Anymore, it seems everywhere you look, there is some form of an elimination diet being touted as “THE” diet to go on to improve health or to address a certain health condition like IBS. As a GI Specialist Dietitian/Nutritionist who works primarily with women suffering from IBS, elimination diets can be an extremely useful clinical tool, when undertaken correctly and I use them in my practice with great success. However, many times I see some form of dietary restriction or elimination diet that has been self-imposed by my clients with little to no understanding or awareness of long-term consequences that could be occurring from undertaking an elimination diet without guidance.
This got me to thinking that since elimination diets are so common but the consequences of doing them is not, maybe it would be helpful for me to cover this topic.
So let’s dig in, shall we?
Let’s start with the basics – what is an elimination diet?
To make sure we are on the same page, let’s clarify what an elimination diet is. An elimination diet is a short term systematic dietary approach that omits (for a period of time) a food or food group that is believed to be causing symptoms, before reintroducing back into the diet. Elimination diets are actually considered the gold standard for identifying food sensitivities and intolerances (you can read more here about the differences here).
When talking about digestive symptoms such as those that occur with IBS, there are some common elimination diets that practitioners use such as the low FODMAP diet, Specific Carbohydrate Diet (SCD), some will remove whole foods groups like foods containing gluten or dairy while other approaches can become quite restrictive such as an Autoimmune Paleo/Protocol (AIP) (which removes grains, dairy, eggs, legumes, nightshades etc.).
While these different approaches can provide initial relief from symptoms, what they are not designed for is long term symptom management (especially the more restrictive approaches) and ultimately, staying on an elimination diet long term can have real consequences. And let me clarify something before moving on, if say for example, you feel better being gluten free and every time you try to reintroduce gluten containing foods, your symptoms come back, it’s perfectly acceptable to remain gluten free as long as you are replacing nutrients like fiber, B vitamins and minerals that many times are lacking when we remove gluten containing grains from our diet. Keeping these things in mind is the science and art of nutrition……
Now that we established what an elimination diet it, let’s move onward…..
Let’s talk about some signs that you may have been on an elimination diet for too long.
Your diet is progressively becoming more and more restrictive.
Maybe you started by going gluten free but not all symptoms resolved so you decided to try dairy free, then you layered on removing all grains, then you felt like beans were an issue so out those went……see where I’m going with this? And now, here you are, having arrived at chicken, steamed broccoli, olive or coconut oil and potatoes…..day in and day out and guess what? You still have symptoms……am I right? I see this all the time in my practice, so many clients eating 6-10 foods and still miserable.
You are struggling to reintroduce any foods
Most likely one reason you have ended up at chicken, broccoli, olive oil and potato is because when you did try to reintroduce a food, symptoms came back or worsened. But let’s face it, if you still have symptoms on such a limited diet or symptoms quickly return when you try to add foods, it’s time to move on to a different level of intervention and get some help to dig deeper into why this is occurring. Underlying issues such as dysbiosis (imbalance in the gut bacteria or microbiome), reduced digestive “fire” (natural or medication induced loss of digestive enzyme production), intestinal hyperpermeability (aka "leaky gut") or unidentified food sensitivities can all be underlying root causes and if they are not addressed appropriately, you will continue to struggle with your symptoms and your diet.
Your symptoms either never completely went away, are worsening, returning or new ones are arising
Many IBS sufferers do experience initial improvement in symptoms when trying some type of an elimination diet; this is the main reason why most do not pursue the reintroduction phase of a diet. People want to feel good and if you are finally having some success, who wants to rock the boat by reintroducing foods, am I right? I get it but when you eliminate food for too long, especially foods that are beneficial to our overall digestive health (like those higher FODMAP foods for example) or the diet becomes so restrictive that you are consuming only a handful of foods, ultimately, the diet can end up contributing to the worsening of gut function as well as nutrient deficiencies (which can contribute to other health issues).
Due to this, eventually, the effectiveness of the restrictive diet begins to wear off (because now there are different underlying issues contributing to symptoms) but because of the initial connection between food and some symptom relief, this is what leads to continuing to look for and eliminating a continually growing list of “triggers” and the more restrictive the diet becomes. But, sooner or later, you realize there is nothing left to eliminate, your symptoms are back, and you are feeling a whole lot worse than when you began the elimination diet journey.
You’ve stopped relying on resources to be able to tell if something is low FODMAP, AIP or SCD friendly and/or your friends or family are coming to you as an “expert”.
The truth is, an elimination diet done correctly, will eliminate foods for about 4-6 weeks on average at which point, a structured reintroduction/challenge phase should be started. Many of these diets can be quite complex as far as what is or isn’t allowed, specific serving sizes etc. so it can take quite a bit of time to really get comfortable with what you can eat. So if you are no longer needing to refer to an app, have a food list tucked away in your purse or your best friend’s sister is asking for help on implementing the diet……..can we say, red flag?
Now that we covered some signs you’ve been on an elimination diet to long, let’s discuss the why behind it.
You may be asking yourself, if an elimination diet is considered the gold standard for determining food sensitivities, there are studied diets like low FODMAP for IBS and ultimately these diets are supposed to help, what’s the big deal about being on them long term?
I’m glad you asked….
While I mentioned some things throughout this post, let’s talk about them again here, in one spot. In general, for optimal health, we want to have a primarily whole, real food diet steeped in variety and as much as possible eat with the seasons. To clarify, whole, real foods are foods that came from the earth, grew on a tree or had a mother and are minimally processed. They are the foods that for the most part don’t require labels and or come in a package (this doesn’t mean all foods in a package are bad; think low sodium canned beans, a bag of brown rice, a snack bar made with whole foods like dates, nuts and other fruit). And for variety, I teach my clients to “eat the rainbow” by keeping track of the different colored foods they eat every day so they can make good decisions on foods to include that may be lacking. When we eat with the seasons, this also helps us to naturally get variety as well. By eating this way, we provide our bodies with a wide variety of nutrients that is crucial to our health.
When we start to eliminate foods or groups of foods, if it is going to be long term (as I mentioned above with gluten for example), we need to make sure that we are making up for nutrients lost from that elimination with other foods. Most elimination diets though, especially when we are talking about ones to help with relief from IBS (like low FODMAP), remove large amounts of many healthy foods and it can be very difficult to make sure that all nutrients are being replaced (thus the need for it to be short term).
In addition to crucial nutrients, using low FODMAP again for an example, FODMAPs are prebiotic foods which means that they help feed our microbiome (gut bacteria) and keep it healthy some examples include apples, cherries, cauliflower, and many types of beans to name a few. Pulling these foods for a few weeks and focusing on low FODMAP sources of fiber during that time, isn’t a big deal but if you stay on it indefinitely, then the microbiome pays the price which leads dysbiosis. Even the researchers behind the low FODMAP diet have stressed that it is a temporary diet.
At this point, you may be wondering what do you do if you want to eat normally but your struggling to do so without making IBS symptoms worse?
Great question! Ideally, if you have started an elimination diet without the help of a health practitioner and several of the signs discussed in this article sound familiar, it’s time to begin to work with someone who can really assess your situation, make appropriate testing recommendations and get to the root cause of your IBS. If you would like to learn more about working with me and how I can help, head on over to my scheduling page and get started by scheduling an initial visit. This will provide an opportunity for me to learn more about your situation and make recommendations for working together.