Last week, I wrote about why we suspected Bean had food intolerances. Or, maybe you suspect that you might have a food intolerance. Now it’s time to talk next steps.
While allergists can test for allergies, they cannot test for food intolerances. The only way to figure it out is through an elimination diet. (Allergists sometimes don’t want to test young infants for allergies anyway, which will lead you right back here)
An elimination diet is pretty straight-forward on its face — eliminate the food, see if you feel better. Ta-daaaa!
The problem is that that one food can be anything. Milk, peanuts, soy, squash, eggs, rice, potatoes.
First, I’ll talk mechanics: how do you actually do this. Next week, we’ll discuss the ramifications of an elimination diet, and what surprised me about going on one.
How to go on an elimination diet:
1. Start piecemeal or go total elimination diet
There are a few ways to go about starting. You could cut out the most likely culprits, or you can go whole hog and go straight to the total elimination diet. I’d recommend starting with likely culprits, and start adding to the list and hope for the best. If you don’t see any improvements, consider the total elimination diet. (We met a woman who eventually went on a total elimination diet because nothing was working. Even the total elimination diet didn’t work. Turns out her kid was allergic (anaphylactic) to rice. RICE.) If you want to try a total elimination diet, head over to Dr. Sears’ site for the rundown.
2. What foods to cut out first
Ok, so going step by step. There are 8 foods that make up the “Big 8” food allergens. They’re the most common. They are:
milk
eggs
fish
shellfish
tree nuts
peanuts (they’re technically legumes, not tree nuts)
wheat
soy
If you’re breastfeeding a baby that is showing signs of food intolerance, your best bets are milk and soy. Start there, then keep a food diary for a few weeks/months. If your baby exhibits symptoms one day, you can look at your food diary and start eliminating other problematic foods.
3. No, really, milk and soy
These two intolerances go hand in hand — half of all babies with a milk protein intolerance will also have a soy protein intolerance. It’s usually a good idea to start with both.
You can cut first milk out and then soy, obviously. Your body, your rules. In my head at the time, I wanted the symptoms gone as soon as possible (hello, blood in poo), so I thought it’d make more sense to clear up symptoms first and then work backwards and do milk/soy challenges to see if I could add one of those foods back in. (I couldn’t.)
Oh, and this isn’t a lactose issue, so eating/drinking lactose free products won’t make a difference. People who are lactose intolerant can’t process the sugars in milk; babies that can’t process milk are usually having a problem with the milk protein.
4. Milk takes a month to leave both of your systems; you may not seem improvements for weeks.
Soy will leave your system pretty quickly, but milk will take a couple of weeks. And then add a couple of weeks for it to get out of your baby’s symptom. So, it’ll be about a month before you should know whether it’s working or not.
5. “Milk” means milk derivatives. “Soy” means soy derivatives
I’ve heard doctors only recommend cutting out obvious dairy, like straight cow’s milk or cheese. I feel like it’s a waste of time. If you only cut out obvious dairy and see no improvements, there’s no way to know whether it’s because derivatives are also a problem or because dairy isn’t the culprit.
If you go ahead and cut out all derivatives as well as the obvious food, there will be no doubt if the food is or isn’t causing the problem.
Basically, treat this like an allergy and read labels very carefully. Most labels will have allergen warnings for dairy or soy, which makes it easier.
For us, Bean reacted to minute traces of both dairy and soy derivatives at first. It seemed unbelievable that such a small amount could find its way into her body, and then cause a reaction.
Oh, and “soy derivatives” — I include soybean oil in there, which is more commonly known as “vegetable oil.” Some people do not, because the idea is that all soy proteins have been expunged by the time the soybean has been converted to oil. That wasn’t our experience; Bean reacted to it. Yes, I realize it’s very limiting. Yes, I realize you basically can’t eat any packaged product or go to any restaurants anymore. Once she was older, we tried it again and all was well.
6. You may need to cut out other foods
Milk and soy are so commonly eaten every day (if not every meal) that cutting them out will help you tremendously in figuring out whether other foods might be problematic as well. You just don’t eat the other allergens as often, so you’re more likely to see a spike in symptoms after you eat it. If you eat it one night, and your kid has a reaction the next morning, then bingo.
Now, the reaction can happen 3 to 12 hours past when you ate the food. You have to eat the food, the proteins have to enter your milk supply, baby has to nurse, then baby’s body has to have a reaction. Allergen reactions are more immediate than intolerance reactions. Intolerance reactions sometimes happen at the next bowel movement, so maybe 12 hours after you even ate the offending food, and you’ve probably eaten a lot of food since that one meal.
This is where the food diary comes in helpful. You’re looking for a trend. “Hm, whenever I eat peanut butter, baby projectile vomits on me the next day.” “HMm, baby is covered in a terrible rash and is having explosive poo; this happened last time I ate eggs for breakfast too.”
Of course, when you cut out those foods, you should also go after the derivative forms as well.
7. Again, it could take a month of this before you start seeing improvements
Isn’t that brutal. We saw some immediate improvements in Beans’ eczema and diaper rash, but the other symptoms took weeks to go away.
If your baby has been experiencing bloody poop, it might take even longer to see that all cleared up (a couple months). If things got so bad that she was pooping blood, her intestines and stomach have a lot of healing to do. The healing only begins to happen once dairy is gone from her system, which again, happens after 4 weeks (see #4 above).
It takes a lot of gumption to stick with something so difficult without seeing immediate results, I know. But, there’s no way around it.
8. Once symptoms have cleared up, start adding foods back in
Once you’ve reached a steady state you’re comfortable with, it’s time to do at-home challenges. This is where you eat the food and see whether baby has a reaction after her next feeding.
Now, you might not want to go full throttle with an ice cream sundae with a side of brie and milk duds. Add in the derivatives first. So, if you’ve been completely off soy, try eating something cooked with vegetable (soybean) oil. If all is well, take a week off and then try out soy lecithin. For dairy, a good place to start is baked-in dairy or yogurt.
Also, if you’ve been only testing cow’s milk products, you can try goat and sheep’s milk. It is supposed to be easier on the stomach than cow’s milk. This worked for one mother I know, but Bean reacted to all milk. (2016 Update: It’s has also worked for us now!)
9. Keep testing and adding foods back in until the child is 5 years old
Yeah, don’t expect this to be a rush job. Your kid will likely start solids before this all clears up.
I’ve heard so much about how most kids outgrow this by their first birthday; I don’t know anyone this was true for.
More Reading:
Surviving the MSPI Diet: A List of Comfort Foods
Our Latest Deliciously and Deceptively MSPI-Approved Comfort Foods
Tips for Traveling on the MSPI Diet
