Understanding the Elimination Diet

Updated: Oct 22, 2019

"Diet" itself has become a four letter word that makes most of us cringe or roll our eyes if it's ever mentioned in conversation. The actual definition of "diet" is divided into two different contexts. A diet can mean the food that we habitually eat as an individual OR how we restrict ourselves through food to achieve a deserved weight or outcome of health. General intake compared with restriction seems a bit contrary.


The elimination diet has taken this a step further in adding reduction of food types with the assumed definition of restriction. Because of this combo, elimination diets have gotten a bad rap lately with accusations of psychological stress, nutrient deprivation, and poor food variety and choices. While I won't disagree that these "diets" are hard to follow, if any of these above mentioned issues are occurring, something is wrong or needs to be changed with the food plan.


So, let's start over and explore what an elimination diet really is.


An elimination diet is a food plan set up that takes out any possibly irritating foods for the person, allowing the system to calm down, then tries to reintroduce types of food one at a time to gauge the reactions of the system. If the system reacts, the food is left out of the person's diet.


There are MANY different types of elimination diets out there. You may have heard of some of them: gluten-free diets, paleo diets, autoimmune diets, low FODMAP diets, keto diets, plant based diets, etc. These diets all eliminate something in hopes of feeling better.


Here is how we discuss elimination diets with our clients (we call them TEDs - temporary elimination diets):


1. The elimination part of the diet is meant to be temporary. When you take the foods out of your system that are irritating, it takes the body about 23 days to stop making the antibody that is reacting within the body. After the temporary anti-inflammatory phase, food exploration should begin with a professional to determine the right course for you.


2. Some of these diets are not necessarily healthy for everyone to stay on in the long term. The low FODMAP and keto diets should be monitored by a professional and used briefly (unless using the keto diet for adjunct therapy with seizures - this should be monitored closely with a professional with keto strips to be sure you are in ketosis).


3. If you feel worse, something is wrong. Fatigue, headaches, stomach pains, or any other issues that arise and become consistent after starting an elimination diet are signals that something is wrong. A common issue is lack of nutrient dense foods (see number 4). Consulting with a professional is highly recommended before anyone decides to tackle an elimination diet.


4. Focus on the nutrient dense foods that you are able to eat. Too often, those trying to follow an elimination diet focus on what they can't eat so they don't see all of the options they have to chose from. Or perhaps they aren't familiar with some of the foods in the safe category, so they avoid them. These are short term food plans, so picking out three or four nutrient dense rotating dinners can hold you over through the course of treatment. We are in a spoiled time where a world's worth of groceries are available in one store and we have the option of a different genre of food every night. If you are eating quality food that is not irritating for you, limited variety should not cause harm to your health.


5. The idea of an elimination diet is to eventually allow you to eat MORE variety than you were tolerating previously. Although we all have our different sensitivities and gut function that effects our digestion, after you calm down the inflammation from eliminating irritants, you should be able to add more food back in. Eventually you should tolerate a larger variety of food without reactions. This doesn't necessarily mean you will be returning to eating the foods you want or crave, but the ones that work well with your system.


6. Elimination diets vary in how much is restricted and it depends on why you are looking at this for a treatment approach. Some have specific sensitivities and just need to eliminate the one type of food. Those with more severe systemic inflammation may have to adopt a more aggressive approach with an anti-inflammatory plan that eliminates all potential inflammatory irritants and can leave a small variety of food (there is still nutrient dense food that can be used throughout the plan, it may take some preparation and planning before you start and working with a professional that understands the condition you are dealing with). Quantity of food should not necessarily be restricted if you are solely looking at an anti-inflammatory approach to a diet. The limitations are in types of food, not in total intake. In fact, some are able to eat more on an elimination diet. Again, the focus is on the intake of nutrient dense quality food in overall good quantity.


7. You don't have to do it all at once, but it may be more tolerable that way. As we mentioned before, it takes the body 23 days to stop producing the antibody to a certain irritant. If you need to follow an anti-inflammatory plan because your system is reacting to many things or everything, you have to get rid of ALL of the inflammatory foods before adding ANY back in. So the choices are plow through the 23 days from the start, or to eliminate one food group or so a week until you get everything out. Psychologically taking it slowly sounds better to many approaching the diet, but it makes the entire process last longer in the elimination phases until you begin adding foods back in. It may be months of eliminating rather than the 3-week approach before the next step can be taken.


Elimination diets can be helpful in calming down systemic inflammation if done appropriately and healthily. It is very easy to approach this in a limiting manner which also potentially limits nutrients and can cause psychological distress and disordered eating. If it creates these issues or you have a history of these in the past, please be sure to be followed by a medical professional that specializes in psychological health relevant to your issues while on your journey.


An elimination diet should focus on abundance of the nutrient dense, non inflammatory foods that are safe for your plan before exploring the potential to expand and add foods back in after the system has calmed down. Most importantly, if you are dealing with a systemic condition and are thinking about starting an elimination diet, be sure you are working with a professional that can guide you through the process. Finding a practitioner that also specializes in the diagnoses you may have feeding into your gastrointestinal problems would be the best case scenario.