Episode 132: Elimination Diets: When And How To Use One

Thanks for joining us for episode 132 of The Ancestral RDs podcast. If you want to keep up with our podcasts, subscribe in iTunes and never miss an episode! Remember, please send us your question if you’d like us to answer it on the show.

Today we are answering following question from a listener:

“I would love for you to touch on the topic of elimination diets. I am seeking to heal from an autoimmune condition which has caused lichen planus, weight gain, and digestive problems. I’m using the AIP model for healing my gut and reintroducing foods, but I feel that it’s taking forever and I’m struggling to know how accurate my responses are to the new foods I’m reintroducing. I’ve struggled with eliminating foods and feeling restricted, especially in social situations. Thanks!”

Elimination diets are often used as a strategy to uncover foods that may be triggering symptoms when trying to heal from many health conditions. While elimination diets can be helpful for short term symptom management, they are not a long term solution and can actually cause more problems in the long run.

Join our conversation today as we share how we deal with elimination diets in our practices and provide you with a sustainable, long term approach to healing beyond food restriction.

Some of what we’ll be discussing is why focusing on root causes of illness before beginning a strict elimination diet will provide the most improvement, and we’ll tell you the main offender foods that are starting points on an elimination diet.

We’ll also cover the crucial but often overlooked factor of maintaining appropriate macro and micronutrient balance as well as calorie intake when experimenting with elimination diets.

As you learn when to use an elimination diet and how to implement one according to your needs, you’re sure to come away with a new perspective on the role of elimination diets as part of a healing journey.

Here’s what Laura and Kelsey will be discussing in this episode:

  • [00:06:09] How where you are in your healing journey is a deciding factor in considering if you should begin an elimination diet
  • [00:08:12] Why it’s best to begin dealing with some of the root causes of an illness before starting an elimination diet
  • [00:16:35] How short term elimination diets can help with symptom relief
  • [00:18:24] Which foods are considered main offenders and good starting points to remove
  • [00:22:20] Why working with a professional can help take the uncertainty out of elimination diets
  • [00:23:55] How consistency in a health intervention is more effective than inconsistently trying multiple things
  • [00:29:28] How modified elimination diet and reintroduction of foods after investigating root causes can lead to discovery of a personalized diet and determine if further elimination is needed
  • [00:33:49] The importance of maintaining appropriate macro and micronutrient balance as well as calorie intake
  • [00:46:46] How skin conditions can take long to notice improvement
  • [00:50:49] How food isn’t always the most important factor, and the other lifestyle factors that contribute to illness and healing

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TRANSCRIPT:

Laura: Hi everyone! Welcome to Episode 132 of The Ancestral RDs podcast. I’m Laura Schoenfeld and with me as always is my co-host Kelsey Kinney.

Kelsey: Hey everyone!

Laura: We’re Registered Dietitians with a passion for ancestral health, real food nutrition, and sharing evidence based guidance that combines science with common sense. You can find me, Laura, at LauraSchoenfeldRD.com, and Kelsey over at KelseyKinney.com.

Over the next 30 to 45 minutes we’ll be answering your questions about health and nutrition, and providing our insights into solving your health challenges with practical tips and real food.

Kelsey: If you’re enjoying our show, subscribe on iTunes so that you never miss an episode. And while you’re there, leave us a positive review so that others can discover the show as well!

And remember, we want to answer your question, so head over to TheAncestralRDs.com to submit a health related question that we can answer or suggest a guest you’d love for us to interview on an upcoming show.

Laura: Today on the show we’re going to be discussing elimination diets, and when and how you should use one in your healing journey. But before we get into the question for the day, here’s a quick word from our sponsor:

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Laura: Welcome back, everyone. Here is our question for today’s show:

“I would love for you to touch on the topic of elimination diets. I am seeking to heal from an autoimmune condition which has caused lichen planus, weight gain, and digestive problems. I’m using the AIP model for healing my gut and reintroducing foods, but I feel that it’s taking forever and I’m struggling to know how accurate my responses are to the new foods I’m reintroducing. I’ve struggled with eliminating foods and feeling restricted, especially in social situations. Thanks!”

Kelsey: This is a really good question and I’m glad somebody asked this because I feel like at least for me, and I’d be curious to hear about you, Laura, I know that my kind of feeling the way that I practice with elimination diets has really changed a lot over the years.

When I first started practicing I used to with pretty much everybody that came in, I would have them just get on a strict Paleo or just normal Paleo type diet right off the bat to just like get them on some sort of quote “elimination” type diet so that we could get started with that process. But that’s changed a lot for me over the years. I’ll talk a little bit about how that’s changed in more detail later in the show. But I want to hear from you, Laura too, like has that changed at all for you in terms of how you practice?

Laura: Yeah. I think in general my perspective on food has changed a lot in the last few years. Not that it’s changed radically. I mean it’s not like I’m like promoting veganism or something like that, but I think just my overall philosophy has changed.

I have found that over-restriction often causes a lot more problems than…well I shouldn’t say more. I’d say it’s kind of a balance because not restricting things that are causing problems certainly is an issue for a lot of people. But then if they go too far on the other end of the spectrum where they’re restricting too much, it causes problems from its own side of things.

Because I tend to get the people that are on the other end of the spectrum, a lot of times I’m not doing elimination diets. If anything, I’m kind of catching them after they’ve already eliminated so many things and I’m helping them reintroduce.

I know you’re going to talk about this, but for me it’s very dependent on where the person is coming from. If somebody is coming from having a history of restrictive dieting, then I’m probably not going to put them on a restrictive elimination diet. But if they’re coming from scratch or if they haven’t really tried an AIP diet or something like that, then I might be more willing to test that out with them.

Kelsey: Yeah. You’re definitely right in that I think probably both of our clientele has changed quite a bit over the years, too. We’re getting people because of our podcast, and the types of things that we talk about, and how our philosophies have changed, I think we do tend to get those people that are more on the other side of the coin where they’re more restrictive than they have to be rather than less restrictive than they have to be. I think that feeds a lot into it as well for me, too.

I guess what I’d like to do today to help to answer this question is to walk through my current approach for elimination diets which I use in my own practice and also in my online program, Build Your Biome.

One thing that I start with typically is that if you’re feeling okay right now, like you don’t have a ton of symptoms or at least your symptoms are manageable…that may not be the case for this person asking the question. We don’t have enough details here to really know that. But I know that in my own practice and for a lot of people that go through my online program, they’re at this point where they’ve probably taken out some foods, they’ve probably dealt with some of the underlying root causes of whatever they’re dealing with to the point where they’re there at least sufficiently managed they can get through the day.

It’s not super great of course. They don’t feel wonderful. That’s why they’re trying to heal. But it’s not like they feel like they can’t do anything, like their lives are completely to the point where their illness is just taking over their life essentially.

If you’re at that point, like if you’re really having a lot of trouble with your symptoms and they’re really, really disruptive, I do think in that case sometimes that going into a more restrictive diet right off the bat can be helpful.

But again like Laura was mentioning, it really depends on where you’re coming from. If you’ve been super restrictive and you’re already on some really strict elimination diet, restricting further and taking out more foods probably isn’t the right way to go. In fact, you’re probably going to want to go the other direction. But if you’re on a standard American diet or you haven’t really played a lot with elimination diets in your journey, then I would say it might make sense to go into a more restrictive elimination diet right off the bat.

But for me because of the clients that I tend to work with, usually they’re in this place where their symptoms aren’t great, but they’re manageable, I often recommend waiting on a strict elimination diet until after they’ve dealt with some of the bigger underlying root issues that are probably causing some of the symptoms that they’re experiencing because they have to do with some of the body systems that are most likely to get disrupted.

To give some examples of that specifically for my Build Your Biome people, in that course we’re focused on gut health. So of course we’re going to be thinking more about gut infections. If you’ve got digestive problems, which I know is at least one of the things that this person is dealing with, that’s certainly something that if you haven’t done any testing for, that should be like the first thing you do.

We need to know if you’ve got some sort of gotten infection because that’s going to really wreak havoc on the whole system, your whole body really I should say. So definitely your digestive system, but then it’s also going to cause this sort of low grade inflammation throughout your body which causes tons of problems. It can lead to insulin resistance, it can play a role an autoimmune disease.

It’s just like this huge, huge issue that if you don’t deal with that first or if you don’t deal with that ever because no one’s ever testing you for gut infections, that is going to be a huge problem for you and you’re never going to get to the point where you feel truly healed if you’ve got some sort of gut infection going on.

For people with digestive issues, certainly gut infections, but for anyone really, I think it makes sense to just sort of think about all of the different body systems, how they’re functioning, and what sort of symptoms that you are exhibiting that might play a role in some of those body systems dysfunctioning.

That includes the digestive system of course like we just talked about. It can include the thyroid. How is your thyroid functioning? Have you had a full thyroid panel? Do we know if you have Hashimoto’s? If you’ve got a thyroid panel done but they didn’t test for antibodies, let’s test for antibodies and see if you’ve got some sort of autoimmune issue going on with your thyroid.

And then dealing with the thyroid, so that includes nutrient repletion. If you are not getting enough selenium or iodine and that’s causing your thyroid to be dysfunctional, then we need to deal with that. Or maybe you’ve got Hashimoto’s and it’s to a point where you need thyroid hormone medication. We can’t just ignore those things. We really have to test for them and then deal with them as well.

It could include things like your adrenals. Laura and I have our Paleo Rehab: Adrenal Fatigue program where we walk people through how to test their HPA axis, see if anything’s not functioning correctly, and then we get them on a supplement protocol to help move cortisol in the right direction. If their cortisol is too low, we’ll get them on supplements to help raise their cortisol. Of course we work on lifestyle factors as well to help that in addition to that. And then on the other side of the coin, if it’s too high, if you’re producing too much cortisol, we’re going to help you to lower that cortisol. So basically getting the HPA axis to function appropriately.

And then like Laura was just saying, if you’re somebody with a history of disordered eating, and you’re not eating enough, and under eating has been a problem for you for years, we’re going to want to address that before we dive really into this very restrictive type of diet.

Laura, I always love what you call it: the low hanging fruit. We have to deal with these low hanging pieces of fruit first because those things can cause so many symptoms that you might be experiencing and it’s really hard to figure out if you’re reacting to different foods when you’re reintroducing them after eliminating them if there’s so many other things going on.

It’s just like the noise level is so high, you can’t pick out the individual sounds, if that makes any sense. You just need to quiet everything down first, get everything functioning as best as it possibly can given what’s going on, and then that’s where an elimination diet can become more useful because then when you start adding things back in, it’s a lot easier to pick up on the things that you are reacting to.

Laura: Definitely. I think with the low hanging fruit or the noise analogy, we’re just thinking about what to focus on first to really get the most improvement. I think you might have this experience too, but a lot of the people we work with are very well educated, have done a ton of research on their current health condition, what might be helpful. A lot of times they’re doing so many different things that it’s really hard to tell what’s helping, what’s not helping, what’s actually causing harm. And then how are you supposed to figure out what to do next if all of that noise is part of the picture?

I definitely agree with you that looking for a root cause is very important because you might be having certain symptoms that maybe you don’t react well to a certain food, but that doesn’t mean that that food was the problem. It might just be that you have something else going on that’s causing that problem. Something else that I see in the work that I do with clients is a lot of times there’s micronutrient deficiencies that can affect how somebody tolerates certain foods or how they feel. There’s just so many different things that can be underlying these symptoms.

The elimination diet piece is helpful. I’m not going to say that you shouldn’t do it, but to have that be the only thing someone’s doing is rarely a long term solution.

Kelsey: Yeah, exactly. Just to give an example of what you were talking about with a food sensitivity or intolerance being related to an underlying cause, I think the best example of this is like somebody who’s intolerant to high FODMAP foods. Because if you’ve got some sort of gut infection like SIBO, that causes FODMAP intolerance very, very often.

If you just go on the low FODMAP diet, yes, that’s probably going to reduce your symptoms, you’re going to feel a lot better. But basically you’re never going to be able to eat FODMAP foods again because you’re not getting rid of the underlying cause. You’re not getting rid of the reason why you can’t tolerate FODMAP foods. But if you clear out that SIBO infection, most people can tolerate at least the majority of high FODMAP foods without any issues.

That just goes to show that it’s so, so important that you identify any body systems that aren’t working correctly or have some sort of issue going on with them, heal from that first or at least get that process started.

You don’t have to like fully heal from anything, I would say. I’ll often have people, like we’ll sort of identify these main root causes, we’ll get them on some sort of program protocol, or we’ll start dealing with those things in some respect, and then they’ll start feeling better.

They don’t have to feel 100 percent better, but as long as we’re seeing progress in the right direction, that to me is like okay, we’ve identified things that are a problem, we started to fix this person is feeling better, I know that we’re doing the right stuff. Now we just need to either give it a little bit more time, or if we’ve given it time and they’ve maybe gotten 70 percent better, 80 percent better, but they’re still having some problems, that’s where something like a more restrictive elimination diet might come in handy. Might, not always, depending on what we think is causing the leftover problems to still be there. But it can be a useful tool in that.

Let’s see, where do I want to go back to here? I guess what I would say is that my typical approach is to….in my Build Your Biome program because it’s a group online program, I sort of have to have it set up of course where you are you are calling the shots. It’s a DIY program essentially. What I do there is actually give people the option to start an elimination diet as soon as they begin the program if they’re really, really having problems with the digestive issues that they’re having, and they’re very disruptive to their life, and they really just need to get symptom relief as soon as possible. That’s where I think something like a more strict elimination diet can be useful.

Like I was talking about before, if you’re just having tons of symptoms, super disruptive, and you just need symptom relief as soon as possible, and you’re not concerned at least at that point about dealing with the underlying root causes…that’s the long term goal, but the short term goal is to just feel at least like a human again that you can get through your day and these things aren’t completely disrupting your life. That’s where I think an elimination diet can be useful.

But that said, I also give people an option in that program to do what I call like a modified elimination diet and that is something that they can get on to sort of…basically the minimum effective dose I’d say of dietary changes that help you to then clear out any bacteria that’s there.

For most people coming into that program, I can pretty much guarantee that they’re going to have at least something going on with their gut bacteria that we’re going to need to deal with. And so this modified elimination diet just takes out like the major main offenders that cause inflammation, can lead to or at least worsen leaky gut. We take out those things to just like help your body function a little bit better, help the digestive system to feel a little bit more in control while you’re working on some of these other underlying causes.

When I say modified elimination diet, it’s really easy. It’s basically just taking out industrial seed oils, taking out gluten, maybe grains. For digestive issues I tend to err on the side of taking out grains. If somebody is really just suffering and they want to get relief as soon as possible, then I’d say yeah, take the grains out. But that’s not always. If I’m working with somebody one on one, I’ll really talk with them and get their health history, their diet history, symptom history to make that call as to whether it would be useful for them to take out all grains.

Probably more often than not, the people who work with me one on one are coming from the more restrictive side of things anyway. In that sense most of the time we’re not taking out grains fully. But I do think it can be very useful for somebody who’s never done that before to take out grains entirely and just see if that makes a difference.

And then in addition to that, I’d also just want to make sure that somebody is reducing their sugar consumption if they’re eating a lot of sugar or eating a lot of processed foods. We’ll switch basically over to a real food diet, take out these main offenders, focus a lot on like fruits and veggie consumption, variety, all the things that we talk about on this podcast all the time in terms of like just a general healthful diet.

And again that’s to just reduce inflammation, give the gut a chance to at least breathe a little bit. If somebody is coming from a diet where they’re eating a lot of processed foods, they’re eating industrial seed oils, just taking out those things is going to make a big difference in terms of how the gut functions. It’s not going to fix everything, and neither would a stricter elimination diet, but at least doing that modified elimination diet is going to help a lot for somebody who’s coming from more of like the standard American type of diet. Do you do something similar, Laura?

Laura: Yeah, definitely. There’s some foods that are kind of no-brainers to try removing. Like you said, the industrial seed oils are something that I don’t think anyone needs to be eating. It’s not like taking those out is going to cause problems for anyone. It kind of goes from there as far as what where the person’s coming from, what they need, what they’re ready to do, which I think is something that is a huge part of it.

I know I’ve helped some people in my personal life with some diet changes and it’s funny because I’m so used to working with people that are like totally obsessed with health and nutrition, and know everything, and they’re almost more information overload. And then when I’m helping people in my in my life that are just coming to me because they know I’m a nutritionist and we’re starting from scratch, we might be doing something as simple as like just doing gluten free or something like that. It’s one of those things where the person is coming from will make a huge difference.

But like you’re saying, there are certain things that are pretty universally helpful for most people and certainly won’t cause harm. That’s kind of what I’m looking to accomplish too is just what’s going to give the best results without either causing physical problems, mental problems with the level of restriction, or are just going to be arbitrary and not actually helpful.

Kelsey: Right. I would say that’s probably where working with someone one on one can be really useful is if like you’re not really sure where to go to from here, wherever here may be, it could be that you’re more than standard American side of things and you don’t want to have to think about which things to take out. Even though to us it’s like really simple to think about those things, for somebody personally it can be a lot more difficult. Working with someone one on one gives you that objective view.

I know for me, and I’m sure this is the case for you too, Laura, when I’m working with someone one on one like I was talking about before, I get their symptom history obviously, their whole health history, their diet history. All of those things help me to figure out and determine if there are certain things that I’m like for this person specifically I really think dairy is possibly a problem. So even though I don’t normally take that out in my modified elimination diet, I think for this person specifically it would make sense to just try taking that out.

Laura: Definitely.

Kelsey: That’s where I do think that working one on one can be potentially helpful if  you feel like there’s maybe a few of those things that you personally just can’t pick up on, but you think that somebody who’s of course trained in this kind of stuff might be able to, that can be really helpful to do. I’d say that if you’re confused about the whole process, definitely working one on one might be a good idea for you.

Just to talk a little bit more about the reason for doing it this way, because I think at least what I hear from people in my personal practice and when I have students come into Build Your Biome, I think there’s this idea that when you’re suffering, even if it’s not that sort of extreme disruptive suffering that I was talking about before where the immediate goal is just symptom relief so you can get through the day, but more of this like moderate suffering where it’s like I can manage this, I’m getting through life okay, but obviously I want to feel better; I think that there is this idea that no matter where you fall on that spectrum that you just need to do absolutely anything and everything that you hear or read about that could possibly influence the symptoms that you’re having.

That I think it’s a mistake. I was going to say it’s a myth, but I think I would call it a mistake because I tend to find that that people who just dive into everything like that where I see their supplement list and they’re taking like 25 supplements a day and they’re trying to do all these different things to address every single possible way that something could affect their symptoms, they tend to not do anything fully. Maybe they’ll take a supplement for like two weeks and they’re like oh this doesn’t help me, it’s not working.

I think we’ve talked about this before on the podcast too, but I just find that to be such a common occurrence at least for the people that I tend to see in my practice and in my programs that I think that has influenced me to start to be really selective with the things that I want somebody to work on, do things one at a time sometimes unless we find like a couple of body systems of course that aren’t functioning very well, we’ll probably deal with those together. But I really have made it a focus of mine to get people to fully commit to something and stick with it consistently. I know we talk about consistency a lot on this podcast, but it’s because it’s hugely, hugely important. And just like really give each thing a shot and see if it really makes a difference for them.

I have found that to be really, really helpful and it’s part of what has influenced my thinking on elimination diet because I’ve just found of all the things that I’ve worked on with people that while food is of course a big piece of it, I find that the most benefit comes from taking out those main offenders that we were just talking about. Getting into the nitty gritty of things like histamine intolerance or getting on an autoimmune Paleo diet, yes, those things can be very useful for some people, but for the majority of people just taking out those main offenders and then focusing on all those other body systems that might not be functioning appropriately, that makes the biggest difference for people.

Laura: Yeah. I mean it’s one of those things where I feel like there’s so much information on the Internet about different conditions and different things that are going to be helpful, and a lot of times it ends up just over complicating things.

Kelsey: Yeah.

Laura: I don’t want to make it sound like the work we do isn’t complicated, but I feel like a big part of the work that we do is identifying again that low hanging fruit, the heavy hitters that are really going to make the biggest difference. But then like you said before, you have to be consistent. So it’s like yeah, these major changes can help, and they can make you feel better, and they can help reduce some of the symptoms so that way you have a little bit more wiggle room as far as trying different things, but also the consistency piece is a huge part of it. Like you said, if somebody is doing way too many things or on a way too restrictive diet, then a lot of times it is hard to be consistent.

I definitely agree with simplifying as much as possible, looking at root causes, and then also if there’s specific food that might be a problem, like you said dairy is one that I also will often have people remove and it just depends on what their problem is or what their symptoms are. But it’s really just trying to figure out what is going to make the most sense to try removing so that way you’re not either overwhelming someone so that they can’t be consistent, or let’s say they are super consistent, maybe they’re miserable on that level of consistency or it’s just maybe not even something that they need to do.

I see that as being one of my main beefs with using the ketogenic diet as a solution for people’s problems.  I’m not saying that it can’t have good results in the short term because I’m sure no one would be doing it if it didn’t, but I just don’t see it as something that’s sustainable for most people and it’s not necessarily solving root problems.

Kelsey: Right.

Laura: I think just any time you’re looking at a solution, you want to think about longevity as well as sustainability So it’s like okay, is this something that’s going to work for the long term, or is this just a short term fix? And then also is this something that I can see myself doing for months or years if it was something that was going to be a long term solution?

Kelsey: Yeah, absolutely. Just to kind of get back to the process of using elimination diet, we talked about taking out sort of these big hitters things like industrial seed oils, gluten, grains maybe, and then anything else that we personally as practitioners have identified to be a likely problem for a client.

Then what we do from there, at least what I do from there typically is we’ll deal with all those other underlying root causes, we’ll all at least identify them and get started with that process. And then like I was saying before, I try to get people to a point where they feel like they’ve made pretty significant progress in terms of their symptoms just from dealing with those underlying root causes, and then if we’re if we sort of hit a plateau or we get stuck somewhere, then that’s where I start to think about other foods that we might want to try taking out. Often because of the fact that we’ve reduced symptoms by a lot, we’ve reduced that noise that I was mentioning before, it’s a lot easier to identify some foods that might be problematic.

That’s where I would maybe start to have people add things back in if we if we’ve taken out more than just the heavy hitters. If we took out dairy for a while and now they’re feeling a lot better because we took that out and we did a lot of other things, maybe at that point and have them try adding that back in. And if we notice like a lot of symptoms start coming back, then done, like we figured out one of your main sensitivities. We can use that information and we know at least for the time being you’re going to have to keep at least some of those dairy foods out to maintain the progress that you’ve accomplished so far.

But if we’re adding things back and they don’t seem to make much of a difference or we do notice they make a difference, we get you on this diet that makes sense for you. So it’s a personalized diet. I wouldn’t call it an elimination diet at that point because we have reintroduced those things and we either know they’re a problem or they’re not a problem. So at that point we just have your own personalized diet that you’ll need to be on at least right now while we’re still working on some of those underlying factors or it just maybe something that forever you may need to at least be careful with those kinds of foods.

But once we’ve got you on that personalized diet, we’ve dealt with a lot of the underlying factors that are related to your symptoms, and you’re still having some problems, that’s where I think that thinking about those other potential food sensitivities and intolerances can be useful. That would include things like I’d maybe have somebody try an Autoimmune Paleo Diet at that point. Or it could be like a modified AIP diet where if they’ve done like the main sort of Paleo diet, we’ve added some things back and those things aren’t issue for them, but we haven’t tried taking out nightshades for example, we would maybe just at that point take out nightshades and then reintroduce nightshades in a month or two and see how they do. Or histamines.

I’m trying to think of what else. I guess I would throw FODMAPs in there, though I do tend to find of course that FODMAP intolerances typically are really tied into any sort of gut imbalance and once you do fix that, usually FODMAPs are not much of an issue. But sometimes people can have FODMAP intolerance to just a couple of FODMAP foods that might persist after getting rid of SIBO or some other type of gut imbalance. So that might be something I start to think about there.

Anything else you can think about, Laura, that you tend to think more about after somebody has made significant progress that you’d maybe take out?

Laura: I think I’m on the same page there with a lot of the removals. I would say just to think about also things might be needing to be added in is another side of the coin. That might be certain micronutrients that somebody is not eating a lot of or it could be certain types of foods that they need to get more of in their diet. Maybe that’s they’re not eating any fish so they’re not getting any omega 3 fats, or maybe they don’t eat organ meat so they have low vitamin A intake or something like that.

I don’t usually wait until after an elimination diet to address that, but I think that’s something that elimination diets often don’t take into consideration is either like are you may be actually missing some foods? Or if it’s not an issue of missing foods, maybe there’s things that when you do the elimination diet that you’ve removed and then it causes problems in the long term.

I just feel like looking at both sides of that equation and not just thinking that removing foods is always the answer, which you’re definitely not saying. I just want to make sure that people realize that elimination diets are not the only way that food can actually improve your health.

Some of the foods that you would think might help to remove from some people’s diets, a lot of times I want to make sure that we’re replacing those with something else. For example if we have to remove eggs, then that’s when I’m like okay, you really need to be getting liver in your diet now because if you’re not eating eggs, then you’re not going to be getting a lot of vitamin A or choline or anything like that.

Just thinking about certain foods that if you remove them for certain issues, which I definitely take eggs out of people’s diets sometimes, that’s something that replacing that food with something else is important.

And then another thing to keep in mind is the possibility that something like eggs. I’ve seen it happen where somebody has just been eating so many of them that they take them out and something is improved, and then they can reintroduce them down the road and it’s fine. It doesn’t necessarily mean you have to remove them forever. It could just be a short term thing while you’re dealing with root cause issues or maybe you’ve just been eating too much of that food and it’s causing some kind of reaction that is just from overconsumption.

I just think there’s a lot of different nuance in what foods to eliminate, and how long to keep them out for, and what to replace them with, and then also do they need to be kept out forever.

Kelsey: Right, absolutely. I agree. I think that’s a really important point about adding foods into and kind of thinking about both sides of the coin there. You just brought this up for me, I had a client recently that he had been dealing with a lot of digestive issues and fatigue issues, just like not really feeling great overall. We had sort of dealt with a lot of the underlying issues. He was still clearing out some gut infections. But just adding in the liver to his diet made a huge difference for him. I think it was probably because he had been on these restrictive diets for so long before coming to see me that he was probably just really nutrient depleted and adding in liver helped that so much to the point where he just like felt like a new person having added liver into his diet, which was really cool to see.

So I think that’s a good point. You have to think about the other side of this that especially if you’ve been really restricted for many, many years or you have a history of disordered eating, you really need to think about like what things can I add in to increase my calorie intake if it’s too low of course, but also to just like get these nutrients that you probably have been deficient in for quite some time back into your diet so you’re feeling a lot better just because you now have that nutrition in your diet.

Laura: Also along the lines of adding things to replace what you’ve removed, sometimes it’s even more simple than specific nutrients that you’ve removed. Like I know one of my friends that I’ve been helping with her specific health issues, she pretty much a pretty standard American diet so like she wasn’t following anything special like Paleo or anything like that. I had suggested that she tried doing gluten and dairy free just to see if that helped with her symptoms. I think this is something that probably happens with a lot of people, but because so much of what she was eating was gluten and dairy based, she ended up reducing her food intake and also just like not knowing what to eat when she was hungry.

And to be fair, this is someone who like I said, it wasn’t a client of mine so we didn’t go through all the details of like what to eat, what foods that in. I just offhand kind of been like oh you should try this and maybe it’ll be helpful. I was checking in with her to make sure that she wasn’t like totally failing because just knowing the kind of foods that she likes, like pizza is her favorite food, she’s going to struggle with the gluten and dairy free thing. But I would talk to her and she would tell me that she was like feeling really tired and hungry all the time and she just had no energy.

If somebody was doing that on their own, like let’s say she had come across an article on the Internet that said do gluten and dairy free and you’ll feel awesome! And so she did that and she was feeling so tired, she would probably think that this change wasn’t helpful. I mean it’s kind of not an unreasonable thing to think if you make a food change and then all of a sudden you’re exhausted.

But then when I was asking her what she was eating, like it was so clear to me that one, she wasn’t eating enough in general, so that it was simply a big issue for her. And then two, the other big issue she had is that a lot of her protein from her diet was coming from dairy in the past so she was eating a lot of cheese, she was putting milk in cereal, that kind of thing. And so when she pulled the dairy out, even some of these like dairy free replacement things like almond milk, there’s like no protein in the things.

She ended up essentially hardly having any protein in her diet so I was trying to help her find other foods she could eat to help bump her protein up, which for her was a little tough because she’s not super into meat. She doesn’t dislike it, just it’s not like her first thought where she’s like I’m hungry, I should eat meat. I think at this point she’s feeling a lot better than she had, but still having some challenges just trying to figure out what to eat.

But I just think that’s a really good example of someone who in the immediate response to the diet, she might have thought that gluten and dairy free made her feel bad and that it wasn’t worth doing, which we’ve now discovered that it does make a big impact on a lot of her symptoms. It’s just one of those things where if you’re used to eating those foods or if it’s just like your go-to when you’re hungry to have yogurt or cheese or something like one of these foods that you’re removing, you really have to look at the entire diet and make sure that it’s still appropriate.

That’s something that I work with a lot of my clients on where they come to me after doing some kind of elimination protocol and they’ve just like slashed a huge amount of calories, or they’ve slashed protein, or carbs, or whatever. It’s not that they have to introduce those foods back, like I didn’t think my friend needed to eat dairy to get protein. It’s just looking at different ways to get those nutrients in is really important.

I feel like that’s way more common than I think even people realize because I feel like a lot of the people out there that do things like AIIP or ketogenic diets, that kind of thing, like they think that because they’re educated and they read up a lot on nutrition that there’s no way that I’m accidentally under-eating or that I’m not getting enough of a nutrient. Six months down the road they start to see problems because they’ve been malnourished, even just subtly malnourished for long enough that their body stops functioning optimally. That’s where a lot of these elimination diets I think can get people into trouble.

So again, not saying you shouldn’t do an elimination diet and I’m not saying somebody needs gluten or needs dairy to have a complete diet that’s balanced and gets them what they need. But I think people would be surprised how complicated it can get once you start pulling out major food groups and major foods that a lot of times are the only thing that’s available the in the real world when it comes to just meal and snack options.

Kelsey: Definitely. I think we’ve heard a lot of stories like former Paleo Rehab students because we talk so much about under-eating in that program. We get a lot of people that are like wow, I have been researching this stuff forever and I really felt like I was on top of this and your program made me realize how much I was under-eating. And as soon as I added calories and carbs back in, I felt 1000 times better. I think it’s way more common than people realize.

Laura: Yeah. As you can imagine, there’s a lot of that happening in my Get Your Period Back program since a lot of people develop amenorrhea because they change their diet to something more healthy and then they’ve stopped eating enough.

I hate to always hammer that point home because it’s like alright, enough Laura, stop talking about it. But I just really feel like it almost shocks me how many people that come to work with us or come to do our programs, like they’re still having that problem. So obviously this message hasn’t fully permeated people’s brains because like I said it’s something that it’s so easy to not realize if you’re not paying attention. I’m sure you and I have been in that situation before even accidentally where it’s just like you’re not eating enough and it’s causing these problems.

Like I said, I feel like until I stop getting people in my programs and my personal one on one practice that don’t eat enough, then we’re going to have to keep talking about it.

Kelsey: Right, exactly. I totally agree.

We don’t know exactly what this person asking the question today, what they’ve done to test and deal with any sort of underlying root causes. But just knowing our audience and the kind of people that that come to us in our practices, maybe she, or he I guess…I don’t know…has done a few things. Like maybe they’ve tested for some bacterial imbalance and started to deal with that, but maybe they haven’t thought about thyroid or adrenal.

That’s pretty typical for people that I get at least. They’ve maybe thought about one of these things, but they haven’t really thought about everything all together. So I would definitely say that if this person is trying to heal a few different things here obviously, mainly the autoimmune condition which they think has caused some of these other symptoms for them, I think it’s really important to figure out if some of these underlying causes are a problem for them before diving really deep into the AIP diet.

And again, not that the AIP diet is a bad idea at all, but it just not only might be more difficult to figure out if some of those things are actually problems for this person just because there’s so much else going on potentially in terms of other body systems dysfunctioning and causing a lot of symptoms, that it’s hard to tell which foods are being problematic when they reintroduce them.

Also it sounds like it’s just tough for this person. They’re feeling restricted, they mentioned especially in social situations that it’s problematic for them. I think just from a mental standpoint as well as a physical standpoint they may not be at the point where they’re really ready to truly use the AIP elimination diet to its best effect I guess I would say.

I would I would try to get to a point where they’re feeling significantly better by testing for and then dealing with any of the other underlying causes that we talked about today. So that includes gut infections, adrenal issues, thyroid issues. I’m trying to think of other things. Under eating which we talked about, so any sort of history of disordered eating, nutrient deficiencies. Anything else we talked about, Laura, or anything else you would add to that list of underlying root issues? I know obviously there’s a lot, but some of the main ones.

Laura: Yeah. Those are definitely some of the more common ones. I think with skin issues, like this person is saying she has lichen planus, which I’m not even sure if I’m pronouncing that right. But a lot of times skin issues are something that those take a lot longer to see progress in for a lot of people. That’s another issue with doing of elimination and reintroduction protocol is like first of all if you just do that, a lot of times it’s not enough so you won’t see the improvement. I see a lot of people benefiting in skin issues with micronutrient replacement and supplementation, so doing just the AIP or just an elimination diet on its own a lot of times doesn’t solve that problem for a lot of people.

But then also the fact that she says she feels like it’s taking forever, sometimes these skin issues do just take time to see improvement. I’m not saying like if it hasn’t improved in six months at all then keep doing it because obviously there’s something that’s not working. But if it’s been a month or two and you’re not seeing any progress, if you’re just doing elimination diet, again I definitely want you to look at the different potential factors that we talked about today, but also just give it some time because it may take time off of these foods for a while before you’re going to actually start seeing your skin improve.

Kelsey: Absolutely, yeah. I always say to my clients that time is an extra supplement that I’m having to take because people want to see results immediately especially if they’re putting a lot of effort into the changes that they’re making. But I think you really do have to consider time this other factor that you really need to put into place and you just have to be patient with it.

If this person has dealt with all of these other potential underlying issues and she’s on the AIP diet to help, yeah, like Laura said it might just be about time and then being consistent of course with AIP, like not coming off of that for things like social situations. Which I know it really sucks, but if you do want to see that progress, and you’ve dealt with all these other things that we talked about today, and you’re now on an elimination diet, especially for skin issues like Laura was saying, they can take a long time. You do just have to be patient with it give it that time and consistency that it needs.

But I would guess probably more likely than not, this person has not dealt with some of those other underlying root causes and that might make this whole process a lot easier for them in terms of seeing if specific foods are problematic for these symptoms that they’re experiencing.

This is obviously a pretty complicated topic or it can be because it’s so individualized to each person, but that’s what functional medicine and integrative medicine is all about. You really just have to see each person as an individual and test all these different body systems, see if anything’s not functioning correctly, deal with that. Food is of course one of those underlying factors that we have to think about, but I think when we start to see that as just a matter of restriction, that’s where that can get us into trouble.

Like Laura was saying before, we have to consider first of all just overall calorie intake as a potential issue when it comes to food, but then also things like micronutrients that if you’ve been on really restrictive diets in the past, you might just be nutrient depleted and you have to replete those nutrients to feel better.

So yes, food is an underlying cause, but we can’t just think about it in terms of always restricting things. We have to think about it within the context of the bigger picture and like picking those low hanging fruit when it comes to not only diet, but all these other underlying factors as well.

Laura: I don’t want to get into too much detail about this because it is its own podcast, but we really just mostly talked about food in this podcast. It’s funny as a dietitian you would think obviously you think food is like the most important thing to help somebody’s health. And I actually feel like it’s not.

Kelsey: Yeah.

Laura: I just remember Dallas Hartwig put a blog post up, I don’t know if it was like a couple of months ago or something. I remember I saw it on Facebook that he was saying how their book with The Whole 30, it was called It Starts With Food and then how he’s like changed his philosophy to the four keys of living better and his number one is now sleep. So sleep, and then food, and then movement, and then social connection. That’s his personal philosophy. I think that everyone can have their own ideas about what’s the most important thing.

But the main point that I want to get across is that the food piece is not necessarily the most important piece. It’s definitely important. I don’t want people to think I’m saying it’s not important to eat well and to eat nutrients that your body needs, that kind of thing. But a lot of times there’s so many other factors in somebody’s life that’ll contribute to these issues especially with autoimmunity. I mean I think stress is such a big factor there. Circadian rhythm entrainment, so staying up late, not getting enough sleep, getting too much artificial light at night, or not getting enough daylight during the day. All these things are so important to your general health as well as just immune function, and dealing with autoimmune disease, and inflammation, that kind of thing.

I just feel like people tend to overemphasize the food piece. That is something that I’m always very cautious of in my practice with clients because I’m like they’re coming to me, I’m a dietitian/ nutritionist, obviously they think food is going to be the main thing that we focus on. And to be fair, it usually is a large component. But I also really hammer home that it’s not the only thing that matters and a lot of times it’s not even the most important thing.

If somebody is getting like super stressed and hardly having any social connection because their diet is so restrictive, then I really don’t think that that restrictive diet is something that’s worth doing for them.

Again, this is definitely like another podcast, but I just wanted to throw that in there because we were mostly just talking about dietary factors. I’m not saying that that’s not accurate, but I also just want to kind of play devil’s advocate and say that sometimes dietary factors are not what you should be focusing on.

Kelsey: Yeah, I would totally agree with that. I always think it’s funny as a dietitian that that has become like my major stance on diets is that you can’t just think about food. There’s so many other things to a person’s well-being that you need to consider oftentimes before you even think about food as long as they’re eating like a relatively healthy diet.

I hope this helped. I know that we talked about a lot of different things today. I hope just hearing how we personally deal with elimination diets in own practice and in the programs that we make, I hope that is helpful to hear.

I think that if you haven’t identified some of these other root causes…I would include things like sleep and overall stress level like Laura was just talking about in some of those potential root causes for your symptoms. If you haven’t identified those and really worked on those, that to me is like the first step that you should take before diving into some of these really restrictive elimination diet especially since you’ve already kind of started that and you’re feeling like it’s just taking forever, like it feels really restrictive, it’s affecting your social life.

If you’re feeling all of those things and you haven’t dealt with some of these other bigger underlying root causes, I would take a step back honestly because I think you’re going to be a lot happier for it and you’re probably going to make more progress than you are right now.

Laura: Awesome. Well I think that definitely covered the topic pretty well. Like we were saying, there’s little subtopics as part of this topic that I’m sure we can get into more details with. But definitely the underlying message of this podcast is that elimination diets are a tool in the tool belt and they can help, but they’re not necessarily a magic bullet that’s going to fix all your problems.

Just keep that in mind and put it in its rightful place as something that can be helpful, but not necessarily taking it to an extreme. And again, seeking help is definitely going to be helpful for those of you who have tried a lot of things on your own and haven’t seen progress.

Anyway, thanks for joining us, everybody. We’re always happy to have you here every week. Like we said in the beginning of the show, if you want to submit a question that you’d like to have us answer on the show, go to TheAncestralRDs.com. There’s a contact tab on the top of the page that you can click and submit a question that way and hopefully we’ll be able to answer it on a future show. But otherwise, thanks for joining us and we’ll see you next time!

Kelsey: Alright. Take care, Laura.

Laura: You too, Kelsey.

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