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Eat EmpoweredWhen and How to Prescribe an Elimination Diet to Your Clients
By Ellie Erlich, MS, RDHome » Coach » When and How to Prescribe an Elimination Diet to Your Clients
Some of the first comments I get offered when anyone finds out I’m a dietitian are “how do I know if I have a gluten sensitivity?” or “why have I been so bloated lately?”. My response is generally: “I need a lot more information.”
As a practitioner, I like the idea of an elimination diet as it provides so much more data to work with when pinpointing what someone’s intolerances or sensitivities are. In short, it allows us to identify foods that cause symptoms such as bloating, fatigue or acne via a process of elimination.
Beginning with a “reset phase” and transitioning into a “reintroduction phase,” this diet will allow you and your client together to determine which foods cause symptoms to come back and which foods they can confidently tolerate.
3 Keys to a Successful Elimination Diet Journey
There are three key factors to keep in mind when deciding whether or not to embark on this journey with a patient or client:
Commitment
With this being such a restrictive diet in the beginning, and a pretty arduous (and sometimes frustrating) process, it is important to assess your client’s commitment to the journey. If they are someone who eats out frequently, is not willing to give up on favorite foods or has a background of crash dieting, then you may need to talk through their level of commitment at length. During that talk, you’ll need to thoroughly explain how this process will need to work in order for results to happen.
Monitoring
Keeping good notes of daily dietary intake and any associated symptoms is so important to pinpointing foods that trigger your client’s key complaints. They can keep track via a food journal, the notes app on their phone or a food tracking app. It’s important to determine which method they would like to use before starting any elimination diet.
Consistency
In the reintroduction phase, it is crucial to stay consistent with the frequency at which each food is brought back into the diet and which foods consistently stay out, depending on which phase they are in.
Once these factors have been assessed, it’s time to begin! Starting with the elimination phase.
2 Main Phases of an Elimination Diet
Elimination Phase
Generally, the foods being cut out include:
- All processed foods (including processed oils and condiments)
- Alcohol
- All refined sugar
- Dairy
- Gluten
- Soy
- Shellfish
- Nightshade vegetables (tomatoes, eggplant, potatoes, peppers)
- Depending on the client’s main symptoms and diet history, you may also choose to omit eggs, legumes and nuts
Foods You Can Eat
So what CAN they eat? While it may seem like just about every food is off-limits, there are still plenty of filling and nutritious ways to fuel up during this phase. These include:
- Vegetables (other than those mentioned above)
- Most fruits
- Certain grains (quinoa, brown rice, millet)
- High-quality meats (wild salmon, grass-fed beef, organic chicken)
- High-quality oils (extra-virgin olive oil, organic virgin coconut oil)
It is important to help your client build out a sample meal plan using these foods so that they can easily identify nutritionally-balanced breakfasts, lunches, dinners and snacks.
(Pro Tip: If you’ve taken our Foundational Program, there are sample meal plans available for you there. Join our community to gain these benefits and much more. The Nutritious Life Studio (NLS) provides cutting-edge nutrition, coaching, and business education to passionate students around the globe. Learn more!)
The elimination phase usually lasts about two to six weeks, as this is generally the amount of time it takes to get symptoms under control. When symptoms have significantly decreased, you and your client are ready to begin the reintroduction phase.
Reintroduction Phase
During the reintroduction phase, food journaling is key! This is where you work with your client to add the excluded foods back into the diet, one at a time. Have them reintroduce the single foods or food groups for two to three days each, and take notes of which ones trigger any negative symptoms.
I usually start with eggs, then gluten, then dairy—but this is highly individualized and should be a collaborative effort between you and your client. No matter which food you choose to start testing with, make sure it is the only food being reintroduced at that time.
A three-day testing method can look like this:
Reintroduction Phase Type 1: Dairy
- Day 1: test day – small amount (1 – 2 tablespoons yogurt)
- Day 2: test day – moderate amount (1 slice cheese)
- Day 3: test day – large amount (6 oz. yogurt, ¼ cup cheese, or 6-8 oz. milk)
- Day 4-6: rest days
Or you can add a rest day in between:
Reintroduction Phase Type 2: Dairy
- Day 1: test day – small amount (1 – 2 tablespoons yogurt)
- Day 2: rest day
- Day 3: test day – moderate amount (1 slice cheese)
- Day 4: rest day
- Day 5: test day – large amount (6 oz. yogurt, ¼ cup cheese or 6-8 oz. milk)
- Day 6 – 8: rest day
Type 2 reintroduction takes a little longer, but it may be useful if your client’s usual symptoms include constipation. This is because it may take longer to show up. Plus, a rest day in between can help your client feel more secure and stress less over the possibility of returning symptoms.
Fine-Tuning Reintroduction
If your client has a concern about a particular food group, try adding one food from that group at a time for more direct control. For either reintroduction type, an example of this would be testing just yogurt, then moving on to cheese, then moving on to milk, etc.
If your client experiences no symptoms during the period where you reintroduce a food, you can assume that it is safe to add it to their “green light” list. Then, move on to the next food group.
However, if your client experiences any negative symptoms, like those mentioned above, then you have successfully identified a trigger food. You should then collaborate on best methods to remove it from the diet. Keep nutritional deficiencies, food preferences and lifestyle in mind when building out a comprehensive list of “yes” and “no” foods. Work with a physician or allergy specialist if you suspect that there are more complex issues at play.
Walking your client through the process of an elimination diet doesn’t have to be complicated or daunting (for anyone involved!). As long as commitment, monitoring and consistency are in place, the rest will follow. Remember to focus on the many benefits and rewards that we reap when we figure out what foods serve us and what foods don’t. The end result is worth it.
(Image: Shutterstock)
Ellie Erlich is a registered dietitian and holds a Master of Science in clinical nutrition from New York University. She is the program mentor for The Nutritious Life Studio and works privately with clients to accomplish a wide range of wellness goals from weight loss to chronic conditions and autoimmune disorders.
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