Elimination Diet

[Jean]

The Elimination Diet
If you have food allergies and react violently when you come in contact with the offending food, this elimination diet is not for you. You should never knowingly ingest an allergen.

Some symptoms of food intolerances can indicate other, more serious medical conditions. Be sure that your physician has ruled out these possibilities before embarking on the elimination diet. I highly recommend that anyone considering the elimination diet talk to his or her doctor before beginning. With MC, you may have already learned that you doctor doesn't know about food intolerances. I don't think this diet can hurt you.

Phase I, Elimination Diet
At the first stage of this diet, it is important to eliminate every possible food offender. The reason for this very simple diet is twofold. First, by eating only a very few foods, there is no chance of accidentally ingesting a food being tested for. Second, this simple diet is a good way to let the gut heal quickly. Some of us Multiple Intolerants (MI's) go back to it whenever they are having trouble with their diet, or when they get sick for unknown reasons.

The foods allowed at this stage have been picked because they very seldom cause food sensitivities. They are easy to digest, and therefore easy on the gut. Ideally, your diet will only consist of chicken, potatoes, bananas and tea. I have exchanged potatoes for rice, an earlier version, because some of us have discovered rice intolerances.

The chicken should be fresh or frozen and plain. Be sure that nothing is injected into the chicken (Miller is good, Tyson is injected). You can prepare it by grilling, baking, boiling in water, or frying in a little olive oil (see below). It can be seasoned with salt and pepper. Potatoes can be baked, broiled, grilled or microwaved, with only salt and pepper added. Frying potatoes in olive oil is also acceptable. Eat only fresh bananas or dried ones with no additives or preservatives. Tea should be fresh brewed and without added flavoring. Unsweetened, unflavored bottled teas should be OK. Be sure to check that there are no ingredients besides tea and water (at the present time Nestea is OK, Lipton has citric acid added which is often made from corn). Any type of tea is fine, but I'd pick one or two and stick with them.

You will be eating only these foods for at least two weeks, so make sure that you like them and that they will be available. Water, salt, pepper, olive oil, applesauce, other fresh meats, and steamed green vegetables may also be added or substituted. Keep your diet as simple as you possibly can. If you hate chicken, by all means substitute beef. If you're a vegetarian exchange the applesauce for the chicken. You know your body and yourself best. Be sure that you pick foods that you will stick with. Don't eat anything during this part of the diet that you remotely suspect of having caused you trouble in the past. The more foods that you allow yourself at this stage, the more likely that you will miss a food intolerance.

It is wise to pick a time to start this diet when you don't have any upcoming events that will interfere. If you are going on a cruise in a week, you will probably want to wait until you get back. Nobody is that strong! Be sure that you are dedicated to getting through the testing phase. Start when you are mentally ready. A few short weeks will probably make a huge difference in your health. Keep that in mind when you are eating bananas again.

What about coffee? Ask yourself if you can live without it for a while. Have you tolerated it up to this point? Giving up coffee will probably cause withdrawal symptoms like headaches and fatigue. This may interfere with your tests. I drank it during the elimination diet. If you do, keep in the back of your mind that you may have to test it in the future. Of course, it is only allowable if it is black and unflavored.

How about cigarettes? Many changes take place in your body when you eliminate cigarettes. It would be very difficult to tell a food reaction from a nicotine withdrawal symptom. Now is not the time to quit smoking.

Medications can contain gluten, corn, diary and soy. Do not stop taking any prescription medications without your doctor’s approval. If you do find out that you have one or more of these four intolerances, check your medications after the elimination diet is over. There are usually alternate prescription drugs that are intolerance free. See the last chapter.

Over the counter medications, vitamins and supplements are another story. It is best to stop taking all of these while you are on the elimination diet. Most all of them contain corn and some contain soy, gluten and dairy. If you continue to take them, it may skew the results of the elimination diet. Do not take aspirin, ibuprofen or Tylenol (you may add these back in after you test corn and are sure that it’s not one of you intolerances).

Stay on this elimination diet for two weeks. If you feel that you are symptom free in less time, start the second phase. If, after two weeks, you don't feel like your symptoms have made enough improvement, stick to the diet for another week. After three weeks, there is concern about adequate nutrition. You may want to go back and try the gluten free diet until your symptoms improve enough to start the elimination diet again.

Cheating
No matter how tempted you are, you cannot cheat on the elimination diet. If you do, you will have to go back on the elimination diet and wait three days. When you are tempted to cheat, ask yourself if that particular food is worth three more days on the diet. I can't think of a food that is.

Phase II, Testing
When you have determined that you are ready to start testing foods, pick the one that you would like to try first. I would start with the top of the list below, or the one that you miss the most.

First thing in the morning, eat a good size serving of a pure form of that food and nothing else for at least two hours. Observe any reactions that you get in the next 48 hours. There will probably be no doubt in your mind that you are reacting. For some reason, after a food has been eliminated for a while, the reaction to it is more intense. Reaction symptoms that you can expect to experience include; bloating, gas, aches, pains, stomach cramps, diarrhea, constipation, heartburn, nausea, vomiting, fatigue, feeling feverish, dizziness, and foggy thinking.

When I did these tests, I noticed that I react to each offending food in a different way. When I eat gluten, I notice bloating and swelling in four hours. At exactly six hours, I get intestinal cramps followed by explosive diarrhea and sometimes vomiting. The diarrhea lasts for 24 hours and I am fatigued and achy enough to stay in bed for another day. At exactly 48 hours after I have ingested gluten, I feel great again.

The diary reaction is much quicker. I start aching within ten to fifteen minutes. Three hours later I have explosive, battery acid, diarrhea. That lasts for a few hours and then I ache for 48 hours.

Almost immediately after I ingest corn, I start aching and it lasts for 24 hours. I don’t get diarrhea, but I do get what is known among my multiple intolerant friends as puffy poop.

Soy causes a reaction in six to eight hours. I get diarrhea that is almost white in color. For the next 20 hours I feel faint and dizzy.

Your reactions will vary from mine. It’s a good idea to write them down. When you accidentally ingest one in the future, it will help you figure out which one it was.

A Reaction
If you do react when you test the first food, you have found one of your food intolerances. This is a good time to stomp your feet and wonder why you are so unlucky. Many of us on the board will offer our sympathies because we know what discovering an intolerance feels like. After that, go back on the elimination diet until you are symptom free. You should be able to try a new food every three days.

No Reaction
If, after 48 hours, you don’t have any noticeable reaction, Wahoo!!! Do a celebratory dance and tell everyone who will listen. You may now add that food back into your diet. Try the next food. Follow this procedure until you have exhausted your list.

Here is a list of possible food offenders to try and how to try them. They are in order of most likely to offend:

Gluten, eat a good size piece of matzo cracker (found in Jewish section of grocery store and is made from wheat flour and water)
Dairy-casein (milk protein), eat an ounce or more of an aged white cheese like mozzarella (yellow cheeses may contain coloring)
Dairy-lactose (milk sugar), if you reacted to the cheese, you can skip this step. If you didn’t react to the cheese, drink a glass of milk
Corn, eat an ear of fresh corn, or at least a ½ cup of canned corn packed in water and salt only. Don’t forget to leave off the butter.
Soy, eat a ¼ cup or more of roasted soybeans, found in the snack section of grocery and health food stores (soymilk and tofu contain corn or wheat)
Rice, eat at least a ¼ cup of cooked rice, do not use packaged rice with flavoring or enriched rice (may contain gluten or corn).
Egg, eat one hard-boiled egg
Yeast, try a ¼ teaspoon of bakers yeast free of gluten
Citrus, eat a whole orange or drink a glass of pure orange juice
Coconut, eat some pure coconut or drink some coconut milk
Chocolate, No, No! Not chocolate. Try a teaspoon of pure cocoa powder and pray.
Nuts, try each one individually. I'd recommend starting with peanuts and almonds. If you are allergic to nuts and have a violent reaction, DO NOT eat them.

Once you have tried all of the above, there may be other foods that you want to try. There may be a food that you have suspected in the past or one that someone in your family has a problem with. You’ve gotten this far; you might as well suffer through a few more days and try them all.

Phase III, Testing Complete
Congratulations! You have made it through a very difficult process. Be very proud of yourself. You have taken a big step to getting your health back. I know that if you made it through the elimination diet and testing process that you will be very good at eliminating your food intolerances from your diet. You deserve a prize and a big hug.

The amount of food that causes a reaction varies from one person to another. Food additives made from, say, corn may not affect one person who is corn intolerant, but may affect another. You will have to find your own threshold. Some multiple intolerant people report that after they have avoided an offending food for a year or two, they are able to eat small amounts of it without trouble. The jury is still out on wether we can ever safely eat a food again. Stay tuned to the board for further information, and definitely add your own!

Retesting
At some point it would be wise to retest the foods that you consider to be your intolerances. It is very important not to eliminate anything that you don’t have to. I have met people who have twenty or more items on their list. I am concerned that they are avoiding foods that they don’t have to. I wonder if they didn’t conclude that a food was an intolerance when really they were still too sick to get an accurate test result. If you have a long list, why don’t you wait until you have felt great for six months to a year and then test each item again. I would be especially suspicious of single items like chocolate, nuts, vegetables and meat. Gluten, dairy, soy and corn are much more likely to be true intolerances. You don’t have to go back on the elimination diet to test individual items, but be sure that you don’t eat anything new during the days you are testing. I hope you are pleasantly surprised!

To be truly scientific, each food intolerance should be double blind tested. That means someone should give you a food without either you or he/she knowing what it is. That food should be in a form that you can’t taste. I have not come up with an easy way to do this at home. Though, I have thought of filling capsules with each intolerated foods and sending them to people who want to be sure.

However, being on a diet like ours gives us plenty of opportunities to do the double blind test without even trying. No matter how careful you are you will occasionally eat a forbidden food. With a little detective work, you will probably be able to go back and figure out what it was. This is good time to pull out your list of reactions from the testing phase. It may help you determine what you accidentally ate. Reactions to offending foods tend to get less severe with time. Keep this in mind.

If Symptoms Return
Occasionally, you will have some symptoms return for a week or more. One of two things are happening; either you are coming in contact with one of your intolerances without knowing it, or a new intolerance is rearing its ugly head. If you are pretty sure you know what it is, eliminate that item until you are symptom free and then eat or use it again. If you react, you should probably retry it to be sure.

If this method doesn't work, your other option is to go back on the elimination diet. This time it shouldn’t take as long because you have experience recognizing a reaction. Two or three days may be all it takes to be well enough to start testing foods. Your list of suspects will be shorter too. It seems like I have to go back to this about every six months.

Good luck trying the elimination diet. Please keep us informed about your progress. This board is a tremendous place to get information and support.

Love, Jean

[coryhub]

Hi Jean,
I read your elimination diet and thanks, it is a really good guideline for me to follow. I just bought a blender and the Jack Lalane juicer last week but still don't know what I am safe to blend or make in them so your elimination diet gives me a starting place. I never knew some chicken is injected so I'll have to learn to watch for that. I have so much to learn. I love the different descriptions of BM's people use on this forum. Puffy Poop was a new one and it made me smile because I know exactly what that is, I have a movement I've nicknamed "floaters". Yes, I need to order the Potty People T-shirt. I'm so glad to find a forum where I'm not embarrassed to discuss things that are such an every day reality in my life.

[blackcatjordie]

You said that steamed green vegetables could be added. What would be the best ones to start with. Would spinach work.

[coryhub]

I'm curious too about the green vegetables because I tried brussel sprouts last week and had an awful time with them.

[Lesley]

Heartburn has become so bad I need to give up F&V, juicing etc. I was tolerating it well, but along with the constipation, it's now become unbearable.
I actually had a terrible reaction to a banana. Pain and nausea were terrible. But I still a struggling with the constipation.
So! Tomorrow I start the elimination. I have to find out what my sensitivities are. It's quite literally a pain in my rear end, but there is no choice.

Questions - is a light white fish acceptable alongside chicken breasts? Or will one more food mess up the testing? What veggies are OK?

[tex]

Hi Peggy, Cory, and Lesley,

Jean was able to achieve remission and maintain it by diet alone, years ago, so it has been several years since she has posted. Hopefully, she's enjoying life, now.

To answer your questions, (as best I can - remember that we're all different in our responses to some foods, drugs, etc.):

Spinach might work, though a few members have problems with it. Spinach is high in oxalic acid, which can act as a stimulant for the peristaltic action by which the intestines move food along, (IOW, spinach can increase motility). It is also claimed to be a cause of kidney stones, for some people. Quite a few members seem to have problems with foods high in oxalic acid, until after their gut heals. Foods which are low in oxalic acid include foods such as avocado, apples and apple juice, bananas, cherries, cabbage, cauliflower, peas, etc.

As I said, we are all different, but most of us seem to be able to tolerate vegetables such as squash, broccoli, green beans, cauliflower, etc. Cabbage and broccoli tend to generate some gas, which can be a problem for some people who are in a flare, (IOW, they can make the bloating worse). Vegetables should always be peeled, (to remove most of the fiber), and over-cooked, (to make them easier to digest). There are other possible choices - I don't claim to be a dietitian.

Brussels sprouts are a descendent of wild cabbage, so they have the same gas issues as cabbage. Other than that, they should safe for anyone who is not having gas issues, so long as they're well-cooked.

Bananas are mostly fiber, and so they pass into the colon mostly undigested, (I think I read somewhere that they pass through the small intestine something like 85% undigested), where they are usually fermented by bacteria in the colon. I eventually had to stop eating bananas, (or at least minimize my intake), for that reason, until my gut was able to do some healing.

Most fish are generally safe, (except for some canned fish that contain soy oil, or some other off-limits ingredients). By "safe", I'm not referring to mercury levels, or any other possible ocean, bay, or river contaminants - I mean "safe" in the sense of not causing an autoimmune reaction for someone with MC. Baked fish, should be an excellent and safe food, during an elimination diet, (unless you happened to be allergic to certain types of fish or seafood to begin with). Most of us can also eat pork, (being careful that we don't buy injected pork), lamb, turkey, duck, goose, bison, elk, venison, etc. A few members react to beef, and even fewer react to chicken. For anyone who reacts to chicken, turkey is usually a workable substitute.

Sorry that I missed these posts earlier, (and apparently so did everyone else). Since this isn't actually an active discussion forum, if you don't get responses to your questions in this forum, please feel free to post them on the Main Message Board, or in the forum at the link below, or one of the other forums in that group:

http://www.perskyfarms.com/phpBB2/viewforum.php?f=47

Tex

[Lesley]

I don't know why I am still not getting notifications, but at least I can see the posts and replies.

Thanks for that. I am really struggling at the moment, and I appreciate all the help more than I can say.

[tex]

Lesley,

If you want the system to notify you, (by e-mail), whenever there is a reply to one of your posts, you need to go into your profile, and under the "Preferences" category, select "Yes" to the option, "Always notify me of replies". If you can't locate it, I'll be happy to change it for you, if you just let me know that you want me to change it.

I hope you start feeling better soon.

Tex

[coryhub]

Thanks Tex, I never thought about it but Brussels sprouts would be similar to cabbage which I don't eat except when I juice it with carrots and oranges. YUM!
I made my first loaf of gluten-free bread in the bread maker Sunday. It turned out real good. Hard clean up as the ingredients were more gooey. What made it so good and tasty was the buckwheat flour. I'm going to post the recipe.

[tex]

Cory,

Good for you. Making good gluten-free bread is an art. That sounds like an interesting recipe. I don't recall ever seeing a bread recipe that uses buckwheat flour.

Tex

[Stephanie]

So, I just joined your group. I have been reading the boards for a few weeks though!
I have decided to start the elimination diet in a few weeks. I was diagnosed with CC and CD during a colonoscopy just over a year ago. My GI doc made it seems that CD was the big issue and the MC was minor and would be solved by going gluten free. I have been GF for over a year and only had about 2-3 months of somewhat normal poops. I have been on entrocort twice (currently on it now and it's doing nothing). Also tried Olystr and Sucralfate and live on Immodium and Petpto. Nothing is helping me so I think this diet is my next step. I started taking Cymbalta just after my diagnosis, but have made an appointment for next Friday to try to come off of it. I am wondering, after reading some of your posts, if it may be making my CC worse.

I am 35 years old, married and have three kids (2,4,6 years old). I have also been a type 1 diabetic for almost 30 years. I am always tired and cranky and pooping. I just want my life back and be a fun mom again. Thanks for this group and all the information!

Stephanie

[tex]

Hi Stephanie,

Welcome to our Internet family. Your doc seems to be confused about MC. MC is actually a rather complex and debilitating disease, and in general, it is very poorly understood by the medical community. Most of us find that controlling celiac disease is a walk in the park compared with controlling MC. Only having to avoid gluten in order to maintain remission is something that many of us can only dream about.

There's a very good chance that Cymbalta might prevent you from being able to achieve remission, because it is a relatively common cause of MC. Not all MC patients are affected by it, but a relatively high percentage of us seem to be. There are a number of other drugs that can also trigger MC, and the problem with them is that it is virtually impossible to reach remission while taking them, even if we do everything else right. IOW, various triggers of the disease almost always trump even the best of treatments, so we have to avoid at least the major triggers.

Regarding the lack of effectiveness of Entocort in certain cases, here is what my research of the medical literature indicates: Corticosteroids apparently work by expressing vitamin D receptors (VDRs) in inflamed tissue. The inflammation is then suppressed by the active form of vitamin D, after it attaches to the vitamin D receptors. Attachment activates the VDRs, thereby allowing the immune system to take additional actions to suppress the inflammation. Here's the point of all this, and remember that this is not medical advice, because I am not an MD, and this theory is strictly mine, and it has not yet been verified by medical research.

If the mechanism of action for the corticosteroid/vitamin D interaction as described above is correct (and that part has indeed been verified by published medical research), then it follows that maintaining an adequate blood level of vitamin D should allow corticosteroids to work at optimum effectiveness. It is known that corticosteroids deplete vitamin D levels (because they cause it to be used up for fighting inflammation). Therefore, when taking a corticosteroid, it would appear to be a very good idea to take additional supplemental vitamin D, in order to prevent the available supply of vitamin D from becoming deficient (and preventing the corticosteroid from working). At least one member here, whose mother's Entocort had stopped working for her, verified that increasing her vitamin D intake did indeed allow the Entocort to become effective again.

It's also worth noting that not only does a vitamin D deficiency greatly increase the chances of developing an IBD, but all IBDs deplete vitamin D (because vitamin D is consumed by the immune system as it tries to suppress inflammation). You are probably already aware that celiac disease is also an IBD, although most doctors don't seem to even be aware of that fact. Have you had your vitamin D level checked recently?

However, please be aware that in many cases, even when working optimally, Entocort is not always able to overcome the inflammation generated by food sensitivities that remain in the diet. IOW, most members here find it necessary to remove their food sensitivities from their diet in order to control their symptoms, even when they use Entocort (but the Entocort will bring remission from symptoms faster than diet changes alone, making life much easier while the diet changes slowly heal the gut).

You seem to be on the right track to get your life back. Again, welcome aboard, and please feel free to ask anything.

Tex

[Stephanie]

Tex,

Thanks for you help! The Entocort worked the first time I used it, but this time....nothing. I will try increasing my vitamin D. I am currently taking 2000ui daily. How much should I increase it by? I have not had any blood work done since diagnosis a year ago. When I go in to get off the Cymbalta, I will ask to have all my levels checked.

After reading a lot of posts on this site, I decided to order your books today. I am excited to learn more about CC as over the last year I have mainly been focused on the celiac disease and not my colitis. In retrospect, I think most or all of my issues are CC related, and not from the CD!

Thanks once again. I am eager to learn as much as I can!

[tex]

I will try increasing my vitamin D. I am currently taking 2000ui daily. How much should I increase it by?

According to the Vitamin D Council, normal people typically use around 5,000 IU of vitamin D daily, and anyone who has an IBD uses much more. Without test results to go by, we can only guess, but as far north as you live, you cannot derive any significant amount of vitamin D from sun exposure this time of year, so I would add at least 2,000–3,000 IU per day, if I were in that situation. After you receive your test results you can adjust your dosage up or down, depending on what the results show.

There is a lot of information in the MC book that should be helpful for understanding and treating both celiac disease and MC. I hope that you find it to be very, very beneficial.

Many people seem to find the vitamin D book difficult to read, so I am in the process of rewriting it to hopefully make it easier to read. The information will be the same, but I'm trying to add more detail and more explanations to make the information easier to understand.

If you would like to have a copy of the revised edition, if you will remind me after I get it completed, I'll be happy to send you a revised copy free of charge.

You're very welcome. As they say, "Knowledge is power", and with MC especially, the more we learn about the disease, the sooner we are able to get our life back.

Tex

[nerdhume]

Tex said:

Regarding the lack of effectiveness of Entocort in certain cases, here is what my research of the medical literature indicates: Corticosteroids apparently work by expressing vitamin D receptors (VDRs) in inflamed tissue. The inflammation is then suppressed by the active form of vitamin D, after it attaches to the vitamin D receptors. Attachment activates the VDRs, thereby allowing the immune system to take additional actions to suppress the inflammation. Here's the point of all this, and remember that this is not medical advice, because I am not an MD, and this theory is strictly mine, and it has not yet been verified by medical research.

If the mechanism of action for the corticosteroid/vitamin D interaction as described above is correct (and that part has indeed been verified by published medical research), then it follows that maintaining an adequate blood level of vitamin D should allow corticosteroids to work at optimum effectiveness. It is known that corticosteroids deplete vitamin D levels (because they cause it to be used up for fighting inflammation). Therefore, when taking a corticosteroid, it would appear to be a very good idea to take additional supplemental vitamin D, in order to prevent the available supply of vitamin D from becoming deficient (and preventing the corticosteroid from working). At least one member here, whose mother's Entocort had stopped working for her, verified that increasing her vitamin D intake did indeed allow the Entocort to become effective again.

I am still researching the VDR issue because I have that gene mutation.
I am thinking this may be why Entocort sometimes doesn't work as well after the 1st time around. Maybe the first round used up the vit D resources? Seems like Uceris worked quicker for me after taking additional vit D. Now I can take 1 Uceris and get right back to remission.