In the last blog post I spoke about how following an elimination diet can benefit a lot of people by determining which foods someone might be sensitive to. After someone has gone on an elimination diet for three or four weeks the next step is to reintroduce foods. While some people will want to continue following the elimination diet after three or four weeks, eventually just about everyone will want to reintroduce certain foods into their diet.
How should you go about reintroducing foods? Well, you always want to reintroduce one new food at a time. The obvious reason for this is because if you were to reintroduce more than one food on the same day and then experienced a negative reaction, you wouldn’t know which food was responsible. It also is a good idea to eat the food you reintroduce a couple of times on the same day, and then wait an additional two days before reintroducing the next food. The reason for this is because it is possible to have a delayed reaction to a food. If all goes well when reintroducing a certain food then you can continue eating that food on a regular basis and can reintroduce the next food.
So for example, let’s say you followed the elimination diet for 28 days. On day #29 you decide to reintroduce eggs, and have an egg for breakfast and another egg with lunch. If by the end of day #31 you experience no negative symptoms, then on day #32 you can reintroduce a new food. On the other hand, if you did experience a negative reaction to the eggs then you would wait until the symptoms subside before reintroducing the next food.
Which Foods Should You Reintroduce First?
It’s usually not necessary to reintroduce foods in a certain order, although some sources will recommend to first reintroduce the foods least likely to give a severe reaction, and to save foods such as gluten, dairy, and corn for last, if you choose to reintroduce these. Many times I will recommend reintroducing eggs first if the person enjoys eating eggs, as they are very nutrient dense. Of course you can choose to reintroduce a different food first if you prefer. For obvious reasons you want to only reintroduce whole foods for now. The reason is because if you reintroduce any type of processed food then you most likely will be reintroducing more than one ingredient. For example, if you reintroduce pizza as one of the first few foods, and you had a negative reaction, you wouldn’t know if the negative reaction was due to the wheat (or other type of grains if it was gluten free), cheese, sauce, or other ingredients in the pizza.
This brings up another important point, as you don’t necessarily want to reintroduce ALL of the foods you originally eliminated. So for example, certain foods are not eliminated because they are allergenic, but instead because they have compounds which can cause issues with the permeability of the gut. Examples include nuts, seeds, legumes, grains, and the nightshade vegetables. While sometimes eating these foods can produce symptoms (i.e. the nightshades commonly cause joint pain), the lack of symptoms doesn’t mean that it’s fine to continue eating these.
This doesn’t mean that everyone will need to completely avoid nuts, seeds, legumes, grains, and the nightshade vegetables. If someone chooses to follow a strict autoimmune paleo diet then they will avoid these foods, along with dairy and eggs. On the other hand, there are some people who are able to eat small amounts of these foods without a problem. If someone has obvious gastrointestinal issues or has tested positive for a leaky gut then I do think these foods should be avoided until the gut has been healed.
When Can Dairy Be Reintroduced?
Dairy is one of the main foods that a lot of people commonly want to reintroduce first. Although there are health benefits of dairy, I’m very cautious about people reintroducing it while trying to restore their health, mainly because many people are sensitive to the proteins of dairy, specifically casein. And remember that is possible for someone to reintroduce a food they are reacting to and not experience any negative symptoms. With that being said, some people do fine with raw dairy, and a good quality whey protein is an excellent source of glutathione. And so if someone insists on adding dairy I would recommend starting with raw dairy (i.e. raw milk), and then perhaps they can add a good quality whey protein. However, if someone is fine not reintroducing dairy I will usually encourage them to go as long as they can without consuming it, letting them know that they will eventually be able to reintroduce dairy products again, if they choose to do so.
What Are Some Symptoms You Might Experience When Reintroducing Foods?
If all goes well then you shouldn’t experience any negative reaction when reintroducing a specific food. On the other hand, if you do have a negative reaction then you want to look out for symptoms such as bloating, gas, abdominal discomfort, headaches, fatigue, muscle or joint pain, insomnia, skin problems, sinus congestion, etc. One question you might have is “if I experience a specific symptom how do I know for certain it’s related to the food I reintroduced?” For example, if someone reintroduces a new food and experiences severe gas and bloating, then there is a good chance it’s related to the food. On the other hand, if they were to experience a headache or a increase in fatigue then it might be related to the food, but there is a also a chance that these symptoms weren’t related.
If you’re not certain if a symptom is related to the food being reintroduced then I would recommend to stop eating the food for a few weeks and then reintroduce it again in the future. So for example, if you reintroduce eggs and experience a headache on the same day, it is possible that you coincidentally had a headache that was unrelated to the food. On the other hand, if you avoid eggs for a couple of weeks and then reintroduce them again, and experience headaches again, then chances are it’s the eggs which are responsible for the headaches.
Should Gluten Be Reintroduced At All?
Gluten is a common allergen, and many healthcare professionals will recommend for their patients to permanently avoid gluten. Others will recommend for them to first heal their gut and restore their health, and then later will give the patient the option to reintroduce gluten. I’ve also taken this approach with my patients, but the problem is that if they are sensitive to gluten but aren’t aware of this, one can argue that it might be best to find out sooner than later. In other words, sometimes it might be best to have the person reintroduce gluten after following an elimination diet, and then if they have a negative reaction this will confirm that they should continue avoiding gluten while trying to restore their health, and perhaps even after their gut has been healed.
However, a possible flaw with this approach is that a leaky gut can cause food sensitivities. In other words, a person might develop a food sensitivity due to a leaky gut, and just because someone is sensitive to a certain food initially doesn’t mean that they will be sensitive to the same food after the gut is healed. And so a person might develop a gluten sensitivity after developing a leaky gut, but it is possible for the gluten sensitivity to no longer be present after the gut has been healed. I’ve spoken to the doctors at Cyrex Labs, as they offer comprehensive testing for gluten, and they recommend that if someone tests positive for gluten on one of their Arrays for them to avoid gluten permanently…even if after healing a leaky gut. Another theory is that if you eat even a small amount of gluten you can have gut inflammation for up to six months, and so based on this you would want to be cautious about reintroducing gluten at all. Plus, since you can’t always go by symptoms there is a chance that someone who has a gluten sensitivity will reintroduce it and feel fine, and because of the lack of symptoms will continue to consume it, thus causing inflammation. So while many people choose to eventually reintroduce gluten, there are risks of doing this.
It can get confusing, and without question there are some people who are sensitive to gluten and will need to avoid it permanently, yet many of these people don’t know they have a gluten sensitivity issue. And so it definitely is a dilemma, as we’re pretty much faced with two different scenarios. Scenario #1 is to reintroduce gluten after eliminating it, and if you have a negative reaction just realize you might experience an increase in gut inflammation for a few months. Scenario #2 is to reintroduce gluten after healing your gut, but then if you are sensitive you might undo some of the positive benefits you received from the gut healing program.
Food sensitivity testing is an option to consider, although there are a few drawbacks to this. One drawback is that it can be very expensive to do this type of testing. Another drawback is that false negatives are common, and so you can have a gluten sensitivity but it might not be picked up by the test. A final drawback is that you need to be consuming gluten in order for this type of test to be accurate. And so if you are on a gluten free diet and do a food sensitivity test for gluten then you are essentially wasting your money.
The Final Verdict on Gluten
I didn’t mean to spend so much time on gluten, but I realize that there is a lot of controversy around this common allergen. My current approach is to have people initially avoid gluten, and ideally I will have them continue to avoid it while following the natural treatment protocol. On the other hand, if someone insists on reintroducing gluten soon after the elimination diet then I will let them know that there is a chance that they can be sensitive to gluten, yet they might not experience any symptoms upon reintroducing it. I will also let them know that if they do fine upon reintroducing gluten from a symptomatic perspective, and choose to continue to eat it, I would still recommend minimizing their consumption of gluten, and of course to try to eat mostly whole foods, which won’t contain any gluten.
In summary, after your elimination diet you want to reintroduce one food at a time. If after three days you don’t experience a negative reaction you can continue eating this food, and can then reintroduce the next food. If you react to a specific food then the symptoms can vary, as some people will experience digestive symptoms, while others might experience symptoms such as fatigue, headaches, brain fog, muscle and joint pain, skin problems, etc. And sometimes the person won’t experience any symptoms. Although food sensitivity testing is an option, this also isn’t completely reliable, and can be very expensive. As for reintroducing gluten and dairy, I usually encourage my patients to continue avoiding gluten and dairy while trying to restore their health, although some of my patients choose to reintroduce one or both of these.
Can you recommend what may be eaten during the first 28 days?