When to introduce an elimination diet?
An elimination diet usually involves the temporary exclusion from the diet of foods that may cause adverse reactions:
- abdominal pain,
- flatulence
- diarrhoea,
- rashes,
- migraines.
Most often, the introduction of such a diet is recommended when there are symptoms suggestive of a food intolerance or allergy. However, it should be remembered that the elimination diet is a diagnostic tool and a method of treating food hypersensitivity. It is therefore not a diet designed for everyone. It should not be used long-term without medical indications and supervision by a specialist [1,2].
How to start?
Before starting an elimination diet, consult your doctor or nutritionist. A specialist will help you:
- choose its type,
- identify potential allergens,
- draw up a diet plan,
- determine the duration of use.
All this depends on the individual symptoms and diagnosis.
An elimination diet requires diligence, commitment and adequate preparation. Otherwise, it may not have the desired effect [1,2]. The first step is to identify potentially harmful products. The daily diet should be carefully analysed and suspect foods should be excluded after consultation with a doctor or dietician. The second step is strict adherence to the diet for a specified period of time – usually 2 to 8 weeks. After the elimination period, the excluded foods are gradually reintroduced, continuing to observe changes in mood.
Products are included in the diet one at a time. After each newly introduced food, the body’s reaction should be observed for a few days before the next food is included. This is the only way to observe possible undesirable symptoms and identify which ingredient caused them. A food diary can be a helpful tool, in which all the foods consumed and possible complaints are recorded [2,3,4].
Consequences, risks
Although an elimination diet provides relief from many complaints, it is also associated with certain risks. Prolonged exclusion of large food groups combined with an incorrectly balanced diet can lead to nutritional deficiencies. Sometimes the avoidance of e.g. dairy or cereal products results in insufficient nutrients (calcium, vitamin D, iron, fibre) in the diet. This is particularly dangerous for children. Insufficient intake of essential nutrients can cause growth and developmental disorders in children [1,2,3,4].
On the other hand, replacing excluded products with highly processed foods influences the development of metabolic disorders such as insulin resistance or increased blood cholesterol levels. An unbalanced diet in the long term may result in the development of type 2 diabetes or cardiovascular disease [1,2,3,4].
There is also a risk that putting a lot of exclusions on the menu will negatively affect mental health. For some people, an elimination diet can lead to obsessive control of food and the maintenance of unhealthy eating habits. Consequently, there is a risk of developing an eating disorder. Additionally, the introduction of an elimination diet is often associated with stress, anxiety and guilt about eating, especially when there are no visible results. Adhering to it can be difficult when socialising, going out to restaurants or travelling. It sometimes leads to social isolation or anxiety related to eating out [1,2,3,4].
It is also worth mentioning that sometimes elimination diets are based on specialised products that do not contain allergens. These are often more expensive than their standard counterparts. Such a diet can therefore increase the cost of daily living [1,2,3,4].
Because of the many risks that are associated with the introduction of an elimination diet, it is important that it is carried out under the supervision of a doctor or dietician. They will help to balance the diet and prevent possible deficiencies. If you are experiencing difficulties, it is also worth consulting a psychologist or psychodietitian. These professionals will provide support during the change in eating habits and help you cope with the stress that comes with this change.
The results of regular blood tests can be useful in monitoring health and detecting possible nutrient deficiencies [2,3,4].
Types of elimination diets
There are many criteria for classifying elimination diets. However, the most important types include:
A diet involving the complete exclusion of one or more ingredients suspected of causing adverse symptoms
It usually takes 2 to 8 weeks to exclude the suspected ingredients. During this time, it is observed whether symptoms resolve. Products are eliminated one at a time to identify the exact cause of the hypersensitivity. If the symptoms disappear when a particular ingredient is excluded, it can be concluded that this product was the cause of the health problem. Such a method is useful when one or more dietary ingredients are suspected to be responsible for the complaints [1,5,6].
The most common diets that exclude individual ingredients are [4,5,6]:
- Gluten-free diet – used in cases of coeliac disease, gluten intolerance or wheat allergy. It involves the exclusion of all products containing gluten. In particular, it avoids cereals such as wheat, rye, barley and oats,
- Dairy-free diet – designed for people with lactose intolerance or allergy to cow’s milk proteins. It requires the elimination of all dairy products and their derivatives,
- Antihistamine diet – used by people with histamine intolerance. Involves avoiding foods high in histamine and ingredients that stimulate histamine release in the diet,
- Low-FODMAP diet – used, for example, in the treatment of irritable bowel syndrome (IBS). It involves limiting the intake of fermentable oligo-, di-, monosaccharides and polyols, which can cause symptoms such as bloating, diarrhoea and abdominal pain,
- Elimination diet in food allergies – may involve the elimination of a wide range of allergens such as nuts, eggs, soya, fish, shellfish.
Elemental Diet
The elemental diet is very restrictive. It is based on single amino acids. Its goal is to provide the body with essential energy while minimizing the risk of allergic reactions. The elemental diet is used when previous elimination diets have not allowed for a clear determination of the allergy source. A characteristic feature of this diet is that meals are liquid or semi-liquid. They consist of single amino acids and are supplemented with specific products (considered safe). The elemental diet is conducted under strict medical supervision. Long-term use may lead to nutritional deficiencies [1,3,7].
Oligoantigenic Diet
The oligoantigenic diet is used in cases where allergy symptoms are triggered by many different food products. It is based on consuming foods that rarely cause allergic reactions, such as corn, rice, cooked apples, or lettuce. This diet is introduced for a short period, usually lasting up to 4 weeks or until an improvement is observed. Due to its strict rules, it should not be followed for an extended period without specialist supervision, as it may lead to nutritional deficiencies [5,6,7].
Each elimination diet has its specific applications and requires proper medical supervision. This is crucial to ensure safety and achieve the desired results [1,3]. The choice of the appropriate diet depends on individual needs and the body’s reactions to specific foods.
Elimination Diet During Breastfeeding
In some cases, an elimination diet may also be recommended for breastfeeding women. It is indicated when infants experience adverse symptoms (such as rashes, diarrhea, or others) suspected to be caused by specific components of the mother’s diet. This diet involves excluding allergens from the breastfeeding mother’s meals, as these may pass into her milk and trigger reactions in the baby. The most commonly avoided foods include:
- Cow’s milk,
- Eggs,
- Soy,
- Nuts,
- Fish.
Breastfeeding mothers should not remove any foods from their diet hastily or start an elimination diet on their own—this should only be done after consulting a doctor and under the supervision of a dietitian. It is essential that the mother’s diet is properly balanced, providing all necessary nutrients. Otherwise, it may negatively impact the health of both the mother and the baby. When following an elimination diet, keeping a food diary can be a useful tool [2,6,7,8].
