The Benefits of Elimination Diets

Last fall, registered dietitian Cara Marrs put one of her clients, a woman in her late 30s, on an elimination diet. The woman's goal wasn't to lose weight or lower her blood sugar levels, says Marrs, who works at UCHealth Yampa Valley Medical Center in Steamboat Springs, Colorado. Rather, the woman wanted to learn what was making her feel bad.

Marrs' patient had been experiencing chronic gastrointestinal distress, like bloating. Marrs had the woman go on the low FODMAP diet to try to ascertain whether a food or type of food was causing her symptoms. (FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharide and polyols, types of carbohydrates that are difficult to digest for some people and could lead to bloating and gastrointestinal distress). Marrs' client followed the low FODMAP diet and spent several weeks abstaining from foods like garlic, onions, bread, pasta, legumes, yogurt, honey, milk, plus offerings high in fructose, such as apples and grapes. Gradually, the woman resumed eating these foods, one food or food type per week, to see how her body responded.

It worked. The woman felt bloated when she resumed consuming dairy products from a cow (she was fine with goat milk and cheese), apples, grapes, garlic and honey. So she cut those offerings from her eating regimen for the time being to work on gut healing. "She feels better," Marrs says.

Elimination diets can be a useful clinical diagnostic tool to help people learn what foods they can't tolerate, says Audra Wilson, a registered dietitian at Northwestern Metabolic Health and Surgical Weight Loss Center at Delnor Hospital in Geneva, Illinois. Elimination diets help assess patients' intolerance to certain foods. "There are not a lot of ways to do this," she says.

Your health care provider may recommend you try an elimination diet to identify what's causing these symptoms:

-- Bloating.

-- Heartburn.

-- Distension.

-- Constipation.

-- Diarrhea.

-- Irritable bowel syndrome.

-- Fatigue.

-- Difficulty sleeping.

-- Stomach pain.

-- Skin rashes.

[See: 10 Lessons From Extreme Dieting.]

How Elimination Diets Work

There are an array of elimination diets, and not all registered dietitians agree on which eating regimens belong in that category. But they work basically the same way: A person who's been experiencing unexplained symptoms stops eating certain foods for several weeks, then slowly resumes consuming them again. The return of symptoms after resuming eating certain foods suggests those offerings caused the distress.

Some foods cause inflammation in the digestive system, which can lead to an array of gastrointestinal and other problems, says Kristine Blanche, a physician assistant and founder of Integrative Healing Center, which has offices in New York City and in Long Island. The center treats patients with a blend of conventional and holistic medicine. "Food can be medicine, or it can be poison," Blanche says. "The gut is the foundation of the body. Most of your immune system is living in the gut, most of your neurochemicals that control anxiety and depression are in the gut. It's where you absorb all of your nutrients. If your gut is out of balance, you could be struggling with all those areas." An elimination diet gives the body a break in order to identify which foods may be causing gastrointestinal symptoms and other issues, like skin rashes and difficulty sleeping. "When you're eating everything in the standard American diet and feeling bad every day, there's no way of knowing what's causing it," Blanche says.

With all elimination diets, it's important to keep in mind that "even though a food may cause you distress, it doesn't mean you have to eliminate it from your diet," says Lisa Jones, a registered dietitian based in Philadelphia. "You may be able to limit your consumption of gluten products, for example, and enjoy smaller amounts to avoid experiencing symptoms. A dietitian can help find the right balance of these foods that works best for you."

Widely Used Elimination Diets

There's no hard and fast rule as to what constitutes an elimination diet. These are five well-known and widely used elimination diets:

-- Elimination diet

-- Gluten-free diet.

-- Low-FODMAP diet.

-- GAPS diet.

-- Specific Carbohydrate Diet.

1. Elimination diet.

A basic elimination diet involves refraining from eating foods like milk, eggs, nuts, citrus fruits, wheat, shellfish, added sugars, alcohol, gluten, beef, processed meats, shellfish and and soy products, Marrs says. "A simple elimination diet can be an (effective) way to detect food allergies or sensitivities and is often used in children and adults," she says. "This type of plan removes from the diet a number of possibly allergenic foods at once to try and determine what foods are causing issues such as migraines, IBS, and skin conditions."

2. Gluten-free diet.

Under a gluten-free diet, you'll refrain from consuming foods that contain the protein gluten. That means no food products made from wheat, barley and rye, triticale (a mix of wheat and rye) and seitan, which is an Asian food made of gluten, as well as oats, because they're vulnerable to contamination with gluten. It's important to keep in mind that wheat can be called other names, like bulgur, semolina, spelt and farro. Abstaining from wheat products means no bread, muffins, cookies or croissants. Many processed foods have gluten, according to the Mayo Clinic. Also out: french fries, hot dogs and processed lunch meats, salad dressings, sauces (including soy), potato and tortilla chips and vegetables in sauce. Keep in mind that gluten is also found in food additives and many sauces and salad dressings, so you should read labels carefully.

3. Low FODMAP diet.

This eating regimen was developed by researchers from Monash University in Australia, says Elana Natker, a registered dietitian based in Oak Hill, Virginia. The low FODMAP diet was designed to alleviate symptoms associated with irritable bowel syndrome, says Natker, who once did consulting work for Monash and its low FODMAP certification program. It calls for eliminating foods with the nutrients included in the FODMAP acronym, typically for between two to six weeks. That means lots of dairy products are out, including sour cream, milk from cows, sheep or goats, chocolate and yogurt. Also out: dried fruit, stone fruit (like peaches), apples, cherries, mango and papaya. You'll have to abstain from an array of vegetables including squash, cabbage and broccoli; beans and lentils (so, no hummus or soy products); coffee, tea and juices made from low FODMAP fruits and vegetables; and high-fructose corn syrup, agave and artificial sweeteners. Foods you are allowed to eat on the low FODMAP diet include meats, poultry, fish, eggs and cold cuts; lactose-free dairy products, hard cheeses, mozzarella and sherbet; nuts and seeds; some fruits, including bananas, berries, oranges and melon; and certain vegetables, like kale and cucumbers. After two to six weeks, you reintroduce the foods you'd abstained from, in order to try to determine which offerings might be causing digestive distress and other symptoms, and adjust your diet accordingly. It's best to work with a registered dietitian, experts say.

4. GAPS diet.

The GAPS diet stands for Gut and Psychology Syndrome and is aimed at healing the gut lining, Jones says. The GAPS diet is divided into two parts, an introduction diet and a full GAPS regimen. The introduction phase "is designed for patients with severe digestive issues" including chronic diarrhea, IBS, Crohn's disease, gastritis and ulcerative colitis, according to the GAPS diet website. It's also designed for people with severe neurological conditions, such as autism, schizophrenia, depression and bipolar disorder. The introduction diet has six phases. This is how the phases work:

Stage 1: Eat homemade meat, poultry and fish stocks, which are building blocks for the rapidly growing cells of the gut lining. These foods can have a soothing effect on inflammation in the gut and aid in digestion. Don't use commercially available soup stock granules or bouillon cubes, which are highly processed and contain ingredients detrimental to your gut health.

Stage 2: Keep eating the foods introduced in Stage 1, and add raw organic egg yolks to each cup of stock or soup. If you're tolerating the egg yolks well, add soft-boiled eggs to your soups. The whites should be cooked and the yolks still runny. Add stews and casseroles made with meats and vegetables, but avoid spices at this stage, though salt and fresh herbs are fine.

[See: How to Survive Acid Reflux -- Without a Pill.]

Stage 3: Continue with all the foods introduced in Stages 1 and 2, and add ripe avocado, mashing it into soups. Start with 1 to 3 teaspoons per soup and gradually increase the amount. Add pancakes, beginning with one a day and gradually increasing the amount. The pancakes should be made with three ingredients: organic nut butter (peanut, almond, walnut and other nuts), eggs and a piece of fresh winter squash, the vegetable marrow or zucchini.

Stage 4: Maintain the eating regimen spelled out in the first three stages, and gradually add roasted and grilled meats and freshly pressed juices, starting with a few spoonfuls of carrot juice. If you tolerate that well, gradually increase to a full cup of juice per day.

Stage 5: If your body is doing well with all the foods introduced in the first four stages, add cooked apples. Peel and core ripe cooking apples and stew in a small amount of water until they're soft. When they're cooked, add some ghee to them and mash them with a potato masher.

Stage 6: If you're tolerating all of the foods you consumed in the first five stages, try eating some peeled raw apples. Gradually introduce more raw fruit and honey. You can also gradually bake cakes that are allowed on the GAPS regimen, using dried fruit to sweeten them while baking.

Full GAPS diet: Once you've completed the six introductory stages of the diet, you can move on to the full GAPS regimen. The majority of a full GAPS diet would include fresh meats, animal fats, fish, shellfish, organic farm-fresh eggs (unless your body doesn't tolerate them), fermented foods and vegetables. It's recommended you eat a cup of bone broth or meat stock with each meal, and that you consume plenty of fermented foods, including yogurt, kefir and sour cream. You should avoid all processed foods -- like snack chips and canned fish -- that come in packages and tins. Dr. Natasha Campbell-McBride, who designed the GAPS diet, recommends staying on the full regimen for 18 months to two years.

5. Specific Carbohydrate Diet.

This is a very restrictive eating regimen that calls for the elimination of most carbohydrates and limits grain products and offerings with lactose and sucrose, Jones says. The Specific Carbohydrate Diet calls for not consuming added sugars, wheat products, potatoes, rice or oats. The diet is outlined in "Breaking the Vicious Cycle: Intestinal Health Through Diet," by Elaine Gottschall, who died in 2005. Gottschall was a young mother in the 1950s when her 4-year-old daughter, Judy, became ill, suffering from "chronic intestinal distress and bleeding that was unresponsive to standard medical therapy," according to the website breakingtheviciouscycle.info. Judy's doctor insisted her illness had nothing to do with what she ate. The little girl's system couldn't tolerate food, and she suffered malnutrition, stopped growing and experienced episodes of delirium. Judy's doctor told Gottschall and her husband he wanted to conduct surgery to remove her colon and attach an external colostomy bag to collect waste. Instead of accepting the doctor's opinion, Gottschall and her husband, Herb, quizzed a series of specialists, hoping for another approach. Most said that if prescription medication couldn't keep Judy's symptoms under control, surgery was the only option, according to the website. Finally, the parents consulted with Dr. Sidney V. Haas, a New York City physician who was 92 at the time. Haas asked what Judy had been eating, and put her on a simple nutritional regimen. Less than two weeks after adopting this eating approach, Judy's neurlogical symptoms diminished, and within months her gastrointestinal problems started to improve. Haas died within a couple of years, and Gottschall made it her mission to preserve his legacy. She earned degrees in biology, nutritional biochemistry and cellular biology. To make Haas' eating approach available to the public, Gottschall wrote and self-published the book, released in 1994.

Strategies

Getting and staying on an elimination diet, even for just a few weeks, can be challenging. Experts recommend these strategies to help you start and sustain such a regimen:

-- Work with a health care professional.

-- Be prepared.

-- Don't be upset if your symptoms worsen initially.

-- Resume eating certain foods gradually.

1. Work with a health care professional.

If you're experiencing gastrointestinal distress or other symptoms that could be related to your diet, you should consult your primary care physician and/or a registered dietitian, Wilson says. Health care professionals can help you figure out what's causing your symptoms and can guide you through an elimination diet, she says. Getting professional help is crucial because you'll be cutting out a lot of nutrients with any elimination diet. A registered dietitian can help you find food options to replace those nutrients. And if you have a chronic condition -- like diabetes -- a registered dietitian can help you maintain a healthy regimen as you're abstaining from certain foods.

[See: Health Issues That Are Sometimes Mistaken for Gluten Sensitivity.]

2. Document and prepare.

Before starting an elimination diet, record what you eat and how your body responds, either with a notebook and pen or with a diet app, Wilson says. Continue to record your consumption and your body's response during the elimination diet and when you resume eating foods you'd abstained from. You can prepare for an elimination diet by stocking up on fresh produce at your area farmers market (assuming fresh fruits and vegetables are allowed by your particular elimination regimen). If you're going to eat out, read restaurant menus online to see if the eatery offers dishes you can eat, Wilson says. You can also call ahead and ask for specific dishes. "Most restaurants will be accommodating," she says.

3. Don't be upset if your symptoms worsen initially.

It's not uncommon for your symptoms to worsen during your first week on an elimination diet, says Elizabeth A. Smith, a registered dietitian in Murfreesboro, Tennessee. She's an assistant professor of nutrition and food science at Middle Tennessee State University. Those worsened symptoms are probably not a cause for alarm, but you should contact your health care provider to discuss your concerns. Worsening symptoms could be a sign that food is not the culprit and further testing is needed to diagnose the problem. Elimination diets can be effective but they aren't perfect, Smith says. "Other factors -- like a stressful day -- can interfere with results," she says. "Discussing your concerns and symptoms with your health care provider is always prudent."

4. Resume eating certain foods gradually.

After abstaining from a favorite food, like pizza, for several weeks, you may be tempted to eat a whole pizza pie once you resume consuming dairy products. Resist the urge, Smith recommends. Eating large amounts of a food you've not consumed in weeks could negatively affect your digestive system and make you sick. Instead, resume eating one food you'd abstained from per week, and start with smaller portions. "Reintroduce the eliminated food by starting with a small portion on the first day, adding a little more the next day and a full portion the third day," Smith says. "If symptoms occur, stop eating the food, record it in your diary and report this to your health care provider." Keep in mind, it typically takes about three days for symptoms to recur, if a particular food is causing them.