TED “How to” pick?

Once you’ve decided to take the leap and jump into a TED it can be really hard to know how to actually go about it and how it will look in your life. We have a post on “What is a TED?” which explains a lot of the different types of TED. Many who start out on a TED find out about the method from the Dr Sears TED recommended on his website for infants of colic.

This is what Dr Sears website suggests as a place to start:

“Eat only range-fed turkey and lamb, baked or boiled potatoes and sweet potatoes (with salt and pepper only), rice and millet as your only grain, cooked green and yellow squash for your vegetable, and for fruit, pears and diluted pear juice. Drink a rice-based beverage drink in place of milk on cereal or in cooking. Do not yet use soy beverage. Take a calcium supplement. (Rice products, such as rice beverage, rice-based frozen dessert, rice pasta, rice flour, and millet are available in nutrition stores.)” Though these foods may be okay for many, they are also higher risk for others.

Millet is contraindicated for those with thyroid problems, which are increasingly common perinatally. Rice can be high in arsenic and has a low recommended daily portion of one serving a day accordingly, so living on it for every meal and maximising products that are rice based may cause arsenic toxicity long term which can impact growth and development. The arsenic is water soluble so rice milks are especially high risk for arsenic contamination. Brown rice is the more nutritious but carries a higher allergy risk and arsenic risk due to the increased husk fibre and protein content, so though rice may be a good source of calories to bulk out a TED cheaply it doesn’t always offer much nutritionally. Rice is also an increasingly common gastro trigger.

Having versatile foods like rice, coconut, oats etc. long term can be really helpful for diversity. But starting off it is so much more simple, minimising the variables we can stress about, to start off from cooking from scratch. It minimises the risk of secondary ingredients (oils, gums, etc.) or contamination from the packaging (like soya and corn in plastics and tin linings) or other foods in the manufacture process impacting the ability to attain or sustain a baseline. So most find it easier to start with the whole food version then trial processed forms on a individual basis to identify which are safe. Though less sensitive little ones may be fine with the various products from the beginning, the only way to know is to try either way.

Some are extra-sensitive to starches/sugars (FODMAPS), grains (Gluten/lectins), legumes (lectins), latex family fruits and nightshades; some people react to the chemicals that cause foods to have a certain colour like orange or red vegetables and fruits, others react to certain naturally occurring food chemicals like lectins, glutamates, oxalates, sulphates, salicylates and sulphites (-thiols) or additives and preservatives like citric acid (often corn derived or derived from mould) and gums (often inflammatory component of legumes). Everyone is so individual which is why it can be so hard to try and put everyone in the same box.

Even tenuous links can be helpful for identifying patterns of triggers that can give insight to help food selection for trials. If you or your little one react to the foods recommended by Dr Sears; this is going to happen to some and frequently happens for those with gastrointestinal symptoms. It’s important to remember it is a simple basic recommendation, not a shopping list or the only way to do TED. At the core of it, a TED isn’t the food you use, it is the method you use to eliminate and reintroduce foods. It is not easy, it can be a long slog and a bit of a battle – but we’re here because we think it’s worth the effort.

For help to navigate the different potential trigger types and patterns of food chemicals that can cause reactions we have a “Cross Reaction Cheat Sheet”for reference.

Organic meats are substantially lower risk because they have substantially lower exposure to chemicals used in animal farming such as antibiotics, steroids and immunisations. They also typically have less stressful lives. Stress can negatively impact the nutritional value of the protein, vitamin and mineral content of meat. So if you can (even if it’s only till you find a baseline) please try to use organic/free range meat. You can try and introduced non-organic as soon as you start reintroducing foods, but many find non-organic prevents them getting to a base level because a lot of hypersensitive children react to it. Fresh meat can also be important as histamine develops as food ages, so fresher and shorter cooked meat can be better tolerated. It is worth noting, chicken is a known egg cross reaction, beef is a known dairy cross reaction. Though they aren’t common they do happen.
Beef mince/ground can also be high risk for contamination from dairy as a result of mammary tissue being included. It’s also worth noting lots of American mamas depend on turkey as their safe protein, but have issues with rosemary extract which is in many makes and contain either corn or soya oil as a non-listed ingredient.

Organic grains, fruit and vegetables would be ideal in a ideal world where everyone has unlimited funds, but we understand this isn’t an ideal world – or we wouldn’t need a TED! – so we have to do our best. Which can be a tough juggling act but we each have to figure out what is best for our families and what is most realistically viable for our limitations including availability and finances.

Grains can be high in pesticides like glyphosate (aka “Round-up”), which can be used to dry out grains before/after harvest to improve yield and shelf life. Glyphosate is listed by WHO (World Health Organisation) as a likely carcinogen and is known to displace vital nutrients in the body; which can make it additionally unhelpful for those on extremely limited diets like TEDs. Lots of oat products, including cereals, have recently been in the news for containing astronomically high levels of glyphosate, including some organic brands. So it can be worth spending a little time looking for known safe brands before trialling or introducing.

Fruit and vegetable pesticide contamination can vary greatly. The EWG lists the dirty dozen top pesticide laden produce (strawberries, spinach, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, white potatoes and sweet bell peppers/capsicum) and the clean fifteen (avocado, sweet corn, pineapples, cabbage, onions, frozen sweet peas, papaya, asparagus, mangoes, aubergine/eggplant, honeydew melon, kiwi-fruit, cantaloupe melon, cauliflower and broccoli) least likely to contain significant contamination. Lists like this can help us prioritise which we will trial, whether we can get away with non-organic versions, and how thoroughly we will prepare them  (soak, peel, de-seed etc.). It’s worth noting that Dr Sears TED includes both pears and white potatoes which are in the dirty dozen.

Seed oils can also be at high risk of pesticide contamination. They can also be higher risk for contamination from other higher risk oils (soya, corn, peanut etc.) especially due to dilution or use of shared machinery. So having a search or asking for recommendations for trusted brands can also make life easier.

Those with little ones already eating solids are likely to chose to include known “safe foods” in their TED. Though this can make it easier short term, it can also mean lesser triggers can slip under the radar. Even if you have suspected safe foods, you may want to consider a brief elimination of them at some point to ensure your little one isn’t reacting to them, especially if you are struggling to reach a baseline.

Dr Sears recommends mum exclusively eats only these items for 9-14 days or until they have reached a base line. Some mistake this for TED only being that 9-14 day period, which can give really misleading expectations. Though that is the first stage of TED, TED itself continues for as long as you are following the elimination and reintroduction methodology. Some people may reach a baseline sooner. Some will take a little longer, but if you have tried them for 2-3 weeks and have had little progress you may want to consider subbing out a base food to deduce if one of them is an unknown trigger.

It is important not to rush things, after a trigger has been removed. For some it can take multiple weeks for the reaction to clear and the inflammation from the reaction to leave the body. Swapping things prematurely, though it can help us feel like we’re being proactive, can slow progress and make identifying triggers less clear.

Once you have reached your baseline you get to enter the world of reintroduction!

Which can be exciting, daunting, and plain anxious making for some!

The way people choose to reintroduce foods will depend on a few factors, including if their little one is already eating solids. There is a lot of conflicting opinions on the risks and benefits of direct and indirect trials.

It’s recommended when reintroducing a food to trial it in the morning or early in the day; so if there is a immediate reaction it is less likely to disturb sleep or be missed overnight. Though this can be less of a concern for those with more delayed reactions.

Some mums like to have a large portion of the trial food, others try a small amount and then gradually increase the amount through the day or over a couple of days. Some find even less frequent exposure of a little every few days can improve tolerance in some situations, which can be more ideal as a part of a rotation diet.

Once a new food is tried it is recommended to wait at least 4 days before trialling another new food. This allows for delayed reactions which can happen up to 3-4 days after exposure.

After a reaction, it is generally recommended to wait at least 24-48 hours following the end of the symptoms before the next trial. Though some wait a whole week or more allowing for gut rest.

Once a food is confirmed to have caused a reaction the general consensus is to wait a minimum of 3-6 months before a repeat trial. Any foods that haven’t been confirmed as triggers can be trialled at any point, to a parents discretion evaluating the suspected risk factors. Depending on the severity of symptoms, you may want to speak to your health care provider regarding reintroduction before attempting re-trialling known triggers. Sometimes testing may be needed to get a prescription for a epinephrine auto-injector (EpiPen, Jext, Auvi-Q etc.) – if you get an auto-injector, you can also get free training pens to practice with.

If you have a nurseling on solids, you have to consider what you deem preferable or safest for your introduction of new foods.

Some recommend before trialling foods directly to rub a wet sample on the child’s skin, then cheek/lips, then trial directly allowing at least 30 minutes at each step to allow for reaction. Though this will only indicate IgE triggers. This is not to be done on inflamed skin as that can increase the risk of sensitisation.

When introducing new foods on TED with a infant on solids, you need to consider the risks and what you think is best for you. You can trial your child first with the new food: if you do this, there is a risk they could have a more severe reaction. You can trial it yourself first: the reaction is likely to be less severe, but it can take longer to clear your milk and your nurseling’s system. Some mums prefer not to do this so they keep their milk “clean” for their little ones. For a more in-depth discussion of the risks and benefits of direct and indirect trial see our “The Clean Milk Theory”post.

Breastmilk can contain up to 100’000 less protein particles to a direct source (example from CMP in breastmilk vs in formula) so the exposure is exponentially less than it would be from a direct source, so some foods may be tolerated better through breastmilk.

It is also worth noting, though possibly less common, some infants react to their mothers reactions to certain foods, which can present a bit of a wild card for identifying trials and triggers.Once you have evaluated your little one’s risk factors, most mamas select 1-2 fruit/veg/meats and an oil.

As a side note, some infants also react to environmental triggers like dust, pollen, pets, detergents, fragrances, toiletries, make up etc. So if your having trouble identifying triggers it can be worth considering these too. We also have a baseline struggles post for more ideas for how to reach a sometimes allusive reaction free baseline.

For more information on “getting started” and the early days on TED please see our FAQs.

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