Restricted Diet a cautionary tale
A restricted diet is a question i get a lot. I met a family a short time ago after their allergist referred them to me. The little girl was having issues with eczema, generalized rashes, nasal congestion, some sinus infections, and occasional upper respiratory infections. The allergist had conducted blood work and skin prick testing to determine food allergy to explain her symptoms. 
The allergist told me that he was concerned about this girl’s height and weight growth pattern—especially her lack of height growth over time.
I met her in my office and her size shocked me. She looked frail, had thinning hair, was pale, and had low energy for someone her age. Her growth stalled to the point that she had “fallen off” of her height and weight growth curve.
Reviewing diet history
After getting an extensive diet history from the parents starting at birth, I learned that she was breastfed and supplemented with infant formula that was supposed to be “easier to digest.” Mom reported the baby had a difficult time transitioning from formula to cow’s milk. She decided to use a combination of alternative kinds of milk–soy and rice milk. Recently, her diet consisted mainly of rice milk since she preferred its taste. Unfortunately, rice milk is naturally a poor source of protein, unlike cow or soy. She ate a variety of foods during the first two years of life, but gradually, her diet became more and more limited. At the time of the first dietitian visit, this girl was on a dairy-free, wheat-free, gluten-free, corn-free, and mostly soy-free diet. She did not include any sources of fish or shellfish and rarely ate any nuts.
Restricted diet. Parents explanation
The parents explained that they read online about how certain foods can cause food allergies and may lead to the symptoms that their daughter was having. By the way, healthcare providers cringe and maybe even cry a little bit on the inside when they hear a patient say the phrase “I read on a website…”
This little girl was not happy on this very restrictive elimination diet. The parents had difficulty finding foods that she enjoyed, and she was eating when her parents forced her or bribed her. Based on what I heard from the parents and the child, she ate just enough to ward off hunger.
I immediately requested additional blood tests to determine just how severe her nutritional deficiencies had become. Most of the results did not surprise me, but one lab value did, and that was her deficient prealbumin level. Prealbumin can reflect the body’s capability to call on protein stores to support many different body functions. It also is a useful indicator of nutritional status.
A well-intentioned mistake
The food elimination or restricted diet, which limited primary foods/food groups, looked to find a solution to her symptoms. They preferred to avoid controlling her symptoms and multiple medications or restrict her activity. What they failed to recognize is that by removing the top 8 food antigens, they were slowly and unknowingly starving their daughter and jeopardizing their growth potential.
Malnutrition is a direct result of the restrictive diet. Furthermore, the symptoms did not improve, –eczema, generalized rashes, and frequent respiratory infections.
Her diet made symptoms worst because she lacked calories, fat, protein, vitamins, minerals, and other nutrients. Calories have much higher calorie needs than adults because of their growth and development.
The body must have protein, fat, glucose, vitamins, and minerals to fight illness,
higher demands placed on the body, the body can draw from its reserves to fight off infections. A restricted diet is essential, but y supervised by a doctor. This little girl was approaching the need for a lengthy hospital stay to acquire nutritional support. Her body did not have any reserves to fight off infections and simultaneously grow.
Your must visit an allergist, to confirm any suspicions about allergies and symptoms. The dietitian determines your child’s calorie, vitamin, and mineral optimal intake. The dietitian will decide the foods that will help your child grow. Simply removing foods without finding alternatives that provide a comparable nutrient profile can potentially do more harm than good.
Fortunately for this little girl, the parents were very open to change and wanted their daughter to be happy and healthy again. The allergist helped them find a regimen to control the clear up her skin, stop the itching, runny nose, and cough.
The doctors and team determined, Through trial and error, the cause of her symptoms, (the presence of pets was the ruling factor), and she gradually returned to a regular diet. She was placed on a high-calorie supplement for a short time to help her body overcome her nutritional deficits and regain the weight it so desperately needed. She started to grow again as her overall dietary status improved.
There are situations where food allergy plays a role in the development of a rash or worsening eczema. See your doctor or dietitian before starting an elimination diet.
Our guest blog today comes from Alexia Beauregard. Alexia Beauregard is a Registered Dietitian. The inspiration for this blog is her extensive experience working with the families of patients diagnosed with EoE.
