There is not the same “right” diet for everyone. I may have an issue with dairy, while you are just fine drinking milk. I might need to eat a more “fat” focused diet, whereas you may do better with more carbs. I might have an issue with oxalates, you might not do well with glutamates. I drink Kombucha to supply good bacteria for gut health, but you have SIBO and it makes you worse. I might be okay with intermittent fasting, but your hypoglycemic tendencies would never tolerate it. I might need to snack before bed for better sleep, but it would keep you awake all night.
All of these factors need to be taken into account when we think “diet”. It isn’t just about how many calories you eat, but about consuming the proper ratio of carbs, proteins, and fats in a meal to meet your metabolic needs and maintain steady blood sugar levels.
Additionally, diet is about eliminating foods and substances that are negatively affecting your health and promoting those that enhance it. To accomplish this, a well composed diet takes food sensitivities, underlying health issues, ability to breakdown and assimilate nutrients, lifestyle, meal timing, genetics, and biochemical imbalances into account.
Finally, a good diet maintains diversity to help avoid oral intolerance issues and is rich in fiber and probiotics for a robust microbiome. Unfortunately, for most of us, constructing the proper diet it a lot more complicated than just following the food pyramid.
Although dietary needs are specific for each of us, what is common is our need for high quality food—whole and unprocessed, organically grown, naturally fermented, grass-fed or pastured raised, and wild caught. These nutrient dense foods provide optimal macro and nutrients– necessary for good health and to help us face daily environmental stressors.
Let’s look into some therapeutic elimination diets and discuss when you might consider implementing them. These diets are not focused on weight loss (which might happen naturally as inflammation is reduced), but on maintaining good health.
For some individuals, components of several of these diets may need to be combined to create the most beneficial diet for their current needs.
In addition, many food exclusions overlap in these diets. It may be necessary to work with a nutritionist to help uncover the source of food issues.
It is important to determine which foods are right/not right for you. Do you have some of the common signs of food sensitivity?
The good news is that most food sensitivities are usually not permanent. Unfortunately, the only effective way to recover is by removing the suspected foods for a period of time and then adding them back in a systematic manner. And during the process, you will have gained first-hand knowledge which foods work for you and which ones don’t. You can read more about food sensitivities here.
So why can’t we just test and be done with it? True, there are a myriad of ways to detect food allergies, sensitivities, and intolerances. Cyrex Labs is different than most labs as it tests for an antibody response in foods in the form you’d actually consume them (i.e., cooked versus raw; as cooking will change the internal protein structure).
But the problem remains that most tests are not 100% accurate and depend on too many factors including recent consumption, ability to generate an immune response, etc. For example, issues can be the actual food, the variety, the way it was grown, the way it was prepared or even the combination of foods it was consumed with.
I believe that f you have an issue with a particular food, you need to understand why. For example, maybe you’re pretty sure you have an issue with celery.
Testing just doesn’t have the power that an elimination trial does, namely determining the what, how, why, and when. These factors can help us make better dietary decisions.
These diets are designed for temporary elimination of problematic foods. In some cases though, specific food sensitivities may require lifelong avoidance.
Individuals typically use a trial diet for 1-6 months. This is necessary to give the body adequate time to clear the inflammatory and immune triggers. After the trial period, controlled reintroduction can indicate if these foods are still problematic.
Please work with your practitioner to correctly reintroduce and rotate foods back into your diet.
Many folks prefer to stay on an elimination diet since they feel so much better. But no. We need to avoid the truly reactive foods but should eat as varied and expansive of a diet as possible. If we only eat particular foods, over time, we could develop a reactivity to them as well– perpetuating the cycle.
Eating a diet with high variety strengthens our immune system and maintains something called oral tolerance. The more different foods you can eat, the more tolerant you are.
Additionally, diversity in polyphenol fruits and veggies for those not sensitive also helps create a diverse microbiome to support function throughout the body. If we limit variety, we may limit the diversity of our microbiome.
Why is gluten/dairy free a good place to start? As we know, gluten is quickly becoming a food that many people are now sensitive to. There could be many reasons– from hybridization to GMO to deamidation to storage, etc. but whatever the cause, it has been found to contribute to many chronic health issues and are common triggers for autoimmune disease. You can read more about gluten here.
Unfortunately, dairy contains a similar enough protein structure to gluten that the immune system often confuses dairy for gluten. Issues with dairy might have also developed since milk products are introduced at such a young age —when our gut systems have not fully developed. This makes dairy a prime target for immune issues later in life.
For some folks, it may only be cow dairy that is an issue. After a period of strict dairy elimination, you can work with your practitioner to do a controlled trial of different forms of dairy.
A gluten-free diet is essential for people with celiac disease or other autoimmune conditions. It has been found to benefit those with gut issues, poor brain health, and inflammatory or pain issues. It often a great place to start when trying to uncover your food sensitivities. You can more about food sensitivities here.
All foods containing gluten and casein.
Due to “molecular mimicry”, some foods look like gluten to the immune system even though they do not contain any. Therefore, all grains, soy, and corn are often excluded from the diet. For a complete list, see Cyrex Lab Array 4.
Since both gluten and dairy, create “opioids”, folks may feel worse on this diet initially as they start to “withdraw” from these foods.
Please keep in mind that gluten isn’t just found in food but can be in everyday items items from beauty products to envelop glue–so please check labels carefully if you think you have an issue.
According to the American Autoimmune Related Diseases Association, 50 million Americans suffer from some type of autoimmune disease. Per the National Institute of Health, autoimmunity has now become more common than heart disease which affects around 22 million or cancer affecting 9 million.
Researchers have identified 80-100 different autoimmune diseases and suspect at least 40 other diseases having an autoimmune basis. Autoimmune disease is one of the top 10 leading causes of death in female children and women in all age groups up to 64 years of age. You can read about autoimmunity here.
The Autoimmune Protocol is used as part of a first level support for reducing inflammation, pain, and other symptoms related to autoimmune diseases such as lupus, inflammatory bowel disease (IBD), celiac disease, rheumatoid arthritis, etc.
All gluten, dairy, grains, nightshades, lectins, latex, eggs, citrus, shellfish, sugar, and artificial coloring and flavorings are removed from the diet. You may also want to minimize salt. You can read about these specific food starting with this link.
Since both gluten and dairy, create “opioids”, folks may feel worse on this diet initially as they start to “withdraw” from these foods. You may start to crave specific foods as they are removed from the diet. This should subside in 1-2 weeks.
Additionally, this is a low calorie diet. An individual may feel great for the first week and then notice a loss of energy or endurance and might need to increase food intake, especially fat.
Keep in mind that gluten isn’t just found in food but can be in everyday items items from beauty products to envelop glue–so please check labels carefully if you think you have an issue.
Finally, given the broad number of foods excluded, please expect reintroduction to take awhile. For maximum benefit, try not to rush through this important process.
A ketogenic diet takes a different approach from the two diets just mentioned. Instead of removing specific foods, it focuses on macronutrient composition— the reduction of carbohydrates and an increase in the consumption of high quality fats (with modest amounts of protein).
The focus here is to optimize mitochondria function, reduce free radical damage, and support metabolic function– by generating more ketones.
Ketones are water-soluble energy molecules that are made by mitochondria in your liver from either dietary or stored fats. They can be used as an alternative to glucose during times of scarcity. Because they are water soluble, ketones can pass easily through cell membranes and even cross the blood-brain barrier– for quick energy.
Ketones are produced when your body enters a fat-burning state and in conjunction with low blood glucose levels, produce fewer free radicals than a standard high carbohydrate diet. This reduces oxidative stress as well as the potential for inflammation and degenerative disease.
In ketosis, blood ketone levels typically range between 0.5 and 3 mmol/liter but rarely exceed 6 to 8 mmol/liter. Blood glucose levels can drop to 70 mg/dl or less.
Whenever the supply of carbohydrates from food is low or nonexistent–even after just a few days—-our body converts fat to ketones for energy. This metabolic flexibility was an adaptation for survival during periods of food scarcity and important for good health.
Many people believe ketosis is dangerous but diabetic ketoacidosis is not the same thing. Diabetic ketosis is a life-threatening symptom of uncontrolled diabetes and can be fatal if not properly treated. When both high ketones and glucose are present, the body uses glucose over ketones, which force ketones levels to buildup. Ketone levels in diabetic ketoacidosis are typically over 20 mmol/L with glucose levels as high as 250-400 mg/dl.
Ketones can offer many powerful health benefits: According to Dr. Mercola, DO:
Many people elect this diet to help burn excess fat, but folks with chronic illnesses such as hyperglycemia, autoimmunity, epilepsy, cancer, neurogenerative disease, etc., may find this diet beneficial to signal the body to repair damaged mitochondria and cells.
According to Dr. Mercola, a ketogenic diet is for those who seek mental clarity, anti-cancer benefits, microbiome enhancement, weight loss, increased energy, better insulin sensitivity, inflammation reduction, cellular recycling, and improve mitochondrial health. You can read more about the health benefits to specific areas of the body in his book; Fat For Fuel.
To train your body to use fat, you need to limit the number of “net carbs” you consume.
To calculate “net carbs”, you subtract the amount of fiber from the total amount of carbs. This actually allows you to eat more carbohydrates, key for increased nutrients, dietary diversity, and fiber intake. The high volume of vegetables, together with nuts and seeds, can provide more daily fiber than the average person typically eats. Fiber can then be converted to beneficial short-chain fats in your intestine for improved gut and immune health.
Per Mercola, typically low “net carb” vegetables include: asparagus, avocados, broccoli, brussels sprouts, cabbage, cauliflower, celery, cucumbers, kale, mushrooms salad greens, spinach, and zucchini.
After you are fat adapted, he recommends adding back higher “net carb” veggies such as eggplant, garlic, onions, parsnips, peppers, rutabaga, tomatoes, and winter squash in limited amounts. Berries and grapefruit in small quantities may also be substituted in place of a veggie.
It is important to implement this diet slowly. I like to start at about 75 grams per day. We then reduce slowly to get to the desired 5-20grams per day. Again, this is “net carbs” so it allows for a substantial number of vegetables. If you reduce too fast, you might experience the” keto flu”, which might make you feel worse.
All fats are not equal. It’s important to choose healthy fats and eliminate all processed ones—including vegetable oils and trans fats. Good fats should be eaten in abundance with this diet, making up 50-70% of the daily caloric intake.
Good choices include organic, grass-fed butter and ghee, coconut milk, free/grass/wild animal fats, coconut oil MCT oil, avocado oil, and extra virgin olive oil.
You can read more about fats here.
MCT oil is a cousin of coconut oil. Normally, when you eat a fatty food, it is broken down in the small intestine with bile salts and lipase enzymes. But medium-chain triglycerides are able to bypass this process, and instead, diffuse across the intestinal membrane directly to the liver. Once there, they can be quickly converted into ketones.
It is best to work up slowly with MCT as it can cause stomach upset and loose stools. A word of caution, individuals with liver cancer, elevated liver enzymes, extensive liver metastases, or liver disease should not use MCT oil but may still use coconut oil.
Although proteins can be converted to glucose, they are still an extremely important macronutrient. Our body needs amino acids for just about everything. You can read more about proteins here.
Normally, protein make up 20-25% of the diet. In a ketogenic diet, protein levels may be closer to 10 percent.
A decrease in carbohydrate intake can cause a shift in the fluid and electrolyte balance as the body flushes out the buildup of ketones in the urine. This can deplete both water and sodium levels. It may be necessary to increase your water intake and possibly add an electrolyte replacement supplement.
As your body transitions from a carbohydrate burner to a fat burner, you may experience flu-like symptoms (including muscle cramps, nausea, aches, and fatigue) during the first couple of weeks. Therefore, it is extremely important to reduce carbohydrate consumption very slowly.
It is important to monitor either urinary or blood ketones to know if you are truly in ketosis—you may inadvertently be eating too many carbs and not getting the benefits of the diet.
Those with fat digestion or usage may require support. This is especially true for those without a gallbladder.
Carbohydrate limited diets restricts carbohydrates with the goal of supporting gut issues. The main difference between SCD, GAPS, and FODMAPS diets, are the types of sugar allowed. The SCD is less strict and might be an easier starting point.
All low carbohydrate diets eliminate grains and beans for the following reasons:
SCD was popularized by Dr. Elaine Gottschall to carry on the work of Dr. Sidney V. Haas, MD. He had cured Elaine’s daughter of severe gut disease through diet when everything else had failed. She describes the diet in detail in her book, Breaking the Vicious Cycle.
The doctors believe issues breaking down disaccharides allows sugars to become fuel for yeast and harmful opportunistic bacteria. This diet has been shown to be effective for SIBO, bacteria overgrowth, yeast, etc.
The intentions of this diet is to support gut health by restricting complex carbohydrates.
The diet disallows the following:
Those that have digestive issues especially with fats or proteins may notice decreased energy and muscle endurance (and increased carbohydrate cravings). This occurs as body loses its preferred form of fuel. Others may just have issues processing carbs. Digestive support may help as the body learns to adapt.
The GAPS diet was developed by Dr. Natasha Campbell-McBride as a method to help heal the gut and reduce bacterial toxin overload. The theory is that those with gut issues have difficulty processing disaccharides —which then feeds yeast and other pathogens. Details on the diet can be found here.
GAPS is very similar to SCD with the exception of allowing probiotic foods. These foods can help recolonize good bacteria while counteracting pathogens. The diet is also focuses more on food quality.
The program is broken down into steps, but ultimately the diet removes the following:
Those with gut issues may not tolerate probiotic foods before addressing gut permeability issues.
FODMAP is another carbohydrate restricting diet for those with gut issues. FODMAP refers to limited consumption of Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These sugars may present an issue for folks who cannot process carbohydrates effectively.
The FODMAP diet was developed by a dietician named Sue Shepherd to help those with irritable bowel syndrome. As with the SCD approach, folks with gut issues tend to have issues when it comes to breaking down disaccharides, a condition that allows the sugars to become food for yeast and harmful bacteria.
FODMAP foods feed bacteria that ferment and create gas. These carbohydrates also draw water into the colon, causing diarrhea. For those with SIBO, dysbiosis, and other digestive disorders, are often more reactive to these types of carbohydrates.
Refer here for a full list.
According to this PubMed article, “As a restrictive diet, the low-FODMAP diet carries risks of nutritional inadequacy and of fostering disordered eating, which has received little attention. Strict FODMAP restriction induces a potentially unfavorable gut microbiota, although the impact of this consequence upon health is unknown. ” Therefore, it may be necessary to support the microbiome since is normally done through a varied vegetable intake. Additionally, a multivitamin should be considered under a strict FODMAP diet.
This diet limits the consumption of a component found in many plant foods. Oxalates are organic acids produced by plants to protect themselves from insects. In our body, oxalates are created through normal metabolism, dietary consumption, or as a byproduct of fungi infections such as candida and aspergillus.
If we can’t effectively process oxalates, they can bind with minerals and crystallize, acting like shards of glass, creating irritation wherever they go. Oxalates can form crystals in the heart, bone, brain, and kidney, and when excreted from the kidneys, can damage genitalia—leading to vulvar pain in women.
This diet reduces oxalate consumption, reducing the body’s total oxalate load. Gastrointestinal issues, genetic differences, biochemical imbalances, and nutrient deficiencies are factors that can increase oxalate load. You can learn all about oxalates here.
Oxalates can cause oxidative stress, impair cellular energy, and deplete certain nutrients, triggering widely varied symptoms. Common signs and symptoms include:
I often recommend this diet when I see signs of mineral and low B6 issues as that is a normal end result of oxalate issues. Additionally, I look for underlying systemic yeast with those having issues with oxalates.
The University of Pittsburg Medical School has a good list of oxalate-rich foods on their website, plus they classify foods by their oxalate content. Foods considered high in oxalates are those that contain more than 10 mg per serving. Find more on specific foods here:
Also, keep in mind, according to this study, it may be difficult to assess the true oxalate content in food.
” The variability in the oxalate content of foods will influence the accurate assessment of the amount of oxalate ingested in diets. To date, we have observed a large variability in many fresh foods and even in some processed foods. Factors known to influence the oxalate content of plants include the plant variety, the developmental stage of the plant, the season, and growth conditions”.
Additionally, “Variability caused by food processing, food preparation, and factors that influence the bioavailability of the food oxalate after its ingestion is another consideration.”
This is a low oxalate diet, not a no oxalate diet.
It is important to reduce oxalates very slowly, over time. It may take several weeks to months before you actually get to a “low oxalate” diet. It’s vital that you do not remove oxalates all at once or you could experience a worsening of symptoms called the “oxalate dump”. Consider reducing oxalate intake by 5-10% per week.
As mentioned, oxalates may change through cooking/preparation, so you may want to read more about your specific food choices.
In addition, supplements can help support the binding of oxalates to allow them a safe route from the body. You can also minimize oxalate damage with supplementation.
Phenols are fat-soluble chemical found in over 9,000 plant foods. Like oxalates, their job is to protect the plant from harm. The more a plant is subjected to harsh conditions, the more phenols it creates.
Phenols differ from oxalates in that they actually enhance health. For instance, the 2013 Journal of Nutrition reported that older adults with a high polyphenol intake of over 650 mg per day had a 30% reduction in mortality compared to with those who consumed less than 500 mg per day.
Unfortunately, some folks have a sensitivity to certain phenolic compounds or have issues with phenol clearance— which requires dietary restriction. Low phenol diets include low salicylates, low amines, and/or low glutamate diets. This is a necessary distinction as some people may only react to salicylates, whereas others might react to multiple forms of phenols.
Phenols can be broken down into the following categories:
This diet may help those with issues with poor detoxification, ADHD, autism, dysbiosis, autoimmune. chronic fatigue syndrome-like symptoms, anxiety disorders, etc.
According to Dr. Feingold, folks with sensitivities who consume large quantities of foods high in salicylates may experience these symptoms:
Please refer to this website for the Feingold Program list of allowable foods.
The Feingold Program removes high-phenol foods and salicylate-containing foods, artificial colorings and flavorings (i.e., FD&C colors, vanillin), artificial preservatives (BHA, BHT, and TBHQ), and aspartame. The program also takes away non-food phenol and salicylate sources, including aspirin, toothpaste, medicines, and gum.
They are also quick to point out that is isn’t always an easy task:
Phenols are processed by the body mainly through sulfation but also glucoronidation. Those with cofactor or genetic issues might not be able to effectively clear phenols. In addition, gut infection may affect glucoronidation. Supporting supplements, Epsom salt baths (for sulfate), and improving gut health may be helpful for those with phenol issues.
This low phenol diet focuses more on brain issues through the reduction of amines and/or glutamates. Many folks have genetic issues or lack the nutrient cofactors required to utilize these compounds. Supporting supplements may be helpful.
According to the Clinical and Translational Allergy Journal, amines are formed as proteins are broken down and are produced by bacteria during fermentation, storage, or decay of food.
Problematic amines typically include:
The amine content of foods can vary based on its method of processing, age, ripeness, handling, storage, variety, cooking method, and other factors.
In addition to food, amines can be found in over-the-counter cold medicines, decongestants, nasal drops or sprays, some pain relievers, anesthetics, and antidepressants.
Glutamate is the most abundant neurotransmitter in our brain. Its role is excitatory which is a good thing, We need neurotransmitters that amp up us as well as those that slow us down.
Glutamate is one 20 amino acids that is used a building block for all proteins in our body. It is not considered essential as it can be made from other amino acids, but it is definitely important.
Glutamate are found in 2 forms: bound or free. The bound form is usually found in proteins in food. The proteins are slowly broken down into amino acids and then absorbed. This allows glutamate to be better tolerated. The free form creates what is referred to as the fifth taste, “umami,” which is something between savory and meaty. Unfortunately, free forms are quickly released and can become an excitotoxin.
You can learn more about amines and glutamates here.
Elevated glutamate levels are associated with:
Genetics and nutrient cofactors play a huge role here. It may be difficult to find all the hidden glutamate sources. Supplements such as magnesium, B3, and B6 may be very helpful in supporting glutamate metabolism.
Histamine is an amine best known as being a response to an allergic agent. It sounds the alarm for the immune system to respond to the perceived threat while it dilates the blood vessels to allow white blood cells to do their thing. Once histamine has finished its job, enzymes break it down so it doesn’t continue to affect us.
There a 4 types of histamine receptors, each affecting specific parts of the body. According to Bob Miller CTN, histamine helps to regulate a variety of functions:
Histamine can be released depending on:
You can learn more about its affect on the body here. There are supplements that can be used to support both histamine release and histamine breakdown.
The low histamine diet may help people with a high histamine load. or in those who develop symptoms, such as sneezing, itching, or hives, in response to foods that contain or release histamine, and those with environmental sensitivities. It is also used in those gut infections which generate a histamine response and those with paracellular leaky gut.
We need to consider both histamine containing and releasing foods. Foods that effect the removal of histamine may also lead to symptoms. Dr. Amy Myers, MD, recommends those with histamine issues avoid the following foods:
DAO is one of the enzymes that help remove histamine from the body.
The longer a food sits, the higher the histamines it develops due to microorganisms on the food. Cooking will not degrade the histamines. Freezing may help slow the process.
A low histamine is about reducing total load to a tolerable level. Genetics and nutrient cofactors play a huge role here. There are supplements available that may help support histamine neutralization and clearance.
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