The Elimination Diet and Food Challenge Program

Transcription

1 The Elimination Diet and Food Challenge Program Elimination Diet and Food Challenge Program Page 1 of 20

2 The Food Elimination and Challenge Program The purpose of this program is to help you identify hidden food sensitivities that may be causing some or all of your symptoms. During the elimination period, all common sensitivities are completely eliminated from the diet for two to three weeks. After your symptoms improve, foods are added back, one at a time, to determine which foods provoke symptoms. THE ELIMINATION PHASE FOODS YOU MUST AVOID: DAIRY PRODUCTS Milk, cheese, butter, yogurt, sour cream, cottage cheese, whey, casein, sodium caseinate, calcium caseinate, any food containing these. WHEAT Most breads, spaghetti, noodles, pasta, most flour, baked goods, durum semolina, farina, and many gravies, etc. CORN Including any product with corn oil, vegetable oil from an unspecified source, corn syrup, corn sweetener, dextrose, glucose, corn chips, tortillas, popcorn. EGGS Avoid whites and yolks, and any product containing eggs. CITRUS FRUITS Oranges, grapefruits, lemons, limes, tangerines and foods containing citrus. COFFEE, TEA, ALCOHOL You must avoid both caffeinated and decaffeinated coffee, as well as standard (such as Lipton) tea and decaffeinated tea. Herb teas are OK, except those containing citrus. REFINED SUGARS Including table sugar and any foods that contain it; candy, soda, pies, cake, cookies, etc. Other names for sugar include sucrose, glucose, dextrose, corn syrup, corn sweetener, fructose, maltose, and levulose. These must all be avoided. Some patients will be allowed 1-3 teaspoons per day of pure, unprocessed honey, maple syrup or barley malt. This will be decided on an individual basis. Those restricted from all sugars should not eat dried fruit. Others may eat unsulphured (organically grown) dried fruits sparingly. ARTIFICIAL SWEETNERS NutraSweet, Aspartame, saccharine, Sucralose, Acesulfame-K Elimination Diet and Food Challenge Program Page 2 of 20

3 HONEY, MAPLE OR BARLEY SYRUP (1-3 teaspoons per day) Allowed Not allowed FOOD ADDITIVES Including artificial colors, flavors, preservatives, texturing agents, artificial sweeteners, etc. Most diet sodas and other dietetic foods contain artificial ingredients and must be avoided. Grapes, prunes, and raisins that are not organically grown contain sulfites and must be avoided. ANY OTHER FOOD YOU EAT MORE THAN 3 TIMES A WEEK Any food you are now eating 3 times a week or more should be avoided and tested later. KNOWN ALLERGENS Avoid any food you know you are sensitive to, even if it is allowed on this diet. TAP WATER (includes cooking water) Allowed Not allowed If tap water not allowed, use spring or distilled water bottled in glass or heavy plastic. Water bottled in soft (collapsible) plastic containers tends to leach plastic into the water. Some water filtration systems do not take out all potential allergens. Take your water with you, including to work or restaurants. READ LABELS! Hidden allergens are frequently found in packaged foods. "Flour" usually means wheat; "vegetable oil" may mean corn oil; and casein and whey are dairy products. Make sure your vitamins are free of wheat, corn, sugar, citrus, yeast, and artificial colorings. Vary your diet, choosing a wide variety of foods. Do not rely on just a few foods, as you may become sensitive to foods you eat every day! FOODS YOU MAY EAT: CEREALS HOT: Cream of rye, Rice and Shine. DRY: Puffed rice, puffed millet, Oatio's (wheat-free), Good Shepherd (wheat-free), Crispy Brown Rice Cereal. Diluted apple juice with apple slices and nuts go well on cereal. May use rice or nut milk that has no corn oil added (such as some Rice Dream products; please read the ingredients carefully). Also may use almond nut milk. Most of these foods are available in health food stores. Elimination Diet and Food Challenge Program Page 3 of 20

4 GRAINS AND FLOUR PRODUCTS: 100% rice cakes, rice crackers, rye crackers; any 100% rye or spelt bread with no wheat; Oriental noodles, such as 100% buckwheat Soba noodles; rice, potato, buckwheat, and bean flours; rice or millet bread (as long as they do not contain dairy, eggs, sugar, or wheat); cooked whole grains including oats, millet, barley, buckwheat groats (kasha), rice macaroni, spelt (flour and pasta) brown rice, amaranth, quinoa. Most of these grains are available at health food stores. LEGUMES (BEANS) Includes lentils, peas, chickpeas, navy beans, kidney beans, black beans, string beans, and others. Dried beans should be soaked overnight. Pour off the water and rinse before cooking. Canned beans often contain added sugar or other potential allergens. Some cooked beans packaged in glass jars, sold at the health food store, contain no sugar. Read labels. May also use bean dips without sugar, lemon, or additives. Canned soups include split pea and lentil soup (without additives). VEGETABLES Use a wide variety. All vegetables except corn are permitted. PROTEINS For best results, I recommend a whole-foods, plant-based diet during the elimination process. This is because research shows that meat (including fish), dairy, eggs, and all animal proteins decrease the diversity of the microbiome and increase the concentration of Bilophila wadsworthia, a strain of bacteria that leads to increased inflammation in the gastrointestinal tract. For protein, use a pea-based protein powder and beans, nuts, and seeds. NUTS AND SEEDS Nuts and seeds, either raw or roasted without salt or sugar. To prevent rancidity, nuts and seeds should be kept in an airtight container in the refrigerator. May also use nut butters from health food stores or from fresh ground nuts (this includes peanut butter if allowed, almond butter, cashew butter, walnut butter, sesame butter, and sesame tahini). Nut butters go well on celery sticks and crackers. OILS AND FATS Sunflower, safflower, olive, sesame, and flaxseed (edible linseed) oils. Use cold-pressed or expeller-pressed oils (available from health food stores), as they are safer for the heart and blood vessels. Do not use corn oil or "vegetable oil" from an unspecified source, as this is usually corn oil. Sunflower or safflower margarines are OK from a sensitivity standpoint, but we do not consider margarine a desirable food due to the hydrogenated and trans fats. Also suggested are vegetable and bean spreads, instead of butter or margarine. Elimination Diet and Food Challenge Program Page 4 of 20

5 SNACKS Any food can be eaten as a snack. Also suggested are celery, carrot sticks or other vegetables; fruit in moderation (no citrus); unsalted fresh nuts and seeds; Barbara's Granola Bars (from health food stores); wheat-free cookies (check ingredients). BEVERAGES Herb teas (no lemon or orange); spring water in glass bottles or clear plastic, seltzer (salt free); Perrier; pure fruit juices without sugar or additives (dilute 50:50 with water); almond nut milk (Nut Quick); rice milk without corn oil (such as Rice Dream); Cafix, Inka and Roma may be used as coffee substitutes. Tap water contains chlorine, fluoride and other potentially allergenic chemicals. In some cases, distilled or spring water in glass bottles is the only water allowed. This would include water used for cooking. If tap water is eliminated, it should be reintroduced as if it were a test food. Restrictions on the type of water permitted will be made on a case-by-case basis. THICKENERS Rice, millet, barley, or amaranth flours; arrowroot, agar. SPICES AND CONDIMENTS Salt in moderation; herbal spices without preservatives, citrus or sugar; garlic, ginger, onions; catsup and mustard from the health food store (without sugar); wheat-free tamari sauce; Bragg liquid aminos; vitamin C crystals in water as a substitute for lemon juice. MISCELLANEOUS Sugar-free spaghetti sauce; fruit jellies without sugar or citrus; soups such as split pea, lentil, turkey/vegetable, etc. GENERAL SUGGESTIONS: DO NOT RESTRICT YOUR CALORIES! Start with a good breakfast, eat frequently throughout the day, and consume at least 4 glasses of water per day. If you do not eat enough, you may experience symptoms of low blood sugar, such as fatigue, irritability, headache, and too-rapid weight loss. To ensure adequate fiber, eat beans, permitted whole grains, whole fruits and vegetables, homemade vegetable soup, nuts and seeds. Be sure to chew thoroughly, in order to enhance digestion. PLAN YOUR MEALS FOR THE WEEK. Take a list with you to the health food store. If your schedule is very busy and it is hard to think of what to fix, take some time before starting the diet to make a list of all of your favorite types of foods and possible meal plans. For ideas, look through cookbooks that specialize in hypoallergenic diets. Most meals can be modified easily to meet the requirements of the diet, without changing the meal plan for the rest of your family. When you go to the health food store, ask for assistance in locating "allowed" versions of breads, Elimination Diet and Food Challenge Program Page 5 of 20

6 crackers, cereals, muffins, soups, etc. Some people find it helpful to prepare additional foods on the weekend, to cut down on thinking and preparation time during the week. DINING OUT Do not hesitate to ask questions or make requests. WITHDRAWAL SYMPTOMS About one in four patients develops mild "withdrawal" symptoms within a few days after starting the diet. Withdrawal symptoms may include fatigue, irritability, headaches, malaise, or increased hunger. These symptoms generally disappear within 2-5 days and are usually followed by an improvement in your original symptoms. If withdrawal symptoms are too uncomfortable, take buffered vitamin C (calcium ascorbate - 1,000 mg in tablet form or 1/4 teaspoon of the crystals, up to 4 times a day) in water as needed, up to 3 times a day for several days. These products may be obtained from our online dispensary or a health food store. In most cases, withdrawal symptoms are not severe and do not require treatment. It is best to discontinue all of the foods abruptly ("cold turkey"), rather than easing into the diet slowly. The Food Challenge Phase TESTING INDIVIDUAL FOODS It may take 3-4 weeks for symptoms to improve enough to allow you to retest foods. However, you may begin retesting after 2 weeks if you are sure you are feeling better. If you have been on the diet for 4 weeks and feel no better, contact the office for further instructions. Most patients do improve. Some feel so well on the diet that they decide not to test the foods. This could be a mistake. If you wait too long to retest, your sensitivities may "settle down" and you will not be able to provoke your symptoms by food testing. Then, you will not know which foods you are sensitive to. If reintroducing certain foods causes a recurrence of symptoms, you are probably sensitive to those foods. Food sources for testing Test pure sources of a food. Example: do not use pizza to test cheese, because pizza also contains wheat and corn oil. Do not use bread to test wheat, as it contains other ingredients. Organic sources are the best to use for testing, as you will not experience interference from pesticides, hormones or other additives, which may be used in commercial preparations. Test one new food each day. If your main symptom is arthritic pain, test one new food every other day. Sensitivity reactions to test foods usually occur within 10 minutes to 12 hours after ingestion. However, joint pains may be delayed by as much as 48 hours. Eat a relatively large amount of each test food. For instance, on the day to test milk, add a large glass at breakfast, along with any of the other foods on the "permitted" list. If after Elimination Diet and Food Challenge Program Page 6 of 20

7 one serving, your original symptoms come back, or if you develop a headache, bloating, nausea, dizziness, or fatigue, do not eat that food anymore and place it on your "food sensitivity" list. If no symptoms occur, eat the food again for lunch and supper and watch for reactions. Even if the food is well tolerated, do not add it back into your diet until you have finished testing all of the foods. If you do experience a reaction, wait until your symptoms have improved before testing the next food. If you wake up the next morning with head or joint pain, nausea, or any other suspicious symptom, you may be experiencing a delayed reaction to the food you tested the day before. If you are uncertain whether you have reacted to a particular food, remove it from your diet and retest it 4-5 days later. You do not have to test foods you never eat. Do not test foods you already know cause symptoms. Foods may be tested in any order. Begin testing on a day you are feeling well (without colds, unusual headaches, flu). Review the list of symptoms at the bottom of this handout to watch for and keep a journal of how you feel. Dairy tests Test milk and cheese on separate days. You may wish to test several cheeses on different days, since some people are sensitive to one cheese but not another. It is usually not necessary to test yogurt, cottage cheese, or butter separately. Wheat test Wheatena (with no milk or sugar) or another pure wheat cereal. May add rice or nut milk. Corn test Use fresh ears of corn or frozen corn (without sauces or preservatives) Egg test Test the whites and yolks on separate days, using hard-boiled eggs. Citrus test Oranges, grapefruits, lemons, and limes. Test these individually on four separate days. The lemon and lime can be squeezed into water. In the case of orange and grapefruit, use the whole fruit. Test tap water Test your tap water if you have eliminated it, followed by those foods you have restricted (such as foods being consumed more than three times a week). Optional Tests The following foods and beverages are considered undesirable, regardless of whether or not you are sensitive to them. If any of them are not now a part of your diet, or if you are fully committed to eliminating them from your diet, there is no need to test them. However, if you have been consuming any of them regularly, it is a good idea to test them and find Elimination Diet and Food Challenge Program Page 7 of 20

8 out how they affect you. Reactions to these foods and beverages may be severe in some cases. They should be tested only on days that you can afford to feel bad. Coffee and tea tests (separate days) Do not add milk, non-dairy creamer or sugar. May add rice milk. If you use decaffeinated coffee, test it separately. Coffee, tea, decaffeinated coffee, and decaffeinated tea are separate tests. Sugar test Put 4 teaspoons of sugar in a drink or on cereal, or mix with another food. Chocolate test Use 1-2 tablespoons of pure baker's chocolate or Hershey's cocoa powder. Alcohol test (test this last) Beer, wine, and hard liquor may require testing on different days, as the reactions to each may be different. Have 2 drinks per test day, but only if you can afford not to feel well that day and possibly the next day. Food additive test Buy a set of McCormick's or French's food dyes and colors. Put 1/2 teaspoon of each color in a glass: Add one teaspoon of the mixture to a glass of water and drink. If you wish, you may test each color separately. SYMPTOMS THAT MAY BE DUE TO FOOD SENSITIVITY: These are the symptoms you need to be on the look out for when you are going through your food re-introduction/challenge phase of this program: Skin reactions Itching, burning, hives, red spots, sweating, etc. Ear, Nose, Throat Sneezing, runny nose, sore or dry throat, hoarseness, ringing in the ears, dizziness. Eyes Blurring, spots before eyes, watering, pain, twitching, sensitivity to light, redness and swelling of lids. Respiratory Wheezing, mucous formation, shortness of breath, tightness of chest, asthma. Elimination Diet and Food Challenge Program Page 8 of 20

9 Cardiovascular Pounding heart, increased heart rate, flushing, tingling, faintness. Gastrointestinal Increased salivation, canker sores, indigestion, bloating, stomachache, heartburn, colic, constipation, pain, diarrhea, gas, itching or burning of rectum or anus. One may also experience weight gain from a food intolerance. Genitourinary Frequent, urgent or painful urination, inability to control bladder, itching, discharge, pain, water retention. Musculoskeletal Fatigue, weakness, pain, swelling, stiffness of joints, backache. Nervous System Headache, migraine, drowsiness, inability to concentrate, depression, irritability, restlessness, hyperactivity, dizziness, numbness, tremors. Note: most of these disorders have more than one cause, but food sensitivity is a relatively common and frequently overlooked cause. AFTER THE TESTING IS FINISHED IT IS TIME TO RETURN TO THE DOCTOR'S OFFICE FOR A FOLLOW-UP VISIT: When you are within 10 days or so of completing your testing, call the office for an appointment. Bring your journal with you, so you may review your experiences with the doctor. SUGGESTIONS FOR ONGOING SELF-HELP. IF YOU ARE SENSITIVE TO FOODS: Rotation Diets If you eat the same foods every day, you may eventually become sensitive to them. After you have discovered which foods you can eat safely, make an attempt to rotate your diet. A four-day schedule is necessary for some patients, but most people can tolerate foods more frequently than every four days. You may eventually be able to tolerate foods you are sensitive to after you have avoided them for 6-12 months. However, if you continue to eat these foods more frequently than every fourth day, the sensitivity may return. Consume a wide variety of foods. Do not just latch onto a few favorites. If you are rotating foods, be sure to avoid all forms of the food when you are on an "off day. For instance, if you are rotating corn, be sure to avoid corn chips, corn oil, corn sweeteners, etc., except Elimination Diet and Food Challenge Program Page 9 of 20

10 on the days that you are eating corn and corn products. It is not necessary to do strict food rotation during the elimination and retesting periods. Watch for other sensitivity reactions You may be sensitive to foods other than those you have eliminated and tested on this diet. Pay attention to what you are eating and if you develop symptoms, review your recent meals and try to identify what may be different in what you have eaten. You can then eliminate that food for two weeks and test it again, to see if you can provoke the same symptoms. Diet Diaries Please find below a set of diet diaries for you to use during the food elimination phase of this program. Please follow the directions and bring these back to our office when you have completed the food elimination phase. Thanks Elimination Diet and Food Challenge Program Page 10 of 20

11 Diet Diary Instructions Day 1 Wake up: Day 2 Wake up: Day 3 Wake up: Morning Meal Time: Morning Meal Time: Morning Meal Time: NAME: Date Started: Please fill out this diet diary every day for 7 days. Please note the time you get up. Please list and describe all of the food you eat at each meal and snack. Please give the amounts and how it was cooked: raw, baked, fried, grilled etc. Please note the time of each meal and snack. Please note how much water you drink in fluid ounces. Also note any additional beverages you consume that you have not already listed. Please note any exercise you take each day. Note the type of exercise and how long you did it. Please also list any periods of relaxation you did and what kind it was. Lastly, please note the time you went to bed Thanks! Snack: Time: Snack: Time: Snack: Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Snack: Time: Snack: Time: Snack: Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Snack: Time: Snack: Time: Snack: Time: Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Time to bed: Time to bed: Time to bed: Elimination Diet and Food Challenge Program Page 11 of 20

12 Day 4 Wake up: Day 5 Wake up: Day 6 Wake up: Day 7 Wake up: Morning Meal Time: Morning Meal Time: Morning Meal Time: Morning Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Time to bed: Time to bed: Time to bed: Time to bed: Elimination Diet and Food Challenge Program Page 12 of 20

13 Instructions Day 8 Wake up: Day 9 Wake up: Day 10 Wake up: Morning Meal Time: Morning Meal Time: Morning Meal Time: NAME: Date Started: Please fill out this diet diary every day for 7 days. Please note the time you get up. Please list and describe all of the food you eat at each meal and snack. Please give the amounts and how it was cooked: raw, baked, fried, grilled etc. Please note the time of each meal and snack. Please note how much water you drink in fluid ounces. Also note any additional beverages you consume that you have not already listed. Please note any exercise you take each day. Note the type of exercise and how long you did it. Please also list any periods of relaxation you did and what kind it was. Lastly, please note the time you went to bed Thanks! Snack: Time: Snack: Time: Snack: Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Snack: Time: Snack: Time: Snack: Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Snack: Time: Snack: Time: Snack: Time: Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Time to bed: Time to bed: Time to bed: Elimination Diet and Food Challenge Program Page 13 of 20

14 Day 11 Wake up: Day 12 Wake up: Day 13 Wake up: Day 14 Wake up: Morning Meal Time: Morning Meal Time: Morning Meal Time: Morning Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Mid-Day Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Evening Meal Time: Snack: Time: Snack: Time: Snack: Time: Snack: Time: Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Other: Exercise? Relaxation? Time to bed: Time to bed: Time to bed: Time to bed: Elimination Diet and Food Challenge Program Page 14 of 20

15 Food Re-Introduction Symptom Response Chart Name: Date: Day/Date Food Time Food Energy Level Digestion Joints and Muscles Headache or nausea Nasal congestion or wheezing Kidney or bladder function Please be sure to follow the directions in the Food Elimination and Challenge Program handout to make sure this process is done correctly. The Food Elimination and Challenge Program Page 15of 20

16 Fruits q Apples, applesauce q Apricots (fresh) q Bananas q Blackberries q Blueberries q Cantaloupe q Cherries q Coconut q Figs (fresh) q Grapefruit q Huckleberries q Kiwi q Kumquat q Lemon, lime q Loganberries q Mangos q Melons q Mulberries q Nectarines q Papayas q Peaches q Pears q Prunes q Raspberries q Strawberries * All the above fruit can be consumed raw or juiced Beans q All beans except soy q Lentils q Split peas Oils q Almond q Flax Seed q Canola q Olive q Pumpkin q Safflower q Sesame q Sunflower q Walnut Food Elimination Shopping List Vegetables q Artichoke q Asparagus q Avocado q Bamboo shoots q Beets & beet tops q Bok Choy q Broccoflower q Broccoli q Brussels sprouts q Cabbage q Bell peppers q Carrots q Cauliflower q Celery q Chives q Cucumber q Dandelion greens q Eggplant q Endive q Kale q Kohlrabi q Leeks q Lettuce -- red or green leaf & q Chinese Mushroom q Okra q Onions q Pak-Choi q Sea vegetables seaweed, kelp, nori q Parsley q Potato q Snow peas q Spinach q Squash q Sweet potato & yams q Swiss chard q Tomato q Watercress q Zucchini * All the above vegetables can be consumed raw, juiced steamed, sautéed, or baked Breads & Baking q Arrowroot q Baking soda q Rice bran q Gluten free breads q Flours: rice, teff, quinoa, millet, tapioca, amaranth, garbanzo bean, potato, tapioca q Rice flour pancake mix q Mochi Dairy Substitutes q Almond Milk q Rice Milk q Coconut Milk Beverages q Herbal tea (non- caffeinated) q Mineral water q Pure unsweetened fruit or vegetable juices q Spring water Sweeteners q Fruit sweetener (Mystic lake Dairy, or Wax Orchards, or apple juice concentrate) q Agave nectar q Molasses q Rice syrup q Stevia Condiments q Mustard (with apple cider vinegar) q Nutritional yeast Nuts and Seeds q Almonds q Cashews q Flax seeds q Hazelnuts q Pecans q Pistachios q Poppy seeds q Pumpkin seeds q Sesame seeds q Sunflower seeds q Walnuts *All of the above can be consumed as nut butters and spreads The Food Elimination and Challenge Program Page 16 of 20

17 Non-Gluten Grains q Amaranth q Millet q Quinoa q Rice -brown, white, wild q Teff q Buckwheat Cereals & Pasta q Cream of rice q Puffed rice q Puffed millet q Quinoa flakes q Rice pasta q Buckwheat noodles (must make sure they are 100%) q Rice crackers Herbs, Spices & Extracts q Basil q Black pepper q Cinnamon q Cumin q Dandelion q Dill q Dry mustard q Garlic q Ginger q Nutmeg q Oregano q Parsley q Rosemary q Salt-free herbal blends q Sea salt q Tarragon q Thyme q Turmeric q Pure vanilla extract The Food Elimination and Challenge Program Page 17 of 20

18 Food Substitutions and Alternatives for Use in the Food Elimination and Challenge Program Milk To replace Use Rice, almond, coconut, or homemade nut milk (1/2 cup raw nuts or seeds with 1 cup water blended until smooth) Cheese Eggs Peanut butter Breading Rice and almond brands read labels and watch for casein-free brands Ener-G egg replacer; or blend 1 T. flax seeds in blender with 1/4 cup water and allow to thicken Nut butters made from almonds, cashews, macadamia, walnut, pumpkin, hazelnut, sesame (tahini) Grind any allowable rice cracker and use as breading Ice cream Soda Jams Sugar Pasta Rice Dream (vanilla), 100% frozen fruit juice bars(dole and Tazo brands); Cascadian Farms berry sorbets Knudsen, seltzer and juice; water; diluted juice Cascadian Farms all-fruit jams, Sorrel Ridge or Polaner (read label carefully) Fruit juice concentrate (Mystic Lake Dairy or Wax Orchard); brown rice syrup; Stevia Rice noodles (e.g., Mrs. Leepers, Pasta Risio and Food for Life brands), 100% buckwheat udon noodles; cellophane noodles made from bean threads Wheat bread Rice cakes, rice crackers (Trader Joe 's), rice almond and rice pecan breads, Ener-G brown rice or tapioca bread Wheat cereals Perky's nutty rice, Crispy Brown Rice, puffed rice, puffed millet, cream of rice Wheat flour Rice, quinoa, amaranth, millet, teff, arrowroot, tapioca bean; nut and seed flours use in combination with others to replace the full amount of wheat flour Meat Get protein from beans, nuts, and seeds The Food Elimination and Challenge Program Page 18 of 20

19 DAIRY SUBSTITUTIONS/ALTERNATIVES Milk Ice Cream Mayonnaise Cheese Butter Instead of * Make sure all butter substitutes are free of trans fatty acids and hydrogenated oils Yogurt Consider Amasake (rice milk nectar) Rice dream Soymilk White almond beverage Nut milk (almond, cashew) Seed milk Mocha mix Fresh fruit sorbets Fresh or frozen fruit smoothies Juice popsicles, juice ice cubes Tofutti products Home-made "ice cream" Ice bean (soy base) Rice dream Coconut bliss Tofu sour cream Soy yogurt Nut butter Avocado Soymage casein-free cheese Nutritional or brewer's yeast Ground sunflower seeds Almond casein-free cheese Brazil Nut casein-free cheese Homemade nut or seed cheeses Blue bonnet diet Diet imperial Fleischmann's unsalted Mazola salt-free Parkay light Purity Weight watchers' Soy yogurt The Food Elimination and Challenge Program Page 19 of 20

20 Milk/Dairy Free Cooking When a recipe calls for Substitute with 1 cup milk 1/2 cup milk substitute + 1/2 cup water 1/2 cup juice + 1/2 cup water 1 cup water 1 cup milk (for baking) 1 cup soy milk or unsweetened Rice Dream 1 cup milk (for yeast dough) 1 cup real ginger ale 1 cup buttermilk 1/2 cup milk substitute + 1/2 cup water + 1 tablespoon lemon juice The Food Elimination and Challenge Program Page 20 of 20