Elimination diets

First, a note about elimination diets:

Elimination diets are HARD- physically, emotionally, mentally- especially if you are nursing a baby. They should ONLY be done under the supervision of a health care provider. If you feel at any point during the diet that your health is being compromised, STOP IMMEDIATELY! Your health is most important- without that, you have no chance of helping your baby/child get better.

That said, elimination diets are the cheapest and most reliable way to test for food intolerances. (If you suspect IgE/anaphylactic allergies, you should never trial a suspected 'bad' food without a doctor.) The point of the ED is to get yourself (or your babe) to "baseline", meaning they are having no reactions. At that point, you can start reintroducing foods into the diet, or 'trialing' foods. If you are breastfeeding, you must be on the same ED as your babe.

If you are breastfeeding and watching for signs of allergy in your baby- in our experience, symptoms would start within 3-6 hours, but wouldn't become really noticeable until about 12 hours after DD nursed (when I ate something bad). I've heard stories of reactions starting anywhere from 15 minutes to 4 days later though, so don't be fooled if your baby doesn't react immediately. For this very reason- when you are 'trialing' foods (adding foods back into your diet after you reach baseline), you should only do one food at a time, and no more than one new food per week.

Couple things to remember:

• DON'T CHEAT!! - This will completely start over your timeline for clearing the foods from your system. When someone says, "Oh, I'm sure a little won't hurt" don't believe them! A little is all it takes to start you over from scratch.
• WATCH FOR HIDDEN INGREDIENTS!! - check the Hidden Ingredients link to see some common terms for hidden igredients. READ LABELS. Even if it's a product that you buy every week, read the label each time you buy it. Very often, manufacturers change their ingredients or their processes.
• WATCH FOR CROSS-CONTAMINATION - many foods are made in "shared facilities" or "on shared equipment" with dairy, soy, wheat, etc. If you avoiding one of those foods, make sure your 'safe' food isn't contaminated with it.
• Easiest way to avoid this is to avoid all packaged/processed foods. Make all your food at home, from fresh, organic ingredients. Yes, it is very time consuming and sometimes frustrating, but it's worth it.
• KEEP A FOOD JOURNAL! - Perhaps the most important rule of the ED. It will help you look back at your diet and see patterns with symptoms. Write down everything that you eat, and any symptoms you observe.
  

Some helpful hints for an ED:

• Make a special place for your food- one shelf in the pantry, one shelf in the fridge, etc. That way, you won't accidentally grab a food that's not on the diet.
• Make food ahead! Especially on a TED, you will be hungry. It's nice to have food prepared so that you don't have to cook every time you want to eat.
• On the same note, have snacks available. If you can only have pears (for fruit), make sure to keep your house stocked.

Taking out one or two foods

This is the easiest form of an elimination diet, although it's rarely the most efficient.

In this form of the diet, you want to cut out one or two foods that you suspect are bad. Most common allergies for babies are milk and soy, so those are often the first choice to eliminate for a breastfeeding mom.

Dairy can take weeks to completely leave your (and your babe's) system, so don't give up hope if the symptoms don't disappear immediately. But normally, if this food is a problem, you should at least start to see an improvement in symptoms within the first week. If you don't see improvements, it does not necessarily mean that your baby isn't allergic... it could simply mean that he/she is allergic to more than this one food you eliminated.

IF your babe is only allergic to the one or two foods that you have eliminated, then you are done. Quite often though, the babe is allergic to more than the one or two foods you eliminated, which makes diagnosing them much more difficult with this diet. You will have to continue taking out food after food after food to try and figure out which ones are bad.

This diet did not work for us, although it was a good starting point. I saw results within the first few days after cutting dairy. And then the symptoms returned and got worse when I subsequently increased my consumption of soy and eggs.

ED - Elimination diet

In an elimination diet, you will be eliminating all common allergens to see if symptoms improve. There are many forms of an elimination diet (check some of the books I listed in the Books link).
A common elimination diet for food allergies might eliminate:

• the top 8 allergens - milk, soy, eggs, peanuts, tree nuts, fish, shellfish, wheat (I recommend cutting gluten altogether)
• corn - this is not in the top 8, but because this government subsidized crop has made it's way into almost every processed food and is inadvertently consumed daily by many Americans, it is quickly becoming a common allergen
  
• nightshade vegetables - potatoes, tomatoes, eggplant, peppers (hot and sweet)
• nightshades are a common source of inflammation in the body, so although they might not be causing an allergic reaction, they can add to the reaction from other foods
• refined sugars - can worsen a yeast problem and/or feed bad bacteria in your gut
  
• food dyes and preservatives - these are common sources of allergy problems in children
  

An ED is for SHORT-TERM USE ONLY. Most practitioners recommend doing an ED for about 10 days. If there is no improvement of symptoms, you should return to eating normally. If you do see an improvement, you can start the trialing period of the diet.

Trialing foods - Again, if you suspect an IgE/anaphylactic allergy, DO NOT DO THIS AT HOME. Trials should only be done in a doctor's office. For food intolerances, you can trial a food by eating it for 4 days (at least 1-2 servings a day) and watching for symptoms. If, at the end of 4 days, you don't notice any new symptoms, you can assume that food is 'safe' and add it to your diet. Keep trialing foods until you are back to a sufficient, healthy diet.

TED - Total elimination diet

This is the most restricted form of an ED, and like the ED it should not be done for more than about 10 days or it can lead to severe nutritional depletion of you and/or your child.

In this form of an ED, you are basically starting from the bottom and working your way up. You would start with around 5 foods, usually the least allergenic in each food group, like:

• turkey
• rice
• zucchini/squash
  
• olive or safflower oil
• sea salt

Same as the ED- if symptoms improve, start trialing foods to add back to your diet. If you DON'T see a complete recovery from symptoms, don't be discouraged. There is always a possibility that you or your child is actually allergic to one of the foods on your TED. DD ended up being allergic to both pears and yellow squash, so the TED did not work for me until I started switching the foods around.

Trialing foods

If you are doing an ED or TED, you want to start trialing foods once you reach baseline. This means adding foods back into your diet to see if they are the allergy triggers. When trialing, you should never introduce more than one food at a time. (Trust me... it makes it very confusing when you have a reaction. I had to completely start over on the TED a few times because of this mistake.) Most sources recommend eating at least one full serving of the food for 4 days. Obviously, if you see a reaction on the first day, stop eating the food. If you see no reactions after your 4 day trial, you can assume the food is safe and add it back into your diet.

If you find a 'bad' food - some allergists might want you to trial the food again in a few weeks or a few months. BUT, in my opinion, and in much of the literature that I've read- you really want your body (or your baby's body) to complete heal and let all those antibodies die down. Don't rush to reintroduce foods, no matter how bad you want to eat them again. :) For babies showing a reaction, I recommend waiting at least one year to trial a 'bad' food. The longer you wait, the better chance they have of outgrowing the allergy. (This point is somewhat controversial. There have been research studies done that show that complete avoidance of triggers is the best way to outgrow an allergy, and there have been studies done that show continuous small exposures is the way to go. Either way, I think it's best if the food is initially removed for a period of 6-12 months before trialing or starting small exposures.)

**If you suspect an IgE/anaphylactic allergy to a food, do NOT trial it at home. Trialing of IgE allergens should only be done at a doctor's office!!! I can't stress that enough. Anaphylactic reactions can happen in a matter of minutes- it could be life-threatening before you have time to give Benadryl, an EpiPen, or take your child to the hospital.