How and Why to Do an Elimination Diet

Food intolerances and sensitivities are very common. In fact, it is estimated that between 2-20% of people worldwide may suffer from a food intolerance.

Elimination diets are the standard for identifying food intolerances and allergies, sensitivities through diet.

Certain foods that are known to cause uncomfortable symptoms are eliminated and then reintroduced at a later time while testing for symptoms.

Allergists and registered dietitians have been using elimination diets for decades to help people rule out foods they do not tolerate well.

What is an Elimination Diet?

An elimination diet involves removing foods from your diet that you suspect your body cannot tolerate well. Foods are then reintroduced, one at a time, while looking for symptoms that indicate a reaction.

It lasts only 5 to 6 weeks and is used to help those with a sensitive gut, food intolerance, or food allergy identify which foods are contributing to their symptoms.

In this way, an elimination diet can relieve symptoms such as bloating, gas, diarrhea, constipation, and nausea.

However, if you believe you have a food allergy or suspect it, then an elimination diet should only be attempted under the supervision of a medical professional. Reintroducing a food allergen can trigger a dangerous condition called anaphylaxis.

If you suspect you have a food allergy, consult your doctor before starting an elimination diet. Symptoms of an allergy include rashes, hives, swelling, and difficulty breathing.

How Does It Work?

An elimination diet is divided into two phases: the elimination phase and the reintroduction phase.

The Elimination Phase

The elimination phase involves removing the foods you suspect trigger symptoms for a short period of time, typically 2-3 weeks.

Remove the foods you think your body does not tolerate, as well as foods that are known to cause uncomfortable symptoms.

Some of these foods include nuts, corn, soy, dairy products, citrus fruits, nightshade vegetables, wheat, gluten-containing foods, pork, eggs, and seafood.

During this phase, you can determine if your symptoms are due to the foods or something else. If symptoms persist after removing the foods for 2-3 weeks, it is best to notify your doctor.

The Reintroduction Phase

The next phase is the reintroduction phase, in which the previously eliminated foods are slowly reintroduced back into your diet.

Each food group should be introduced individually, over 2-3 days, while monitoring for symptoms. Some symptoms to watch for include:

• Rashes and skin changes
• Joint pain
• Headaches or migraines
• Fatigue
• Difficulty sleeping
• Changes in breathing
• Bloating
• Stomach pain or cramps
• Changes in bowel habits

If you do not experience any symptoms during the period when a food group is being reintroduced, it can be assumed that you are fine eating them and you will move on to the next food group.

However, if you experience negative symptoms as mentioned above, then you have successfully identified a trigger and should eliminate it from your diet.

The entire process, including the elimination, lasts 5 to 6 weeks.

If too many food groups are eliminated, consult your doctor or a nutritionist. Eliminating too many food groups can cause a nutritional deficiency.

What Foods Cannot Be Eaten on an Elimination Diet?

The best elimination diets are the most restrictive.

The more foods removed during the elimination phase, the more likely you are to discover the foods that trigger uncomfortable symptoms.

The foods eliminated during the elimination phase include:

• Citrus: Avoid citrus fruits such as oranges and grapefruits.
• Nightshade Vegetables: Avoid nightshades, including tomatoes, peppers, eggplants, white potatoes, cayenne pepper, and paprika.
• Nuts and Seeds: Eliminate all nuts and seeds.
• Legumes: Eliminate all legumes, such as beans, lentils, peas, and soy products.
• Starchy Foods: Avoid wheat, barley, corn, spelt, rye, oats, and bread. Also avoid any other foods that contain gluten.
• Meats and Fish: Avoid processed meats, deli meats, beef, chicken, pork, eggs, and seafood.
• Dairy Products: Eliminate all dairy products, including milk, cheese, yogurt, and ice cream.
• Fats: Avoid butter, margarine, hydrogenated oils, mayonnaise, and derivatives that contain them.
• Beverages: Avoid alcohol, coffee, black tea, soft drinks, and other sources of caffeine.
• Spices and Condiments: Avoid sauces, condiments, and mustard.
• Sugar and Sweets: Avoid sugar (white and brown), honey, maple syrup, corn syrup, high fructose corn syrup, agave syrup, desserts, and chocolate.

If you find that other foods not on this list make you uncomfortable, it is highly recommended that you also eliminate them.

What Can Be Eaten on an Elimination Diet?

Although an elimination diet is very restrictive, there is still enough variety of foods to make healthy and delicious meals.

Some foods you can eat include:

• Fruits: Most fruits, excluding citrus.
• Vegetables: Most vegetables, excluding nightshades.
• Grains: Such as rice and buckwheat.
• Meats and Fish: Such as turkey, lamb, game, and wild-caught fish like salmon.
• Dairy Substitutes: Including coconut milk and unsweetened rice milk.
• Fats: Including cold-pressed olive oil, flaxseed oil, and coconut oil.
• Beverages: Water and herbal teas.
• Spices, Condiments, and Others: Includes black pepper, fresh herbs and spices (excluding cayenne pepper and paprika), and apple cider vinegar.

To maintain motivation during this restrictive phase, try designing new recipes and experimenting with herbs and spices to add flavor to your dishes to make them delicious.

Other Types of Elimination Diets

In addition to the traditional elimination diet described above, there are several other types of elimination diets.

Here are a few different types of elimination diets:

• The FODMAP Diet: The FODMAP diet eliminates short-chain fermentable carbohydrates. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.”
• Limited Food Diet: Involves eating a combination of foods that are not regularly consumed. An example is the lamb and pear diet, which is popular in the U.S., where lamb and pears are not commonly consumed.
• Rare Foods in the Elimination Diet: Similar to other diets, only foods that are rarely eaten can be consumed, as they are less likely to trigger your symptoms. Rare foods include yam, buckwheat, and starfruit.
• Fasting as an Elimination Diet: Involves strictly drinking good quality water for a maximum of five days, then reintroducing food groups. This type of diet should only be done with your doctor’s permission, as it can be dangerous to your health.

• Other Elimination Diets: These include lactose-free, sugar-free, gluten-free, among others.

Benefits of an Elimination Diet

Elimination diets help discover which foods cause uncomfortable symptoms so you can eliminate them from your diet. However, an elimination diet has many other benefits, including:

1. Can Reduce Symptoms of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a very common intestinal disorder that affects between 10-15% of people worldwide.

Many people find that an elimination diet improves IBS symptoms such as bloating, stomach cramps, and gas.

People who follow the elimination diet can reduce their symptoms by 10%, and those who fully adhere to it can reduce symptoms by up to 26%.

2. Can Help People with Eosinophilic Esophagitis

Eosinophilic esophagitis (EE) is a chronic condition where allergies trigger inflammation of the esophagus, the tube that supplies food from the mouth to the stomach.

People with EE have difficulty swallowing dense foods, which increases the risk of choking.

Many studies have shown that elimination diets are effective in improving EE symptoms.

In a study of 146 patients with EE, more than 75% of patients experienced significantly fewer symptoms and less inflammation through an elimination diet.

3. Can Reduce Symptoms of ADHD

ADHD (Attention Deficit Hyperactivity Disorder) is a behavioral disorder that affects 3-5% of all children and adults.

Studies have shown that elimination diets can reduce ADHD symptoms.

One analysis focused on 20 studies that restricted certain foods to improve ADHD symptoms. Researchers found that elimination diets helped reduce ADHD symptoms in children who were sensitive to foods.

However, children should not follow an elimination diet without the supervision of a medical professional.

Elimination diets restrict many essential nutrients that are important for growing children, and long-term restriction could hinder their growth.

4. Can Improve Skin Conditions such as Eczema

Eczema is a group of skin diseases that appear as redness, itching, cracking, and inflammation of the skin.

There are many different causes of eczema, but many people find that eating certain foods can worsen their symptoms.

Several studies have found that elimination diets can reduce eczema symptoms.

In a study of 15 participants with eczema, 14 found that an elimination diet reduced their symptoms and helped identify their trigger foods.

5. Can Reduce Chronic Migraines

Approximately 2-3 million people in the U.S. suffer from chronic migraines.

The causes of migraines are still unclear, but studies have shown that inflammation could be a cause.

An elimination diet excludes foods that cause inflammation and has been shown to reduce chronic migraines.

In one study, 28 women and two men with frequent migraines followed an elimination diet for six weeks, which helped reduce the number of headache attacks during that time.

The Risks of an Elimination Diet

Although elimination diets are a great way to discover which foods cause problems, they can also pose some risks.

To start, elimination diets should only be followed for a short period of time, or between four and eight weeks.

Following an elimination diet for longer is not recommended, as it could cause nutrient deficiencies as a result of eliminating certain food groups.

Additionally, children and individuals with known or suspected allergies should only undertake an elimination diet under the supervision of a doctor.

Because elimination diets restrict certain nutrients, a short period of time could hinder a child’s growth.

Children are also more likely to have severe reactions, such as anaphylaxis, when reintroducing a food group. This is because their bodies can become much more sensitive to foods after restricting them.

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