GI Issues? Try an Elimination Diet

Gastrointestinal (GI) issues can affect your quality of life, and it can be difficult to figure out whether food sensitivities, allergies, IBS (irritable bowel syndrome) or something else is causing the problem. 

If your doctor has ruled out common GI issues like gastritis and thinks you may have a food sensitivity, they may suggest an elimination diet. This is not meant for weight loss. Instead, elimination diets — also called exclusion diets — help people with GI issues determine their food sensitivities. 

You may be tempted to start eliminating food groups on your own, but a gastroenterologist partnered with a registered dietitian can guide and monitor your progress, pinpointing foods to eliminate and when to reintroduce them. 

There are certain foods that doctors know are common food intolerances, including: 

• Eggs

• Soy

• Dairy

• Gluten

• Caffeine

• Fructose

• Food additives, such as food colorings and aspartame

• Histamines, found in fermented foods and beverages like wine, yogurt and sauerkraut

• Sulfites, found in baked goods, soups, jams and canned vegetables 

Another common group of foods that can cause GI distress are called fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs). This is a category of carbohydrates found in wheat, beans, onions, garlic and other foods that can be difficult to digest. 

Elimination Diet How-Tos 

For about five to six weeks, a registered dietitian will advise you on which food group to eliminate and monitor your symptoms using a food journal. The goal is to eliminate bloating, gas, diarrhea, constipation, and other GI issues and get to the bottom of which foods are causing your symptoms. 

After six weeks, you’ll reintroduce those foods into your diet in gradual, amounts, logging any symptoms in a food journal. 

Just can’t give up garlic or other preferred foods? You can work around that. Garlic is a common food sensitivity and a common ingredient in many recipes. Your dietitian may use the results of the food reintroduction phase to determine the volume of garlic you can consume without triggering major symptoms. Sometimes patients can tolerate certain foods at a reduced volume. 

In other cases, some patients learn that they can tolerate Greek yogurt, which has less lactose, than ice cream or another dairy food higher in lactose. 

Similarly, cooking methods might have an effect on how your digestive system reacts to a certain food. For example, you may be able to tolerate something that’s been steamed or mashed over the same food served raw. 

Differences Between Food Sensitivities, Allergies and Intolerances 

Unlike a food allergy, a sensitivity or intolerance may begin a few hours after eating something versus instantly reacting to the food. 

Food sensitivities and intolerances are caused by gut microbiome imbalances, immune system dysregulation or lack of specific digestive enzymes needed to properly digest the food. Both conditions can cause digestive issues or other physical symptoms like hives. 

On the other hand, a food allergy — an immune system response — can include those symptoms but can also be life-threatening, causing respiratory airways to restrict and close. 

How Dietitians and Gastroenterologists Work Together 

Registered dietitians can work with a gastroenterologist to help patients identify foods that might trigger symptoms. Together, both clinicians can come up with an individualized elimination diet that’s most appropriate for each patient. 

Dietitians also ensure that you’re replacing lost vitamins and minerals supplements, especially if you’re missing out on essential vitamins or minerals supplied by an entire food group. Your care team will review your food journal with you to identify any symptoms that may indicate an underlying dietary intolerance.