This is the diet used by Dr Gail Darlington and colleagues in their study published
in The Lancet {Darlington LG, Ramsey NW, Mansfield JR (1986): Placebo controlled,
blind study of dietary manipulation therapy in rheumatoid arthritis.
The Lancet 1(8475), 236–38; see section 7.2}. However, Dr Darlington (pers.
comm., 2005) comments:
‘Many patients find it very difficult to comply with the diet at this level of
strictness in the elimination phase. For the past five years or so, I have permitted
really rare fruits and vegetables such as sweet potatoes, papaya, mango, papaw
and kiwi fruit in the elimination phase which aids compliance and at the same
time makes it easier for patients to hold their weight. I am not aware of any loss
of efficacy as a result of this minor level of leniency although I cannot back up
that statement with scientific data.’
The diet was later retyped into the format below and used by Dr Dorothy
Pattison when she was Senior Dietician with St Albans and Hemel Hempstead
NHS Trust, 1992–1995, mainly, but not exclusively with RA patients. Undertaking
the diet regimen was the patient’s decision and agreed by the rheumatologist.
Dr Pattison (pers. comm., 2005) reported:
‘A small number of patients (approximately 6%) identified foods that aggravated
symptoms but other positive outcomes were weight loss (when overweight –
though surprisingly few patients experienced “unwanted” weight loss), improved
eating habits and improved “feeling of wellbeing”. Though these are not particularly
robust measures, they were important to the patients. There were plenty
of people who could not follow the regime, but at least they had given it a try.’
Dr Darlington (pers. comm., 2005) comments:
‘The diet sheet you quote for the dietary elimination and reintroduction of foods
is at a level of strictness which I used originally, to be a complete purist in our
original research studies.’
The diet
Stage 1
For seven days your diet will be totally restricted to the following:
Trout, salmon, cod either grilled, roasted, hot or cold
Pears (fresh) which can be eaten raw or baked or boiled but with
no additions
Carrots (fresh or frozen) raw or boiled in mineral water
Mineral water still or sparkling spring water (no additions)
Use only sea salt
NB Pear juice can be made by removing the skin from pears and liquidising
them with spring water.
Optional
On the first day of the diet, in the morning, three teaspoons of Epsom salts in half
a pint of warm water may be taken to eliminate previous foods from the bowel. If
constipation occurs later in the seven days, a further dose may be given.
It is vital to the whole investigation that there is absolutely no break in this diet.
A small sip of coffee, for example, in those seven days could completely change the
pattern of response that is crucial for detecting an adverse reaction to a specific food.
As well as restricting your diet, it is very important NOT TO SMOKE.
It is very possible that initially you will feel worse than usual, especially in the
first three days. Keep a comprehensive record of all symptoms you notice on each
day of this restricted diet, for example, headaches, tiredness, dizziness, aching
muscles, catarrh, joint swelling and other such symptoms.
Medications almost always include food substances. Wheat, corn, potato and
yeast are used as base materials or fillers in a wide range of tablets. Try and avoid
using medications for symptom relief or keep the use of these to a minimum.
DO NOT ALTER YOUR MEDICATION FOR ARTHRITIS WITHOUT FIRST
DISCUSSING THIS WITH YOUR CONSULTANT RHEUMATOLOGIST.
Stage II
The first four foods to be assessed in Stage II are broccoli, runner beans (fresh or
frozen), pineapple (fresh) and turkey (fresh). It is worthwhile buying these foods in
advance, so that they are ready for use after your seventh day consultation with
your nutritionist. These foods will be introduced one at a time in the second stage,
followed by many others as the week goes on.
The main aim in stage II is to obtain a list of about 20 foods that do not cause
you to have an adverse reaction. By the end of Stage II you should have a reasonable
range of ‘safe’ foods to eat while you are testing further foodstuffs. These
initial foods have a relatively small risk of producing a reaction – but no food is
completely safe.
A suggested order of introduction is given below. It is advisable to keep rigidly
to this as the order has been arranged for two specific reasons. Firstly to ensure
that the ‘safest’ foods are introduced first and secondly to ensure that new foods are
tested in such a way that members of similar food families are separated by four
days. This avoids the possibility of false-negative responses from cross-reaction
within the food family.
Stage II: list of foods
Broccoli Fresh or frozen
Runner beans Fresh or frozen
Pineapple Fresh
Turkey Fresh or frozen, whole or pieces
Stick to the foods that have been suggested for each day but these foods can be
tested in any order on that particular day. Once a food has been tested and found
to be ‘safe’ it can be included in any subsequent meal. It is a cumulative process
with each meal usually consisting of the new food to be tested plus any foods
already found to be safe.
When testing a food, the most important feature to watch for is the recurrence
of symptoms. Symptoms would normally occur within five hours of eating a sensitive
food. Therefore, if one food is introduced at breakfast time, e.g. 8am and no
adverse response occurs by 1pm, then it is usually safe to introduce another food
at approximately 1pm. Similarly, if no response occurs to the lunchtime food by
6pm, it is usually safe to try a further new food then.
Never introduce two new foods at the same time as it will be impossible to tell
which food is causing an adverse reaction if one does occur.
Symptoms can vary from person to person, e.g. one person may develop a
headache while someone else may have increased joint pain or swelling and others
just might feel lethargic or depressed. Reactions may also vary in intensity. There
is usually little doubt about strong reactions but mild reactions can be difficult to
be certain of. If you are uncertain, a reaction can be confirmed or rejected by retesting
a food at a later stage.
There are two major rules on food testing:
(1) If in doubt about a food reaction leave the food out of the diet.
(2) Never re-test a food in less than five days from the original test.
Important notes: if an adverse reaction does occur and symptoms return, then
no further testing should be done until symptoms clear. To assess whether a food
reaction has occurred or not you must be quite sure about what symptoms occurred
when the new food was tried.
If an adverse reaction does occur then you must restrict yourself to only the
foods that have been tested and found to be ‘safe’ until symptoms clear. This may
take between 1 and 3 days.
Remember to keep a strict food and symptom diary to record what you eat and
if any reactions occur.
Stage III list of foods
Eggs – not fried in oil
Potatoes – not fried in oil
Wheat as wholemeal bread IF yeast test is negative
Use homemade bread or from a bakery in order to reduce the level
of additives. Alternatively, use pure wheat flakes or wholewheat
macaroni (plain and boiled)
You must test wheat at every meal for the next two days
Percolated coffee (coffee beans)
Mushrooms
Cane sugar (demerara)
Oranges Black pepper
Beet sugar (white)
Bacon IF pork test negative
Corn test. Using corn on the cob or glucose powder.
Use at least two dessertspoons of glucose powder or fresh corn on
the cob at every meal for two days
Onion
Natural peanuts (in the shell)
Cheddar cheese (if other dairy test negative)
Spinach
Stage IV: list of foods
White bread IF yeast and wheat tests negative
Garlic
Peas Fresh or frozen (NOT petit pois)
Grapefruit Fresh
Dates Natural (try health food shop)
Cucumber Fresh
Celery Fresh
Cauliflower Fresh or frozen
Rye bread – this is a two-day test. IF the yeast test was positive,
use yeast-free rye based alternative, e.g. Ryvita. If using bread, try
homemade or from a bakery as beforeTuna fish Fresh tuna steak – in most
supermarkets or fishmongers
*Rhubarb
*Honey Natural, clear
*Instant coffee – this is a chemical test. Look for a coffee without
corn added. Do not test if you reacted to ordinary coffee.
Asparagus
Lemon
*Olive oil
Lentils
*Tinned carrots – do not test if you reacted to fresh carrots. This is
a test for the phenolic resin lining of the tin. Check that the tin says
‘no sugar added’
Oats e.g. porridge oats. Take at every meal for two days
*Monosodium glutamate – this is a flavour enhancer used in many
processed foods. Can be obtained from some supermarkets and
Chinese supermarkets. To test, sprinkle on top of some meat.
*Prawns or shrimps
*Brussels sprouts
*Saccharin tablets
*Herrings
*Almonds
Malt extract – at every meal for 1 day (in supermarket or health
food shop)
Avocado pear
Green or red peppers
Raisins
Chocolate – contains wheat, corn and sugar. Do not test if any of
these caused a reaction
Spice mixture
Food items marked with an asterisk* are unrelated to other items and can be
interchanged as long as the spacing between other foods is undisturbed. Food
dyes, emulsifiers and other additives have not been specifically assessed but when
standard foods have been evaluated reactions to such chemicals are usually obvious.
Seasonal fruits such as cherries, plums, apricots, peaches, strawberries, raspberries,
gooseberries and blackcurrants have not been included but should be tested
during their season.
You have at this point assessed more than 60 different food items, which
account for at least 95% of what most people eat.
For help, guidance and support through difficult elimination diets please contact Cynthia Sillars on 07599520406 or email cynthia@healingtouchtherapy.co.uk