Dec 18, 2012

A Low-Sulphur Elimination Diet

Of all the inflammation problems I have had, my dermatitis is always the first to appear if I eat something inflammatory. I can begin to diagnose the problem by following my low-sulphur elimination diet. The term "elimination" refers to eliminating from the diet all foods that are known or suspected to cause inflammation. The few foods remaining are the Elimination Diet.

RATIONALE FOR A LOW-SULPHUR DIET AS A TEST. Why are the foods on my Elimination Diet low sulphur? Because, for me, the concentration of sulphur in a food is the best predictor of whether I will get an inflammation reaction. (I do not know whether sulphur is the cause of the inflammation or whether it is a "confounder," that is, something that is always present when the real cause is present.)

Example foods that are very high in sulphur are mustard and clams. All animal products, except isolated fats, are high in sulphur. Almost all nuts, beans, peas, and grains are high in sulphur. (There are exceptions.) Example foods that are very low in sulphur are yams, celery, and many fruits.

PROCEDURE. If I follow the low-sulphur elimination diet, with perfect compliance, for one to two weeks and see some improvement, then I suspect that I have eliminated something that was causing the problem. I can then begin the long process of adding eliminated foods back into my diet. 

The standard reintroduction test is to add one serving of the suspect food (for example, asparagus) per meal for six meals in a row (two days). If I start on Monday morning at breakfast, the reintroduction will be completed with the evening meal on Tuesday, and then I eat only the elimination diet foods while waiting for a reaction, if any. If there is no reaction by Sunday, then on Monday I will test the next food.

Even if no inflammation reaction appears after testing a food, it is important to wait the five days (Wednesday-Sunday) between tests— to give the body time to dispose of the test food and its effects.

GUIDE TO SULPHUR IN FOODS. I have not been able to find a recent, comprehensive list of foods ranked by their sulphur content (milligrams of sulphur in each 100 gram serving). The guide I am using is this old document, "The Sulphur Content of Foods," by Margery Masters and Robert Alexander McCance, now on pdf: 

So far, it has confirmed my earlier tests and worked perfectly as a predictor.

ALLOWED FOODS. To follow this diagnostic diet, I eat foods from the following list and no other foods, not even seasonings. All the listed foods are rated at less than 25 milligrams/100 gram serving. Numbers in parentheses are the amounts of sulphur, in mg/100 g serving. All the foods listed below should be either organic or pure (no additives of any kind, especially no sulphur-based preservatives). To save money, I buy pure foods, either frozen, fresh, or canned (in water or juice) and generally avoid organics, which are very expensive. (Fruits canned in syrup can be washed.)

In my personal Elimination Diet list, I have excluded some low-sulphur foods that have a reputation for causing inflammation problems in some individuals. Citrus fruits (grapefruit, oranges, and so forth) are examples, though I am not certain about them. I have included "nightshades" (eggplants, tomatoes, and potatoes). They cause no problems for me; but some other individuals report getting a reaction from them. If you are unsure of your reaction to citrus fruits and nightshades, then you might start by excluding them. You can use them as test foods, introducing one per week back into your diet. Be cautious about generalizing. I have a strong adverse reaction to grapefruit, but no reaction to lemons.

AMBIGUOUS RESULTS. In testing a food, you might get an ambiguous result. You might not be sure whether you are experiencing an inflammation reaction. My suggestion is to set that food aside. Test it again months later, and test it with a higher dose—for example, two servings per meal for six meals in a row.

ALLOWED FOODS. The following foods are the foods I know to be safe for me. They do not cause inflammation problems in my skin. I eat something from each of the first three categories at every meal.

1. STARCHES: celery root (9 mg/100 g); pumpkin, canned, pure (10); winter squash, such as acorn, fresh or in frozen blocks, pure (10); sweet potatoes (15); yams (15); parsnips (15); and Russet, red, or gold potatoes (boiled, peeled at dinner table, 23).

2. VEGETABLES: carrots (9 mg/100 g); beans, green ("French" or "string," 9); celery (9); eggplant (9); cucumber (11); artichoke hearts (16); beets (22).

3. FRUIT (including "salad fruit"); pineapple (3 mg/100 g); apples (4); plums (5); pears (5); peaches (6); apricots (6); cherries (7); honeydew and other melons (7-12); grapes (9); nectarines (10); tomatoes (10); blackberries (13); bananas (13); figs, green (13); strawberries (14); raspberries (18); prunes (19).

4. FLAVORINGS: honey (1); white cane sugar (14); vinegar (19); salt (23-35?).

Suggestion: If you want to be extra cautious, you might start with foods that are rated at 15 mg/serving or less, which would include yams and parsnips.

Burgess Laughlin


Dan P said...

I have been following a gluten free mcdougall diet and have recently looked at your approach. I knew something was wrong when I started feeling worse ( muscle/joint pain, dermatitis) after having a large bowl of oatmeal and some pieces of gluten free bread every morning, as well as a natural granola for staple snack. The pral system made sense to this acid overload.
Question: I want to maintain a bmi 20 or higher, I know you have mentioned problems with weight loss and have experiment with increasing fats. Could you just increase total servings of current food per meal (starch) and maintain higher weight? Do you think the percentage of fat in a anti_itis diet is too low for any reason (nutrient absorption, dry skin, etc.)?

Burgess Laughlin said...

1. PRAL AND SULPHUR. Potential Renal Acid Load was an effective way for me to build a diet. For me, it wasn't a perfect predictor of getting an inflammation reaction but it was effective.

The only PRAL list that I found to be reliable, because it was apparently conducted through actual lab tests, is the one I link to here:

I am repeating this information above in case someone new to the idea is confused.

2. MAINTAINING HEALTHY WEIGHT. According to nutritionist Jeff Novick, a healthy BMI for men is in the 18-19 range. Of course, if a man has developed large muscles, he will have a higher BMI and still be relatively healthy.

I cannot eat any more than I do now. I simply do not have room in my stomach. (I do not, however, eat between meals, for simplicity, but eating between meals might be a way to increase input.) Also, I have found that eating more non-grain starches makes me lose weight not increase it.

The only way I know to increase my BMI is to add fat: olives, avocados, and coconut milk are candidates. I seem to get a reaction resembling low blood sugar when I eat half an avocado at each meal, so I avoid avocados now, but the other two are possibilities.

Yes, I suspect the percentage of fat in the anti-itis diet that I have developed for myself -- in the recent, low-sulphur version may simply be too low fat for some individuals because it might cause so much fat loss that one has no reserves. I have not had any other problems however.

The solution is simple: Add a few sources of fat from whole foods. Experimenting is the only way to find out the effects.

I don't see any problem in raising the fat level with olives, avocados, and coconut milk (in small quantity), along with adding a little sugar in some form. Of course, each individual must make selections appropriate for him.

Pam said...

I am a 60 year old recently retired nurse. I have been a McDougaller for 20 years. I was recently diagnosed with iritis in my left eye. I knew immediately a trigger was all the potatoes I consume. I mean consumed, for I have stopped eating them. I eliminated the potatoes in hopes I would not need an ED. my doctor placed me on oral and eye drop steroids. I was on them for a week, stopped, the symptoms came back (eye pain and weeping at night). We resumed the steroids and did a slow wean. I stopped the steroids on Sunday. Started the ED on Sunday. I looked all over the Internet for the most comprehensive info I could find on ED. Yours was the best I could find.

Here is what I have been consuming....

Sweet potatoes with cooked apples for breakfast and supper.
A large amount of cooked veggies for lunch. Cabbage, zucchini, carrots, broccoli.

That is it. No spices or condiments.I have had no pain until last night not bad pain, but still some pain and some increased weeping from my left eye. The weeping has not ceased. My concern is there may be something else I should eliminate from what I am eating right now.

I have added brown rice. I was constantly hungry and needed something else.

Do you have any thoughts or ideas as to anything else I should be doing? I am also guessing this could be a result of stopping the steroids and some rebound effect. If I stop eating rice, I need another grain to help fill me up.

I appreciate any help.
With gratefulness,
Pam M

Burgess Laughlin said...

1. Of course, I can only offer suggestions based on personal (and therefore very limited) experience. I am not a physician. I have had more than 15 episodes of iritis in one eye or the other during the last 40 years. My episodes of iritis did not stop when I switched to the version of the McDougall diet that I follow now, a process which began about 12 years ago. However, the number of episodes has decreased. Especially once I realized that something I was doing -- perhaps rubbing my eye -- was a direct cause, the episodes decreased a lot. I now have had no episode in more than four years, a record long time. Perhaps I am done as long as I don't rub my eyes.

I suspect that the trigger for my inflammation problems in my eye was "mechanical." It could be something as innocent as rubbing my eye when I had a speck of something airborne under the lid. If food alone was the cause, I probably would have had iritis in both eyes simultaneously. That never happened in all those years. Probably years of inflammatory diet set me up and something "mechanical" was the trigger.

2. How did you "know" that potatoes cause your inflammation in one eye? How much potato do you or were you eating regularly?

3. My eye doctor convinced me that the weaning off process must be very gradual, a matter of a week to three weeks. The Pre Forte I was taking was powerful. Very helpful but powerful. (BTW he and I discovered that only the original Pred Forte worked; the generic version was too weak, perhaps because the "delivery system" was not effective, my doctor speculated.)

More in next comment.

Burgess Laughlin said...

Part 2

If you are not having other inflammation problems, then I would doubt that anything in particular in your diet is triggering an episode of iritis. (Apparently you have already eliminated all traces of wheat; if so, that is good.)

In summary, I can only suggest that you be sure to wean slowly from the anti-inflammatory you are using. There is a "bounce-back" effect from reducing the dosage too quickly.

As for what to eat, if you are convinced that all potatoes (and not merely Russett, brown potatoes) are the culprit, which I doubt, and if you want to emphasize starches that are less likely to trigger inflammation, I would recommend sweet potatoes, yams, pumpkin (I eat 1 or 2 29 oz cans per week as a thick soup or pudding side dish, but it is not very filling), and rutabagas.

If you are going to eat a grain I would recommend white rice, which is much lower in sulphur and much less acid producing. You might also try quinoa, prepared in a way similar to rice. I have also found recently that I can tolerate corn, at least in small quantities.

You may need to simply eat more meals, but remember that there is usually a transition period of greater hunger when you switch to a leaner diet. For me that was about 1-2 months.

I empathize. I now how uncomfortable (and frightening!) iritis can be.

If anything is not clear, please ask again here.

Pam said...

Thank you for your long and thoughtful reply. I too am surprised and pleased that I have iritis in only one eye. I do have several areas of arthritis in my hip and three joints in my fingers. As far as potatoes, when I was working as a nurse, I wanted to make sure I would have energy all day so I would eat a big breakfast which included 1 cup oats (prior to cooking) with a banana and blueberries, I would microwave as many as 4 russet potatoes and eat those also. Needless to say, this would give me energy and hold me until lunch or even later if I had to delay eating lunch. I started having pain in my left eye last fall. I was tolerating the pain and blamed work stress for the pain. My eye dr apparently didn't notice the iritis until January when it came back with a vengeance. I was off work for five weeks with a broken foot in December. I didn't eat potatoes at all for breakfast. I only had oatmeal. The pain completely resolved and I assumed the pain was gone because I was not at work. When I went back to work and resumed my normal breakfast the pain returned after three days. So, that is how I came to that conclusion. I really would have preferred that my job was the cause of my pain:)

When I saw my eye dr he then diagnosed me with iritis and placed me on the oral prednisone and the Pred Forte. I was on the steroids for a total of one month starting at four times daily with a slow wean the last week of every other day. I have recently retired so I again stopped the potatoes. Up until starting the ED I was consuming wheat and lots of beans and rice dishes.
I will get some quinoa. I will drop the rice. I like parsnips and will add those as well.

Thank you for all your help. I truly appreciate it!
Pam M

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Anonymous said...

My husband is on day 2 of the elimination diet. He is hoping to get his colitis under control in order to avoid some nasty drugs that are being recommended. He is experiencing extreme hunger. Is this normal? How do we deal with it so that he won't feel the need to end the diet?


Burgess Laughlin said...

In my experience, it is completely normal (and a sign of health) to experience greater hunger when eating leaner food. It is as if the body is saying, "Lean times! Eat more!"

The immediate solution is simple in concept: Eat more, which means either bigger meals or more meals or both. (It is, of course, perfectly normal to be hungry in the hour or two before a regularly scheduled meal. Live with it. Or schedule physical activities during that time, if possible.

The long-term solution is to begin testing "heavier" foods as your first test foods. If the illness symptoms decrease after a week or two on the strict ED, then test a food such as potatoes. Follow the rules for re-introducing foods.

katydid said...

Thanks for this. I knew I had the sulphur problem. But I am also worse on orange foods--think beta carotene.