Discovering your food sensitivities: how to do an elimination diet

1. Discovering your food sensitivities:how to do an elimination diet

2. Food allergies vs sensitivities • An allergy involves the immune mediated reaction between an ‘antigen’ (usually a protein molecule) and an IgE antibody • Allergic symptoms include: hives, watery eyes, sneezing, nasal congestion, skin rashes, swelling of the lips or tongue, trouble breathing, anaphylaxis (rare) • Mild allergic symptoms can be alleviated with antihistamines (e.g. Benadryl)

3. A food sensitivity or intolerance • Does not involve IgE antibodies and is not able to be tested for with skin prick testing • May involve IgG antibodies but blood testing is unreliable • Never life threatening • Reactions may include: skin rashes (e.g. eczema), bloating/gas/diarrhea, nasal congestion, headaches, burning eyes, fatigue, joint pain

4. Common food sensitivities • Dairy products • Wheat/gluten • Soy • Eggs • Shellfish/fish • Citrus fruits/grapes • Corn • Tree nuts • “Nightshade vegetables” potatoes, peppers, tomatoes, eggplant

5. The ‘gold standard’ An elimination diet is considered the gold standard for detecting food sensitivities

6. Planning an elimination diet • Plan to do your elimination diet over a time when you will be mainly eating your meals at home. • Avoid doing an elimination diet over a holiday seasons or while traveling • You will need around 2 months to complete phase I and II of the diet

7. Phase 1

8. Fruits Peaches, apricots, bananas, pears, cherries, blueberries, raspberries, kiwi, pineapple, papaya, watermelon, etc Allowed Avoid Grapes and all citrus fruits, such as oranges, grapefruits, limes, lemons, tangerines

9. Vegetables Yellow beans, squash, carrots, peas, onions, garlic, broccoli, kale, cabbage, beets, Swiss chard, spinach, lettuce, cucumbers, sweet potatoes, etc Allowed Avoid Corn, mushrooms, tomatoes, peppers, eggplant, potatoes

10. Grains All breads, cereals, noodles, or whole grains that do not contain gluten or corn, for example, rice, buckwheat, millet, tapioca, quinoa, wild rice. Allowed Avoid Corn, oats and all gluten containing grains, such as, wheat, rye, barley, spelt, kamut, triticale, cous cous, egg noodles

11. Legumes/nuts/seeds All dried beans other than soybeans (garbanzo beans, black beans pinto beans, kidney beans, etc). Sunflower, sesame, flax, chia, hemp and pumpkin seeds. Coconut. Allowed Avoid Soybeans, tofu, soymilk, soy nuts and all soy products. Tree nuts: walnuts, almonds, cashews, pecans, macadamia nuts, pistachios, peanuts, etc

12. Alternate list: Legumes/nuts/seeds Vegetarians only: All dried beans other than soybeans (garbanzo beans, black beans pinto beans, kidney beans, etc). Coconut, pine nuts, flax. Allowed Avoid Soybeans, tofu, soymilk, soy nuts and all soy products. Sesame, pumpkin and sunflower seeds. Tree nuts: walnuts, almonds, cashews, pecans, macadamia nuts, pistachios, peanuts, etc

13. Meat/fish/eggs All fresh or frozen fish (plain, unbreaded), such as salmon, sole, trout or halibut. Chicken, turkey and lamb are also allowed. Allowed Avoid Shellfish, eggs, beef, pork, processed meats (eg. salami, sausages, ham, bacon)

14. Dairy Rice milk. (No dairy or soy) Allowed Avoid Milk, cheese, ice cream, yogurt, sour cream, butter, casein, whey

15. Fats Olive, canola, sesame oil. Non-hydrogenated margarine (with no soy and no dairy ingredients) Allowed Avoid Butter, most margarines, oils made from tree nuts (eg almond oil), hydrogenated fats

16. Beverages Water, tea, coffee, herbal teas, fruit or vegetable juices from allowed foods Allowed Avoid Citrus juices, milk, soy milk

17. Spices/condiments Salt, black pepper, cinnamon, cumin, dill, ginger, garlic, oregano, parsley, rosemary, thyme, turmeric, cardamom Allowed Avoid Choose gluten free condiments. Avoid cayenne, paprika, chili powder and other peppers. Soy sauce. Ketchup.

18. Sweeteners Honey, maple syrup, brown rice syrup, agave, blackstrap molasses, dried fruit Allowed Avoid Corn syrup, wheat/gluten, soy or dairy containing sweeteners, cocoa, chocolate, white sugar

19. A few other things to avoid Food additives/coloring agents MSG (monosodium glutamate), food coloring, BHA, BHT, sulfites, artificial flavoring, nitrites, etc

20. Before you begin…

21. Stock up (read labels carefully!) • Gluten free (GF) bread (make sure it is also free of corn, eggs, dairy, etc.) GF bread is best toasted. • Gluten free breakfast cereals • Rice pasta • Gluten free flours: rice, tapioca, buckwheat, quinoa, amaranth, teff, sorghum • GF cooked breakfast cereals: cracked rice, quinoa, millet

22. More good things to have around • Pumpkin seed butter and/or sesame tahini • Rice milk • Rice crackers • Sunflower, sesame, flax, hemp seeds • Lots of the allowed fruits and vegetables • Extra virgin olive oil • Fresh herbs and spices: basil, oregano, garlic, ginger, etc

23. Phase 1 • For 3-4 weeks, completely eliminate all of the ‘avoid’ foods • Keep a diary- write a short note about how you are feeling each day • In general, avoid restaurant meals, sauces, canned soups and pre-packaged foods, as these tend to contain ingredients that may be on the avoid list. • In order to obtain accurate information, you must completely, 100%, eliminate all the avoid foods.

24. Phase 2 • After the initial three weeks, you will begin to reintroduce foods on the avoid list into your diet. • Choose one food at a time to reintroduce. Eat this food freely for two days, along with all the allowed foods you have already been eating. • Continue writing a daily entry in your diary

25. Phase 2 • After two days of adding in a new food, you will either notice no change, or you will notice new symptoms. • For instance, you may notice that you are congested, clearing your throat, coughing or sneezing. You may have abdominal cramps, bloating, diarrhea or gas. You may develop a headache or have joint pains. You may feel just generally unwell and fatigued.

26. Phase 2 • If the new food does NOT cause unwelcome symptoms, add it into your diet and go on to add the next new food the following day. • If the new food does causes unwelcome symptoms, remove it again from your diet, wait two days, and then add the next new food.

27. Some foods/food groups can be added back in together • Dairy products may be introduced all at once • Various kinds of peppers may be introduced together • Different types of potatoes may be introduced together

28. Sample meal ideas: breakfast • 1. Cooked cracked brown rice cereal with molasses, mixed berries, herbal tea • 2. Cooked quinoa porridge with dried cranberries and sliced banana, pineapple juice, herbal tea • 3. 2 slices toasted rice bread with sesame or pumpkin seed butter and “fruit only” jam, kiwi and apple fruit salad, herbal tea

29. Sample meal ideas: lunch • 1. Home made vegetable soup, 2 slices toasted rice bread, salmon salad (olive oil and rice vinegar dressing) with sugar snap peas, green onion, lettuce, cucumber and avocado • 2. Lentil soup or carrot ginger soup, sliced roast chicken sandwich on toasted rice bread with spinach, avocado and cucumber, carrot and celery sticks

30. Sample meal ideas: supper • 1. Lamb chops, brown basmati rice, steamed broccoli, baked sweet potato, rooibos tea • 2. Roast chicken, rice pilaf with brown rice, wild rice, sesame and sunflower seeds; baked winter squash, vegetable medley of steamed peas, collard greens, carrots; hot apple cider • 3. Grilled halibut, rice noodles tossed with olive oil, basil and oregano; asparagus, green beans and baby carrots, herbal tea

31. Snacks • Allowed fruits and vegetables • ½ avocado • Apple, banana • Carrots, celery, snap peas • Rice crackers (read ingredients!) • Cookies/muffins made with allowed ingredients

32. What about supplements? • Keep it simple (e.g. calcium and vitamin D) • Ensure that the supplements you are taking are free of all of the avoid foods/additives

33. When you are unsure • If you are not sure about whether or not you reacted to a certain food, wait a week or two and try re-introducing it again. • Prepare for the fact that some of your favorite foods may make you feel unwell

34. What to do next… • If some of your favorite foods make you feel unwell, don’t despair! Sometimes, the food can be successfully reintroduced into the diet after completely avoiding it for 3-6 months. It may then be possible to eat the food occasionally, in small quantities, without any significant symptoms.

35. Milk sugar vs milk protein • If you discover dairy products bother you, it is possible that taking Lactaid tablets or drops along with milk products may help you. Lactaid will help you to digest milk sugar (lactose). • If you have a problem with milk protein (casein), lactaid will not help you.

36. Gluten intolerance and celiac disease • If you discover that gluten containing grains make you feel unwell, you should be screened for celiac disease (a blood test). This test will need to be done after you have been eating gluten containing grains again for several months. • Or, you could arrange to be screened for celiac disease prior to doing the diet. • NOTE: Some people feel better on a gluten free diet even if they do not have celiac disease

37. You can choose • Doing an elimination diet can give you some very valuable information • It is up to you how to make use of the information • You may decide to continue to eat certain foods, on some occasions, knowing that you may ‘pay a price’ • Or you may develop some new favorites that seem to suit your body

38. Good luck!