Elimination Diets
(cont') - By Tish Richardson PhD.
- So, unfortunately, identifying a problem food is not as simple as just looking
up your symptoms on a chart, finding the associated problem food and avoiding
it. Certainly some foods are more likely to be associated with a specific
symptom or range of symptoms, but 2 (or more) totally different foods can
produce identical symptoms in different individuals. Migraine is
a good example—chocolate may precipitate a migraine in one person, cheese in
another and oranges in third—the reaction, a migraine, is the same, but the food
triggers clearly differ.
- Where more than one food is a problem. In this example, failure to
eliminate all the problem foods simultaneously may result in no significant
improvement in symptoms—and lead to a misdiagnosis that diet is not an
underlying factor in the presenting health problem.
- The part or fraction of the food causing the reaction. Milk sensitivity
is a good example—where one of the milk proteins, such as casein, or the
milk sugar, lactose, may be the problem. In this case, dairy as a ‘whole’
food may have been rigorously excluded from the diet, while the problem
component may unknowingly be being eaten regularly as an additive in one or
more commercially prepared products. For example, casein is commonly found
in products such as beverage whiteners (often misleadingly labelled as
‘non-dairy’), coconut milk powders, margarines, etc., while lactose is added
to many tablets as a binder or ‘glue’. Eaten in adequate quantities, these
products can result in a reaction on a so-called ‘dairy-free’ diet.
- The amount of food consumed. Some people can tolerate a small amount of
a problem food, but react after consuming large amounts or additional
amounts at subsequent meals—so confusingly these people do not appear to
react every time they eat a certain food.
- The time to onset of the reaction to a food. Where the reaction does not
occur immediately but is delayed by up to 24 hours—so a food eaten at the
most recent meal may appear to be the problem, while in fact the reaction is
a delayed reaction to a food eaten earlier in the day or even the day
before.
- Other factors which can influence someone’s sensitivity or tolerance to
a specific food can be as diverse as:
◦
the way
in which a food is prepared and cooked, since this can alter its chemistry
and, hence, its reactivity;
◦ the
presence of a viral infection or other illness;
◦
the level
of airborne allergens such as pollens, which may result in a form of cross-
reactivity to components in a food;
◦ psychological factors can also affect the results, for example, where
someone
reacts as a result of expecting to rather
than actually reacting to the food.
Taking all of the above into account, besides fasting which is an extreme
means of eliminating food, there are two levels of elimination diet that can be
used. The first is the simpler approach where the food (or foods) suspected of
causing the reactions is eliminated from the diet. In this case, if the
symptoms do not improve, it could be that not all the problem foods have been
eliminated or that food is not the cause of the problem. In either case, a
stricter or full elimination diet may be required to correctly determine any
food involvement.
In a full elimination diet, only foods which are the least likely to be the
cause of the reaction are used as the base of the initial phase of the diet.
Often, this means that the base diet is very restricted, typically including
only 4 or 5 different foods. This type of diet can be very monotonous and
bland—a strict diary of what is eaten when and of any symptoms must be
maintained. If the symptoms do not disappear soon after starting on this very
basic diet, it is unlikely that food is causing the symptoms, and the return to
a normal diet is usual while other medical investigations are carried out to find the
cause of the problem.
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