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Elimination Diets: How and why to do them?

Updated: Jan 23, 2022

Have you noticed that certain foods worsen your symptoms? Have you gone dairy-free or gluten-free and felt better? Well then listen up, an elimination diet may be your best friend. Read on if you want to learn more about elimination diets, foods to remove, foods to eat and answers to some of the most common questions we get.

What is an elimination diet?

Elimination diets do remove certain foods for a period of time—usually 3-6 weeks. They’re used to identify the many food sensitivities, allergies and intolerances that can contribute to a wide range of symptoms and health conditions:

  • bloating

  • brain fog

  • diarrhea

  • fatigue

  • headaches

  • inflammation

  • joint pain

  • and rashes, among others

By removing and then slowly reintroducing specific foods, people can identify which foods trigger or worsen their problems.

4 Phases of the Elimination Diet

1. Preparation

Start by removing the offending foods from your kitchen, pantry and garage freezer (yah, I went there). You will get a list of nice food and naughty foods, shopping lists and recipes to choose from. THROW AWAY THE STUFF YOU ARE NOT SUPPOSED TO EAT. Get a garbage bag and throw it away.

You will need to journal your foods throughout the process. This includes what foods are eaten, what date/time these foods are eaten, and any notable changes in your symptoms. I suggest download an app for recording your foods. Clients of Beyond Medicine get access to our mobile app which allows you to not only track your foods but this can be viewed with your physician. If you like pen and paper, a sample journal is linked below.

2. Elimination

I know it sounds redundant but I kind of have to say it, you should not eat the food on the naughty list. It defeats the purpose of this diet. You are only harming yourself long-term.

Ok, now that common-sense stuff is out of the way, lets learn about the science behind the elimination of foods. Foods are grouped by botanical food families which are very similar in protein structure. Therefore, if you are sensitive to one member of a food family, you may also experience adverse reactions to other members of the same food family. For example, if you experience adverse reactions to bananas, you may also experience an adverse reaction to plantains.

Review ingredients in prepared and prepackaged items to ensure minimal or no exposure to reactive foods.

There may be alternate ways that some foods are listed on ingredient labels. For example, some food products may list eggs as mayonnaise or albumin. If you are instructed to avoid eggs for the elimination diet, you should also avoid mayonnaise and products listing albumin. These food companies are pretty slick with the naming of their foods.

3. Reintroduction

Eliminated foods are reintroduced one food at a time while monitoring for any adverse food reactions. You are encouraged to consume the test food several times throughout the day for one day. Meanwhile, keep track in your journal which food is being reintroduced and any adverse reactions over the following three days.

If you experience an adverse reaction, the food should be immediately removed for the duration of the elimination diet. Your clinician may want you to wait until the adverse reaction resolves before moving on to another food.

Common symptoms that may indicate a food reaction include headache, itching, bloating, fatigue, diarrhea, constipation, joint pain, indigestion, or worsening of your chronic health complaints.

If the food does not cause symptoms during the reintroduction phase, it can be added back into the diet. Continue the process with each food that was previously eliminated.

Caution: It is NOT recommended that you reintroduce a known food allergy. Ask your healthcare provider to discuss the signs and management of immediate hypersensitivity reactions prior to food reintroduction following an elimination diet. If reintroduction of a food causes an immediate allergic reaction (i.e. swelling of face, mouth, tongue, etc.,; wheezing, rash/hives, or other allergic symptoms), it is imperative that you be treated as soon as possible. Following resolution of the immediate hypersensitivity reaction, consult with your healthcare provider on how to proceed with food reintroduction.

4. Long-term management

An elimination diet based on food sensitivity testing is part of a comprehensive approach to overall gastrointestinal health. Based on your test results and symptoms, a long-term plan is usually developed utilizing the results of the reintroduction phase.

Benefits of an Elimination Diet

The elimination diet remains the gold standard for identifying food sensitivities. It works a lot like a science experiment to help people identify foods that lead to bothersome symptoms—as well as foods that help them to feel better. These diets help people collect and analyze empirical evidence, which is gathered through experimentation and observation.

If someone’s headaches disappear during the Removal Phase, only to suddenly resurface when they reintroduce chocolate, that’s a clue. And it’s a powerful one. Without an elimination diet, people are left to guess about causes and their effects. Are they bloated because of the onions they ate at lunch? Or was it the beer? Or is the bloat from something non-food related?

Naughty foods

Here is a list of common foods removed on most elimination diets:

  • Milk, including dairy products like yogurt, kefir, butter, cheese, cottage cheese, creamer, half-and-half, sour cream, ice cream, whey or dairy-based powders, any packaged products made with dairy and more.

  • Eggs, including foods made with eggs like some mayonnaise brands, baked goods, egg-based powders and more.

  • Tree nuts, including almonds, walnuts, pistachios, cashews, pecans, pralines, pine nuts, nut butters, nut milks, nut extracts or pastes and more.

  • Peanuts, including peanut butter, peanut oil, peanut flour and more.

  • Wheat, including wheat-based bread, cereal, pasta, breadcrumbs, crackers, flours and more, bulgur, farro, matzoh meal, seitan, wheatgrass, wheat germ oil and more.

  • Soy, including soy sauce and tamari, edamame, tofu, tempeh, miso, soymilk, soy yogurt, soy ice cream, soy oil and more.

  • Fish, including salmon, tuna (fresh or canned), tilapia, bass, anchovies, sardines, haddock, pollock, swordfish, trout and more.

  • Shellfish, including crabs, crawfish, lobster, shrimp, prawns, clams, mussels, oysters, scallops and more.

Limitations of the Elimination Diet

These diets require sustained effort and time. Some people just don’t have 6 or more weeks to pay close attention to what they eat and how they feel. Plus, the Removal Phase can require a lot of effort. How does a busy parent with a house full of picky eaters manage to omit so many foods for several weeks? Not easily.

We’d also like to point out: Elimination diets aren’t magic. They don’t always solve the problem. The human body is complex. An elimination diet may not deliver all the answers. If you have underlying issues, you may need referral to a medical professional. Ahem, you rang?

Are there people who shouldn't do an elimination diet?

Short answer is yes. Here is a short list. Again, ask your physician if an elimination diet is right for you before you start anything you read here.

People who suspect food allergies or Celiac disease

  • People with multiple health conditions

  • Pregnant women

  • Children

  • People with eating disorders

  • Anyone looking for a quick-fix regarding weight loss

Tips & tricks

  1. Block off time for the Removal phase. It is usually a 3-6 week window where you feel like you can be most successful. Mark the start date on a calendar

  2. Carefully plan out the first 7 days. Those can be the most stressful.

  3. Shop ahead. Plan your meals ahead.

  4. Organize your food areas. Creating a section of their fridge, pantry, and freezer for elimination diet friendly foods can help take the guesswork out of what you can and can’t eat throughout the elimination process.

  5. Dates. Take note of the date you start the Reintroduction Phase. Mark it on a calendar as well.

  6. Physician Guidance. Decide when you’ll check in with your physician to go over problems, next steps, and progress.

  7. Look into social support. Do you think your partner would be on board? Do you think family members could help you prepare some of the foods you need? If your partner does most of the cooking, will they consider making Removal Phase friendly meals for you?

The bottom line

Elimination diets can be extremely useful, even considered the gold standard for helping address systemic issues that might be related to foods and inflammation. They are tough to do, time consuming and require patience. The information we can gather is phenomenal and can really jump start your health journey. Coupled with Functional medicine, it becomes the powerhouse starting point for most people on their way back to health and vitality.


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