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Elimination Diets - By Tish Richardson
PhD. As mentioned in the article When
you react to food...allergy or intolerance?, a reaction to a food can be the
result of an ‘allergy’ or an ‘intolerance’ to the food - excluding, of course,
reactions such as food poisoning. Food intolerance is the more common food
sensitivity reaction and is more often diagnosed using some form of elimination
diet in the absence of a reliable, straightforward diagnostic or laboratory
test.
As the name suggests, the objective of an elimination diet is to ‘eliminate’
a suspect food from the diet; the diet usually comprises 2 phases. The first,
the elimination phase, involves totally excluding the food in all its forms from
the diet for a minimum of 7 days. Then, if the eliminated food is problematic,
the symptoms should have significantly improved or disappeared. The second phase
is the ‘re-introduction’ or ‘re-challenge’ when the eliminated food is
reintroduced—if the symptoms recur, it is likely that the food is the underlying
problem and treatment can be based on the subsequent exclusion of the culprit
food from the diet.
This may sound straightforward, but while elimination diets can be an
effective tool for identifying food sensitivities, they are by no means
foolproof; the results can be complicated or skewed by a number of factors.
These include:
- Problems with initial identification of a suspect food. Preliminary
identification of a suspect food often depends on a detailed food diary so
that symptom patterns can be correlated with ingestion of a food. This in
itself is often complicated by the very widespread use of food derivatives
in many commercially manufactured foods and ingredients (see section on
Avoiding ‘No-Go’ Foods and their Derivatives for examples). The suspect food
may, therefore, be ‘hidden’ and eaten in many more foods and meals than
would be obvious when the diet is first examined.
- The symptoms associated with eating a specific food. Food-evoked
symptoms can vary widely from one individual to another. For example,
ingestion of wheat and other gluten-containing grains as a routine part of
the diet may result in:
◦ local
reactions, such as bloating, gas and diarrhoea, or
◦ significant
changes to the lining of the bowel resulting in malabsorption and
nutrition, and associated chronic health problems
such as seen in coeliac disease,
or
◦ acute or chronic skin conditions
ranging from hives to eczema to dermatitis
herpetiformis’, or
◦ a combination of the
above.
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