Elimination Diet to Diet Minimalism: Why, How & What (Part I)
Disclaimer: I am not a licensed dietitian or nutritionist, nor am I even close to being an expert on health and nutrition. This is a personal account of my elimination diet journey, in which a few different types of diets are briefly introduced and simplified for the sake of brevity.
Upon returning to San Francisco after nine months on the road, Jeff and I settled back into normative life in a big city with all its routines and familiarity, and decided this was as good (or bad) of a time as any to commit to an elimination diet. For years, I’d experienced stomachaches, bloating and gassiness that occurred as as frequently as 3-4 times per week. On a scale of 1-10 with 10 being excruciating, immobilizing pain, it rarely went beyond a 7, but the discomfort often hovered around 4-5. Over time, feeling a 4-5 became my new baseline, my new normal. Sometimes, I would continue to eat, drink or socialize with friends at the initial onset of discomfort (when it was at a 2 or 3), and it would worsen over the next several hours to a 5-7. After chatting with several friends (most of whom are female), I started to realize how common this experience is―we all continuously put up with pain and discomfort, trading in instant and temporary gratification for what could potentially be detrimental to our health long-term. I think it’s fair to assume that chronic bloating, feelings of indigestion and stomachaches are not normal; they signal inflammation, and pose a threat to our health. But it takes so much time, effort, care and discipline to sort through all the noise in the multitude of diets, blogs and research out there to pinpoint what exactly works (and doesn’t work) for each of us on an individual level that we simply don’t know where to start. We are paralyzed by choice and information.
For the past several years, I’ve experimented with various diets and fads―pescatarianism, juice cleanses, paleo, paleo pescatarian, gluten-free, sugar-free, intermittent fasting, prolonged fasting, fast-mimicking diet, keto, etc. Some of these led to hypothyroidism, iron deficiency, weight loss, while others led to an increase in energy, blood sugar stabilization, mental clarity, etc., but none (outside of fasting) seemed to solve for the frequent bloating or aches I still regularly experienced after a meal. Through trial and error, I confirmed that I was lactose intolerant, as most Asians unfortunately are―there was a clear causal relationship between consuming milk or ice cream and the inevitable onset of bloating and gassiness an hour or two later. I also managed to figure out that too many almonds (particularly in the form of almond milk) triggered aches that were often far more painful than drinking a glass of milk. It made logical sense to me―the amount of almonds it takes to make a little bit of almond milk is radically disproportionate to the amount of raw almonds I would ever consume in one sitting. But this is exactly what makes health so impossible, that even once you’ve determined what your body is sensitive to, the work is only half-way done, because the quantity of what you consume also matters. Too often people default to the maxim of “everything in moderation,” but what the heck does that even mean? What exactly is “moderation” in its measurable form? Some foods I cannot eat in moderation, if at all, because of their inflammatory potential in my body.
Knowing that most dairy products and almonds (so random) resulted in hours of agony, I steered clear of them in my diet when possible. When I ate cheese around wine-o-clock, it was a deliberate choice of mindful indulgence. Still, the bloating and aches lingered even after I cut these two foods out, and as these mini-explosions of inflammation continued to go off across my stomach lining year after year, I finally decided, that’s it. One of my favorite sayings from Jeff is, “Have a bias towards action.” I needed to be proactive about this―I needed to get to the root of what’s causing these mini-explosions in my body before they triggered something bigger and harder to beat. On a communal level, I also hoped that my experimentation―assuming it produced positive results―would encourage my friends who were having similar experiences to take action, too.
An elimination diet, as defined by Healthline, is a short-term diet that helps identify foods your body can’t tolerate well by removing them from your diet temporarily and reintroducing them one at a time. Imagine if you had a pristine windshield―the moment a nat or bug hits the windshield, you’d notice it. On the other hand, if you had a soiled windshield covered with nats and bugs, you’d hardly notice, if at all, when another hits your windshield. The purpose of the first few weeks of an elimination diet is to get the windshield so immaculate that no suicidal nat will land unnoticed. Or, in other words, to establish a new, healthful baseline.
And so, the research and analysis began as to what, exactly, to eliminate. Fortunately, I’d already been following a gluten-, corn-, soy- and sugar-free diet for a few years and found that this worked well for me, so it was an easy decision to continue down that path. A handful of other diets that I had been exposed to in our communities and was curious to explore included the ketogenic diet, the autoimmune protocol (AIP) and a low-FODMAP diet, each of which are briefly introduced below.
A ketogenic diet is a low-carb, high-fat diet (not to be mistaken with Atkins or other low-carb diets) that puts your body in a metabolic state called ketosis, in which your body transitions from burning glucose for energy to burning fat. There are a few different types of ketogenic diets, but for our elimination diet, we decided to stick to a blend of the standard ketogenic diet and a high-protein ketogenic diet, as distinguished below:
Standard ketogenic diet: low carb, moderate protein and high fat at about 75% fat, 20% protein and 5% carbs
High-protein ketogenic diet: slightly more protein that the SKD at about 60% fat, 35% protein and 5% carbs
For comparison’s sake, the standard American diet is currently 50% carbs, 15% protein and 35% fat. The health research for the ketogenic diet is heaviest and most conclusive in its benefits for blood sugar stabilization and insulin resistance (aka diabetes and pre-diabetes) though newer research indicate a positive correlation between the keto diet and a lowered risk of heart disease, cancer, Alzheimer’s, polycystic ovarian syndrome, acne, etc.; however, these studies are far from conclusive. Most of the benefits we’d heard concerning the keto diet were anecdotal―mental clarity, a need for less sleep, more (balanced) energy throughout the day, etc.―but it was enough to pique our interest to try it ourselves, so we decided to incorporate this into our elimination diet.
The autoimmune protocol is rooted in the paleo diet, but is more specialized and restrictive. It takes on an elimination approach that focuses on nutrient density and removing all foods containing compounds that may stimulate the immune system or harm the gut environment. Many people with autoimmune conditions (where one’s immune system become overactive and overstimulated to the point it mistakenly attacks itself and its tissues) have seen positive results from transitioning to an AIP diet and staying on it. But for most normatively healthy people, it can serve as a learning diet rather than a permanent diet.
We decided to incorporate AIP into this elimination diet because I had been previously diagnosed with hypothyroidism but was never tested for Hashimoto’s―an autoimmune condition where the immune system attacks the thyroid; (Hashimoto’s is a common root cause of people with hypothyroidism). While I’d managed to rebalance my hormones and thyroid over the past few years, it seemed like a good idea to to play it safe anyway and eliminate any and all foods that might be problematic for me.
The most commonly consumed foods that are eliminated on the AIP diet (outside of the paleo diet) include eggs (in particular, egg whites), caffeine, most sugars, sweeteners & sugar substitutes, nightshades and spices derived from nightshades and seeds, and chocolate. This was a tough category of foods for me to eliminate―I made some concessions here by allowing myself caffeine and egg yolks. If I experienced bloating and stomachaches upon eating these after the first few days, I would cut them out for the remainder of the elimination month.
This diet was the most unfamiliar to me out of the three. It’s the least black-and-white as it’s not only about what you can or can’t eat, but also about how much you can or can’t eat of a certain food. FODMAP is an acronym for fermentable oligo-, di-, mono-saccarides and polyols―scientific terms to classify groups of small-chain carbs (sugars and fibers) that may trigger digestive symptoms like bloating, gas and stomach pain (symptoms often associated with IBS ad SIBO) due to malabsorption in the small intestine. Like AIP, the low-FODMAP diet is a learning diet, but unlike AIP, it has less to do with immunity and everything to do with promoting a healthy gut microbiome. Why is maintaining a healthy gut microbiome important? Our gut microbes help us degrade carbohydrates for fuel, create vitamins for good health and maintain balance in our immune system.
In recent years, research has found that people with symptomatic IBS (irritable bowel syndrome) and SIBO (small intestinal bacterial overgrowth) benefit the most from transitioning to a low-FODMAP diet. The simplified reason for this is that people with an unbalanced gut microbiome may have too much of certain types of bacteria in their small intestine that thrive on the prebiotics found in high-FODMAP foods, leading to symptoms of bloating, gassiness and stomach pains. Whereas your large intestine should have an abundance of diverse gut flora, SIBO occurs when a host of bacteria typically found elsewhere (such as the colon) have found their way to the small intestines. Being on a low-FODMAP diet starves those bacteria and thus promotes healing of the damaged gut lining.
While I was never diagnosed with IBS or SIBO (not that I ever tested for it), my symptoms were analogous to that of IBS and SIBO. Out of the three diets, I was certain that I’d find the culprit in one of the FODMAP categories, hoped for it even so that I could finally diagnose what’s been aching me. But incorporating this particular diet into our elimination month would prove to be the toughest as some of my favorite foods―garlic, onions, cauliflower, blackberries, chamomile, cashews and pistachios―would have to be sacrificed.
Monash University created a helpful app to track which foods are high-or-low FODMAP for those who are considering this for their elimination diet.
Everlywell is a start-up on a mission to make lab tests easier. Last year, I was targeted by their Instagram ads and saw that they offered an at-home test kit for food sensitivity, and after doing a little reading and research, I decided to give it a go. It’s a simple finger-prick test that measures a body’s immune response to 96 different foods―it does not claim to be an allergy test nor is it comprehensive, but may provide some insight into what foods cause a low, mild, moderate or high reactivity in the body based on the Immunoglobulin G (igG) antibody (the most abundant circulating antibody in our immune system). Based on this test, I was shown to have low and mild reactivity to a few things that did not surprise me―such as almonds, peanuts, milk, yogurt, soft cheeses, gluten, etc.―and a few things that did―eggs, sweet potatoes, avocados, black pepper, cauliflower.
Based on this, I decided to eliminate sweet potatoes, avocados and cauliflower from my diet for the month (in addition to everything else above), but kept egg yolks and black pepper for sanity’s sake.
A Quick Note on the Carnivore Diet
As we eliminated foods that followed the keto, AIP, low-FODMAP and low-reactivity ways of eating, it looked as though we were only a half dozen dark leafy greens and berries away from embarking on a month of carnivore dieting. We considered simplifying further and following a carnivore diet for the month (I sometimes find it easier to go to an extreme and have distinct boundaries when it comes to dieting and food) but ultimately decided against it as it just wasn’t necessary. We agreed that having some diversity in our nutrient intake would be beneficial and help us feel more satiated. We were already making some pretty big changes to our diet, so going full carnivore seemed excessive and would have been an unnecessary ancillary stressor.
We started our elimination diet during the last week of August and maintained this way of eating until the last week of September, at which point I began to reintroduce a few ingredients in preparation for our travels to Thailand.
During the first four plus weeks, we eliminated the following categories of food:
High-FODMAP―onion, garlic, lactose, xylitol, banana, apple, artichoke, avocado, etc.
Grains―wheat, oats, corn, bread, pasta, cornstarch, etc.
Legumes―soy, beans, peanuts, etc.
Omega-6 Rich Oils―soybean oil, safflower oil, corn oil, peanut oil, canola oil, etc.
Excess Fructose―honey, sugar, apple, mango, pear, watermelon, dried fruit, fruit juice, etc.
Nightshades―peppers, eggplant, okra, white potatoes, tomatoes, goji berries, nutmeg, etc.
Dairy―milk, cheese, butter, yogurt, ice cream, etc.
Farmed Meats―factory farmed meats, farm-raised seafood, etc.
High Carbohydrate―fruit, maple syrup, cassava/tapioca, pineapple, grape, squash, etc.
Nuts & Seeds―cashew, almond, cacao, dark chocolate, macadamia, chia seed, cumin, coriander seed, etc.
Food Additives―carrageenan, guar gum, aspartame, MSG, sulfates/sulfites, nitrates/nitrites, etc.
Alcohol―beer, wine, liquor, vanilla extract, etc.
Everlywell’s Mild Reactivity Foods―peanut, cashew, tuna, sweet potato, cauliflower, green beans, kelp, egg whites, etc.
This left us with a much shorter list of what we could eat:
Pasture-Raised Meat & Animal Products―beef, lamb, pork, chicken, turkey, egg yolks, etc.
Wild-Caught Seafood―salmon, sardines, anchovies, cod, shrimp, oysters, clams, etc.
Bone Broth―beef broth, chicken broth
Leafy Greens―arugula, spinach, kale, collard greens, lettuce, swiss chard, etc.
Vegetables―cucumber, radish, oyster mushrooms
Herbs & Spices―basil, bay leaf, chives, cinnamon, turmeric, ginger, oregano, sage
Healthy Fats―avocado oil, coconut oil, ghee, olive oil, olives
Acids―vinegar, apple cider vinegar, lemon/lime juice
The following foods have small amounts of FODMAPs and fructose, and were fine for me to consume in small quantities (meaning have a handful or have as a side dish but not a main):
Low-FODMAP―bok choy, broccoli, brussels sprouts, cabbage, fennel, jicama, zucchini, green beans, celery
Berries―blueberry, raspberry, strawberry
Low Carb Starches―carrot, parsnip, rutabaga
Kombucha―low in sugar
After the first week, we found ourselves rotating between a few simple recipes and settling into this new lifestyle of stress-free eating that I call diet minimalism. Little-to-no mental effort was ever spent on answering the question, “What should we eat today?” and we regained a huge part of our days because of how efficient and streamlined we were with what and how we ate. It was in many ways a relief. What I’d thought would be a stressful experience turned out to be the opposite―though I owe much of it to a supportive partner who graciously agreed to embark on this elimination journey with me (with the exception of a few snack privileges).
Below are five meals that formed the foundation for how we ate during this month―to our surprise, we never tired of these foods. We got creative with how we cooked and paired the ingredients, but the core of it remained the same.
a handful of simple RECIPES (serves 2)
Set oven to 400-degrees fahrenheit, spread one pound of 100% grass-fed ground beef across a circular oven-safe pan, salt and pepper as needed, and let bake for about 10 minutes. Meanwhile, place 4-6 strips of bacon on a baking sheet and let bake alongside the ground beef for approximately 8-10 minutes. Once the bacon is ready, remove from baking sheet and set aside. Keep the fat on the baking sheet, toss a few handfuls of raw spinach onto it, salt and pepper as needed and place back into oven for 5-7 minutes. Remove ground beef, add 3-6 egg (unscrambled) yolks on top and place back into oven for 8-10 more minutes (or until it is as cooked as you like). Once the spinach and ground beef pizza (beefza) are ready, remove from oven and eat with spinach, bacon and avocado tossed on top or served on the side. Finish the meal with a handful of berries.
Short Rib & Oxtail Stew
Boil a large pot full of filtered water and toss in 2-4 lbs of 100% grass-fed short ribs and oxtail; salt & pepper as needed. Lower to a simmer and let it cook for 4-8 hours depending on how “fall-off-the-bone” you like your meet―6 hours worked well for us. 20-30 minutes prior to serving, wash, chop, prep and steam, sauteé or bake your leafy green of choice―we rotated between organic cabbage, baby bok choy, green beans, zucchini and/or an Italian salad dressed with olive oil and vinegar. When sauteéing, use a healthy fat as your cooking oil―coconut oil, avocado oil, beef tallow, olive oil or ghee work well. Serve the short ribs and oxtail with Maldon salt. Finish the meal with half of a kiwi or small handful of berries.
Tip: keep all of your bones and throw it back into the pot afterwards; let it simmer overnight and you’ll have enough broth to last you through the week.
Lamb Chops + Grass-Fed Ribeye Steak
Marinate the lamb chops and ribeye steak with salt, pepper, rosemary (and/or other herbs) 20-40 minutes prior to cooking. Set oven to 375-degrees fahrenheit and throw both on a cooking sheet. Let bake for ― minutes depending on how rare or well done you like your meat. We like our meat medium-rare, and found that ― minutes worked well. Remove from oven for a final two-minute sear over medium-heat on the stovetop. Remove from heat. Pair with a leafy green, vegetable or salad of choice. Top off the meal with half of a kiwi or small handful of berries.
Organic Pasture-Raised Whole Chicken
Marinate chicken with salt, pepper and whichever other herbs of your choosing 8-12 hours before cooking. Set oven to ― degrees and put the whole chicken in on a baking sheet. Let bake for ― minutes. Remove from heat and cut up to serve. Pair with a leafy green, vegetable or salad of choice.
Marinate salmon with salt, pepper and whichever other herbs of your choosing (i.e - ginger!) 20 minutes-to-an-hour before cooking. Depending on how you like your salmon, you may pan-fry, broil or bake. If you bake (which we often did because we’re lazy), set the oven to ― degrees and let bake for ― minutes. Pair with a leafy green, vegetable or salad of choice.
I don’t think I would have been able to get through those four weeks without at least some snacks, which in spite of all of our restrictions, we still managed to stockpile a solid selection. Below are the snacks, supplements and drinks that kept us sane and satiated:
Homemade Beef Bone Broth
San Pellegrino Mineral Water (mix w/ two pinches of pink Himalayan salt & juice from half of a lemon)
In a follow-up post, I’ll dive into the re-introduction process and share my week-by-week progress and results.