my elimination diet

UPDATE August 16/2011: I have refined my list of tolerated safe foods combining the Paleo diet + low food chemicals + low-FODMAPs and it can be found here in my latest post.

***

Ok, as you are aware, I have been dealing with a lot of different symptoms in the last months. I first thought going Paleo would clear everything. Since then, I was diagnosed with a parasite infection (Blastocystis Hominis), took 2 kinds of antibiotics (TinidazoleMetronidazole), without any improvements in my symptoms. However, my last blood tests were showing improvements in many markers. I felt like eating some foods were making things worse for me, but couldn’t point my finger on it, until my gastroenterologist mentioned Fructose Malabsorption (FM). At first, I thought, well I don’t eat fruit nor sugar, so that cannot be the problem. However, I did my homework and found that FM is also linked to problems with ingesting fructans, sorbitol and mannitol (found in many vegetables).

I eliminated many of the problematic foods from my diet and experienced some relief on a few days but always ended up eating something that would trigger the re-apparition of my symptoms. The problem is that there are many lists of SAFE and UNSAFE foods on the internet, but not all of them are accurate. I started deciphering the published literature (here and here) and learned tremendously from the Fructose Malabsorption Yahoo! Group. I decided to go with a very strict approach.

Last week, I followed an elimination diet, but only by avoiding the unsafe foods. I think their cut-off may not be low enough, so this week, I will continue my elimination diet by eating only the safest foods.

I also stopped ALL SUPPLEMENTS, except for my digestive enzymes (now super enzymes; contains no sugar, salt, yeast, wheat, gluten, soy, milk, egg, shellfish or preservatives). I feel like I really need these. Otherwise, I feel like my meal get stuck in my stomach for so long…..

The goal is to eliminate my symptoms for 4 whole weeks (the most I have succeeded to far is to be symptom-free for 12-16 hours…). And then I will be able to reintroduce foods one by one to see what works or not. I have tried keeping variety in my diet and my supplements in the last week, but I think I will get better results by eliminating ALL confounding factors and sticking to a few safe foods.

I will be posting my meals, which will be very BORING, PLAIN and REPETITIVE. But if you have IBS-like symptoms, bloating, fatigue, lack of concentration, depression and brain fog while following the Paleo diet, I suggest you look into FODMAPs. I *think* I have finally found what is wrong with me and am looking forward to share my journey with you.

My diet for the next month (updated here)

Protein:

  • free-range eggs
  • grass-fed meat
  • free-range chicken
  • wild-caught fish
  • NO cured meat, NO bacon, NO nitrates
Fat:
  • coconut oil
  • macadamia oil
  • animal fat
  • organic butter (no more than 1 tbsp.)
  • NO avocado

Vegetables ( no more than 1/2 cup at a time, 1 cup for lettuce):

  • lettuce (mesclun)
  • cucumber (peeled)
  • celery (no more than 1 stick)
  • red bell pepper (no more than 1/2)
  • eggplant
  • turnip (1/4 cup only)
  • pumpkin (1/4 cup only)
  • zucchini (peeled)
  • green beans
  • bamboo shoots
  • bean sprouts
  • NO onions, tomato of any kind, mushroom, garlic, leeks, broccoli, cauliflower, Brussels sprouts, cabbage (nor sauerkraut), etc.
Seasonings:
  • salt & pepper
  • gluten-free tamari sauce (no more than 1/2 tbsp.)
  • fresh ginger (no more than 1 tsp.)
  • NO vinegar of any kind, curries, spices or herbs
No-Nos:
  • NO fruits
  • NO wine
  • NO coconut (flour, milk, cream, butter or dessicated)
  • NO chocolate (dark chocolate, cocoa powder or nibs)
  • NO nuts
  • NO caffeine
  • and of course NO sugar, NO grains, NO legumes and NO dairy (except for organic butter)




Learn more about the Personal Paleo Code


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23 thoughts on “my elimination diet

  1. I’m enjoying your posts. I went Paleo 1/11 and didn’t have digestive issues before but have some now (difficulting burping, 2 episodes of ? acid reflux so bad that I developed an upper GI bleed for 4 days, and now maybe some gall bladder problems (pain under my right shoulder blade). Refused to be scoped or take PPI. Paleo cured my chronic fatigue, brain fog, muscle wasting, weight loss, etc. though.

    So I appreciate all the new info you’re sharing. The fructose group has added value.

    I’m interested in knowing why you are reducing your butter/fat intake. I’m wondering if my high fat intake could be causing some issues even though my BMs are normal and not fatty foul smelling.

    Best wishes

    • Thanks for sharing your info and I hope that you will find an answer to your problems soon…

      Regarding the fat intake, I am not reducing it at all. Just for *fun* (I am a dietitian after all! lol), I logged the food I ate yesterday in fitday and here is the breakdown for day 1: 1413 calories, 99.1 g of fat, 15.8 g of carb, 5.1 g of fiber and 113.4 g of protein, which corresponds to 63% fat, 4% carb and 33% protein. =)

      I take digestive enzymes to help me digest the fat and protein and see a big difference.

  2. Hello,

    I have helped hundreds of people execute FODMAPs elimination diets followed by challenge, and I have a suggestion. The FODMAPs effect is “dose sensitive”. If you just challenge with one serving of one food at a time you might not learn much, especially if the food you choose is rather low in the FODMAP in question. Rather than challenge with one FOOD at a time, consider challenging with one FODMAP at a time, for example, a lactose challenge rather than a yogurt challenge.

    Just wanted to invite you to check out the FODMAPs resources on my web site, http://www.ibsfree.net. Looks like you are a dietitian, and might be interested in my patient education handouts for yourself or your clients, which you can order through the web site.

    Best of luck to you in your FODMAPs journey.

  3. I’m relieved to find someone else doing a paleo FODMAPs diet! I ordered Patsy’s book and appreciate her work, but can’t relate almost at ALL to the meal plans and food lists in there. I have been paleo-ish (grain free) for over a year and just shake my head at the recommendations in there. I would feel like CRAP if I ate those meal suggestions… so much grain and so little fat. Margerine? Not on my deathbed, seriously.

    I think I’m in a pretty similar boat to you… I feel a lot better on a paleo diet, but still have a lot of IBS symptoms (mostly gas and bloating). So far my reductions in FODMAPs don’t seem to be getting rid of them, though it is better. I think I might have to get stricter, as you have. I hate having SUCH a limited diet, though…

    Sigh! Thanks for your posts.

    • I am glad you have found my blog! I have the same book and I agree, I have to skip all the grain, fruit and sweet section. I can’t believe avocado are not even mentioned and that the fat section is so limited. And the fat? OMG, yes it would be great to have a Paleo / low-FODMAP ebook, wouldn’t it? I might come up with that! 😉

      I know it’s hard to give up vegetables, but it’s not forever and feeling better will be your reward. The hardest for me were the first few days when I was so careful with what I ate but still felt awful, but the morning I woke up slightly better was really worth all the efforts, and then it kept improving. It is very limiting though…

      Good luck and let me know how it goes!

  4. Hi I found your blog and happy to find it. I saw that you will be eating green beans. I believe green beans are a legume. Just in case you didn’t know…peanuts they too are legumes. I have been really sick with GI issues for most of my life. I tested positive for the breath test for SIBO. I took antibiotics and went off gluten and for years was great. Then about 9 months ago my symptoms came back with a vengeance and antibiotics didn’t help. I have a scientist friend who is very interested in leaky gut syndrome. He suggested I try following Dr.Dahlmans plan (he is on the internet). I am 100% better. However I also have stopped eating eggs and rice and potatoes because of bloating. The problem I am having is weight loss. I have lost 11 lbs in 2 months and I started out very thin. This is a serious concern for me.
    My diet right now is no fructose, dairy, legumes, soy, corn or gluten or sugar. I also avoid the nightshade veggies. I eat meat, fish, spinach and yellow squash. I also eat a ton of cashew nut butter. I take 2 kinds of probiotics as well as two kinds of enzymes, plus peppermint oil that has some herbs that are anti spasmodics. I also find that if I eat more volume in the earlier part of the day and less volume at night, I don’t bloat so much. The down side to the Dahlman plan is that the probotics and enzymes and powder for healing the intestines are very expensive about 300 a month for three months. After that– you start to reintroduce foods. It’s worth it to me even though I live on a tight budget because I can leave the house now without worrying about leaving a bathroom! Also no more pain!! So I’m committed to this for two more months. I imagine there are many good plans out there. I just haven’t looked at the other plans. I’m looking forward to following your progress! Good luck to you 🙂

  5. I have just found out I have fructose mal. What a relief!! Now i can finally start doing the same and eliminating things from my diet, My investigation into paleo diet led me here. The fodmaps diet seems great but i saw alot of what i know effects me there. They all say that white rice and even the humble potato are okay. Not for me. pls click on

    http://www.earth360.com/diet_paleodiet_balzer.html

    for some interesting information on potato’s. Im sure you will eliminate potatoes to see what they do when reintroduced. With me, my heart beats rapidly, and become extremely lethargic both physically and mentally!

    • I hope you try the SCD diet. I tried fodmap as did my kids and it did not help any of us. We are all doing the SCD now and it’s the answer for us. It eliminates complex carbs–polysaccharides and di-saccharides. No grains or starches and sugars basically. try testing eating sugar or honey. If sugar makes you bloat and honey does not that’s pretty good information. Honey is ok on SCD and sugar is ok on fodmap. The problem is until your gut really calms down you can’t tell…. SCD is similar to paleo but not as limited. I did paleo too but I needed a more balanced diet. Here is a link to the biochemist who figured this out and also another link to a really helpful site. Good luck!
      http://www.breakingtheviciouscycle.info
      http://www.pecanbread.com

      • Thanks for your comment! I am actually on the GAPS diet (which is based on the SCD diet) since Sept 1st and have had excellent results! 😉

      • The GAPS diet is very similar to the SCD diet. Same sugar and starch restriction. However, I felt like the GAPS diet allowed for non-dairy sources of probiotics (fermented vegetables: raw sauerkraut, etc.) and included more gut-healing components, such as bone broth. 😉 Food quality is also emphasized. Meat from grass-fed, pastured animals and eggs from free-range chicken for example offer more nutrition and a better omega-6 to omega-3 ratio (less inflammatory and more anti-inflammatory). You can read more about it on http://gapsdiet.com/ and http://gaps.me/.

  6. Very good website you have here but I was wondering
    if you knew of any message boards that cover the same topics talked about here?
    I’d really love to be a part of group where I can get opinions from other knowledgeable people that share the same interest. If you have any recommendations, please let me know. Thanks a lot!

  7. Hi Aglaee

    Thanks a lot for the work you put into this page! It’s very inspiring!

    My case has similarities to yours. I’ve had gastrointestinal disorders for a long time and tried different diets (from gluten and dairy free to raw vegan and paleo) but without succes in curing my gut. I’ve also had various parasites (I’ve travelled a lot in South America and lived in very poor and unsanitary conditions, especially in my rural travels) which I’ve treated both with herbs and antibiotics. I’ve recently done a very heavy antibiotics treatment, the so called ‘triple therapy’ against a very resistent B. Hominis infection. It’s still too early to test and see if it worked but one thing is for sure, my intestinal flora in now left completely devastated!

    I’m very happy to have learned about the FODMAD, SCD and GAPS diets from your blogs (my research on BH brought me here). I’m now on a diet very similar to your current diet and my symptoms are now slowly improving.

    My question is: Seeing that the diets seem to adress the same problem but with varying rules/recomendatios – can you recommend on of those three diets so that I can dedicate myself to one when I improve and start to introduce a bit more variety in my diet? I want to find out what book(s) and essential to get.

    Again – thank you!

    • Hi Luis and thanks for sharing your story. To answer your questions, the low-FODMAP diet is not enough on its own. Both the SCD and GAPS diets are good, but I have a preference for the GAPS diet because it is more careful with the dairy aspect and introduce more gut-healing components (bone broth, etc). My suggestion (until my own book explaining how to combine the best aspects of each of these approaches) is to combine the GAPS and low-FODMAP diet at first and slowly reintroduce FODMAPs as tolerated. Good luck and please keep me posted.

      I also offer monthly REAL food challenge groups, one of which include a digestive health components. The next one starts on Nov 23rd and you can find out more and sign up at paleo-dietitian.com.

  8. Aglaee

    Thank you so much for this great site and all of the useful information. Will your book be available in ebook? I hope so 🙂

  9. Aglaee, excited to see that you have started GAPS. So curious to see how you are feeling. I have been on GAPS for 7ish months and have had a lot of healing in many ways….but there are lingering gas/bloating/abd pain that I would LOVE to be gone. I really think there might be something to the FODMAP thing with me, because I will eat the most easily digestible GAPS soup with homemade broth @ times and it will cause cramps and bloating…..im realizing how much cauliflower. onions, garlic and other FODMAPS I am using….all in one dish! Ahh!! And fruit def bothers me…but i didnt know it was just sugar over all….now im realizing the fructose, along with other FODMAPS components are probably the culprit. Frustrated….but hopeful. Please share where you’re at, whats helped, what hasnt from the point of starting GAPS!!! THANKS!

    • Hi. I’m sorry to hear about your struggles and can totally relate to how you’re feeling. It’s been about 2 years now since I started a modified GAPS diet and I’ve had great results! You can find more info about my approach on my website paleo-dietitian.com and in my recently released book “Digestive Health with REAL Food”: http://bit.ly/14ox3wY. 😉

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