← All chapters·Chapter 06 · free opening

Addition, not elimination

Why the standard remove-then-reintroduce phase was cut, what replaces it, and the doses and timeframes the trials actually used.

Every protocol in this category opens by taking food away. This one does not, and the reason is not a preference.

Why the elimination phase was cut

D Untested. None of the 15 dietary patterns in the umbrella review was an elimination protocol, and none of its 30 reviews tested a remove-and-reintroduce design against inflammatory markers (PMID 40657695, by absence). Not weak evidence. None.

C And there is a documented risk on the other side. Restrictive eating patterns are associated with roughly double the rate of reported orthorexia symptoms (OR 1.99, 95% CI 1.21–3.25; n = 23,783; PMID 41230622), with the causal direction unresolved and the underlying studies cross-sectional.

An unevidenced ritual with a documented risk attached is an easy decision once the two facts are put next to each other. It is only hard if the ritual is what is being sold.

There is one honest exception, and it is not this: a person with a specific suspected food intolerance, working with a clinician, testing that one food. That is a diagnostic procedure with a defined question. It is not a phase of a general protocol, and this publication does not run it.

4 more sections in this chapter

What replaces it

The doses and timeframes that were actually tested

Sequence

Where people stop, and what it costs

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