipation on a regular basis. Due to our diverse diets it can be hard to pinpoint the exact cause of our digestive woes, but that's where the elimination diet comes in. Listen now for more details!
Want to recommend an episode topic? Send me a message on Instagram @nutritionbitespodcast
Credit to MonoSheep for the theme music.
Welcome to Nutrition Bites. The no nonsense podcast where you get the truth about food so you can eat what you want, and be healthy. I’m your host Maggie and welcome to Episode 24 of this series! Today’s topic is a listener recommendation. Which is a good reminder that if you ever have a topic you want covered send me a message on instagram @nutritionbitespodcast. Let’s get to it. On the menu today, elimination diets.
The year 2016 was marked with a lot of world-changing events - the infamous US election, Brexit, and the release of the Lemonade album by Beyonce. This year also marks the moment that I discovered I was lactose intolerant - my own life-changing event. At the time, my work lunch often consisted of a delectable pesto and mozzarella sandwich. And not the crappy, dry, grocery store Mozzarella, I’m talking the fresh, bougie stuff you get from a cheesemonger. It was amazing. But after a whileI came to realize that following every mozzarella lunch break, I experienced massive digestive pain. This happened to coincide with a time where I also regularly ate a lot of ice cream, and would subsequently spend the next few hours struggling with abdominal cramping. Eventually, this ol noggin put two and two together and realized, I may have a problem with dairy. I tested out this theory by experimenting with different levels of milk, yogurt, and cheese, and sure enough, came to the conclusion that I was lactose intolerant. Over the years I’ve tested out my tolerance, figuring out my own individual thresholds. Like, the fact that the cheese on pizza is OK, but creamy alfredo pasta is a no-go. And this kind of food experimentation is what a lot of people go through who experience digestive issues, it’s almost instinctual. But while this investigative process can by DIYd at home, there’s a more scientific method that professionals use to help people - it’s called the elimination diet.
Our diets are complex puzzles. We eat and drink so many different types of things and a lot of the time we have no clue exactly what we’re ingesting. Most people can tolerate a wide variety of foods, but some bodies are a little extra rebellious, causing a lot of grief when encountering a blacklisted ingredient. Since there are so many dietary possibilities to blame for uncomfortable symptoms ranging from bloating to migraines, it can be hard to pinpoint exactly what the cause is. Influences outside of our diet, like stress, can also contribute to the confusion. But for some people, what they eat are grounds for investigation.
The elimination diet is a short-term approach to identifying food intolerances and sensitivities. Although it has the sacrilegious word “diet” in it, it has nothing to do with weight loss, calories, or macronutrient restriction. This is a tool to discover food triggers which may cause a variety of symptoms such as indigestion, bloating, abdominal cramping, bad skin, migraines and joint pain. It’s a temporary process, lasting a few months, where you radically reduce the types of foods you consume in order to identify any items that trigger a negative health symptom. It’s like a real life game of Clue, but more tasty.
An important distinction with the elimination diet is that it’s meant to identify food intolerances and sensitivities, not allergies. An allergy occurs when your body overreacts to a protein, causing a big immune system response. The most common food allergies include: milk, eggs, soy, wheat, tree nuts, peanuts, fish and shellfish. The symptoms often include swelling, difficulty breathing, rashes, hives, and itchiness and they occur almost immediately after exposure. Like when Will Smith’s character in Hitch accidentally eats seafood. Even eating a really tiny amount can cause a potentially life-threatening reaction.
A food intolerance, on the other hand, relates to the difficulty your body has in digesting a type of food, and so the symptoms tend to relate to digestive distress like: bloating, abdominal cramping, and diarrhea. Although less common, a food intolerance can also contribute to other health issues like acne, fatigue, and migraines. Symptoms can show up immediately after eating, or take a few hours or days before appearing. Lactose and gluten are the most common food intolerances. And most people can handle ingesting some level of their trigger, but the scale varies per individual - like a small amount of gluten in soy sauce may be OK but a loaf of ciabatta will cause you to be in the fetal position for the rest of the day.
Sitting in the grey area between intolerances and allergies are “food sensitivities”. This term is not really well defined, nor medically accepted, but it covers the experiences of people who have a small immune reaction to a certain food, but with symptoms closer to those of an intolerance. Things like joint pain, fatigue, rashes and brain fog. The types of things people claim sensitivities to is varied, including a group of vegetables called nightshades. These veggies, which include tomatoes, peppers, eggplant, okra, and white potatoes, contain compounds called alkaloids which are thought to contribute to inflammation and worsen joint pain, especially in people with Rheumatoid Arthritis.
From speaking with friends, it’s clear that as we age we’ve become more in tune with how our bodies function, or don’t function. Somehow, a can of Coke now is considered too sweet when a decade earlier we practically hydrated with the stuff. It’s become increasingly popular to investigate food intolerances and sensitivities because a lot of us are discovering that what we eat and drink has a huge impact on how we feel. And one way to uncover these trigger foods is to undergo an elimination diet. While there’s no standard protocol for this process, all elimination diets have three key phases in common: track, eliminate, and re-introduce.
One skill you need to develop for a successful elimination diet is tracking, that is, writing down every single thing you eat and drink, along with any symptoms you may feel. Tracking is considered the first phase of an elimination diet because it gives you a baseline - the “before” snapshot of what you regularly ingested, and how it made you feel. But, be warned, it may not be as easy as it seems. Specificity is necessary in this process. You can’t just write that you had toast for breakfast, a sandwich for lunch, and stirfry for dinner. You gotta embrace your inner Bill Nye the Science Guy and get real detailed. Document the ingredients, quantity, and the timing of EVERYTHING - including supplements! Same thing when it comes to symptoms. Don’t just say your energy feels “low” today - choose a numerical scale, and rate it. And because this process is most helpful for digestive issues, you gotta take a peak in the toilet too. Get to know yourself a little better you know?
Once you’ve been tracking your regular diet for a few weeks, it’s time to enter the next phase: elimination. Although this may spark memories of video games and South Korean survival dramas, it’s much less exciting. The purpose of the elimination stage is to remove any food, beverage, or ingredient from your diet that is suspected of triggering a health symptom. The common suspects eliminated include items that contain the popular allergens and intolerances, along with other suspects like caffeine, nitrates, and sulfites. Translating this into real foods and beverages, the elimination phase can look like removing any or all of the following: dairy, wheat, barley, rye, corn, soy, beef, processed meats, peanuts, tree nuts, alcohol, coffee, pop, eggs, most condiments, and essentially anything highly processed. If this sounds like everything in your kitchen is now a potential offender, you’re not alone. But, before mario kondo-ing the contents of your fridge, here’s what a list of quote unquote “safe” things to eat during this stage: non-dairy products (like almond milk or coconut yogurt), rice, quinoa, oats (from a gluten-free facility), beans, legumes, chicken, most nuts and seeds, fresh herbs, vegetable oils, herbal teas, and almost all veggies and fruits. An important thing to remember during this phase is that what you do and don’t eliminate should be personalised. This stage usually lasts around 4 to 6 weeks - and you need to be able to stick with it! With a food diary, and the guidance of a health professional, you’ll be able to better identify specific items to restrict, rather than removing everything that could be a potential offender.
After the month of elimination is complete, it’s time for the science experiment: re-introduction. This phase is all about trying to pinpoint exactly which items trigger a health symptom. This, is where all your tracking skills shine. This is your Olympic moment. In this phase Items are reintroduced slowly and one at a time, with the quantity building over a three day period. For example, let’s say a suspected trigger is eggs. You introduce a small amount one day, and if it’s tolerated, double the quantity the next, and again for the third day. As soon as the food triggers a symptom, note it down and remove it. But if all goes well, you may realize that this item is not the cause of your dietary woes, and so you can celebrate by doodling hearts and stars in your food diary, and then get back to business and prepare for the next item. A key thing here is that reintroducing foods and beverages has to be done one item at a time. Even if you end up tolerating eggs, after 3 days you have to remove them from your diet for the remainder of this phase. The length of time the re-introduction stage takes all depends on how many foods or items were eliminated. So it can last anywhere from one week to several weeks.
Once you have tested out all of your potential trigger items, you should have a narrowed down list of foods, ingredients and beverages to either completely avoid, eat occasionally, or consume in small amounts. With this information you can create a new individualized eating plan that addresses the health symptoms you previously experienced. One of the benefits of this entire process is the ability to understand your thresholds for certain foods. For example, if lactose is an identified intolerance, you are now equipped to make an informed choice about if, and when, to make an exception. For example, you may realize that eating ice cream should generally be off limits, but you can handle a small scoop at the beach, without having to pre-plan where the nearest bathroom is.
While the process of the elimination diet is fairly simple on paper, it’s a lot more complex in practice. So if you’re tempted to try this strategy out, here’s a few things to consider before diving in. First, if you feel like you are suffering from a food allergy, please go get tested by an allergist. A homemade elimination diet is not the way to go when anaphylactic shock is on the table. Similarly, if you are suffering from extremely painful digestive issues you may want to go get tested celiac’s or Crohn’s disease.
Second, before trying to lay the blame for your digestive woes on a couple of foods, take a good, honest look at the way you’re eating. If your diet is generally composed of fast food, take out, and highly processed items you could very well be feeling like crap, because you’re eating like crap. I mean no one feels good after eating Taco Bell. So instead of jumping into a lengthy and detailed elimination diet, first try reducing your processed food intake, cooking at home more often, drinking water, and eating whole fruits and vegetables.
Now if you’re still convinced you want to try out the elimination diet, this third piece of advice is incredibly important: hire a trained health professional. Every Skywalker needs an Obi-wan after all. Having professional guidance will help with so many things, such as ensuring you are tracking properly, that your list of eliminated foods is personalized, you are getting adequate nutrition during the elimination phase, your medication use is unaffected, your re-introduction strategy is well planned, and most importantly, that the appropriate food triggers are identified. If you’re on your own, it can be pretty confusing to identify patterns in your food diary. For example, if you notice that dairy causes diarrhea and bad skin, how can you identify that it’s from a casein allergy vs. a lactose intolerance vs. a histamine sensitivity. I know that the American hustler spirit has convinced us to try and do everything on our own, but sometimes you gotta lean into the teamwork. We’re all in this together, wildcats.
The last consideration for elimination diets is to recognize and accept the flaws of this process. It is not a perfect way to identify all your food woes and even with professional help, it can be difficult to tell with absolute certainty which items can trigger a health issue. A lot of other factors, including stress and anxiety, can cause some of the symptoms under investigation. You may also need to go through multiple rounds of this process before you’re able to identify all your trigger foods. And keep in mind that this is not an easy undertaking - you have to be patient and committed to the journey in order to find success. So check yourself, before you stress yourself.
We’ve now covered the ins and outs and pros and cons of the elimination diet. So is it worth it? Well, for someone who is suffering from digestive issues like in Irritable Bowel Syndrome, migraines with no known cause, or autoimmune conditions like Rheumatoid Arthritis, this could very well be a helpful, and cost-effective tool to try and help you feel better. But if you don’t find any regular disturbances to your health from the way you eat, this process may be a bit too extreme and not provide you with much value. Remember, for at least a few months your entire life has to radically change in order to accommodate this strict Sherlock-style investigation. It’s definitely not a one-size-fits-all solution, and there are plenty of people who won’t be suited to undertake this detail-oriented side project. But, with all that said, it’s a free, temporary, tool, with no real health effects, so if your diet is not making you feel great, this is something relatively safe to explore. So, dust off that Sherlock Holmes hat, grab a pen and paper, and start investigating!
That’s been the bite for today. Stay hungry.