Naturopathic Doctor: Food Sensitivity Testing or Elimination Diet?

February 17, 2008

Naturopathic Doctor: Food Sensitivity Testing or Elimination Diet?

Dr. Nicole Sundene, NMD

Naturopathic Dermatology

"Should I do a Food Sensitivity Test, a Food Allergy Test, or an Elimination Diet for my skin rash? I know my hives are triggered by something I am eating and I need to know the best way to figure out the source of the allergy."

Jennifer J Scottsdale, AZ

In Naturopathic Dermatology it's all about the diet! I actually recommend ALL OF THE ABOVE as the best option to determine which foods are irritating the skin. Sometimes it is difficult for patients to follow an Elimination Diet and that is when Food Allergy testing is helpful. Hives, eczema, psoriasis, dermatitis, and skin rashes can result from both food allergies and food sensitivities.

Usually, when a reaction is very severe and requires an epipen it is an IgE reaction which can be determined through standard blood work at a lab via insurance. To determine Food Sensitivities we have to eliminate all suspicious and likely foods and/or test the blood for an IgG reaction via a Food Sensitivity Test.

I simply cannot help patients that are not willing to change their diet to whatever I tell them their skin needs them to eat. If you are researching natural treatments for skin issues and looking only for an herb to fix everything you will fail. I am not trying to sound negative, I just want everyone to have realistic expectations and not sign up for a service they cannot do on their end.

My other pet peeve is when a Naturopathic Doctor or Functional Medicine doc tells you to eliminate your food sensitivity for the rest of your life. While with some foods this is mandatory, the real problem with food sensitivities is "Leaky Gut Syndrome," so if we do not address and treat the inflamed gut and heal it with herbs, correct yeast overgrowth in the microbiome or other unwanted organisms then the patient just continues to react to whatever new foods they eat and eventually ends up "Painted in a corner" with 3 "Safe Foods" they can eat. If this has happened to you, it is imperative you schedule a visit with me so we can work to heal your gut so you do not continue to develop reactions to foods that should be safe.

If you are unwilling to change your diet and heal your gut I cannot help you with your skin issue.

How can I say this? Because I have worked in both Traditional Dermatology and Naturopathic Dermatology since 1999. So I have seen many different skin problems every day for over 23 years. I have seen what prescription drugs can cure with medications, and I have seen what Naturopathic Medicine can heal when a patient does everything I ask them to do to the letter in my Holistic Dermatology practice.

Patients that cannot or will not change their diets do not improve with Naturopathic Dermatology. So when patients ask me if I can help their skin question, it is never a question in my mind IF Naturopathic Medicine will help my patient's dermatology condition. But my question to the patient is can you do the Naturopathic work? Can you change your diet to what we determine your skin needs you to eat? Can you take supplements and herbs in the forms of capsules, teas or tinctures? Are you serious about getting better? If you answered no to any of those questions my service will not be a good fit for you.

If I can't use the tools in my Naturopathic Toolbox on you, Nauropathic Medicine will fail, and you will need prescription drugs for your itchy skin. Please do not enroll in my practice if you are not open to changing your diet to the diet your skin needs you to eat, or if you cannot remember to take supplements as both are generally required in the first few months of care.

My detective process often results in making changes we don't want to make. But we also must listen to the skin because it is telling us something is seriously wrong with our body. In Chinese Medicine imbalances begin on the skin. When we fail to listen to them the imbalance drives in the body deeper and precipitates as an even worse chronic disease.

I have never seen a patient in fifteen years that did not need a dietary change to fix their skin issue with lasting results. Food is the trigger and hormone imbalance is often the underlying reason the skin is aggravated.

Whether it be Acne, Psoriasis, Eczema, Dyshidrotic Eczema, Dandruff, Seborrheic Dermatitis, hives or itchy skin I cannot help you be successful in achieving beautiful skin if you cannot change your diet. If that scares you but you are open to making gradual changes, I promise that I am the same exact way and will coach you through the process. Eventually you will learn what triggers your skin and want to avoid it through a process of trial and error.

Sometimes the food triggers is not even a food my patient likes to eat but is only eating "to be healthy." Such as my own soy intolerance I discovered from Food Sensitivity Testing. I developed eczema in college when I switched to a Vegan diet! So we cannot heal your skin if you do not want to change your diet. My most successful Dermatology patients already know this and hire me to help them figure it out. Let me explain why today.

Food allergies and food sensitivities are the #1 factor driving the common skin conditions I treat such as Eczema, Acne and Psoriasis. I am leaving this Food Elimination Diet from Bastyr University here for those of you that cannot afford a Food Sensitivity Test.

While I recommend testing, eliminating AND challenging to understand skin triggers, digestion, fatigue, joint pain and so forth, I do understand it is simply not affordable for some patients. The limitations of food sensitivity eliminations are that most of my patients cannot last 3 weeks on this diet and appreciate the ease of simply having their finger poked to determine the cause of the food sensitivity or allergen.

If you or your physician suspect that you might have a food allergy you can follow these basic guidelines to best determine the food that is the culprit.

Symptoms of food allergies can be insidious or immediate and include symptoms such as: skin rashes, dermatitis, eczema, psoriasis, seborrheic dermatitis, irritable bowel syndrome, fatigue, suppressed immune system, autoimmunity, rheumatoid arthritis, depression, brain fog, neurological symptoms and much more.

Because 70% of our immune system surrounds our gut in the form of GALT (Gut Associated Lymphatic Tissue) it only makes sense that food allergies and intolerances easily place a burden on our immune system.

Blood testing for food allergies may be helpful for children or patients that are unable to follow this regimented of a diet such as those with a history of eating disorders. However, blood testing for allergies is truly only 70% accurate and is helpful for determining which foods should be elminated and tested.

The immune system can create IgG and IgE responses to food. IgE reactions are immediate and typically result in anaphylactic shock whereas IgG allergies are insidious and most patients only notice improvement once the food has been eliminated for at least four days. Generally two full weeks is needed to determine the impact. IgG tests for sensitivity. Intolerances are possible without true allergy. Lactose intolerance for instance is a classic example of a food like milk causing a problem such as diarrhea without the presence of allergy.

The gold standard for determining food allergies/intolerances is therefore the Elimination Diet. Be sure to follow the specific diet prescribed to you by your physician. I have been using Bastyr University's elimination diet with patients since 2005 and not every patient can do it. Please look at it below to determine if you can realistically follow it, otherwise you need to schedule yourself for allergy and sensitivity testing.

As with any health care suggestions given here be sure to check with your own Naturopathic Doctor before attempting a food allergy elimination diet. Those with history of eating disorders whether active or dormant for instance are not candidates for this regimented of a diet. If you are suffering from any chronic health complaints you absolutely should not attempt this on your own and should be under the supervision of a licensed health care provider.

To identify foods that may be causing some or all of your symptoms. During the elimination period, foods that commonly cause symptoms are completely eliminated from the diet for one to two weeks. After your symptoms improve, foods are added back one at a time to determine which foods provoke symptoms. The following is a basic template used by many health care providers and may need to be modified to suit your specific needs.


Cereals:Hot: cream of rice, quinoa cereal (Quinoa Flakes).
Dry: puffed rice, puffed millet

Grains: Rice: no wild rice but all kinds of other rice including rice products such as pasta (Brands: Pastariso, Lundberg), plain rice cakes, rice bread without yeast (Brand:Energy), mochi (found frozen or fresh in Asian stores), buckwheat (kasha), millet, quinoa (a quick cooking grain), amaranth, and teff

Flours: Rice, millet, quinoa, amaranth, teff, bean flours, and tapioca

Fruit: All fruits except citrus fruits (oranges, lemons, limes and grapefruit)

Protein: Meat: lamb and wild game meats such as venison
Beans/legumes: all beans and legumes, except soy and peanuts. Check labels of canned beans, dips and soups for sweeteners, spices and additives (Brand: Taste Adventure dried refried beans and split pea soup). Do not eat canned beans with chemical additives (EDTA)

Vegetables: All vegetables except tomatoes, eggplant, peppers, potatoes, and corn

Nuts/Seeds: All nuts and seeds except peanuts

Oils/fats: All oils except peanut oil, corn oil and soybean oil

Sweeteners: Maple syrup (pure) and brown rice syrup

Beverages: Water (plain, mineral or sparkling), rice milk (plain or vanilla – check labels for ingredients, gums are allowed but barley malt or corn syrup are not allowed), all fruit juices except citrus juices are allowed and all herbal teas are allowed

Condiments: All condiments are allowed except for chocolate, tomato products (catsup), pepper products (Tabasco, hot peppers), and vinegars that contain malt or other ingredients requiring elimination. Black pepper is allowed. Check all condiments to make sure that the ingredients are allowed.

Elimination Diet Guidelines

1. Do not eat any food that you suspect is causing symptoms even if it is on the list of acceptable foods.

2. Use only those foods allowed unless you check with your health practitioner. READ LABELS! “Flour” usually means wheat flour, “vegetable oil” may mean corn oil or soybean oil, casein and whey are dairy products, and potato and soy flour is in some gluten free foods.

3. Withdrawal symptoms may occur during the first few days or week on the diet. Some or all of your symptoms may increase temporarily. You also may experience symptoms that you do not usually experience. The symptoms usually subside within 10 days. The following may help you feel better: drinking at least 8 glasses of water a day, buffered vitamin C, baths with Epsom salts or baking soda, naps and mild exercise such as walking.

4. The elimination diet may be followed for up to 4 weeks. When you have had 5 days in a row, without symptoms or your symptoms have decreased you are ready to challenge.

5. If no improvement occurs in 4 weeks, then the food substances were probably not the cause of your problem and you can gradually return to a normal diet. However, it is possible that you are eating something in the Elimination Diet that you are actually allergic to, and therefore testing should be conducted before assuming there are no food triggers. Testing must be conducted while the patient is on the food. Testing for Celiac Disease or gluten sensitivity will not be accurate unless the patient has eaten the food in the past 4 weeks. Occasionally patients are allergic to cashews and beans in this diet. If you cannot stomach beans, eat lamb for your protein source during elimination as fish, eggs, cheese, beef, and chicken are common protein allergens.


Start: Begin challenging when you have been on the elimination diet for at least 2 weeks and when you have had at least 5 days in a row without symptoms or at least your symptoms have decreased.

Challenge: Challenge one food or food group at a time, eating the recommended amount of food for 3 days in a row. For instance if you are challenging dairy you should have a glass of milk three times a day for three days. Try to use the purest form of the food possible. Cream of wheat is a better choice than bread when testing wheat for instance in order to ensure that the problem is the wheat in the bread and not the yeast or any other additives.

Stop: If symptoms occur, stop the challenge. Do not start the next challenge until you have had 1 full day free of symptoms.

When you challenge, keep a record of both your physical and behavioral symptoms.

Be patient, reactions can take up to 48 hours to begin. If you hurry your challenges, you are likely to end up getting confused and having to start again. If a reaction is doubtful, wait until the end of the challenge period and repeat the challenge to confirm a reaction.

Food Challenges: When challenging individual foods, eat one serving three times a day along with the elimination diet foods. Challenge for at least three days. Stop the food immediately if reacting.

Occasionally some patients will have severe “anaphylactic” reactions to a food they are challenging. If you experience extreme symptoms such as shortness of breath, sensation of your airway closing, swollen tongue or lips, redness or swelling of your entire body, or any other symptoms of an urgent nature do not hesitate to call 911. These symptoms can come on quite suddenly and it is better to be safe than sorry.

Meal Planning
Breakfast Ideas
• Mochi with cashew butter, peeled pear or apple
• Rice toast with cashew butter, pear
• Rice cereal and rice milk
• Rice pudding with soy milk

Lunch and Dinner Ideas
• Lamb, rice and green beans
• Lentil soup and rice crackers
• Cabbage soup and rice bread toast
• Beans and rice, lettuce salad
• Rice cakes with cashew butter, celery sticks
• Lamb, cabbage and rice soup
• Lettuce salad with cashews, celery, shallots and mung bean sprouts
• Rice pasta with parsley and green beans
• Bean soup and rice cakes
• Split pea soup and rice bread toast

Helpful Hints:
Eat as much as you want.
Add cold pressed oil to vegetables and rice for flavor and calories.
Read a good book (not a cookbook!)


Combination Cereals

Hearty Morning Cereal
1/2 cup amaranth
1/2 cup millet
1/2 cup teff
1/4 cup cashews

Sweet Rice Cereal
1 cup brown rice
1 cup sweet brown rice

Cashew Millet Cereal
1 cup millet
1 cup brown rice
1 cup cashews

Millet and Quinoa Cereal
1 1/2 cup millet
1 cup amaranth or quinoa

Place all grains and nuts in a fine strainer; rinse and drain. Toast grains in one of two ways:

Oven toasting:
Preheat oven to 350? F. Spread grains on a cookie sheet and toast in oven until they give off a nutty aroma (12-15 minutes).

Skillet toasting:
Place washed grains in a large skillet on burner and toast on medium heat, stirring constantly, until grains give off a nutty aroma (5 - 8 minutes).

Let toasted grains cool and store in sealed container. You can toast a big batch of several different grains at one time and store them in separate jars.
For the best nutrition, grind grains just prior to using in a small electric grinder or food processor. Once a grain is ground it begins to lose nutritional value within 24 to 48 hours. Store the whole toasted grains in labeled, sealed containers and grind the amount you need before cooking.

To cook ground grains into cereal use 1/3-cup ground cereal and 1 cup water per person. Combine cereal and water in a pot; bring to a boil. Reduce heat to low and simmer, covered, for 10-12 minutes. Using a flame-tamer or heat deflector on the burner while simmering the cereal helps prevent scorching or sticking.

Top plain cooked cereal with a little fruit sauce topping.

Amaranth Breakfast Cereal
1 cup amaranth
2 cups water
1 pear, peeled and chopped

In a small saucepan, bring the amaranth, water and pear to a boil. Lower heat to simmer, and cook for 20-30 minutes, or until all water has been absorbed. Garnish cereal with maple syrup, vanilla or rice milk.

Rice Waffles
2 cups rice flour
4 tsp. baking powder
2 cups rice milk
3 tbsp. safflower oil

Sift the dry ingredients together. Add the milk and oil gradually, stirring the mixture constantly until smooth. Bake in a hot oiled waffle iron. Serves 4

Rice Pancakes
1/2 cup ground cashews
1 1/2-Cup amaranth, quinoa or rice flours 1 1/4-cup water
1 tsp. baking powder 2 tbsp. oil

Combine dry ingredients, mix well. Combine liquid ingredients in small bowl, mix well. Stir into dry ingredients. Cook pancakes on preheated, un-greased, non-stick griddle or fry pan. When bubbly and brown, turn. As batter thickens, add water, a tablespoon at a time to keep cakes thin.

1 head cabbage, chopped
3-4 cloves garlic
2 tbsp. sunflower oil
16 oz can white beans, drained

In a large pot, steam cabbage with a small amount of water. Cook until soft. Remove cooked cabbage from pot and add oil and garlic. Sauté garlic for 2-3 minutes. Add the cabbage back to the pot with enough water to cover the cabbage by 1 inch. Add bean to cabbage and let cook for 30 minutes on low heat. Add salt to taste.

Nutty Drizzle (serve over grain, vegetables or pasta)
1/4 cup cashew butter
1/3 cup water

Place all ingredients in a small saucepan on low heat. Stir with a whisk until mixture is smooth and warm. Serve over your favorite grain, vegetables or pasta.

Quinoa Pilaf
1 cup quinoa
1/2 cup red lentils
1/4 cup chopped parsley
3 cups water

Combine all ingredients in a medium saucepan on high heat. When quinoa comes to a boil, lower heat to simmer and cook for 20 minutes. Fluff with a fork. Option: This mixture can be eaten warm as is or cold as a salad with added chopped vegetables.

Lentil Stew (6 servings)
1 lamb leg bone or 4 oz lamb blade steak, trimmed of fat and chopped (optional)
2 tsp. canola oil
1/2 green cabbage, chopped
6 cloves garlic, coarsely chopped
2 cups green lentils, washed and checked for stones
chopped parsley

Heat canola oil in large saucepan over medium-high heat. Add lamb bone or steak (optional). Sauté until brown on all sides. Add cabbage and garlic. Sauté until soft and just beginning to brown. Add lentils and water. Bring to a boil. Turn heat to low and simmer with a lid on until lentils and lamb are very tender, 1-2 hours. After cooking, add parsley to taste.

3-4 cups cooked garbanzo beans
5 cloves minced garlic
1 cup parsley
2-3 tbsp. safflower oil
3-4 tbsp. water
1 tsp. cashew butter
garbanzo bean flour

Mix all ingredients in food processor except the flour. When smooth, add flour until a thick batter/thin dough consistency is reached. Fry in oil in skillet until browned/crisp on both sides. Top with tofu dressing.

Black Bean Garlic Stir Fry
4 cloves garlic, minced
chopped vegetables (cabbage, scallions, leeks, celery, green beans)
chives and parsley, to taste
2 cups cooked black beans
4 cups cooked rice

Sauté garlic in a wok or large skillet. Add chopped vegetables and sauté until soft. Add chives and parsley and black beans and cook until heated thoroughly. Serve over rice.

Bean Dip
2 shallots
1/2 cup chopped leeks
2 cloves garlic, minced
16 oz cooked beans (Garbanzo, black, kidney or white)
1 tbsp. cashew butter
3 tbsp. chopped fresh parsley
1 tbsp. oil

In a small skillet, heat oil on medium heat. Add leeks, shallots and garlic. Sauté for 5-10 minutes or until leeks are soft. While vegetables cook, add remaining ingredients to a food processor. When vegetables are cooked, add to bean mixture in food processor. Process until all ingredients are well mixed and texture is creamy. Allow to cool before eating.

Split Peas and Rice (serves 4)
3 tbsp. oil 2 cups brown rice
1 leek chopped 6 cups water
1 clove garlic minced 1 cup yellow split peas
2 tsp. chopped chives
2 tsp. chopped parsley

In a large heavy pot, heat 3 tbs. oil and sauté leeks, garlic, chives and parsley until leeks are tender. Stir in rice and cook for 5 minutes or until rice begins to turn white. Add water and bring to a boil. Reduce heat and cook covered for 20 minutes. Add split peas to the cooking rice and cook 30 minutes more.

Split Pea Delight
1/4 cup dried green split peas
1/4 carrot, sliced
1 1/4 cups water

Wash peas and scrub carrot. Put peas, carrot, and water in a small pan; bring to a boil. Reduce heat and simmer, covered, for 20-30 minutes. Puree in a blender.

Bean Salad
2 cups cooked beans (lentils, black, kidney, chick peas)
1/2 cup celery, chopped
1/2 cup parsley, chopped
2 shallots chopped
2 cloves garlic, minced
1-2 tbsp. oil

Combine the beans and chopped vegetables in a large bowl and toss until well mixed. Add oil and salt to taste and mix until beans and vegetables are evenly coated.

Rice Pasta and Vegetables
1 package rice pasta cooked according to package directions
2 leeks, chopped
3 shallots, chopped
2-3 cloves of garlic, minced
2 tbsp. fresh parsley, chopped
2 tbsp. fresh chives, chopped or 2 tsp. dried
2 tbsp. safflower oil

Heat oil in a skillet over medium heat. Add leeks, shallots and garlic and sauté for 5-7 minutes until leeks are soft. Add fresh parsley and chives and cook 1 minute longer. Remove vegetables from heat. Add rice pasta to vegetables, mix well. Add salt to taste.

Rice Salad
4 cups cooked brown rice
1 cup celery
2 tbsp. fresh chives
1 cup chopped red cabbage
1 cup chopped parsley
1/3 cup cashews
2 tbsp. oil

Toss brown rice with chopped vegetables and cashew nuts until evenly mixed. Add oil and salt to taste. Optional: add 1/2 cup to 1 cup canned beans or lentils.

Rice Pudding
* this recipe can be made with cooked leftover rice or uncooked rice
1 cup cooked rice
1 cup rice milk
1 tsp. vanilla

Place cooked rice in a pan with the rice milk. Heat on medium heat until most or all of the rice milk has been absorbed. Remove pan from heat. Add vanilla. If consistency is too hard, add more rice milk and return to stove.

To make this recipe with uncooked rice, add I cup uncooked rice with 2 cups rice milk and 1 cup water. Cook like ordinary rice. When rice is cooked, add vanilla.

Millet and Pears
1 cup millet
2 cup water or rice milk
1 pear, peeled and chopped

In a pan, bring millet, water and pear to a boil over high heat. Lower heat to simmer and cook for 30 minutes. remove from stove top. Mix well. If desired, add some rice milk for a creamier texture.

Fruit Sauce
Use 1 cup water per 1/4 cup cut-up pear or apple. Peel and slice the fruit. Place cut-up fruit and water in a pot; bring to a boil. Reduce heat and simmer until the fruit is tender and water has cooked off (about 15 minutes). Puree in a blender.

As you can see from the limited diet options this may be difficult for many patients to follow for a minimum of three weeks and therefore testing is helpful. If you are in need my help and support while on a food elimination diet or need Food Sensitivity Testing feel free to BOOK A VISIT with me. I am happy to help you feel happy in your skin again!

~Dr. Nicole Sundene

(480) 837-0900

Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause,  Thyroid,  Hashimotos,  PMS, PerimenopauseAutoimmunePostpartumChronic Fatigue, DepressionAnxiety, Food Allergies,  DigestionDermatology, AcnePsoriasis Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease. She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on InstagramTwitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!

Location: 14300 N Northsight 
Blvd Ste 124
Scottsdale, AZ 85260
Ph: 480-837-0900
Fax: 480-409-2644
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