What is an elimination diet?

An elimination diet is when someone avoids one or more foods or food components for a set period of time. As breastfed babies can react to traces of food proteins in breast milk, mums will need to follow the elimination diet strictly for optimum results.

For formula fed babies, there are different types of hypoallergenic formulas, two of which are extensively hydrolysed formulas (which most babies with cow’s milk allergy can tolerate) and amino acid-based formulas (for those babies with severe cow’s milk allergy or multiple allergies).

It is highly recommended to continue expressing breast milk if formula is being trialled in case you need or prefer to go back to it. Sometimes the formula option can appear successful initially but the problems can sometimes return after a couple of weeks so it is important to plan for this just in case.

When should I consider going on an elimination diet?

Food sensitivities and intolerances are more common than many realize, particularly when it comes to the immature digestive system of a young baby.  Many babies simply can’t break down some of the larger proteins without difficulty.

In some cases symptoms can flare up immediately but more often than not when it comes to food intolerances, symptoms get stronger with increased exposure to the trigger food/s. All these symptoms are signs of food sensitivities:

• Skin reactions – rash around the mouth, cheeks and chin, eczema, cradle cap, hives
• Loose stools – blood, green froth or mucous visible in stool
• Nasal congestion – stuffiness, accompanying cough
• Colic – GI pain, heartburn, stomach cramps, gas
• Reflux, GERD
• Persistent ear infections
• Dark circles under the eyes
• Frequent interruption of sleep
• Slow or stalled weight gain in infants
• Failure to thrive/not reaching milestones

If any one or some of these symptoms occur and its making life a struggle cutting out a suspected food group can make a big difference in a relatively short space of time.

What foods do I cut out first?

Dairy:

• Unless there is an obvious allergy history in the family to certain foods such as peanuts, removing all traces of cow’s milk protein/dairy is usually the first step in an elimination diet.
• Dairy is by far the most common food allergy but also the hardest to eliminate because of the time it takes to completely leave the system. It can take up to 6 weeks for it to become undetectable in breast milk. Saying that if dairy is the culprit you could see an improvement in symptoms in as quickly as 48 hours to 2 weeks.
• Complete avoidance is necessary for accurate results, which means avoiding many packet foods and reading labels extremely carefully. Dairy, casein and whey is also hidden in many unsuspecting places such as medications, supplements, sorbets, deli meats, rotisserie chickens and most processed foods.
• For peace of mind avoid packets that say ‘may contain traces of….’ It’s just not worth sabotaging your efforts and casting doubt on what’s affecting your child.
• Mishaps do happen so don’t punish yourself, but you’ll need to start again. Also mishaps can be very insightful. If your baby’s symptoms return you have your answer that an intolerance or allergy is evident and avoidance is recommended while you rehabilitate your baby with diet and supplements (for more details on this check out RAISING BABIES WITH ALLERGIES).
• Also note that another animal milk is generally not an alternative for those babies with cows milk protein intolerance or allergy, such as goat’s milk.
• NOTE: If you are breastfeeding, some mums notice a drop in supply during the elimination process. This can be best maintained by continuing good breastfeeding practices such as breast on demand. Often the supply is not due to the elimination of food but the stress in avoiding common food groups. Meal planning and prioritizing whole food cooking will help. Check this blog for recipe ideas (all are dairy, soy and wheat free).

Soy:

• Often time its suggested to remove soy at the same time as dairy as the protein in soy is very close in genetic makeup to cow’s milk protein. To avoid wasting time and effort I tend to recommend coming off both soy and dairy at the same time for 3 weeks plus, but there is no hard and fast rule.
• If coming off soy at the same time is too daunting try just dairy for a week and if there is not much improvement I’d recommend coming off dairy and soy together moving forward.
  it does depend on the severity of the situation. The more uncomfortable the symptoms the more I’d suggest coming off both as you just want to relieve the symptoms as soon as possible.

Other food triggers:

• While the most common food to trigger a reaction in susceptible babies is cows milk, followed by soy. Other allergens can also be triggering your baby too and other common culprits can be eggs, peanut or tree nuts, wheat/gluten or seafood. These would be classic allergens but increasingly some babies are susceptible to other triggers such as rice, legumes, salicylates and aimines, as well as food additives and preservatives. The list can be endless so it is a process of trial and error and patience!
• Practitioners are also becoming increasingly aware of salicylates and aimines, a natural occurring chemical in most fruit and vegetables. Following a low salicylate and aimine diet may be recommended which is limiting. It does however allow you to eat most proteins and grains, but fruit is highly limited, pear being the safest. As for vegetables the list of safe foods includes green beans, red cabbage, Brussels sprouts, swede, pumpkin etc.
• Babies diagnosed with Food Protein-Induced Enterocolitis Syndrome (FPIES) have a severe systemic response to food protein that occurs 1 to 4 hours after ingestion. Milk and soy protein are the most common trigger foods, but other foods can cause a reaction including rice, oats, chicken, beef, peanut, potato, fish and egg.

How do I start?

One-food-at-a-time elimination diet:

• Some mothers opt to eliminate one allergen at a time to see if there is any improvement.
  Start by eliminating the most likely suspect that is causing a reaction such as cows milk and its dairy products – butter, cheese, yoghurt etc.
• Eliminate the one food or food group for a minimum of 2 weeks and up to 6 weeks. Most cases will improve within 48 – 96 hours.
• Avoiding dairy can be hard to do. The safest way is to eat a whole foods diet from home. The recipes in this blog  will make this easier for you. Reading labels  is crucial and avoid any products that say ‘may contain traces of….’
• Dairy is hidden in many areas and not just food but various medicines (asthma sprays, some vaccines and cosmetics). Be as diligent as you can, as a break from the inflammatory trigger will help heal your baby’s wellbeing greatly and allow that over-reactive immune system to calm down.
• If there has been no changes in your baby’s symptoms after a couple of weeks, the mother can usually add this food back in the diet taking note of any reactions and trialing another food. Often however mums may chose to remove soy from the diet and trial a dairy and soy free diet for a couple of weeks to determine any improvements.

The low allergen or total elimination diet:

• An alternative approach for an elimination diet is to eat a low allergen diet of only ‘safe’ foods.
  Once your baby’s symptoms improves and they are more settled you can test the likely allergen by reintroducing one food group back in isolation for a period of time.
• This often wouldn’t be your first strategy especially if your baby’s symptoms are fairly mild. Often this approach is taken when a few food groups have been eliminated and symptoms have not improved greatly.
• Often a total elimination diet will have lists of foods that are unsafe to eat such as dairy, soy, beef, eggs, chicken, shellfish, corn, wheat and nuts (plus any others that have been noted).
• Certainly this approach requires ongoing consultation with an experienced nutritionist/practitioner to avoid malnutrition and nutrient deficiencies, which would greatly impact the wellbeing of your child.

Keeping a food diary

• Other ideas involve keeping a comprehensive food diary for a few days (weekdays into weekends) to try and pinpoint the trigger food.
• Write down what you are eating for breakfast, lunch, dinner, snacks and drinks, along with timings and any symptoms. Watch out for fussy or irritable periods, nappy contents and frequency, rashes etc.
• As you look for correlations bear in mind that what you ate on Monday could affect your baby on Thursday.
• Remember this change in diet doesn’t have to be forever and what you learn on the way can be priceless when it comes to raising your child in optimum health and wellbeing.

Download this free printable: Food & Symptoms Dairy