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The Exceed Nutrition Certification / www.ExceedNutrition.com

Advanced Nutrition Protocols -‐ The Elimination Diet By Ru Anderson The elimination diet is an accurate protocol that can be used to resolve food sensitivity, allergies and intolerances. The user must follow a strict set of rules and eat a highly restrictive diet for some time in order for it to be successful, thus making it one of our advanced nutrition protocols. What Is An Elimination Diet In general we get two main types of clients:

1) Those with current eating habits that are poor or inconsistent, or 2) Those who are eating good food choices with consistency, yet not seeing

results. If a client falls into number 1, and eating habits are poor and lack any structure, the use of an elimination process is not required – they just need an improved diet. However, it is possible that some clients may still not get the desired benefits/results from an improved diet, and it is therefore necessary to look a little deeper into their eating habits, particularly their food choices. In my experience, it is food sensitivities or intolerances in the diet that may be causing a lack of results. Of course, this is assuming you have already addressed overall energy balance (calories in vs. calories out) to match current goals, macro and micronutrients breakdown, along with nutrient timing and frequency in the daily diet. If not, then this should be your starting point, and will actually be a much easier option. It’s important to note that this is not a fat loss protocol, so it shouldn’t become the ‘go to’ diet for those who are having difficulty in losing bodyfat, but it could be an option. Instead, it is likely to become one of your ‘go to’ diets to help treat those with the following conditions:

− Fibromyalgia − Chronic Fatigue Syndrome − Psoriasis − Arthritis − Asthma


− Eczema − IBS − Infertility − Chronic Migraines − GERD − Anxiety − Constipation /Diarrhoea − Sinus problems

It is therefore a protocol that is based on improving the user’s health by removing food sensitivities and intolerances. Of course, not everyone has been diagnosed with these conditions, and other symptoms or problems of the digestive system may prescribe the use of an elimination diet:

− Gas after a meal; − Stomach cramps or aches; − Poor mood/energy levels; − Slow digestion, bloating; − Poor stools.

So this protocol is ideal for anyone who feels their gut is working sub optimally and is seeking improved body composition and health. How It Works Some of our clients will have intolerances/allergies/sensitivities to certain food groups which can suppress hormones and disrupt the digestive system. This usually results in poor outcomes and despite people’s best efforts, progress can come to a complete halt. As this area of nutrition coaching becomes more popular and is researched, it’s important to understand the difficulties between the terminologies when discussing it with clients:

1) Food allergy: an immediate food reaction that will always provide an immune response within minutes. The perfect example is a nut allergy, and this will always remain with the person.

2) Food sensitivity: a delayed reaction to foods which can take up to some days before symptoms are felt. Typical symptoms are diarrhoea, bloating, skin conditions, constipation and tiredness.

3) Food intolerances: defined as “an adverse physiological response to food(s)’” and, unlike allergies or sensitivities, there is no immunological mechanism of adverse food response. The perfect example is lactose


intolerance, which essentially means you are lacking the enzyme lactose to aid digestion of lactose (milk/dairy).

It is important to find the foods causing these issues and remove them. For some people a general clean up of the diet works just fine, for others a stricter approach is needed. Enter The Elimination Diet A good elimination diet is a strict, controlled eating plan that removes typical food intolerances along with those that may be individual to that person. There are a number of ways you can start to apply elimination, and one of the easiest places to start is to simply remove the common offenders:

− Gluten (wheat) − Dairy − Soy − Eggs

Another approach is to make it more personal to the client by using a food diary (like the one contained in this article) to track the client’s food intake and link their symptoms to timing of meals and certain foods. It can also be helpful to ask a few key questions:-‐

− What foods do you eat most often? − What foods do you crave? − What foods do you eat to feel better? − What foods do you have trouble giving up?

This will allow you to create a more personal perspective of the client’s issues which may lead you to quicker results. Often, the answers to these questions seem to be the foods that are most important to eliminate and test. The last option is to head straight into the full elimination diet that will be the most restrictive, reducing all possible offenders. Although this might sound daunting at first, it can be the quickest and most accurate method of all – the more you remove the more likely you are to discover foods you’re intolerant to.


When following this type of elimination diet, the following table gives an example of what to include and exclude:-‐ Foods To Include Foods To Exclude Fruits: whole fruits, unsweetened, frozen or water-‐packed, canned fruits and diluted juices

Oranges and orange juice

Dairy Substitutes: rice milk Dairy and eggs: milk, cheese, eggs, cottage cheese, cream, yogurt, butter, ice cream, frozen yogurt, non-‐dairy creams

Non-‐gluten grains and starch: rice (all types), millet, quinoa, amaranth, teff, tapioca, buckwheat, potato flour

Grains: wheat, corn, barley, spelt, oat

Animal protein: fresh or water-‐packed canned fish, wild game, lamb, duck, organic chicken and turkey

Pork, beef/veal, sausage, cold cuts, canned meats, frankfurters, shellfish

IF YOU ARE A VEGETARIAN: Split peas, lentils and legumes If you are not a vegetarian, do not include these foods.

Soybean products (soy sauce, soybean oil in processed foods, tofu, soy milk, soy yogurt, textured vegetable protein)

Nuts and seeds: Coconut, pine nuts, flax seeds

Peanuts and peanut butter, walnuts, sesame, pumpkin, sunflower seeds, hazelnuts, pecans, almonds, cashews, nut butters such as almond or tahini

Vegetables: all new, steamed, sautéed, juices or roasted vegetables

Corn, creamed vegetables. If you have arthritis avoid nightshades: tomatoes, potatoes, eggplants, peppers, paprika, salsa, chilli peppers, cayenne, chilli powder

Oils: cold pressed olive, ghee Butter, margarine, shortening, processed oils, salad dressings, mayonnaise, and spreads, flax, safflower, sesame, almond, sunflower, walnut, canola, pumpkin

Drinks: filtered or distilled water, decaffeinated herbal teas, seltzer or mineral water

Alcohol, coffee and other caffeinated beverages, soda pop or soft drinks

Sweeteners: use sparingly: brown rice syrup, agave nectar, stevia, fruit sweetener, blackstrap molasses

Refined sugar, white/brown sugars, honey, maple syrup, high fructose corn syrup, evaporated cane juice

Condiments: vinegar, all spices, including salt, pepper, basil, carob, cinnamon, cumin, dill, garlic, mustard, oregano, parsley, rosemary, tarragon, thyme, turmeric

Chocolate, ketchup, relish, chutney, soy sauce, barbecue sauce, teriyaki, and other condiments


If you are avoiding:

Also avoid:

Dairy Caramel sweets, carob confectionery, casein and caseinates, custard, curds, lactalbumin, goats milk, milk chocolate, nougat, protein hydrolysate, semisweet chocolate, yogurt, pudding, whey. Also beware of brown sugar flavouring, butter flavouring, caramel flavouring, coconut cream flavouring, “natural flavouring,”

Peanuts Egg rolls, “high-‐protein food,” hydrolysed plant protein, hydrolysed vegetable protein, marzipan, nougat, candy, cheesecake crusts, chili, chocolates, pet food, sauces.

Egg Albumin, apovitellin, avidin, béarnaise sauce, eggnog, egg whites, flavoprotein, globulin, hollandaise sauce, imitation egg products, livetin, lysozyme, mayonnaise, meringe, ovalbuman, ovogycoprotin, ovomucin, ovomucoid, ovomuxoid, Simplesse.

Soy Chee-‐fan, ketjap, metiauza, miso, natto, soy flour, soy protein concentrates, soy protein shakes, soy sauce, soybean hydrolysates, soby sprouts, sufu, tao-‐cho, tao-‐si, taotjo, tempeh, textured soy protein, textured vegetable protein, tofu, whey-‐soy drink. Also beware of hydrolysed plant protein, hydrolysed soy protein, hydrolysed vegetable protein, natural flavouring, vegetable broth, vegetable gum, vegetable starch.

Wheat Atta, bal ahar, bread flour, bulgar, cake flour, cereal extract, couscous, cracked wheat, durum flour, farina, gluten, graham flour, high-‐gluten flour, high-‐protein flour, kamut flour, laubina, leche alim, malted cereals, minchin, multi-‐grain products, puffed wheat, red wheat flakes, rolled wheat, semolina, shredded wheat, soft wheat flour, spelt, superamine, triticale, vital gluten, vitalia macaroni, wheat protein powder, wheat starch, wheat tempeh, white flour, whole-‐wheat berries. Also beware of gelatinized starch, hydrolysed vegetable protein, modified food starch, starch, vegetable gum, vegetable starch.

Although there are a number of tolerance tests now available, it is important to know that they may not show all intolerances and do not work as effectively as a good old fashioned elimination diet. However, they are a good addition when starting an elimination diet to ensure all bases have been covered. Time In order for the diet to work successfully, it is important to give it sufficient time in order to help heal the GI system, before testing. This is usually anywhere between 2-‐4 weeks, depending on the severity of the problem initially. This is known as the removal phase.


Below is a typical elimination shopping list that can be used throughout the removal phase (unless known intolerances). Fruit: • Apples, applesauce • Apricots (fresh) • Bananas • Blackberries • Blueberries • Cantaloupe • Cherries • Coconut • Figs (fresh) • Grapefruit • Huckleberries • Kiwi • Kumquat • Lemons and limes • Loganberries • Mangos • Melons • Mulberries • Nectarines • Papayas • Peaches • Pears • Prunes • Raspberries • Strawberries *all the above fruit can be consumed raw or juiced Vegetables: • Artichoke • Asparagus • Avocado • Bamboo shoots • Beets and beet tops • Bok choy • Broccoflower • Broccoli • Brussels sprouts • Cabbage • Cauliflower • Celery

• Chives • Cucumber • Dandelion greens • Aubergine • Endive • Kale • Kohlrabi • Leeks • Lettuce • Mushroom • Okra • Pak-‐choi • Parsley • Potatoes • Sea Vegetables • Spinach • Sweet potatoes and

yams • Snow peas • Swiss chard • Tomatoes • Watercress • Courgettes * all above can be consumed raw, juiced, sautéed or baked. If you have arthritis avoid nightshades.

• Animal Protein: • Free-‐range chicken,

turkey, duck • Fresh ocean fish:

salmon, halibut, haddock, cod, sole, pollock, tuna, mahi-‐mahi

• Lamb • Water-‐packed canned

tuna (watch for added protein from soy)

• Wild game

Oils: • Ghee • Flax • Olive coconut Herbs, Spices & Extracts: • Basil • Black pepper • Cinnamon • Cumin • Dandelion • Dill • Dry mustard • Garlic • Ginger • Nutmeg • Oregano • Parsley • Rosemary • Salt-‐free herbal blend • Sea salt • Tarragon • Thyme • Turmeric • Purse vanilla extract Breads & baking • Arrowroot • Baking soda • Gluten free breads • Flours: rice, teff,

quinoa, millet, tapioca, amaranth, potato

• Michi • Rice bran • Rice flour pancake

mix • Rice tortillas


Non-‐gluten Grains: • Amaranth • Millet • Quinoa • Rice – brown, white,

wild • Teff • Buckwheat • Rice crackers Cereals & Pasta • Cream of rice • Puffed rice • Puffed millet • Quinoa flakes • Rice pasta • 100% buckwheat

noodles • Rice cakes Dairy Substitutes: • Almond milk • Rice milk • Coconut milk • Oat milk

Beans: If you are a vegetarian include these foods. If you are eating animal foods, eliminate these foods. • All beans except soy • Lentils – brown,

green, red • Split peas * all the above beans can be dried or canned Nuts: • Coconut Vinegars: • Apple cider • Balsamic • Red wine • Rice • Tarragon • Ume plum

Sweeteners: • Fruit sweetener

(100% juice concentrate)

• Agave nectar • Rice syrup • Stevia Condiments: • Mustard (made with

apple cider vinegar) Beverages: • Herbal tea (non-‐

caffeinated) • Mineral water • Pure unsweetened

fruit or vegetable juices

• Spring water

One of the further difficulties with this diet during the removal phase is coming up with great tasting meals with plenty of variety. This tends to force people into eating a plain meat and veg diet which can result in poor dieting compliance with the protocol as people ‘fall off the wagon’ due to hunger and cravings. It is important to highlight the importance of variation and some creativity when following the protocol, so below are some ideas to stimulate your own creativity. Breakfasts:

• Cooked whole grain (oatmeal, cream of brown rice, buckwheat, teff, millet or quinoa) served with fresh or frozen fruit. Can add a bit of coconut, ghee, sweetener and/or cinnamon. To boost protein, have rice protein powder drink.

• Home-‐fried potatoes: Cut onions, peppers, broccoli, mushrooms and other vegetables of your choice into small pieces and sauté in olive oil or ghee. Cut pre-‐baked potatoes into cubes and add to vegetables. Add salt/pepper/herbs/spices.

• Fried rice: use recipe above. Add rice instead of potatoes. • Toasted rice or lentil flax bread with coconut oil or ghee, 100% fruit jam

or apple or pear butter, fresh fruit and herbal tea.


• Fruit smoothie: blend rice milk with fruit. Possible choices: berries, bananas, pears, pineapple, mango, papaya, etc. Add flax seeds or psyllium seeds as desired. Add fish oil as desired. Drink on its own or as part of a breakfast.

• Rice pancakes topped with apple butter or apple sauce or sautéed apples. • Cold rice or amaranth or other gluten-‐free cereal (read label carefully)

with fresh fruit (bananas, berries, pears, apples, etc) and rice milk. • Sweet potato delight, half a cantaloupe filled with blueberries or half a

papaya with lime juice. • Mochi rice waffles topped with sautéed apples and fruit smoothie with

rice protein powder. • Breakfast rice pudding, rice milk, berries.

Lunch or Dinner:

• Large salad with grilled chicken or fish. Serve with non-‐gluten-‐containing bread or baked potato or winter squash or boiled new potatoes.

• Broiled salmon plus streamed or oven-‐roasted vegetables with cooked millet or baked potato or sweet potato or quinoa salad. Can also add a salad with vinaigrette dressing.

• Asparagus soup(or other soup), cabbage salad, rice cakes with ghee, fresh fruit.

• Broiled lamb chop, green rice, cooked vegetables, fruity spinach salad. • Fruit salad with coconut/or pine nuts. Serve with protein and rice

crackers. • Broiled or poached halibut, baked winter squash sprinkled with

cinnamon and ghee, mixed green salad with vinaigrette dressing, mocha rice squares and fruit for dessert.

• Brown rice and grilled chicken, steamed greens, baked potato or sweet potato.

• Halibut salad: mixed greens of your choice, leftover halibut cut into chunks, vinaigrette dressing. Serve with baked potato with ghee.

• Chicken breast sprinkled with garlic powder and tarragon, steamed asparagus or broccoli, brown or wild rice or kasha, ghee or olive oil.

• Quinoa with chicken-‐vegetable soup or vegetable soup. • Quinoa salad: leftover chicken, mixed greens, guacamole, millet with pine

nuts. • Fresh tuna steak topped with herbs and broiled, rice pasta with olive oil

and mock pesto, steamed kale or collard greens tossed with olive oil and garlic and vinegar, mixed green salad with vinaigrette dressing. Fruit for dessert.

• Tuna salad: canned tuna mixed with vinaigrette or eggless mayonnaise, baking powder biscuits, fresh fruit.

• Roast turkey breast or broiled turkey burger, brown or wild rice, steamed vegetable, salad with vinaigrette. Baked apple or poached pear


• Turkey salad: leftover turkey breast, mixed greens, other fresh vegetables, lemon or oil and vinegar, rice crackers or baking soda biscuits, fresh fruit or cup of soup.

• Rice pasta primavera, pickled beets, mixed green salad with vinaigrette, leftover breakfast rice pudding topped with berries.

Snacks: • Rice cakes or crackers with ghee or unsweetened apple butter or coconut

oil, raw carrot • Guacamole on rice cakes • Vegetables dipped into guacamole • Baked apple • Poach pear

Again, it is important to avoid any foods that you know or believe may cause problems, even if they are on the ‘allowed’ list. Re-‐introduction Once symptoms have improved it is time to start ‘challenging’ the body with the eliminated foods. To challenge the body, add a food group every three days. It take three days to be sure that symptoms have time to come back if they are going to. On the day that the eliminated food is tested again for the first time, start with just a small amount in the morning. If there are no symptoms, eat two larger portions in the afternoon and evening. After a day of eating the new food, remove it, and wait for two days to see if you notice any symptoms. If a food doesn’t cause symptoms during the challenge, it is unlikely to be a problem food and can be introduced back into the diet. However, don’t add the food back until you have tested all the other foods on the list.


Below is a summary of the process just discussed; Day Number Step 1 Begin Elimination Diet 2-‐7 You may notice symptoms worse for a day or two 8-‐14 Symptoms should go away if the right foods have been removed 15 Re-‐introduce food #1 (for example, dairy) 16-‐17 Stop food #1 and watch the symptoms* 18 Re-‐introduce food #2 (for example, wheat) 19-‐20 Stop food #2 again and watch for symptoms 21 Re-‐introduce food #3 …and so on * you only eat a new food for one day. Do not add it back into your meal plan again until the elimination diet is over.

Throughout the removal and re-‐introduction phases it can be beneficial to keep a food log to track foods and possible symptoms in reaction to this. The following food diary can be used to help with this:-‐

A ONE WEEK FOOD DIARY CHART

Log in foods eaten and times. Note the symptoms you experience and at what times. DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7 MORNING FOODS

MORNING SYMPTOMS

AFTERNOON FOODS

AFTERNOON SYMPTOMS

EVENING FOODS

EVENING SYMPTOMS


Benefits And Negatives The key benefit from the elimination diet is it’s potential to reduce and even resolve any number of the health problems previously mentioned. It is one of the best options for those suffering from GI issues, and can even reduce the need for medication. When used for the right symptoms, it really can make people healthy. Another added benefit from following an elimination diet is the amount of biofeedback you get from your body in the process. By devoting a number of weeks to a detailed and restrictive eating plan you can learn a lot about how certain foods can affect you. This experience is a great tool for anyone who is interested in understanding how nutrition can work for them. You learn a lot more than any test or medication protocol can show you. The major downside to this is that it is hard. Even if you know that it may benefit a client, they may not want to do such a protocol due to its restrictiveness. Also, if a client ‘falls off the wagon’ at any stage, the whole process may be ruined. Many people notice that in the first week, especially in the first few days, their symptoms will become worse before they start to improve. If these continue, it’s important to see a medical practitioner. On some occasions people will find that they still cannot source the problem and they have to repeat the process using a number of different foods as their base. At this point, some testing may be of benefit. It is possible some clients will not go on to replace some of the eliminated foods and therefore missing out on adequate nutrition. For example, if a client gives up dairy, it is important to highlight a calcium supplement to replace this. Overall this is a perfect test. It can also be confusing and difficult to truly track all of the issues or the ‘trigger’ foods. The key is to be consistent throughout the protocol. Summary This article has shown you what an elimination diet is, how it works, and how to successfully apply it to your clients.


References And Further Reading

1. http://wholelifenutrition.net/programs/elimination-‐diet/ 2. http://www.fammed.wisc.edu/sites/default/files/webfm-‐

uploads/documents/outreach/im/handout_elimination_diet_patient.pdf 3. http://global.oup.com/us/companion.websites/9780195371109/pdf/00

_Mullin_Appendix_3.pdf

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