Who should do an elimination diet? In my opinion everybody should do an elimination diet at least once in their lives!
Even if you eat a healthy diet and think you have a great digestion system, there could be foods in your diet that are causing symptoms, or if you are struggling with health issues, or knowing what foods you should be eating then an elimination diet might help to identify your triggers.
If you are one of the many people that experience digestion problems, then you should definitely do an elimination diet to see if food is a trigger for your symptoms. I recommend an elimination diet as a starting point before doing more comprehensive stool testing, or SIBO testing. These comprehensive tests can help to see if the cause of your problems is pathogenic bacteria, yeasts and parasites, or it could simple be food intolerances.
Elimination diets can conjure up images of “nothing to eat” and living off “rabbit food” for 4 weeks, especially if your diet revolves around cereals, breads and other packaged foods. But an elimination diet has plenty of food options to eat, with good planning you will have plenty of tasty satisfying food choices, it will just be different to what you were previously doing.
When planning an elimination diet many people start off with a feeling of dread, thinking of all of the foods that they are going to miss out on, withdrawal symptoms and generally start out with a negative mindset. I agree that an elimination diet is not an easy process and I can understand that people may feel this way, especially if the elimination diet is not their choice, or you have been told you “have to do this”, nobody likes being told what to do.
Instead a different way of looking at elimination diets is with a sense of curiosity and excitement, after all you are about to start on a one month “experiment” on yourself, it is like being a researcher investigating what food triggers could be causing a variety of signs and symptoms that you are experiencing, the cool thing is that you are researching yourself.
The number one purpose of doing an elimination diet is to investigate what foods are having a negative impact on your health. It is easy to understand how food may cause digestion symptoms like constipation, diarrhea or excess bloating and gas, but how exactly does food cause these many other health symptoms that I have mentioned?
A healthy body starts with a healthy digestive tract, this has been known for over 2,000 years since Hippocrates the father of modern medicine proclaimed “all healing begins in the gut”. This idea that a healthy gut is key to a healthy body has been lost on modern medicine for a long time, but over the last 20-30 years there has been a lot of research into gut health. In particular the role that gut bacteria play in our health, and the importance that the gastrointestinal wall has in protecting us from absorbing unwanted toxins and partially digested proteins in food.
The gastro-intestinal tract is rich in neurotransmitters (there is more serotonin in the gut than the brain!), hormones, bacteria, enzymes and chemical messages that influence our digestion and all aspects of our health.
The food we eat influences the composition of the bacteria in our digestive tract, while a diet of processed foods will create an environment that does not favour your beneficial bacteria, this allows for the overgrowth of bacteria that can have a negative aspect on your mood, skin and even influence joint pain.
Gluten which is found in wheat, rye, barley and oats can be a fairly controversial topic, some people can have an allergy to gluten which is called celiac disease, and for these people they must avoid gluten 100%. But you can be still sensitive to gluten without being celiac, the researcher Dr. Alessio Fasano was the first to discover that gluten stimulates the release of a protein called Zonulin which causes intestinal permeability, also known as leaky gut.
Other foods can also trigger an immune response that causes leaky gut, these foods can vary from person to person which is why I recommend an elimination diet to help you identify what your particular food triggers are.
Your digestive tract should be permeable to allow for the digestion of vitamins, minerals, fatty acids and amino acids which are also essential for good health, but the foods you eat create inflammation in your digestive tract making the gastro-intestinal wall more permeable, and this allows for things to pass though into body that otherwise should be eliminated.
Your immune system recognizes these toxins and undigested proteins and mounts an immune response against them, this is one of the main triggers for autoimmune conditions like Hashimoto’s thyroiditis, Rheumatoid arthritis and lupus. This immune response can also be cause of other symptoms like brain fog, depression, anxiety, eczema and general fatigue.
It is easy to identify when you are experiencing a lot of uncomfortable digestive symptoms to know that your digestive tract is not healthy, but it is possible to to have no digestive symptoms and still have leaky gut or an imbalance in your gut bacteria.
Sometimes people don’t realize that they are experiencing brain fog, fatigue or that their sleep is not of good quality, until they do the elimination diet and think “WOW” I have so much more energy, I can think clearly and I am waking up so refreshed!
So now it is time to look at what to eliminate.
We have talked about who should do an elimination diet, and why you should do an elimination diet, but what exactly is an elimination diet?
There are a lot of different variations of the elimination diet, and like most things involving diet and health there is no one perfect solution for everybody. The type of elimination diet you do will depend on your signs and symptoms and your overall health, your diet will be a bit different if you are just trying to identify what triggers your digestion symptoms, versus an elimination diet trying to identify the cause of more systemic symptoms like autoimmune conditions.
Also if the idea of eliminating foods seems so daunting that you do not want to even try, you maybe better of just trying to eliminate 2-3 foods at a time, this could mean trialling going gluten and dairy free for one month and seeing what difference that makes to your digestion and overall health. Or if you have mood issues you may want to trial eliminating gluten, sugar and processed vegetable oils for a month, as these can create inflammation and cause psychological changes to your health.
The length of an elimination diet can be between 7 and 30 days, with at least 3 weeks being the ideal, as this is how long it takes for the immune system to settle down and not be on constant high alert.
Eight foods account for 90% of all food-allergic reactions, these are dairy, eggs, peanuts, tree nuts (e.g., walnuts, almonds, cashews, pistachios, pecans), wheat/ gluten, soy, fish, and shellfish.
However with an elimination diet we are usually trying to identify food intolerances and sensitivities which are causing inflammation and not just food allergens. People who are allergic to fish, shellfish and nuts usually have quite an acute reaction, there is nothing subtle about it as their face swells up and they can have difficulty breathing, this is a life threatening event and different to the types of responses we are trying to identify. Most people have already discovered that they are allergic to fish or peanuts!
As a minimum I recommend eliminating the gluten, dairy, soy, vegetable oils and as much processed food as possible. This means we don’t want to just cut out bread and replace it with highly processed gluten free bread, but cut out bread and replace with real food.
If you can go a step further and eliminate sugar, which causes both psychological symptoms and cravings for food, as well as disrupts your hormonal imbalance. While I don’t think everyone has to avoid sugar all the time, just for the 30 days on an elimination diet it can help break the psychological addiction to certain foods, as well as help gut bacteria, reduce candida and improve the key hormones that control appetite, hunger and weight.
When you cut out sugar you also don’t want to replace with sugar free substitutes like dates and other dried fruits, rice syrup, agave syrup, honey and maple syrup, while they maybe considered natural they are still a form of sugar (by the way sugar is also natural). We are trying to break the psychological “addiction” or craving for these foods, and if you think you are not addicted to sugar it should make it easier to cut out, or you may actually find that you have a lot of cravings in the first week or two.
I also recommend eliminating grains in general, and this includes rice and quinoa, I know many people can tolerate these grains quite well but unless you cut them out for a month it is hard to know if they are creating a negative response in your body. Eliminating grains is especially important if you are overweight or experiencing hypoglycaemia symptoms, as they can cause a dramatic rise and fall in blood sugar levels in some people. The high blood sugar creates inflammation, insulin resistance and a variety of symptoms, as well as increasing your risk of diabetes.
Legumes are another grey area like rice, while many people can tolerate them ok, for many others they are difficult to digest and can lead to a wide range of digestion symptoms.
For most people I recommend a general elimination diet as this is a good start to identify most food intolerances that are causing your health issues, but for some health conditions a more specific elimination diet may benefit you.
The FODMAP diet is the best researched diet for reducing Irritable Bowel Syndrome (IBS) symptoms, it was developed at the Monash medical centre in Melbourne, and it helps to reduce the fermentable carbohydrates that can cause gas, bloating, reflux, constipation and diarrhea.
The FODMAP diet stands for Fermentable Oligosaccharides Disaccharides And Polyols, which in English just means carbohydrates that are easily fermentable.
Like the standard elimination diet the FODMAP diet still cuts out dairy, gluten, legumes, and most sugars but also eliminates highly fermentable fruits and vegetables like onion, garlic, apples, watermelon and mango to name a few.
The FODMAP diet does allow certain grains like rice and quinoa, and does not exclude any protein foods like eggs or fish.
If Irritable Bowel Syndrome is your number one complaint then the FODMAP diet maybe the best place for you to start, once again this is only a short term diet and if you find great benefit from this approach it is a good indication that you may have Small Intestinal Bowel Overgrowth (SIBO) and would benefit from having a SIBO test. Addressing SIBO would address the underlying cause of your IBS.
As the name suggests this is the best option for anyone with an autoimmune condition, but it would also benefit anyone who has a lot of pain and inflammation, this includes arthritis, fibromyalgia, Chronic Fatigue and Migraines.
Once again you eliminate the same foods that are on the standard elimination diet, but you also eliminate eggs, nuts, nightshade vegetables and caffeine.
The autoimmune paleo diet (AIP) can be a challenge as it is more restrictive, and for many people and even if you have a autoimmune condition it is not necessary to be so strict. I recommend starting with the basic elimination diet or FODMAP diet and if that does not lead to big improvements in your health, then you can try the AIP diet.
While the elimination phase is quite simple, with the elimination phase you will have a list of foods you are allowed to eat and a list of foods that you must avoid 100% for 3-4 weeks.
The reintroduction phase begins after 3-4 weeks, and it is important to get this right as we want to identify the problem foods and know what food your body likes to eat. If you just start randomly adding in foods the “experiment” will be a waste of time as you will not know what your particular triggers are.
The minimum time for the immune system to “turn down” the inflammatory response to foods is around 3 weeks, so I recommend 3 weeks as a minimum and ideally 4 weeks before you start to reintroduce foods.
If you are feeling great after three weeks this is a good time to start the reintroduction phase, if not leave it a bit longer, some people may even do the elimination phase for 6-8 weeks if there response is a little slower, like it can be with chronic health conditions.
Add in one new food type at a time, it does not really matter which food you introduce first, you can go for the one you are craving the most (though that maybe a sign that it is a problem food). For example on day one of the reintroduction introduce dairy, you can eat a variety of different types but only have it on that one day, observe any symptoms that you notice over the next 3 days, and if you don’t notice any negative symptoms you can reintroduce the next food on day 4.
However if at any stage during the reintroduction you notice a flare up of your symptoms due to a particular food, wait until all of your symptoms settle down before reintroducing anything new.
It can take several weeks to test out all of the foods that you have eliminated, but as you add more foods back in your variety of foods that you can choose will be expanded, you just need to continue avoiding any food that you reacted to.
It is a good idea to write a food and symptom diary during the elimination and reintroduction phase (remember you are conducting a scientific experiment on yourself) so that you can have a better idea of what food is triggering any symptoms.
The physical symptoms to take note of are digestive symptoms like bloating, gas, reflux, diarrhea and constipation, also fatigue, headaches, skin flare ups, sneezing, and dizziness. You can rate your symptoms out of 10 to start with, and at the end of the elimination phase and the reintroduction phase you can rate your symptoms again.
Also be aware of mood changes like anger, irritable, depression, anxiety, insomnia, brain fog, memory problems and hyperactivity. Take note of how these symptoms change during the elimination phase, and look out for any reactions during the reintroduction phase.
Just because you have reacted to one or more foods on the elimination diet this does not mean that you have to exclude them forever! This is particularly true if you reacted to many different foods, as this probably indicates that you have “leaky gut” and if the underlying cause is addressed, and you follow a leaky gut healing program you will likely be able to “test out” these foods again to see if you still react.
Also reacting to specific foods like the FODMAP’s may indicate that you have an underlying SIBO or candida infection, you can find out more about testing for SIBO here. Candida, parasites and dysbiosis can be tested with a comprehensive digestive stool analysis (CDSA test) and you can find out more about the CDSA test here.
An elimination diet is your own scientific experiment to discover what the best foods are for you to eat, and what foods create a negative/ inflammatory reaction in your body.
While you are doing your own personal scientific experiment on yourself one of the secrets to success is to try and get your partner or a friend to do it with you, this way you can support and encourage each other along the way. This is especially important in the first few weeks of the elimination diet, this is the hardest stage and it is possible that symptoms like headaches and fatigue will actually get worse before they get better, this is caused by a withdrawal from your food triggers.
Focus on the many foods that you can eat, rather than the ones that you can’t eat! Most people eat the same foods most of the time anyway, the elimination diet just changes around the foods that you can choose. Having more choice of foods is not always the answer, often is is just choosing 3-5 meals that you can have for breakfast, lunch and dinner, this helps to eliminate “decision fatigue” and wondering what you should be eating for your next meal.
Not sure where to start, or need help and support to do the elimination diet?
At Planet Naturopath we can help guide you through the elimination diet, helping you to know which plan is the best option for you, providing you with meal plans, recipes and email support to help you successfully complete the elimination diet and identify your food triggers.
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Michael is head consultant at Planet Naturopath - Functional Medicine and Nutrition Solutions. As Seen