Rotation Diet: A Diagnostic and Therapeutic Tool

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Chapter 46 Rotation Diet

A Diagnostic and Therapeutic Tool

Sally J. Rockwell, CNN, PhD

Chapter Contents

Introduction

The Elimination Diet

Variations of the Elimination Diet, 
Procedure, 

The Diversified Rotation Diet

Using the Master Charts, 
Modifications for Vegans, 
Food Preparation, 
Helpful Hints and Suggestions, 

Contact the author at PO Box 60266, Shoreline, WA 98160; email: SR@DrSallyRockwell.com; website: www.DrSallyRockwell.com.

imageIntroduction

Food allergy and/or intolerance is a common component of many chronic diseases (see Chapter 53). However, it is not readily recognized as problematic. Conventional laboratory diagnosis is not geared for testing food allergies, and most allergists dismiss the concept of delayed hypersensitivity reactions to foods (see Chapter 15). A time-honored, effective approach to both diagnosis and treatment of food sensitivities is an elimination–rotation diet. This approach has the advantage of being low cost, and the techniques must be followed assiduously to ensure clinical efficacy. Box 46-1 lists the typical indications for an elimination diet.

BOX 46-1 Indications for the Use of the Elimination Diet

• Documented or suspected food allergies and/or intolerances

• Chronic complaints that have not subsided with treatment

• Patients who have symptoms and whose tests results are all “normal”

• Patients in whom mental health problems are suspected because of lack of significant progress

• Children and teens who are labeled as having attention deficit disorder or as being hyperactive, autistic, or who have behavior problems

imageThe Elimination Diet

The first step in the elimination diet is to remove from the diet (1) all of the most common allergenic foods—i.e., wheat and other glutinous grains, dairy products, eggs, corn, soy and tofu, peanuts, citrus fruits, yeast, and refined sugars—and (2) other often problematic substances, such as highly processed foods, chemicals, additives, preservatives, artificial colorings, flavorings, caffeine (coffee, tea, cola drinks, chocolate), and alcohol.

The object is to avoid intake of all suspect foods and substances for at least 5 days, or long enough to clear all traces of those foods from the digestive tract. The omitted foods are then reintroduced into the diet one at a time. Keeping an accurate food and symptom diary enables the offending foods to be identified and eliminated; depending on the severity of the initial test response, the foods can be carefully reintroduced into the diet within 3 to 6 months.

Although some authorities recommend eliminating only one food at a time, clinicians in this area have found that multiple allergies are the rule, not the exception. Eliminating only one allergen may not clear symptoms well enough to notice improvement. The advantages of eliminating all major allergens in the beginning are rapid clearing, minimal adverse reactions, and accurate test results. Also, when symptoms clear rapidly, the patient becomes inspired and eager to continue with the testing.

As Dr. Doris Rapp1 explained:

If there are several tacks in the bottom of a shoe, the whole foot hurts; removing only one tack will make little or no difference. But remove all the tacks, let the foot heal, then add back one tack at a time and the source of pain is isolated and easily identified. If only one tack (or food) is removed, no significant difference will be noted.

Variations of the elimination diet range from the most stringent plan, involving elimination of all the major allergens, refined foods, and toxic substances, to a more lenient approach, which eliminates only wheat, dairy, and refined sugars. Consideration of the patient’s lifestyle, age, weight, general health, food preferences, attitude, and family system determines the approach. For children and pregnant or lactating women, the amount of calories or carbohydrates should not be restricted; one should simply omit the major allergens.

Variations of the Elimination Diet

As can be seen in Table 46-1, all elimination and/or challenge diets are variations of this four “Rs” procedure:

1. Remove suspect foods for at least 5 days.

2. Reintroduce and/or test by challenge ingestion.

3. Record reactions.

4. Rotate foods, avoiding those shown to cause adverse reactions.

TABLE 46-1 Elimination Diet Variants

Type Protocol
Water fast Water-only fast for 5 days; reintroduction of foods
Dilute juice fast Diluted fruit juice fast for 5 days; reintroduction of omitted foods
Fruit, melon, and vegetable plan Only fruits, melons, and vegetables for 5 days; reintroduction of omitted foods
Caveman (caveperson) plan Proteins, nuts, seeds, legumes, fruits, and vegetables for 5 days; reintroduction of omitted foods
Only natural, unprocessed foods are eaten

Water Fast

Water fast should be implemented only under the close guidance of an experienced health professional. A lifetime of accumulated toxins may be released in a short time, creating unwarranted discomfort and complications that may overwhelm the patient and interfere with testing (see Chapter 37 for a complete description of fasting methodologies).

The Dilute Juice Fast

Less severe than water fasting, and more acceptable to patients, is the dilute juice fast. Diluted juices provide a modest amount of calories, stabilize blood glucose levels, and decrease the adverse detoxification–withdrawal reactions that may occur during elimination of all common allergens. The basic procedure is to use three parts of distilled or mineral water to one part of fresh, sugar-free juice. The diluted juices are sipped throughout the day. Ideally, a different juice is used each day: celery, carrot, papaya, cranberry, berry, apple, pineapple, and other fruits or vegetables that have not been consumed on a daily basis. Citrus fruits should be avoided. Low-allergen protein supplements, such as Ultra Clear, MEDIPRO Protein Powder, pure free-form amino acids, N Foods, and Vivonex, may be added after the third day. In addition, liberal amounts of pure water should be consumed throughout the day to dilute and flush out toxic substances.

Note: This approach works for most patients with Candida yeast infections, because the juice is so dilute that it rarely creates a problem. However, commercially prepared juices (especially tomato and citrus juice) often contain molds, which can be problematic.

Fruit and/or Vegetable Plan

In the fruit and/or vegetable plan, the patient consumes unlimited amounts of clean fresh fruit and melons and raw, steamed, or baked vegetables throughout the day. If Candida overgrowth is severe, or if weight loss is desired, vegetables should be emphasized and fruits limited.

The Caveman (Caveperson) Plan

The caveperson plan consists of the following basic foods that the caveperson consumed, after the major allergenic foods have been eliminated: vegetables, fruits, berries, honey, nuts, seeds, beans, peas, sprouts, roots, gourds, poultry, fish, seafood, and wild game.

Procedure

Beginning the Elimination Diet

An ideal elimination diet begins as follows:

1. Two days of diluted juices

2. Fruits and vegetables for the next 2 days

3. The caveperson diet for 2 days or until symptoms clear

Any one, or any combination, of the previously described elimination plans will clear the patient of allergenic substances. If after 5 days the patient’s symptoms have not diminished (or disappeared), continue the diet for another 5 days. If symptoms are not clear in 10 days, begin to rotate foods, because the patient may be reacting to a food or substance he or she is consuming every day. (Unsuspected environmental allergens may be contributing to the symptoms also; see “Helpful Hints and Suggestions” later in this chapter.)

Testing by Challenge Ingestion

One suspect food is introduced every other day. The object is to give the patient sufficient calories, build a reliable list of safe foods, and delay unpleasant reactions for as long as possible. Challenge should begin with rarely ingested foods that are least likely to cause adverse reactions. Foods that are known to cause severe reactions should not be tested with challenge.

Suggested Testing Sequence

Introduce foods back into the diet in the following order whenever possible: vegetables, fruits, melons, beans, nuts and seeds, yeasts, dairy products, and, finally, grains. When dairy is added, goat products should be tested first: plain yogurt, cheeses, and then milk. Follow the same process with cow’s milk. Grains are best tested in the following order: quinoa, amaranth, buckwheat, wild rice, brown rice, millet, barley, spelt, kamut, teff, oats, rye, corn, and, lastly, wheat (gluten-containing grains are in italics). Dietary supplements should also be tested one at a time.

Food and Symptom Diary

The patient records, chronologically in a notebook, all foods, liquids, supplements, moods, symptoms, and reactions. The foods eaten throughout the day should be noted in either pencil or blue or black ink. Symptoms are highlighted or circled in colored ink so that those adverse reactions stand out clearly. In 2 to 3 weeks, a repetitive pattern of symptoms will be clearly visible, allowing for identification and elimination of the problematic foods or food combinations that cause symptoms.

In the beginning, a patient may not be able to describe in exact words how he or she feels, so a numbering system may be useful for noting general moods throughout the day. Numbers go from 1 (poor) to 10 (excellent); feeling sort of medium, neither poor nor excellent, would be recorded as a 5. In general, depending on the patient’s health and motivation, foods causing a mild reaction should be avoided for 3 months, and those causing a severe reaction are best avoided for at least 6 months before being reintroduced.

Testing Children

Play a game with children to make testing fun. Have them draw a picture of how they feel, or write their names before and after testing a substance. Note all before and after differences in the drawings or writings.

imageThe Diversified Rotation Diet

The basic concept of the diversified rotation diet is to achieve the following:

• Eliminate all major allergenic substances

• Eat the remaining foods once every 4 days

• Allow 2 to 4 days between food families

Rotation can be simplified by using a template—the “master chart”—with foods correctly arranged according to their botanical family classifications. The spacing of the foods and food families are organized into four columns, one for each day, so the patient simply chooses foods from the appropriate column each day. A color-coding system further simplifies the process of choosing the correct foods.

See Appendix 10 for an easy-to-follow template. The chart provides 4 days between specific foods and 2 days between food families. A second chart (Master Chart II) may be needed for severely sensitive individuals. It provides 4 days between specific foods and 4 days between food families. If necessary, it can be easily adapted to a 7-day rotation.

Using the Master Charts

The clinician uses a pencil to cross out the major allergens, plus any known or suspected problem foods, in each of the four columns. The patient may eat the remaining foods from the appropriate column throughout the day. The foods that are not crossed out are allowed in the diet.

Arrows on the chart (↔) indicate a food that is essentially the only food of a family and that is not cross-reactive with other foods. Therefore, it is not restricted to any one particular day and can be moved to another column if additional food choices are needed.

Patients who will be rotating foods for any length of time will welcome the benefits of using the color-coding system. A color is assigned to each day. Each column represents a day: day 1, green, is column 1; day 2, yellow, column 2; day 3, blue, column 3; and day 4, red, column 4. After day 4, the patient returns to day 1 and repeats the process. Food containers are labeled and color-coded to coordinate with the color of the day; for example, green labels, twist-ties, or rubber bands are placed on all containers of foods for day 1. The color-coding system enables the entire family to see at a glance which foods the patient is permitted to eat on each day.

Modifications for Vegans

The master charts can be used for vegans. Simply cross out all foods of animal origin. Legumes (beans and peas) are generally an important part of the vegan diet, thus all legumes should be tested, one at a time, beginning with the least allergenic, rarely eaten beans and proceeding to soy and tofu, with peanuts tested last. Depending on the allergic response to legumes, the patient may be able to tolerate legumes daily, as long as he or she eats a different legume each day. In other words, although the 4-days-between-foods rule continues to be honored, the 1-day-between-food-families rule may be ignored for less-sensitive patients.

Food Preparation

For testing purposes, fresh, organic foods should be used whenever possible. Otherwise, frozen or dehydrated foods are a better choice than canned goods. Most vegetables are best eaten raw, steamed, or baked. Fish, poultry, and meat are best poached, steamed, sautéed, baked, or simmered in a slow cooker (e.g., crock-pot). Soups and stews are fine. Use only sea salt for seasoning; all spices and flavorings must be avoided unless they are individually tested.

Blood glucose levels may need to be stabilized with small, frequent meals throughout the day. Have the patient prepare four mixtures of “trail mix”—nuts and dried fruits—one for each day (refer to the master chart for specific food choices). A supply of healthy snacks must be maintained everywhere: home, school, office, and automobile.

Helpful Hints and Suggestions

Control of Withdrawal Symptoms and Allergenic Reactions

Vitamin C buffered with calcium, potassium, and/or magnesium is suggested as the daily source of vitamin C for allergenic individuals. These substances help to balance an acidic body pH and are valuable for neutralizing unpleasant allergic reactions. Stabilization of pH eases the symptoms of withdrawal from allergenic foods and the cravings that occur when the patient is breaking an addiction, whether it is to sugar, wheat, coffee, cigarettes, alcohol, or a drug.

For daily supplementation: begin with 1/8 teaspoon of buffered vitamin C powder (or one 500 mg capsule) in 1/2 cup of water three times a day (between meals and at bedtime). Gradually increase the dosage by an additional 1/8 teaspoon (1 capsule) per dose every 2 days until the patient reaches bowel tolerance—loose stool, gas, or diarrhea—at which point the dosage is reduced. As the patient improves, the vitamin C requirement will likely lessen, and the dosage can be reduced again.

Note: Buffered vitamin C should not be taken with meals, since it may neutralize stomach acid, which is commonly deficient in patients with food allergy and/or intolerance (see Chapter 53).

For temporary relief of symptoms or to neutralize an adverse reaction, the patient should mix and drink 1/2 teaspoon of buffered vitamin C in 1/2 cup of water or dilute juice. Available commercial products include Klaire Labs Bi-carbs (see www.klaire labs.com), Cardiovascular Lab’s Tri-salts (see www.cardiovascularlabs.com), and Alka Seltzer Gold label (not the blue label, see www.alkaseltzer.com); if none of these products is available, 1/2 teaspoon of baking soda in 1/2 cup of water can be useful.

Environmental Allergies

If the patient does not respond to the diet in a timely fashion, and all other possibilities have been ruled out, the clinician should suspect environmental and/or chemical sensitivities. The first step in this instance is to eliminate use of all scented toiletries, room sprays, and cleaning solutions in the home and workplace.

Ensuring Adequate Protein Intake

The most allergenic foods tend to be those highest in protein, thus, care must be taken to ensure that the patient is consuming adequate amounts of protein. Patients with multiple food allergies may need to be referred to an experienced nutritionist to develop a balanced diet.

Patience

The clinician must be especially supportive and patient with individuals who have been in only long-term conventional treatment. You may be the first physician to discuss the rewards of listening to their bodies, and explain how symptoms are the body’s way of communicating. Learning to pay attention to what they eat and drink and the possible adverse symptoms is a vital part of getting well again.

Reference

1. Rapp D. The impossible child in school, at home, 2nd ed., Buffalo, NY: Practical Allergy Research Foundation, 1989.

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