Food allergies are common all over the world. A study published in Social Science and Medicine in 2008 indicated that about 2-20% of the global population is sensitive to certain foods and experiences symptoms on the consumption of such foods, without realising what they’re going through. Suffering from long-term food allergies can cause metabolic syndrome and digestive disorders, which in turn can lead to chronic health issues like irritable bowel syndrome, inflammatory bowel disease, wheat allergy or celiac disease

To diagnose and treat these allergies right at the beginning, dieticians and allergy specialists recommend elimination diets to figure out exactly which foods from your diet are causing the allergy. Elimination diets are the standard tests doctors use to identify all types of food intolerances, sensitivities and allergies that are triggered by food items you may have included in your regular diet. 

It is important to remember that elimination diets are used to identify the sources of allergies and are therefore short-term diets. These elimination diets are not long-term prescriptions for weight loss or any other aspect of health and should only be undertaken under the strict guidance of a trained nutritionist, gastroenterologist or similarly specialised medical professional. Here’s everything you need to know about elimination diets.

(Read more: Common weight loss mistakes)

  1. What is an elimination diet?
  2. How does an elimination diet work?
  3. Foods to avoid during an elimination diet
  4. Foods allowed in an elimination diet
  5. Who should try an elimination diet?
  6. Benefits of an elimination diet
  7. Risks of following an elimination diet
  8. Doctors for Elimination diet for allergies: Benefits and Risks

When you eat or drink anything, your body synthesizes the food or breaks it down to supply energy and nutrients to every single cell in the body. But if your system is sensitive to certain foods, it can react and let you know about the sensitivity by triggering symptoms like skin rashes, headaches, joint pains, nausea and vomiting and digestive symptoms like bloating, gas and diarrhea. In extreme cases, these allergic reactions can lead to anaphylaxis, which can turn fatal if not tended to immediately.

An elimination diet is one that helps discover such symptom-triggering foods so that you can avoid them in the future. It’s important to remember that an elimination diet takes time, usually about four to eight weeks. Once the source of your allergy is identified, you have to take immense care to avoid its consumption. 

Over the decades, experts have tailored many types of elimination diets based on the kind of and degree of allergy you’re suspected of having. The most basic and popular type of elimination diet involves a period of elimination, where all possible allergy-triggering foods are removed from the diet, and a period of reintroduction where foods are brought back into your diet in stages. There are many other types of elimination diets that may be used as per your individual needs and doctors’ recommendations. The following are some such types of elimination diets:

  • Low FODMAPs diet to eliminate short-chain carbohydrates 
  • Lactose elimination diet for lactose intolerance
  • Wheat and gluten-free diets for wheat and gluten sensitivity
  • Seafood elimination diets to examine if there is a sensitivity or allergy of shellfish
  • Rare foods elimination diet
  • Fasting elimination diet where you drink only water for five days and then gradually reintroduce food groups. This is the most severe type of elimination diet and must be done under the continuous surveillance of a doctor as it can be very dangerous for your health.

(Read more: Is it safe to eat fish during pregnancy?)

An elimination diet has two phases, the elimination phase and the reintroduction phase. Strictly adhering to these phases and their guidelines can help you identify the source of your allergy. 

  • The elimination phase: This phase involves the removal of all possible culprits behind your allergy and usually lasts for two-three weeks as per your doctor’s recommendations. Foods which might be responsible for your symptoms in particular, as well as the most common allergenic foods, are eliminated from your diet during the elimination round.
  • The reintroduction phase: This phase can last longer than the elimination phase, depending on how many foods you eliminated during the first phase. The eliminated foods are reintroduced into your diet one by one - and at a gap of two-three days - to see if the allergy symptoms reappear. If the symptoms don’t appear, you can continue to consume them. If they do appear, you should immediately eliminate this food from your diet. In some cases, carrying anti-allergic medications or injections is also recommended to people with severe allergies in case of an emergency due to accidental consumption.

The following are some of the most common foods to remove during the elimination phase of an elimination diet:

  • All nuts and seeds
  • All citrus fruits like oranges, lemons, etc
  • All nightshade vegetables like eggplant, tomatoes, capsicum, etc
  • All legumes, beans, lentils and soy products
  • All starchy or gluten-ridden grains like barley, wheat, corn, etc
  • Processed meat, red meat, chicken, fish, eggs and seafood
  • All dairy products
  • All fats
  • All caffeinated and alcoholic beverages
  • All sugars and sweeteners
  • All dried spices and condiments

If this list seems alarming, it’s because the elimination diet is rigorous and needs to be foolproof for the sake of your safety. It’s very important to remember that eliminating all these foods for at least two weeks as per this diet can lead to severe nutritional deficiencies. This is why an elimination diet should be tried under the guidance and supervision of a healthcare professional.

While the long list of foods you must avoid during an elimination diet might make you think that you will have to go hungry for a few days, the fact is that you can continue to eat a number of foods. The following are all the foods you can eat while on an elimination diet:

  • Gluten-free grains like amaranth, buckwheat and millets
  • Non-citrus fruits
  • Other vegetables than nightshade
  • Dairy substitutes like rice milk and coconut milk but not nut milk
  • Cold-pressed oils without any adulteration, like olive oil and coconut oil
  • Water, herbal tea, green tea
  • Fresh herbs and whole spices

An elimination diet is not a weight loss diet. It should not be confused with a diet that can help you lose weight. In fact, an elimination diet is not even a balanced diet since it does not include the most nutrient-dense foods from all essential categories. This is why not everyone should try an elimination diet or use it for a long period of time. Studies also suggest that people with eating disorders should not be prescribed an elimination diet under any circumstances.

The only people who should give an elimination diet a try are those who have been recommended to do so by a doctor or nutritionist. Even when you do try this diet, it should be done with the constant guidance of a medical professional and must not exceed the duration recommended by the doctor. The following are groups of people who may benefit from an elimination diet:

By identifying the sources of inflammation and allergic reactions, an elimination diet can help you cut off these foods that are ultimately harming you. While this is the primary benefit of an elimination diet, some studies even suggest that this diet can help those with attention deficit hyperactivity disorder (ADHD) and chronic migraines cope with their symptoms better. Those who suffer from IBD, IBS, GERD and other metabolic or digestive disorders can benefit immensely from elimination diets and so can those with gluten intolerance, wheat sensitivities and lactose intolerance.

An elimination diet must be adopted by a person with the recommendation and proper guidance of a nutritionist or doctor. This is also important because elimination diets come with a number of associated risks:

  • An elimination diet should not be done for more than four to eight weeks as this can lead to serious nutritional deficiencies and health issues.
  • If you have severe allergies then an elimination diet should be done in phases as it can lead to anaphylactic shock if not done properly.
  • Children should only be recommended an elimination diet when absolutely necessary as even a few weeks of this diet can stunt their growth or cause aversion to other foods.
  • People with eating disorders should not be prescribed an elimination diet as this can exacerbate their disorder and make their health condition much worse.
Dt. Akanksha Mishra

Dt. Akanksha Mishra

Nutritionist
8 Years of Experience

Surbhi Singh

Surbhi Singh

Nutritionist
22 Years of Experience

Dr. Avtar Singh Kochar

Dr. Avtar Singh Kochar

Nutritionist
20 Years of Experience

Dr. priyamwada

Dr. priyamwada

Nutritionist
7 Years of Experience

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References

  1. Meyer, Rosen. et al. The impact of the elimination diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies. Clin Transl Allergy. 2016; 6: 25. PMID: 27418957
  2. Nelson, Mia and Ogden, Jane. An exploration of food intolerance in the primary care setting: the general practitioner's experience. Soc Sci Med . 2008 Sep;67(6):1038-45. PMID: 18584930
  3. Reed, Craig C. et al. Food Elimination Diets are Effective for Long-term Treatment of Adults with Eosinophilic Oesophagitis. Aliment Pharmacol Ther. 2017 Nov; 46(9): 836–844. PMID: 28877359
  4. Lim, Hee-Sook. et al. Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease. Clin Nutr Res. 2018 Jan; 7(1): 48–55. PMID: 29423389
  5. Chey, William D. Elimination Diets for Irritable Bowel Syndrome: Approaching the End of the Beginning. Am J Gastroenterol . 2019 Feb;114(2). PMID: 30676371
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