Step #2: Elimination Diets

Basically, an elimination diet is simply a self test. You avoid a prime suspect such as milk or wheat, in all forms, for up to three weeks, and see how you feel. Than you eat food again – preferably in generous portions at several meals. Meanwhile, continue to observe your symptoms. Obviously, you only need to test the food or foods you’re unsure of.

If you go into anaphylactic shock, get giant hives or suffer a splitting headache each time you eat shellfish, eggs or any other food, there’s certainly no need to test them. Just avoid them. Period. Elimination diets are designed to help people (or their doctors) confirm suspicions about a particular food.

And they provide a starting point for those individuals who experience symptoms every day but don’t have the foggiest notion which foods are to blame. Elimination diets are especially useful for diagnosing people who may have many, many food allergies.

If you’re one of those people, begin by testing common food allergens – milk, eggs, wheat, corn, yeast, beef and so on – continuing with the less common ones until you’ve identified all the culprits. Tailor the plan to your individual problem, though. If you have a hunch about wheat, by all means start with wheat.

The same goes for eggs, corn and so on. Allergy doctors sometimes ask hard to diagnose people to fast – to go without any food at all – for three days or so before starting an elimination diet. This make is somewhat easier to pinpoint the allergen.

However, going without food can be extremely stressful (and hazardous in some cases), so we don’t recommend that you fast without close medical supervision. Even if you don’t fast, the first our five days on an elimination diet can be pretty rough – if you’re on the right track.

For one thing, food like milk, wheat and eggs – so often the glue and mortar of baked goods and other dietary staples – aren’t easy to avoid. And even if you eliminate every trace, you may at first feel worse instead of better: withdrawal symptoms, more or less. Don’t let all that discourage you, though. By the fifth day or so, you’ll feel much better.

”If food allergy is the problem, the patient is virtually well on the fifth or sixth day,” wrote Dr. Breneman in an article on elimination diets, published in the New York State Journal of Medicine (December, 1979). After two or three weeks on an elimination diet for, say, milk or wheat, try the excluded food.

Choose a day on which you feel free of symptoms until lunchtime. Than eat the food in various forms for three consecutive meals. To test milk, for example, you could have a big cheese sandwich at lunch, a generous scoop of cottage cheese with dinner, and milk and cereal for breakfast the next morning.

If the food provokes symptoms, stop eating it. Proceed to the next prime suspect. Dr. Rapp emphasizes that it’s important to test only a day when you’ve felt well all morning. And for good reason. If you wake up with headache, for example, and your headaches gets worse after you’ve tested the food, you won’t be sure if the food made you worse or if your headache was due to something else and would have gotten worse anyway.

Like all good detective work, food diaries and elimination diets take some time and careful observation. There may be a false lead or two long the way. If you get to the point where you feel you really need the guidance of an allergy doctor, by all means take along your diary and other records. They’ll be an enormous help in fine tuning the diagnosis.

Sample Food Diary

This format will help you organize your diary of food related symptoms. All entries are hypothetical. Foods mentioned are simply examples, not necessarily a suggested menu.

Monday, October 26 Tuesday, October 27
Time Food-Drink-Medication Time Symptoms
12:00-7:30 A.M. Up twice during night with coughing and sneezing
7:30 A.M. Woke up 7:30 No symptoms
8:15 A.M. Orange juice (unsweetened)
Wheaties, sugar, milk
English muffin, butter, apple jelly
Coffee, cane sugar, cream
9:30 A.M. Runny nose (2) Sneezing (2)
10:00 A.M. No symptoms
12:00 noon No symptoms
12:30 P.M. Vegetable soup (beef stock, peas, carrots, celery, potatoes)
Ham sandwich (whole-wheat bread, butter, mustard)
White cake (chocolate icing)
Coffee, sugar, cream
1:00 P.M. Trouble breathing (4)
Feel faint (lasted 10 minutes)
3:00 P.M. Glass of milk
3:10 P.M. Stomach pains (4)
3:15 P.M. 2 antacid tablets
3:30 P.M. No symptoms
5:45 P.M. Stuffy nose (1)
7:15 P.M. Tomato juice, fried chicken (corn oil), peas, mashed potatoes, butter
Salad (lettuce, tomato, carrots, pepper, artichoke, bleu cheese dressing)
Vanilla ice cream, chocolate sauce
8:00 P.M. Belching (1)
Nausea (2)
8:15 P.M. 2 antacid tablets
10:00 P.M. Glass of milk 10:30 P.M. Hives on neck for 1 hour (4)
11:30 P.M. Went to bed

Source: Patient information from Robert Giller, M.D.