Does the RPAH elimination diet increase sensitivity to foods?

People in the Network sometimes claim that they get far more reactions to foods now than they did before they reduced food chemicals. Here is a recent example:

I never had the symptoms I have now before starting elimination and I never had headaches before it. The disruption caused by taking on this diet is hard to justify, if it weren't for the evidence of food challenges and change in symptoms - Jen

My standard response has been that we understand that RPAH say that people think that they are more sensitive because with the background of effects from food removed, you can see more clearly when you are affected. The other thing is that effects of food intolerance come and go, and change with time and illnesses. So it can be hard to say that it was reducing food chemicals caused the effects. It is important to do gradual re-introduction of foods to establish exactly what your tolerance limits are and this is why working with a dietitian is so important. Having a dietitian to back you up can also help convince others in your life who are less than supportive.

We are grateful too for authoritative advice from Dr Elizabeth Pickford, Paediatric Allergist who worked 20 years at RPAH and now works privately and at Macquarie University Centre for Paediatrics. 


My reflection over the years is that people often do elimination diets for too long, without trying to liberalise/reintroduce foods as challenges. Reintroduction of as much food variety as possible, as soon as possible, is important to overall health and nutrition.

Clearly, restricting the diet for too long will lead to increased sensitivity to food chemicals in many cases. I think there is a lack of understanding in many people that the RPAH elimination diet is a part of an investigation of the causes of symptoms, not a permanent total lifestyle change.

I agree with your comments about having a competent dietitian involved in the care of patients, as an individualised approach is vastly superior to “going it alone”. It’s really important to maintain nutrition through the whole process, and to avoid being overly restrictive, if possible. A competent dietitian will also be able to steer people back to a better/fuller diet as soon as possible, and may in some cases even discourage people from starting restrictions which may prove to be harmful rather than helpful (such as people with pre-existing eating disorders (for example, anorexia nervosa and bulimia), or people where the symptoms are not likely to be related to food at all).

You are right about the symptoms/severity of food intolerance waxing and waning with different factors such as hormone changes and intercurrent illnesses.

I think that not every symptom can be attributed to food intolerance, and that people need to understand clearly what they are trying to achieve before diving into a long, hard process of dietary change. I often say that a big problem calls for a big solution, and sometimes, for a small problem, on balance, the effort isn’t worth it.

[1504] Reactivity and the importance of adding foods back into diet

More information on using a dietitian

[1290] Does food avoidance lead to increased food sensitivity? - facebook thread (November 2014)