Here we are, amid the seductive pages of a food magazine. Mouth-watering photographs, tempting recipes, and invitations to dine out abound. It’s a perfect place to discuss restrictive diets, or eliminating certain foods entirely. Think about taking a culinary comfort, perhaps your most favorite, and waving goodbye.

I recently began an elimination diet that excludes most carbohydrates, including sugar and sweeteners, grains, fruits, root vegetables, beans, and alcohol. I’m not eating dairy either, except for the dollop of cream I tip into my coffee each morning. My goal is to avoid the hay fever that plagues me every June, making me feel useless with low energy and an itchy, puffy face. My husband, an enthusiastic rock climber, is on the diet with me, and his usually achy knees hurt and inhibit his movement much less since he started. Meals in our house consist of meat and vegetables.

This is not my first experience with a restricted menu. When I was younger, I suffered from recurring urinary tract infections. Every time I showed up in a doctor’s office with a positive test result, I was prescribed a round of antibiotics. My symptoms would subside, only to re-emerge in a few weeks or months.

I decided that repeatedly assassinating my gut microbiome, the very beings who might help me fight my chronic infections, was no longer my preferred method of treatment. I resolved to address my infections with herbs and diet. I visited a naturopathic doctor who put me on a protocol of antimicrobial herbs. I read a book with a Chinese medicine-informed approach to diet. After concluding that my constitution was too “hot” and “damp,” a result of my deep and abiding love for cheese and ice cream, I stopped eating dairy, sugar, and gluten. I ate a lot of broth, mushrooms, asparagus, and beans cooked down to mush. My repertoire eventually expanded to include more vegetables and gluten-free grains. As time passed, I felt better and my infections never returned. I concluded that diet had been the root cause of my recurring infections.

The experience of healing myself with food and herbs rearranged the way I approached health, and started me down the path towards becoming a clinical herbalist. The adage “food is medicine” took on new meaning. But the theories behind food sensitivity are controversial, and those who try elimination diets have mixed success for various reasons. It seems the number of people restricting foods is on the rise and there’s plenty of anecdotal evidence that it can make us feel better.

Dr. Michelle Hemingway, MD, believes that certain foods, even those generally considered healthy, have the potential to irritate and chronically inflame people. The mechanism works like this: In a healthy intestinal lining, the cells that make up the gut wall adhere tightly to one another, forming an impenetrable layer. If those cell walls become weak (which can result from inadequate nutrition, frequent use of over-the-counter painkillers, viruses, parasites, etc.), they shrink away from one another and leave open spaces where undigested food can pass through. This is called leaky gut syndrome. As food particles penetrate the intestinal walls, they encounter lymph and immune cells, which treat them like invaders, attack, and cause inflammation. Inflammation is a perfectly normal and healthy immune response until it becomes chronic or excessive (like every time you eat). Then, it can cause disease. Arthritis, irritable bowel, autoimmune disorders, cardiovascular disease, and cancer can all have their roots in chronic inflammation.

This is why Dr. Hemingway often recommends elimination diets to her patients. The treatment is to heal the gut. Along with supplements and herbs, her method often includes completely eliminating a group of potential offenders for between six weeks and three months. The list includes: citrus, gluten, grains, corn, nightshades, dairy, sometimes eggs and nuts. Once the patient starts to feel better, they can reintroduce foods one by one. By watching and tracking their symptoms, they can find out what irritates them. She says that elimination diets are appropriate for almost anyone who has any chronic condition.

Ronda Ramsier, NP, on the other hand, doesn’t think food sensitivity causes inflammation. The theory behind leaky gut syndrome seems to her to work backwards. “True food allergies are rare and can cause an autoimmune response, which eats away the gut lining, like in Celiac disease. But not the other way around. I don’t think leaky gut is a widespread problem that’s leading to disease,” she says. Ramsier says her office does a lot of tests on the upper gastrointestinal tracts of patients, and blood tests looking for markers of non-specific inflammation. She believes she would see high levels far more often if leaky gut were so widespread: “I don’t see evidence that sensitivity is the first step on the road to disease.” She’s not alone. Many in the allopathic medical community are skeptical of the idea that leaky gut syndrome causes other ailments, while the theory is widely accepted by alternative medicine practitioners.

Ramsier does agree that foods can cause health issues, and often suggests dietary changes to her patients. “Food intolerance and sensitivity are on a continuum, and it has to do with the body’s ability to metabolize. Some people do not have the right enzymes to digest certain foods,” she says. She asks her patients to “be scientists, and to pay attention.” Write down everything you’re putting in your mouth. If you don’t feel good, what did you eat? If you have gas, you’re not digesting what you just ate. She adds that when she has enough time to work with a patient, determine which foods they don’t digest well, and come up with a plan, she often sees results and improvement.

When Karen (who asked me to change her name for privacy), a former baker with Hashimoto’s disease, an autoimmune disorder that attacks the thyroid, was told by her naturopath to give up gluten, she replied, “How about you just cut my left arm off instead?” Karen had years and years of recipes she had to give up. “I was baking all of my own bread. Bakeries are a sad vision for me, I can’t even go in there,” she laments as she remembers the hardest parts about saying goodbye to one of her favorite foods. “It’s hard to wrap your mind around when someone tells you [to eliminate something you love], especially when it’s not an allergy, so it’s not like I’m going to double over in pain if I eat it.”

But Karen saw the research illustrating that people with Hashimoto’s do better without gluten and she bit the bullet. “You just have to decide to do it. It’s like quitting smoking,” she says. Lo and behold, after she had been on a regimen of medication, supplements, and herbs, regular blood tests show that it was removing gluten from her diet that stabilized her thyroid hormones. For the first few years, every time she inadvertently ate some gluten, “usually in a sauce, sauces are hard,” she would experience intestinal gas and uncomfortable digestive changes, but she’s become less sensitive over time. “I think in the long run, it’s probably been a saving grace,” Karen says. She’s always been able to eat whatever she wants without gaining weight, but she “checks every box at the doctor’s office” when it comes to illnesses in her family. She says it was in her best interest to be forced to change her habits.

Not everyone who practices dietary restriction is able to make such clear connections to their symptoms. Sandy Thomson is a mother of three and a childcare worker in Bayfield, Colorado. Twelve years ago, she started feeling constantly tired and sapped of energy. Her joints hurt, she was always in a bad mood, and she struggled with brain fog and depression. Like many patients who share her ailment, she sought help for years before finally being diagnosed with Lyme disease.

“I’ve tried everything from antibiotics to hyperbaric chambers to shamans,” says Thomson of her long-lasting efforts to feel well. The first time she tried an elimination diet, she cut out wheat, corn, eggs, and dairy for six weeks, and then reintroduced one food per week. She didn’t notice any differences in the way she felt, and that made her lose incentive to continue being strict about food. “I’m not the best person to notice that stuff, either,” she confessed. “I was a busy person. I had three kids, I lived in a co-housing community and had responsibilities there.”

Since then, Thomson has spent time on a handful of different dietary regimens. “I haven’t had a lot of luck with diets helping my symptoms. I wasn’t very systematic. I would do it, not do it, do it again. Being in a family and trying to do different diets, I just found it really difficult. People would be eating things in the house, so I wasn’t very good at staying on plans for a long while,” she says.

Thomson joins Ramsier in stressing the importance of writing down data and keeping good records when trying a diet. She took part in a program where she kept charts rating ten symptoms every day. She saw an improvement in her numbers over time, but was never able to connect that to any specific foods.

Thomson did eventually feel better, and she attributes her recovery to “mind and body stuff. Your thoughts are important.” She practices meditation, records five things she’s grateful for each day, and participates in conference calls where many people with Lyme disease talk about improvements in their health. “I believe it worked because I saw people in my group getting better and I believed I could get better,” she says.

Dr. Hemingway and Ronda Ramsier both stress that each individual is unique, and they treat each patient on a case-by-case basis. When someone identifies an irritating food, Dr. Hemingway’s recommendations depend on the person and their problem. “I tend to not be super rigid [about never eating that food again]. For some people [being strict] is helpful, but for some people that doesn’t tend to work great. I suggest they try another three months to let their gut heal, at which point you can decide if it’s worth it. Usually over time, they like feeling good so much and they don’t want to feel bad anymore,” she says.

Ramsier warns it’s possible to be “too tuned in. Some people are looking for the magical solution to make them feel better and be happy and solve all their problems. Don’t turn food and health into a religion. Be scientific, tune in, but don’t obsess.”

This need for balance seems to be the crux of sticking with my own elimination diet. I swing on a pendulum between motivation and compliance, and a “screw it” attitude. I see myself in both Karen and Sandy: I value and physically feel the benefits of sticking to a plan, but staying on the deprivation train can be really difficult in stressful moments. Food is a powerful coping mechanism. A graceful dance between discipline, mental health, and enjoyment is required. The belief that restriction is morally superior is seductive, and causes guilt and shame when the rules get broken. My goal is to do just enough “cheating” to make a diet sustainable, while staying true to my goals. Changing our eating habits may not make us happy, successful, morally righteous people, but it clearly solves some problems. Dr. Hemingway encourages all of us: “It can be quite challenging, but the body always wants to heal, so if you don’t give up, you will find what works.” ϕ