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ALLERGY ELIMINATION DIET “A” (easier version)


Prepared by Alan R. Gaby, M.D. (modified from Tracking Down Food Allergies by William Crook, M.D.)

Purpose: To identify hidden food allergens that may be causing some or all of your symptoms. During the elimination period, all common allergens are completely eliminated from the diet for 7-21 days. After your symptoms improve, foods are added back, one at a time every 1-2 days, to determine which foods provoke symptoms. Symptoms will usually return within 24 hours, but it may take up to 48 hours to see a reaction.

FOODS YOU MAY EAT


Cereals - Oat meal, oat bran, cream of rye, rice and shine, puffed rice, puffed millet, Oatio's (wheat-free), Good Shepherd (wheat-free), Crispy Brown Rice Cereal, puffed rice cereal. Diluted apple juice with apple slices and nuts go well on cereal. Read the ingredients carefully. Also, may use almond nut milk. Most of these foods are available in health food stores.

Grains and flour products - 100% rice cakes, rice or rye crackers; any 100% rye or spelt bread with no wheat; Oriental noodles, such as 100% buckwheat Soba noodles; rice, potato, buckwheat, and bean flour rice or millet bread (as long as they do not contain dairy, eggs, sugar, or wheat); cooked whole grains including oats, millet, barley, buckwheat groats (kasha), rice macaroni, spelt (flour and pasta) brown rice, amaranth, quinoa. Most of these grains are available at health food stores or Whole Foods.

Legumes (beans): Lentils, peas, chickpeas, navy beans, kidney beans, black beans, string beans, and others. Dried beans should be soaked overnight Pour off the water and rinse before cooking. Canned beans often contain added sugar or other potential allergens. Some cooked beans packaged in glass jars, sold at the health food store, contain no sugar. Read labels. May also use bean dips without sugar, lemon or additives. Canned soups include split pea and lentil soup (without additives).

Vegetables - Use a wide variety. All vegetables except com and tomatoes are permitted. This includes artichokes, asparagus, bamboo shoots, bean sprouts, all peppers, broccoli, broccoflower, brussel sprouts, cabbage of all types, cauliflower, celery, chives, cucumber, egglplant, garlic, green beans, greens and lettuces (bok choy, kale, romaine, endive, arugula, escarole, swiss chard, collards spinach, dandelion, mustard and beet greens, red and green leaf lettuce, radicchio, watercress, chicory, iceberg, others). Mushrooms, okra, onion radishes, scallions, sea vegetables, snow peas, sprouts, squash (yellow, butternut, acorn, spaghetti, summer, pumpkin, zucchini, water chestnuts.

Proteins – Poultry of all kinds and fowl, fresh fish (such as tuna and salmon, packed in spring water). Shrimp and most canned orpackaged shellfish (such as lobster, crab, oysters) may contain sulfites and should be avoided. Canned tuna, salmon and other canned fish are OK.. Pork may be eaten unless specified otherwise. Lamb rarely causes allergic reactions, and may be used even when other meats are restricted. Also recommended are grain/bean casseroles (recipes in vegetarian cookbooks).

Nuts and seeds - Nuts and seeds, either raw or roasted without salt or sugar. To prevent rancidity, nuts and seeds should be kept in an air-tight container in the refrigerator. May use nut butters from health food stores or from fresh ground nuts (this includes almond, cashew, walnut, and sesame butters, and sesame tahini). Nut butters go well on celery sticks and crackers.

Oils and fats - Sunflower, safflower, olive, sesame, peanut, flaxseed (edible linseed), canola oils. Use cold-pressed or expeller-pressed oils (available from health food stores) as they are safer for the heart and blood vessels. Do not use corn oil or "vegetable oil" from an unspecified source, as this is usually corn oil. Sunflower or safflower margarine is OK from an allergy standpoint, but we do not consider margarine a desirable food, as there is evidence it may promote heart disease. It is acceptable to use margarine during the elimination and testing period. However, if you are not allergic to butter, we recommend it instead of margarine, once you have completed food testing. Also suggested are vegetable and bean spreads, instead of butter or margarine.

Snacks - Any food can be eaten as a snack, any time of day. Also celery, carrot sticks or other vegetables; fruit in moderation (no citrus); unsalted fresh nuts and seeds; Barbara's Granola Bars (from health food stores); wheat-free cookies (check ingredients).

Beverages - Herb teas (no lemon or orange); spring water in glass bottles or clear plastic, seltzer (salt free); Perrier; pure fruit juices without sugar or additives (dilute 50:50 with water); almond nut milk (Nut Quick); Cafix, Inka and Roma may be used as coffee substitutes. Tap water contains chlorine, fluoride and other potentially allergenic chemicals. In some cases, distilled or spring water in glass bottles is the only water allowed. This includes water for cooking. If tap water is eliminated, it should be reintroduced as if it were a test food. Restrictions on the type of water permitted will be made on a case by case basis. Filtered tap water allowed? Yes_____ No______

Thickeners - Rice, oat, millet, barley, or amaranth flours; arrowroot, agar.

Spices and condiments - Salt in moderation; pepper, herbal spices without preservatives, citrus or sugar; garlic ginger, onions; catsup and mustard from the health food store (without sugar); wheat-free tamari sauce; Bragg liquid aminos; vitamin C crystals in water as a substitute for lemon juice. Agave nectar may be used as a sweetener.

Miscellaneous - Sugar-free spaghetti sauce; fruit jellies without sugar or citrus; soups such as split pea, lentil, turkey/vegetable, etc.

FOODS YOU MUST AVOID:



Soy - soybeans, tofu, miso, soybean oil, soy sauce, soy protein isolate

Dairy Products - milk, cheese, butter yogurt, sour cream, cottage cheese, whey, casein, sodium caseinate, calcium caseinate, any food containing these.

Wheat - most breads, biscuits, bagels, crackers, spaghetti, noodles, pasta, most flour, baked goods, durum semolina, farina, and many gravies, etc.

Corn - including any product with com oil, vegetable oil from an unspecified source, com syrup, com sweetener, dextrose, glucose, com chips, tortillas, popcorn

Eggs - avoid whites and yolks, and any product containing eggs

Chocolate – anything with cocoa in it

Citrus fruits - oranges, grapefruits, lemons, limes, tangerines and foods containing citrus. (Small amounts of lemon or lime juice may be used for flavoring.) Tomato products (juice, V8, pasta sauce, etc.)

Coffee, Tea, Alcohol - must avoid both caffeinated and decaffeinated coffee, as well as standard (such as Lipton) tea and decaffeinated tea. Herb teas are OK.

Yeast-containing products or fermented products such as vinegar and wine.

Refined sugars - including table sugar and any foods that contain it; candy, soda, pies, cake, cookies, etc. Other names for sugar include sucrose, glucose, dextrose, com syrup, com sweetener, fructose, maltose, and levulose. These must all be avoided. Some patients will be allowed 1-3 teaspoons per day of pure, unprocessed honey, maple syrup or barley malt This will be decided on an individual basis. Those restricted from all sugars should not eat dried fruit. Others may eat unsulphured (organically grown) dried fruits sparingly.

No more than 3 teaspoons of Honey, Maple, Agave Nectar, or Barley syrup

Food additives - including artificial colors, dyes, flavors, preservatives, texturing agents, artificial sweeteners, etc. Most diet sodas and other dietetic foods contain artificial ingredients and must be avoided. Grapes, prunes, and raisins that are not organically grown contain sulfites and must be avoided.

Any other food you eat more than three times a week

Known allergens

Unfiltered Tap water (includes cooking water). You may have water that is bottled in glass or heavy plastic. Water bottled in soft (collapsible) plastic containers tends to leach plastic into the water and are best avoided. Some water filtration systems do not take out all potential allergens. Take your water with you, including to work or restaurants.

Read labels! Hidden allergens are frequently found in packaged foods. "Flour" usually means wheat; "vegetable oil" may mean com oil; and casein and whey are dairy products. Make sure your vitamins are free of wheat, com, sugar, citrus, yeast, and artificial colorings. Vary your diet, choosing a wide variety of foods. Do not rely on just a few foods, as you may become allergic to foods you eat every day.

GENERAL SUGGESTIONS

Do not restrict your calories! Start with a good breakfast, eat frequently throughout the day, and consume at least 4 glasses of water per day. If you do not eat enough, you may experience symptoms of low blood sugar, such as fatigue, irritability, headache, and too-rapid weight loss. To ensure adequate fiber, eat beans, permitted whole grains, whole fruits and vegetables, homemade vegetable soup, nuts and seeds. Be sure to chew thoroughly, in order to enhance digestion.

Plan your meals for the week. Take a list with you to the health food store. If your schedule is very busy and it is hard to think of what to fix, take some time before starting the diet to make a list of all of your favorite types of foods and possible meal plans. For ideas, look through cookbooks that specialize in hypoallergenic diets. Most meals can be modified easily to meet the requirements of the diet, without changing the meal plan for the rest of your family. When you go to the health food store, ask for assistance in locating "allowed" versions of breads, crackers, cereals, muffins, soups, etc. Some people find it helpful to prepare additional foods on the weekend, to cut down on thinking and preparation time during the week. If you need further assistance, talk with your diet counselor.

Dining out - Do not hesitate to ask questions or make requests. For instance, you could ask for fish topped with slivered almonds, cooked without added seasoning, butter or lemon. Get baked potato with a slice of onion on top. Order stead or lamb chops with fresh vegetables, also prepared without added seasoning (with the exception of garlic and plain herbs). Use salad bars that do not use sulfites as a preservative, and bring your own dressing (oil and cider vinegar with chopped nuts/seeds and fresh herbs). Get into the habit of carrying pure water, snacks, seasonings, etc. wherever you go, to supplement your meals or to have something on hand if you start to get hungry.

Withdrawal symptoms - About one in four patients develops mild "withdrawal" symptoms within a few days after starting the diet. Withdrawal symptoms may include fatigue, irritability, headaches, malaise, or increased hunger. These symptoms generally disappear within 2-5 days and are usually followed by an improvement in your original symptoms. If withdrawal symptoms are too uncomfortable, take buffered vitamin C (calcium ascorbate - 1,000 mg in tablet form or V* teaspoon of die crystals, up to 4 times a day) or % teaspoon of "alkali salts" (2 parts potassium bicarbonate, 1 part sodium bicarbonate) Alka-Aid 2-3 tabs in water as needed up to 3 times a day for several days. These products maybe obtained from the office. In most cases, withdrawal symptoms are not severe and do not require treatment It is best to discontinue all of the foods abruptly (cold turkey), rather than easing into the diet slowly.

Testing individual foods: It may take 3 weeks for symptoms to improve enough to allow you to retest foods. However, you may begin retesting after 2 weeks if you are sure you are feeling better. If you have been on the diet for 4 weeks and feel no better, contact the office for further instructions. Most patients do improve. Some feel so well on the diet that they decide not to test the foods. This could be a mistake. If you wait too long to retest, your allergies may "settle down" and you will not be able to provoke your symptoms by food testing. Then, you will not know which foods you are allergic to. If reintroducing certain foods causes a recurrence of symptoms, you are probably allergic to those foods.

Food sources for testing. Test pure sources of a food. Example: do not use pizza to test cheese, because pizza also contains wheat and corn oil. Do not use bread to test wheat, as it contains other ingredients. Organic sources are the best to use for testing, as you will not experience interference from pesticides, hormones or other additives which may be used in commercial preparations.

Test one new food each day. If your main symptom is arthritic pain, test one new food every other day. Allergy reactions to test foods usually occur within 10 minutes to 12 hours after ingestion. However, joint pains may be delayed by as much as 48 hours.

Eat a relatively large amount of each test food. For instance, on the day to test milk, add a large glass at breakfast along with any of the other foods on the 'permitted' list. If after one serving, your original symptoms come back, or if you develop a headache, bloating, nausea, dizziness, or fatigue, do not eat that food any more and place it on your "allergic" list. If no symptoms occur, eat the food again for lunch and supper and watch for reactions. Even if the food is well tolerated, do not add it back into your diet until you have finished testing all of the foods. If you do experience a reaction, wait until your symptoms have improved before testing the next food. If you wake up the next morning with head or joint pain, nausea, or any other suspicious symptom, you may be experiencing a delayed reaction to the food you tested the day before. If you are uncertain whether you have reacted to a particular food, remove it from your diet and retest it 4-5 days later. You do not have to test foods you never eat. Do not test foods you already know cause symptoms.

Foods may be tested in any order. Begin testing on a day you are feeling well (without colds, unusual headaches, flu). Review the list of symptoms to watch for and keep a journal of how you feel.

Dairy test - Test milk and cheese on separate days. You may wish to test several cheeses on different days, since some people are allergic to one cheese but not another. It is usually not necessary to test yogurt, cottage cheese, or butter separately.

Wheat test – Farina or Cream of Wheat or Shredded Wheat (with no milk or sugar) or another pure wheat cereal. May add nut milk or rice milk.

Corn test - Use fresh ears of corn or frozen corn (without sauces or preservatives).

Egg test - Test the whites and yolks on separate days, using hard boiled eggs.

Citrus test - Oranges, grapefruits, lemons, and limes. Test these individually on four separate days. The lemon and lime can be squeezed into Perrier or seltzer. In the case of orange and grapefruit, use the whole fruit.

Frequently eaten foods - Test tap water, if you have eliminated it, followed by those foods you have restricted (such as foods being consumed more than three times a week.

Optional tests - The following foods and beverages are considered undesirable, regardless of whether or not you are allergic to them. If any of them are not now a part of your diet, or if you are fully committed to eliminating them from your diet, there is no need to test them. However, if you have been consuming any of them regularly, it is a good idea to test them and find out how they affect you. Reactions to these foods and beverages may be severe in some cases. They should be tested only on days that you can afford to feel bad.

Coffee and tea tests (separate days) - Do not add milk, non-dairy creamer or sugar. May add soy milk. Coffee, tea, decaffeinated coffee and tea are separate tests.

Sugar test - Put 4 teaspoons of sugar in a drink or on cereal, or mix with another food.

Chocolate - Use 1-2 tablespoons of pure baker's chocolate or Hershey's cocoa powder

Soy - tofu, soy milk, soybean

Alcohol test (test this last) - Beer, wine, and hard liquor may require testing on different days, as the reactions to each may be different. Have 2 drinks per test day, but only if you can afford not to feel well that day and possibly the next day.

Food additive test - Buy a set of McCormick's or French's food dyes and colors. Put 1/2. teaspoon of each color in a glass. Add one teaspoon of the mixture to a glass of water and drink. If you wish, you may test each color separately.

AFTER THE TESTING IS FINISHED, IT IS TIME TO RETURN TO THE DOCTOR'S OFFICE FOR A FOLLOW UP VISIT. When you are within 10 days or so of completing your testing call the office for an appointment. If you have been keeping a food and symptom journal, bring it with you, so you may review your experiences with the doctor.

Suggestions for ongoing self-help, if you are allergic to foods: Rotation diets: If you have an allergic constitution and eat the same foods every day, you may eventually become allergic to them. After you have discovered which foods you can eat safely, make an attempt to rotate your diet. A four day schedule is necessary for some severely allergic patients, but most people can tolerate foods more frequently than every four days. You may eventually be able to tolerate allergenic foods, after you have avoided them for 6-12 months. However, if you continue to eat these foods more frequently than every fourth day, the allergy may return.

Use common sense and consume a wide variety of foods. Do not just latch onto a few favorites. If you are rotating foods, be sure to avoid all forms of the food when you are on an "off” day. For instance, if you are rotating corn, be sure to avoid com chips, com oil, com sweeteners, etc., except on the days that you are eating com and com products. It is not necessary to do strict food rotation during the elimination and retesting periods.

Watch for other allergic reactions: If you have an allergic constitution, you may be allergic to foods other than those you have eliminated and tested on this diet. Pay attention to what you are eating and if you develop symptoms, review your recent meals and try to identify what may be different in what you have eaten. You can then eliminate that food for two weeks and test it again to see if you can provoke the same symptoms.

SYMPTOMS THAT MAY BE DUE TO FOOD ALLERGY: General: Fatigue, anxiety, depression, insomnia, food cravings, obesity
Infections: Recurrent colds, urinary tract infections, sore throats, ear infections, yeast infections.
Ear, nose and throat: Chronic nasal congestion, postnasal drip, fluid in the ears, Menieres syndrome.
Gastrointestinal: Irritable bowel syndrome, constipation, diarrhea, abdominal cramping, ulcerative colitis, Crohn's disease, gallbladder disease.
Cardiovascular: High blood pressure, arrhythmia, angina.
Dermatologic: Acne, eczema, psoriasis, canker sores (aphthous ulcers), hives
Rheumatologic: Muscle aches, osteoarthritis, rheumatoid arthritis.
Neurologic: Migraines and other headaches, numbness.
Miscellaneous: Asthma, frequent urination, teeth grinding, bedwetting, infantile colic.
Note: most of these disorders have more than one cause, but food allergy is a relatively common and frequently overlooked cause.

ADDITIONAL READING:

Allergy Self Help Cookbook
Recipes From an Ecological Kitchen
If It's Tuesday, It Must Be Chicken (primer on rotation diets)
Detecting Your Hidden Allergies, W. Crook
Allergy-Free Cooking, E. Yoder
5 Years Without Food, The Food Allergy Survival Guide, Dumke
Allergy and Candida Cooking Made Easy, Understanding and Implementing Plans for Healing, by Sondra Lewis*
The Whole Way to Allergy Relief and Prevention, J. Krohn, MD*
Allergy Recipes, Sally Rockwell, MD*
Allergy-free Cooking, How to survive the Elimination Diet and Eat Happily ever after, by E.R. Yoder, Ph.D.
Food Allergy Field Guide, A lifestyle manual for Families, by Theresa Willingham
Food Allergy Survival Guide, Delicious Recipes and Complete Nutrition, by V. Melina, J. Stepaniak, and D. Aronson
Breaking the Vicious Cycle, Elaine Gottschall (about the effects of disaccharides on bowel disease)
The Impossible Child, Doris Rapp, MD, avail from PARF (Practical Allergy Research Foundation)
Help For the Hyperactive Child, Dr. William Croook.
Why Can’t I Eat That?, John Taylor/R. Sharon Latta (Helping Kids Obey Medical Diets)