Watching what you eat is a crucial part of living with systemic mastocytosis (SM). Some foods will trigger allergic reactions and significantly impact your quality of life — but identifying exactly which foods trigger symptoms can be challenging. Following an SM diagnosis, you will work with a dietitian to track your reactions to certain foods, first in a food diary and then through an elimination diet.
Read more about SM signs and symptoms
What is an elimination diet?
An elimination diet is a short-term diet that temporarily restricts what foods you eat to pinpoint which ones act as symptom triggers. While some foods are frequent symptom triggers — like tomatoes, shellfish, and chocolate — everyone with SM reacts to foods differently. An elimination diet also aims to identify the specific symptoms a food triggers, such as skin irritation, flushing, hives, headaches, fatigue or gastrointestinal issues such as nausea, stomach pain, vomiting or diarrhea. Anaphylaxis is also a risk in severe reactions.
The structure of an SM elimination diet is as follows:
Elimination phase (2–4 weeks): The first phase eliminates all high-histamine foods or histamine-releasing foods from your diet. The goal is to ensure you’ve eliminated any symptoms related to foods. You will also need to be vigilant in avoiding all other potential triggers, such as emotional stress, physical exertion, sudden changes in temperature, pollens, insect stings, certain medications and skin friction.
Reintroduction phase (several weeks): Also called the “challenge phase,” this next phase reintroduces one new food every three to five days by eating just a small sample and monitoring your reaction over 24 to 48 hours. If symptoms occur, stop the food. Record in detail the type, onset, severity and duration of your symptoms in your diary. Don’t reintroduce a new food until symptoms have stabilized.
Once you have reintroduced all eliminated foods, your dietitian will create a personalized long-term diet designed to avoid SM symptom episodes.
Tips for managing an elimination diet
Eating according to an elimination diet can be challenging in day-to-day life. It can feel very restrictive, since many foods you normally eat may be cut out for weeks on end. You may find yourself spending lots of time reading food labels, especially if additives and food dyes are eliminated.
As challenging as daily eating is, meals outside the house can be harder. Avoiding eliminated ingredients means asking questions of restaurant staff or a friend hosting a cookout. You will need to insist on the importance of knowing exactly what is in your meal and might have to skip the meal instead of taking the risk.
If you can’t stay to home during the elimination phase, here are some tips to keep in mind:
- Always carry a snack or two with you.
- Carry two epinephrine doses, just in case.
- Remember that consistency is key: there is no point cheating, as you may skew the results and cause yourself to suffer symptoms.
- Keep a detailed record of all meals and symptoms, wherever you are.
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