Chances are you’ve heard about an elimination diet by now. Even if you haven’t heard of an “elimination diet", you’ve probably come by Whole30 (it’s become all the rage in the past few years) which is just an elimination diet with fancy packaging and good marketing. Naturopathic doctors have been using elimination diets to help their patients achieve optimal health for decades.
An elimination diet and challenge answers the question: Is there a hidden food sensitivity that could be causing some or all of your symptoms? Maybe you’re eating something that could be triggering not only digestive issues but causing you to feel sluggish, achy or even just off. I see food intolerance or sensitivities contributing to symptoms and disease states all the time. If you haven’t thought about it, I would highly encourage you to explore this possibility.
The first time I did an elimination diet was my first year of medical school, and I'll admit that it was incredibly challenging. I had to rethink my grocery shopping and cooking. But the struggle was short term. Once I oriented myself with what I could and couldn’t eat, it became second nature after a week or two. And the reward was priceless. In the end, I found out that I’m sensitive to gluten - it makes me feel sluggish, bloated and breakout. Even today, gluten is an ongoing sensitivity for me. I also found I was sensitive to eggs, which caused stomach pain. By avoiding eggs and working on healing my gut, my egg intolerance eventually resolved.
I used the elimination diet to find culprits to digestive issues, skin problems and fatigue, but you can use it for much more. Here are the most common reasons I recommend an elimination diet.
Skin issues: eczema, psoriasis, acne
Migraines, headaches and brain fog
Feeling off (you just don’t feel as good as you used to)
The idea behind an elimination diet is to remove potentially problematic foods from your diet for 3-4 weeks, or until symptoms improve, then slowly introduce or challenge the foods to determine if they provoke symptoms
Before we go any further, I want to clarify the difference between food allergies and a food intolerance or sensitivity.
Food allergies are an immune system response that results in an immediate reaction. For example, you may know someone who eats shellfish and breaks out in a rash, or someone who eats peanuts and experiences itching mouth or difficulty breathing. These are food allergies.
Food sensitivities or intolerance are a delayed reaction that creates inflammation in the body. The symptoms generally aren’t as apparent as an allergy because they have a delayed effect - you could eat a certain food and only feel symptoms 1-2 days later.
There is a basic version of an elimination diet removing the most common food sensitivities, and there is an extended version. I’ll outline both here
Basic elimination diet
Gluten: wheat, spelt, farro, kamut, barley, rye, bulgar
Diary: milk, cheese, butter, cream, yogurt, kefir, sour cream
Soy: soy milk and other soy dairy alternatives, tofu, miso, tempeh and edamame
Corn: including corn oil
Sugar and artificial sweeteners: this includes soda and other beverages
Processed Oils: canola, vegetable, soy, corn
Food additives: artificial colors, flavors, preservatives, sweetness
Coffee, tea and alcohol
Extended elimination diet includes the above plus
Legumes: beans and lentils
Nightshades: tomatoes, potatoes, eggplant, peppers
Citrus: lemon, lime, orange
Non-grass fed beef, non-pasture raised pork
Elimination phase: Choose which elimination diet you want to do. If you start with a basic and don’t achieve results after two weeks then move on to the extended. If you have an autoimmune disease, I recommend starting with the extended. Do the elimination for 3-4 weeks. A good rule of thumb is to continue the elimination until there are noticeable improvements.
Challenge phase: Once you’ve completed the elimination, you’ll add back one food every three days. On the day you’re challenging a food group, have several servings of it that day and in its pure form, then see how you feel that day and the next two days. For example, if you’re challenging gluten have a piece of wheat bread for breakfast, lunch and dinner on day one then observe how you feel days two and three. Avoid things like pastries, cookies and pizza as these have other ingredients that you’re avoiding.
Note how you feel the day of the challenge and the next two days. If you have any symptoms ranging from a return of old symptoms or feeling sluggish, headache, bloating or other symptoms, you are sensitive to this food. If you are sensitive, remove the food from your diet again until you’re feeling well then move on with the challenge. If you don’t react to the food, you can keep it in your diet and start to challenge other foods every third day.
It can be helpful to keep a food and symptoms journal during the challenge phase. Otherwise, it can be hard to track your response.
Withdrawal symptoms: Some patients may experience withdrawal symptoms in the initial elimination phase which may include fatigue, irritability, headaches, malaise, or increased hunger. If this happens, take 1-2 grams of buffered ascorbic acid (vitamin C), and 300-500 mg of magnesium per day.
You feel deprived or overwhelmed: If the thought of eliminating all these foods sounds like too much for you right now, then just eliminate one food at a time. Start by eliminating gluten for four week, then challenging it back. Then dairy for four weeks, etc. I work with a lot of patients who have a history of disordered eating, in these patients restriction isn’t a good idea.
You don’t feel any different after four weeks: at this point, you should work with a naturopathic or functional medicine practitioner to assess for the root cause of your symptoms.