Unsupervised Elimination Diets May Lead to Malnutrition

Following an unsupervised elimination diet to treat suspected food allergies may lead to malnutrition, according to a case report in Clinical and Experimental Dermatology (2002;27:715–6). People who restrict their diet without the guidance of a nutritionist may become deficient in vitamins and minerals, which may lead to unwanted weight loss, hair loss, dry skin, brittle nails, and other conditions.

In this report, a 27-year-old woman with severe eczema submitted a blood sample for food allergy testing to a nutritional laboratory. She had previously not responded well to conventional topical steroid treatment. Her tests showed sensitivity to wheat, oat, rye, egg white, cow’s milk, and soy. Based on these results, she eliminated all of these foods from her diet for six months. When seen again by her physician after six months, she had lost almost eight pounds (an unwanted weight loss) and reported significant hair loss. Evaluation by a nutritionist revealed that her diet was deficient in calcium; zinc; iron; folic acid; and vitamins A, B2 (riboflavin), D and E. After reintroducing the suspect foods back into her diet, her weight returned to normal and the hair loss subsided.

Food allergies have been shown to be an underlying cause of certain disorders of the skin, intestines and stomach, and lungs. However, the reliability of some of the methods used to diagnose food allergies has been controversial. Conventional tests for food allergies are geared toward identifying foods that can cause immediate, life-threatening reactions (such as breathing difficulties in children following the ingestion of peanuts). However, some physicians believe there is another type of food intolerance that leads to delayed reactions and which cannot be detected by conventional allergy testing. A number of different blood tests and other techniques are used to identify these allergies, but none have clearly been shown to provide reliable information.

Consequently, some physicians recommend following a supervised elimination diet to determine one's food intolerances. Specific foods are eliminated for two to three weeks and then reintroduced one at a time. If the symptoms are due to food allergy, they will usually improve during the elimination phase. Subsequently, ingestion of an offending food will often cause the symptoms to come back. While many individuals have benefited from this approach, poorly designed elimination diets may be deficient in calories, vitamins, and minerals. It is therefore important that people undergoing an elimination diet be supervised by a dietitian, nutritionist, or doctor.

One study suggests that up to 8% of children younger than three years old and up to 2% of the adult population may experience reactions to foods. However, since it is often difficult to identify these reactions, the true incidence of food intolerance may be much greater than 8%. Conditions that have been found to be associated with food allergies include asthma, irritable bowel syndrome, ulcerative colitis, some types of arthritis, fatigue, migraines, bedwetting, recurrent ear infections, and attention deficit-hyperactivity disorder.

Darin Ingels, ND, MT (ASCP), received his bachelor’s degree from Purdue University and his Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. Dr. Ingels is the author of The Natural Pharmacist: Lowering Cholesterol (Prima, 1999) and Natural Treatments for High Cholesterol (Prima, 2000). He currently is in private practice at New England Family Health Associates located in Southport, CT, where he specializes in environmental medicine and allergies. Dr. Ingels is a regular contributor to Healthnotes and Healthnotes Newswire.

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