Elimination diet protocols can vary among practitioners, explains Sharon Zarabi, a registered dietitian for the Katz Institute for Women’s Health and Director at Northwell Health,
“My approach varies based on my client’s current diet and their personality and relationship with food. I typically remove foods in phases (rather than all at once) and educate them so they know the why in what we are planning,” says Zarabi.
A popular example of an elimination diet is the low FODMAP diet, adds Dr. Mendez. The goal of this diet is to provide immediate symptomatic relief, identify trigger foods and then allow for a slow and mindful reintroduction of foods. “The acronym FODMAP stands for Fermentable Oligo-, Di-, Mono- saccharides and Polyols. These are tiny carbohydrates found in many foods [such as apples, broccoli, wheat, soy and foods containing high-fructose corn syrup] that can increase symptoms of irritable bowel syndrome and other GI issues,” explains Dr. Mendez explains.
It’s important to note that the FODMAP diet (as well as any other elimination diet) is not meant to be followed forever. And it should be guided by a medical professional who specializes in nutrition, Dr. Méndez adds. “Typically, the process of elimination is anywhere between two to six weeks, followed by the reintroduction phase,” she says. Following such an extreme protocol could impact your overall nutrition, so it’s important to keep the elimination phase to a minimum.
While elimination diets can vary slightly in terms of protocols and the exact foods taken out, the process typically includes:
The Elimination Phase
The initial phase of an elimination diet involves removing all forms of a suspected food (or group of foods) from your diet, including cooked, raw and protein derivatives, says Morey. Often, an individual will remove all suspected foods at once (such as cutting out all forms of dairy and gluten), before slowly phasing them back in.
This phase of the diet is followed for about two to four weeks—without any exceptions—so if you accidentally consume the food, it’s recommended you start over. Sometimes, symptoms may become worse before they begin to improve; This typically occurs within the first few days of beginning the elimination phase.
Zarabi encourages her clients to keep a food diary to track their symptoms during the elimination phase, which also helps them stay compliant. “We can review and collaborate together, and reassess what is working and what is not,” she says.
The Reintroduction Phase
After the designated elimination phase, possible trigger foods are systematically reintroduced into the diet to see if any adverse reactions occur, says Morey. However, if your symptoms persisted even with careful avoidance of suspected foods beyond four weeks, it’s time to consider other causes of your symptoms.
Before reintroducing eliminated foods, make sure you’ve been symptom-free for at least five days. Then, start with one food at a time. Dr. Méndez advises starting with a small amount of the food—even just one teaspoon—into your diet. If that’s tolerated well, continue to slowly increase the portion size.
Do this progressively until you reach a full serving of the food, or until you notice a threshold—or the amount of food that causes your symptoms to return, says Dr. Mendez. It’s best to limit the reintroduction phase to one new food every three days, as that’s the time it usually takes for symptoms to come back if they’re going to.
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