Total Elimination Diet

An elimination diet is a (usually) short term restriction of specific foods with the purpose of eliminating problematic symptoms.  Once the symptoms have resolved, foods are reintroduced one by one in order to determine which foods cause the symptoms.  This reintroduction is called a “food trial”.  Foods are trialed and either stay in your diet (pass) or are removed permanently from your diet (fail) if symptoms reoccur.

There are elimination diets and then there are Elimination Diets. A Total Elimination Diet is different than other elimination diets in the sense that it is more restrictive and aims to cut out entire categories of foods from your diet, not just a few items.  If you suspect that your baby may have MFPI or FPIES, then a more intense total elimination diet might be right for you. (Read more about MFPI and FPIES here.)

When I first started the elimination diet, I kept making mistakes. Then I saw a Naturopath who had experience with MFPI  and was able to offer some helpful tips. After that, things improved.  Slowly at first, but then steadily over the course of the next year.

What I Did Wrong

(1) I didn’t eliminate enough foods at the onset of the diet. I eliminated foods slowly, and instead of letting empirical evidence guide me, my incredulity kept telling me, “no one is allergic to cauliflower” or “it can’t be corn”.  Both were true, and then some.

(2) Once I had a full list of foods that I should avoid, I had to get better at learning the hidden sources of things like dairy, soy, wheat, and corn. I had to get better at reading labels. A year later and I’m still making mistakes in this area, but I continue to learn and it continues to get easier.

(3) I had a really difficult time accepting such a limited diet for myself and for my little one. It didn’t seem fair (cue the eye roll, I know!), and it was unbelievably boring. I just had to get over it and move forward knowing that boring was a whole lot better doing harm. I still cried, though, when my baby’s first birthday came and went and she couldn’t have cake or a special dinner or anything, and we missed sharing that moment together.

What I Did Right

(1) I gave it enough time. When it didn’t seem like things were improving after two weeks, I kept going and I increased my vigilance when it came to those frustrating and confusing labels. When things didn’t seem like they were improving as much as I had hoped after four weeks, I still kept with it. When I wasn’t sure I was controlling enough variables I gritted my teeth and limited *our* diet (I was still breastfeeding at this time) even more, to just a handful of items. I stayed on the full elimination diet for over six months, until I was done breastfeeding. It was 100% worth it.

(2) I kept a health journal for my daughter and I recorded everything that she ate, no matter how little the amount. I also recorded every symptom, even if I wasn’t totally sure it really was a symptom. This helped me to gain perspective when I needed it, as well as providing quality info to the pediatrician at each visit.

The Total Elimination Diet

Enough about my experiences with the diet, let’s talk about the total elimination diet itself. It can be done in stages or all at once. As always, seek the advice of a medical professional before making any changes to your, or your baby’s, diet or health care.

Phase 1: Dairy and Soy Elimination

This is self-explanatory and sounds simple, but it is really difficult to execute well.  Dairy and soy are in everything!

Here is a link to a hidden dairy “cheat sheet”.

Here is a link to a soy allergy avoidance list.

Those will help to give you a leg up. Don’t be intimidated. You’ve got this!

Phase 2: Big 8 Elimination

If cutting out dairy and soy have not eliminated your baby’s symptoms after two weeks (formula fed) or 5 weeks (breastfed) you can trying cutting out the rest of the Big 8 common allergens:

(1) Milk / Dairy – you’ve already done this one.
(2) Soy – you’ve crossed this one off your list already, too!
(3) Peanuts
(4) Shellfish
(5) Fish
(6) Tree Nuts
(7) Eggs
(8) Wheat

Here is a link to a peanut allergy avoidance list to help you find hidden sources of peanut (you’d be surprised!).

Here is a link to a list of tree nuts.  Thankfully, coconut is not really a tree nut and is usually a safe food even for people with tree nut allergies.

Here is a link to a list of hidden sources of egg.  Baked goods can be really difficult to come by when you eliminate eggs, but it is doable. 

Here is a link for tips on how to read food labels to see if an item contains wheat.

Now you’re starting to see why it is called a Total Elimination Diet!

Phase 3: The Other Problem Categories

If your little one is still experiencing the typical FPIES or MFPI symptoms and you want to continue down this path, I have compiled a list of the other main categories of foods that you may want to consider eliminating.

(1) Corn – and all of its derivatives.  Removing corn from your diet may be more challenging that removing soy if you eat a lot of packaged foods or soft drinks.  Anything with corn syrup or even corn starch could be a problem, depending on how sensitive your baby is to corn.  My daughter can’t have food coloring (bummer, right?) or even frosting made with traditional powdered sugar (did you know that powdered sugar has corn starch in it?!).  

You can read more about avoiding corn derivatives here.

(2) Nightshades.  This one was a big surprise to me.  Who would have guessed that tomatoes and potatoes were in the same family of vegetables?  Here is a list of vegetables in the nightshade family that will be helpful if you’re considering eliminating them from your diet: Nightshade Vegetables.

(3) Citrus.  I was also skeptical of this category when it was suggested to us, but it turns out, citrus is a problem for our little one.  Oranges and lime juice, the two citrus foods that we did food trials with, both failed.  If you think this might be a category of food that you want to try eliminating, this little list may help you.

(4) Lastly, there are the common FPIES trigger foods:

• Milk / Dairy
• Rice
• Oats
• Soy
• Barley
• Meat (poultry, red meat, pork, etc)
• Green Peas
• Green Beans
• Sweet Potatoes
• Squash

A Word About Forumulas

We were in the rare minority where our daughter even reacted to elemental “hypoallergenic” formulas. We tried two elemental formulas to supplement our baby’s calories and nutrition, and she reacted pretty strongly to both. As I said, it’s pretty rare for a sensitivity to be that strong, but it does happen.  If you’ve had suspicions about whether your baby is reacting to a formula but you think that’s crazy, I just wanted you to know that it’s not.  Trust your gut and talk to your health care professional about other options that might be right for your family.

One Last Thought

Due to the nutrient loss from such a restrictive diet, I strongly advise checking in with a nutritionist. For my daughter, the Total Elimination Diet coupled with very careful nutrition planning saved her life. She went from Failure to Thrive to back on a normal growth curve in about a year. It was a long scary year, but we made it, and so can you!