There are two kinds of elimination diets. The first one eliminates for a period of one week a single food item in order to observe the effect of that elimination. The second one eliminates for one week all the highly allergenic foods. During this period, the child is fed the following hypoallergenic diet which does not contain wheat, eggs, or milk. Bread should be banana rye, potato bread, or Ry-Krisp. The only beverage should be tea with sugar. Olive oil and lamb drippings should be used as fats. The only meat should be lamb. Beets, spinach, and sweet potatoes (all thoroughly cooked with no sauces added), and apricots, cherries, peaches, and prunes (all thoroughly cooked with nothing added except sugar) should be the only vegetables and fruits.

To this diet, one suspected food item can be added each week, and the effect of that addition observed. If the diagnosis is still not conclusive, then the child’s food intake for the next week should be limited to water, sugar, and allergy-free proteins. (Allergy-free proteins are called Amigen by Baxter, Nutramigen by Mead Johnson, Amino Acids by Stuart. Their purpose is to provide healthy nutrition on a restricted diet.) To this restricted allergy-free diet, one suspected food item can be added every two to three days, and the parent can observe how that addition is tolerated.

Provocative Diet

This consists of adding a large quantity of a suspected food item to the regular diet to observe the effect of that addition.

*6/99/5*

A few patients do not get better, even though they are very careful to avoid

gluten. This may be because their gut lining is badly damaged and needs time to repair itself. Zinc deficiency can contribute to this problem, and a zinc supplement may be useful. Continuing symptoms can also be due to lactase deficiency, a consequence of structural damage to the gut lining. Avoiding milk may help in such cases. Soya milk can be used instead, and yoghurt or cheese made from cow, sheep or goat milk can be eaten, but not cottage cheese.

Alternatively, persistent symptoms may be due to some other problem, such as a tumour, or a defective pancreas. More commonly, however, the patient turns out to have sensitivities to other foods, besides wheat. The damage done to the gut lining by coeliac disease makes it much more leaky, so other food molecules get through into the bloodstream, paving the way for food sensitivity. Soya is a common culprit, perhaps because it is so widely used in gluten-free products. Milk, fish, rice and chicken have also been known to cause this problem. They can perpetuate the damaging reactions in the gut lining long after gluten has been eliminated from the diet. In theory, any food might have this effect. An elimination diet should help to track down the offender, but this should only be tried under medical supervision.

*183\180\8*