Dietary Intervention for Chronic Bowel Problems€¦ · diet (elimination or provocation diets), and second diet (interchange of elimination or provocations diets). ... •Better
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Dietary Intervention for Chronic Bowel Problems: The Role of Diagnostic Testing, Special Diets and
• IgG - antibodies produced when a germ attacks in a subsequent invasion and may also be involved in causing food sensitivities.
• IgA - antibody that is involved with protection of the lining of the nasal passages and intestinal lining from germs.
• IgM - usually the first antibody produced by the immune system when a new germ is encountered and is the body’s early defense system.
• IgE - the antibody most widely known for its involvement in allergies of all kinds.
Types of Antibodies
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IgE• Releases histamine• Tested by skin pricks• Anaphylactic shock• Symptoms immediate• Most common allergy
test.• Clinical usefulness
mainly with allergic reactions, hives, sneezing, etc.
IgG• Does not usually release
histamine.• No immediate skin prick
reaction.• No anaphylactic shock• Symptoms may be delayed• Most common sensitivity test• High clinical usefulness for
chronic illnesses, psychiatric diseases.
Differences Between IgE and IgG Food Reactions
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• Gluten (wheat, rye, barley).
• Casein (cow milk, milk products).
• Citrus (orange, lemon, grapefruit).
• Peanuts
• Hen Eggs
• Baking or brewer’s yeast (Saccharomyces cerevisiae).
Most Common Food IgG Immune Sensitivities
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Pathogenesis of Celiac Disease
• Gluten proteins disrupt the epithelial barrier in the lining of the small intestine setting off complex autoimmune (antigen) response.• Results in destruction of surface epithelium and
flattening of mucosa.1
• Develops “leaky gut syndrome.”• Protein called zonulin “unlocks”
intestinal barrier and creates leaky gut, allowing large peptides to cross lining into blood stream.2 Healthy villi – lining the
intestinal mucosa
1 Niewinski, 20082 Center for Celiac Research
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MALABSORPTIONIN CELIAC DISEASE
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The Effect of Gluten Withdrawal on Laboratory
Findings of 90 Patients with Adult Celiac Disease
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Diagnosis
Serologic Tests
Requires inclusion of gluten in diet before testing
Recommended: IgA anti-transglutaminase antibody
Not valid if patient has IgA deficiency
Intestinal Biopsy
Flattened mucosa - used to confirm but many false negatives.
Food trial
Does health improve after + weeks of gluten-free diet?
Gluten then reintroduced to test, and track symptoms
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IgG Sensitivity
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J. Neurol Neurosurg Psychiatry2002;72:560–563
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Neurol Neurosurg Psychiatry2002;72:560–563
Neurological Insult
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Brain of a patient with gluten ataxia showing onset of cerebellar atrophy over a period of 15 months before diagnosis of gluten ataxia.
Neurol Neurosurg Psychiatry
2002;72:560–563
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• Only 1/3 of the patients with neurological disorders associated with gluten sensitivity have villous atrophy on duodenal biopsy - celiac confirmation.
• There are, however, patients where the immunological disorder is primarily directed at the nervous system with little or no damage to the gut.
“Our practice is to offer a gluten-free diet to these patients even if celiac disease test (anti-
transglutaminase antibody) or intestinal biopsy (flattened mucosa) is negative.”
Neurol Neurosurg Psychiatry2002;72:560–563
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• 21 patients diagnosed with migraine and IBS in double-blind, randomized, controlled, cross-over clinical trial composed of baseline (usual diet), first diet (elimination or provocation diets), and second diet (interchange of elimination or provocations diets).
• IgG antibody tests against 270 food allergens revealed mean positive food reactions to be 23.1.
IgG-Based Elimination Diet in Migraine Plus Irritable Bowel Syndrome. Aydinlar EI et al.
Headache. 2013 Mar;53(3):514-25.
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• Compared with baseline levels, elimination diet was associated with significant reductions in attack count (4.8 vs 2.7); maximum attack duration (2.6 vs 1.4 days); mean attack duration (1.8 vs 1.1 days); and maximum attack severity.
• Significant reduction in pain-bloating severity; pain-bloating within the last 10 days, and improvement obtained in quality of life by the elimination diet as compared with provocation diet.
• Findings indicate that food elimination diet based on IgG antibodies in migraine patients who suffer from concomitant IBS may effectively reduce symptoms from both disorders with possible positive impact on the quality of life of the patients as well as potential savings to the health-care system.
IgG-Based Elimination Diet in Migraine Plus Irritable Bowel Syndrome. Aydinlar EI et al.
Headache. 2013 Mar;53(3):514-25.
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• Significant difference of IgG antibodies in serum between CD patients and healthy controls.
• In 84% and 83% of the patients, respectively, IgG antibodies against processed cheese and yeast were detected.
• The daily stool frequency significantly decreased by 11% during a specific diet compared with a sham diet.
• Abdominal pain reduced and general well-being improved on specific diet based on IgG testing.
Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet
intervention study. Bentz S, et al. Digestion. 2010;81(4):252-64.
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Gut 1992 Jul;33(7):909-13 Antibody (IgG, IgA, and IgM) to baker's yeast
(Saccharomyces cerevisiae), yeast mannan, gliadin, ovalbumin and betalactoglobulin in monozygotic twins
with inflammatory bowel disease.Lindberg E, Magnusson KE, Tysk C, Jarnerot G
Department of Medicine, Orebro Medical Center Hospital, Sweden.
• Twins who had developed Crohn's disease displayed higher antibody titres towards yeast cell wall mannan in particular, but also to whole yeast (Saccharomyces cerevisiae) of all antibody types (IgA, IgG, and IgM). • Yeast cell wall material, that is, mannan, or some antigen rich in mannose and cross reacting with mannan, may play an aetiological role in Crohn's disease, but not in ulcerative colitis.
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• Abnormal peptides in both patients with autism and schizophrenia.
• High titers of IgG antibodies to gliadin (wheat) found in 87% of patients with autism and 86% of patients with schizophrenia.
• High titers of IgG antibodies to bovine casein found in 90% of patients with autism and 93% of patients with schizophrenia.
• A gluten and casein free diet caused significant improvement in 81% of patients with autism within 3 months.
R. Cade et al. Autism and schizophrenia: Intestinal disorders. Nutritional Neuroscience 3: 57-72,2000. Depts. of Medicine,
Physiology, Psychology, and Psychiatry, University of Florida, USA.
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Urinary Peptides
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Urinary Peptide –Great Plains Laboratory
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• Clinical Improvements Observed:
• Better bowel function, i.e. less constipation and/or diarrhea.
• Trial Diet: 100% - no infractions and done minimally for at least 3 months. Start with casein 1st for 3 weeks, then start to eliminate gluten.
Gluten and Casein-Free (GFCF)
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Main Point: A1 (beta-casein), A2 (beta-casein), B casein
• A few thousand years ago European dairy cows carrying the A2 beta-casein mutated to A1.
• This change in gene coding switched proline (pro) in A2 to histidine (his) in A1 (B-casein found in Jersey Cows, and is a subtype of A1) :
History of Milk Problems (not lactose, but casein)
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When a peptide is acted upon by digestive enzymes there is a releaseof a morphine-like chemical (aka. casomorphin) that can have opiate activity throughout the body, including the brain and nervous system.
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Childhood Autism Rating Scale (CARS)
Measuring the amount of casomorphin in urine and severity of autism
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1 2 3 4 5 6 7
• Gluteomorphin: tyr-pro-gln-pro-gln-pro-phe
• DPP-IV (Dipeptidyl-peptidase IV) – breaks down peptide chains at the second proline position.
• This leaves: tyr-pro + gln-pro-gln-pro-phe
• PROBLEM: When DPP-IV goes after the next proline segment the amino acid chain byproduct cycles back and inhibits further DPP-IV activity.
• While consuming gluten the activity of DPP-IV can be inhibited – what else does DPP-IV do?
DPP-IV Activity
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Camel Milk Option
Camels milk contains no beta-lactoglobulin and a “new” beta-casein. Therefore, it is not reactive to children with autism and even non-allergenic to for the majority of those
with even the most severe allergy to milk and casein.
• The IgG ELISA food allergy testing method showed consistency both in a split sample on a single day and over the course of a week in the reported results.
• The cell size testing method (ALCAT) generated random results for split samples in both time periods (split sample and over a week).
ALCAT versus IgG Elisa
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ALCAT IgG
Natural Medicine Journal 2(3), March 2010
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• This study calls into question the reliability of blood cell size testing (ALCAT) as a method for identifying food allergies.
• While the sample size was small, these tests are completed for individual patients in a clinical setting and thus, variability must be minimal for the test to be clinically valid.
• IgG food allergy testing was reproducible and reliable in this study.
Conclusions
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• IgG4 antibodies usually represent less than 6% of the total IgG antibodies.
• IgG4 antibodies differ functionally from other IgG subclasses (IgG1, IgG2, IgG3) in their lack of inflammatory activity, which includes a poor ability to induce complement and immune cell activation because of low affinity for C1q (the q fragment of the first component of complement).
Total IgG versus IgG4 testing
Source: Shaw, W. Clinical usefulness of IgG Food allergy testingTownsend Letter, January 2014.
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• IgG4 has become the preferred subclass for immunotherapy in which IgG4 antibodies to antigens are increased to reduce severe antigen reactions mediated by IgE.
• If antigens preferentially react with IgG4 antibodies, the antigens cannot react with IgE antibodies that might cause anaphylaxis or other severe reactions.
• IgG4 antibodies are often termed blocking antibodies
Total IgG versus IgG4 testing
Source: Shaw, W. Clinical usefulness of IgG Food allergy testing Townsend Letter, January 2014.
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• IgG1, IgG2 and IgG3 all are capable of causing inflammation because these antibodies do not exchange heavy and light chains with other antibodies to form bispecific antibodies. Thus, they are more clinically useful.
• IgG1, IgG2, and IgG3 antibodies to food antigens can and do form large immune complexes or lattices that fix complement and increase inflammation in contrast to IgG4 mediated reactions.
Total IgG versus IgG4 testing
Source: Shaw, W. Clinical usefulness of IgG Food allergy testing. Townsend Letter, January 2014.
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Combining Food IgG and Urinary Peptide Tests
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Dairy
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Specific Carbohydrate Diet
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Specific Carbohydrate Diet (SCD)
“The Specific Carbohydrate Diet™ is predicated on the understanding that Ulcerative Colitis, Crohn's
Disease, Irritable Bowel Syndrome (and SIBO), and gluten therapy resistant Celiac are the consequence
of an overgrowth and imbalance of intestinal microbial flora. By altering the nutrition we take in, we can effect the constitution of our intestinal flora, and bring it back into balance, healing our digestive
SCD History • Developed by a Dr. Sydney Haas as an attempt to help children
suffering from Celiac disease, many of whom where dying.
• In the early 50’s, Dr. Haas wrote a book called “Management of Celiac Disease.”
• Dr. Haas’ diet also became useful for sufferers of Chron’s Disease, Ulcerative Colitis (UC), Irritable Bowel Syndrome, diverticulitis, chronic diarrhea, etc.
• Elaine Gottschall, a mother of an 8 year suffering from UC, sought guidance from Dr. Haas who placed her child on his SCD.
• She went on to obtain a post-graduate degree in biology and worked in the areas of nutrition and cell science. She helped to spread the word about the benefits of SCD.
• Her first self-published book was “Food and the Gut Reaction.”
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Diet Used Primarily To Help Inflammatory Bowel Diseases and Pathogen Overgrowth Disorders
• Overgrowth of intestinal flora, particularly in the small intestine, leads to toxic byproducts, i.e. methane, hydrogen, carbon dioxide, lactic acid through fermentation causing mucosal damage.
• Neurochemical influences can occur from these byproducts, i.e. lactic acid.
• Imbalance leads to worsening microbial overgrowth
• Brush border and microvilli function are compromised
• Enzyme function is compromised
• Digestive nutrient absorption is compromised
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The Diet
• The SCD is based on the principle that selective carbohydrates (monosaccharides) require minimal digestion and absorption leaving less available for bacteria and yeast fermentation.
• Looks to eliminate all complex starches (disaccharides) which comprise two sugars. Ex: sucrose, lactose, and maltose:• Sucrose – a combination of glucose and fructose. Found as
various forms of sugar commonly used in processed foods.
• Lactose – milk sugar as a combination of galactose and glucose
• Maltose – combination of two glucose molecules. It is produced when amylase breaks down starch, i.e. barley. Maltose is found in may sweetened beverages, beer, cereal, pasta, potatoes and in many processed products.
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The Diet (continued)
• The SCD diet relies heavily on specially home prepared yogurt that is fermented for at least 24 hours.
• This fermentation allows for lactose (disaccharide) to breakdown into galactose (monosaccharide).
• In Autism, because of the extensive problems with dairy, cow derived yogurt is discouraged for at least the first 12 months of the SCD diet. • Only dairy product allowed is Ghee (which does not include
lactose or casein).
• Goat yogurt advocated instead
Specific dietary recommendations for autism are found at www.pecanbread.com.
• Main website for Specific Carbohydrate Diet for individuals with inflammatory bowel disease, irritable bowel, SIBO, Celiac, and other chronic digestive problems –www.breakingtheviciouscycle.com
Pecan Bread:
• Main website for children, including autism-spectrum kids - www.pecanbread.com
General supplements recommended for the GAPS diet:
1. Therapeutic strength probiotic (at least 8 billion organisms per gram) – GAPS primarily promotes Bio-Kult probiotic.
2. Digestive enzymes – primarily with Betaine HCL. 1. With children need to be cautious if cannot swallow capsule or tablet
2. Can use combination enzymes: protease, lipase, and sucrase
3. Essential fatty acids1. Omega-3/omega-6
2. Cod Liver Oil – to supply vitamin A, vitamin D, EPA, and DHA
4. Vitamin A – in the form of Cod Liver Oil is recommended
5. Vitamin & mineral supplement – try to keep supplements to a minimum, but multivitamin/minerals okay to use.
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Starter Packets
www.nbnus.com
Package contains approximately 2 to 3 month supply
• Spectrum-mate ‘powder’ – 1 scoop or teaspoon (adults or kids > 4 years of age). Less than 4 years of age – ¼ to ½ scoop or teaspoon daily.
• Cod liver oil – one teaspoon daily to start.
• Calcium chewable w/magnesium – 1 to 4 tablets daily (children > 8 years to adults – 4 tablets, children greater than 1 year of age to 7 years – 3 tablets daily).
Package contains approximately 2 to 3 month supply
• Spectrum-mate ‘capsules’ – 6 capsules daily (adults or kids > 4 years of age). Less than 4 years old use 1 to 3 capsules daily.
• Cod liver oil – one teaspoon daily to start.
• Calcium chewable w/magnesium – 1 to 4 tablets daily (children > 8 years to adults – 4 tablets, children greater than 1 year of age to 7 years – 3 tablets daily).
• Salicylates are a group of chemicals related to aspirin
• They occur naturally in plants for protection against disease, and act as natural pesticides.
• There are many varieties of salicylates:• Acetylsalicylate
• acetylsalicylic acid
• Ethyl Salicylate
• Isooctyl salicylate
• Methyl Salicylate
• Monosodium salicylate
• Octyl Salicylate
• Phenyl Salicylate
• Salicylic Acid
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Phenyl Salicylate
Phenol
Carboxyl Group
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The Challenge In Avoiding Salicylates
• There are many varieties and don’t always know which ones will cause problems.
• Amount of salicylates can vary among different fruits or vegetables, and which part of the plant is being used (seeds, pulp, peel).
• Levels can change in plants from season to season, and region in which it grows.
• Organic fruits and vegetables may contain more natural salicylates.
• Cooking can change salicylate levels
• Tolerance to salicylates in food can change overtime with avoidance.
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What About Phenols?
• Class of chemical compounds where a hydroxyl group (-OH) is bonded directly to an aromatic hydrocarbon.
• Can be produced industrially
• Can be produced naturally from plants and microorganisms.
• Estrogen, Serotonin, Dopamine are phenols.
• L-Tyrosine is a phenol
Benzene Quercetin
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Structure of 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA)
HO
CHOHCH2COOH123
1
23
4
5 6
Phenyl group
Hydroxyl group
Propionic acid
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Structure of 4-cresol (methylphenol)
HOCH31
2
3
4
5 6
Phenyl group
Hydroxyl group
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Structure of aminophenol - major acetaminophen metabolite
HO1
2
3
4
5 6
Phenyl group
Hydroxyl group
NH2
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Phenol-Sulfur-Transferase (PST)• PST is necessary to oxidize sulfur compounds, i.e. foods with
phenols, salicylate, amines, including various hormones (estrogens) and neurochemicals (serotonin, norepinephrine).
• Inadequate function of PST allows for sulfur compounds to build-up in the body leading to a host of physical problems such as sleeping difficulties, night sweating, excessive thirst, reddened ear, facial flushing, etc. Mental problems happen too.
• Autism – is often found to have low serum sulfate and high urine sulfate.• Generally, inadequate sulfate available for optimal PST activity
• Low phenol diets can help take pressure off of the PST system
• Also, nutrients such as vitamin C, N-acetyl-cysteine (NAC) and glutathione can aide in phenol metabolism.
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Some Remedies To Help With Phenol Sensitivity
• Molybdenum – 50mcg to 100mcg daily
• No-Fenol Enzyme – 1 capsule with phenolic food or meals.
• Epsom Salt creams and baths
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Epsom Salt (magnesium sulfate)
Cream Bath
• 1 to 2 cups of epsom salts in bathwater.
• Soak in bathwater for at least 15 to 20 minutes.
• Can do once to twice daily.
• 3 to 7 days per weekApply 1 or more grams to skin 2 to
3 times daily.
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Failsafe Diet• Free of Additives, Low in Salicylates, Amines, and Flavor
Enhancers.
• Term coined by Sue Dengate (from the Food Intolerance Network in the United Kingdom) for the comprehensive low chemical and low reactive food exclusion program from the Royal Prince Alfred Hospital in Sydney, Australia.
• The Failsafe diet is designed to treat intolerances and sensitivities to chemicals in foods – not allergies.
• Diet has been around since the early 80’s, but not well known outside Australia.
• Considered to be a more advanced diet than the traditional Feingold Diet, which Failsafe advocates consider to be incomplete and outdated.
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What Is Eliminated Through The Failsafe Diet?
• Approximately fifty artificial food additives including colors (like tartrazine, sunset yellow), flavors, preservatives and antioxidants (sulphites, nitrates, benzoates, sorbates, parabens).
• Salicylates (aspirin) and polyphenols (natural flavors, colors and preservatives) found in a wide range of fruits and vegetables.
• Neurotransmitters in food: free glutamates (MSG) and amines(histamine, serotonin, dopamine, phenylethylamine, tyramine and others) found in aged proteins and fermented foods like cheese, chocolate, game, and hung meat.
• Aromatic (strong smelling and tasting) chemicals found in perfumes, cleaning products, commercial cosmetics, and scented and colored toiletries, especially mint and menthol products.
• Some pharmaceutical drugs, including aspirin, NSAIDS and other COX II inhibitors including ibuprofen, and the methyl-salicylates found in decongestants and anti-inflammatory creams.
Common Problems Observed In Individuals With Chemical Sensitivities
• Dark circles under eyes, red cheeks and ears.
• ear infections, asthma, sinus problems.
• Diarrhea and digestive discomfort.
• hyperactivity, impulsivity, and aggression.
• Inappropriate laughter
• Bed wetting and day wetting
• Dyslexia
• Hives
• Headaches, head banging/self-injury.
• Impatience, short attention span.
• Difficulty falling asleep, night walking for several hours, inappropriate.
• Sensitivity to noise/lights/touch.
• Speech difficulties, tics and some forms of seizures.
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Failsafe Diet - basics
• Diet is mainly composed of fresh (non-vacuumed packed or hung meat), chicken, white fish, eggs, fresh dairy products (if tolerated, such as yogurt, cottage cheese, milk, and butter), some grains (if tolerated), peeled potatoes, beans and legumes, peeled pears, certain green vegetables.
• Heavy flavors, additives, exotic fruits, vegetables, and spices are not allowed.
• Failsafe Diet is an elimination/challenge test.
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Failsafe Diet - basics
• Diet must be treated as a scientific experiment
• The diet must be followed strictly. If not followed directly as outlined by the Failsafe program –www.failsafediet.com, inconsistent results will be seen.
• Generally, it takes 2 to 4 weeks for results to be seen, sometimes upwards of 3 months may be needed.
• Once an individual is feeling well on the diet, or a parent notices positive physical and/or behavioral changes with their child they can begin the challenge phase of the diet.
• This involves testing each food or chemical individually
GFCF (Gluten-free and Casein-free)No gluten (wheat, rye, barley, spelt, kamut, and oats) or casein (dairy).
Food Sensitivity Elimination/RotationEliminating all other food sensitivities: Soy, corn, eggs, citrus, peanuts, chocolate, cane sugar.
SCD (Specific Carbohydrate Diet)/GAPSRestricts carbohydrates to only fruits, non-starchy vegetables, and honey. No grains, starchy vegetables, or mucilaginous fiber
Paleo/Primal BlueprintMeat, fruit, vegetables, fat and nuts. No grains or beans. Often removes potatoes and dairy too.
Low Oxalate DietRestricts high oxalate foods (nuts, beans, greens).
Low FODMAPS DietLow in fermentable, poorly absorbed carbs such as fructose, lactose and FOS.
Body Ecology Diet & other Yeast DietsAnti-yeast diet combining principles of anti-yeast diets including no sugar, acid/alkaline, fermented foods.
Feingold/FAILSAFE DietsRestricts high phenolic foods, including all artificial ingredients and high salicylate fruits (and more).
Weston A Price Dietary Principles: Solid nutrition foundation for everyone
Can dramatically help improve behavior and many systems of the body when phenols are an issue (sulfation and methylation): irritability, aggression, skin, respiratory
Removes many healthy, high antioxidant foods.If diet not needed, it can overly restrict important nutrients.
Failsafe Can help migrainesGood for those with MSG reactions.
Very restrictive when removing salicylates, amines and glutamates.
Low Oxalate Oxalates inhibit mineral absorption, minimizing them helps mineral statusMay help people with digestive/microbiome, mitochondrial issues.
Must remove oxalates slowly over time.Reactions can seem confusing –with new implementation often worse before better.