How to do an elimination diet

Medically reviewed on July 6, 2021. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.


If you’re wondering whether some of the foods in your diet could be contributing to symptoms you're experiencing—like digestive issues or migraines—a two-step elimination diet can be an effective tool to identify potentially problematic foods.

Keep reading to learn what an elimination diet is, how it can help, and what the steps are to do one.


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What is an elimination diet?

In some cases, if you have a food intolerance or sensitivity your body may react and cause unwanted symptoms. If a food sensitivity is present, the offending food may contribute to abdominal pain, bloating, and other forms of gastrointestinal distress (or other symptoms, such as migraines). In a situation like this, an elimination diet may help you see which trigger food is causing your uncomfortable symptoms.

In an elimination diet, you temporarily remove specific foods that you suspect could be causing symptoms. After a period of time, you then reintroduce the “suspect foods.”

In this phase of the elimination diet, foods are reintroduced in isolation—meaning the “suspect foods” aren’t added back to your diet all at once, but are instead added back incrementally, one-by-one. With each “suspect food” you add back, you watch out for any symptoms that could be connected with that particular food.

Though there are many different approaches to elimination diets, the majority follow this two-step approach.

How can elimination diets help?

An elimination diet may help you find out what foods you’re sensitive to and connected with unwanted symptoms. Frequently reported symptoms that may be related to a food sensitivity include gastrointestinal issues like bloating, diarrhea, abdominal pain, constipation, and gas—to name a few. Symptoms may vary, depending on the individual.

An elimination diet plan can be useful because each of us have unique experiences when it comes to food and how food affects our bodies. We typically eat meals consisting of many different foods and ingredients, and it’s not always obvious which part of a meal is connected to an unfavorable symptom. When a food or food group is removed and then reintroduced in isolation, this can be an effective way to determine if that food or food group is a culprit.

The main purpose of an elimination diet is to investigate. It's not meant to be used as a dietary strategy for weight loss. Elimination diets have been around for decades, and have long been used to pinpoint concerns related to food—such as sensitivities, intolerances, and allergies.

Before you begin an elimination diet

Before beginning your elimination diet, it may be helpful to take a food sensitivity test so you can start with a personalized list of “suspect foods” based on IgG antibody reactivity levels (IgG antibodies are a part of your immune system).

The Everlywell at-home Food Sensitivity Test measures your body’s IgG immune response to 96 different foods (you can also take the Food Sensitivity Comprehensive Test to check 204 foods). Using the results of this test, you can guide your elimination diet—taking out a lot of the guesswork and potentially making it easier to find what problematic food you’re sensitive to. (Note that our test does not test for food allergies, which involve the antibody IgE—not IgG.)

An elimination diet can sometimes be difficult since meals tend to be a social activity involving family or friends. Some people find it best to start an elimination diet after major events have passed—such as weddings, holidays, or travel.

Preparation is key, so think about what you can eat during the elimination phase—as this can help you craft grocery lists and create meal plans. While you are doing the elimination diet, it’s a great idea to have a food diary on hand to record your findings. There are several benefits of keeping a food journal, and diligently taking notes can give you a better idea of what foods could be causing your uncomfortable symptoms.

How to do an elimination diet

There are different types of elimination diets, which is where a registered dietitian or other healthcare professional can help guide you. Someone with irritable bowel syndrome, for example, might do what’s referred to as a low FODMAP diet. This elimination diet removes fermentable sugars (high FODMAP foods) which may cause excess gas, bloating, abdominal pain, and/or diarrhea.

A basic elimination diet plan is divided into two phases: the elimination phase and the reintroduction phase (an approach that’s also used for someone undergoing a low FODMAP diet).

The elimination phase

The elimination phase requires removing potentially problematic foods from your diet—foods that may be involved with your symptoms. The number of foods to remove at first can vary, but ultimately, nutritional balance is encouraged and desired during the elimination phase—which is why it’s important to plan ahead and decide what foods you can use as substitutions.

Here are some examples of foods or food groups that may be considered for the elimination phase.

  • Citrus fruits: grapefruit, oranges, limes, lemons
  • Nightshade vegetables: nightshades include tomatoes, peppers, eggplant, white potatoes
  • Nuts and seeds: all tree nuts and seeds like, cashews, almonds, sunflowers seeds, chia seeds
  • Legumes: all legumes like lentils, beans, peanuts, and peas
  • Gluten-containing grains: wheat, barley, rye, oats (Related: What are the signs of gluten sensitivity?)
  • Meat and fish: processed meats, beef, chicken, pork, shellfish
  • Eggs
  • Dairy products: cow’s milk, cheese, ice cream, yogurt, butter, and foods items that contain milk (Related: Dairy sensitivity symptoms)
  • Fat: fried foods, high-fat meats
  • Drinks: alcohol, black tea, soda, coffee
  • Spices: black pepper, chili powder, cayenne pepper, paprika
  • Sugar: white sugar, brown sugar, honey, maple syrup, corn syrup, agave, high-fructose corn syrup
  • Artificial sweeteners and sugar alcohols
  • Sweets: chocolate and desserts

A healthcare provider may advise that you remove one specific food at a time—or a particular food group, like legumes or dairy—depending on what they suggest as the best individualized approach for you.

The reintroduction phase

During the reintroduction or add-back phase, you’ll slowly start to reintroduce eliminated foods back into your diet. This is often done about 30 days after you removed the specific food from your diet.

Each food or food group is reintroduced individually so you can monitor for symptoms that might be associated with that food or food group. If you don’t observe a flare-up of your symptoms, then the food you’ve added back isn’t likely to be a culprit. This reintroduction phase continues until you’ve added back each food in isolation.

The entire process—including the elimination phase and the reintroduction phase—can vary in duration, depending on the number of foods that are removed and that need to be reintroduced. For more details, check out this two-step elimination diet planner here!

The Everlywell at-home Food Sensitivity Test may help speed up the process. Take this easy-to-use test to identify what foods it might be useful to eliminate first (based on how your immune system’s IgG antibodies react with 96 different foods)—from the convenience of your home.


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Benefits of keeping a food journal


References

What You Should Know Before Trying an Elimination Diet. University of Washington Medicine. URL. Accessed May 4, 2020.

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