What Is an Elimination Diet, and Could It Help Me?

You may be 1 of the 26 million Americans who deal with food allergies. Food allergy is a serious condition that leads to 30,000 emergency room visits per year and 150-200 deaths.

Or, you may be one of the 15% to 20% of people who are sensitive to certain foods or have a food intolerance. Sensitivities and intolerances can cause a negative reaction after eating specific foods, but they are not life-threatening, like food allergies.

Food allergy requires a diagnosis from an allergist, who can perform testing. To find out if you have a food intolerance or sensitivity, an elimination diet may help. The diet includes removing certain foods from your diet, then reintroducing them to pinpoint what foods are causing negative side effects.

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If you’re thinking about giving this diet a go, keep reading to learn all of the steps and if it’s a safe option for you.

What is an elimination diet?

The elimination diet is pretty much exactly how it sounds — you remove any food(s) from your diet that you think is causing a problem. There are 4 steps to the process:

• Step 1: The planning phase. Work with your doctor to go over diet logs, symptoms, and any foods you believe are causing side effects.

• Step 2: The avoidance phase. The diet goes into full swing in this phase. A low-intensity elimination diet only takes out one food or food group, a moderate-intense one will remove multiple foods or food groups, and a high-intensity or “few-foods” one only allows you to eat certain foods. Regardless of what type of elimination diet you follow, it’s recommended to follow it for at least 10 days.

• Step 3: The challenge phase. Next, every 3 to 4 days, reintroduce a single food to see if symptoms return. If no symptoms return, reintroduce another food, wait 3 to 4 days, and so on. During this phase, be sure to record food intake and symptoms experienced to help confirm a potential sensitivity or allergy. If you have symptoms of an allergic reaction (more below), get medical assistance right away.

• Step 4: Creating a long-term diet plan. The diet is done, and (hopefully) you’ve indicated which foods are causing problems. While there isn’t an exact timeframe for continuing the elimination diet, it’s usually 3 to 6 months. It’s possible that after this time a food previously not tolerated could be eaten without side effects.

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Remember that every phase of the elimination diet should be monitored by your healthcare provider.

Who might benefit from trying an elimination diet?

If you’re dealing with symptoms that aren’t going away despite treatment, the elimination diet may be for you.

The diet can help your healthcare provider to determine if you’re experiencing food intolerances or allergies, which are often misdiagnosed. For example, food intolerances can look like symptoms of irritable bowel syndrome (IBS), such as gastrointestinal issues. 

What symptoms can elimination diets treat?

Elimination diets aim to treat the symptoms of an allergy or intolerance to a specific food. Symptoms of food allergies can vary, with common ones being:

• Swelling of the skin, hives, or rashes

• Itching in mouth or on lips

• Diarrhea

• Vomiting

• Breathing difficulties

• Muscle stiffness

• Feeling tired 

• Headache

• Irritability

Symptoms could occur right away or may appear hours or days after eating the allergen. Food allergies can be life-threatening, so it’s important to get tested if you think you have one.

Food intolerances may show similar but less severe symptoms. A 2019 review discusses various foods that have been linked to intolerances, along with their side effects. These include:

• Bloating and gas

• Stomach pain

• Diarrhea or constipation

• Brain fog

• Headache

• Fatigue

• Skin rash

Which foods might be eliminated on an elimination diet?

In short, eliminate foods that you suspect you can’t tolerate well. Keep in mind that the more foods you eliminate, the more likely you’ll be able to identify what’s triggering you. If you believe you’re experiencing a food allergy or intolerance, it may be helpful to start with common culprits of each.

Some of the most common culprits of food allergies are:

• Peanuts and tree nuts

• Fish and shellfish

• Eggs

• Milk

• Wheat

• Soy

Some of the common culprits of food intolerances are:

• Lactose (found in milk and other dairy products)

• Gluten (found in wheat and wheat)

• Monosodium glutamate (MSG)

• Caffeine

• Alcohol

• Artificial sweeteners

• Histamine (found in fermented foods, alcoholic drinks, and mushrooms)

• Artificial food colors and preservatives

While these are common foods eliminated when looking for a food intolerance or allergy, there are many different types of elimination diets depending on your goals. These include low-FODMAP diets and the rare-foods diet, among others. 

Are elimination diets safe?

There are some risks to following an elimination diet, so it shouldn’t be done without the assistance of your healthcare team.

One risk is that reintroducing a food after avoidance could cause anaphylaxis, a severe reaction from a food allergy that results in difficulty breathing and even shock. A 2014 study on children with a peanut allergy found that reintroducing peanuts could cause peanut-related symptoms.

Other risks include:

• Malnutrition due to the removal of certain foods

• Eating disorder trigger

• Fear of food

Also, elimination diets can be expensive. For example, studies have shown gluten-free products can be 242% more expensive than regular products.

Bottom line

The elimination diet is an option for people dealing with a food allergy or intolerance, but aren’t sure what food(s) is causing them problems. After a few weeks of eliminating certain foods, then reintroducing them, you should be able to pinpoint which have a negative effect on you. Be sure to work with your healthcare provider when trying an elimination diet.

Why trust our experts?

Written by:

Lauren Armstrong, RDN

Lauren Armstrong, RDN, is a registered dietitian and freelance writer who has work published on sites such as Greatist, LIVESTRONG.com, and CNBC.

Edited by:

Kelsey Abkin

Kelsey Abkin has been working as a journalist since 2016. She has held many titles throughout her career, including editor, content strategist, digital strategist, and writer.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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