The Elimination Diet

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What is it?

An elimination diet is a type of dietary intervention that is used to identify food sensitivities or allergies. It involves eliminating certain foods from the diet for a period of time, and then gradually reintroducing them to see if any symptoms occur.

After the elimination period, the foods are gradually reintroduced, one at a time, and symptoms are monitored. If a food is suspected to be causing symptoms, it is eliminated again and another food is reintroduced. This process is repeated until all foods have been reintroduced or a problem food is identified.

The elimination diet itself is often a short term plan, lasting several weeks. However, it leads to the creation of long term dietary solutions.

Food sensitivity testing

The elimination diet is often considered alongside the IgG Food Sensitivity Test, which is a blood test which examines how your body reacts to certain foods.

The elimination diet is more practical, meaning that what you test will be directly felt and experienced, as will any changes in symptoms. It’s also much cheaper to do, although it is harder to carry out.

The blood test is more theoretical, meaning that the test may show you are highly reactive, but it may not be related to your symptoms. It’s much more expensive, and unfortunately rarely covered by insurance, but it is easier to do.

Who should try it?

An elimination diet may be beneficial for individuals who have symptoms that they suspect may be related to a food sensitivity or allergy, such as:

Digestive issues: People who experience symptoms such as bloating, gas, diarrhea, and constipation may benefit from an elimination diet to identify any foods that may be causing these issues.
Skin conditions: People who have eczema, hives, or other skin conditions may benefit from an elimination diet to identify any foods that may be causing or exacerbating these symptoms.
Respiratory issues: People who have asthma or nasal congestion may benefit from an elimination diet to identify any foods that may be causing or exacerbating these symptoms.
Migraine headaches: People who experience migraines may benefit from an elimination diet to identify any foods that may be causing or exacerbating these symptoms.
Fatigue: Some people may experience fatigue, brain fog and difficulty concentrating, an elimination diet may help to identify any foods that may be causing these symptoms.
Autoimmune disorders: People who have autoimmune disorders such as rheumatoid arthritis, lupus, and multiple sclerosis may benefit from an elimination diet to identify any foods that may be causing or exacerbating symptoms.

Protocol

Elimination phase (1-2 months): Your healthcare provider will provide you with a list of foods/food groups you must avoid. If you choose to slowly wean yourself off the foods as opposed to going cold turkey, the elimination phase does not begin until all the foods have been removed.
Challenge/test phase (1-4 weeks): Each food group to be tested will be re-introduced one at a time into the diet, by consuming only the food to be tested for one day, and returning to the elimination diet for one day afterwards. You will then alternate between testing one food, taking one day break.

How long do I do it for?

The Elimination part of the diet is temporary, usually being done for anywhere from 1-13 weeks depending on the main symptoms you are trying to target.

Typically, shorter time frames (less than a month) are used for issues more closely related to gastrointestinal issues, like gas, bloating, or constipation.

Longer time frames (a month or more) are used for issues that might be deeper and related to the immune system, like inflammation or skin issues.

Side effects

Some people experience temporary “withdrawal” symptoms at the beginning of the diet, including increased hunger, fatigue, irritability or headaches. The withdrawals usually last no longer than 5 days and is followed by an improvement of symptoms.

Sometimes, patients experience some temporary weight loss as they carry out the elimination diet.

The elimination diet is generally quite safe to carry out, although you should still ask your doctor if you have any underlying medical or nutritional issues.

What to avoid

The most common foods that are eliminated in an elimination diet include gluten, dairy, soy, eggs, nuts, fish, and shellfish. These are foods that are known to be common allergens or triggers for food sensitivities.

Strive to eliminate even traces of the foods to be eliminated, since trace amounts can still aggravate highly sensitive individuals.

Read labels if you plan to purchase prepackaged food, and be mindful of hidden ingredients. For example, “flour” usually means wheat, “vegetable oil” usually contains corn oil, and “casein” and “whey” are dairy products. Do not hesitate to ask questions or make requests if you plan to dine out.

Keep in mind that this list by no means comprehensive. If you experience symptoms to a food that is on the allowed list, eliminate that as well, and it may be challenged later if you so wish. If you have an allergic/anaphylactic reaction to any of the foods of the list, they are to be avoided, and will not be challenged.

General food list

Food group	Avoid	Allowed
Dairy	Milk, cheese, ice cream, yogurt, cottage cheese, cream, butter, sour cream, whey, casein containing foods	Rice, nut milks (almond, coconut milk)
Grains	Wheat, gluten containing foods, spelt, kamut, rye, barley, triticale	Brown rice, oats, quinoa, amaranth, buckwheat, teff, millet
Meat	Red meat, processed meats (cold cuts, sausages), pork	Lamb, chicken, turkey
Fish	Shellfish, albacore tuna, shark, swordfish, escolar, marlin and orange roughy	Fresh or water-packed fish such as halibut, salmon, light tuna, tilapia, sole, trout
Egg	Eggs (whites and yolks)
Fruits	Citrus fruits (oranges, tangerines, lemons, limes, grapefruit), bananas, and strawberries	All other fresh or freshly juiced (no processed juice)
Corn	Corn, foods made with corn
Legumes	Beans, lentils, split peas, in any form	Chickpeas
Nightshades	Tomatoes, potatoes (white), eggplant, red peppers	Sweet potatoes
Soy	Soy, soybean products (soy sauce, tempeh, tofu, textured vegetable protein)
Drinks	Milk, coffee, caffeinated beverages, alcoholic beverages, soda pops	Filtered/spring water, herbal teas
Nuts and seeds	Peanuts, pistachios, peanut butter, cashews, walnuts, pecans	Almonds, sunflower seeds, hazelnuts, sesame, pumpkin seeds, flax
Oils and fats	Margarine, butter, processed oils (trans-fats), mayonnaise	Cold pressed olive, flax, safflower, grapeseed, sesame, almond, sunflower
Sweeteners	Refined sugars (white or brown), honey, maple syrup, fructose, corn syrup, agave nectar, all artificial sweeteners	Brown rice syrup, stevia, xylitol

Tips and recommendations

Do not restrict calories. This means maintaining 3 meals a day, and snacks as hunger warrants.
Plan and prepare meals ahead of time. Find recipes online and in books that work with your elimination diet.
A weekly meal planner can help you purchase ingredients in advance. Preparing meals and freezing them the night before can make preparing food on an elimination diet easier.
Aim for fresh, organic foods when possible. Many prepackaged or canned foods have hidden ingredients and preservatives that may cause food sensitivities.
Eliminate means eliminate. Even reduced amounts of the offending food may still cause problems.
If you experience withdrawal, try to slowly wean yourself off certain foods/drinks such as coffee. Abruptly stopping coffee can lead to caffeine-withdrawal headaches. Maintaining adequate hydration (at least 1.5 L water per day) is also important in reducing withdrawal symptoms.
Persevere, you can do it! Remember, the degree of success depends on your level of commitment.