EDITORIAL NOTE: We enact eliminations all of the time and it’s really important as clinicians that we have some experience with enacting these in our own lives. My whole movement into practicing Functional Medicine originated from my family’s own health experience and needs, and we have essentially been on an Elimination Diet for the best part of a decade. In our clinical practice, you’ll find us individualizing the Elimination Diet to no end. We often pull out some combination of other intolerances (non-immunological), food sensitives, food allergens and pollen-food cross-reactions. The power and flexibility of the Elimination Diet as both a diagnostic and therapeutic tool cannot be understated. Below is part of my story, food-journaling our recent road trip. In it I hope you and your patients find the tips and inspiration you need to make any Elimination Diet a success – Romilly Hodges, Director of Nutrition Programs
Our family of four just returned from a 10-day road trip to Montana, South Dakota and Wyoming. It was the most fabulous adventure and we hit many of our ‘bucket list’ places to see. But what about our myriad dietary requirements – serious snag or ‘s-no problem? Read on to find out!
Learn why an Elimination Diet is a fundamental Functional Medicine tool here.
My 8-year-old son has anaphylaxis to egg. We carry an epi-pen everywhere we go and (thankfully, knock on wood) have never had to use it. Egg is not something any of us eat at home/together now, since we don’t want to add to the risk of exposure. Most people who are using an Elimination Diet (either temporarily, or longer term) don’t have to worry to that extent, but that’s how it is for us. Side note: if you’re on a longer-term elimination, you’ll also need to pay closer attention to avoiding nutrient insufficiencies which CAN happen even on a whole-foods diet.
In addition to avoiding egg, we don’t eat gluten, dairy or soy for reasons related to triggering a variety of symptoms among us including eczema, joint pain, headaches and sinus congestion. It’s not a hop too far for us to avoid the other foods often excluded on an Elimination Diet such as corn, shellfish and peanuts (which we did only for this exercise—we don’t have any reactions to these foods ordinarily).
Since, with patients, we typically do an Elimination Diet for 3-8 weeks, this process sometimes conflicts with travel plans. In fact, it’s one of the biggest reasons we hear for delaying on starting the Diet! But erring on the longer side is better since any delayed food sensitivity antibodies will only have reduced by half after 21 days. And it’s really important to stick to the Elimination Diet without deviation because any consumption of the eliminated food ‘resets’ your antibody levels back to the beginning and you have to start again. Ugh! In the end, for many of us, the reality is that we will be following an Elimination Diet while traveling.
In an effort to avoid having all your hard work go to waste, I’m sharing my own notes on traveling with dietary restrictions, should you have to do the same. I hope it helps you!
By the way, some of you are very savvy about managing dietary restrictions on the road. Please comment away at the bottom of this blog. We would LOVE to hear your tips.
Top tip! Traveling on an Elimination Diet. Yes, there is a bit of grieving for the loss of your previous carefree ways, but if you allow that to happen—and not hold you up—you’ll see that an inspiring, just as great, if somewhat different, travel experience is waiting for you ahead! And maintaining your therapeutic diet while traveling is empowering and motivating in a way that immersion in the creature comforts of home just cannot be…you’ve really accomplished something!
Big sky country
Travel has always been a part of my life, other than perhaps for a brief period when the kids were very little. Big chunks of my childhood were spent in Africa, South and Central America and Europe, where my parents and most of my extended family still lives. The American West is completely romanticized in my mind, with its backdrop of big vistas, Ansel Adams-captured landscapes, horses, wild animals and stars. To say that we were excited about this trip was somewhat of an understatement. Amidst the chirps of “Can we go to Mount Rushmore?” “Will we see a bear?” “What about the Badlands?” and “What’s a geyser?” my husband quietly said, “What are we going to do about food?”
Where there’s a will there’s a way… and advance planning helps.
Tom Miner Basin, MT (most grizzly bears per square foot in North America)
A few months before…
First stop, Airbnb.com! Seeking out places with kitchens, where we could do some food prep for the day and cook simple dinners.
Both our outbound and inbound flights from/to New York City left at 6am or earlier, so we also chose to stay overnight in airport hotels each way.
Top tips! Before you even get in a plane, train or car, traveling on an Elimination Diet requires some planning. While there are some restaurants and store-bought foods that will meet your requirements, you can’t always guarantee they will be available when and where you want them. You’ll want to ensure that you won’t have to go hungry or give in to temptation.
Accommodations with kitchens are ideal. If you have to stay at a hotel where they can’t fully accommodate your diet, a rice cooker will work in a pinch. You can usually pick one up locally pretty inexpensively and donate it when you leave. It can make all the difference!
A few weeks before…
As our travel dates neared, I started collecting various dry/light foods that I wanted to take with us, like seed crackers (Mary’s Gone Crackers, the soy-free ones), Vermont Mini Beef Sticks*, TJ’s Crunchy Broccoli Florets, and Go Raw bars. I like teas a lot, but not the ubiquitous Lipton, so I set aside a variety of oolong, rooibos, chamomile, chai and breakfast teabags. I pre-mixed some favorite spice blends in single-use baggies.
Our dehydrator was set to work, making granola, veggie chips, cauliflower ‘popcorn’, fruit leather, snack bars and buffalo jerky. Everything made in a dehydrator comes out super light and concentrated, so it makes great travel food.
Greybull, WY (view from ‘our’ back deck)
The day before our flight…
The kids and I baked some breakfast nut and seed muffins for the plane (see here for similar recipe).
I also made extra of the dry mixture and popped it in a container to take with (for return plane muffins). To make the dry-mix recipe simple, I used garbanzo bean flour, which is more ‘bind-ey’ by itself than most gluten-free flours, baking powder, baking soda and salt, and added some dehydrated nuts, seeds and dried blueberries. This left only oil, mashed banana and milk/water to be added in when the time came to finish it off. If you want to be able to use zucchini or carrot, I would suggest dehydrating them ahead and adding to your dry mix, more for convenience than anything else. Free standing paper baking cups worked perfectly and meant we wouldn’t need a muffin pan to bake them.
Off to the airport hotel we went. Airport hotels are so charming, aren’t they? 😉
At least we could sleep in until 3:30am instead of having to get up at 1:30am!
In the air!
Needless to say, we all managed to be very awake and present at the required time. Exciting vacations will do that for you. Fueled with an onboard muffin, an apple and cup of tea with almond milk (thank you Starbucks!), we felt like we had conquered the first hurdle well.
Layover in Chicago O’Hare – we found fresh fruit, fresh veggie sticks and hummus, and supplemented with our own snacks.
With the early start and time difference, tummies were rumbling for lunch on the second flight to Bozeman, MT. Enter the lunch pot: Dr. McDougall’s Pistachio Citrus Quinoa Salad and Sweet Potato Kale Quinoa Salad were our choices here, as well as Chef Soraya’s New Mex Chili Lime Beans and Rice. They’re very light, and with some hot water sourced from the cabin crew we were good to go. “There goes the ramen noodle family,” snarked one steward. Little did she know…
Don’t worry, if you’re just doing this for one person, you’ll be far more discreet 😉
Landed, what now?
Bozeman is quite the food-forward city! Organic, farm-to-table, fresh cooked options were readily available. Nowhere else on our trip was quite as amenable as this “Most Livable Place.”
In our rental car (with only 4 miles on the clock!), we headed to the Bozeman Co-op. Score! Happily, we gathered our almond and cashew milks (grass-fed cow’s milk for DH’s coffees, who was only prepared to partake in this Elimination Diet experiment up to a point!), fresh veggies (pre-cut/prepped as possible), berries, rice, chicken and some ground bison. Oranges and apples make good travel fruits since they’re less delicate than stone fruits or pears. Almond butter and rice cakes. Bob’s Red Mill Gluten-Free Tropical Muesli. Some compostable plates and cutlery snuck in too, anticipating picnics.
Next stop, Walmart, to pick up a car-powered, iceless cooler. Yes, a bit of an investment but well worth it to keep our cold food items fresh on our long drives, and much less than the cost of most meals out. A few muffled curses later, and hubbie had rearranged the trunk to fit it in.
Bighorn Canyon, WY (picnic spot)
On the road…
Well, we soon learned that keeping ALL the snack items in a big bag close to hand results in significant bingeing. The novelty for the kids, combined with there being not much else to do while you’re driving and looking at the view was just too much temptation! Most of the snacks, except what we thought we’d need immediately had to be sadly confined to the trunk.
Since we were on the road a lot, and visiting the sights, we often arrived back to our residences rather late. It worked best to stick the oven on, or get food started as soon as we arrived, even before unpacking. Then dinner could be making itself while we sorted other things out.
These are some of the meals we made in the various kitchens. They aren’t anything terribly fancy, especially since we bought pre-prepped veggies as much as possible and I had my spice mix baggies to tip in or sprinkle.
- Mexican-spiced chicken with roasted cauliflower, baby spinach leaves and refried black beans
- Salmon steaks with rice and broccoli
- Chicken-coconut curry with onion, sweet potato and carrots (one-pot meal)
- Ground bison with onion, beans and rice, kale and tomato salad
- Chicken legs with new potatoes and carrot-cabbage slaw (no mayo)
- Warm cumin-chickpea chunky salad with sun-dried tomatoes, lettuce, cucumber, carrots and parsley
Often, we’d make extra dinner to have cold in a salad the next day.
Grand Prismatic Spring, Yellowstone (now that’s a microbiome!)
I really didn’t expect to find much in some of the places we’d be traveling to, but I was pleasantly surprised! Here are some of our favorite food finds from along the way:
Some favorite finds:
- Co-op in Bozeman, MT: Treeline Cashew Garlic and Herb Cheese, olive snack packs
- Reese & Ray’s IGA in Buffalo, WY: Shredded carrots and cabbage for instant mayo-free coleslaw
- Blair’s Market in Greybull, WY: Almond milk
- Mountain High Health Foods in Cody, WY: More cashew milk and muesli
- Minneapolis St. Paul airport (return layover): Kale chips, hummus
Eating in restaurants.
Eating out on an Elimination Diet or with food allergies can be challenging. Since we had access to ingredients and kitchens along the way, we planned only 3 meals out for the entire trip.
Being in cattle country, we wanted to take advantage of the local foods, especially grass-fed beef*, bison and trout. And we certainly weren’t disappointed!
When trying to find somewhere to eat, I find that planning, again, pays off in spades. There’s nothing worse than trekking from place to place at 7pm, trying to find somewhere suitable, getting hungrier (and grumpier) by the minute. I strongly recommend researching and talking to restaurants in advance, even before you leave on your trip. Obvious good choices are restaurants that have a top-8 allergy menu listed on their website – score! Another good place to start is any restaurant that looks like it takes pride in its ingredients – such as farm-to-table. Places that will be much harder work (and probably best avoided) are diners, brunch places, and most fast-food restaurants.
Oftentimes, I find it easier to ask for what I want rather than what I don’t want. For example, asking for simply-cooked meats, vegetables, rice, cooked with only olive oil and salt often seems to bring relief to the poor staff member I’ve just put on the spot and most-frequently is answered with ‘yes, we can do that!’
These are the restaurants that worked for us on our journey:
- Deadwood Legends, Deadwood SD. We ate steak* with green beans and baked potato drizzled with olive oil.
- Chico Hot Springs, Pray MT. We ate trout with asparagus and sweet potato.
- Ted’s Montana Grill, Bozeman MT. We ate a bun-less bison burger with kale salad, avocado, tomato and onion. Their pickled cucumbers were delicious!
Crazy Mountains, MT (remember that scene in The Horse Whisperer?)
Catering for a serious food allergy
Not everyone on an Elimination diet will need to go to extreme lengths to avoid minute food contamination, but if one of your party has life-threatening food allergies, or Celiac Disease, here are my top tips:
- Bring aluminum foil to line baking sheets in rental kitchens
- Bring your own kitchen scrubby sponges
- Don’t use toasters or toaster ovens (too difficult to keep clean)
- Wash pots, pans, plates and cutlery before use
- Know where the nearest hospitals/ERs are
- Keep your medications available, not packed at the bottom of the trunk
When talking with restaurant front-desk staff, serving staff or chefs, I always mention the serious egg allergy off the bat and note the response. I like to hear the staff talk knowledgeably about their menu and ingredients, about potential food cross-contamination on grills and in fryers, and to be aware of ingredients labeled ‘made in a facility with’… We talk about likely places a food allergen can hide, such as sauces, marinades, flavored rice and stock-based foods.
If I can’t have this level of conversation with restaurant staff and chefs, I just move on. It isn’t worth the risk in my book.
Supplement food options
We didn’t use any supplemental ‘medical food’ smoothies, shakes or bars on this trip since we were fortunate to be able to plan access to fresh foods and kitchens. However, if you’re unavoidably traveling to a hotel (such as for a conference), you might find that bringing some of these along can be helpful when you really get stuck. Talk to your nutritionist about which ones would fit with your dietary plan or Elimination Diet.
I admit, though, to always checking out and using local accommodations with kitchens near the conference venue where I can!
Overall, have fun!
Life is for the living, in my book. And I don’t want food requirements to stop us from bonding as a family and having fun experiences that make lasting memories. Taking a little time to plan can really make all the difference in both sticking to that all-important health plan, and making your trip enjoyable.
Cabin at Green Mountain. Nemo, SD (spot my shadow!!)
Please share your travel and food experiences below! We love to hear from you.
*If you’re following the IFM’s Elimination Diet, you’ll likely be avoiding beef. As an alternative, choose bison/buffalo, or fish such as salmon.