Purpose: To identify hidden food sensitivities that may be causing some or all of your symptoms. During the elimination period, all common allergens are completely eliminated from the diet for two to three weeks. After your symptoms improve, foods are added back one at a time to determine which foods provoke symptoms.
FOODS YOU MUST AVOID:
DAIRY PRODCUTS – any food that contains milk, cheese, butter, yogurt, sour cream, cottage cheese, whey, casein, sodium caseinate, and calcium caseinate.
WHEAT – most breads, spaghetti, noodles, pasta, most flour, baked goods, durum semolina, farina, and many gravies, etc.
CORN – including any product with corn oil, vegetable oil from an unspecified source, corn syrup, corn sweetener, dextrose, glucose, corn chips, tortillas, popcorn.
EGGS – avoid whites and yolks, and any product containing eggs.
CITRUS FRUITS – oranges, grapefruits, lemons, limes, tangerines, and food containing citrus.
COFFEE, TEA, ALCOHOL – must avoid both caffeinated and decaffeinated coffee, as well as standard (such as Lipton) and decaffeinated tea. Herb teas are okay, except those containing citrus.
REFINED SUGARS – including table sugar and any foods that contain it such as candy, soda, pies, cake, cookies, etc. Other names for sugar include sucrose, glucose, dextrose, corn syrup, corn sweetener, fructose, maltose, and levulose. These must all be avoided. Some patients will be allowed 1-3 teaspoons per day of pure, unprocessed honey, maple syrup or barley malt. This will be decided on an individual’s basis. Those restricted from all sugars should not eat dried fruit. Others may eat unsulphured (organically) grown dried fruits sparingly.
HONEY, MAPLE OR BARLEY SYRUP (1-3 teaspoons per day) – Allowed ( ) Not Allowed ( ) (depending on suspected sensitivity to refined sugar).
FOOD ADDITIVES – including artificial colors, flavors, preservatives, texturing agents, artificial sweeteners, etc. Most diet sodas and other dietetic foods contain artificial ingredients and must be avoided. Grapes, prunes, and raisins that are not organically grown contain sulfites and must be avoided.
ANY OTHER FOOD YOU EAT MORE THAN 3 TIMES A WEEK – Any food you are now eating 3 times a week or more should be avoided and tested later.
KNOWN SENSITIVITIES– Avoid any food you know you are sensitive to, even if it is allowed on the diet.
TAP WATER (includes cooking water) – Allowed ( ) Not Allowed ( ) (tap water is eliminated in cases where more extreme sensitivity is suspected). If tap water is not allowed, use spring or distilled water bottled in glass or heavy plastic. Water bottled in soft (collapsible) plastic containers tends to leach plastic into the water. Some water filtration systems do not take out all potential allergens. Take your water with you, including to work or restaurants.
READ LABELS! Hidden allergens are frequently found in packaged foods. “Flour” usually means wheat; “vegetable oil” may mean corn oil; and casein and whey are diary products. Make sure your vitamins are free of wheat, corn, sugar, citrus, yeast, and artificial colorings. Vary your diet, choosing a wide variety of foods. Do not rely on just a few foods, as you may become allergic to foods you eat everyday!
FOODS YOU MAY EAT:
CEREALS – HOT: oatmeal, oat bran, cream of rye, Rice and Shine. DRY: Puffed rice, puffed millet, Oatio’s (wheat-free), Good Shepherd (wheat-free), Crispy Brown Rice Cereal. Diluted apple diluted juice with apple slices and nuts go well on cereal. May use soy milk that has no corn oil added (such as some Eden Soy products; please read all the ingredients carefully). Also may use almond nut milk. Most of these foods are available in health food stores.
GRAIN AND FLOUR PRODUCTS: 100% rice cakes, rice crackers, rye crackers; any 100% rye or spelt bread with no wheat; Oriental noodles, such as 100% buckwheat Soba noodles; soy, rice, potato, buckwheat, and bean flours; rice or millet bread (as long as they do not contain dairy, eggs, sugar, or wheat); cooked whole grains including oats, millet, barley, buckwheat groats (kasha), rice macaroni, spelt (flour and pasta) brown rice, amaranth, quinoa. Most of these grains are available at health foods stores.
LEGUMES (BEANS): Includes soybeans, tofu, lentils, peas, chickpeas, navy beans, kidney beans, black beans, string beans, and others. Dried beans should be soaked overnight. Pour off the water and rinse before cooking. Canned beans often contain added sugar or other potential allergens. Some cooked beans packaged in glass jars, sold at the health food store, contain no sugar. Read labels. May also use bean dips without sugar, lemon, or additives. Canned soups include split pea and lentil soup (without additives).
VEGETABLES – Use a wide variety. All vegetables except corn are permitted.
PROTEINS – Poultry and fowl, fresh fish (such as tuna and salmon, packed in spring water). Shrimp and most canned or packaged shellfish (such as lobster, crab, oysters) may contain sulfites and should be avoided. Canned tuna, salmon and other canned fish are okay. Beef and pork may be eaten unless specified otherwise. Lamb rarely causes allergic reactions and may be used even when other meats are restricted. Also recommended are grain/bean casseroles (recipes in vegetarian cookbooks).
NUTS AND SEEDS – Nuts and seeds, either raw or roasted, without salt or sugar. To prevent rancidity, nuts and seeds should be kept in air-tight containers in the refrigerator. May also use nut butters from health food stores or from freshly ground nuts (this includes peanut butter if allowed, almond butter, cashew butter, walnut butter, sesame butter, and sesame tahini). Nut butters go well on celery sticks and crackers.
OILS AND FATS – Sunflower, safflower, olive, sesame, peanut, flaxseed (edible linseed), canola and soy oils. Use cold-pressed or expeller-pressed oils (available from health food stores), as they are safer for the heart and blood vessels. Do not use corn oil or vegetable oil from an unspecified source, as this is usually corn oil. Soy and sunflower or safflower margarine is okay from an allergy standpoint, but we do not consider margarine during the elimination and testing period. However, if you are not allergic to butter, we recommend it instead of margarine, once you have completed food testing. Also suggested are vegetable and bean spreads, instead of butter or margarine.
SNACKS – Any food can be eaten as a snack, any time of day. Also suggested are celery, carrot sticks or other vegetables; fruit in moderation (no citrus); unsalted fresh nuts and seeds; Barbara’s Granola Bars (from health food stores); wheat-free cookies (check ingredients).
BEVERAGES – Herb teas (no lemon or orange); spring water in glass bottles or clear plastic, seltzer (salt free); Perrier; pure fruit juices without sugar or additives (dilute 50:50 with water); almond nut milk (Nut Quick); soy milk without corn oil (such as Eden Soy Plain); Cafix, Inka and Roma may be used as coffee substitutes. Tap water contains chlorine, fluoride and other potentially allergenic chemicals. In some cases, distilled or spring water in glass bottles is the only water allowed. This would include water used for cooking. If tap water is eliminated, it should be reintroduced as if it were a test food. Restrictions on the type of water permitted will be made on a case by case basis.
THICKENERS – Rice, oat, millet, barley, soy, or amaranth flours; arrowroot, and agar.
SPICES AND CONDIMENTS – Salt in moderation; pepper, herbal spices without preservatives, citrus or sugar; garlic, ginger, onions; catsup and mustard from the health food store (without sugar); wheat-free tamari sauce; Bragg liquid amino; vitamin C crystals in water as a substitute for lemon juice.
MISCELLANEOUS – Sugar-free spaghetti sauce; fruit jellies without sugar or citrus; soups such as split pea, lentil, turkey/vegetable, etc.
GENERAL SUGGESTIONS:
DO NOT RESTRICT YOUR CALORIES!
Start with a good breakfast, eat frequently throughout the day, and consume at least 4 glasses of water per day. If you do not eat enough, you may experience symptoms of low blood sugar, such as fatigue, irritability, headache, and too-rapid weight loss. To ensure adequate fiber, eat beans, permitted whole grains, whole fruits and vegetables, homemade vegetable soup, nuts and seeds. Be sure to chew thoroughly, in order to enhance digestion.
PLAN YOUR MEALS FOR THE WEEK. TAKE A LIST WITH YOU TO THE HEALTH FOOD STORE.
If your schedule is very busy and it is hard to think of what to fix, take some time before starting the diet to make a list of all of your favorite types of foods and possible meal plans. For ideas, look through cookbooks that specialize in hypoallergenic diets. Most meals can be modified easily to meet the requirements of the diet without changing the meal plan for the rest of your family. When you go to the health food store, ask for assistance in locating “allowed” versions of breads, crackers, cereal, muffins, soups, etc. Some people find it helpful to prepare additional foods on the weekend to cut down on thinking and preparation time during the week. If you need further assistance or ideas, talk with your diet counselor.
DINING OUT:
Do not hesitate to ask questions or make requests. For instance, you could ask for fish topped with slivered almonds, cooked without added seasoning, butter or lemon. Get baked potato with a slice of onion on top. Order steak or lamb chops with fresh vegetables and prepared without added seasonings (with the exception of garlic and plain herbs). Use salad bars that do not use sulfites as a preservative, and bring your own dressing (oil and cider vinegar with chopped nuts/seeds and fresh herbs). Get into the habit of carrying pure water, snacks, seasonings, etc., wherever you go to supplement your meals or to have something on hand if you start to get hungry.
WITHDRAWAL SYMPTOMS:
About one in four patients develop mild “withdrawal” symptoms within a few days after starting the diet. Withdrawal symptoms may include fatigue, irritability, headaches, malaise, or increased hunger. These symptoms generally disappear with 2-5 days and are usually followed by an improvement in your original symptoms. If withdrawal symptoms are too uncomfortable, take buffered vitamin C (calcium ascorbate-1000 mg in tablet form or ¼ teaspoon of the crystals, up to 4 times a day). Your doctor may also prescribe “alkali salts” (2 parts sodium bicarbonate and 1 part potassium bicarbonate) for withdrawal symptoms. In most cases, withdrawal symptoms are not severe and do not require treatment. It is best to discontinue all of the foods abruptly (“cold turkey”), rather than easing into the diet slowly.
TESTING INDIVIDUAL FOODS:
It may take 3 weeks for symptoms to improve enough to allow you to retest foods. However, you may begin retesting after 2 weeks if you are sure you are feeling better. If you have been on the diet for 4 weeks and feel no better, contact the office for further instructions. Most patients do improve. Some people feel so well on the diet that they decide not to test the foods. This could be a mistake. If you wait too long to retest, your sensitivities may “settle down” and you will not be able to provoke your symptoms by food testing and determining your food sensitivitiesbecomes more difficult. If reintroducing certain foods causes a recurrence of symptoms, you are probably allergic to those foods.
Food sources for testing. Test pure sources of a food. Example: do not use pizza to test cheese, because pizza also contains wheat and corn oil. Do not use bread to test wheat, as it contains other ingredients. Organic sources are the best to use for testing, as you will not experience interference from pesticides, hormones or other additives that may be used in commercial preparations.
Test one new food each day. If your main symptom is arthritic pain, test one new food every other day. Sensitivity reactions to test foods usually occur within 10 minutes to 12 hours after indigestion. However, joint pains may be delayed by as much as 48 hours.
Eat a relatively large amount of each test food. For instance, on the day to test milk, add a large glass at breakfast, along with any of the other foods on the “permitted” list. If after one serving, your original symptoms come back, or if you develop a headache, bloating, nausea, dizziness or fatigue, do not eat that food anymore and place it on your “allergic” list. If no symptoms occur, eat the food again for lunch and dinner and watch for reactions. Even if the food is well tolerated, do not add it back into your diet until you have finished testing other food. If you wake up the next morning with head or joint pain, nausea, or any other suspicious symptom, you may be experiencing a delayed reaction to a particular food, remove it from your diet and retest it 4-5 days later. You do not have to test foods you never eat. Do not test foods you already know cause symptoms.
Foods may be tested in any order. Begin testing on a day you are feeling well (without colds, unusual headaches, flu, etc.). Review the list of symptoms to watch for and keep a journal of how you feel.
Dairy tests – test milk and cheese on separate days. You may wish to test several cheeses on different days, since some people are allergic to one cheese but not another. It is usually not necessary to test yogurt, cottage cheese, or butter separately.
Wheat test – Wheatena (with no milk or sugar) or another pure wheat cereal. May add soy or nut milk.
Corn test – Use fresh ears of corn or frozen corn (without sauces or preservatives).
Egg test – Test the whites and yolks on separate days, using hard-boiled eggs.
Citrus test – Oranges, grapefruits, lemons and limes. Test these individually on four separate days. The lemon and lime can be squeezed into Perrier or seltzer. In the case of orange and grapefruit, use the whole fruit.
Frequently eaten foods – test tap water, if you have eliminated it, followed by those foods you have restricted (such as foods being consumed more than three times a week).
Optional tests – The following foods and beverages are considered undesirable, regardless o whether or not you are allergic to them. If any of them are not now a part of your diet, or if you are fully committed to eliminating then from your diet, there is no need to test them. However, if you have been consuming any of them regularly, it is a good idea to test them and find out how they affect you. Reactions to these foods and beverages may be severe in some cases. They should be tested only on days that you can afford to feel bad.
Coffee and tea tests (separate days) – Do not add milk, non-dairy creamer or sugar. May add soy milk. If you use decaffeinated coffee, test it separately. Coffee, tea, decaffeinated coffee and decaffeinated tea are separate tests.
Sugar test – Put 4 teaspoons of sugar in a drink or on cereal or mix with another food.
Chocolate test – Use 1-2 tablespoons of pure baker’s chocolate or Hershey’s cocoa powder.
Alcohol test (test this last) – Beer, wine and hard liquor may require testing on different days, as the reactions to each may be different. Have 2 drinks per test day, but only if you can afford not to feel well that day and possibly the next day.
Food additive test – Buy a set of McCormick’s or French’s food dyes and colors. Put ½ teaspoon of each color in a glass. Add one teaspoon of the mixture to a glass of water and drink. If you wish, you may test each color separately.
AFTER THE TESTING IS FINSIHED, IT IS TIME TO RETURN TO THE DOCTOR’S OFFICE FOR A FOLLOW-UP VISIT.
When you are within 10 days or so of completing your testing, call the office for an appointment. Bring your journal with you, so you may review your experiences with the doctor.
SUGGESTIONS FOR ON-GOING SELF-HELP, IF YOU ARE SENSITIVE TO FOODS:
Rotation Diets:
If you have an allergic constitution and eat the same foods everyday, you may eventually become sensitiveto them. After you have discovered which foods you can eat safely, make an attempt to rotate your diet. A four-day schedule is necessary for some severely allergic patients, but most people can tolerate foods more frequently than every for days. You may eventually be able to tolerate allergenic foods, after you have avoided then for 6-12 months. However, if you continue to eat these foods more frequently than every fourth day, the allergy may return. Use common sense and consume a wide variety of foods. Do not just latch onto a few favorites. If you are rotating foods. be sure to avoid all forms of the food when you are on an “off” day. For instance, if you are rotating corn, be sure to avoid corn chips, corn oil, corn sweeteners, etc., except on the days that you are eating corn and corn products. It is not necessary to do strict food rotation during the elimination and retesting periods.
Watch for other allergic reactions:
If you have an allergic constitution, you may be sensitive to foods other than those you have eliminated and tested on this diet. Pay attention to what you are eating and if you develop symptoms, review your recent meals and try to identify what may be different in what you have eaten. You can then eliminate that food for two weeks and test it again, to see if you can provoke the same symptoms.
SYMPTOMS THAT MAY BE DUE TO FOOD SENSITIVITY:
General: Fatigue, anxiety, depression, insomnia, food cravings, and weight gain.
Infections: recurrent colds, urinary tract infections, sore throats, ear infections, and yeast infections.
Ear, Nose and Throat: Chronic nasal congestions, postnasal drip, fluid in the ears, and Meniere’s syndrome.
Gastrointestinal: Irritable bowel syndrome. constipation, diarrhea, abdominal cramping, ulcerative colitis, Crohn’s disease, and gallbladder disease.
Cardiovascular: High blood pressure, arrhythmia, and angina.
Dermatologic: Acne, eczema, psoriasis, canker sores (aphthous ulcers), and hives.
Rheumatologic: Muscle aches, osteoarthritis, and rheumatoid arthritis.
Neurologic: Migraines and other headaches, focus and concentration, numbness and tingling of hands and feet.
Miscellaneous: Asthma, frequent urination, teeth grinding, bedwetting, and infantile colic.
Note: most of these disorders have more than one cause, but food sensitivity is a relatively common and frequently overlooked cause.
ADDITIONAL READING:
Allergy Self Help Cookbook
Recipes From an Ecological Kitchen