Elimination Diet

[glutengal]

Hope I put this in the right forum. If not I guess one of the moderators will move it.

I have a 26 year old daughter who has been gluten free for 2 years now. The diet has helped get rid of the daily headaches and stomach pains, as well as peroidic bouts of diarrhea. She was tested by both blood test and biopsy for celiac disease and both came back negative so I put her on a gluten free diet after testing. However, she started getting bad chest pains about 6 months ago and was diagnosed by biopsy with eosinophilic esophagitis. She has tried omeprazole and some others and none of them have helped her. The doctor then put her on flovent and said to eliminate the eight major food allergens. She has not had any relief with the flovent or eliminating gluten/wheat, dairy/casein, eggs, soy,peanuts/tree nuts, fish and shellfish. The chest pains have actually worsened. She went back to her GI 2 weeks ago and he said to stop the flovent since it was not helping. He then gave prescriptions for Donnatal and Nulev because he thinks she may be having esophageal spasms. However, when we went to have them filled the Pharmacy could not fill them because she has medicare and medicaid and said they were not covered under either one. We have since filed with medicare for a pre-authorization to see if they will cover them and are waiting a response. If they will not cover them, I am thinking about putting her on an elimation diet to see what foods are bothering her (I am actually thinking of doing this anyway because medications only mask the problem). I had wanted to do this under the supervision of a Dietician but once again, NOT covered under medicare or medicaid. I am not sure how to do this and this is the part where I am looking for some help from the others on this forum. I have read some on elimation diets and most say to start with just Turkey, Brown Rice, and Cooked Vegetables and to hold off on Fruits. They state to do this for about 1 week. My questions are: How does she get enough nutrition? Does she eat these same foods for breakfast, lunch and dinner every day for a week or can she eat a few meats, vegetables etc. to start out and then add back one food at a time? Please if anyone has knowledge of how to start this I would greatly appreciate it. Maybe some ideas for breakfast, lunch and dinner meals. Also, if she can actually eat any other foods starting out than the ones above please let me know.

[GlutenFreeManna]

There is no set elimination diet. Everyone sort of does what works for them, but the basic concept is the same. You start out with three or four foods and eat ONLY those for a set amount of time (I have seen people do the beggining foods anywhere from three days to one month but I think one week or two weeks is the most common). Then, if you seem to feel better with just those basic foods you can add a new food one at a time and note your reactions. She can start out with any foods she wants but there are a few that are reccomended because very few people have intolerances of them. From reading here, turkey and lamb are two common meats people do. I did chicken because I was pretty sure I didn't have a problem with plain chicken breasts. Since your daughter is having reflux issues you probably want to choose turkey or chicken or another lean meat and limit the amount of it she eats per day. Stay away from red meat or fatty meats because they are more likely to cause high acid. Everyone is different of course, but I know fatty meats are something to avoid if you have heartburn issues.

I did no carbs when I did mine so I didn't even have rice/potatoes/corn just chicken and vegetables. A lot of people choose one vegetable and stick with it the whole time. I allowed myself to eat any green vegetable that I liked as long as it was steamed so I had a little variety. It is pretty boring. You do eat those foods for breakfast, lunch dinner and snacks while on the trial period. Some people allow salt and pepper, some people cut those out too. I did sea salt for my only seasoning and olive oil for my only cooking oil. You need to cut out any beverages other than water as well--no soda, no coffee, no tea, etc. If you don't feel better after a trial period then you change your trial foods and do another trial period. I did my trail diet for a month but I think two weeks is a good time frame. If you typically eat a lot of processed foods or drink cafinated beveraged the elimination diet could have you in major withdrawl. Most people recover from the withdrawl after two weeks. Some people might recover and feel better after a few days. So if you still feel bad after a week and you don't think it's due to your trial foods you might want to try go two weeks and then switch trial foods. Hopefully your daughter's withdrawl symptoms (if any) will be different from the reflux symptoms and she can figure out if she just needs to give it one more week or change out a food.

As far as nutrients you can take a multi-vitamin if you are worried (and she should be taking one anyway if she has celiac) but since this is a short term diet not long term IMO there is not a long term nutriional risk to going a week or two on this limited diet. I would not limit amount/# of calories of food she eats during this time. Just focus on only eating those foods and let her eat as much as she wants of the trial food. Many people will lose weight on an elimination diet if they don't eat enough, but it's not a healthy weight loss if it's lost due to starvation-- she'll gain more weight than she lost once she goes back to eating normally. So don't worry about weight loss or weight gain just try to get her to eat enough. I think the key realy is choosing foods she likes. If she hates the trial food she will not stick with it. Even with food you like it's hard to go a week of having nothing but that food.

[GFinDC]

That's good advice from GFM. Do remember though that everything she takes in has to be eliminated as a problem. That includes vitamins and meds, and any drinks such as soda, coffee, tea etc. I imagine you have checked the ingredients on all her meds already? Also be sure to carefully check multi-vitamin pills as they have very small print on some and the can have wheat or oat or barley grass or soy in them. It is best to not do any vitamins during the elimination diet for a while at least.

[GlutenFreeManna]

That's good advice from GFM. Do remember though that everything she takes in has to be eliminated as a problem. That includes vitamins and meds, and any drinks such as soda, coffee, tea etc. I imagine you have checked the ingredients on all her meds already? Also be sure to carefully check multi-vitamin pills as they have very small print on some and the can have wheat or oat or barley grass or soy in them. It is best to not do any vitamins during the elimination diet for a while at least.

I agree. Vitamins can have all kinds of fillers in them and it's better to skip them for that short time if you can. I did do iron pills on my elimination diet because I was anemic and didn't want to risk skipping them. But other than something like that I think it's better to cut out vitamins.

[ravenwoodglass]

When I did my doctor guided elimination diet he chose foods I rarely ate as a starting point. For me it was turkey, sweet potatoes, plain white rice, peas, pineapple and cranberry juice as the only beverage other than water. No tea, coffee, soda, condiments, butter or spices other than salt. After two weeks I was allowed to add 1 item, in pure form, at a time for a week or until I had a reaction. If I had a reaction I was to drop the food and wait until the reaction was over before I added anything else. It was boring but since mine started right before thanksgiving at least I got to have dinner with the family.

For her starting point do go with whole unprocessed foods and to help her make sure she is as nutritionally balanced as possible her starting point should be colorful.

[glutengal]

There is no set elimination diet. Everyone sort of does what works for them, but the basic concept is the same. You start out with three or four foods and eat ONLY those for a set amount of time (I have seen people do the beggining foods anywhere from three days to one month but I think one week or two weeks is the most common). Then, if you seem to feel better with just those basic foods you can add a new food one at a time and note your reactions. She can start out with any foods she wants but there are a few that are reccomended because very few people have intolerances of them. From reading here, turkey and lamb are two common meats people do. I did chicken because I was pretty sure I didn't have a problem with plain chicken breasts. Since your daughter is having reflux issues you probably want to choose turkey or chicken or another lean meat and limit the amount of it she eats per day. Stay away from red meat or fatty meats because they are more likely to cause high acid. Everyone is different of course, but I know fatty meats are something to avoid if you have heartburn issues.

I did no carbs when I did mine so I didn't even have rice/potatoes/corn just chicken and vegetables. A lot of people choose one vegetable and stick with it the whole time. I allowed myself to eat any green vegetable that I liked as long as it was steamed so I had a little variety. It is pretty boring. You do eat those foods for breakfast, lunch dinner and snacks while on the trial period. Some people allow salt and pepper, some people cut those out too. I did sea salt for my only seasoning and olive oil for my only cooking oil. You need to cut out any beverages other than water as well--no soda, no coffee, no tea, etc. If you don't feel better after a trial period then you change your trial foods and do another trial period. I did my trail diet for a month but I think two weeks is a good time frame. If you typically eat a lot of processed foods or drink cafinated beveraged the elimination diet could have you in major withdrawl. Most people recover from the withdrawl after two weeks. Some people might recover and feel better after a few days. So if you still feel bad after a week and you don't think it's due to your trial foods you might want to try go two weeks and then switch trial foods. Hopefully your daughter's withdrawl symptoms (if any) will be different from the reflux symptoms and she can figure out if she just needs to give it one more week or change out a food.

As far as nutrients you can take a multi-vitamin if you are worried (and she should be taking one anyway if she has celiac) but since this is a short term diet not long term IMO there is not a long term nutriional risk to going a week or two on this limited diet. I would not limit amount/# of calories of food she eats during this time. Just focus on only eating those foods and let her eat as much as she wants of the trial food. Many people will lose weight on an elimination diet if they don't eat enough, but it's not a healthy weight loss if it's lost due to starvation-- she'll gain more weight than she lost once she goes back to eating normally. So don't worry about weight loss or weight gain just try to get her to eat enough. I think the key realy is choosing foods she likes. If she hates the trial food she will not stick with it. Even with food you like it's hard to go a week of having nothing but that food.

Thanks GFM for your reply it is greatly appreciated. You say there is no long term nutritional risk to going a week or two on this limited diet. But if we are only adding 1 food back at a time after the week or two trial period it seems as if the would be pretty long term in order to get enough foods back into her diet. Maybe I am looking to deep into this, I don't know but just concerned it will take months to get enough foods back to be healthly and get the proper vitamins and minerals.

[GlutenFreeManna]

Thanks GFM for your reply it is greatly appreciated. You say there is no long term nutritional risk to going a week or two on this limited diet. But if we are only adding 1 food back at a time after the week or two trial period it seems as if the would be pretty long term in order to get enough foods back into her diet. Maybe I am looking to deep into this, I don't know but just concerned it will take months to get enough foods back to be healthly and get the proper vitamins and minerals.

I'm not a doctor nor a nutritionist, however the theory behind doing an elimination diet is to cut out foods that are making you sick. You should be eating protein, vegetable, and starch at the very least. You get your nutritients from these foods unless your body is so damaged it can't get nutrients from food or you have an intolerance to one of your trial foods. Whole wheat bread is considered to be a nutritious choice for those without celiac disease, gluten intolerance, or wheat allergy. If you eat wheat when you have any of the above conditions your body makes antibodies and you may have trouble absorbing nutrients from your food due to the damage in your body. In my opinion, it's better to go on a limited diet for a few months to figure out that something is making you sick than to keep eating something that may hinder your absorption of nutrients. This of course assumes that your have no known major health issues that require an extra amount of something (like I mentioned my having anemia and choosing to keep taking my iron pills).

Most people do the elimiantion diet as a last resort when nothing else has worked for them to figure out what they are reacting to. Yes, it is extreme. Yes it is hard and boring and tedious. Since your daughter has been told she has a know condition (acid reflux), it would probably be better for her to first cut out things from her diet that are most likely to cause reflux. Do a search and you will find lists of things that are most common reflux triggers. Rather than do an elimination diet she could try keeping a food journal with her reactions. For some people that's enough to figure out their trigger foods.

[glutengal]

I'm not a doctor nor a nutritionist, however the theory behind doing an elimination diet is to cut out foods that are making you sick. You should be eating protein, vegetable, and starch at the very least. You get your nutritients from these foods unless your body is so damaged it can't get nutrients from food or you have an intolerance to one of your trial foods. Whole wheat bread is considered to be a nutritious choice for those without celiac disease, gluten intolerance, or wheat allergy. If you eat wheat when you have any of the above conditions your body makes antibodies and you may have trouble absorbing nutrients from your food due to the damage in your body. In my opinion, it's better to go on a limited diet for a few months to figure out that something is making you sick than to keep eating something that may hinder your absorption of nutrients. This of course assumes that your have no known major health issues that require an extra amount of something (like I mentioned my having anemia and choosing to keep taking my iron pills).

Most people do the elimiantion diet as a last resort when nothing else has worked for them to figure out what they are reacting to. Yes, it is extreme. Yes it is hard and boring and tedious. Since your daughter has been told she has a know condition (acid reflux), it would probably be better for her to first cut out things from her diet that are most likely to cause reflux. Do a search and you will find lists of things that are most common reflux triggers. Rather than do an elimination diet she could try keeping a food journal with her reactions. For some people that's enough to figure out their trigger foods.

[glutengal]

I'm not a doctor nor a nutritionist, however the theory behind doing an elimination diet is to cut out foods that are making you sick. You should be eating protein, vegetable, and starch at the very least. You get your nutritients from these foods unless your body is so damaged it can't get nutrients from food or you have an intolerance to one of your trial foods. Whole wheat bread is considered to be a nutritious choice for those without celiac disease, gluten intolerance, or wheat allergy. If you eat wheat when you have any of the above conditions your body makes antibodies and you may have trouble absorbing nutrients from your food due to the damage in your body. In my opinion, it's better to go on a limited diet for a few months to figure out that something is making you sick than to keep eating something that may hinder your absorption of nutrients. This of course assumes that your have no known major health issues that require an extra amount of something (like I mentioned my having anemia and choosing to keep taking my iron pills).

Most people do the elimiantion diet as a last resort when nothing else has worked for them to figure out what they are reacting to. Yes, it is extreme. Yes it is hard and boring and tedious. Since your daughter has been told she has a know condition (acid reflux), it would probably be better for her to first cut out things from her diet that are most likely to cause reflux. Do a search and you will find lists of things that are most common reflux triggers. Rather than do an elimination diet she could try keeping a food journal with her reactions. For some people that's enough to figure out their trigger foods.

Thanks again, you have been very helpful.