Tools For Physicians - Elimination Diet
Overview
My name’s Tyler Nicholson and I’ve been working in the fitness industry for almost 15 years. I’ve spent most of that time helping people achieve their fitness goals which often includes losing significant amounts of weight, resolving chronic conditions like high blood pressure, pre-diabetes, acid reflux, and autoimmune conditions like lupus, Hashimotos, IBS, and more.
Through a lot of learning combined with real world trial and error I’ve arrived at a set of habits and tools that when used appropriately deliver very consistent results for the participant. I want to share these tools with the medical community so they can use them with their patients to drive improvements in chronic health and together we can save lives and reduce the reliance on pharmaceuticals that only mask the underlying issues.
Let’s start with food.
There are two major factors causing people problems based on what they eat. These two factors are systemic inflammation from problematic foods and regular surplus calorie intake.
Elimination Diet Basics
Systemic inflammation from foods like glyphosate covered wheat, seed oils, dairy products, alcohol, and more is something you can think of as smoking for your GI tract. This kind of inflammation can cause a wide variety of symptoms that includes everything from bloating, constipation, and stomach pain to brain fog, skin issues like eczema, and more serious conditions like IBS, colitis, and plays a big factor in autoimmune issues like RA, Lupus, Hashimotos, and more.
While there’s some promising emerging science around identifying sensitivities to foods via blood tests, I’ve found the most accurate way to assess people’s individual reactions to inflammatory foods is via an elimination diet. This process includes eliminating all of the possibly problematic foods for a period of at least 8 weeks before reintroducing them one at a time to assess the consequences and individual reaction.
The rationale here is that if you’re already accustomed to the symptoms caused by having inflammatory foods consistently in your diet you may not notice anything being “wrong”. However, once all that inflammation goes away by removing all the possible offending foods, an uptick in inflammation can be easily identified. I like to get people feeling REALLY good first, then have them test foods to see the impact.
Due to individual variation, people will respond differently to different foods. Things like dairy and beans can be very well tolerated by some and cause serious symptoms in others, whereas some foods like wheat seem to be poorly tolerated by just about everyone. The severity of reaction upon reintroduction combined with a value assessment of that food can drive a decision tree on how often to include that food in an individual's diet.
Foods with severe reactions, or those with milder reactions and less value to the individual, might be avoided entirely or eaten only occasionally following the completion of the elimination diet. Conversely, foods that are well tolerated, or those that cause only mild symptoms but have a high value to the individual might be incorporated more frequently based on their own judgment.
The goal is for each individual to be put in control and made aware of their own reactions to inflammatory foods so they can modulate their intake to keep themselves feeling good, but not feel arbitrarily restricted.
The How To
For eight weeks individuals should completely eliminate all possibly offending foods and stick to a whole food diet of meat, vegetables, fruit, and healthy fats. These plant and animal foods are not only anti-inflammatory, but also nutrient dense, and safe for just about everyone.
The list of foods I’ve found that should be restricted is as follows:
Wheat and grains (cereal, breads, beer, soy sauce, breakfast bars, etc)
Dairy - excepting butter which tends to be well tolerated (milk, cream, cheese, yogurt)
Eggs (whole eggs, yolks, and egg whites)
Sugar (table sugar, agave, honey, HFCS, cane syrup, etc)
Alcohol (wine, liquor, hard seltzers, etc)
Drinks with calories (soda, juice, smoothies, sweet tea)
Artificial sweeteners (aspartame, sucralose, sugar alcohols)
Legumes (all types of beans)
Corn
Seed oils (Canola, palm, palm fruit, corn, soybean, cottonseed, grapeseed, and sunflower oi)
Processed and packaged foods - these are suspect since they almost always contain ingredients mentioned above
This list will invariably include foods that don’t necessarily cause issues for everyone, but much like excising a cancerous growth surgically, it’s far better to cut with a little wider margin than necessary then to accidentally leave a problematic food in. Some foods such as eggs and corn tend to be well tolerated in moderation only after a period of elimination. While specific mechanisms are in need of more research, it’s my belief that the elimination period allows the gut to heal and become much less reactive. As an example, we find eggs, corn, and dairy to have highly individual responses with some showing almost no reaction after the eight week period, while others still see significant symptoms from reintroduction.
Also, those with a suspected or diagnosed autoimmune condition are encouraged to eliminate an even broader list of foods that are associated with AI conditions. This AIP protocol should further eliminate:
All nuts and seeds including:
Almond
Brazil nut
Cashew
Chia
Coffee
Cocoa
Flax
Hazelnut
Hemp
Pecan
Pine nuts
Pistachio
Pumpkin
Safflower
Sesame
Sunflower
Walnut
Seeds and Berry Spices
Allspice
Anise
Caraway
Celery seed
Cumin
Fennel seed
Mustard
Nutmeg
Pepper
Poppy seed
Nightshades
Eggplant
Goji berries
All peppers (including sweet, bell, and chile)
White potato
Tomato
Tomatillo
All red spices
Which then begs the question, what DO we eat while we do this elimination diet. In my experience almost 100% of people feel fantastic and see dramatic reductions in inflammation when eating only:
Meat (chicken, turkey, beef, pork, game meats, fish, shellfish)
Vegetables (asparagus, broccoli, brussels, salad greens, squash, cucumbers, the list is almost endless..)
Fruit (berries, apples, citrus, stone fruit, etc)
Safe starches (rice, potatoes, sweet potatoes, oats, yams, and squash)
Healthy fats (from olive, coconut, avocado, and grass fed butter sources)
Participants should plan to eat to satiety during the elimination phase. When hungry, eat more, but not beyond what makes one comfortably full. There’s no need to experience hunger at this stage.
If guidance on portion sizes is helpful, encouraging the following tends to work well:
Eating every 3-5 hours to proactively curb hunger helps maintain fidelity to the process. Getting overly hungry seems to reduce compliance and increase the risk of resorting to food on the avoid list
Meat portions of 4-6oz for females and 6-8oz for males
A large handful of vegetables or fruit per meal
A tablespoon of fat from olive oil, avocado oil, coconut oil, or butter)
If whole fat sources are used like olives or whole avocado / guacamole, a baseball sized portion of fats is acceptable due to the reduced calorie density
One to two cups of safe starches or less based on activity level. Very high activity levels will respond well to increased starch content, and sedentary populations can skip starches altogether.
What to expect
While the above recommendations may seem restrictive from an experiential standpoint, I find it hard to argue that eating only these foods would cause anyone to be unhealthy. In fact, it’s my experience that when eating ONLY meats, plants, and healthy fats individuals see rapid and dramatic improvements in every measure of health and fitness you can find.
The subjective measures such as energy level, GI discomfort, sleep quality, mental clarity and more improve rapidly alongside the subjective measures such as HBA1C, lipid profile, blood pressure, HRV and RHR, work capacity, and more.
It’s also common to experience substantial weight loss in the first week or two of the elimination diet, to the tune of two to twelve pounds, or even more. While the elimination diet may favorably improve caloric balance, the weight loss is too rapid to be explained by body composition change via a shift in thermodynamics.
My current hypothesis is that this “water weight” loss is due to the elimination of chronic inflammation from the gut and possibly greater abdominal cavity and tends to taper off within two weeks or less as symptoms and overall experience improve.
The changes experienced while completing the elimination diet are often dramatic enough that people rarely return to their previous eating habits. They feel so good they’re reluctant to give up their newfound vitality to go back to their previous eating habits, which is telling.
Running the elimination diet for a short period of time, say 10 days, can be a powerful experience and create the motivation to lengthen the commitment without feeling overwhelming at the outset. Best practice of duration for optimal assessment of food sensitivity seems to be somewhere around eight to twelve weeks. Sometimes it makes sense to start small and build once people start to feel the positive changes.
How to Reintroduce
Once someone has taken a break from the suspect foods they can test each of these food groups for tolerance. We think it’s unreasonable that anyone eliminate a food from their diet permanently based solely on what someone else tells them, so the major factor in how often and how much one eats of these foods is going to be based on the calculated cost / benefit.
The cost is measured in negative reaction to the food with regard to experience, comfort, and affect on symptoms. The benefit can be assessed as the joy the food brings, cultural importance, roll in social life, etc.
Here’s how we recommend testing out each of the previously eliminated foods:
Try out one single food group at a time. For example, to test dairy, try some cheese along with other safe foods you’ve been consuming regularly as opposed to having pizza which contains several of the groups above. Singular foods will allow you to assess individual reactions and not confuse the test by introducing multiple factors at the same time.
Take into consideration ones current state when doing so. Has anything else changed in their routine that might confound your results? Ie. Did they sleep well the previous night? Are they well hydrated? Are there new supplements or meds in their routine? All of these factors can confuse the outcome
Test different individual foods within groups. Keeping with the dairy example, we find many people tolerate heavy whipping cream and greek yogurt well, however very few tolerate skim milk. Homemade sourdough bread seems to be tolerated much better than store bought white bread. While the list can seem overwhelming, testing one food within a group and getting a favorable response might encourage further investigation. Conversely, a significantly negative response might be all the data one needs to label that food group an occasional or rare introduction.
Wait for at least 24 hours between food tests, several days is even better. Did you know wheat can stay in your digestive system for 7-10 days after eating it compounding GI inflammation and causing cross reactivity with foods like corn?
Start with a small serving size of the food you’re testing, and if you find you tolerate it well consider increasing the size of the serving next time. Remember, the poison is in the dose. Sometimes our bodies can handle a little of something, but not a lot.
Lastly, watch how the food in question affects body weight. Short term fluctuations in body weight are almost always inflammatory in nature. If eating some yogurt causes a weight increase of a pound or two that’s an indication there’s a significant inflammatory response active.
Below are the most common symptoms we see reported by clients from reintroduction of inflammatory foods:
Stomach discomfort
Bloating
Gas
Acid reflux or heartburn
Rumbly tummy or gurgling
Diarrhea or loose bowel movements
Constipation
Brain fog
Loss of energy or lethargy
Disrupted sleep
Skin irritation, hives, or eczema
Nasal congestion or increased mucus production
Joint pain or muscle tenderness
Immediate weight gain (within 24 hours)
Finding Balance
Once someone has tested some foods and identified symptoms and severity of response they’re ready to start making some individual decisions about what foods to include in their lifestyle.
The goal of this process is to find a diet (meaning a selection of foods) that allows them to achieve their goals while living a rich, meaningful lifestyle. Most individuals will find that occasional inclusion of inflammatory foods allows them to enjoy the social, cultural, and flavorful joys of food without sacrificing long term health and fitness goals.
Doing some basic cost / benefit analysis is appropriate at this stage. There are great reasons to incorporate foods that might not make one feel their best for a short period of time. Eating a home cooked meal with family you don’t see frequently, or celebrating a big night out for an occasion are both great reasons to make short term compromises.
However, everyone will find there are foods that make them feel bad enough that eliminating them completely from their diet makes sense and improves their quality of life.
One important point here is that participants make a decision about food that fits THEIR values. Only you know the relative value and cost of eating these foods. We want to instill confidence that they can make these decisions themselves and do so without any guilt or regret. The perfect diet is different for everyone and it’s all a matter of balance and informed, educated choices.
When someone asks what rules you follow when you eat, we should all strive to be able to answer simply “I know what makes me feel good and what gets me to my goals, so I eat whatever I want”.
Phase One
We refer to the elimination diet part of our coaching process as Phase One. To accompany this process we’ve developed a helpful infographic that you can print out and pin to the fridge. You can download a copy for free below: