There are essentially 4 stages to doing an elimination diet:
- The preparation stage, which takes as long as it takes to get emotionally and physically prepared
- The elimination stage, which takes 4-7 days
- The testing stage, which takes 21 days
- The healing stage, which takes 3 months to a year, or sometimes even longer
PREPARATION STAGE
For many people, doing an elimination diet is physically and emotionally hard, so it’s important to be adequately prepared. The more committed you are, the easier it will be.
- Start weaning off your supplements. If you are taking large doses of Vit C, for example, you will need to decrease slowly, so it may take some weeks to get ready. (You should, however, keep taking all prescription drugs throughout the diet)
- Bob says: You shouldn’t be taking ANY supplements (especially Ester-C) when doing food testing. It would water down the reactions you might have to foods, since it strengthens the immune system.
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- Recommended reading.
- As many of these as you can get hold of:
- Nutrition & Physical Degeneration – Weston Price
- Nutrition & Psychological Strength – George Watson
- Biobalance – Rudolph Wiley
- Brain Allergies – William Philpott
- An Alternative Approach to Allergies – Theron Randolph
- Plus: The elimination diet archives on Walt Stoll’s website
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- If you have bad withdrawal symptoms, you may not feel up to shopping or preparing food for a day or two. So it’s good to make sure you’ve got a couple of days supplies before you start and it can be a big help to prepare and freeze some food in advance. Examples are: stewed fruit, pureed root veges, and fish head broth.
- To make the broth, simmer some non-oily fish heads and carcasses in water for 4-24 hours. You can add some carrot or celery if you are allowed them in your diet. At the end, strain, and season with sea salt. This sadly does stink out your kitchen, but if you are a Protein/Hunter Gatherer metabolic type you will find this keeps you going. Thanks to Bob’s wife Trish for this suggestion. ~
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- Make sure you have access to plenty of good quality water
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- Buy a bottle of magnesium citrate (found in the laxative section) and alka-seltzer ‘gold’ (it’s found only in the gold coloured box). If you’re in NZ, you won’t be able to find these products, but epsom salts will do instead of the magnesium citrate.
- Bob says: The magnesium citrate is used at the start of the elimination diet to induce bowel movements to clear the large intestine of most of it’s contents. Since these contents often contain previously eaten food allergens, the overall effect it to speed ‘clearing’. You don’t have to take the citrate — it just speeds the ‘clearing’ process.
- Walt Stoll adds: With Irritable Bowel Syndrome, I would not recommend magnesium citrate. Magnesium glycinate, orotate or aspartate would be a much better choice. Later on, when your IBS has been resolved for a year or so, mag citrate might be a cheaper way to go.
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- If you are a smoker, you will get best results if you don’t smoke during the diet, so consider stopping smoking a while ahead. Don’t try and stop just before the diet, as you won’t be able to tell what you’re getting withdrawal symptoms from.
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- You won’t be able to eat out during phases 2 & 3, so plan it for a time when this will be possible. (For example, unless you’re desperate and very committed, don’t think of trying to do it at Xmas or Easter!)
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- Make sure you have a support person. If someone else in the household is also doing the diet or can help you, it makes it much easier. Otherwise, you need someone you can phone or email if it gets tough.
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- Gentle walks and rebounding are good, but avoid strenuous exercise.
- Bob says: Take it easy. I usually suggest nothing more strenuous that a fresh air walk for people on the elimination diet. The problem is that if you have aches and pains from exercise it will be difficult to distinguish the same from a reaction to a food during the testing phase.
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- Plan some ways you can support yourself during this time. Have someone else look after the housework, take time off work, take Aromatherapy baths or burn cleansing oils, get out some funny movies, read one of those books you never have time to read.
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E-DIET STAGE
Steaming or baking are good ways of preparing foods during your elimination diet. All the foods eaten during this stage must be fresh and in their ‘whole’ or natural form. No cans or other packaging are allowed. The foods allowed are:
- Fish – Preferably trout or mackerel. If you can’t get these fresh or frozen, cod is allowable and other white fish will do in a pinch. People who are pretty sure they are H-G can add in lamb if they have trouble functioning on the fish (but only if it’s not usually eaten regularly).
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- Vegetables – Parsnips, turnips, rutabaga (swede), sweet potatoes, yams, celery, zucchini, carrots. (NZ yams are different than US yams, but they are still OK, as are kumera)
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- Seasonings – Sea or mineral salt
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- Drinks – Spring water or sparkling water are the only acceptable liquids
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- Any foods you regularly eat more than twice a week must be removed from this list.
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| A snippet from the archives:Q: Robert, Your elimination diet is much more restrictive that other approaches. What is your basis for choosing only those foods? How many people are allergic to such things as turkey and celery? Couldn’t you broaden the elimination diet some? Maybe if it was less restrictive more people would be willing to try this approach. Eliminating a food that maybe 1 in a thousand is sensitive may be unreasonable.
A: The elimination diet that I suggest was developed by Dr. John Mansfield over the course of 20 years and some 10,000 patients. I’ve always wondered why his elimination diet was so much more effective than others. Now I know, and for reasons that I’m sure not even Dr. Mansfield was aware.
The mix of foods on the elimination diet are skewed to the Agriculturist side of the metabolic spectrum. Dr. Mansfield was completely unaware of the metabolic work done by Watson and Wiley but the rather low fat and low purine content of the ‘safe’ foods on the elimination diet are critical to the success of the diet.
One of the things that I’ve found is the simple fact that people that occupy the EXTREME ends of the metabolic spectrum are much more likely to develop chronic disease. An individual with an EXTREME Agriculturist metabolism would find that they could sufficiently ‘clear’ their symptoms due to the low fat and purine content of the elimination diet foods. They would find that they would do quite well on meals consisting of primarily vegetables and fruit with the addition of fish only during the evening meal.
Unfortunately something like turkey (even the breast meat) would have too much fat and especially purine to allow complete clearing by an individual with an EXTREME Agriculturist metabolism.
Fortunately EXTREME Hunter-gatherers will find that they can effectively clear during the diet BUT they will find that they have to eat a good sized portion of fish at each meal and might require 4-5 meals a day to get enough purine and fat.
The root vegetables on the elimination diet should be little surprise since we have eaten them for a long enough period of time to become well adapted.
I have considered creating two elimination diets. One for each metabolic type. The problem is that if you guess wrong and go with the H-G elimination diet and you are actually an Agriculturist, the diet would not reveal anything. The converse (happily) is not true.
You can successfully use the rather ‘light’ elimination diet if you possess a H-G metabolism. You will find that you will have to eat the fish 3-4 times a day to maintain energy level while avoiding overly excessive amounts of fruit and yam/sweet potato. If you are SURE that you are a H-G (as some people have played with the metabolic diets before running the elimination diet), add lamb and olive oil to your list of safe foods on the elimination diet. Pull out the yam/sweet potato, zucchini and peaches. This will speed the entire process. |
If you work weekdays, Thursday evening will be the best time to begin. Wait two hours after dinner and pour one-half of the contents of the bottle of magnesium citrate into a tall glass. Add an equal amount of water and some ice and drink slowly. Repeat the same procedure with the remainder of the magnesium citrate just prior to retiring.
Friday morning’s breakfast and all subsequent meals for the next six days should consist exclusively of the ‘safe’ foods (cod, trout, mackerel, pears, parsnips, turnips, rutabaga, sweet potatoes, yams, celery, zucchini, carrots and peaches). You may eat them in any combination and in any amount as often as you want throughout the first six days. Take note of what you are eating and how often you are eating it. You probably won’t be able to remember so keep a diary. You will need that information later.
By Friday evening (day 1) you may start feeling your first ‘withdrawal’ symptoms. You won’t be getting the temporary lift provided by your addictive food(s). Withdrawal symptoms can take many forms. The most obvious is an increase in joint swelling and pain. Headache, muscle aches, fatigue and other flu-like symptoms are very common. Strong hunger pangs and cravings are usually present. It’s not unusual to still feel hungry shortly after a meal.
Withdrawal symptoms often worsen on Saturday and Sunday (days 2 and 3). The intensity of these symptoms should not be underestimated. In fact many will feel completely crippled during these days. Withdrawal symptoms can be somewhat ameliorated by taking one tablet of alka-seltzer (in the gold box) in a large glass of water. This can be repeated every 4 hours if needed. You should try to drink plenty of water. It will help speed elimination and the ‘clearing’ of symptoms.
By Monday (day 4) some will feel significantly better as their withdrawal symptoms begin to clear. This ‘clearing’ will continue on Tuesday and Wednesday (days 5 and 6). While younger people tend to clear their symptoms earlier, 85% of all arthritics will clear a large part of their arthritis symptoms by day 6. After clearing most report that they feel better than they have in years.
By clearing, we mean that any withdrawal symptoms have abated, and along with them many of the chronic symptoms that were the reason for doing the e-diet in the first place. Clearing is a multi-faceted phenomenon. You cease to feel the intense cravings that are driven by food allergies. You feel calmer and more relaxed. Food allergens create inflammation. Inflammation creates edema (swelling) and water retention. I don’t know if you’ve been watching your ankles but they should be a lot less puffy as you dispense with this water weight.
| WHAT IF YOU DON’T CLEAR?This can happen sometimes and there are a number of possible reasons why. First of all, about 85% of people will experience strong to moderate withdrawal while 15% DON’T have any withdrawal. They will all experience some clearing.
Those that clear 100% of their symptoms usually don’t have a yeast or bacterial problem — they just have a leaky gut. If they let it persist, however there is a VERY good chance that dysbiosis (the lost balance of bacterial micro-flora) will occur in the future.
Those that clear significantly less than 100% of their symptoms at the end of the elimination diet have other factors creating mischief. The usual culprits are yeast and gram negative bacteria. Inhaled allergens (primarily house dust and moulds as well as some chemical sensitivities (usually chlorine in water, formaldehyde and solvents) can also play a part. Once these are addressed, most people will find that they clear almost all of their symptoms.
About 15% of people on the elimination diet may not have a noticeable withdrawal or clearing. Usually the reasons fall into one of five categories:
- There is a significant chemical exposure or inhaled allergy that is effectively masking symptoms. Common chemical exposures take the form of formaldehyde or carpet solvents in a new house/place of business or a leaking gas stove. The inhaled allergen is frequently dust and/or dust mite from old carpets and bedding. Moulds from the basement can create a significant problem. A general clean-up of the surrounding environment is always a good idea prior to and following the elimination diet. Changing the bedding (especially the pillowcase) every evening can help reduce dust/dust mite exposure. Showering before going to bed is effective in removing pollens and other allergens from hair to keep them from being transferred to the pillowcase and inhaled through the night.
- The individual has an extreme metabolism (usually demanding more fat, purine and cholesterol) than provided by the foods in the elimination diet. If they disdain eating the fish in the elimination diet they will rob themselves of key ingredients to their energy cycle. These people usually describe a worsening of symptoms (especially fatigue) followed by a lack of clearing on the diet. These symptoms will resolve as they move to the Metabolic Diet phase of the program.
- There is a significant problem with intestinal candidiasis (specifically reacting to the candida albicans micro-organism) which is so severe that it’s symptoms mask the results of the elimination diet. Usually these people have withdrawal symptoms followed by only a marginal clearing of symptoms. These symptoms will clear once the candidiasis is properly treated.
- The individual is reacting to toxins from other flora or parasites in the intestinal tract. Overabundance of gram negative bacteria or amoebic parasites are the usual culprits. See the gram negative test below.
- You are allergic to one of the foods on the elimination diet (very rare).
Any combination of the above can cloud the results of the elimination diet.
If you haven’t cleared completely after 6 days, start testing anyway. It won’t be as easy to tell when you have reactions, but set the way you feel at the 6 day mark as your benchmark, and compare back to that. Your food/symptom diary will be invaluable in this situation.
After going through the testing phase and settling into your appropriate whole food diet, you’ll need to investigate and address whatever caused you to not clear. |
TESTING/METABOLIC DIET STAGE
Now that symptoms have cleared new foods can be introduced, one by one, to the base diet of ‘safe’ foods that you’ve been eating the past 6 days. Your food testing will have to stop after 21 days. You can go on testing foods for a reaction, but many will not generate a hyper-acute response after that 21 day period. The problem is that we tend to re-develop tolerance over time. The re-acquisiton and timing of this tolerance varies greatly from person to person. You have about 21 days AFTER completing the elimination diet phase to complete the testing phase, so you want to test as many foods as possible in that time.
The following guidelines will help you get the most out of this time.
- It will be useful to have worked out what metabolic type you think you are by this stage. If you felt energised even while hungry, during the diet, you are most likely down the Carbo/Agriculturist end of the scale. If you felt hungry, fatigued and didn’t clear, you are most likely a protein/Hunter-Gatherer type.
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- Start with the things that have a lower allergenic potential ie. whole foods that are suitable for your metabolic type and that you are fairly confident you will be OK on. This will enable you to expand your food list fairly quickly, and make the diet easier to stick to.
NEW COMMENT FROM BOB, Jan 2004: I suggest testing a core food in the morning, a supplemental for lunch, and a small portion of an avoid food for dinner. This works well since I DO want folks to eat avoids at appropriate times (in the evening) to give them more foods. I’ve had a few folks test all the cores first, the secondaries next, and the avoids last. After having a couple of days of testing new avoids, they start feeling worse and think that it is a food allergy, rather than just a metabolic shift bringing on their symptoms.
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- Test a new food each meal. If there is no reaction, you can try another food 4 hours later. So 3-4 foods can be tested each day.
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- Test the BIGGIES (wheat, corn, milk, soy, brewers yeast, bakers yeast) toward the end of the first week in the testing phase, after you have established a workable repetoire of foods, but before your sensitivity reduces. Remember milk, milk products, and grains sometimes need to be taken for several meals before their full effects are felt.
NEW COMMENT FROM BOB, Jan 2004: I now recommend that in order to test a grain or milk, you should consume it 3 times for 4 consecutive days.The bakers and brewers yeast can be tested early on and with a single ingestion. It is pretty good at delivering a reaction.
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- Reactions tend to happen 45 minutes to 2 hours after ingestion. Fatigue, headache, abdominal distress, sleepiness, dizziness, brain fog and confusion, aching joints, etc. are the major symptoms. Hyper-acute reactions are usually an exacerbation of whatever symptoms that you had prior to the elimination diet. In other words, they can vary. You may be concerned that you won’t know what they are — but you will. Headache, joint pains and sudden fatigue lead the list.
- Be sure to keep a diary of everything that you eat and how you felt afterward. In rare cases there is a delayed reaction (usually with wheat and milk) that gradually builds over a day or two.
- Grains like wheat are fairly insoluble compared to other foods. Most reactions happen within 2 hours BUT reactions to grains are sometimes delayed as much as 4 days!
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- If you have a reaction, the food has “failed” and you must avoid it for at least 3 months. Wait 24 hours before testing another new food. Be aware that reactions can be physical or mental. If it’s physical, it may be your old problems resurfacing, or it might be something new. If it’s mental or emotional, you may not notice the reaction yourself. Ask someone close to let you now if they notice any negative mood swings.
- The alka-seltzer gold is a mixture of salts that helps with withdrawal symptoms. One tablet can be taken in a large glass of water every 4 hours. The alka-seltzer does two things. It does seem to help with acidosis and it does speed up the excretion of the unwanted metabolites after a reaction to food.
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- If you have no reaction, add the food to your safe list, and add another new food next meal
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- When testing fats, to use them sparingly if you want to get a true read on whether they are a true food sensitivity. Too much will cause a metabolic shift that will give you some symptoms similar to food allergy reactions.
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- If you only RARELY eat a food, don’t waste time testing it. Bob personally found that there were at maximum 30 foods that required his testing — which was done in 13 days with 8 major food allergies found.
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- Don’t add supplements back till after the testing phase is over. Men will be able to restart supplements immediately after they’ve done testing foods. Women should wait minimally a full month to check for ‘cycling’. Since acidophilus/bifidophilous are good for all metabolic subsets, those could be started after food testing for women as well. You might be surprised that your supplements are doing less for you than you think. Bob finds that about 25% of people can’t tolerate ANY vitamins no matter what metabolism they’ve inherited. They simply make them feel worse.
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HEALING STAGE
This is the time when your body can start to repair itself.
You’ve established your safe foods, and these should be the only foods you eat for at least 3 months. The longer the better. During this time, you’ll need to prepare all of your food yourself. If you “stray” from your safe foods, you won’t feel good. After maybe 6-12 months, you may be able to test some of the foods you “failed” on earlier. If they are suitable for your metabolic type, you may be able to eat them reasonably regularly again, once the addiction has cleared.
If you have problems with candida, gram negative bacteria or chemical sensitivities, now is the time to address those as well.
| The test for gram negative bacteria…… can only be run AFTER you have run the elimination diet (and determined your major food allergens) and moved to the appropriate metabolic diet. You won’t be able to FEEL the difference until you’ve ‘cleared’ symptoms created by food allergens and metabolic problems.
The test consists of taking 4 Pepto Bismol tablets (the round ones) right before going to bed. If you wake the next morning and notice that your symptoms are significantly improved then you’ll want to continue using a ‘pulsed dose’ regimen that Bob has developed.
Basically the pepto test tells you to what extent enteric toxins (probably from gram negative bacteria) are adding to your arthritis symptoms.
Note that Pepto Bismol may not be available in all countries. If you need to look for an alternative, each tablet contains:
Active Ingredients
Bismuth Subsalicylate (262 mg (102mg of salicylate))
Inactive Ingredients
Adipic Acid, Calcium Carbonate, D&C Red #27 Aluminum Lake, Flavor, Magnesium Stearate, Mannitol, Povidone, Saccharin Sodium, Talc
Bob’s pulsed dose regime:
“Some folks have found that they actually CURED their arthritis simply by going on pulsed courses of strong antibiotics like flagyl (metronidazole). I have found that pepto-bismol can be just as effective and much safer.
Pepto-bismol is really bismuth salts stabilized in a salicyate base. Bismuth salts have broad spectrum anti-biotic properties. They probably kill anaerobic as well as aerobic bacteria but not has powerfully or as wide a spectrum as prescription antibiotics (i.e. tetracyclines or flagyl).
Here is the protocol I suggest:
Take 4 pepto-bismol (or less expensive generic) tablets just before going to bed. Take on the following schedule:
Week 0-2 : Take 4 tabs daily
Week 2-6 : Take 4 tabs on alternate days
Week 6-10 : Take 4 tabs once every 4 days
Week 10- 12 : Take 4 tabs once a week
Discontinue after 12 weeks. During this time be sure to supplement daily with acidophillus (3x a day with meals) since the bismuth salts do kill some good bacteria too.
You will find that as you go further out on the protocol you won’t see as much difference in regard to your symptoms between the days you do and the days you don’t take the pepto. Near the end you won’t be able to tell the difference.”
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