TED stands for Total Elimination Diet. TED is a type of few food diet many nursing mothers use to identify the food triggers that contribute to their infant’s colic, gastro and atopic/allergy symptoms. Though it can be used by people of all ages to identify their food triggers.
Many TED babies have midline defects including tongue and lip ties, which contribute to their symptoms. Ties can have a huge knock on effect on muscular tensions through the body, and can impede milk transfer, potentially causing irritation to the gut. Unfortunately many health care professionals assume attachment is fine because it “looks” okay, but some infants have more difficult ties that can impact attachment while superficially looking fine. It is very important to get checked by someone who is sufficiently trained, and comes highly recommended for identifying them, such as a preferred provider. For more information, including a full list of symptoms associated with ties, please see the milk matters link at the end.
Dr Sears’ TED, AIP TED, Jay Gordon’s TED and the RPAH Elimination Diet are all popular types of few food diets. Though the TED method can also be applied to other dietary restrictions or concerns, such as a full GAPS TED, FPIES TED, or a Low Histamine TED.
In essence, they all use the same principle of cutting back your diet to a core group of foods, often as little as 5-8 foods; then systematically reintroducing foods to identify the triggers. Reintroductions tend to need to be staggered by at least 4 days to allow for delayed reactions. The versatility of the TED method allows it to be adapted for an individual’s symptoms. For example, those with gastro symptoms often do better on a FPIES TED; those with reflux or multi systemic symptoms often do better on a low histamine TED; those with chemical intolerances (salicylate/oxalates/glutamine) often do well with a RPAH Elimination Diet. Though sometimes it can help to doubly modify the TED for example those with multi-systemic reactions including gastro symptoms might benefit from a low histamine FPIES TED. See Key below for more info on types.
For many people, elimination of common triggers, like those that are labelled top 8 in many countries (dairy, eggs, gluten, soya, peanuts, tree nuts, fish and crustaceans) will be sufficient to relieve their symptoms and have them on their journey to healing. In the EU the top 14 common allergens are legally labelled with emphasis on all food, which in addition to the top 8 listed above, contains celery, mustard, sesame, lupin, molluscs and sulphites. Unfortunately these labelling laws only apply to ingredients containing over a threshold of the food’s protein, so though the labelling works for many, there will be exceptions who will still react to foods like lecithins, oils, etc. that aren’t widely labelled because they fall under this threshold.
Once a dietary change has been made it can take up to 4-6 weeks for the trigger, and the inflammation from an ongoing reaction, to fully resolve. Depending on the symptoms and degree of damage, this can sometimes take longer. But unless symptoms become noticeably worse following an elimination, it is best to try and wait at least these 4-6 weeks between making further changes to avoid unnecessary eliminations and dietary restrictions. Although food can be the problem causing reactions, nutrition is also essential for the body to heal. So any unnecessary eliminations can be counterproductive long term.
For those with sensitivities, like histamine intolerance, there can be a certain threshold of certain foods that the body can tolerant before the histamine/inflammation bucket is full. This can make it more difficult to identify triggers as they can be more delayed and accumulative than thetypical 3-4 days. There are also some foods and herbs that have mast cell stabilising properties, that can improve tolerance of foods.
To improve tolerance for any food trials these mast call stabilising and antihistamine foods can help improve the body’s overall stability. So can be worth introducing early if possible, especially if someone is having troubles reaching a reaction free baseline. Though as with any trial, they will need trialling and may cause reactions.
Supplements can be challenging when on a TED, though ideally it would be great to have a balanced source of vitamins and minerals, but unfortunately this isn’t necessarily realistic for many on a TED. Many, if not most, prenatal and multivitamins contain common allergen derivatives that can cause reactions in hypersensitive nurselings. Many, if not most, also contain cheaper less bioavailable forms of vitamins like B vitamins, vitamin A, and so on, which depending on genetics or current state of health, can be poorly absorbed if at all, and can block the body’s absorption of them through diet. Some mothers even take hypoallergenic infant formula themselves to help support themselves, though it’s not uncommon for TED babies to react to even the most hypoallergenic formulas directly or indirectly through their mothers breastmilk.
When reintroducing foods, after reaching as reaction free a baseline as possible. It’s best to trial at least a small number of low allergenicity foods before trialing any higher risk, like common allergens or suspected triggers. This is so it isn’t too nutritionally restrictive or unsustainable; nutrition is important to support healing. Though it may seem a good idea to trial higher risk foods, and is often recommended by professionals. For most with multiple triggers they will cause reactions, which can cause further damage and inflammation, which can make it take longer to return to a baseline. Higher risk foods can also be better tolerated after a “tincture of time” which the elimination and reintroduction of lower risk foods can aid through minimising the risks of reactions.
We also suggest that it can be important to track calories for at least the first few weeks on TED. Kellymom suggests mums trying to lose weight take a minimum of 1500-1800 calories a day to prevent the body going into starvation mode, or detoxing too heavily. This is an absolute minimum, 2000-2500 calories is normally more appropriate, some mamas needing as many as 2500-3000 or more especially if nursing multiples. Not only can insufficient calories impact a mother’s milk production, but burning too many calories – burning fat stores – can release toxins that have accumulated over your lifetime. As the body detoxes, the toxins exit the body through bodily fluids including breastmilk. This is why it’s important to plateau as soon as possible, Kellymom recommends mums aim to only lose 1.5-2lb a week because of this.
TED Mamas Community
If you are planning to do a TED for a nurseling, and your on Facebook, you’re welcome to join our “TED mamas” community for support.
For those with an older child with extreme allergies we have “TED Allergy Families”.
You can also follow my page “TED mum” on Facebook.
This is written by TED mum, a mum who shares what she has learned on her TED journey and helping support others on theirs. TED mamas is not a written by a health care professional, and opinions should not be taken as such. Please endeavour to find appropriate support from an understanding professional during any extreme dietary modifications.
TED : Total Elimination Diet
AIP : Auto-Immune Protocol, a modified Paleo diet aimed at those with autoimmune disorders.
RPAH : Royal Prince Alfred Hospital, Sydney. They have a simplified elimination diet and a chemical intolerance elimination diet.
GAPS : Gut And Psychology Syndrome, A modified version of the Specific Carbohydrate Diet, modified by Dr Natasha Campbell-McBride. Specifically formulated to maximise gut healing, she formulated it following her work with those with neurological symptoms such as Autism, Hyperactivity, Obsessive Compulsive Disorder, Depression, schizophrenia, etc. http://www.gaps.me/gaps-what-is-it.php
FPIES : Food Protein-Induced Enterocolitis Syndrome, a type of allergy that causes severe gastro symptoms, vomiting and diarrhoea, that can be extreme to the point of dehydration, lethargy, and negatively affect body temperature and blood pressure.
FODMAP : Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols, this is a group of sugars found in grains, dairy, fruits and vegetables in varying degrees. Those with irritable bowel syndrome (IBS) often find a low FODMAP diet beneficial.
Low Histamine : Histamine is produced by the body during reactions, and can also be found in certain foods. Aged, fermented, tinned/canned foods often have much higher amounts of histamine. Other foods can be high in histamine, or liberate it in the body outside of an immune response, like citrus, cocoa, tomatoes, legumes etc. Those with Histamine Intolerance, or Mast Cell involvement, can struggle to eliminate the build up of histamine in the body resulting in pseudo-allergy symptoms.
Mast Cells : Mast cells are the white blood cells in the body which release histamine and other chemicals during allergic reactions. In some people they can “misbehave” for various reasons, this is called Mast Cell Activation Syndrome. Others have too many Mast Cells, which can cause skin lesions, this is called “Mastocytosis”
Dr Sears : American Paediatrician, Attachment parenting advocate, Dr Sears Popularised the approach his wife Martha discovered to help improve colic symptoms in breastfed babies.
Jay Gordon : I only include Jay Gordon because some people ask about his elimination diet, when really in the 2+ years of running TED mamas I don’t recall anyone praising his diet, or even noticeably having any success with it. The top allergens they list are different to all the lists I have ever seen, and the food restrictions suggested are not complementary to any specific set of food sensitivities that I can identify. But some professionals do recommend it.
Kellymom : Blog by Kelly Bonyata, IBCLC (International Board Certified Lactation Consultant), is a fantastic resource for nursing mothers. https://kellymom.com/nutrition/mothers-diet/mom-weightloss/