It’s time to start a sequential food re-introduction using a daily food diary if you’ve followed an elimination diet for at least 21 days AND your symptoms have improved. Tracking your symptoms during food re-introduction is critical to determining which foods may be responsible for your symptoms.
Ideally, try to keep a food and symptoms record the last week of your elimination diet to have a clear idea whether or not your symptoms have improved.
Sidebar: Food challenge and re-introduction for most IgE-mediated reactions, and those suspected to cause severe reaction should be conducted under medical supervision. This discussion is primarily related to IgG-mediated reactions and food intolerances. (See my other website pages for a discussion of IgE and IgG mediated reactions).
A free diet journal and food re-introduction chart created by Kathie Swift MS, RD can be found at www.theinsidetract.org. This food re-introduction chart outlines the order of foods to test and may or may not match the foods on your specific elimination diet. Remove foods that are not pertinent to you and add other foods that you have excluded to the list with foods that have a greater likelihood of causing reaction at the end of the sequence.
1. Continue your prescribed elimination diet for all meals/snacks throughout the testing period. Foods are not added back into your diet until all of the foods within a category have been tested separately, even if they produce no reaction during the testing (for example, while testing milk products, if you have no reaction after testing cheese do not add this back into your diet until milk, yogurt, ice cream, etc. have also been tested).
2. Test the food in a pure form so that you can be certain of your results (for example, if you are testing eggs use a hard boiled egg and test the yolk and the egg white separately or if you are testing wheat use plain puffed wheat or cream of wheat instead of cereal with milk).
3. Perform an initial oral screening challenge by placing the test food in your mouth and allowing it to rest there for a few minutes. Remove the food and observe for any reactions. These can occur up to 30 minutes after the challenge. If you have symptoms during the challenge then do not retest the food and record it as a “fail” on your food reintroduction chart or daily food diary (and wait 48 hours after the symptoms have disappeared to test the next food). If no symptoms occur then proceed with testing the food.
4. Consume the test food three times on the test day, at 4 hour intervals, and watch for symptoms. For example, eat a small quantity (2 TBSP) of the test food in the AM. If no symptoms occur wait at least 4 hours and consume double the quantity of the same test food eaten in the AM. Wait 4 hours, if no symptoms occur, consume double the quantity of the test food eaten in the afternoon. If the test food does not cause a reaction on Day 1 of reintroduction, continue to monitor for symptoms and delayed reactions on Day 2 and 3. Record your results on your chart or daily food diary.
a. If no symptoms occur during the testing or on Days 2 or 3, the test food can be considered safe, record as “pass” on your chart or daily food diary and proceed with testing the next food in the sequence with each new food having been tested 3 days apart.
b. If the test food does cause symptoms, record as “fail” and continue to eliminate the problem food. Test the next food in the sequence 48 hours after symptoms have disappeared.
Foods that failed the re-introduction test should be avoided for about 4-6 months and then re-tested. You may find that you are no longer sensitive to that food or food group after 4-6 months time and you don’t want to unnecessarily avoid certain foods long term.
Which brings up another important point…
If you are avoiding certain foods or food groups based on your food re-introduction findings, make sure that you are replacing nutrients that may be lost. For example, when dairy products are avoided, ensure that you are obtaining adequate calcium from dairy substitutes and/or nutritional supplements.
This is a general guide to food re-introduction following an elimination diet and using a daily food diary. It should be detailed enough for you to determine whether or not you have food sensitivities that may be responsible for your digestive or whole body symptoms. For additional information see my references or refer to my other website pages.
Some references: Joneja, JV Dealing with Food Allergies, 2003; Mullin GE and Swift KM The Inside Tract, 2011; IFM Functional Nutrition Course conference 2012
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