The Elimination Diet: What It Is and How to Do It

An elimination diet can help you to determine whether you have any food sensitivities or intolerances. It involves a process of eliminating common trigger foods from your diet for a time to see if symptoms subside. Then, these foods are slowly reintroduced, one at a time, while monitoring your body's response. It is one of the best ways to identify food sensitivities that may be missed by traditional allergy tests. We look at how to do this kind of diet below.

Symptoms of Food Sensitivities

Some common symptoms of food sensitivity or intolerance include:

• Bloating
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Stomach cramps
• Rashes

However, there can be less obvious symptoms such as:

• Attention Deficit Disorder (ADD)/ Attention Deficit Hyperactivity Disorder (ADHD)
• Headaches
• Weight gain
• Pain
• Depression

Can Anyone Do An Elimination Diet?

Anyone can do an elimination diet. However, this diet is restrictive, so it generally is only used for individuals with food sensitivities or intolerances. Additionally, this diet can restrict your nutrient intake, increasing the risk of deficiencies. Having guidance from a healthcare provider can help.

Steps of an Elimination Diet

An elimination diet can help you determine whether your symptoms are caused by food senitivities. It involves removing specific groups of food from your diet for a period of three weeks, then gradually incorporating them back into your diet (1). During this time, it is important to take note of whether your symptoms improve when you remove these foods from your diet and whether your symptoms flare up when you reintroduce each one.

Step 1: The Preparation Phase

This phase is important to help set you up for success, and it generally takes seven to nine days. The first aspect is to journal and record your symptoms. This is when you write down what you eat and whether or not you experience symptoms.

During this phase, it is important to consider whether or not it is a good time to do the elimination diet. For example, it may not be the right time if you are traveling or if multiple celebrations are happening. It's also important to have support in place during this time as it can be emotionally tough and tricky during cooking. In this phase, you can research recipes, determine what foods you will have to eliminate the floods and get the groceries needed (2).

Step 2: Eliminate Possible Problem Foods

Once you feel adequately prepared, remove all possible problem foods from your diet. You will need to follow this elimination diet for three weeks. Remember to write down how you feel each day and if symptoms improve.

What Foods to Eliminate

The elimination diet has various versions, depending on what you suspect is causing your symptoms.

One version is the six-food elimination diet. These foods are (3):

• Dairy
• Gluten
• Eggs
• Soy
• Nuts
• Fish/Shellfish

You may also want to eliminate caffeinated beverages, as the caffeine can contribute to headaches and gut symptoms. In addition, it would be wise to cut out processed sugar from your diet.

If you are concerned that a six-food elimination diet is too strict, you can modify it to a one-, two-, or four-food elimination diet. Here you can choose which foods you would like to eliminate (3). A food diary in your preparation phase can help you pinpoint a few food groups that may be contributing.

Avoid Hidden Ingredients

If you are eliminating these foods, it is important to remember that some can be hidden ingredients in other food products. Examples of hidden ingredients include (2):

• Milk: Chocolate, salad dressings, baked goods, frosting, instant drinks like coffee or hot chocolate
• Gluten: Sauces such as soy and teriyaki sauce, marinades, seasonings such as some brands of taco seasoning, salad dressings, soup that has been thickened with roux- a mixture made with flour
• Eggs: Baked foods, Caesar salad dressing, hollandaise sauce, mayonnaise
• Soy: Flavorings, vegetable gum, vegetable starch, and vegetable broth
• Nuts: Sweets, chocolates, biscuits, flavor coffees, marzipan, and marinades
• Fish/Shellfish: Barbeque sauce, Caesar salad dressing, Worcestershire sauces

If you aren't sure if a food product contains a hidden ingredient, read the label under ingredients. Additionally, it may be listed under allergens on the label.

What Can I Eat?

Whilst there are multiple food groups restricted on the elimination diet, there are alternatives you can have, such as:

• Dairy: Rice milk. However, read the label beforehand as there may be some hidden ingredients.
• Gluten: Amaranth, buckwheat, kasha, millet, oats, quinoa, rice, and teff.
• Eggs: In main meals, you can use chicken. Flax seed, applesauce, or mashed banana can be used as alternatives if you are baking. With the applesauce, check the label beforehand.
• Soy: Here you can try legumes such as chickpeas and lentils. If you use soybean oil, you can use extra virgin olive oil (EVOO), avocado, or sesame oil instead.
• Nuts: For a similar texture, you can use seeds such as chia, flax, and pumpkin seeds.
• Fish/Shellfish: Other proteins can be used, here you can focus on lean proteins such as chicken without the skin.

Other foods to incorporate during this time include fruits, vegetables, and legumes. These foods are rich in nutrients, can improve many different aspects of your health, and can help with reducing inflammation.

Fruits can be taken with a small portion of protein or fats to help stabilize your blood sugar levels. With vegetables, you should focus on eating a rainbow of different colored vegetables. This will help to increase the beneficial nutrients to your body. Note that legumes can be known to cause bloating, which can be mistaken for a food sensitivity or intolerance. To help prevent this from occurring, start with small portions of legumes and gradually increase your portion size. Soaking legumes or removing the fluid from the can before eating them can help to reduce bloating.

Keeping hydrated is also important. To improve and maintain your hydration you can have water, vegetable juices, meat stocks, and teas that do not contain caffeine.

Step 3: Food Reincorporation Challenges

Before you begin this step, you need to be symptom-free for at least five days. In this step, you begin to 'challenge' your body with foods that you have eliminated. Be careful to only add back one food at a time, as it makes it easier to determine what is causing your symptoms. Here, you can choose a food that you are missing the most.

When you reintroduce the food, try to use the purest form of it. For example, when reintroducing wheat, use a cereal that only contains wheat. With some foods, there are different components to the food that you may react to. For example, with egg, there is the egg yolk and egg white. If possible, try to test the different components separately (1,2).

On the first day, start with a small portion of the food; the next day, double the portion; and on the third day increase the portion size again. If you don't experience any symptoms, you can reintroduce it back into your diet. However, be sure to spend a few days adding it back (2).

If you have any symptoms, record them in your food diary along with the food and portion you ate. Here, it is important to remember that you may tolerate some foods in smaller amounts. If you react to the food, remove the food and make a note of it. You can try to reintroduce it back into your diet after four to five days. If you continue to react to it, it may mean that you have a food sensitivity/intolerance (2).

Once you have successfully challenged your body with one food, you can try with the next food.

Step 4: Maintenance and Creating A Long-Term Plan

Once you have finished step 3, you may have a list of foods that you do not react to and some foods that you do. In this step, you can continue eating the foods that you do not react to.

With the foods that have caused symptoms, you can continue to avoid them for three to six months, then challenging again (2). In the meantime, try to find alternatives to these foods. If you do eliminate entire food groups, you may start to miss out on nutrients. Here make sure that you consume alternative sources of this nutrient; a supplement may also be necessary.

Cautions of An Elimination Diet

Whilst an elimination diet can help determine sensitivities or intolerances, this diet is restrictive and can limit the amount of nutrients you receive. This makes it important that you follow the diet for the recommended time and that you have nutrient-dense alternatives during this period. If you are unsure about how to do this safely, chat with your healthcare provider for guidance.

What If The Elimination Diet Does Not Work?

An elimination diet helps with food sensitivities or intolerances. If it does not work, it could mean that you are reacting to a food that has not been eliminated yet, a food you are trying to avoid could be slipping back into your diet, or it may not be a food sensitivity or intolerance.

There are conditions that can cause similar symptoms to food sensitivity/intolerance. One of these conditions is Adrenal Fatigue (AF). This is the non-Addison's form of adrenal dysfunction, where the body's stress response cannot keep up with life's chronic stressors. This happens when your body is exposed to chronic stress. During short-term stress, your adrenal glands produce stress hormones such as cortisol, and the NeuroEndoMetabolic (NEM) Stress Response System activates to help you to manage stress.

In chronic stress, however, your adrenal glands become depleted of cortisol and imbalances within your NEM system start to occur, resulting in Adrenal Fatigue. Symptoms of Adrenal Fatigue will depend on where the imbalance in the NEM circuit is occurring. One of the circuits that can be affected is the bioenergetics circuit. Symptoms of an imbalance here include changes in weight and dizziness. Other symptoms you may experience in Adrenal Fatigue include fatigue and ADD/ADHD. These symptoms may be confused with food sensitivity/intolerance. However, they may improve with the elimination diet or when the root cause of stress is addressed.

If an elimination diet is not improving your symptoms, Adrenal Fatigue may be one of the causes, and seeing a healthcare provider can help to determine the cause of your symptoms.

Takeaway Message

An elimination diet is one way to help determine sensitivities or intolerances to food and it can be effective. The four phases of this diet include:

• Preparation
• Elimination
• Challenging
• Maintenance

If your symptoms are not improving, there may be another cause. Chronic stress can cause similar symptoms. In addition to identifying food sensitivities, diet is critical in managing stress and overall health. Dr. Lam's Nutritional Adrenal Fatigue Recovery Program offers a comprehensive approach to addressing Adrenal Fatigue through personalized nutrition plans, stress management techniques, and lifestyle adjustments.

Dr. Lam's program focuses on nourishing the body with the right nutrients to support adrenal health. It includes guidance on specific foods to avoid, those to incorporate tailored supplements, and practical strategies to manage stress effectively. This program aims to restore balance and enhance overall well-being by addressing both dietary and lifestyle factors.

If you are unsure whether your symptoms are stress-related or due to Adrenal Fatigue, or if you're interested in learning more about how a tailored diet can aid in your recovery, call us at +1 (626) 571-1234 for personalized advice.