Elimination Round

Identify food intolerances with this easy diet.
By Matthew Kadey, RD

For more years than she cares to remember, La Vaughn Kemnow, 73, of Chiloquin, Oregon, was plagued by unrelenting stomach ailments—heartburn, bloating, sharp pain—along with extreme mental and physical fatigue. Whatever virus or bug happened to be floating around, Kemnow would catch. “Eventually I got so sick, I had to quit my job and rely on my aging mother to do all my shopping,” she says. Looking for answers, Kemnow visited her family doctor, who diagnosed her with a bad case of “tired housewife syndrome.” Eventually, suspecting the culprit to be something in her everyday environment, she made an appointment with an allergy specialist, who recommended an elimination diet, or a nutrition plan in which foods commonly consumed are temporarily removed in order to diagnose low-grade food intolerances. After eliminating gluten and dairy, Kemnow recalls, “almost instantly, I felt better than I had in years,” and she had the answer to her health problems.

Utter the words food intolerance and the first thing that may come to mind is a life-threatening reaction to peanuts or shellfish. But these responses are food allergies, or immune-system reactions that produce “immediate, often localized reactions, such as hives or breathing difficulty,” says Melinda Ring, MD, medical director of the Center for Integrative Medicine and Wellness at Northwestern Memorial Physicians Group in Chicago. Because reactions are often severe, food allergies are usually diagnosed in childhood.

In contrast, says Ring, “a food intolerance is a low-grade reaction such as bloating or fatigue that may not be immediate or even always occur.” For example, a cup of milk for lactose-intolerant people—a demographic that includes 30 million to 50 million Americans—may unleash crippling stomach pain or have no effect at all. Because symptoms vary and the etiology is often unclear, many sufferers like Kemnow can remain undiagnosed for years.

Although data varies, some studies suggest that more than 20 percent of Americans suffer food intolerances to dairy, corn, soy, eggs, or gluten, in addition to other foods and additives. Why are food intolerances so prevalent? Theories abound, but imbalances in gut flora due to too little fiber (in addition to other poor dietary habits) and too many antibiotics and environmental toxins can disrupt both digestion and immunity, says Kelly Morrow, RD, assistant professor in the Department of Nutrition and Exercise Science at Bastyr University in Kenmore, Washington. “Sixty percent or more of our immune system lives in our gut, and a healthy gastrointestinal (GI) tract is vital for healthy immunity,” she says. “Some chemicals in our food, water, air, personal and cleaning products, and environment can have a negative impact on our immune system.” Intolerances to added chemicals in food have also been linked to the increase in food sensitivities. In addition, although experts agree further research is needed on the relationship between genetically modified organisms (GMO) and food intolerances, some think that GMO grains and vegetables have increased the prevalence of food sensitivities.

According to Jared Hanson, ND, a naturopath in New York City, food intolerances can cause a maze of symptoms, including weight loss or gain, chronic fatigue, migraines, muscle aches, asthma, insomnia, food cravings, nasal and sinus problems, frequent infections, infertility, skin reactions (rashes, acne, eczema), and a number of intestinal problems. “Left untreated, symptoms may become osteoporosis, arthritis, fibromyalgia, ulcerative colitis, Crohn’s disease, and depression,” says Hanson. Remarkably enough, though, curing symptoms is often as simple as a few easy nutritional changes. Follow these four steps for better health and dietary happiness.

1. Cut the right foods
For at least two weeks, eliminate all dairy, corn, soy, eggs, and gluten, along with any foods, drinks, or supplements that contain citrus (citric acid), peanuts (which can contain mold), alcohol, refined sugars (including high-fructose corn syrup), artificial sweeteners, yeast, and caffeine. Also steer clear of multi-ingredient foods that you eat every day or to which you feel “addicted,” says Hanson, as well as highly processed foods that contain preservatives, dyes, or flavorings like monosodium glutamate. If you’re battling inflammatory conditions such as arthritis or lupus, Hanson also suggests eliminating nightshade vegetables­—tomatoes, peppers, potatoes, and eggplant—which may increase inflammation.

During an elimination diet, it’s crucial to adhere to the plan. “Even tiny amounts of an ingredient can cause reactions to continue, thereby invalidating the test,” Hanson says. Compile a thorough list of ingredients to avoid, and read labels as if you were Sherlock Holmes. Stock up on allowed foods—quinoa, berries, hemp milk, walnuts, wild salmon, and budget-friendly lentils—to ensure your diet is packed with necessary nutrients. “If you eat a variety of allowed foods, you will cover all your nutritional bases and probably become a healthier eater over the long run,” Hanson says.

You may experience flu-like symptoms in the first few days of an elimination diet as your body goes through withdrawal from caffeine, sugar, or other addictive substances. Allay symptoms by staying hydrated, practicing deep breathing, and exercising, Hanson says.

2. Scribble it down
Morrow advises keeping a food journal for the duration of any elimination diet. Write down all foods, drinks, and supplements; time of day and amount consumed; and any symptoms you experience, in order to help your healthcare provider follow your progress. “By keeping a food journal, you can pinpoint your own slip-ups and quantify how and when symptoms change,” Morrow says.

3. Keep it simple
It can be difficult to stick to an elimination diet if you regularly dine out or eat packaged convenience foods. For best results, Hanson suggests a three-step plan: “Eat whole foods like brown rice and beans; take time to carefully plan a safe-foods-only menu; and prepare almost all of your own meals.” he says. If your budget allows, Hanson endorses eating organic to reduce your exposure to pesticide residues, which may cause sensitivities and other health problems.

4. Challenge yourself
After a two-week elimination period, reintroduce suspected foods, one at a time and in no specific order, to see if your symptoms reappear. Morrow recommends introducing one or two servings of a pure form of a challenge food, like milk or edamame, and waiting at least 24 to 48 hours for a reaction. If nothing happens, put the food on your “safe list,” and move on to the next challenge item. To avoid confusion, keep tolerated foods out of your diet until you complete the challenge period. “If you have a reaction, wait until your symptoms subside, or several days, before challenging the next food,” says Morrow. “If you react to a food when it’s reintroduced, then it’s safe to assume you are sensitive to it.”

If you discover intolerances, avoid reactive foods for three to six months. Morrow also suggests taking probiotics or eating fermented food, which contain good bacteria, to help nourish your GI tract. After a trial reintroduction, you may be able to eat reactive foods again in small amounts if you gave your digestive system enough time to heal. For example, although gluten still irritates, Kemnow can now drink some milk.

If your symptoms persist after eliminating suspected foods, a health practitioner may suggest trying the diet again or exploring other potential triggers, such as environmental toxins like mercury. Stress is another possible factor, Hanson says: “The typical high-paced Western lifestyle can set off food sensitivities, as can frequent use of antibiotics, corticosteroids, or acid-reducing medications.”

Although an elimination diet may seem like a Herculean effort at first, Kemnow can vouch for how worthwhile the undertaking can be. Entirely symptom free, she now has the energy to not only do the family shopping, but also to hike the mountains near her home that once seemed as insurmountable as Mount Everest. “I don’t even want to think about where I would be today without trying an elimination diet,” Kemnow says.

Elimination Superfoods
Although an elimination diet can seem restrictive at first, you can still pack your grocery cart with a bounty of nutritious, delicious, safe foods. Here’s what to look for.
Grains: Choose gluten-free whole grains for the biggest nutritional wallop.
Best bets: Quinoa, brown rice, millet, amaranth, buckwheat, teff, and sorghum
Proteins: Select protein-rich foods that are low in saturated fat and free of antibiotics, hormones, and contaminants.
Best bets: Lentils and beans, organic and free-range poultry, hemp protein powder, and low-mercury fish, including wild salmon, sardines, and trout
Beverages: Opt for drinks that are caffeine-free and low in sugar.
Best bets: Water, rooibos tea, and unsweetened rice, almond, and hemp milks
Fruits: Look for brightly colored fruits, which contain higher antioxidant levels.
Best bets: Berries, apples, pears, grapes, and plums
Sweeteners: Use natural alternatives that have higher levels of vitamins and minerals.
Best bets: Agave syrup, pure maple syrup, honey, brown rice syrup, stevia, and date sugar
Fats: Fill your pantry with heart-healthy unsaturated fats that include antioxidants like vitamin E.
Best bets: Almonds or almond butter, extra-virgin olive oil, walnuts, avocados, and pumpkinseeds

Quinoa Porridge
Serves 4

1 cup uncooked quinoa
2 cups water
1 teaspoon cinnamon
1/4 teaspoon nutmeg or allspice
1/4 teaspoon sea salt
1 cup unsweetened hemp or rice milk
1 apple, diced
1 cup blueberries or other berries
1/2 cup chopped pecans or walnuts
Agave syrup (optional)

1. Add quinoa, water, cinnamon, nutmeg,
and salt to a small pot. Bring to a boil, reduce heat, cover, and simmer for 15 minutes, or until most of the water has been absorbed.
2. Add milk, and simmer uncovered for an additional 10 minutes. Stir in apple, berries, and nuts. Remove from heat.
3. Let sit covered for 10 minutes while the porridge thickens. Drizzle with agave before serving if desired.
nutrition info per serving: 307 calories; 14 g fat; 1 g saturated fat; 0 mg cholesterol; 8 g protein; 40 g carbohydrate; 6 g fiber; 159 mg sodium

Falafel With Carrot Tahini Sauce
Serves 4

1 1/2 cups dried chickpeas (garbanzo beans)
2 tablespoons olive oil, divided
1 shallot, diced
2 cloves garlic, diced
1 cup fresh cilantro, chopped
2 teaspoons cumin powder
Salt to taste
1/4 cup brown-rice flour
or other gluten-free flour
1/3 cup raw, shelled sunflower seeds (optional)

2 large carrots, peeled and chopped
1 English cucumber, peeled and chopped
1 inch of fresh ginger, peeled and diced
1/3 cup tahini
1/4 cup unsweetened hemp or rice milk
1 tablespoon apple-cider vinegar

1. Place chickpeas in a bowl, and cover with water. Place bowl in refrigerator, and soak for several hours.
2. Drain beans, and place in a large pot with water so that beans are covered by at least 3 inches. Bring to a boil, reduce heat, and simmer for about 1 hour, or until beans are tender but not mushy.
3. Drain beans, and place in a food processor with 1 tablespoon olive oil, shallot, garlic, cilantro, cumin, salt, and flour. Pulse until well combined but still slightly coarse. Mix in sunflower seeds, and remove from processor.
4. Dampen hands before rolling mixture into meatball-size balls. Flatten balls slightly, and set aside.
5. To make the sauce, in a clean processor, add the carrots and cucumber, and mince. Add ginger, tahini, milk, and vinegar. Blend until smooth.
6. In a large skillet, heat remaining oil over medium flame. Cook falafel patties for 4 to 5 minutes per side, or until golden. Serve topped with carrot sauce.
nutrition info per serving: 517 calories; 22 g fat; 3 g saturated fat; 0 mg cholesterol; 19 g protein; 64 g carbohydrate; 17 g fiber; 97 mg sodium

Steamed Catfish With Brown Rice
Serves 4

1 cup brown basmati rice
1 1/2 cups water
4 6-ounce US-farmed catfish fillets
Salt and freshly ground black pepper to taste
Parchment paper or aluminum foil
3 to 4 tablespoons chopped chives
2 medium carrots, julienned
2 zucchini, julienned
2 cups sugar snap peas, ends trimmed

1. Bring rice and water to a boil in a saucepan. Reduce heat, and simmer for 40 to 45 minutes, or until all the water has absorbed. Do not stir while cooking.
2. Preheat oven to 375 degrees. Rinse catfish, and pat dry with a towel. Season with salt and pepper. Set aside.
3. Cut out four 20-inch-wide heart-shaped pieces of parchment paper or foil. Place one fillet on each heart shape so that fish sits close to the crease, leaving a 1-inch border around the edges for folding.
4. Place a quarter of the chives, carrots, zucchini, and peas on each fillet. Seal the packet by folding the edges in small, tight folds. Twist the tip, and tuck underneath.
5. Place the packets on a large baking sheet (packets may overlap slightly). Cook until the fish is opaque in the center, about 20 minutes. Carefully cut open packets, and place fish and vegetables on a plate. Serve with rice.
nutrition info per serving: 443 calories; 15 g fat; 3 g saturated fat; 80 mg cholesterol; 33 g protein; 44 g carbohydrate; 4 g fiber; 150 mg sodium