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Elimination/Reintroduction Diet Frequently Asked Questions

For those with thyroid and autoimmune thyroid conditions, there is no diet that fits everyone perfectly.  But I do think it’s a good idea for most people to follow an elimination diet.  For those with Graves’ disease and Hashimoto’s thyroiditis, I frequently recommend an autoimmune Paleo diet initially, which also serves as an elimination diet, as it not only eliminates the most common allergens (i.e. gluten, dairy, corn, soy), but it also removes foods that can interfere with gut healing (i.e. nightshades).

Even though I have written articles and blog posts on eliminating and reintroducing foods, I still commonly get asked questions about this, and so I figured I’d put together a blog post that answers some of the most commonly asked questions.  If there are other questions you have about eliminating and/or reintroducing foods that haven’t been addressed in this blog post please feel free to ask them in the comments section below.

I need to mention that I have gained a lot of my knowledge in this area from Sarah Ballantyne, and so for even more information please visit her website (www.thepaleomom.com). [1]  Another great resource is www.autoimmunewellness.com [2], as both Mickey Trescott and Angie Alt have used the AIP/elimination diet to help get their health back.  So in this blog post there will be times when I will include links to their respective resources to answer some of these questions.

What’s The Purpose of Following an Elimination Diet?

There are a few reasons why people follow an elimination/reintroduction diet.  First of all, you are trying to see if you’re reacting to certain foods that can be a trigger of your autoimmune condition.  In addition, you are avoiding certain foods which can have a negative effect on gut healing.  This is important because according to the triad of autoimmunity [3], an increase in intestinal permeability (a leaky gut) is a factor in all autoimmune conditions.

Why Should You Consider Following An Elimination Diet?

As I mentioned in the opening paragraph, an elimination diet will allow you to avoid common food allergens (i.e. gluten, dairy, corn, soy), which in turn can be inflammatory and prevent you from healing.  Similarly, you will avoid unhealthy foods such as refined sugars, fast food, and unhealthy oils for the same reason.  Some healthier foods are also eliminated (i.e. eggs, nightshades [4], nuts, seeds) because they can potentially interfere with gut healing.

What Foods Should You Eliminate?

If you want detailed information on the foods you can eat and which ones you should avoid, I would highly recommend checking out Sarah Ballantyne’s excellent book “The Paleo Approach [5]”.  There is also some great information on her website, and if you sign up for the Autoimmune Wellness newsletter [6] you’ll be sent some specific lists as well.

That being said, here are the categories of foods you will want to avoid during the elimination process:

How Long Should You Eliminate These Foods For?

Ideally you want to eliminate these foods for a minimum of 30 days.  Sarah Ballantyne recommends eliminating these foods for 30-90 days.  While many people struggle to follow an elimination diet for 30 to 90 days, some feel so good that they choose to follow it for a longer period of time.

Are There Risks of Following An AIP/Elimination Diet?

When following an AIP/elimination diet you want to eat plenty of fiber-rich vegetables.  If you don’t eat a sufficient amount of these veggies on a daily basis this can have a negative effect on your gut microbiome, as the good bacteria in your gut need the fiber to flourish.  There is also a similar concern with following a ketogenic diet long-term.

When Should You Start Reintroducing Foods?

As I already mentioned, most people will follow the elimination diet for 30-90 days, and then you can start reintroducing foods.

How Do You Know If You Should Follow An Elimination Diet For 30, 60, or 90 Days?

Sometimes it can be challenging to know exactly how long to follow an elimination diet for.  As an example, if you follow the diet for 30 days and notice some positive changes in your health and if you’re not stressed out about following the diet, then it makes sense to go another month or two.  On the other hand, if after 30 days someone doesn’t notice any symptomatic improvement, does this mean they should stop?  Maybe, as while eliminating certain foods can do wonders for someone’s health, many people have other triggers and imbalances that need to be addressed before they start feeling better.  In addition, if someone is stressed out about following this diet then this also needs to be considered, as it’s not a good thing to be in a chronic state of stress over any diet.

What Symptoms Should You Look For When Reintroducing Foods?

Of course not everyone will experience symptoms when reintroducing foods.  For those who do experience symptoms, because everyone is different, the symptoms will also differ from person to person.  For example, someone might experience headaches when reintroducing a specific food, while someone else might experience digestive symptoms when reintroducing the same food.  Here is a list of symptoms that people commonly experience when reacting to a food they are reintroducing:

When Reintroducing A “Family of Foods” (i.e. nightshades, nuts) Do You Need To Reintroduce Them Individually?

You do want to reintroduce each food within a family individually.  For example, when reintroducing nightshades, you wouldn’t want to eat tomatoes, eggplant, peppers, and white potatoes all at once.  The reason for this is because you might do fine with one or two of these but react to the others, and if this is the case, you wouldn’t know which of these foods were responsible for the symptoms if you reintroduced them all at the same time.  For the same reason you would want to reintroduce each nut individually.

How Many Days Should You Wait Between Reintroducing Foods?

You want wait at least 3 to 5 days before reintroducing foods.  For example, if you reintroduced egg yolks on Monday, you wouldn’t want to reintroduce the next food until Thursday at the earliest.  In this example, if you experienced symptoms upon reintroducing egg yolks then you would want to wait for the symptoms to resolve before reintroducing the next food.

How Important Is It To Wait 3 to 5 Days Between Reintroductions?

It is very important to wait 3 to 5 days between reintroductions, and the reason for this is because it’s possible to have a delayed reaction to a food.  For example, if you reintroduced egg yolks on Monday and then reintroduced macadamia oil on Wednesday morning, and experienced a headache Wednesday afternoon, while it’s possible the macadamia oil was responsible for the headache, it’s also possible that the person had a delayed reaction to the egg yolks.

How Do You Know The Symptom Is Caused By The Food You Reintroduced?

In the example given above, how would you know that the headaches were caused by the food, and weren’t just coincidental?  The truth is that there is no way to know for certain, and if you experience a symptom that you’re uncertain is related to the food you reintroduce, then I would still recommend to stop eating that food, document the symptom you experienced, and then you can try to reintroduce the same food in the future and see if you experience the same symptom.

What Should You Do If You React To A Certain Food?

Of course you should avoid that food, but this doesn’t necessarily mean that you will need to permanently avoid that food.  If you are certain that you are reacting to a specific food it would be wise to avoid that food for at least 3 to 6 months before attempting to reintroduce it back into your diet.

How Much of The Food Should You Eat During the Reintroduction?

Sarah Ballantyne recommends to go very slowly with reintroducing foods, starting with half a teaspoon and seeing if there are any reactions after 15 minutes.  If not then you can eat a full teaspoon and wait another 15 minutes, and if there are still no reactions to eat 1 1/2 teaspoons, and if all goes well you can reintroduce the next food in 3 to 5 days.

What Order Should You Reintroduce Foods?

Ultimately this is up to you, but it makes sense to start with foods that are most nutrient dense first, and hold off on those that are most likely to result in inflammation.  Sarah Ballantyne divides the reintroduction into four stages, which you can read about in this article [7] (you’ll need to scroll down to the middle):

When Reintroducing Alcohol, Does It Matter What Kind?

Red or white wine is a good place to start, and I would make sure not to reintroduce any grain-based alcohols (i.e. beer, ale), at least initially.  Besides wine, other alcoholic beverages that are not derived from grains include rum, tequila, brandy, sherry, and cognac.

When Can Foods That Aren’t Included In The Reintroduction Stages Be Reintroduced?

This ultimately is your decision, but many advocates of the AIP diet recommend to avoid certain foods on a permanent basis, including gluten, peanuts, etc.  This doesn’t mean that you can’t successfully eat these foods again, but some foods are riskier to reintroduce than others.

Can You Do Food Sensitivity Testing Instead of The Elimination/Reintroduction Diet?

While food sensitivity testing is an option to consider, I don’t recommend this initially for a few reasons.  First of all, false results are common.  Second of all, it’s expensive, especially when you use a good quality company such as Cyrex Labs.  Also, if you do food sensitivity testing, please keep in mind that you need to be eating the food you’re testing for.  As an example, if you have been 100% dairy free for 6 months and did a food sensitivity panel, even if you have a dairy sensitivity you should expect the dairy markers to be negative, and the reason for this is because by not consuming dairy your body won’t produce antibodies.  It’s similar with other food allergens.

When I mention how false results are common with food sensitivity testing, some will argue that the elimination diet also isn’t perfect.  Without question this is true, but it also doesn’t cost hundreds of dollars.  But once again, it’s not just the cost, as the truth is that if food sensitivity testing was even 95% accurate I probably would have most of my patients do it initially.

What’s Your Experience With Eliminating and Reintroducing Foods?

Have you gone on an elimination diet?  If so, please feel free to share your comments below.  How long did you follow the elimination diet for?  Did you have any problems when reintroducing foods?  Thank you for sharing your experience with everyone.