How to Go on an Elimination Diet

In an age where countless people seem to have some kind of food sensitivity or intolerance, elimination diets have become incredibly common. They help you find out what foods, if any, trigger or worsen conditions ranging from joint pain to acne. 

The tricky thing about them – besides the fact that even temporary diet change is hard – is that there isn’t a clear set of rules. Ask five people, “What is an elimination diet?” and you’ll probably get five different answers. Google “How to do an elimination diet” and nearly 59 million results pop up. 

Don’t let the volume of information or the different approaches concern you. The reason for so much variation is simply that we’re human: We have different cultures and diet preferences, different genes and conditions, different personalities. Elimination diets must cater to our uniqueness to be effective. 

Different Approaches, Same Goal
You may need a vegetarian elimination diet, keto elimination diet, dairy elimination diet or gluten elimination diet. You may try a 21-day elimination diet or stick with it for twice as long. You may eliminate one potential trigger food or several all at once. 

No matter what style you choose, it will follow the same basic format. First, you remove certain foods that you or your doctor consider symptom triggers. Then you gradually add these foods back to see how they affect your body. 

Start to finish, elimination diets take roughly one to two months. You can do them on your own or under the supervision of your doctor, but working with your physician is probably the best place to start. You’ll get a more reliable picture of your triggers, plus answers to all your questions from someone who knows your symptoms and health concerns well. 

Ready to try it? Here’s what you need to know about how to go on an elimination diet. 

Step 1: See Your MDVIP-affiliated Doctor 
If you haven’t been completely forthcoming about all your symptoms with your doctor, do it before you start the diet. We know it can be embarrassing to talk about some things, like gas and diarrhea, but they may be important clues that help rule out or identify underlying conditions. If your doctor suspects lactose intolerance, for example, it can be diagnosed with a simple breath test that measures certain gases.

You should also bring these questions to your visit, especially if you’ll be on an elimination diet for a couple months:

• Do I need to make any changes to my medications?
• Should I add anything else to my diet to compensate for the nutrients I won’t get? 
• Can you recommend tips on meal planning?
• Are there any “hidden” ingredients I should look for on food labels? 

Step 2: The Elimination Phase
The elimination phase is when you stop eating the potential trigger ingredient or food for a few weeks.  
You’ll be lucky if you discover your trigger is a single, whole food, such as strawberries -- or even a class of foods, like nightshade vegetables like tomatoes or peppers. These are simple to avoid in the long run. 

Be patient if the elimination diet doesn’t yield clear, immediate answers. Sometimes it’s difficult to identify a trigger when it’s a chemical or ingredient among many others – like sulfites in dried fruit or wine. Gluten is an exception, though. A protein in wheat, barley and rye, gluten is in countless foods, from bread products to deli meat. And it makes some people feel miserable: bloated, gassy and toilet-bound.

Celiac disease is a severe gluten intolerance that can be diagnosed with a biopsy. A less serious reaction, gluten sensitivity, can be identified with an elimination diet. Those who suspect they have a gluten sensitivity, and therefore avoid gluten-containing foods, should consider an elimination diet to be sure their gluten-free diet is necessary. 

If you truly have a reaction to this protein, all foods with high amounts of gluten will make you ill – cafeteria sandwiches and gourmet desserts alike. And if they don’t, gluten isn’t the problem. 

Step 3: The Reintroduction Phase
Feeling better after the elimination phase? That’s a good indication that your body can’t tolerate one of the restricted foods very well. Now is when you’ll slowly reintroduce each one. This reintroduction phase is also known as “the challenge phase.” 
Start with small amounts – a bite or two – and move on to larger portions if you don’t have an adverse reaction. Record the amount you ate and whether any symptoms developed afterward. 

The better your records about reintroduced foods, the more you’ll know about what you can and cannot eat – and in what amount. For example, you may learn that eating a chocolate bar causes headaches, but one square of chocolate is OK. 

At the end of the elimination diet, you may need to make some important changes. Not all of them will be about what you can’t have anymore. If you discover that certain foods trigger symptoms, eliminating those foods may mean fewer medications and more days with less discomfort.