Elimination diets first became popular within the medical community in 1941 when physician Albert Rowe published Elimination Diets and the Patient’s Allergies. They have declined in popularity as blood tests have become available because blood tests require considerably less patient effort. But as our understanding of the complexity food intolerances and allergies has increased, blood tests have not been able keep up. Blood tests can be very useful diagnostic tools, but they are limited. For example, all my blood tests for food allergies have come back saying I was fine eating whatever, but it was only when I tried an elimination diet that I discovered some foods were making me sick. Also compared to the thousands of dollars that food allergy testing can be, the elimination diet costs were just that month’s groceries. Elimination diets are, comparatively speaking, very inexpensive.
An elimination diet is simply a period of time in which you remove certain foods from your diet and then slowly, one at a time, reintroduce those foods after a few weeks or months and monitor your body’s response to those foods.
Not only is an elimination diet inexpensive compared to a lot of blood tests and specialist visits, but it is also, if done properly, really effective. What exactly you choose to eliminate is going to depend, to some degree, on your own physical condition and temperament. For most people, an elimination diet that follows the autoimmune protocol (effective in helping to manage autoimmune conditions such as Arthritis, Eczema, Celiac, MS, Type I Diabetes, Ulcerative Colitis, etc) will be effective in helping identify problem foods. Some conditions are going to need to be mindful of the balance of how much fiber (FODMAPS), or fructose (fruit), or carbohydrates (fruit and starchy veggies) they should be having as well. And often autoimmune conditions take a lot longer than the standard four weeks to show improvement. If you have these sorts of conditions I would highly recommend ThePaleoMom.com and her book The Paleo Approach and cookbook, Diane Sanfilippo’s book Practical Paleo, and Terry Wahl’s book The Wahl’s Protocol. Temperament wise, some people are going to have a harder time eliminating everything at once, and may actually prefer to slowly cut down on one group of foods at a time because the restrictive and rigid rules of an elimination diet are too much (A great resource for that approach is Real Life Paleo by Stacy Toth and Matt MCcarry.) An elimination is a big commitment, one that has the potential to really help you, but will also take some time to research and reflect on your own condition before being embarked upon.
The first question that people had when I explained I was doing an elaborate elimination diet was always, “Amy, what can you eat?” So let’s answer that first, before diving into all the things to eliminate, and then the timing of when to try to add something back: You can eat high quality meat and vegetables cooked with herbs and quality fats for meals. If you’d like, you can have some fresh fruit for desserts. At every meal, eat enough meat so you are mostly, about 2/3, full—eating slowly and chewing thoroughly. Then top yourself off with a variety of green and colorful vegetables.
“Quality meat” is a key here. You want unprocessed meats. When we did our elimination diet we actually only ate lamb, wild game (we ate a lot of pheasant that month), and fish. I think this was, on the whole, unnecessary. I think we (and our wallet) would have had a better time if we had incorporated chicken, beef, and pork into our elimination diet. But you do want to try to eat the highest quality meat you can afford—organic, grass fed, pastured if possible. But if that isn’t possible, just stick to buying meats in which the only ingredient in them is the single meat on the front of the package. (i.e. no deli meats with fillers, no pre-spiced meats). Organic, Pastured and grass-fed meats are not only better for the animals, but they also effect the Omega 3 and 6 balance, the vitamins and minerals available in the meat. It can be expensive, but as much as you can it’s important to vote with our dollars and to eat the most nutritiously dense food.
“Vegetables” should be straightforward, but since there are impostor vegetables (like corn and ketchup), let’s be clear on what precisely a vegetable is. A vegetable is not a grain (like corn), or a legume (like soy), or a night-shade (like tomatoes). A vegetable is usually the whole plant or the edible leaf, steam, or root of a plant. There is some mixed information about whether to eat vegetables cooked or raw. Most people suggest a combination, although some vegetables like spinach are best eaten when cooked. While regular potatoes are out, sweet potatoes are a great option, although we definitely over ate them on our elimination diet, so I’d suggest filling up more on meat and less on sweet potatoes.
Herbs, which add a lot of flavor to your meat and veggies, differ from spices. Herbs are just a subset of vegetables—so they are the leaves, roots, and stems of a plant while spices tend to be the fruit and seeds, often of nightshades. Sarah Ballantyne of ThePaleoMom has a great list of what herbs and spices can and cannot be included, but generally if it’s a leaf (rosemary, basil, thyme, oregano), or a root/bulb (garlic, onion, turmeric, horseradish), or the bark (cinnamon), or part of the flower (clove, chamomile, saffron) then it’s an herb and ok for you to eat.
Cooking and Salad Oils. Refined seeds oils and dairy are out on the elimination diet, so you just want oils from fatty fruits (olives, coconuts, avocados) or meats (rendered lard). Besides being a seed or a legume or a grain, refined highly processed oils, like canola, soybean, rice bran, or safflower seed oil tend to be less stable than extra virgin press oils and go rancid much more easily.
Next, fruit, in moderation. Fruit is a little of a gray area because of the seeds and the sugars. The seeds of plants tend to have the most difficult components for our guts to digest, and grains, legumes, and nuts are all types of seeds that need to be eliminated. Usually seeds in berries are so few that they aren’t a problem, but that is one of the reasons for moderation. Fructose and glucose in fruits are usually hard to over-consume if you are eating fresh fruit that also has a lot of water and fiber, but it is still possible. Some people like to use elimination diets as a sugar detox (like the 21 day sugar detox ), so cutting most out most fruit out may be helpful. Our elimination diet suggested cutting out all apples and citrus (minus lemons and limes). I don’t think this was necessary, but we definitely ate way too much fruit in berry-coconut milk smoothies and would have been better off eating… you guessed it more meat.
How you combine your meat + vegetables + herbs + quality oils + moderate fruit is really up to you. I would recommend not worrying too much about eating breakfast-type foods at breakfast if you can. But ground pork + sage + onions + garlic + spinach + apples makes for a pretty good breakfast that tastes pretty breakfast-like. For lunch, try cooked meat like salmon or chicken over a salad with olive oil and vinaigrette dressing with fresh herbs. For dinner cook up a starchy vegetable, like a sweet potato, a green veggie, like broccoli, and 6 to 8 oz of meat. I would also recommend drinking bone broth, eating organ meats, and eating fermented vegetables like sauerkraut.
Alright, so without any further ado, here is the list of what not to eat, now that you have some ideas of what to eat.
An Auto-Immune Paleo Elimination Diet:
Eliminate: All Grains and Pseudo-Grains for example wheat, corn, rice, oats, barley, rye, quinoa, couscous, etc.
Eliminate: All Egg and Dairy Products for example butter, milk, cheese, whey powder, egg whites, egg yolks etc.
Eliminate: All Nuts, Seeds and Legumes for example peanuts, beans, soy, peas, cashews, pecans, coffee, chocolate, etc.
Eliminate: All Nut and Seed Oils for example canola, peanut, soy, walnut, corn, safflower oils etc.
Eliminate: All Night Shades for example white potatoes, tomatoes, green or spicy peppers, egg plant, spices etc.
Eliminate: All Refined Sugars for example sugar, sugar cane, honey, molasses, maple syrup, agave, stevia, aspartame etc.
Eliminate: All Dyes and Additives for example MSG, food colorings, guar gum, carrageen etc.
Eliminate: All Alcohol and NSAIDS: for example Wine, Beer, Hard Liquor, aspirin, ibuprofen, naproxen etc.
Other items to be aware of are the additives in herbal and black teas and the material the tea bag is made from, and some people experience gluten-cross reactions with tapioca, cassava, and yeast.
Reintroduction
You take everything out for a month, and then slowly every four days or so you can add something back in and see how you feel. It’s really up to you how you want to try and add things back in. I’d suggest if you feel good, especially if it is a dramatic difference to how you felt before you started, try to stay on the strict elimination as long as you possibly can. It will give your body more time to heal. But if you are ready to try to add something back in, I’d suggest you start with the auto-immune add-ons: try egg yolks first from a quality source, then whole eggs, then maybe some night shades or spices (I’d save tomatoes until later though), then some natural sweeteners, then some nuts (but not legumes i.e. peanuts), then perhaps some grass fed butter. Hopefully by the end of the month (and the weeks that it will take to add things back in afterwards), you’ll be an expert on how you feel without certain foods and you’ll be able to notice what is making you feel good or not. You want to pay attention to how tired you feel, how well you sleep, if you have any rashes, any digestive distress, changes in inflammation, or sinus or other kind of headaches.
Resources
Some other good resources for doing a Paleo-style elimination diet are a Whole 30 and PaleoSpirits’ strictly Paleo these isn’t auto-immune, but they’re otherwise excellent, resources for figuring out what exactly is and isn’t allowed on the Autoimmune Protocol are Sarah Ballantyne’s ThePaleoMom.com and Mickey Trescott’s Autoimmune-Paleo.com and cookbook.
Doing an elimination diet is without a doubt one of the best things I have ever done. It was difficult, but I can think of few things that have had more of a positive impact on my day to day health and well being.
Have you tried an elimination diet? What are your suggestions?
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