Elimination diets: How and why to do them


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Reviewed by Okoro Ezinne K. MD, MSc, Jennifer Boxterman, MS, RD, and Ryan Maciel, RD


Definition | Basics | Benefits | Symptom list | How they work | Types | Food List | Recipes

Maybe you’ve heard a lot about elimination diets—and you’re wondering, “What the heck is one, and should I try it?” Or perhaps a health care provider has suggested you go on one and your first thought was, “I dunno. That sounds like a lot of work. But I’m willing to read more.”

Or, maybe you’re already sold, but you need help getting started.

In this article, we hope to answer all of your questions about elimination diets. You’ll learn the basics, how elimination diets work, the symptoms they address, and the common types. You’ll also find a list of removal foods, recipes, and more, as well as the answers to the questions below.

(Looking for a deeper dive? Download our Elimination Diet e-book for nutrition and health coaches. It’s loaded with helpful resources, food lists, recipes, and advice. Oh, and it’s free.)

What is an elimination diet?

Why would you go on an elimination diet?

What is a food sensitivity or food intolerance?

What symptoms can be addressed by an elimination diet?

What are the benefits of an elimination diet?

What are the side effects of an elimination diet?

What are the most common food sensitivities?

What are the types of elimination diets?

How does an elimination diet work?

Can you do an elimination diet if you’re pregnant or breastfeeding?

What can you expect on an elimination diet?

What foods do you remove during an elimination diet?

What recipes work for an elimination diet?

What is an elimination diet?

Elimination diets pretty much do exactly what the name suggests: exclude certain foods for a short period of time—usually 3 weeks. Then you slowly reintroduce specific foods and monitor your symptoms for possible reactions.

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Why do an elimination diet?

Elimination diets are used to identify food sensitivities and intolerances. (Wondering what food sensitivities and intolerances are? See the next section.)

Elimination diets work a lot like a science experiment to help you identify foods that lead to a wide range of bothersome symptoms. (You’ll find a list of common symptoms a little later in this article.)

What’s a food sensitivity? What’s a food intolerance?

According to the American Academy of Allergy Asthma & Immunology, “A food intolerance or a food sensitivity occurs when a person has difficulty digesting a particular food.” For simplicity, we’ll use the word “sensitivity” throughout this article.

Unlike food allergies—which involve the immune system—food sensitivities occur when the gut reacts poorly to specific foods and ingredients. These reactions generally unfold in a couple ways:

  • Inflammation: Certain foods irritate gut tissues, leading to symptoms throughout the body. For example, the amines naturally present in red wine can expand blood vessels, triggering migraines in some people.
  • Indigestion: Other times, the digestive tract fails to properly break down certain foods. For example, you’ve probably heard of lactose intolerance. Some people’s intestines don’t produce enough of the enzyme lactase to digest lactose, a sugar present in dairy. The result: gas, bloating, and diarrhea.

(Learn more about food sensitivities.)

What symptoms can be addressed by an elimination diet?

A growing body of evidence shows that food sensitivities can lead to a wide range of unwanted symptoms.1,2 For example, food sensitivities have been linked to:

  • ADD/ADHD3,4
  • Bloating
  • Brain fog
  • Depression
  • Diarrhea
  • Fatigue5
  • Headaches6,7,8
  • Obesity9
  • Pain10
  • Rashes
  • Stomach aches

And much more.

Wow, that’s a big list! You may wonder: If food sensitivities involve the gut, how do symptoms show up all over the body—in the skin (rashes), brain (headaches), or joints (pain)?

Here’s why. Our gastrointestinal (GI) tract does a lot more than just digest and absorb food. Surprisingly, the GI tract also has its own independently working nervous system (aka the enteric nervous system).

Therefore, the GI tract is rich in neurotransmitters, hormones, chemical messengers, enzymes, and bacteria. Indeed, it’s even home to 70 percent of your body’s entire immune system!

Food sensitivities may also contribute, directly or indirectly, to many other problematic aspects of digestion: microbial imbalances, motility issues, detoxification abnormalities, and intestinal permeability.

This explains why problems in the gut can show up all over—in the form of migraines, chronic pain, eczema and other rashes, and brain fog, among many other symptoms and health problems.

So it makes sense that, if you’re suffering from food sensitivities, following an elimination diet for a few weeks could be the most profound dietary change you’ll ever make. For some people, the results can feel nothing short of miraculous.

(Read more on how food sensitivities affect the whole body.)

What about food sensitivity testing? Does it work?

Why do an elimination diet when you could just undergo food sensitivity testing?  IgG food sensitivity tests (a blood test for food sensitivities) are unproven as well as expensive.11 The Canadian Society of Allergy and Clinical Immunology, American Academy of Allergy Asthma and Immunology, and The European Academy of Allergy and Clinical Immunology have all issued position statements against their use.12,13,14

For this reason, the elimination diet remains the gold standard for identifying food sensitivities.

As with all sensitivity tests, it too has its flaws. There’s no universal diet for all people, and  findings are unique to each person, too. But elimination diets are inexpensive, relatively easy to do, and empowering (you do it, not a lab). Plus you experience the results first-hand, which can be a more powerful stimulus for dietary changes than a lab test.

What are the benefits of an elimination diet?

Elimination diets help you to collect and analyze empirical evidence, using experimentation and observation based on what happens in your body as you change what you eat. If your headaches disappear after you’ve removed certain foods only to suddenly resurface when you reintroduce chocolate, that’s a powerful clue.

Without an elimination diet, you can only guess about causes and their effects. 

Are you bloated because of the onions you ate at lunch? Or was it the beer? Or is the bloat from something non-food related, such as eating too quickly?

This guesswork gets even more difficult when:

  • Symptoms show up outside of the gut. Did you wake with a migraine because of the wine you had with dinner? Or are you just dehydrated? Or maybe you didn’t sleep well? Similarly, was that skin rash caused by something you ate—or was it caused by contact with a perfume, detergent, or some other irritating substance?
  • You can eat small amounts of certain foods without symptoms. For example, one square of chocolate might not cause problems, but when you eat half a bar? Your body rebels.
  • Symptoms are delayed. You eat some red pepper and feel fine. Then days later, your joints are achy and swollen. Yep, it’s possible.

An elimination diet helps you pinpoint the true source of such problems, once and for all.

Is it a food sensitivity? Or just normal digestion?

Occasionally people assume they’re sensitive to certain foods when, in reality, they’re merely having a quite normal bodily-response to foods that tend to result in gas-production during digestion.

These include Brassica vegetables—such as cabbage, cauliflower, broccoli and kale—as well as beans, legumes, raw onion, and raw garlic. Rather than eliminate these foods, you may only need to prepare them differently and/or introduce them slowly to allow enough time for your digestive tract to adjust. You may also want to take a probiotic supplement that contains Lactobacillus rhamnosus GG, which is one of the most studied gut bacteria strains. Look for a supplement that contains at least 1 billion live cultures.15

What are the side effects of an elimination diet?

Whenever you dramatically change your diet, your body is likely to have a few things to say about it—and this can be especially true with elimination diets.

Though some people truly feel amazing pretty quickly, other people feel worse before they feel better.

Why? An elimination diet involves a rapid and dramatic change. It’s like jumping into high-intensity-interval-training after being out of shape for years.

This is especially true if you go from a heavy intake of caffeine, sugar, and highly-processed foods to a zero intake of these foods and beverages.

As a result, you may initially notice withdrawal symptoms like headaches, fatigue, irritability, or skin flare-ups for a few days to a week.

What are the most common food sensitivities?

Based on data we’ve gathered from the thousands of clients we’ve coached, we can say pretty confidently that the following categories tend to cause the most problems:

  • Gluten
  • Dairy
  • Eggs
  • Sweeteners (example: sugar)
  • Soy

Types of elimination diets

In this article, we’ve included a food list for one type of elimination diet, but many other elimination diets exist. They include:

The whole foods elimination diet

Highly-processed foods house a wide range of additives that can trigger gut irritation and sensitivities in many people. These include food colorings, sugar alcohols, monosodium glutamate (MSG), and sulfites, among others.

By shifting to a diet rich in minimally-processed whole foods, you can naturally reduce or eliminate those food chemicals while boosting your overall health. As an added bonus, minimally-processed whole foods tend to contain fiber and other nutrients that nourish the digestive tract.

Eliminate just 1 food or food category

If you’re pretty sure you already know which food causes your problems, this is a great option. Let’s say, for example, from past experience, you know that you feel pretty horrid whenever you eat dairy. Then, on this type of elimination diet, you’d eliminate just dairy for 3 weeks. Then you’d reintroduce it to see how you feel.

Eliminate up to 4 foods

This is another great option if you’re pretty sure you know what foods bother you. To do it, only eliminate 1-4 foods that you think might cause problems for you.

The Precision Nutrition Elimination Diet

We usually refer to this as the “elimination diet medium” because it offers a middle way between hardly removing anything at all and removing so many foods that you think you can’t last another day.

You’ll find a food list a little later in this story that shows you, in detail, which foods to eat and which foods to remove.

The full elimination diet

This much more extensive type of elimination diet excludes a wide range of foods, including many types of meat, legumes, grains, nuts, and seeds—even a wide variety of fruits and veggies.

Because of the highly-restrictive nature of this elimination diet, however, you should only try it with the guidance of a professional who specializes in integrative medicine and/or medical nutrition therapy.

The FODMAP elimination diet

FODMAP stands for:

Fermentable
Oligosaccharides
Disaccharides
Monosaccharides
And
Polyols

These carbohydrate fibers are not fully absorbed in the small intestine. For many people, that’s not an issue. But in people with Irritable Bowel Syndrome (IBS), this incomplete digestion can trigger a range of bothersome symptoms: gas, distension, pain, diarrhea, and/or constipation.16

Over several years, researchers at Monash University in Australia have developed and extensively studied a low-FODMAP elimination diet for people with IBS, showing that it can help to alleviate these symptoms.17

Unlike other types of elimination diets, however, the FODMAP diet is a highly specialized form of medical nutrition therapy. The reintroduction phase of this diet is much more complex than the reintroduction phase of a typical elimination diet.

As a result, if you’ve been diagnosed with IBS and suspect you might have a FODMAP issue, you’ll need the expertise of someone qualified to offer medical nutrition therapy, such as a FODMAP-trained nutritionist. 

Check out the Find an Expert page of the Academy of Nutrition and Dietetics and/or the FODMAP dietitian directory from Monash University.18,19

Can you do an elimination diet if you’re pregnant or breastfeeding?

As it turns out, you need a lot of nutrients to grow and feed a baby, which is why rapid changes in dietary consumption are not recommended.

That said, when you’re pregnant or nursing, you can experience a range of uncomfortable problems, such as gas, bloating, and acid reflux.

If you suspect something you are eating may be worsening your symptoms, mention it to your physician or nurse midwife.

Under the direction of a specialist in integrative medicine and/or medical nutrition therapy, you may be able to safely remove and reintroduce a small number of foods—such as dairy, gluten-containing grains, or soy—thought to be behind the vast majority of food sensitivity issues.

How does an elimination diet work?

Elimination diets are organized into three phases: A prep phase, removal phase, and reintroduction phase.

Prep phase (7-9 days)

During the prep phase, you’ll… prepare for the removal phase.

This may be the most important part of the diet—so don’t skip it. People who spend a week getting prepared do far better than people that jump right into it.

Some of your prep work involves keeping a food journal to help identify trigger foods as well as deciding which foods to stop eating during the removal phase. This will help to personalize the elimination diet.

This prep time also involves planning what you will eat: finding recipes, finding groceries, organizing your kitchen, and so on.

Removal phase (3 weeks)

This is when you stop eating a variety of common trigger foods, such as gluten, dairy, and eggs.

Phase 3: Reintroduction phase (3+ weeks)

Now it’s time to systematically reintroduce the eliminated foods—testing them one at a time while monitoring for possible reactions.

The removal phase: What to expect

During the removal phase of an elimination diet, you stop eating 1 or more foods.

Depending on how many foods you eliminate, you might begin to feel better pretty quickly. Within days to weeks, you might notice clearer skin, heightened energy, more regular bowel movements, improved sleep, and other improvements.

Though this is an encouraging outcome, it’s not always evidence that the removal phase is working. For example, more whole foods, fewer highly processed foods, and smaller portions can also lead to improved energy, fewer GI symptoms, and an overall sense of well being.

You won’t know for sure whether you have a food sensitivity until you get to the reintroduction phase.

Also, it’s important to note that not everyone feels better right away.

Some people feel worse before they start to feel better as they withdraw from caffeine, sugar, and other foods.

Foods to eliminate during the removal phase

The following table gives an example of what to include and exclude during a typical elimination diet.

You’ll of course find other lists available on the Internet allowing more, and sometimes fewer, foods in the diet. The key here is to not get too dogmatic.  Self-experimentation rules the day. Try different things and see what works for you.

Foods to Remove Foods to Keep
Vegetables Highly-processed veggies (ex: battered and fried)
Nightshades: eggplant, peppers, tomatoes, white potatoes
All fresh, raw, steamed, sauteed, or roasted vegetables (except eggplant, tomatoes, peppers, and white potatoes)
Fruit Dried fruit (with sugar), canned fruit All fresh or frozen fruit without added sugar
Starches Gluten-containing grains: barley, bulgur, couscous, farro, kamut, rye, spelt, triticale, wheat
Gluten-containing bread, cereal, crackers, pasta, and wraps (including bran pellets, couscous, muesli, orzo, naan, roti)
Oats*
Corn
Gluten-free grains: amaranth, brown rice, buckwheat, millet, quinoa, sorghum, teff
Roots and tubers: beets, parsnip, rutabaga, squash, sweet potato, taro, turnips, yuca
Legumes Soybeans and soybean products: edamame, miso, natto, soy sauce, soy milk, tempeh, textured vegetable protein, tofu
Peanuts, peanut butter
Beans & lentils
Nuts & seeds N/A Tree nuts: almonds, brazil nuts, cashews, hazelnuts, pecans, pistachios, walnuts

Seeds: chia seeds, flaxseeds, hemp seeds, pinenuts, pumpkin seeds, sesame seeds, sunflower seeds

Oils & nut butters made from tree nuts, seeds

Meat, fish, meat substitutes, & shellfish Eggs
Processed fish: smoked, canned, and breaded options, such as canned tuna and fish sticks
Processed meat: bacon, burger patties, canned meats, cold cut, cured sausage, deli meats, hot dogs
Beef
Soy-based meat substitutes and seitan
Meat: chicken, duck, lamb, pork, turkey, wild game
Fresh fish, shellfish
Rice-based protein powder
Dairy & dairy alternatives Milk: cow, oat, goat
Buttermilk, cheese, condensed milk, cottage cheese, cream, ice cream, custard, non-dairy creamers, sour cream, yogurt
Unsweetened coconut, rice, almond, and hemp milk
Fats & oils Butter, dips, canola oil, margarine, mayonnaise, processed and hydrogenated oils, spreads, salad dressings (unless made from oils on the Foods to Eat list) Oils: avocado oil, coconut butter, coconut oil, cold-pressed olive oil, flaxseed oil, grapeseed oil, sesame oil
Foods: coconut meat, flakes, and milk (unsweetened), olives, avocado
Beverages Alcohol: beer, coolers, hard beverages, mixed drinks, spirts, wine
Caffeinated beverages: black tea, coffee, green tea, energy drinks, soft drinks
Fruit juice
Water, non-caffeinated herbal teas, mineral water
Spices & condiments Barbecue sauce, caviar, cayenne pepper, chocolate, chutney, cream-based sauces, curry paste, ketchup, mustard, pasta sauce, paprika, relish, soy sauce, tomato-based sauces, tzatziki Apple cider vinegar (and other vinegars without sugar or flavorings)
Sea salt
Most fresh herbs and spices (see exceptions in red list)
Sweeteners Brown sugar, corn syrup, coconut sugar, desserts, high fructose corn syrup, honey, jam, maple syrup, raw cane sugar, white sugar Stevia (if needed)

Removal phase meal ideas

An easy way to adapt to an elimination diet? Make a list of the foods and meals you eat regularly—and then look for ways to adapt them. For example, if you plan to follow our Elimination Diet Medium food list above, perhaps you could…

  • Make tacos or burritos in a bowl or lettuce wrap with turkey or tilapia, brown rice, and guac.
  • Try homemade 100% salmon, lamb, chicken, or bison burgers, either wrapped in lettuce or with sweet potato toast, or eaten on their own.
  • Have pasta made from zucchini noodles or brown rice pasta, mixed with a sauce made from lemon, salt, pepper, and olive oil. Top with roasted salmon.
  • Add avocado to a smoothie to replace the creaminess of yogurt.

Another great strategy is to make a list of all of the foods you can eat, and organize them into these categories: Proteins, vegetables, carbs, healthy fats.

Then, whenever you want to assemble a quick meal, just pick one option from each of those four categories.

In other words, you might choose salmon for your protein, broccoli for your veggie, brown rice for your carb, and avocado oil for your fat. Then you might use the oil to roast the broccoli and salmon, serving both with the brown rice. Add herbs and spices as needed.

(Find an extensive Create-a-Meal template, along with additional recipes and food lists, see our new Elimination Diet ebook for nutrition coaches. Download it here. It’s free.)

Removal phase packaged food list

Elimination diets can feel pretty restrictive, mostly because so many packaged foods contain gluten, dairy, soy, and corn. To make this easy, we read label after label, searching for packaged foods that work well with a typical elimination diet removal phase. You’ll find a complete packaged food list in our free Elimination Diet ebook for coaches.

Removal phase recipes

The following recipes all work with the Elimination Diet food list presented in this story.

Simple Fruit Smoothie

Blend (in this order): 2 cups coconut or rice milk, 2-4 thumbs of avocado, 2 cupped hands of fruit chunks (use frozen for a thicker smoothie), 2 scoops rice protein powder.  (Makes 2 servings.)

Sweet Potato Toast

Slice a large sweet potato in half lengthwise. Then slice 2 pieces from that center cut on each side, 1/4 “ to ⅓” thick. Toast until fork tender. (This may take several rounds in a toaster). Alternatively, lightly brush both sides with oil and bake at 350°F for 15-20 minutes, until fork tender, but not soft. Serve topped with ½ mashed avocado, 2 sliced radishes, and sea salt. (Makes 2 servings.)

Basic energy balls

Blend 10-12 pitted, coarsely chopped dates, 1 cup unsweetened shredded coconut (or any variety of finely chopped nuts, except peanuts), and ½ teaspoon cinnamon in the food processor. Then roll into balls. (Makes about 8 balls, 2 per serving.)

Avocado cakes

Mash ½ avocado. Spread on 8 Lundberg “Thin Stackers” brown rice cakes. Sprinkle with sea salt. Top each with 1-2 cucumber slices and a small sprig of dill, parsley, or cilantro. (Makes 2 servings.)

Banana “nice” cream

Coarsely slice 4 ripe bananas into small chunks, set on a plate or baking sheet, and freeze 1-2 hours. Once frozen, add banana chunks to a food processor and blend until creamy, scraping down the sides as necessary. Freeze for 1-2 hours for scoopable ice cream—or eat right away for “soft serve.” Top as desired. (Makes 4 servings.)

Baked Salmon with Brussels Sprouts

On a foil-lined or nonstick baking sheet, combine 1 pound (4 cups) trimmed and halved Brussels sprouts, 2 Tbsp melted coconut oil, 1 cup fresh cranberries, ½ tsp sea salt, and ¼ tsp apple cider vinegar. Scoot to one side of the sheet, then add six 4-oz salmon fillets, seasoned with salt and pepper. Bake at 400°F for 20 minutes, or until the salmon flakes with a fork and the sprouts are golden. (Makes 4 servings.)

(Find more recipes in our comprehensive elimination diet ebook for nutrition coaches. Download it for free.)

The reintroduction phase: What to expect

Of course, it’s not the purpose of the elimination diet to get rid of all the foods above forever. That would be awful. Rather, the point is to eliminate the foods and then slowly reintroduce them, one at a time, so you can monitor yourself for symptoms.

During the entire reintroduction phase, pay attention to how you’re feeling.  For example, you’ll want to monitor your sleep, mood, energy, digestion, bowel habits, and so on.

Reintroduce foods using a 3-day cycle:

Day 1: Reintroduce one food, eating at least two servings of it at different times of the day. For example, clients might reintroduce eggs on a Monday by having two scrambled eggs at breakfast and two hard boiled eggs at lunch.

Days 2 & 3: Stop eating the new food. For example, if you reintroduce eggs on day 1, you’ll stop eating eggs.

Day 4 and beyond: What happens after day 4 will depend on how things went on days 2 and 3.

  • If you feel great, you’ll reintroduce a different food (say wheat) for one day, repeating the three day cycle.
  • If you’re still experiencing reactions, you’ll wait until those symptoms subside before reintroducing another food.

What to do next

By now you should realize that the elimination diet isn’t necessarily easy.  But it’s not that hard either. It just requires that you have a plan and you pay attention.

To get started on an elimination diet, you might want to:

  • Download our comprehensive Elimination Diet book for nutrition coaches, which includes food lists, recipes, and all of the resources you or a client would need to get started and be successful.
  • Keep a food journal for a few weeks. Jot down what you eat and drink, along with how you feel. Then examine it for clues to see if you can get a sense of the foods leading to your symptoms.
  • Try to see this journey as an experiment that helps you learn more about yourself, your body, and your eating choices.
  • Consult with your health care provider to learn how such a diet might interact with any health conditions or medicines you might be taking.

If you decide to give an elimination diet a try, we hope it helps you get to the bottom of your symptoms, learn more about the foods that do and don’t work for you, and feel a whole lot better.

Are you a coach who wants to help clients with elimination diets?
Learn everything you need to know with our FREE e-book, The Ultimate Guide to Elimination Diets. It shows you how to create an elimination diet that’s 100 percent customized for each individual client. Plus, it includes extensive food lists, recipes, and instruction sheets you can share directly with your clients (or use for yourself). All so you have everything you need to confidently (and expertly) coach anyone through an elimination diet. Download it today—for free.

References

Click here to view the information sources referenced in this article.

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