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Elimination Diet 101

by , | August 24, 2022 | Articles, Nutrition

fruits and veggies

What is an Elimination Diet?

An elimination diet is a type of nutritional plan that can help you determine foods that cause gastrointestinal distress and sources of certain chronic, inflammatory conditions. Elimination diets can be effective in determining food intolerances and sensitivities through modifying one’s diet 1. An elimination diet removes foods from the diet that are believed to be causing distress, in an effort to alleviate symptoms (bloating, gas, diarrhea, migraines, skin rashes, etc). According to The Academy of Nutrition and Dietetics, elimination diets are typically done for a limited period of time, ranging from 4-8 weeks, although this can vary 2. It is important to note that elimination diets should not be used long term due to the risk of nutrient deficiencies. In our experience in the practice, the elimination phase is typically implemented for 4-8 weeks and the reintroduction phase is typically 2-4 weeks, depending on how many foods need to be reintroduced. After the elimination diet has been completed, foods associated with symptoms or “challenge foods” are reintroduced into the diet, one at a time in two-day intervals. It typically doesn’t matter which food is reintroduced first (this usually tends to be the food that’s missed or craved the most) 14. It’s important to eat a decent amount of the challenge food (two or three average size portions throughout the two days) and track any symptoms in a symptom tracker to determine if there’s a reaction (think headache, rash, bloating, joint pain, changes in bowel habits). If there’s no reaction, you can keep that food in the diet and introduce the next food on day three. If there is a reaction, that food is removed from the diet. It’s important to note that foods removed might not necessarily be lost and gone forever, and they should typically be reintroduced after 3 months, allowing for gut repair. Foods commonly eliminated are the most commonly allergenic foods. These typically include gluten, dairy, soy, corn, peanuts, eggs and shellfish. In some cases, citrus fruits, nightshades or high FODMAPs 3 foods may be eliminated. While following an elimination diet, alcohol, sugar and artificial sweeteners should be avoided. In certain cases, it may be beneficial to eliminate foods high in histamine and foods that produce histamine, such as fermented foods, avocado, dried fruit, vinegar, smoked meats, aged cheeses, chocolate and coffee. It’s important to work with a Registered Dietitian or a Certified Nutrition Specialist, as they can review your typical eating patterns and food preferences and provide you with a list of food items to eat in place of the foods you are eliminating. This will ensure nutritional optimization while on this diet.

What are the benefits and risks of an Elimination Diet?

Following an elimination diet can help determine specific foods or ingredients responsible for symptoms and can help a person identify foods they are sensitive to or have an intolerance to 4. It can be utilized as part of the diagnostic process to uncover what foods people can and can’t tolerate. Elimination diets may reduce gastrointestinal symptoms such as gas and bloating, as well as symptoms associated with autoimmune conditions, fatigue, brain fog, headaches, migraines, acne, eczema, and ADHD 1. Elimination diets can be restrictive, however. If you have a history of an eating disorder it’s important to let your practitioner know, as this diet may be contraindicated.

Who should go on an Elimination Diet?

You might ask who should go on an elimination diet. That’s a great question! An elimination diet is not for everyone, nor is it a weight loss method. It’s a tool commonly used that may help those with issues ranging from gastrointestinal disorders such as GERD 5, IBS 6 or IBD 7, headaches or migraines 8, skin conditions such as acne and eczema 9, eosinophilic esophagitis 10, chronic fatigue 11 as well as those with ADHD 12 and mental health disorders 13. Before starting an elimination diet, it’s important to speak with your doctor to determine if this diet is appropriate for you.

If an empiric elimination diet is not effective in ameliorating symptoms of chronic conditions mentioned above, there may be a role in food sensitivity testing, which can help target the foods to eliminate. You can learn more about research and applications of food sensitivity testing here.

If you are experiencing digestive symptoms (including abdominal pain, diarrhea, constipation, heartburn, nausea, gas, and bloating), hypothyroidism, autoimmune symptoms, migraines, acne, skin rashes, brain fog or fatigue, we invite you to reach out to us. You may email Bridget at bridget@drbojana.com or call us at 646.627.8000 to learn about how our clinical team can support you!

Written by Erica Gittleson, RD; Select sections of article written by and article reviewed by Dr. Bojana Jankovic Weatherly. Erica is a Registered Dietitian with a Bachelor of Science in Nutrition from Syracuse University. She completed a post graduate Dietetic Internship and received an Advanced Graduate Certificate from State University of New York at Buffalo.

She has 13 years of experience in Nutritional Counseling, Nutrition Education, Clinical Nutrition, Motivational Interviewing and Health Coaching. Erica has both personal and professional experience with integrative and functional nutrition. She trained at the Integrative and Functional Nutrition Academy and has helped many patients with issues ranging from thyroid disease to gut health imbalance and food sensitivities. Erica’s mission is to help each one of her clients not only manage their health but to thrive and enjoy life. In her free time, Erica enjoys meditating, playing tennis, riding her bike, and discovering all the fascinating cuisines of Manhattan!

References

  1. Raman, Ryan RD. 2017. How To Do an Elimination Diet and Why. Healthline. 8/2/22. [How to Do an Elimination Diet and Why (healthline.com)]
  2. Gordon, Barbara, LDN. 2019. What is an Elimination Diet. Academy of Nutrition and Dietetics. 8/2/22. [What is an Elimination Diet (eatright.org)]
  3. Monash University. What Are FODMAPS? 8/2/22. [About FODMAPs and IBS | Monash FODMAP – Monash Fodmap]
  4. Kubala, Jillian, RD. Nall, Rachel, MSN, CRNA. 2021. What is an Elimination Diet? 8/2/22. [What is an elimination diet? (medicalnewstoday.com)]
  5. Tosetti, C., Savarino, E., Benedetto, E. et al. Elimination of Dietary Triggers Is Successful in Treating Symptoms of Gastroesophageal Reflux Disease. Dig Dis Sci 66, 1565–1571 (2021). https://doi.org/10.1007/s10620-020-06414-z
  6. Chey, William D. MD, AGAF, FACG, FACP, RFF. Elimination Diets for Irritable Bowel Syndrome: Approaching the End of the Beginning. The American Journal of Gastroenterology: February 2019 – Volume 114 – Issue 2 – p 201-203 doi: 10.14309/ajg.0000000000000099
  7. Cucinotta U, Romano C, Dipasquale V. Diet and Nutrition in Pediatric Inflammatory Bowel Diseases. Nutrients. 2021; 13(2):655. https://doi.org/10.3390/nu1302065
  8. Hindiyeh, N. A., Zhang, N., Farrar, M., Banerjee, P., Lombard, L., & Aurora, S. K. (2020). The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache, 60(7), 1300–1316. https://doi.org/10.1111/head.13836
  9. Katta, R., & Kramer, M. J. (2018). Skin and Diet: An Update on the Role of Dietary Change as a Treatment Strategy for Skin Disease. Skin therapy letter, 23(1), 1–5.
  10. Swoger, J. M., Weiler, C. R., & Arora, A. S. (2007). Eosinophilic esophagitis: is it all allergies?. Mayo Clinic proceedings, 82(12), 1541–1549. https://doi.org/10.1016/S0025-6196(11)61101-4
  11. Campagnolo, N., Johnston, S., Collatz, A., Staines, D., & Marshall-Gradisnik, S. (2017). Dietary and nutrition interventions for the therapeutic treatment of chronic fatigue syndrome/myalgic encephalomyelitis: a systematic review. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 30(3), 247–259. https://doi.org/10.1111/jhn.12435
  12. Pelsser LM, Frankena K, Toorman J, Savelkoul HF, Dubois AE, Pereira RR, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011 Feb 5;377(9764):494–503.
  13. Gillian R. Hart (2017). Food-Specific IgG Guided Elimination Diet; A Role in Mental Health? BAOJ Nutrition. Volume 3; Issue 1; 045.
  14. The Institute For Functional Medicine. 2018. Elimination Diet Comprehensive Guide.

Disclaimer

Nothing stated or posted in this article is intended or should be taken to be the practice of medical or counseling care. The information made available in this article, including, but not limited to, interviews, text, graphics, images, links to other articles, websites, and other material contained in this article, is strictly for informational and entertainment purposes only. The information in this article is NOT (and should not be used as) a substitute for professional psychiatry, psychology, medical, nursing, or professional healthcare advice or services, nor is it designed to suggest any specific diagnosis or treatment. Please always seek medical advice from your physician or a qualified health care provider regarding any medical questions, conditions or treatment, before making any changes to your health care regimen, medications or lifestyle habits. None of the information in this article is a representation or warranty that any particular drug or treatment is safe, appropriate or effective for you, or that any particular healthcare provider is appropriate for you. Never disregard professional medical advice or delay seeking help from a health care provider due to something you have read or seen in this article. Your reading/use of this article does not create in any way a physician-patient relationship, any sort of confidential, fiduciary or professional relationship, or any other special relationship that would give rise to any duties. This article does not recommend or endorse any specific tests, healthcare providers, procedures, or treatments, and if you rely on any of the information provided by this article, you do so solely at your own risk.