EP.276/ Why I don’t recommend rushing into an elimination diet for endo
This episode is a bite size episode – so expect practical tips and easy to digest information, without all the deep dive science. If you’re after more information, I’ve linked to some further reading in the show notes.
Today I want to do a bite size episode on elimination diets – specifically, why I don’t recommend rushing into them straight away.
So, before we start. What is an elimination diet? An elimination diet is currently, the gold standard for testing whether you have food intolerances and is a method for calming down the gut, allowing for healing of the intestinal lining and reducing intestinal and full body inflammation.
With an elimination diet, you remove some of the key food allergens and inflammatory foods for a short period, normally about 4 weeks and then reintroduce each food one by one in a systematic order, to test your tolerance to these foods and look for reactions.
There are several types of elimination diets, including the low FODMAP diet and the low histamine diet, but typically, the go-to one which is used initially, before these more advanced diets, would remove foods like gluten, sugar, alcohol, caffeine, dairy, soy, corn, maybe eggs and processed foods and meats. Those are typically the key ones. For some people, they may also benefit from removing foods like grains or nuts, but I try not to do this in the beginning because that can get very restrictive and there are many nutrients we can start missing out on once we begin adding nuts, etc. into the mix.
Elimination diets are used within the endometriosis community because we tend to have several food intolerances as well as gut disorders. An elimination diet helps to calm and heal the gut, but also allows us to see which foods we’re reacting to, that are worsening inflammation levels, and therefore heightening our symptoms like pain.
Elimination diets can be really helpful, but I strongly, strongly recommend that they’re done with a practitioner and they’re not always necessary to get results. And if you are going to do one, I really recommend thinking it through carefully and trying other options first.
So, here are my three reasons not to rush into an elimination diet:
Number one is that elimination diets can cause disordered eating patterns. This is especially true if someone has decided to go through an elimination diet alone and doesn’t necessarily understand the reintroduction phase. Often people believe the elimination diet is an all or nothing approach, where they take out a food, like gluten or dairy and believe that they can never have these foods again and that these foods are “bad”. This ends up creating a lot of obsession and anxiety around these foods, and can hinder someone’s joy around food, especially if that person is eating out with friends or travelling on holiday and doesn’t have access to their usual “safe” ingredients and dishes.
Now, that’s not to say you’re going to tolerate every food you reintroduce after an elimination diet. But you may be able to have small amounts here and there without a problem, so that’s why the reintroduction phase is such an important part of this approach.
My next reason is that people can get stuck on these diets. So, similar to my last reason, people can start diets and find themselves never able to get off it, not so much due to thinking these foods are “bad” but more so because they don’t know how to control their symptoms without these diets.
This is especially an issue for elimination diets focused on removing food groups to ease IBS symptoms, so for example, the low FODMAP diet, or diets that remove histamines or oxalates, but where the person hasn’t worked out or resolved the root cause of their symptoms yet.
For some people, the low FODMAP diet may be enough to resolve their symptoms, esp. if they identify one or two foods that were triggering or worsening symptoms, but in our demographic, the low FODMAP diet is more of a supportive tool, rather than something that will resolve symptoms entirely after you’ve used it. Normally, symptoms end up gradually returning with time, if the root cause hasn’t been resolved.
So, in a case like that, what kind of root causes are we talking about? Well, within our community, the most common root causes I see are small intestine bacterial overgrowth, chronic stress causing vagus nerve problems (which leads to gut dysfunction), coeliac disease and conditions like POTS or Ehlers Danlos syndrome (which are common with endo), and adhesions around the intestines. In these cases, while the low FDOMAP diet can definitely help calm down symptoms for some time, it won’t resolve the root cause, so we must address that to get long-term relief, otherwise, you may feel pulled to stick to low FODMAP foods long-term, and that’s not a healthy and robust diet.
Number three is feeling overwhelmed and quitting. I commonly notice clients with the worst symptoms, will come to me very panicked, and will want to jump on the most intensive protocol to resolve symptoms. This is obviously quite logical. If you have severe symptoms, you may think you need the most severe protocol, but often, there are so many more simple steps that they haven’t tried yet that could bring just as much relief, if not more.
A lot of the time, these clients have already put themselves on these diets and are now extremely overwhelmed and end up quitting, because they’ve rushed into the decision, started the next day or same week as thinking about it, and they haven’t had the chance to plan ahead, get foods in or consider the impact it may have on their lives. Additionally, due to the severity of their symptoms, these clients are often already overwhelmed and at maximum capacity, so then getting stressed over foods and having to change your meals suddenly, can just take them into overload.
An elimination diet can be fantastic and in some cases, very necessary, but that doesn’t mean we have to rush into it for results. The best results come from a considered place where we plan what those four weeks will actually look like and how they will fit into your life.
So, what do I recommend instead?
Plan ahead in terms of how an elimination diet is realistically going to fit into your social life, family life, finances and job. Will you need to start taking lunches into work? Will you need to eat differently from your family? Will the elimination or reintroduction phases fall in with a religious or family celebration or event, which may require you to come off it or at least make it harder to perform.
I also really recommend experimenting with the foods and meals you can actually eat, and play with some new recipes and meal prep ideas ahead of time, so that you can go into the four weeks knowing what you can and can’t eat and what you like and don’t like. There’s nothing worse than spending lots of money on your food shopping for your elimination diet, only to discover you don’t like the foods or the recipes don’t work. That ends up being a pretty miserable few weeks!
My final tip is to consider whether you really need to do a full elimination diet, or do you just need to make a few small changes? Could you do with drinking less caffeine, or cutting down a bit more on sugar or alcohol? Or could you swap out some processed foods like crisps and sweets, for whole foods like nuts and dried fruit?
I know these don’t seem like big changes, but they can create huge results with much less hassle and effort.
If you want to learn more about elimination diets and calming intestinal and full body inflammation, and why these would even matter to endo, you can listen to some of my previous podcast episodes, which I’ve listed in the show notes.
Show notes:
https://www.theendobellycoach.com/podcast/what-is-the-endo-belly-endometriosis-ibs
https://www.theendobellycoach.com/podcast/endo-belly-treatment-endometriosis-ibs
https://www.theendobellycoach.com/podcast/endo-belly-treatment-endometriosis-ibs
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Produced by Chris Robson