Nutrition is an important determinant of overall health. The foods you eat affect your gut health and how you feel. Poor nutrition often leads to poor gut health and chronic, unexplained symptoms.
Gut health and good digestion play a significant role in overall health. Research has illustrated connections between gut health and the brain, heart, immune system, and the ability to absorb nutrients that provide fuel to keep the body healthy and functioning optimally. Poor gut health may even affect weight loss efforts.
An elimination diet effectively determines what foods may negatively impact your gut and overall health.
What is an Elimination Diet?
Functional medicine healthcare practitioners often use an elimination diet to remove foods that are known to commonly cause food allergies, sensitivities, or food intolerances to see if symptoms improve. Once symptoms resolve, the foods are reintroduced one at a time to assess for any negative symptoms associated with food.1,2
An elimination diet is usually followed for about four to six weeks and can be used to help identify which foods are contributing to symptoms, such as which foods may be causing an imbalance in your gut microbiome.
An elimination diet may also help you determine if you lack digestive enzymes that prevent you from properly digesting sugars or proteins in foods, for instance, lactase in lactose intolerance. Food intolerances can cause various unpleasant symptoms, from eczema to digestive issues. These symptoms might be improved by avoiding foods your body can not digest properly.3,4
Types of Elimination Diets
Different types of elimination diets are aimed at helping different conditions and symptoms.
Some types of elimination diets include:
- Low-FODMAPs diet: Removes FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), short-chain carbohydrates that some people can’t digest. FODMAPs may cause gas, bloating, diarrhea, and brain fog.
- Paleo diet: Removes common foods that may cause food sensitivity or intolerance, but it is not as restrictive as other diets, so it can be easier to adhere to.
- Few foods elimination diet: Eating a combination of foods you don’t eat regularly. One example is the lamb and pears diet, popular in the US, where lamb and pears are not commonly eaten.
- Rare foods elimination diet: Similar to a few foods diet, you can only eat foods that you rarely ever eat, as they are less likely to trigger your symptoms. Common foods on a rare food diet include yams, buckwheat, and starfruit.
- Fasting elimination diet: Involves strictly drinking water for up to five days, then reintroducing food groups. This type of diet should only be done with permission from your doctor, as it can be dangerous to your health.
- Other elimination diets: These include lactose-free, sugar-free, gluten-free, and wheat-free diets.
How to Do an Elimination Diet
Before starting an elimination diet, it’s important to be aware that this diet should not be followed long-term. Instead, it should be used to determine which foods are causing your symptoms so you can avoid them in the future.
You should also seek professional advice from a physician or registered dietitian before starting an elimination diet to ensure it is safe.
An elimination diet has three phases:
During the elimination phase, you eliminate suspected trigger foods for a short period, typically two to three weeks.
You should start by eliminating the foods that you suspect your body can’t tolerate, as well as foods that are commonly known to cause symptoms.
Common trigger foods include nuts, corn, soy, dairy, citrus fruits, nightshade vegetables, wheat, and foods containing gluten, pork, eggs, and seafood.5
During this first phase of the elimination diet, you should be able to determine if your symptoms are caused by food or another trigger. However, if your symptoms persist after removing trigger foods for two to three weeks, it is best to consult your doctor.
The next phase of the diet is the reintroduction phase, in which you gradually reintroduce eliminated foods back into your diet.
Each food group should be introduced individually over two to three days while observing for any possible symptoms. Before starting the elimination diet, you should look for any symptoms you previously experienced. Additional symptoms to watch for include:
- Rashes and skin changes
- Joint pain
- Headaches or migraines
- Difficulty sleeping
- Changes in breathing
- Stomach pain or cramps
- Changes in bowel habits
If you experience no symptoms after introducing a food or food group, you can assume that the item is fine to eat and move on to the next food group.
However, if you notice negative symptoms like the ones listed above, you have successfully identified a trigger food and should remove it from your diet.
The entire process, including elimination, takes roughly five to six weeks.
If you plan to follow a more restrictive type of elimination diet, such as the fasting elimination diet or rare foods elimination diet, you should first consult your doctor or a registered dietitian. Following a diet that is too restrictive may cause nutritional deficiencies.
The maintenance phase is the last phase of the elimination diet. It involves simply continuing to follow an eating style that does not include any foods you found to trigger symptoms during the reintroduction period. You should include a variety of foods from different food groups and only avoid the foods that cause symptoms.
What to Get Rid of on an Elimination Diet
Several foods are commonly removed during the elimination phase. These foods often include:
- Dairy Products: If you are sensitive to dairy, you may have digestive symptoms such as gas, bloating, stomach pain, diarrhea, or constipation. This could be due to lactose intolerance, milk allergy, or other sensitivity. Eliminate all dairy, including milk, cheese, yogurt, and ice cream.
- Nuts and Seeds: Nuts contain many proteins that can act as allergens. Eliminate all tree nuts, nuts, seeds, nut butter, or foods that contain these products.6
- Legumes: Legumes (black beans, kidney beans, lentils) contain FODMAPs and should be avoided during the elimination phase.
- Eggs: Eggs are commonly eliminated during the elimination phase as they are one of the top eight common food allergens.
- Wheat: Wheat may cause negative symptoms in some people due to its gluten content. Avoid wheat, barley, corn, spelt, rye, oats, and bread. Avoid any other gluten-containing foods.
- Nightshade vegetables: People sensitive to nightshade vegetables may experience negative side effects, including gas, bloating, diarrhea, heartburn, nausea, and joint pain due to inflammation. Avoid nightshades, including tomatoes, peppers, eggplant, white potatoes, cayenne pepper, and paprika.
- Soy: Soy is a common allergen or irritant, so you may want to eliminate this ingredient during the elimination phase.
- Shellfish: Another of the eight common allergens, shellfish may cause a range of symptoms from mild to severe, depending on whether there is an allergy or sensitivity.
- Fats: Some people may have difficulty digesting and absorbing fats properly. Avoid butter, margarine, hydrogenated oils, mayonnaise, and spreads.
- Certain spices and condiments: Some spices and condiments can contain irritants that cause uncomfortable symptoms. Garlic and onion, particularly, are eliminated in a low FODMAP diet.
- Caffeine-rich beverages: Caffeine has been shown to cause frequent contractions in the digestive tract. It can also increase stomach acidity by triggering the production of more gastric acid.
- Artificial sweeteners: Aspartame, diet drinks, and sugar-free products are often full of artificial sweeteners that should be avoided during an elimination diet.
If you suspect that other foods not on this list make you feel uncomfortable, you should consider eliminating them as well.
What to Eat on An Elimination Diet
Elimination diets can be extremely restrictive, but there is still enough variety to make healthy and delicious meals.
Some foods you can eat include:
- Fruits: Most fruits, with the exception of citrus fruits, can be eaten. Fruits provide vitamins and minerals to help prevent deficiencies during a restrictive diet.
- Vegetables: A good source of vitamins and minerals, most vegetables can be eaten with the exception of nightshades.
- Grains: Gluten-free grains like rice, buckwheat, and quinoa can be included in an elimination diet.
- Meat and fish: Including turkey, chicken, lamb, wild game, and cold-water fish like salmon can help you reach your protein needs while following the elimination diet. Opt for lean cuts or grass-fed options.
- Dairy substitutes: When eliminating dairy, you may use dairy-free alternatives like coconut milk and unsweetened rice milk.
- Fats: Be sure to include healthy fats like cold-pressed olive oil, flaxseed oil, or coconut oil. You can utilize these oils to cook proteins or vegetables.
- Beverages: When it comes to beverages, stick to water and herbal teas that do not contain caffeine or additives. This can help you stay hydrated without consuming any potential irritants.
What are the Benefits of an Elimination Diet?
There are several potential benefits of following an elimination diet. Some benefits include:
1. Helps You Identify What Foods Are Negatively Impacting Your Health
Elimination diets can help you figure out what specific foods may be causing an immune system response.
2. Reducing Unpleasant IBS Symptoms
An elimination diet may improve irritable bowel syndrome (IBS) symptoms like bloating, abdominal cramps, and gas. People who followed an elimination diet decreased their IBS symptoms by 10%, and those who best stuck to the diet improved symptoms by as much as 26%.7
3. Reveals Foods That May Interact With Gut Microbiome
Elimination diets can help you learn which foods may be causing an imbalance in your gut microbiome.3,4
4. Determine if There is Any Underlying Medical Condition
Several medical conditions can affect the digestion and absorption of food, including enzyme deficiencies, celiac disease, chronic pancreatitis, and cystic fibrosis. If symptoms are not improved with the elimination diet, seek help from a medical professional to rule out a more serious health condition.
A Week-Long Sample Elimination Diet Meal Plan
Below are five days of elimination diet recipes and suggestions from our in-house nutritionist.
Elimination Diet Breakfasts
- Day 1: 1 cup hot rice cereal, 1 cup strawberries, 1 cup herbal tea
- Day 2: Berry coconut smoothie
- Day 3: Sweet potato breakfast hash with ground bison, 1 cup herbal tea
- Day 4: 1 cup puffed rice cereal, 1 cup rice milk, ½ cup blueberries, 1 cup herbal tea
- Day 5: 1 cup hot rice cereal, 1 cup strawberries, 1 cup herbal tea
Berry Coconut Smoothie Recipe
Blend the following ingredients together.
- ¾ cup unsweetened vanilla coconut milk beverage
- ½ cup frozen mixed berries
- ½ cup frozen sliced banana
- 1 Tbsp unsweetened shredded coconut
- 1 tsp honey
- 3 ice cubes
Elimination Diet Lunches
- Day 1: 4-6 oz. chicken breast, Apple Fennel Watercress Salad, 1 cup herbal tea
- Day 2: 4-6 oz. chicken breast, 1 cup lightly sauteed green beans in olive oil, ½ cup cooked rice, 8 oz. water
- Day 3: Chicken salad with strawberries, cucumber, avocado, and olive oil, 8 oz. water
- Day 4: Shredded chicken burrito bowl, brown rice, roasted veggies, greens, olive oil, and sea salt, 8 oz. water
- Day 5: 4-6 oz. chicken breast, 1 cup lightly sauteed green beans in olive oil, ½ cup cooked rice, 8 oz. water
Apple Fennel Watercress Salad Recipe
Combine all ingredients in a salad bowl.
- 2 Tbsp fresh lemon juice
- 1 Tbsp white wine vinegar
- 3 Tbsp extra virgin olive oil
- 2 tsp honey
- 1/4 tsp salt
- 3 cups chopped baby spinach
- 1 bulb fennel, chopped (white part only)
- 2 heads Belgian endive, thinly sliced
- 1 small Fuji apple
Elimination Diet Dinners
- Day 1: 4-6 oz. baked salmon,1 cup steamed broccoli, ½ cup cooked rice, 8 oz. water
- Day 2: 4-6 oz. chicken breast, 1 cup cauliflower rice, 1 cup cooked asparagus, 8 oz. water
- Day 3: Chicken and ginger “fried” cauliflower rice, 8 oz. water
- Day 4: Zucchini noodles with meatballs, 8 oz. water
- Day 5: Chicken burger, avocado mash, oven-roasted sweet potato “fries,” 8 oz. water
Elimination Diet Snacks
- Day 1: 1 cup raspberries, 1 cup vegetable broth, 1 cup herbal tea
- Day 2: 1 pear, 1 cup herbal tea
- Day 3: Fresh melon with a honey drizzle, 1 cup herbal tea
- Day 4: Beetroot hummus with carrots and celery, 1 cup herbal tea
- Day 5: 1 clementine or kiwi
Final Tips on How to Start Your Elimination Diet Journey
Rethink your meals
You don’t have to eat breakfast foods at breakfast. Having leftovers from last night’s dinner for breakfast the next day is perfectly fine.
Meal prep staples you can cook in multiple ways
At the beginning of the week, prepare a few basic food items that can be repurposed for different meals throughout the week.
Cook enough for leftovers
Instead of making yourself a single serving of a dish, make a larger batch and freeze the leftovers so you have a backup plan if you are too tired or busy to shop and cook throughout the week.
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Frequently Asked Questions
How do I know if I should do an elimination diet?
If you are experiencing symptoms that you think may be food-related, an elimination diet could help you discover which foods may be linked to these symptoms. However, you should consult with a healthcare provider before starting any type of elimination diet.
How long does it take for elimination diets to work?
An elimination diet should last no longer than six weeks. Some individuals feel changes and see a reduction of symptoms in a few days, but it could take several weeks or an elongated period of time to notice differences.
Who shouldn’t try an elimination diet?
Children and pregnant women should not try an elimination diet unless directed to do so by a healthcare professional or registered dietitian.
Topics discussed in this article:
- Spiegel B. Gravity and the Gut: A Hypothesis of Irritable Bowel Syndrome. Am J Gastroenterol. 2022;117(12):1933-1947. doi:10.14309/ajg.0000000000002066
- Meyer R, Godwin H, Dziubak R, et al. The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organ J. 2017;10(1):8. Published 2017 Feb 22. doi:10.1186/s40413-016-0139-7
- Tursi A, Brandimarte G, Giorgetti G. High prevalence of small intestinal bacterial overgrowth in celiac patients with persistence of gastrointestinal symptoms after gluten withdrawal. Am J Gastroenterol. 2003;98(4):839-843. doi:10.1111/j.1572-0241.2003.07379.x
- Naseri K, Dabiri H, Rostami-Nejad M, et al. Influence of low FODMAP-gluten free diet on gut microbiota alterations and symptom severity in Iranian patients with irritable bowel syndrome. BMC Gastroenterol. 2021;21(1):292. Published 2021 Jul 14. doi:10.1186/s12876-021-01868-5
- Böhn L, Störsrud S, Törnblom H, Bengtsson U, Simrén M. Self-reported food-related gastrointestinal symptoms in IBS are common and associated with more severe symptoms and reduced quality of life. Am J Gastroenterol. 2013;108(5):634-641. doi:10.1038/ajg.2013.105
- Okimoto E, Ishimura N, Okada M, et al. Successful Food-Elimination Diet in an Adult with Eosinophilic Gastroenteritis. ACG Case Rep J. 2018;5:e38. Published 2018 May 23. doi:10.14309/crj.2018.38
- Atkinson W, Sheldon TA, Shaath N, Whorwell PJ. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004;53(10):1459-1464. doi:10.1136/gut.2003.037697