LEAP Elimination & Rotation Diet Protocol Training

1. LEAP Elimination & Rotation Diet Protocol Training Jan Patenaude, R.D. Director of Medical Nutrition Signet Diagnostic Corp.

2. Getting Started For this LEAP dietary training you need: • A LEAP Immunocalm Diet Report (i.e. Sample patient LEAP report) • Pen for note-taking

3. Getting Started • Let’s do a “tour” of the LEAP Immunocalm Diet Program Booklet. • The LEAP ImmunoCalm Diet is an elimination diet based on the individual’s MRT results. • Each patient receives his or her own LEAP ImmunoCalm Diet Plan

4. MRT is a food “sensitivity” test, not a food “allergy” test. “I know I’m allergic to strawberries. Why didn’t it show up in my test results?” Regardless of MRT results, patient should avoid “known” problem foods. The goal of LEAP is to help establish a healthy eating plan for all patients, while eliminating all reactive foods from their diet. Understanding MRT Test Results

5. Turn to your LEAP ImmunoCalm Diet Program Test Results page

6. LEAP ImmunoCalm Diet –Phase 1 • Limited to 20 - 25 items or less • Consume freely. • Whole foods, cooked from scratch, ideally • Organic recommended • Better to eat 4-5 smaller meals • Drink plenty of water (64 oz/day) • Salt may be added in moderation. • Withdrawal: May feel worse before you feel better • Should see significant improvement in 7-10 days.

7. “Why can’t I just avoid my yellow and red foods?”Answer: Assume reactive to ALL untested foods until “proven otherwise.”

8. “THERE’S NOTHING TO EAT! I’LL STARVE!” Answer: My phase 1 diet was a feast/banquet compared to what millions of people in 3rd world countries have to eat. Just that realization made it easier.

9. If you think it will make the difference between adherence and non-adherence, consider making small diet changes, trading some preferred foods from phase 2 (or even phase 3 if necessary) to phase one.

10. Food Chemical Reactions • Dose related • May not be enough in a food antigen to trigger, but may trigger if enough of food is eaten that contains a food chemical • Modify diet to move foods from early phases to later phases that contain highly reactive chemicals (this tends to be a clinical judgment on the part of the counselor) • And, if no improvement in 7-10 days, suspect other hidden chemicals

11. Food Chemicals Tested • Acetaminophen, Ibuprophen (Meds only) • Aspartame/Nutrasweet (may contain maltodextrin-corn) • Benzoic Acid (If highly reactive, may want to limit raspberries, cinnamon) • Caffeine Wean off gradually. Common migraine/IBS/insomnia trigger • Candida Albicans (Naturally present, not found in food)

12. Food Colorings (Not a big concern diet-wise as most foods are in their natural state during early phases. May want to review mouthwash, toothpaste and medications, however.) • Fructose (Mostly dose related issue) • Lecithin (Corn, eggs, soy-often dose related) • MSG • Phenylethylamine and Tyramine (Common migraine triggers)

13. Polysorbate 80 (Sorbitol) • Nitrates and Nitrites (natural and added- may want to test water.) • Saccharin-the pink stuff (mouthwash, toothpaste) • Salicylic Acid (Aspirin, personal care products and Food-dose related) • Sodium Metabisulfite -Sodium Sulfite (Assume reactive to all sulfites) • Solanine (Nightshade family) www.noarthritis.com

14. Other Concerns • Yeast (Brewers and Bakers) • Lactose – May cause symptoms even if diary is “non-reactive” • Sugar (Cane vs. Beet) • Coconut (May be very healing to the gut. Soaps-sodium laurel sulfate.) • Mint (Mouthwash, toothpaste, gum) • Cottage Cheese (dry curd) • Yogurt (plain, not flavored) • Meds-PDR, inserts, www.rxlist.com

15. “SO I STILL DON’T KNOW WHAT TO EAT!” • Food Idea List (Review with patient) • Hopefully, you can be creative with combinations • Orange juice concentrate, ginger and some leek with duck, chicken, fish • Oven roasted vegetables, brushed with oil and seasoning • Use your slow-cooker • Roast some meat, cook some grains, steam some veggies, add oil/nuts • Pureed or mashed fruit and/or juice for sauces

16. Menu, Shopping & Cooking Ideas • Local Large Health food stores (Trader Joes, Whole Foods, Wild Oats, naturalgrocers.com, etc) • Farmer’s markets • References in LEAP Booklet: Cookbook, Catalog listings, websites • Two more: How to Cook Everything: The Basics by Bittman and Food Allergy Survival Guide by Melina, Stephaniak and Aronson • LEAP Website –www.nowleap.com (LEAP Patient Section) and www.nutritionresults.com

17. Building a Menu • Review patient’s Phase 1 Foods • Get creative. Can you come up with protein, starch, veggie and fruit dessert for a meal? • Are there “breakfast” items available? If not, is client willing to eat “non-breakfast” foods for breakfast? Leftovers from last nights’ dinner? • If not, some rearrangement may be in order. • Let’s look at your client’s leap results-brainstorm ideas. • Picky Clients –Share “Learning to eat new foods.”

18. Consult 1: Approx 45-60 min • See LEAP Affiliate Physician Guide • Eliminate all vitamins/minerals/herbs and OTC meds if possible, add back when stabilized. • Summarize what you’re about to covered • Obtain patient verbalization that they are willing to follow phase 1 and keep food/symptom records. • Set a “start date” with patient. Schedule F/U appt 7-10 days after patient plans to start diet.

19. Consult 2: 8-10 days after starting diet • Symptom survey • If No Significant Improvement in 7-10 days, review Food/Symptom records for: • Adherence • Pattern of symptoms with 1-2 items? • Dose related issues • IgE allergies • Chemical issues • Lectin issues

20. Consult 2: Continued • Fiber issues • Lactose Intolerance (Should have been anticipated in Consult 1) • Patient often knows/suspects what food is still a problem • Eliminate “suspect” foods, and continue with phase 1 for a few more days, until symptoms subside. • If nothing else, may suspect meds • Continue to “build menu” with more meal ideas

21. Consult 3: Rotation Diet • 4-5 weeks after patient begins diet. (Start Phase 6/rotation diet) • Helps prevent new sensitivities from emerging. • Have patient do another Symptom Survey, compare to earlier surveys • 45 min – 1 hour.

22. Teaching Tips for Rotation Diet • Arranged according to Food Families • If you move a food to another day, move the entire family • If you eat a food in its own family, and only eat it every 10 days, it doesn’t really matter what day it falls in. • Caution: Foods that are very similar in a food family should be consumed more cautiously, and need to be rotated (ex. Dairy or Gluten grains)

23. Teaching Tips for Rotation Diet • Try to find a “milk,” an oil, a sweetener and a “vinegar/sour” for each day. • Cow’s milk, goat’s milk, soy milk, rice milk, almond milk, etc. • Sweeteners: Honey, cane sugar, apple juice concentrate, saccharine, aspartame, brown rice syrup, corn syrup. Try stevia and maple syrup. • Vinegar and/or “sour” (for dressings, vinaigrettes, flavoring): Distilled vinegar, apple cider, rice, and raspberry vinegars; red wine or balsamic vinegar (amine & sulfite alert); lemon juice or yogurt, buttermilk.

24. Teaching Tips for Rotation Diet • Keep a Kitchen/Personal Rotation Calendar • Consider starting a new rotation day before the Dinner (main) meal instead of at breakfast. • Label items with a black marker: 1, 2 or 3 • Continue to add one new food a day. • When all “test” foods have been added, start adding untested foods-Use Food Family Guide. • If reactive to 2 or more foods in a food family, add other foods in that family with caution.

25. Teaching Tips for Rotation Diet -more • If a food is in a family by itself, and not commonly consumed, add it, monitor response. If “safe” add it into the rotation diet food list. • In time, the rotation diet should contain MANY more foods. • Consider homemade “TV dinners.” Prepare a full meal, place in divided freezer container or Ziploc freezer plate with cover. Label with masking tape and permanent marker. Freeze and have available when “that day” rolls around again.

26. Food/Symptom Diary • Essential tool for sleuthing out problems • Recommend them to ALL patients. • They are a hassle, but a tool to getting well. • Think of it as playing “diet detective.” • Forces patient to pay attention to diet and symptoms.

27. FOLLOW-UP • One month and two months after starting rotation diet. • Repeat Symptom Surveys (SF-36 forms?) • Monitor for adherence • Review Food/Symptom Diary if desired • www.LEAPSelfHelp@yahoogroups.com

28. MOST DIFFICULT PATIENTS • 65 year old, refuses to cook, only eats in local restaurant (Probably not a great LEAP candidate.) • Client who’s never cooked a meal in 45 years of life, eats all meals out. • Assess willingness to make major lifestyle changes before testing. • Patient unwilling to do full elimination or rotation diet, but still is thrilled with his results doing just an avoidance diet.

29. The best part of LEAP: Healthier, happier patients