How to Start an Elimination Diet

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As mamas, sometimes we’re so busy taking care of everyone else that we ignore our own health. If you take a moment to reflect, have you noticed you have symptoms that seem to come and go with no obvious cause or pattern? These symptoms could include joint pain, constipation, bloating, canker sores, or rashes. They may appear and then disappear randomly, with no explanation, despite your organic, low carb, low histamine, paleo, or another version of a healthy diet. If so, it could be food-related and you benefit from starting an elimination diet.

There are so many different diets out there now that it’s nearly impossible to keep up. Some include: low carb high fat (LCHF) or keto, high protein/low fat, paleo, autoimmune paleo, the GAPS diet, vegetarian, pescatarian, vegan, raw vegan, and more. Some protocols seem to work miracles for people. Yet, others following the same diet may feel worse. Why is that?

It all comes down to the fact that everyone is different. A food that is healthy and nutritious for one person may cause problems for another person. And this can change over time. It’s all due to individual food allergies, sensitivities, and intolerances. 

The easiest, most cost-effective way to determine if what we’re eating is causing some of our unexplained symptoms and affecting our overall health is to do an elimination diet.

What Is an Elimination Diet?

An elimination diet is a diet that eliminates the foods most connected to food allergies, sensitivities, and intolerances for a specific amount of time, often 28 to 30 days, sometimes longer, sometimes shorter. During that time, you’ll watch for a change in symptoms, and after they have subsided, you’ll slowly reintroduce foods and watch how your body responds. There are a couple of ways to do an elimination diet—an aggressive approach and a moderate approach.

Aggressive Approach

The aggressive approach restricts the most common offenders all at once, including gluten, dairy, soy, corn, eggs, nuts, soy, and nightshade vegetables. If one or more of these common inflammatory foods is the cause of symptoms, eliminating it will significantly reduce inflammation and related symptoms rather quickly. 

However, a very restrictive elimination diet may be difficult for moms and families to jump into all at once. If that’s the case, another option is the moderate approach. 

Moderate Approach

The moderate approach to finding food sensitivities is essentially the elimination diet in reverse. It begins with a very short list of foods to eliminate, such as gluten and dairy. While you are experimenting, you should keep a health journal to see if there is an improvement in symptoms. If symptoms continue, you slowly add to the food elimination list until you (or your kids) notice symptoms have almost or completely gone away.

It is surprising how much of a difference it makes just to eliminate certain foods. It can often be life-changing!

Food Allergies, Food Sensitivities, and Food Intolerances

So, what causes a need for an elimination diet? Food allergies, sensitivities, and intolerances. Some people consider food sensitivities and intolerances to be the same thing, but they are a bit different. I’ll explain each in detail, but in a nutshell, food allergies and sensitivities involve the immune system, while food intolerances occur as a result of improper digestion. 

What Is a Food Allergy?

A food allergy is the result of the immune system producing IgE antibodies in response to a portion of the food that it deems harmful. When IgE antibodies are stimulated, histamine is released into the bloodstream, leading to nearly immediate symptoms. Sometimes the results may be mild, such as rashes, hives, itching, runny nose, joint pain, vomiting, diarrhea, and swelling. But IgE food allergies are also the cause behind anaphylactic food reactions, which can be life-threatening. 

The most common foods that cause food allergy reactions, especially in children, include milk, eggs, tree nuts, peanuts, soy, wheat, fish, and shellfish. 

What Is a Food Sensitivity?

A food sensitivity also involves the immune system but is often triggered by different antibodies—the IgG, IgA, or IgM antibodies. The symptoms of food sensitivities are often less apparent than a food allergy but are much more common. They may present as depression, bloating, anxiety, attention deficit, brain fog, or migraines. With food sensitivities, symptoms may take anywhere from hours to days to surface.

What Is a Food Intolerance?

Food intolerance is a reactive response to a particular food that does not involve the immune system. It may be caused by enzyme deficiencies, an inappropriate response by the gut bacteria, or inflammation of the gut. The more the intolerable food is consumed and not digested, the more undigested matter accumulates in the gut, causing undesirable effects. This could lead to symptoms such as:

  • Constipation
  • Diarrhea
  • Cramping
  • Congestion
  • Weight gain
  • Headache
  • Fatigue
  • Brain fog 
  • Anxiety
  • Bloating
  • Blurred vision 
  • Depression 

The elimination diet is a fantastic way to determine your food allergies, sensitivities, and intolerances. 

How Do Food Reactions Occur? It All Starts With Our Gut

Our gastrointestinal tract (our gut) is our only internal system that has direct access to the outside world through our consumption of food and drink. This makes it vulnerable to significant damage if chronically exposed to compounds our bodies react to. 

The gut lining is composed of a single layer of cells with tight junctions between them, which are there to prevent large, undigested particles or proteins from getting through to the bloodstream. When we are exposed to physical, mental, chemical, or emotional stressors, this can inflame the gut lining, causing those tight junctions to loosen and digestion to falter. You may have heard this referred to as a “leaky gut.”  

When the gut becomes “leaky,” large particles and proteins begin to get into the bloodstream, triggering the immune system to attack unrecognizable substances, like undigested food proteins. Once the immune system has tagged the protein as foreign, every time the food is consumed, it causes an immune response. Researchers estimate that 70% of the immune system resides in the gut. If our gut is damaged due to outside toxins, then it ultimately affects our immune system.

The gut produces or houses enzymes for digestion, neurotransmitters, bacteria, and other chemicals. Then they are transported to other areas in the body, including the brain. When damage to the gut occurs, the enzymes stop working, neurotransmitters stop being produced, overgrowth of bad bacteria occurs, and chemicals needed for various physiological processes are not released. This leads to problems with digesting food, constipation, depression or anxiety, brain fog, food intolerances, skin reactions, etc. When the gut is damaged, the rest of the body suffers. 

There is good news—I promise! By eliminating many of the triggers that may be contributing to leaky gut and incorporating healing foods, such as bone broth, those tight junctions may eventually rebuild themselves. Then previously damaging foods no longer get into our bloodstream and cause immune responses. Bye, bye food reactions!

Who Should Try an Elimination Diet?

If you or the kiddos are experiencing any of the symptoms or conditions listed below, you might want to explore an elimination diet: 

  • Digestive problems, such as constipation, bloating, or diarrhea
  • Skin abnormalities, such as acne, eczema, rashes, hives, or psoriasis
  • An autoimmune condition
  • ADHD
  • Joint pain
  • Asthma
  • Depression and other mood disorders
  • Headaches
  • Migraines
  • Food sensitivities
  • Food allergies
  • Dark circles under eyes
  • Sinus congestion
  • Learning disabilities

Foods to Eliminate

When doing an elimination diet, you can either take an aggressive approach or a modified approach, depending on what works best for you and your family. 

Aggressive Approach Food Elimination List

Let’s first look at what foods should be eliminated with an approach that is more restrictive but will provide faster results. After all, the more foods that are removed initially, the more likely you will be able to identify the foods causing your symptoms. 

Eliminating the following foods for three to four weeks is considered an aggressive approach to an elimination diet: 

  • Gluten
  • Dairy
  • Soy
  • Corn
  • Eggs
  • Tree nuts
  • Peanuts
  • Refined Sugar
  • Alcohol
  • Coffee
  • Caffeine
  • Seeds
  • Legumes (beans and peanuts)
  • Nightshade vegetables (potatoes, peppers, eggplant, tomatoes)
  • Citrus fruits (in some cases)
  • Artificial sweeteners
  • Artificial colorings
  • Flavor enhancers, like monosodium glutamate (MSG)

If that sounds too overwhelming, then consider doing a modified approach instead.

Modified Approach Food Elimination List

The top eight foods recommended to eliminate using the modified approach include:

  • Gluten
  • Dairy
  • Soy
  • Corn
  • Eggs
  • Tree nuts
  • Refined sugar
  • Peanuts

If eliminating ALL of the above foods at once is just not possible, try simply eliminating the two of the most common triggers: gluten and dairy. Then eliminate other foods as needed. A modified approach to the elimination diet allows for an easier transition for the family and the fridge. 

Regardless of which approach you take, it can be difficult to take away the foods that our kids are used to consuming daily. Luckily, there are lots of substitutions and recipe ideas that can make this transition much more doable for you and even the pickiest of kids!

How Long Should You Avoid Trigger Foods?

One of the questions that I always get with an elimination diet is, “Will I have to follow this diet forever?!” The answer is no, not usually because the whole idea behind an elimination diet is to determine which specific food or food groups are causing reactions and eliminate only those foods.

The elimination only needs to last a short time… only a few weeks. According to an article in the Journal of Pediatric Allergy and Immunology, 98% of a cohort consisting of 129 participants reported significant improvement in inflammatory symptoms within four weeks on an elimination diet. However, other studies have indicated relief from symptoms in as little as 3-5 days on the protocol. 

Children generally see relief faster than adults, often within 7-10 days.

Regardless of how quickly or slowly results are seen, sticking to the elimination protocol for a full three to four weeks is ideal. Remember that many of these food allergies and sensitivities did not develop overnight. The immune system may require even more time than four weeks to calm down and decrease symptoms. As a result, some individuals may need six months to a year to completely relieve their symptoms. 

If symptoms are still present, but you suspect diet is playing a major role in symptoms, you might need other interventions. Still, don’t get discouraged. Everybody is different, so we require different types of care. 

Food Reintroduction

After following the elimination protocol for three to four weeks, the reintroduction phase can be a very exciting time. However, please pay very close attention to symptoms and determine if you’re feeling dramatically better, or if you need more time. Are your symptoms completely gone? Do you feel better and have more energy? Do your skin and hair look healthier? If so, reintroduction may begin!

It’s important to properly reintroduce these foods into your diet. Here are the steps for reintroduction:

Step One 

Introduce one food or food group at a time for two consecutive days.

Example: Let’s say you decide to reintroduce eggs on days 29-30 following a 28-day elimination. Eat eggs multiple times during those two days. Eat them scrambled, hard-boiled in egg salad, or use them as an agent in baked goods (goods that are elimination compliant, of course)! Tip: Egg yolks are usually less problematic than egg whites.

Next, we’ll take a break from them again.

Step Two

After two days of egg reintroduction, return to the elimination for another two days. If the symptoms that were present before the elimination return, continue to eliminate eggs for a longer time. This is an indication that the gut-healing benefits of the elimination protocol are not quite complete. You may need more time or additional interventions to heal your gut. 

If you would like more information on ways to heal a leaky gut, see Chris Kresser’s article, 9 Steps to Perfect Health: How to Heal Your Gut Naturally.

Step Three

If there’s no increase in symptoms or any other unpleasant changes within those four days, then you are most likely not reactive to this food. It is then time to reintroduce another food, such as sunflower seeds. Repeat this process until all foods are reintroduced and you are able to successfully identify the food triggers that may be causing the symptoms.

Watch for These Symptoms

There are many more bodily functions than just digestion to be aware of as you’re identifying food reactions. For example, some symptoms may include:

  • Fatigue
  • Sleep disturbances
  • Acne
  • Depression or fluctuations in mood
  • Constipation/diarrhea
  • Headaches
  • Bloating
  • Reduced mental clarity or brain fog
  • Sluggishness
  • Hyperactivity
  • Change in your menstrual cycle

You can add any differences noted that were not present during the elimination phase of the process.

How Long Will Symptoms of a Reaction Last?

If a reaction from a type of food does occur during reintroduction, the length of time it lasts depends on the type of reaction that occurs. IgE-mediated food allergies tend to appear and disappear within a matter of hours, whereas food sensitivities and intolerances last for several hours to days depending on the amount consumed and the inflammatory response. 

Is It Possible to Reverse Food Intolerances?

The effects of food intolerances can be diminished or reversed if the underlying reason for the cause of the food intolerance is addressed. Often, the underlying cause is a leaky gut. Once the gut barrier has completely healed, it may be possible for some reactive foods to be safely consumed in moderation. 

However, it is important to remember that food is often one of the biggest culprits in causing a leaky gut to begin with, so don’t assume that once reactions disappear that the food can be consumed in excess.

Why Not Just Test for Food Allergies, Sensitivities, and Intolerances?

Most food allergy or sensitivity tests use a skin prick or a blood test. However, these tests are usually not as accurate as claimed to be and often require a recent exposure to the reactive foods. Foods are composed of multiple strings of amino acids that form proteins. Food allergy and sensitivity tests identify an immune reaction against a specific strand of protein within that food. Considering the thousands of variations in protein strands and chemicals present in different foods, it is very difficult to get accurate information on paper. 

As a result, food intolerances cannot be tested by checking for an immune response to proteins. In order to determine if you have food intolerances will likely require a deeper look into gut health, digestion, and even genetics. 

Rather than testing food reactions through laboratory testing, looking deeper into gut health testing and the role of genetics in food reactions may be more accurate. I would highly recommend looking into Viome for gut health testing and for genetic testing.

This article was medically reviewed by Madiha Saeed, MD, a board-certified family physician. As always, this is not personal medical advice and we recommend that you talk with your doctor.

Have you completed an elimination diet with amazing success? Share your comments and experiences with us! 


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