If you want to understand the fundamental principles of Functional Medicine, the Elimination Diet is one of the top tools to wrap your head around. One of the most significant ways that we interact with our environment is through food, and how our body responds to different foods that we eat can be very significant. In our practice, we think of using an Elimination Diet not only when someone has gastrointestinal symptoms, but with other symptom presentations too. Joint pain, brain fog, headaches, skin rashes, gallbladder attacks, autoimmunity, numbness/neuropathy, gait and fine motor issues, difficulty concentrating, high blood pressure, and difficulty sleeping are just a handful of other types of symptoms that can be related to how our body responds to foods that we’re eating.
In this interview, our Director of Nutrition Programs, Romilly Hodges, talks with Elimination Diet and Functional Medicine expert, Tom Malterre. Tune in (or read the transcript below) to learn:
- Why, just like with a crying child, we should ask ‘what’s wrong’ with our body
- Examples of just how much of an impact different foods can have on your health and symptoms
- Why an Elimination Diet is a great starting point for doing your own health ‘sleuthing’
- How to use the Elimination Diet as a therapeutic tool to heal your health issues
- The pros and cons of doing an Elimination Diet vs laboratory food sensitivity tests
- What foods to avoid on an Elimination Diet and how to ‘test’ whether those foods are really contributing to your symptoms
- Reasons why we resist removing foods from our diet, and how to rethink that
- How to deal with cravings!
- How to feel confident and take charge of your health through diet
Tom Malterre, MS, CN, began learning about nutrition at the age of 10 from his family doctor, Dr. John McDougall. He continued his studies by attaining both a Bachelor’s and a Master’s degree in Nutritional Sciences from Bastyr University. As a medical affairs team member at Thorne Research, he lectured across North America and educated doctors on nutritional biochemistry and functional medicine. Along with his wife Ali, Tom has co-authored three books, including the recent The Elimination Diet. He has been inspired by his clinical clients and the online practitioner coaching programs he teaches at Whole Life Nutrition. Tom is a Certified Functional Medicine Practitioner by the Institute for Functional Medicine, and he is also on faculty as an educator for the Institute for Functional Medicine. A lover of nature, Tom loves to hike, climb, and wild-harvest plants with his children. Learn more about Tom’s work at www.wholelifenutrition.com.
Romilly Hodges: Hi and welcome, everybody. I am Romilly Hodges, I’m the director of nutrition programs for Doctor Kara Fitzgerald, and I am really delighted to bring you this conversation today with Tom Malterre, who is one of my absolute nutrition heroes. You probably don’t’ realize that, Tom.
Tom is going to be taking us through one of those fundamental dietary tools that we use in functional medicine, which is The Elimination Diet. That’s the area where he’s a recognized expert in, so welcome, Tom.
Tom Malterre: Romilly, it’s an absolute pleasure to be here and I’m sure you don’t know this but I’m a huge fan of yours as well. I was just actually teaching a class on detoxification the other night and quoting your recent article, so absolutely an honor to be with you.
Romilly Hodges: Aw. Well it’s so great to have you, and Tom also very kindly spent some time with our nutrition team recently discussing some of those finer points and the variations of The Elimination Diet from a practitioner’s perspective which was great.
Before we get started I wanted to go over your bio, as well, Tom, to give listeners a sense of who you are, your expertise and recognition that you’ve already gathered in this field.
Tom Malterre: Lovely.
Romilly Hodges: So, Tom is master’s level educated and a certified nutritionist who began learning about nutrition at the age of 10 from his family doctor, Dr. John McDougal. He continued his studies by attending both the bachelors and masters degrees in nutritional sciences from the renowned Bastyr University, and as medical affairs team member at Thorne Research. He has lectured across North America and educated doctors on nutritional bio-chemistry and functional medicine.
Along with his wife, Ally, Tom has co-authored three books including his most recent book which is actually titled “The Elimination Diet”.
I have a copy myself and it’s a fabulous resource.
He’s been inspired by his clinical clients and the online practitioner coaching programs that he teaches at Whole Life Nutrition.
Tom is a certified functional medicine practitioner by the Institute for Functional Medicine, and he is also on faculty as an educator for the Institute for Functional Medicine.
A lover of nature, Tom loves to hike, climb, and wild harvest plants with his children. I also happen to know that Tom likes to spend quite a bit of time in the mountains.
Remind me, is it skiing or snowboarding?
Tom Malterre: Snowboarding.
Romilly Hodges: Snowboarding, that’s right.
So, with that as an introduction, let’s turn to this topic of The Elimination Diet.
Why don’t we start, Tom, by talking about why The Elimination Diet is one of those cornerstone diets for functional medicine?
Tom Malterre: Absolutely. So, Romilly I think we need to back up just a little bit, then, and we have to ask ourselves: “what is functional medicine?”.
We say functional medicine is then a root cause medicine, and everybody uses that so freely. But what does that really mean, root cause medicine?
You know me, I have five kids and I’m very practical as a human being so I’m going to break it down as a dad.
I’m going to say functional medicine is being a good parent to yourself. I’m going to say if I were to be a parent, which I am to five beautiful children, and one of these children, let’s say my youngest, comes into me and my youngest is crying. Here I am, always busy, I’ve got some work to do or some podcast to be on or some interview, or last night I was shooting a documentary. You know, it’s something to do, right?
So, she cries, and she comes to me and I could easily solve the problem of a crying child by saying: “Go to your room”. Right?
I could say: “here’s my issue, my symptom. My symptom is I have a child in front of me crying, it’s bothering me, I’m going to send her to her room”. Right?
That’s conventional medicine. I have elevated cholesterol, it may or may not be something that could lead to heart disease, I’m going to punish it with a statin medication.
I have elevated blood sugar, I am going to punish it by giving it metformin. I have some sort of elevation of a problem, a symptom, and I will quickly get rid of that symptom as fast as possible.
Now, functional medicine says: “aw, Camille, why are you crying?”. Functional medicine will say: “Sweetheart come here. What’s going on?”. And you ask your daughter and maybe she remembers and maybe she doesn’t. Maybe you start thinking, you say: “Aha. Well, you know what? She went to bed really late last night. She’s sleep deprived. I wonder if that’s putting her on edge?”. Or, “Oh my gosh, look at the time. It’s 8:15 and I haven’t fed her breakfast yet. Oh that onus is on me, no wonder she’s crying, I need to give her some food.” Or, “Oh my gosh, her brother just pulled her hair, she has some sort of irritation that’s leading her down the road of being in a state of dis-ease.”.
So, you say to yourself: “all right, if I’m going to be apparent to my dis-ease, why wouldn’t I, instead of punishing it and sending it to it’s room, why don’t I get to the root cause as to why it’s presenting in the first place? Why is this body of mine crying? Why don’t I go and say hmmm, am I getting enough sleep? Huh. Have I eaten enough nutrition to power up my cells and keep my immune system calm? Huh. Am I getting my hair pulled by toxins in my environment? By a stressful work environment? By a spouse who’s non-supportive or abusive? Why don’t’ I look at the needs of this particular situation and address those needs?”
So, that’s functional medicine. And if, on a daily basis, you’re consuming a food whether it’s breakfast, lunch, dinner, or snacks in between, and that particular food is now causing an irritation for you. Whether your immune system is responding to it or your body does not digest it very well and you end up with an intolerance, you end up with diarrhea, with lactose intolerance, for example.
Why wouldn’t we look, then, at that food as something that we can change?
What I’m seeing, Romilly, in my clinical practice, that over 80% of the people that I see will have one or two or more food sensitivities. They have foods that when they eat them their body starts crying.
It says: “my joints are painful, my back pain is worse, I now have a chronic migraine, I have some sort of bowel irritation from that food”.
So, I would say as a foundational functional medicine principle, we would want to consider food as a potential irritant.
The Elimination Diet investigates which foods may be an irritant and which foods may be a nutrient or something that nourishes us. And if you really get to the route of functional medicine as I was taught, by Dr. Sidney Baker, he said: “Tom, all disease is caused by two primary factors. One. You’re getting too many things you don’t need. Two. You’re not getting enough things you do need.”.
So, you have too many irritants, and what I like to call not enough nutrients, things that nourish the body.
I’m blessed, as a nutritionist, I don’t’ have rights to use medications that might punish a pathway. If you look at the definition of nutritionist, it literally means “one who nourishes”. So that’s my job. I look at what might be irritating someone and take it out, and then I add back in things or compliment their existing program with things that nourish them.
The Elimination Diet is a balance of both. The Elimination Diet pulls out certain foods that are known irritants for the vast majority of the population and it adds in foods that are known to be supportive to the system.
So that’s my definition of The Elimination Diet and how it applies to functional medicine.
Romilly Hodges: That’s wonderful, Tom, and I think you just created this perfect analogy to really dive down to what functional medicine is all about and how that Elimination Diet fits in with it. In my mind, too, I love understanding this concept that The Elimination Diet is both diagnostic and a way to investigate what might… what your body might be getting too much of that isn’t helping it, and at the same time being nourishing, being healing.
You’re working from these two angles at the same time.
Tom Malterre: I love that you bring up the investigation piece. It’s interesting, right? I am a guy who loves to research and I don’t just research science for nutrition, I research the quality of the clothing that I’m recommending to my children. If I’m going to buy an air purifier I’ll research the quality of the air purifier. If I’m going to purchase gas I want to know the quality of the gas.
So, it’s interesting to me, as human beings we don’t investigate our food more. If you’re a vet, vets know that certain animals can’t eat grapes or chocolate. You know, if a dog eats chocolate, for example, it can die.
But, we don’t think that foods, the things we’re consuming on a daily basis that come from all over the world, some that are synthetically produced, we don’t think that the foods might be a potential irritant to our system.
But each person’s system is unique. We have different genetics, we have different microbes that exist in our bodies. We have different nutrient statuses depending on what we’ve been eating since childhood. Were we breastfed or not? There’s so many different factors that leave our particular systems unique to be able to either process, digest, metabolize, utilize a particular food or not.
So, the reality is the vast majority of people walking this planet, if not all, don’t tolerate certain foods as well as they tolerate others. So The Elimination Diet literally is a beautiful, really fun, fascinating investigation.
It’s as if you’re running your own experiment and the experiment is you feeling good and the thing that you’re changing is the foods that you introduce into you. It just makes sense that every single human would do that. I mean, you investigate something before you purchase it. Why aren’t you investigating things before you eat them? It just makes sense.
Romilly Hodges: Mm-hmm, and there’s so much power in doing this. Anyway, we’ll get to talk about that more, but while we’re on this topic of how our body is potentially reacting to certain foods or components in our foods. What is going on there? Can you just talk us through the various layers of how we might be reacting?
Tom Malterre: Right. Well, this is a wonderful example. I see, I used to see, when I worked for the autism research institute, a lot of pediatric clients. I’d get referrals from people all over the globe, and I would see these children often times didn’t tolerate dairy. And I started diving into the literature, and I started seeing that: “my gosh, did you know that there are articles showing that 40% of children who consume cow’s milk have occult intestinal bleeding?” Why?
Well, it turns out some of the proteins in cow’s milk look similar enough to humans that we digest absorb them fairly well, but our immune system will look at those proteins and say: “wait a second, this looks like something I’m familiar with but it’s not quite there.”
So we launch an attack against these specific proteins, and in launching an attack anytime you have a battle you have collateral damage and there’s actual intestinal cell damage that can occur.
So that was a red flag. And then one of our colleagues at the Autism Research Institute, Dan Rosignol, started running some cases of children with autism and he started seeing that they produced antibodies to something in the central nervous system called a folate receptor, this is a B vitamin. A receptor for a B vitamin in the central nervous system for these children.
What he noted was there were these antibodies that were attacking these receptors for folates, B vitamins, in the central nervous system after these children were consuming dairy. He would take away that dairy and these antibody levels would drop.
So what this is telling us that certain similarities of proteins can confuse the immune system. We might ingest a specific protein and it has a specific amino acid sequence, and depending on how we digest that sequence, it may become more or less reactive. But if you have this sequence that looks like it should be something that’s okay, and the body says: “All right, wait a second. This is enough difference that I’m going to produce an antibody for it.”
That antibody will not only attack that substance but it will attack other substances in the human body, or attached to, and cause the immune system to attack other substances in the human body that look similar to that.
This is called “molecular mimicry”. So, that specific sequence of amino acids mimics some other tissue. In the case of the folate receptor, we saw when we had an antibody to this specific milk protein, we formed an antibody to the actual folate receptor.
Well, this has been shown in many different things, Romilly, I’m sure you’ve seen the data on dairy consumption and type I diabetes, and that when children are fed formulas that have been broken down into smaller protein fragments they’ll have less cases of type I diabetes.
There’s a whole host of different issues that occur here. We’ve seen connections with rheumatoid arthritis, we’ve seen connections in a lot of different places.
In fact, I’ve seen some fascinating studies indicating that perhaps rheumatoid arthritis and chronic migraines might be food associated responses in many of the people who get it. And some it’s bacteriological, some it’s viral and what-not, and some it is food associated responses.
So, in essence, we consume proteins that our body doesn’t do well with based on our genetics, based on our digestive process, and then it starts attacking us. I would have to say that would be the simplest of definitions.
Romilly Hodges: So anybody that has those kinds of symptoms or an autoimmune condition should be flagged to thinking: “is there something in my diet that could be creating an issue here?”, right? Like, the type I diabetes, the rheumatoid arthritis, you’re describing autoimmune diseases.
Tom Malterre: Absolutely. We were just… we shot that autoimmune summit, the Betrayal Series, and we were interviewing Dr. Mark Hyman, and Dr. Mark Hyman says: “there are three things I think of with every autoimmune client. Gluten, gluten, and gluten”.
So, yes there are specific foods that seem to leave a susceptibility for a person to have an autoimmune response more than others, and I would say gluten and dairy are at the top of the list there.
Romilly Hodges: Top of the list. And even beyond autoimmunity, what are some of the other types of symptoms somebody might have that should really flag them to be thinking about their diet and what’s in their diet?
Tom Malterre: Oh yes, great question. And it’s not just these severe diseases that accumulate over decades of time. It’s also daily dysfunction. I thought it was fascinating when I started doing research. You know, for this book I wrote, I went back into the 1800’s and I looked at medical data. I went back, actually to 790 AD and I read Hypocrites’ work.
Romilly Hodges: That was cool.
Tom Malterre: Yeah, and they’ve been identifying food sensitivities for a very long period of time, in fact, Hypocrites was basically saying that some people would drink milk and gain strength, and some people would gain weakness.
So let’s look at that type of thinking. It’s normal daily function. Do you wake up and do you have energy? Do you wake up and have mental clarity? Are you able to look at life and say: “gosh, I have this long to-do list, I’m excited about my day, let’s go, let’s go”, and for so many people that’s not the case.
What I see with a food sensitivity response is, particularly with things like gluten and dairy and other foods, is that the mental capacity goes down. The circulation in the brain goes down. The frontal lobe activity goes down. There’s actual research that shows this for foods like gluten.
People can’t function very well, they’ll complain of something called “brain fog”. They’ll complain of fatigue itself, and malaise, they just can’t get out of bed. They’ll have poor mood, they’ll have poor excitement so there’ll be a flat affect.
There’s so many symptoms associated with dropping in your energy function. This would also change, then, digestion for some people. Many people will eat and they’ll get gastro esophageal reflux, GERD as we call it, after they eat certain foods.
And don’t get me started on this one, Romilly. You know I educate the physicians all the time on this, how certain medications, including acid-blocking medications, actually increase food sensitivities and decrease nutrient status. There’s tons of research on this with many warnings from the FDA on this.
But, my goodness, there are so many minor reactions that people don’t associate with food responses. Let me give you some odd cases.
I had a person, that every time they ate gluten, the right side of their face would go numb and they would have a terrible ability to walk. So, we call this ataxia issues. That was interesting.
I have people who eat soy and they’ll get these mysterious rashes. I get lots of people who have allergenic-type responses on their knuckles when they consume nuts. Some will get these bumps in their noses, nodules in their noses when they consume certain nuts.
There are people who consume corn and they’ll get psoriatic flare ups. Gosh, I have so many people get so many different responses, it’s hard to keep track of.
Over time, what I recognize is that certain foods lean more towards certain things than others, but each individual’s unique. So while I’d like to say dairy, for example, is very often times associated with constipation, very often times it’s associated with sinus infections, asthma flare-ups. You know that’s not always the case.
Sometimes people’s sinus infections will come from yeast, sometimes they’ll be stimulated by soy. You just never know.
But, what I would say, is it’s pretty darn consistent that food is often times behind many people’s flare-ups of their immune system.
Romilly Hodges Yeah. What do you say to people who perhaps might be looking for an easier way to find out what foods they might be reacting to, maybe through food sensitivity testing? We get this question a lot, of course, but talk us through why we still might want to be considering The Elimination Diet rather than just doing food sensitivity testing.
Tom Malterre: That is such a beautiful question. Yes, such a beautiful question. Let me repeat back what I’m hearing from you. What I’m hearing from you is people will come in and they’ll say: “you are asking me to change my diet, and I don’t necessarily want to change my diet and here’s the reasons why”.
Romilly Hodges: Give up things, right. Give up things that you really like.
Tom Malterre: And, please can I share a case with you to demonstrate this?
Romilly Hodges: For sure.
Tom Malterre: Okay, great.
I had this beautiful human being come in to see me, as all people are. They came in to see me and they said: “yeah, you know I have these terrible symptoms. Joint pain, fatigue, GI problems and everything. And, I have gallbladder attacks. I went in to go see my doctor and they did this testing and found out that I had the genes for celiac, they found out that I have inflammatory markers of celiac diseases, immunological markers for celiac disease. In essence, I’m a card-carrying celiac.”
So, they come back and say “I’m a celiac, and then I went to see the dietician and the dietician said: ‘oh, well the reason you’re having gallbladder attacks is because you’re eating too much fat, so I’m going to take out these high-fat foods from your diet and watch what happens’.”
So they go home and take out high-fat foods from their diet and their gallbladder attacks go away. Now, they still don’t have the energy, they still don’t have good functioning joints, they still don’t have a good functioning life. They’re still in a state of dis-ease, but now this urgent gallbladder attack is gone, and that’s all they address.
They said: “that’s it, I’m just going to keep the fats out and I’ll be fine”.
And I’m, like, “well why are you here to see me?”.
“Well, I have all these other health issues.”
And I said: “okay, well all these other health issues can be associated with gluten.”
“Oh yeah, but I’m taking out the fat and now my gallbladder attack is gone.”
So, I’m reading this as I have a resistance to hear the truth that gluten could be behind my health conditions. And I ask them, I say: “Look, you are much smarter than I am when it comes to your health. You know so much more than me. Can you please help me right now? Can you please tell me why it is that a doctor tells you you have celiac disease, and yet you’re having a tough time letting go of gluten? You have some sort of wisdom I don’t’ understand right now. Can you tell me what that is?”.
And they look at me and they get teary-eyed and they say: “well, my husband is Italian, and I connect with my husband and his family through food. We go Italy multiple times per year and we have these incredible Italian meals, and if I disconnect with gluten that means I disconnect with my husband.”.
And, I said: “thank you. That makes so much sense. Why in the world would you want to address your food sensitivity if that means separating yourself from your husband and your husband’s family?”.
That’s just so logical, it makes so much sense. And I said: “Well what if we created some options for you?”.
Because, Romilly, pain in life, resistance in life, anything that you come up against an obstacle, is because you’re not understanding that there are more options.
So I asked this person: “Did you know that Italy has the best gluten-free food on the planet?”.
And they said: “what?”.
“Oh yeah, they used to test their entire population for gluten sensitivity and celiac disease, and they would recommend these gluten free diets so many of the restaurants will have gluten-free options. They make some of the world’s best gluten-free pastas. There are gluten-free options for pretty much anything you’re looking for.”
They had no idea. They said: “well I still need a good bread”.
And I said: “did you know my wife and I wrote these three books and we have gluten-free bread that will knock your socks off?”.
“No, we had no idea.”
So I started providing some options, and then the openness to actually looking at the food sensitivity appeared. So that issue of you taking away someone’s freedom, you say I want you to eat certain foods for awhile, immediately they hear “I want to take away your favorite toy, I want to take away things that you love”. It’s an autonomy issue.
“I’m a human being, I have a right to eat whatever I want, whenever I want.”
I said: “yes you do, and you have the same rights to feel that joint paint. You have the same rights to feel fatigue all the time. You have the same rights to have your Hashimoto Thyroiditis. Many times the antibodies will decrease by 50% when you cut out that gluten, so yes absolutely, you have that right, and you’re coming to see me because you want to change things.”.
So I think that consciousness has to be raised up first before we start talking about why people want the IGG and IGE-IGG (food allergy/sensitivity) testing.
Yes, food restriction, for some people, can feel like just that: restriction. For other people it can feel like food freedom. I let go of the foods that do not serve me, I start consuming foods that leave me supercharged, and all of a sudden I have freedom from my suffering.
So, with that being said, if someone comes in and says: “I don’t have the time, I don’t have the energy, I don’t have the resources”, right? This is why we wrote a book, this is why we do an online program, we do all these things to support people because they come up with excuses or reasons why they can’t do it.
And we say: “a-ha, I understand you don’t have options, I will make them for you. I will make you option that will get you through your hardship”.
Yes, I understand that.
Now, if they’re still resistant and say: “I just want a test, I want you to take my urine or my blood, or whatever you’re going to do. I want a lab test right now to make my life easy”.
What I have found, and I run thousands of those lab tests, is that they don’t’ appear to be as accurate as the food trial removal investigation experiment called The Elimination Diet.
I’ve seen people have terrible reactions to soy, and corn, and gluten, and dairy and eggs, and they won’t be picked up by these exams.
I’ve had a person who had this terrible rash on their cheek with corn, and they said: “I just ate it last night and this rash comes back, I’ve been doing this over the last couple of months. I’m aware now that corn is a problem for me, and yet look at my lab test. It says no response to corn.”.
I think what the problem is with these tests is they’re limited based on the specific protein what they call antigen that they are testing, versus the antibody that’s secreted by the person in front of you. And the reality is, we’ve seen this for decades in Europe and certain labs here in the U.S., is that some people have been investigating simple antigens for casein and whey, and other peoples are looking at the sub-fraction of casein and whey, and instead of 1 or 2 different things we’re looking at, we’re looking at 8 or 10.
And when it comes to gluten, for example, we now know from Vojdani and the Cyrex people and what-not, there are reactive peptides from gluten that are above and beyond what we ever thought. You can go all the way down to tetra-peptide which is just four amino acids that could be reactive from gluten.
I would say the labs themselves are limited based on what you’re looking for. And here’s the problem I see with that, Romilly, is that so many people put so much stock in conventional medicine. They’ll put stock in the doctor’s word, they’ll put stock in the lab results, and they’ll get back the results and the result says: “I’m not reacting to a specific food”.
When they see that result they’ll say: “well, I don’t need to do an Elimination Diet of gluten and dairy, my lab says right here that I don’t respond to gluten and dairy”.
Actually, the IGG panels often pick up dairy and eggs, they’re pretty good about picking those two up. But gluten, they’re terrible. The soy and corn they’re even worse. There are certain things they don’t’ necessarily pick up frequently, that I wish they would.
A false-negative is terrible.
The other thing about the IGG panels, the IGE panels, is that what you’ll see, Romilly, is someone who’s been on an acid-blocking medication or someone who has a digestive disorder like Whipple’s, or celiac, or cystic fibrosis, they’ll bring back these panels and everything is lit up. Oh my gosh, they’re reacting to asparagus. They’re reacting to blueberries, and they’re reacting to coffee, and they’re reacting to walnuts.
And they’ll say: “wait a minute, I don’t eat any of these foods. What’s going on? Why am I reacting to all these?”.
And when we look closely, it’s in the literature and clinical case studies. It’s very, very, very, very clear that when someone has low gastric acid, when someone has poor digestive capacities they don’t break apart their proteins very well. And when they don’t break apart their proteins very well they react to more of their foods.
In fact, there was a beautiful study in FASEB showing that when people took these acid-blocking therapies called “proton pump inhibitors”, and in a short period of time their acid level went from being similar to battery acid to that of table vinegar. And instead of breaking their foods down they’re now marinating their foods and the protein structures are making it into the upper intestinal track very large, very reactive, and they’ll end up with bacterial imbalances and intestinal permeability.
I don’t know if you know this, Romilly, but in a short time after taking the PPIs, the research is showing that people get intestinal permeability. The same pump that the PPIs work on, the acid-blocking medications work on, work on the same things that keep your intestinal tract closed.
So, you end up with undigested foods that pass through the intestinal lining. Now you have the perfect recipe for people developing food reactions. In fact, that FASEB article showed a drastic increase of both food and airborne allergens when people were on PPI therapy, and even after they stopped the therapy those allergens and those responses would last for upwards of five months.
So it’s really important that we take into consideration the entire system when we’re looking at why a person is reacting. Are they digesting? Are they chewing? Is there a lot of stress in their life causing intestinal permeability?
And what I try and do is raise consciousness about all of those things in my Elimination Diet book.
Romilly Hodges: I think those are all really important points to make about why doing something like an Elimination Diet is so valuable, and the point about stomach acid and proper digestive capacity being so important for anybody who is reactive to food, I think it’s just really worth underscoring that. So often we’ve been ingrained with this thought that stomach acid is destructive and it’s not good, but in the right place and in the right capacity it’s really essential.
That’s really important consideration. It’s a piece of this puzzle of the healing aspects of the food Elimination Diet, not just the investigative aspects of it.
Tom Malterre: Yes, and I’ll share a little tidbit on that. One of my colleagues from Bastyr University, Dr. Adam Geiger, he was my climbing partner. We taught climbing classes at Bastyr together. He really took an interest in the Heidelberg Test, which is a test to determine someone’s functional gastric acid secretion.
When he was working at a medical clinic in Federal Way, he started running all of his clients through this Heidelberg Test. It’s a functional analysis so it determines how much acid a person is secreting. What he found was fascinating.
He tested 199 consecutive patients walking through the clinic door that were complaining of what would be call dyspepsia or indigestion, and they would have things like gas, nausea, bloating after eating, they would have undigested food in the stool. They would have all these symptoms that would label them as having indigestion, if you will.
And he did this analysis on those people, and what he found through those 199 different people is the vast majority of those people were either slightly insufficient, moderately insufficient, or severely insufficient in acid. In that particular trial it was equating out to about 0% of the population that had excessive, but he kept running these people through the Heidelberg, and over years he’s now decided that it’s about less than 2% of the population actually has excessive acid.
Now, that’s one guy in a non-published clinical trial, but if you look at people like Jonathan Right, who wrote a book called “Why Stomach Acid Is Good For You”, you’ll see that there are many, many, many, thousands and thousands of people who have this similar gastric acid insufficiency. I can’t tell you how many articles are now coming out, Romilly, in conventional GI journals, showing that 70+% of prescriptions for PPIs now are uncalled for according to standard medical research protocols.
It might be a bigger issue than both you and I are conscious of, and I’m hoping we raise awareness on that.
Romilly Hodges: Thank you. Thank you for bringing that up as well.
I can still understand from the perspective of somebody, because I’ve done this myself and I’ve done it with my family, but doing an Elimination Diet is not just something you can whip up in a few hours. It does require an investment of work.
How do you get people started, specifically if they’re worried about giving up certain foods, or maybe they’re experiencing cravings and they’re worried that they won’t be able to succeed on The Elimination Diet because of those?
Tom Malterre: Thank you so much for bringing the cravings up. That’s huge for a lot of people. There are some well-known cravings that people know about, and that would be caffeine and sugar, of course. Sugar can be more addictive than cocaine in certain people with certain genetics. And caffeine, of course, you go through that withdrawal period and that is terrible.
Many people crave bread and cheese, and not many people are familiar with the fact that those two food groups, or types of foods I should say, have specific proteins in them, peptides in them, that bind to receptors in the brain that are stimulated by opioids. We all these opio-peptides. The pseudo-opioids stimulating substances, so gluten, morphin, caso-morphin is what they’re called in scientific literature. Morphin meaning, like, morphine.
And what we see is when these peptides are consumed, they actually bind to these receptors and create sedation, so calming, and addiction. You say: “that doesn’t make any sense. Where would that be coming from?”.
In fact, the dairy makes perfect sense, the gluten just happens to be its protein structure that’s similar. But I give this example of a child when it’s young, when you breastfeed, will calm down. I have five children, I know when they’re crying Mom used to breastfeed them, they would have their eyes rolled back and they would be completely docile.
Well, it’s similar in nature. If you have a young animal, like a colt in the wild ranges of Montana, who’s trying to grow quickly to avoid being eaten by wolves, that colt will need to receive some sort of signal from Mom to come back to breastfeed as often as possible. Mammals, those who suckle at the mammary gland, need to come back often, and then they need to stay longer.
If you have something that’s sedated and addicted, then it will feed more. It’s a survival mechanism.
Unfortunately, in the human population, for some reason we’ve chosen the habit of consuming the milk of other species after we’re weaned, and we have an interesting habit of drawing out extra moisture from milk, extra fat from milk, and using something like rennet to ferment or cure cheese over a long period of time. We end up with this block, then, of what’s called casein, or caseomorphin, that can stimulate these receptors, and we call them cheeses.
These things like cheddar cheese, a hard cheese, will have a tremendous amount of these caseomorphins. So what I’ve seen over the years, Romilly, is fascinating. I’ll have people who’ll call me up in the middle of the night and say: “hey Tom, I’m dreaming of cheese right now, I can’t get away from the cheese and I’m having these terrible sweats and nightmares, and it’s all about nachos. I’ve got to have some nachos right now”. And, you know this is a person who had a history of substance abuse and they have the specific genetics that allow them to be over-responsive to these opioid-like compounds, peptides.
So it’s real. If you even look briefly through the social media you’ll hear when people like Oprah, or Kim Kardashian will go on these elimination-type diets, that’s the thing they’re craving, is the cheese.
Yes, these things will happen and I will say how do you get through anything in life? Well, number one, you have a solid foundation and motivation to do it. I often ask people to choose a goal and I’ll say: “shoot yourself talking to yourself about your goal”.
“Hi, I’m Tom. I don’t like my fatigue and my joint pain. I get gastro-intestinal upset, within two days after eating something with gluten in it that’s terrible. I’m done with my fatigue, my joint pain and the gastro-intestinal upset. When I feel better, I am going to communicate and teach the world about this so I can inspire others so they don’t’ have to suffer.”
So there’s an example of a brief video I would shoot of myself, talking to myself so I would have motivation.
Then, when you have the motivation, right, after getting the education that you’ve gotten through me or your clinic, or whoever else you’re going to get it from, then I want you to go ahead and get support and accountability. So you’re either working with a coach, a nutritionist, a physician. You’re working with somebody that you’re accountable to for making progress.
And then, you get somebody close to you. This could be a friend at the office, this could be your best friend, this could be your spouse. This could be somebody that you use as a support team member. If you can, by any way or means, get that person to participate in The Elimination Diet, great. The success rate goes through the roof, when you can get one or more additional people going through The Elimination Diet with you.
I had an entire church go through it, and that was fabulous. They had so much fun, and people had fabulous results. They were sharing recipes, they were doing cooking groups together. It’s great when you can get people to participate with you.
So, you have your goal, you have your accountability and support, and then you just need to make sure you have a plan that’s very well outlined. Whether you’re using a book or a program from your practitioner’s office, something that’s really well outlined and you have all the resources and tools you need to succeed, then run. There you go, you’re off, you’re going to succeed for sure.
Romilly Hodges: Great, great. What happens when people get to the end of their elimination phase? How do you recommend people add foods back in?
Tom Malterre: That’s great. I’m going to go back track one thing, Romilly, and I’m going to say when people are overwhelmed by The Elimination Diet, when they look at the whole process and they look at the yes and no lists, and they look at this thing, and they just… they’re eyes gloss over and they say: “Look, I got three kids, I got a job, there’s no way. I don’t have the time. I just don’t have the time.”.
Here’s what I would challenge people to do. I’ll challenge you to choose 10 to 12 recipes to get totally dominated for your family and yourself, so you know exactly how to prepare for them, how to shop for them. 10 to 12 recipes over the next few months of your life.
So, if you chose a recipe a week, one recipe a week that was Elimination Diet friendly, and then 10 weeks later you had 10 recipes, and then 12 weeks later you had 12 recipes, after the end of those three months, those 12 weeks, you have these incredible recipes. You’re done.
The average United States family eats between 11 and 13 meals, with different variations, over and over and over again. Whether it’s the pasta meal, or the taco Tuesdays, or whatever it is, you eat the same meals over and over and over again.
So all you really need to concentrate on is doing one recipe a week for 12 weeks. You’re done. Now you just choose that time when you start eating nothing but those 12 recipes and life is easy.
Okay, so now to your other question. Your other question was once I’m done eliminating these foods, I’ve taken out at least the top six or seven gluten, dairy, eggs, yeast, corn, soy, sugar, if you take out those foods and you take them out for your 28, 30 days, whatever your time frame’s going to be, your symptoms hopefully go away.
I just got an email this morning. It’s so lovely having a book and blog and a website and everything because I get these communications from people. A person six days in now, all their symptoms are going away, it’s fantastic.
But now, hopefully, your symptoms are calm, and that’s the whole crux of your experiment is you want to have your symptoms calm, your intestinal tract calmed down, your skin clear up, your brain fog go away, your energy increase, your rheumatoid arthritis pain dissipate. If, at that time, the symptoms are gone or diminished enough you can notice a difference if you challenge something back in, then you can start choosing foods.
You can say all right, today I’m going to add in corn. And for corn, I’m going to go get whole kernel corn, and I’m going to make sure it’s an organic-type corn so it’s not some interesting protein structure, different GMO corn or what not, and I’m going to be consuming this corn as a whole corn, and I’m going to do it a couple of times during the day. Or, it’s a sprouted corn tortilla and the only ingredients are corn and water, or whatever the case is.
Then, you’re going to be consuming that a couple of times during the day, and you’re going to wait for symptoms. So, if your primary issue was with energy, does your energy drop? If your primary symptom was joint pain, does your joint pain come back?
Really be conscious of the nuances. Some people will react so mildly they’ll say: “yeah, you know it’s weird, I have this muscle fatigue, but maybe that’s because I worked out three days ago, maybe that’s still resilient.”. Or, “I’m getting this sinus congestion, maybe it’s because I’m coming down with a cold.”, that could be the case.
But my philosophy is if you’re running an experiment you need to be true to your experiment. When in doubt, leave it out. If you start reacting to something and all of a sudden your mind isn’t clear and you get really moody, have looser stools, and you say: “I don’t know, it could’ve been the food, could not have been the food”.
So easy for us to excuse things away. While you’re doing this experiment your job is to suspect, investigate and suspect that if there is a response it may be from the food. You can add that food back in a few months later if you want to re-challenge it and you’re not sure about that food. But leave it out now because your symptoms came back.
Then you wait for those symptoms to subside, and you challenge in the next food if you do have symptoms. If you don’t have symptoms, usually it’s about a 72 hour period that we wait. Some people do an extra day on top of that so 3 to 4 days. After that time frame… and some people do 2. After that time frame if you don’t notice any changes then you can add in the next food and see if something happens there.
Romilly Hodges: Yup, that makes sense, that makes sense. I think that one of the things I see happen and I think you’re kind of in agreement with as well is that sometimes we need to be really convinced of something before we fully let go of needing to have that food in our diet. I know that sometimes it takes this little bit of cycling where you try it, you’re, like, “I don’t know, it could’ve been, but I really wish it weren’t something that I’m reacting to. Am I going to need to try it again to convince myself again, one way or another, if it’s a problem?”.
Sometimes there’s this back and forth that goes on and I think that’s perfectly okay, because if you’re allowing yourself that experimentation and eventually you’ll get back to the place where you won’t want to do it anymore because it’s so clear, that link between consuming the food and your symptoms.
Tom Malterre: I’m raising my hand, because that’s me. Right?
Romilly Hodges: Yeah, I know. It’s all of us.
Tom Malterre: Oh yeah. I did an Elimination Diet and I discovered that I had this gluten sensitivity that was behind my fatigue and my joint pain and valve problems and mood flare ups. I knew that was the issue, I knew it. I did a very good Elimination Diet, I kept track, and it’s great to journal your symptoms. It’s great to do video every day and talk to yourself about what you’re experiencing. It’s amazing what you look at later on because you’re right. You forget, number one, that you had those responses, and number two, your cravings can be so strong sometimes.
Your social setting can be just perfect for your psyche where you just don’t want to restrict yourself. It could be a party, a birthday party, it could be a celebration. Mine was coming off the base of a Mountain, of Whistler, and seeing this huge mound of nachos at the table next to me, I’m just, like, “I want that”. Right?
And then I have a dairy and a gluten sensitivity. There’s different things, there’s different cues, and when it came to gluten my favorite thing to eat on the planet was this burrito that I got wrapped in a whole wheat chapatti. And it was decadence to me, I just thought it was the best thing on the planet. I would just break down and eat one every once in awhile and I’d suffer for a few days or weeks, depending on how long the symptoms would last.
It just came, after awhile, that my head got really sore. It felt like I was just banging my head against a wall going, “okay, you know what? I know every time I eat this it hurts but I’m going to do it again. I know every time I eat this it hurts but I’m going to do it again”.
And then pretty soon I was, like, “wait a second, this really hurts. And it really lasts a long time, and it’s not worth it. Why don’t’ I just take it out, use a corn tortilla, or just eat the beans and rice by themselves, or whatever the case is”, and next thing you know, I get all the benefit of the flavor without that one little thing, and I don’t have to have the terrible suffering that comes with that.
So yeah, you’re right. It takes some discipline, it takes some time, it takes some suffering, you reaching a point. Oftentimes people need to reach a really lousy point of being collapsing in my office, saying: “look, I have now three diagnosis of immune diseases, I have this incredible fatigue, I can barely walk, I’m on 17 different medications. What do I do?”.
And I can go back and say: “well hey, let’s look at your food first”.
We start doing an Elimination Diet, you know, 12, 14, 16 days later energy’s better, all of a sudden blood pressure’s normalized, pain’s gone. It’s just incredible.
Romilly Hodges: That’s great. Thank you. Gosh, I’m just eyeing the time and I was getting carried away not paying as much attention to it as I should. I think we’re going to have to draw, sadly, to a close, but I love the way you talk about this, Tom, and I think you’re very inspiring, and how you share the stories that you have, and the experiences that you’ve had with patients and yourself. I appreciate your time and all of the great information that you’ve shared.
Tom Malterre: Well, I am such a huge fan of you and Dr. Kara. I’m happy to support your endeavors at any time, so it’s an honor to be part of this, thank you.
Romilly Hodges: Aw thank you. Before we go I just want to mention again about your book, The Elimination Diet, and could you just let people know how they can best find you on the web if they want to learn more about you and what you do?
Tom Malterre: Sure. Your best way to get ahold of me at this time is “wholelifenutrition.net”.
So, “wholelifenutrition.net” is our website and you’ll see information about the book there, program, services, whatever it is you’re interested in, and we do have a blog that’s associated there. We do write some blog articles that are interesting about food sensitivities and migraines and gallbladder dysfunction, and all sorts of different things.
Romilly Hodges: Great. So, I hope to anybody listening that this has been helpful and inspiring and maybe just what you needed to kind of move to that next stage, that next step on your path to wellness.
Thank you so much, Tom, and we’ll say goodbye for now.
Tom Malterre: All right, take care. Bye bye.
Romilly Hodges: Take care.