12/12/1999

This Elimination/Rechallenge Diet is a short-term diet for diagnosis and assessment only; it is not a long term treatment diet. The purpose of this diet is to discover and uncover those foods that may be responsible for some, many or all of your symptoms. Whether this test diet is used alone or in combination with skin or blood tests, the results will determine what food allergy treatment diet is best for you. The treatment diet usually consists of the elimination of the worst offending foods and then rotating mild and non reactive foods on an every 3-4 day basis. This treatment diet is called an Elimination/ Rotation Diet and is described in a separate monograph.

Part I: The Elimination Phase

If you or your child are better in a week or less, begin part 2 of the diet on day 8. Improvement noted on day 2 may greatly increase by day 7. The object is to see the maximum amount of improvement which can be noted during the first 7 days.
If you want to help your entire family, urge everyone to try the diet at the same time. Typically, several family members will note improvement in how they feel or act when this is done.

If you or your child are not better within 1 week, recheck the diet records for the initial week of foods eaten: were only the allowed foods eaten? If you or your child repeatedly forgot and ate the wrong foods or drank the wrong beverages at school, work or at home, the item which was not deleted or omitted from the diet may be the culprit. Try Part I of the diet again, but this time try much harder to adhere strictly to the diet. It's best to do the diet only one time, but do it right. This fast, inexpensive method of food sensitivity detection can some times provide rapid, safe relief of many chronic medical and behavioral complaints.

Occasionally, a person is worse during Part I of the diet. This may be from a "clearing out effect" of prior food sensitivities or it may be that you or your child has begun to ingest an excessive amount of an unsuspected offending food or beverage. If this happens, immediately stop the diet. A child who substitutes apple or grape juice for milk, for example, may act or behave much worse if the apple or grape juice is the cause of this child's symptoms. Retry Part I of the diet, but stop the suspected food or beverage which you think made your child worse.

Sometimes, a person who was not helped during the first week will dramatically improve with a more prolonged diet. Continue Part I of the diet for two weeks, not one week. If Part I of the diet is tried and has not helped by the 14th day, this particular diet is probably not the answer for you or your child. The medical problems may not be related to foods or are possibly due to other frequently eaten or craved items, ie, mushrooms, cinnamon, yeast, tobacco, molds, chemicals, etc., which were not removed from the diet.

NOTE: If an infection occurs during the diet, stop the diet until you or your child is well. It is too difficult to interpret the results if it is continued.

During Part I of the diet, the following foods are omitted in all forms:

• Milk and dairy products, (yogurt, cheese, ice cream, casein, sodium caseinate, whey)
• Wheat (bread, cake, cookies, baked goods)
• Citrus (orange, lemon, lime, grapefruit)
• Eggs, corn, sugar, chocolate (cocoa or cola)
• Food coloring, additives, preservatives
• Peas (peanut butter, peanuts)
• Luncheon meats, sausage, ham or bacon
• Caffeine- coffee, tea, cola (yes, even decaf)
• Vitamin and nutritional supplements and over the counter medications. Continue all prescription medication unless directed otherwise by your doctor.

If there is some question about a specific food, do not eat it. Also, exclude any other food or beverage that is craved in excess because such items are frequently unsuspected causes of various medical or emotional problems.

MAJOR CAUTION: Do NOT eat any food you already know causes a severe allergy. This diet is to detect foods that you eat frequently but that are NOT presently recognized as a possible cause of certain medical, behavior, activity or learning problems.

Table of Allowed and Forbidden Foods During Part I

Food Type	Allowed	Forbidden
Cereals/Grains	Rice- rice puffs, rice Oats-oatmeal made with honey Barley	Foods containing wheat flour- most cakes, cookies, bread, baked goods
Fruits	Any fresh fruit, except citrus Canned-if in their own juice and without artificial color, sugar, or preservatives	Citrus- orange, lemon, lime, grapefruit
Vegetables	Any fresh vegetables, except corn and peas French fries (home made only) Potatoes	Any frozen or canned vegetables Corn, peas or mixed vegetables
Meats	Chicken or turkey (non-basted) Louis Rich ground turkey Veal or beef Pork Lamb Fish, tuna	Luncheon meats, wieners, bacon Artificially dyed hamburger/meat HamD yed salmon, lobster Breaded meats, meats with stuffing
Beverages	Water (preferably spring water) Single herb or plain tea & honey Grape juice, bottled Frozen apple juice Pure pineapple juice (no corn or dextrose)	Milk or dairy drink with casein or whey Fruit beverages except those so stated Kool-Aid Coffee Rich (yellow dye) 7-UP, Squirt, Teem, cola, Dr. Pepper, ginger ale Coffee, black teas (even decaf)-be sure to wean slowly off caffeine to prevent headaches
Snacks	Potato chips without additives Ryekrisp crackers and pure honey Raisins (unsulfured)	Corn chips (fritos) Chocolate/cocoa Hard candy, ice cream or sherbet
Miscellaneous	Pure honey Homemade vinegar/oil dressing Sea salt Olive Oil (cold pressed) Pure maple syrup Homemade syrup	Sugar, dextrose Bread, cake, cookies (except special recipes) Eggs Dyed (colored) vitamins, pills, mouthwash, toothpaste, medicines, cough syrup, etc. Jelly or jam Jell-O Margarine or diet spreads (dyes and corn) Peanut butter/peanuts Sorbitol (corn) Cheese All nonessential medications, food/vitamin supplements Red pepper (cayenne)

Be sure to read all labels first! Refer to page 8 for more details on food groups.

Special Tips for the Multiple Elimination/Challenge Diet

The "allowed" foods can be selected, combined and eaten in any quantity. If you are a bit suspicious, start with a tiny amount and increase it during the day if no symptoms are revealed.

For a beverage, you can mix the allowed fruits in the blender with spring water and honey or pure maple syrup.

You or your child's medications can be taken during the diet. If improvement is seen, you may find that certain medicines such as antihistamines are needed less often by the end of the first week. Try to use only white pills (crushed for small children and placed in applesauce or potatoes) or colorless liquids. Most liquid medications contain corn, sugar, artificial flavors, and artificial dyes which can cause symptoms in many children. Check with our office or your or your child's physician about any questions you may have regarding this.

Once you determine which foods cause specific symptoms, you must discuss the problem with us or your physician. Some foods cannot be omitted for indefinite periods of time if proper nutrition if to be maintained.

Do not try the diet when you or your child has an infection or is receiving antibiotics which contain dyes, sugar, flavoring, or corn. Holidays and vacations are also not a good time to start this diet!

Although symptoms from a single food vary, food sensitivities are often evident in several family members. One child might have headaches, another a stuffy, congested nose, a third family member hyperactivity, and another child might wet the bed. The same food, ie., milk, can be a problem for several generations of a family. For this reason, make cooking easier by placing the entire family on the diet. A fringe benefit may be that you relieve some "emotional or learn-to-live-with-it" health problems caused by certain foods or beverages in several family members.

If your child refuses the diet, try offering rewards. Promise a gala party if there is no cheating and if it is obvious that the child is truly trying very hard to cooperate in every way. The party should take place AFTER both parts of the diet are completed. At that time, give your child the foods which caused the symptoms providing they were not severe and incapacitating. This will be a double check confirming the effect of these foods on your child. Alka-Aid (from health food store) will prevent or stop reactions in many children in 10-15 minutes depending upon whether it is given before or after a problem food is eaten. Alternatively, you may offer a reward at the end of each completed day, ie. a hobby item (new stamp, coin, fishing lure, etc) and then an additional gift at the end of the week. Younger children often respond well to a gold star chart. Make a chart with a space for each meal of every day of the week. Give a star for every meal successfully completed. You might even suggest that for every x number of stars (2,3 etc) the child earns a special treat- a trip to the park, a small toy, etc). Be sure to let the child in advance know what are the goals and stick to them. In the end, you must realize, that if your child does not want to go on this diet, he or she won't! Hopefully you can convince them to at least meet you half way.

If your child has asthma, add the test food back into the diet with extreme care. It is possible that an unsuspected food could precipitate a sudden severe asthma attack. Have asthma medications on hand during Part II of the diet and use the Pocket Peak Flow Meter to help find out exactly what is causing your child to wheeze.

You may have some difficulty finding suitable substitutes and foods during your elimination and challenge phases of this diet at conventional grocery stores. If so, try your local health food or gourmet stores for various foods and food products. It is also helpful to plan your diet for the whole time and then purchase exactly what is needed for each day; this way you won't get caught short at the last minute looking for a particular food item to be added or substituted.

Admittedly, this diet is not the easiest to follow; it requires patience and discipline. However, once hidden food sensitivities are discovered, you can take the first step to free yourself or your child from symptoms and problems that have up to now been only partially or even ineffectively treated. Do the best you can, never give up, and the results will follow.

Part II: The Food Challenge

During Part II of this diet, one food is reintroduced into the diet, in excess, each day in the following manner:

• On day 8 add Milk
• On day 9 add Wheat
• On day 10 add Sugar
• On day 11 add Egg
• On day 12 add Cocoa
• On day 13 add Food Coloring
• On day 14 add Corn
• On day 15 add Preservatives
• On day 16 add Citrus
• On day 17 add Peanut Butter
• On day 18 add Coffee or Tea (for adults)
• On day 19 add back your Supplements one new one each day OR every 2-3 days.

Keep detailed records of how you or your child feels at the beginning and the end of each day, and observe carefully for one hour after a food is tried or eaten again. Start with a teaspoon or 2 cup of the test food item and double the amount eaten every few hours, so that by the end of the day a "normal" amount has been ingested. Do any symptoms suddenly reappear? If you want to know even more about what each food does when it is eaten again, do the following (you or have your child do the following):

• Write or draw. Is there a change or deterioration from before a meal to 20 minutes after the tested item is eaten? If so, the item(s) ingested could affect your child's school work.
• Take the pulse before and after eating a food item. If it increases by 20-40 points after eating a particular food, this may be an indication of a sensitivity to that ingested item.
• If you or your child have asthma, use a Pocket Peak Flow Meter before and 20 minutes after each tested food. If the reading on the gauge drops 15%, or 50 or so points, that food or beverage could be the cause of wheezing or asthma symptoms.

If there are no symptoms during that day, during the night or the next morning before breakfast, the food tested the day before is probably all right and may be eaten when desired or preferably as part of a rotation diet. If the test food causes symptoms, stop eating it in all forms (see end of this handout) until you can obtain advise from our office or your physician. Do not give your child another test food until the symptoms from the previous food test have subsided (you may have to push back the above schedule of what day to test a food, this is perfectly OK). Usually, however, you will notice that a symptom(s) caused by a food occurs within one hour. However, symptoms such as canker sores, bed-wetting, tight or painful joints, ear fluid, and bowel problems that are food related tend to be delayed reactions occurring several hours or sometimes several days later.

If symptoms persist, Alka-Seltzer Antacid Formula without aspirin ( Alka-seltzer Gold) or Alka-Aid can be purchased from a health store. The Woodlands Healing Research Center carries similar products for this purpose. The dose is 1 tablet for age 6-12 and 2 tablets for over age 12. Don't use this if you or your child has liver or kidney disease. Your usual prescribed allergy medications can be taken if needed for symptom control.

Note: If one of the listed foods causes a reaction which is not helped by Alka-Seltzer Gold, Alka-Aid or BiCarb Formula and which lasts over 24 hours, DO NOT TRY to check the response to the next test food item until the reaction has entirely subsided!

Watch closely to see what happens each day. One food might cause a stuffy nose, the next, no reaction at all. Some reactions occur immediately, others in several hours.

Once again, if a food obviously causes serious symptoms, it should not be tried. NEVER TEST ANY FOOD WITHOUT YOUR DOCTOR'S ADVICE IF IT CAUSED SERIOUS MEDICAL PROBLEMS IN THE PAST. For example, if egg or peanut caused immediate throat swelling or fish caused severe asthma, it is unsafe to try even a speck of these foods!
If you are uncertain whether a food causes symptoms or not, discontinue it until the other foods have been checked. Then give your child the suspected food again at a five day interval, ie., Tuesday and Saturday. See if symptoms recur each time and stop when you confirmed a food reaction.

As stated, you may add back food and vitamin supplements one at a time in the above fashion to determine if they are causing any symptoms or reactions. Furthermore, it is wise to retest all supplements in this fashion every 6 months to make sure a sensitivity has not developed to that supplement: stop them all for a week and add them back one new one each day.

Once you have determined which foods are tolerated and which foods give symptoms, it is best to avoid the symptomatic foods for 3-6 months and then retry them to see if they still cause symptoms. All other "safe" foods should be eaten in a rotation manner as described in the separate hand out "Rotation Diet". This will hopefully prevent the development of other and new food sensitivities from developing. These recommendations are general guidelines only, discuss any food allergy diet with your physician to individualize these instructions according to your particular needs.

Specific Details of Part 2: Food Challenge

Day 8	The day you add Milk: Give you or your child lots of milk, cottage cheese and whipped cream sweetened with pure maple syrup or honey. No butter, margarine or yellow cheese unless you are absolutely certain they contain NO yellow dyes. Remember to make sure any and all symptoms provoked by milk are totally resolved before proceeding to the next food
Day 9	The day you add Wheat: Add triscuits or pure wheat cereal. If your child had trouble from milk, be sure NOT to give milk products. Use Italian bread or kosher bread because these should not contain milk (casein or whey), but always read labels to be sure. You may bake your own bread if you wish, but you must not use eggs, milk, or sugar. Remember, the child can eat no dairy products or drink any milk if these seemed to cause problems. Remember to make sure any and all symptoms provoked by wheat are totally resolved before proceeding to the next food
Day 10	The day you add Sugar: Whole sugar cubes are eaten and granulated sugar is added to the allowed foods. If milk or wheat caused trouble, they must be avoided or you can't tell if sugar is tolerated. Many children react within one hour after 4-8 sugar cubes. Remember to make sure any and all symptoms provoked by sugar are totally resolved before proceeding to the next food
Day 11	The day you add Egg: Give eggs in the usual forms, cooked or as eggnog or custard (as long as dairy is tolerated). Remember, again, no wheat, milk or sugar can be consumed if any of these caused problems. Be sure to skip this food challenge if you already know egg is a problem. Remember to make sure any and all symptoms provoked by egg are totally resolved before proceeding to the next food
Day 12	The day you add Cocoa: Give dark chocolate with water, cocoa (pure Hershey's cocoa powder) and honey or pure maple syrup. No candy bars are allowed because most contain milk and corn. Remember, no milk, wheat, sugar, dyes or eggs are allowed if any of these caused symptoms. Remember to make sure any and all symptoms provoked by cocoa are totally resolved before proceeding to the next food
Day 13	The day you add Food Coloring: Give Jell-O, jelly or artificially colored fruit beverage (soda pop, Kool-Aid), popsicles or cereal. Try to give lots of yellow, purple and red items because the patient might react to only one of these colors. Remember to avoid milk, wheat, cola or sugar in all forms if any of these were a problem. If sugar caused symptoms, use honey or pure maple syrup, as a sweetener or add food coloring to plain pure gelatin. If milk, wheat, or sugar were tolerated, they may be eaten. Remember to make sure any and all symptoms provoked by food coloring are totally resolved before proceeding to the next food
Day 14	The day you add Corn: Give corn, corn meal, corn flakes, and plain popcorn. Popcorn can be made with salt. If milk, wheat, sugar, dyes, eggs, or chocolate caused trouble, you can't give them on the day you give corn. If you do, and your child is worse, you won't be able to tell which is at fault. Do not use butter on popcorn if your child has a milk sensitivity. Remember to make sure any and all symptoms provoked by corn are totally resolved before proceeding to the next food
Day 15	The day you add Preservatives: Give foods which contain any preservatives or food additives. Read every label. In particular, eat luncheon meat, bologna, hot dogs, bread, baked goods, or soups which contain many preservatives and additives. Remember to make sure any and all symptoms provoked by preservatives are totally resolved before proceeding to the next food
Day 16	The day you add Citrus: Give large amounts of lemon, lime, grapefruit or orange as fresh fruit or in juice. Avoid artificial dyes if food colors were a problem.
Day 17	The day you add Peanut Butter: Give lots of peanut butter or peanuts. Test for this only if it's a favorite food. Use Ryekrisp if no wheat is allowed. Use pure peanut butter without preservatives (Smuckers)
Day 18	The day you add Coffee/Tea: For adults and older adolescents who consume coffee or tea. Go back to the number of cups of coffee/tea or other caffeinated drinks per day you were consuming prior to starting this diet. You may not be able to drink as much if symptoms are rapid and extreme, ie headache
Day 19	The days you add back Supplements: Re-introduce your supplements one at a time each new day or every 2nd day. You can add them back in any order of your preference or as directed by your physician. Monitor and observe for symptoms as you did with your food rechallenge

Further Information
The following books provide more information and recipes to help you with the elimination diet:

• Eating Alive, John Matsen, N.D. (Excellent and most comprehensive discussion of an elimination / detoxification program). This book is available from the Woodlands Healing Research Center.
• Detecting Your Hidden Allergies, William Crook, M.D.
• Food Allergies, How To Tell If You Have Them, What to do About Them If You Do, N. Orenstein, Ph.D.
• If This is Tuesday, It Must Be Chicken, Or, How To Rotate Your Food For Better Health. Natalie Golos and Frances Golos Golbitz. Keats Pub. Co. 1983.
• Special Foods-Is a company which makes common food items from unlikely food sources. The company began to cater to people with extensive food allergies, and in the process has discovered new properties of flours from root vegetables.(703) 644-0991; Fax (703) 644-1006

Table of Food Ingredients

The following table lists those foods which fall into the major categories eliminated from the diet. Any thing listed in the category should be evaluated to determine whether it contains some or all of the major listed item.

Citrus	Cocoa	Sugar	Artificial Sweeteners
grapefruit lemons limes oranges citrus beverages	cakes candies chocolate cereals chocolate & cola drinks frosting pastries & pies	brown sugar candy cake corn syrup soft drinks succanat dextrose, glucose sucrose, fructose	aspartame NutraSweet saccharine
Corn	Dairy	Eggs	Wheat
alcohol-most bacon bread products candies corn batters corn breads corn flakes other corn cereals corn muffins corn oil corn starches cured meats (ham, sausage, bologna) dextrin& dextrose envelope and stamp adhesive fresh/frozen corn fructose hominy gritsi ce cream jelly ketchup maize mazola oil mixed vegetable oil modified food starch mustard pastries peanut butter with corn syrup popcorn salad dressings sherbet toothpaste tortillas zein	butter biscuits cakes candy chocolate cookies cottage cheese crackers cream soups doughnuts ice cream luncheon meats milk (whole, skim, evaporated, goat's, condensed, instant, nonfat, dry) pastries yogurt Read labels for milk derived ingredients- casein, lactalbumin, whey	battered (fried) foods breadcakes (including all cake mixes) candy casseroles cookies custardd oughnuts eggs in any form egg salad egg sauces french toast fritters hollandaise sauce ice cream mayonnaise meringues noodles omelets pancakes pastapies prepared mixes and frozen dinners salad dressings sherbet souffles tartar sauce waffles Read labels for egg derived ingredients- albumin	bagels beer biscuits bran bread (wheat, white, rye, pumpernickel) bulgur cakes cereals (most) commercial gravy cookies cous-cous crackers doughnuts farina flour (wheat, graham, white, high gluten, enriched, unbleached) french toast matzos meats containing fillers (meat loaf, hotdogs, bologna, luncheon meats muffins noodles pancakes pastries prepared batters/mixes rolls semolina soups (with noodles, dumplings, or thickened with wheat flour) soy sauce tabouli wheat cereals wheat germ
Artificial Colorings	Preservatives	Seasonings	Yeast
There are many colorings Yellow dye #5 is most trouble causing and is found in: butterscotch chipscake mixes candy drops and hard candies certain breakfast cereals certain candy coatings certain instant and regular pudding colored marshmallows chocolate chips commercial frostings commercial gingerbread commercial pies flavored carbonated beverages flavored drink mixes ready-to-eat canned puddings refrigerated rolls and quick breads	sodium benzoate (benzoic acid) BHA& BHT MSG Metabisulfite (sulfites) sulfites are not always listed in ingredients, foods possibly containing sulfites: beer, wine & any alcoholic beverage soft drinks cider/vinegar shrimp (esp frozen) soy protein avocado dips potato chips french fries dried potatoes cake mixes processed fruits (canned, juices, frozen, bottled, dried, jam) fruit drinks lemon juice concentrates many medications salad bars at restaurants	Don't pick up anything and shake it on your food until you read the label first.	baker's yeast brewer's yeast condiments that contain vinegar (mustard, ketchup, relish, horseradish, pickles, mayonnaise) dried fruit fermented foods (miso soup, soy sauce) grapes, nutritional yeast peanuts sauerkraut vinegar Yeast products may occasionally cause trouble but were not specifically addressed during this elimination and challenge phases. If you suspect they may be a problem or wish to see if they are, just eliminate the above foods in the yeast category during your elimination phase and then add them back at the end of the rechallenge phase.

Click here to Return to Woodlands home page

---

A Healthy Approach In An Unhealthy World