Elimination Diets (what, why, how, when, etc.)

[Chinese Pistache]

This question gets asked a lot here, so I was wondering if maybe we could all pitch in our ideas, explanations and experiences. That way, we can point people to all of the information at once. I'm thinking that people would like to know the various ways to approach an ED/TED, what the "big" allergens are, where allergens hide (trace ingredients, supplements, etc.) and lots lots more.

So, wanna join the ED fun? Post here! Questions are welcome, too!

I'll come back later today when I have more time with my 2 cents (or more )

[kjbrown92]

Symptoms:
increased thirst
diarrhea
constipation
poor sleep (waking up multiple times, screaming in sleep, arching during sleep, wanting to sleep on stomach when they're really little)
gassy
rash on upper lip
eczema
leg pain (older children)
bedwetting
projectile vomiting

various levels of elimination diet:
TED: lamb, rice, zucchini, pear until you reach baseline (usually 1-2 weeks unless the person reacts to one of those 4 foods)
ED: take out milk OR milk/soy OR gluten/casein OR top 8 allergens OR Feingold diet OR a whole slew of stuff
Regardless, you take things ALL THE WAY OUT of your diet (no cheating) for a week or two. If all the symptoms go away, start adding foods back in one food every four days and see if symptoms come back. If they do, then eliminate that food for at least 6 months before trialling again). If all the symptoms don't go away, the cause could be something else OR you didn't take the right foods out.
Regardless of which diet you choose, keep a food journal with foods, drink, and all symptoms so that you have a record.

Resources:
Dr. Sears (TED)
Doris Rapp's "Is This Your Child?" (ED)

I'm sure I'll think of more later. But that's off the top of my head.

[kjbrown92]

Other symptoms:
recurring ear infections
tantrums/horrible behavior
dark circles under eyes

[matey]

Here is a list of the top 8 allergens
Milk
Eggs
Peanuts
Tree nuts (such as almonds, cashews, walnuts)
Fish (such as bass, cod, flounder)
Shellfish (such as crab, lobster, shrimp)
Soy
Wheat


And a link to the Dr. Sears page
http://www.askdrsears.com/html/4/T041200.asp

[changingseasons]

I'm working on that too as a section in my new blog... so maybe I'll steal some ideas. Or maybe I will eventually get it finished, and you guys can steal my ideas.

[Shelsi]

Going on a TED can be extreme but it can also yield fast results. It's really really hard to stay on though and it can be emotionally draining IMO. That being said, I felt like I'd personally do better with a TED than an ED because I just felt like if I saw results quickly I wouldn't get discouraged. Here's the link to Dr Sear's TED: http://www.askdrsears.com/html/4/T041200.asp

When I started the TED my dd actually got way worse in those first few days. I finally figured out that she was reacting to the rice and switched myself from using rice to using quinoa which was a challenge since it eliminated lots of rice products.

[tarajean56]

What are the symptoms for an adult who may need to do an ED/TED? I'm wondering because I am having some terrible skin issues.

[Chinese Pistache]

There are a few options for identifying allergy foods.

The most extreme is Total Elimination Diet (TED). Dr. Sears and Doris Rapp both have suggestions on foods to include. Basically you eat a very limited diet for about 2 weeks, and then, slowly add back in foods one at a time to see which ones cause new reactions.

And Elimination Diet (ED) is where you cut out certain foods from your normal diet. This could include any or all of the "Big 8" allergens (and I usually recommend corn in addition because it's becoming a very common allergen) and/or any foods you specifically suspect. You stay away from these foods until you reach "baseline," meaning that the allergy symptoms are gone (eczema, diarrhea, etc.). Then, add each of those foods back in one at a time and watch for reactions.

Also, it can take weeks to see improvements. Especially with dairy, it may not clear your system for 6 wks, so give it time when you do an ED that includes dairy.

In both cases, you should add back in one food at a time and consume it for 4-5 days because some reactions take longer to show up (a cumulative effect).

If you're breastfeeding, you should follow the elimination diet. If your baby is bfing and on solids, he/she should also follow the diet.

Dairy is notoriously a problem, so if you're too overwhelmed to do a TED or ED, dairy elimination is a good first step. Also, 50% of people with dairy allergies also have soy allergies, so you might want to eliminate both at the same time.

You have to be strict on these diets. You can't cheat and have a bit of cheesecake and hope to get clear results. You have to get rid of all trace amounts and hidden sources. One site that shows alternate names for foods is: http://www.wholesomebabyfood.com/allergy.htm and this: http://www.cornallergens.com/list/co...ergen-list.php

Food journals are really important during this time. Keep track of what you eat and when. Write down any changes in sleep, skin, bowel movements, etc. There is a lag time usually between when you eat something, and when that thing effects your baby. The time it takes to get into your breastmilk varies. For me personally, it took 3-6 hours on avg.

[Chinese Pistache]

Originally Posted by tarajean56

What are the symptoms for an adult who may need to do an ED/TED? I'm wondering because I am having some terrible skin issues.

Symptoms would be the same for an adult as a child, I would think. What kind of skin issues are you having?

[tarajean56]

Originally Posted by Chinese Pistache

Symptoms would be the same for an adult as a child, I would think. What kind of skin issues are you having?

I have keratosis pilaris that has recently gotten out of control, covering almost my whole body. I had what I thought was athlete's foot, but discovered (on MDC) that it is actually dyshidrosis. The final straw for me is an excema patch that has shown up on my face. Nothing topical has made a dent in any of it. My son (no longer breastfed) has a dairy intolerance, so I think I'll start with that. This thread has already been really helpful as a starting point for me. Thank you!

[Shelsi]

Along the lines of what Chinese was saying, if you suspect corn to be an issue I highly suggest just shopping from the corn free list the first few weeks. Also I'd stop taking any supplements/vitamins unless they are on the list as well. Corn is a sneaky allergen. Many many times it's in a food and yet not listed. There's quite the learning curve to it and if you want to see results from a corn ED I think the list is the only way to be accurate.

Also, like she said, allergies can take a bit to show up in your breast milk. Mine seems to take a bit longer than others here. For me, it seems to take 12-48 hours before my dd reacts to it in my milk.

Another thing I've learned: if your child is reacting to foods in your breast milk then you have some gut healing to do. Check out this thread for lots of help in that area: http://www.mothering.com/discussions...d.php?t=434071 I didn't really understand this at first so even though we were on a strict TED I don't think there was any real healing going on. Now I'm on lots of supplements and dd is on a probiotic and gets bone broth every day and I'm seeing positive changes. She's finally growing for example and I can eat very small amounts of her allergens without it affecting her.

[chlobo]

Shelsi,

What's on your supplement list? Also, how small is your DD? Just wondering b/c Adam is very small & I think bordering on FTT, even though developmentally he's right on track. Started walking around 11 mo.

[adoremybabe]

Chinese, Thanks for the invite over.

How do I determine whether or not to go on the Total Elimination Diet or jsut the Elimination Diet? Ds's Excema is obvious but I wouldn't mind uncovering other hidden food intolerances in our family if they are there. I can also imagine the TED being very over whelming.

-Celia

[Chinese Pistache]

Welcome! I don't think there's any right answer, but I'll tell you what I did. I cut out dairy first because I'd read that it was the most common pediatric allergen. I saw some improvements, but not completely, and over the following months, my dd's eczema got worse and worse. I tried at various times to cut wheat, soy, avocados and so forth with no consistent results. Eventually we went for allergy testing and identified corn.

I cut out corn, which made huge improvements, but then we started noticing small flare-ups here and there (foods that weren't identified by testing, which is very common). I kept a food journal of what I and my dd ate to try and correlate her reactions. As I removed those foods, we stopped seeing reactions. I think, for me, it's less overwhelming to start by eliminating the big 8 or 10 allergens first, but if you aren't seeing improvements in a week or two, I'd move on to a TED. HTH

[Liea]

This might be a stupid question, but what do you ACTUALLY eat on a TED? I mean, can you use any seasonings? I think the reason it seems overwhelming to me (and the reason I haven't done it yet) is because of the thought of eating rice and boiled turkey for every meal. So for anyone that has done it... what did you eat? Did you figure out a breakfast, lunch, and dinner and eat that every day?

[Perpetunia]

My DS started with blood in his stools at about 5 weeks old. I started by cutting out dairy, waited two weeks, then cut out soy also, waited two weeks. When the blood persisted, I decided that more rapid action was needed and cut out dairy, soy, eggs, nuts, wheat, corn, seafood. I waited another two weeks and the blood in stools continued, and over the next few weeks cut out tomatoes, onions, chocolate, apples, pork, citrus, chicken and turkey (desperately trying to follow symptoms based on what I was eating). At the end I was essentially eating lamb, safflower oil, rice (and a few products such as rice milk, vanilla Rice Dream frozen dessert, rice cereal, rice crackers), green beans, black beans (although some would cut out all legumes) and pears. I think the only seasonings I used were salt and pepper.

A typical day would be rice cereal with rice milk for breakfast, some rice crackers for a snack in mid am and mid pm, roasted leg of lamb with green beans for lunch, black beans and rice for dinner, and maybe a rice cake or two at bedtime.

It seemed like it lasted forever, but at about 4 1/2 months (about one week after cutting out chicken which was the last elimination), the blood in his stools went away and has not returned (he is 14 months old now).

Since then I have gradually added back most foods - the only things I still avoid are dairy and eggs.

We have been cautious and slow with introducing solid foods to DS - he eats a wide variety of vegetables and fruits, eats lamb, turkey, rice, oats, corn, potatoes. We have kept him off dairy, chicken, beef, eggs so far. He still nurses (a lot!)

It was hard at the time and I got really sick of the foods I was eating, but looking back, it was only a short time and my DH was very supportive and tried to cook things for me in different ways to make them more interesting. Even DS's doctor was saying "You know, you don't have to do this, you could wean him", but I'm glad I persisted because our breastfeeding relationship is very special to me and he has been extremely healthy, not even a cold in his lifetime!

[Chinese Pistache]

Originally Posted by Liea

This might be a stupid question, but what do you ACTUALLY eat on a TED? I mean, can you use any seasonings? I think the reason it seems overwhelming to me (and the reason I haven't done it yet) is because of the thought of eating rice and boiled turkey for every meal. So for anyone that has done it... what did you eat? Did you figure out a breakfast, lunch, and dinner and eat that every day?

Not stupid at all! Post #6 has a link to Dr. Sears site which says what he recommends to eat on TED. Doris Rapp recommends other foods. If you look at the Joneja food scale, you can construct your own, by choosing from the "least allergenic foods" (this is sometimes tricky because ANY food can be allergenic).

Mostly, you choose a meat (turkey, chicken or lamb), a vegetable (a squash of some sort is the most popular choice), a non-glutinous grain (rice, quinoa or millet), a fruit (pears are the most popular), an oil (olive, canola; not one related to nuts or seeds), and salt (non-iodized). If this doesn't work, change up your food choices. There are ladies on this board with kids allergic to pears and squash, so nothing is fool-proof, but those tend to be the safest options.

[tanyalynn]

One of the biggest questions I've seen (though I have no personal experience with a TED) is losing weight while on it. Any tips from BTDT moms? Seems like a huge issue for breastfeeding moms, especially when there's already gut damage and weight gain or even maintenance is harder than for most folks.

[mommydancer]

Originally Posted by TanyaLopez

One of the biggest questions I've seen (though I have no personal experience with a TED) is losing weight while on it. Any tips from BTDT moms? Seems like a huge issue for breastfeeding moms, especially when there's already gut damage and weight gain or even maintenance is harder than for most folks.

I have been doing ED, not TED. TED should be a last resort, as it really curtails your nutritional diversity. In either situation, you have to keep reminding yourself that you are eating to feed your child, not just yourself, and you need to eat more than you want of the few things you are allowed to eat. You get sick of whatever you're eating, and you eat because you need the calories. And you sometimes cry. Because it's hard to eat to survive, rather than to try the newest recipe or to satisfy a craving or because you just want BBQ or whatever. But when you get a normal BM, or see healing patches of eczema, it is REALLY worth it. If you can find a nutritionist who will help, then get supervised. And check in here for support. I can testify that there are going to be days you don't feel you can keep doing it, and if it gets better the next day you keep going. But you should call it quits when you get to a place where you don't feel okay for more than a day of two. You should only be on a TED for a couple weeks total. One of the tricks I learned from the nutritionist was adding oils to things. Lots of calories. And I had to get used to eating larger meat portions. And you sit and eat a bowl of rice for breakfast. Or a whole bowl of vegetables as a snack.

[Chinese Pistache]

WRT losing weight, I think bfing mothers on TED need to eat a lot of fat at every meal. They need the fattiest portions of meat. They need to fry/douse their food in oil. An of course, a strict TED shouldn't last for weeks on end. It might take some time to change a few items around if the child is reacting to some food during a TED, but it's not meant to be an eating plan. Like some others on this board, if your lo reacts to EVERYTHING, you've got a serious gut damage problem that needs to be addressed, too, WHILE bfing the child, even if they do have some reactions along the way.