How to Do an Elimination Diet: A Complete Guide
But if you want to know, I mean really know about elimination diets, this is it. This is your guide. The A-Z, everything you could have ever wanted to know, guide.
So, settle in.
Grab a cup of tea and let’s get you feeling better.
The Basics of Food Sensitivities
If you’re not feeling 100%, if you’ve got headaches or migraines, nausea, bloating, IBS, constipation, diarrhea, chronic fatigue, eczema, acne, fibromyalgia, brain fog, arthritis or even stubborn weight that won't come off, food sensitivities may be part of the problem.
When we eat foods we have sensitivities to our bodies don’t digest them particularly well.
Undigested particles can permeate the gut barrier and enter circulation. The immune system sees them, doesn’t recognize them as part of the body and launches a full scale attack- this is inflammation.
Food sensitivities, in the most basic sense, are just that- an immune response to an otherwise innocuous food.
Food sensitivities can lead to inflammation in the gut and throughout the body, which in turn can trigger or worsen symptoms. Inflammation can lead to chronic diseases like cancer, heart disease, Crohn's disease, even arthritis and asthma. Inflammation is also linked to a whole bunch of other symptoms: foggy brain, IBS flare-ups, migraines, fibromyalgia pain, depression and more.
Here’s how it works:
The gut's nervous system, the enteric nervous sytem (ENS), and the brain's nervous system, the central nervous system (CNS), are connected through the Vagas nerve.
The Vagas nerve communicates between the CNS and the ENS. When the Vagas nerve is activated it influences metabolic responses to food, including digestion, absorption and metabolism of certain nutrients and plays a role in insulin response and inflammation.
When the gut is not functioning properly, none of it - the ENS, the CNS, the interplay between the two- is functioning properly.
The enteric nervous sytem is home to the microbiome, the bacteria that live in our guts, and they are responsible for a large variety of functions. They make neurotransmitters like serotonin, GABA, catecholamines and dopamine.
The microbiome also makes vitamins (like vitamin K and B12), influences the immune system & memory, interacts with hormones, and modulates permeability of the gut. If you have a problem with your gut health everything in that list is negatively impacted.
When GI dysfunction occurs the gut is not functioning properly, consequently, neurotransmitters are not made as readily. That not only impacts the gut, but the entire body.
For example, 90% of the body's serotonin is found in the gut. Serotonin helps regulate, among other things, mood, appetite, and sleep.
When GI dysfunction occurs, whether through an immune reaction due to food sensitvities or other means, levels of serotonin are altered and the entire body is affected- in the gut this alteration is evidenced by diarrhea or constipation and mood, appetite and sleep are also disrupted.
Food sensitivities can lead to dysbiosis in the gut and impact this whole range of neurotransmitters and more pathways, leading to illnesses, increased stress/anxiety, and a host of other problems.
But, that's not all. Food sensitivities can also lead to leaky gut.
The lining of your small intestine is made up of “tight junctions”, essentially just a whole bunch of cells all lined up together.
The tight junctions function as your intestinal barrier but, when a space opens between those cells and the tight junctions are no longer as tight it’s bad news.
This is leaky gut.
What is Leaky Gut?
When the gut membrane becomes more permeable than it otherwise would be (and should be) it allows particles like food and bacteria located in the digestive tract to translocate and escape into systemic circulation.
Food stuffs need to be broken down to the smallest piece to permeate the normally tightly knit tight junction (for example, a protein needs to be broken down into individual amino acids to slip through) but when tight junctions are no longer tight, bigger particles (like dipeptides- bits of protein that are bigger than amino acids) can slip through. Toxins can also sneak out this way, which, obviously, you don’t want either.
Once a larger bit of food has entered into general circulation circulating immune cells spot the food (“hey! dipeptides don’t belong here!”) and grab on to it. Once they have ahold of it, the immune system has a field day- resulting in an allergic response, autoimmunity, or inflammation.
What Causes Leaky Gut
The list is long: Alcohol, gluten, casein, processed foods, excess sugar, fast food, stress, high fructose corn syrup, autoimmune conditions, inflammation in the gut, certain medications, infections, and/or parasites can all be part of the problem.
An inflammatory diet full of processed foods and excess sugar increases the risk of leaky gut. The most inflammatory diets are low in omega-3 fatty acids, antioxidants and fiber and high in refined starches, sugar and trans-fat (most of which can be found in highly processed foods). Often, these foods make up the basis of the standard American diet (often abbreviated the SAD, and has there ever been a more appropriate acronym?)
Food sensitivities can play a role as well.
The vast majority of your immune system is found in the gut. It makes sense, right? We have skin and muscus membranes protecting the outside of our body, but the GI tract is essentially a sitting duck, exposed to everything we put into our mouths.
Fortunately, the GI tract has figured out a few cheeky tricks to keep us healthy from the vomit reflex to a veritable garden of gut microflora to a robust immune system.
When you eat something you have a sensitivity to (something the immune system has pegged as a bad guy), your white blood cells pick it up in the GI tract. They then attack the offending food, starting a war, right then and there. This battle triggers an inflammatory cascade, starting with the release of various mediators which can, in turn, increase intestinal permeability.
But that's not all. The dysbiosis created in the gut by this inflammatory cascade also affects the nuerotransmitters, the microbiota, hormones and everything they control as well, including permeability of the gut.
I have good news and bad news about food sensitivities.
The good news?
Simply removing the foods that cause inflammation can dramatically reduce symptoms.
The bad news?
Pinpointing the foods you may have developed sensitivities to can be a serious challenge.
Our food supply has over 10,000 different foods, additives and chemicals. On a daily basis we're eating hundreds of different foods and chemicals.
As if that wasn't enough, food sensitivities can also be dose dependent and we all have our own thresholds for how much of a particular food or chemical we can eat.
If you eat under your personal threshold you’ll be fine, but eat above it and it’ll trigger a reaction.
With so many pieces to the puzzle and an austounding number of potential triggers, it can be a challenge to determine which foods trigger inflammation (and impact leaky gut) in your body.
Fixing Leaky Gut
This is where the elimination diet comes into play- it can help you identify which foods trigger inflammation and symptoms and which ones are safe.
When you've eliminated foods you have sensitivities too, inflammation and dybiosis can both quiet down and the tight junctions go back to being tight tight junctions.
The Elimination Diet
An elimination diet is a diet whose sole purpose is to help you identify food sensitivities.
Removing foods you suspect are bothering you (if you don’t know where to start, keep reading for some ideas) and eating only “safe” foods quiets inflammation and calms your gut.
Our bodies are extremely efficient at “detoxing”. But they can become overwhelmed and overburdened. Eliminating foods that are causing inflammation will help these natural systems come back into balance and function effectively once again, reducing inflammation.
After 2-3 weeks the inflammation will have quieted down and you will notice a difference in how you feel.
Your symptoms will decrease.
You’ll have more energy.
You’ll feel amazing- amazing in a way you forgot you could feel.
You may even lose that stubborn weight your body has been holding onto.
Remember, an elimination diet is not a forever diet- removing a whole bunch of foods and food groups is not only boring, it can be downright unhealthy and staying on an elimination diet long term puts you at risk for dangerous deficiencies.
An elimination is a learning diet.
The goal is to learn what bothers you, then avoid it.
To determine what is truly bothering you, you must challenge foods individually and with enough time in between challenges (2-3 days) to know for sure whether or not a certain food triggers a reaction.
If you challenge a food and notice a return of symptoms (pain, bloating, diarrhea, migraines, malaise, nausea, itching and more) you’ll immediately know which food is responsible. Stop eating it and add it to your list of “trigger” foods.
If you challenge a food and don’t notice a reaction (when your gut is squeaky clean, any reaction will be obvious), put that food on the “safe” list.
Sometimes the foods we suspect are the ones causing problems.
Other times foods surprise us, foods we never suspected are the culprits.
Keep working to identify the foods you have sensitivities to while simultaneously expanding your diet until you are eating as normally as possible.
Getting back to as close to your “normal” eating pattern as possible reduces the risk of nutrient deficiencies and overly restrictive eating.
Keep in mind that an elimination diet is not appropriate for every situation.
While an elimination diet is good for food sensitivities, identifying food allergies should be done with your doctor. If you suspect an allergy seek medical care.
If you have a history of disordered eating an elimination diet is not recommended as these diets can be restrictive.
Children shouldn’t do elimination diets without the supervision of a health professional.
If you have diabetes, extreme care should be taken on an elimination diet to manage your diabetes.
If you suspect gluten is a problem talk to your doctor and have celiac disease ruled out before eliminating gluten from your diet. For the test to be accurate it needs to be done while you are still eating gluten. If you take the test after you have cut gluten out you may get a false negative.
Make sure you don’t have a more serious issue and do NOT self diagnose. On top of getting celiac ruled out, head to the doctor to make sure you don’t have colon cancer or irritable bowel disease. These are long term, sometimes life threatening problems.
Elimination diets do have their limitations, they are a great tool but they are not foolproof. Sometimes a food you would never expect is to blame and other times a food can be misidentified as food you are or are not sensitive to.
It can also be hard to pinpoint exactly what the problem is, especially since food and food chemicals can be dose dependent.
Want to find out which foods you have sensitivities to without the guess work?
The Mediator Release Test
The Mediator Release Test (MRT) is a blood test that removes a lot of the guesswork, showing you right off the bat which foods are safe.
The MRT exposes your blood to 170 different foods and chemicals. It measures the size of your body’s inflammatory response to each food to determine which ones are causing excessive mediator release and, consequently, symptoms.
Unlike other tests on the market which only focus on certain pathways, MRT doesn’t really care which pathways are involved, it jumps straight to the point- mediators were released. Because of this, the MRT is the most accurate test for food sensitivities- no matter which pathway triggered it, you know that mediator release occurred, you know exactly which foods triggered that reaction and are likely contributing to (or not contributing to) your food sensitivity symptoms.
Don't worry if you're not ready for that yet, I've got some tips to help you identify foods you may have sensitivities to- keep reading!
Getting Started with the Elimination Diet
An elimination diet is for those who are truly ready to change. It requires a lot of commitment and 6-8 weeks of dedication.
It means saying no to girl scout cookies, catered lunches, champagne brunches and birthday cakes.
It’s not easy, but it is temporary.
And if you are tired of feeling lousy and truly want to find the root of your problem, heal your inflammation and finally feel better, if you truly commit, it will be worth it.
So, if you’re ready to commit, let’s go through the 4 steps of an elimination diet.
Step One: Planning
During this step you’ll decide which foods you should eliminate (and by the same token, which foods you will eat) during the elimination phase of your diet.
Figuring Out Which Foods to Eliminate:
You have a few different options for this:
- Do the Mediator Release Test (MRT )- a simple blood test that identifies inflammatory reactions to 170 common foods and chemicals. You’ll also receive a list of safe foods that don't trigger inflammation in your body.
- Follow the list of “usual suspects” located at the end of this chapter.
- Determine, based on a list of criteria, which foods trigger a reaction in your body- I’ll tell you how below.
If you choose the first way, the MRT, simply stop there- it truly is the gold standard for identifying food sensitivities.
I recommend a combination of the second and third methods to identify food sensitivites on your own.
Start with the usual suspects and add on from there, identifying your personal food triggers.
Over the course of the next few weeks start a food diary. Write down everything you eat and when you eat it. Make note of all your symptoms, how severe they are (using a 1-10 scale) and what time they occur.
Try to find any connections between the foods you eat and the symptoms you’re feeling. Sometimes it can be as simple as seeing it all there before you in black and white.
If you find any connections, write the food(s) you have come to suspect on the list.
Next, think about the foods you crave- write any on the list that come to mind.
Why worry about foods we crave? Oftentimes we crave foods that trigger inflammation in the body (known as Specific Adaptation, a term coined by Theron Randolph).
When the body identifies an intruder and sends out the immune system to keep you safe an endorphin response is also triggered, sending out feel good hormones.
Those feel good hormones are pretty addictive and can start a vicious cycle of cravings (stay strong! 3-4 days should be enough to decrease food cravings).
Finally, identify any other foods you suspect may trigger pain, bloating, headaches, gas or other symptoms. Add these to your list as well.
Keep in mind identifying your personal food triggers can be a challenge, so if you are coming up emptyhanded here that is ok- don't stress.
For starters, we eat hundreds of food and food chemicals each day. Figuring out which of these, whether it’s one or twenty, bother you can be daunting.
We’ve also got that pesky “dose dependent issue”.
Let me explain:
Understanding "Dose Dependent" Food Sensitivities
Imagine your body is a bucket. Some of us have bigger buckets, and some of us have smaller buckets, but we all have buckets.
When we eat foods we have sensitivities to we add to our buckets.
If we add too much to our bucket it starts overflowing and that’s when the troubles (symptoms) begin.
But that’s not all:
Stress, lack of sleep, illness and more also add to our buckets further compounding the issue.
So, let’s say you only have a little of a trigger food. It certainly adds to your bucket, but since you only had a little your bucket doesn’t overflow.
However, if you have too much of that food, or pair it with other offending foods, your bucket fills up quickly and may start overflowing.
Or perhaps you only had a little, an amount which usually doesn’t bother you, but you’re under a tight deadline at work (stress) and had another sleepless night (more stress) and then even that little amount can be the straw that breaks the camel's back.
Your bucket overflows and your symptoms hit you hard.
When we hit our immune systems with too much too fast our body’s can’t empty the buckets fast enough and inflammation runs rampant.
Unfortunately, the world we live in is full of bucket fillers- stressful jobs, busy lives, fast food, junk food, chemicals in our food and drinks, and food sensitivities.
No wonder our immune systems becomes overwhelmed and our buckets end up overflowing.
The Usual Suspects (Most Common Food Sensitivities)
If you’re not sure where or how to start identifying food sensitivities (bucket fillers) a good place to start is the list of usual suspects- the foods most commonly responsible for sensitivities.
Here is a list of the “usual suspects” to eliminate (and foods that are generally safe to try instead).
Stay Away From
Try This Instead
Milk, cheese, yogurt, whey, casein, lactose, cream, ice cream, etc (traditional cow’s milk dairy foods)
Non dairy creamer
Rice Milk (see downloadable cookbook), oat milk, coconut milk, allowed nut milk (look for milks with only nuts/rice water and salt.
Aged/smoked/pickled meats, fatty cuts of meat
Eggs, egg substitutes, soy
Lunch meats, highly processed meats (sausages, hot dogs, etc)
Fresh or canned in water fish, chicken, turkey, lamb, beef, and wild game
Beans, lentils, legumes
Gluten containing grains- wheat, barley, rye, spelt and kamut
Corn and products made with corn
Rice (all kinds), certified gluten free oatmeal, quinoa, buckwheat, teff, amaranth, millet, wild rice, sorghum.
Coffee (including decaf- both are GI irritants), tea, chocolate
Decaf herbal tea
Wine, beer, liquor
Infused water, sparkling (unflavored) water, fruit juice in small amounts (except apple)
Saccharin, Sucralose, Aspartame and Acesulfame
Sugar alcohols- sorbitol, mannitol, xylitol
Stevia (in small amounts)
Soy (and products made with soy: soy sauce, edamame, tofu, etc.)
Beans, lentils and other legumes.
Monosodium Glutamate (MSG)
Hydrolyzed vegetable protein, hydrolyzed yeast,
autolyzed yeast/yeast extract,
Fresh herbs, vinegar (plain white), spices and sea salt to flavor foods
Simple sugars (anything ending in “-ose”), and foods with added sugars (soda, candy, sweets, processed foods), chocolate
Foods high in free fructose: honey, high fructose corn syrup, corn syrup, apples, molasses.
Brown rice syrup, maple syrup, fruit sweeteners (use in moderation).
Fruits (except apples and citrus)
Amines (histamine, phenylethylamine and more)
These are found in aged foods- cheese, meats, wines, beer, kimchi, dried fruits etc.
Avoid anything “aged”, “smoked” or “pickled”
Fresh whole muscle meats, nothing aged/fermented.
Choose fresh fruit instead of dried.
Highly processed foods and fast foods
Sausage, bacon, hot dogs, lunch meats, spam (heads up: processed lunch meat can also contain gluten in their fillers!)
Deep fried foods
(This will also help eliminate added sugars, glutamates and damaging, highly processed/hydrogenated fats)
Whole muscle meats
Fruits, vegetables, whole grains, lean whole muscle meat proteins, legumes
Hydrogenated (trans) or highly processed fats
Shortening, butter, vegetable oils.
Extra virgin olive oil, ghee or up to 1 TBSP coconut oil per day
Whole, fresh fruits, frozen fruits, canned in water fruits
Freeze dried fruits are allowed
Avoid highly processed and
Pickled or fermented vegetables
If you have…
GI issues/IBS- avoid raw vegetables, cruciferous vegetables and onions
Arthritis- avoid nightshade vegetables: tomatoes, potatoes, bell peppers, eggplants, chili peppers, chili powder and cayenne
Any other vegetables raw, canned in water, frozen and/or freeze dried
Nuts and Seeds
Walnuts, pecans, peanuts and peanut butter, unblanched almonds
Blanched almonds (including almond butter, almond flour and almond milk), cashews, sesame seeds, pumpkin seeds, sunflower seeds,
Consider soaking nuts to make them gentler on the stomach
Skip the premade sauces, soy sauces, fermented sauces, sauces with added sugars (bbq, ketchup etc).
Avoid pepper (especially with IBS)
White vinegar, mustard, ginger, pure vanilla extract, fresh herbs and spices (see downloadable for ideas on herbs/spice combinations!). Baking soda is allowed.
Note: Ghee is recommended even for those with lactose intolerance as the vast majority of the lactose has been removed. Use coconut oil in moderation and be sure to consume with plenty of veggies and fiber.
For more on why some of these foods made the list and ideas for specific foods to remove for different conditions, click here.
You may have noticed some things (like chocolate or soy) appear in multiple sections. Foods can have many different chemicals in them that act as potential triggers.
A few more notes on this list:
- Go organic when/if possible
- If you have an allergy to any of these foods, leave them off your list of “safe” foods.
- If you have never had an item in the “try this instead” column don’t try it for the first time during the elimination phase. Try to keep your diet as normal or as close to what you would eat normally without introducing any new, unknown foods.
- If you suspect one of the foods in the “try this instead” column bothers you or has made your list of foods to avoid, don’t use it. This generic list is just designed to help guide you- listen to your own intuition.
- This general list of foods are foods that commonly trigger sensitivity symptoms, but your sensitivities may be different. Remember, an elimination diet is a learning diet and often requires some trial and error.
- Citrus fruits are especially important to avoid if you have any kind of histamine issues, migraines, sinus issues or skin rashes.
Seasonal Allergies and Their Impact on Food Sensitivities
If you have seasonal allergies, there can be crossover to food sensitivities. If you have an allergy to a certain kind of pollen, you may also have sensitivities to foods in that family.
For example, ragweed is also related to banana, cantaloupe, watermelon, honeydew melon, zucchini and cucumbers. If you have a ragweed allergy, you may also have sensitivities to its relatives. Consider adding those foods to your “avoid” list as well.
Ragweed is just fine but grass leaves you stuffy and miserable? Cantaloupe, honeydew melon, orange, tomato, watermelon, Swiss chard, white potato and peanuts are all related to grass pollen.
Bell peppers, broccoli, cabbage, carrot, cauliflower, celery, onion, garlic, parsley, star anise, black pepper, caraway, coriander, fennel, mustard and chamomile are all related to mugwort pollen- consider removing these if you’ve got a mugwort allergy.
If tree pollen (especially birch pollen) gets you, consider removing tree pollen relatives: Apple, apricot, cherry, kiwi, peach, pear, plum, carrot, celery, parsley, peanut, soybean, star anise, caraway, coriander, fennel, almonds and hazelnuts.
If you have a latex allergy also consider removing: avocado, banana, peach, kiwi, fig, tomato, bell peppers, white potatoes and chestnuts.
Now you should have a pretty good idea of the foods to eliminate.
It may look overwhelming, but don’t get bogged down looking at the list of foods to avoid (and remember, this is only temporary).
Instead, focus on the foods you are able to eat.
Hints for Success on an Elimination Diet.
Make a list of foods you can (and will) eat.
Start by sitting down with the list of usual suspects. Go through the right hand column (usually safe foods) and think about what kind of foods from each section you like.
Write those down.
Start brainstorming ideas for meals (sign up for my mailing list to get my FREE downloadable cookbook. The internet and Pinterest are great resources too) and start a grocery list focusing on the foods on your list on the righthand side of that paper.
You have one more crucial thing to do in step one:
Find a cheerleader.
Find someone you trust to support you. Tell them why you are doing an elimination diet, tell them what it entails and ask them to help support you.
When you have the support of your friends or family you’re much more likely to succeed.
Don’t do it alone.
Having someone to talk to when things are not going well or when you feel like quitting will be a lifesaver as you go through this. Have them remind you why you started and what your health goals are.
A cheerleader can help get you through the hardest parts of an elimination diet. Don’t skip this step.
Now, you're ready to move on to step two: the elimination phase.
Step Two: The Elimination Phase
During step two you will need to eliminate the foods on your "avoid" list.
All the foods, at all meals.
For three weeks.
That means reading every label to identify sneaky ingredients that fall on your elimination list. It means saying no to the cookies your coworker brought in. It means cooking most of your own meals from scratch because a whole food diet is the easiest way to avoid eating something unintentionally.
An elimination diet is not for the faint of heart.
But identifying food sensitivities and eliminating offending foods from your diet can make a world of difference. Reducing inflammation in the body can drastically reduce symptoms and make turning down donuts and passing on happy hour very, very worth it.
You may feel worse for a few days before you feel better.
But you will feel better.
What to Expect on an Elimination Diet
Many people go through a bit of an adjustment period (feel rotten) as their bodies deal with the drop in endorphins and adjust to life without inflammatory foods.
This rotten feeling is only temporary and shouldn’t last more than a few days. If it lasts longer than that or if you find them interferring with your day to day routine- stop! Come back to an elimination diet at another time.
I’m not trying to scare you off, but it’s important to know what to expect and to make sure you are fully committed.
After a few days the inflammation will start to quiet down. By the end of the three weeks, the inflammation will have quieted down substantially.
You will be feeling better- you’ll have more energy and fewer symptoms.
So stay strong- it will be worth it!
And I’ve got the secrets to being successful.
The Secrets to Success
Two key secrets will help you on your road to success with step two:
First, remember to focus on the foods you can eat- focusing on a long list of foods to avoid is both overwhelming and frustrating. Focusing on the foods you can eat will help.
Which leads us to secret number two:
Set yourself up for success by planning ahead: research recipes and let your friends and family know what you are up to so they’ll support instead of sabotage your efforts (intentionally or not). Do plenty of grocery shopping, cooking and meal prep before you even start the elimination phase.
Meal plan! Decide what you want to eat over the course of a week, then shop and do any necessary prep for it (chop veggies, cook rice, etc. Here is a quick primer on meal prep).
Prepare and freeze a variety of meals and snacks ahead of time so you’ll have a variety of options. They’ll come in handy on those days you just don’t feel like cooking or when bagels appear in the breakroom.
When you have plenty of “safe” foods to eat, you’ll be able to resist the temptation to munch on a forbidden food or order takeout on those nights you simply cannot cook.
This is especially important for the first week of your elimination diet.
The first few days will be the hardest- you’ll likely feel lousy and be missing your favorite foods. Let your prepwork shine here! You may be tempted to just have a nibble of something but having plenty of snacks and meals on hand and ready to go can help prevent temptation from taking over.
Remember, an elimination diet is an all or nothing proposition, no “moderation” here.
But, again, an elimination diet is only temporary- 3 weeks and then you'll start expanding your diet again.
These weeks will be challenging, some days more than others. Eating adequate calories can make sure you have the energy to face the tougher days and win.
Eat three meals a day and plan for snacks as well to ensure you’re getting adequate calories.
How To Build Your Meals (and Snacks!)
But eating adequate calories is not enough, eating balanced meals and ensuring the calories you are eat are quality calories that fuel your body is just as important.
(These same rules apply whether you're on an elimination diet or not. So pay attention)
Although you may have heard a calorie is a calorie, that’s not quite true.
An empty calorie contributes energy, but nothing else. A nutrient dense calorie provides energy and along with that energy you're also getting nutrients- vitamins, minerals, antioxidants, fiber, protein, fat and more.
Obviously, the nutrient dense calories are what you want to focus on eating. This means plenty of veggies, nuts, lean proteins, whole grains, fruit and legumes. It means less refined flour products, highly processed foods and simple carbohydrates.
When eaten, all foods elicit a response from the body.
Some foods, like sugar, elicit a negative, inflammatory reaction.
Some foods, like blueberries, elicit a positive, anti-inflammatory response in the body.
Since the goal of this elimination diet is to reduce inflammation make sure your meals and snacks are well balanced and nutrient dense to prevent an inflammatory reaction.
That means enjoying plenty of colorful veggies, healthy fats, lean proteins, whole grains (avoid eating all white rice at every meal) and using sugars/sweeteners sparingly, opting for fresh, whole fruit instead.
Build your meals with a balance between micronutrients. The three macronutrients are carbohydrates, protein and fat. They all serve different functions in the body- none can be categorically called “good” or “bad”. Eaten individually they elicit different responses in the body.
For example, carbohydrates on their own will cause an immediate blood glucose spike and insulin response. But, pair those carbohydrates with fat or protein and it slows down the insulin response (and the need for the rapid insulin response) and helps keep blood sugars balanced.
Eaten together, they help mellow out the body’s response.
The Bottom Line: Eat nutrient dense foods (hello, fruits and vegetables!) and enjoy those nutrient dense foods in combination with each other- try to have all three (or at least two of the three) at every meal and snack.
More concretely, here is what that should look like on your plate:
- 50% of your plate should be non-starchy vegetables (spinach, mushrooms, zucchini, beets, carrots, artichokes, asparagus, okra, avocado, cucumbers, celery and more. Keep it colorful- aim for at least one red/orange veggie & one dark green veggie per day)
- 20% of your plate should be a lean protein
- 20% of your plate should be healthy fats (avocado, nuts, seeds, oils, etc. Feel free to use the oil in dressing or to cook your veggies)
- 10% should be fruits and/or whole grains.
Staying hydrated will help as well (oftentimes water weight is shed during the elimination phase, making it even more important to drink lots of water).
During the elimination phase reading labels is critical to make sure all prepackaged foods are 100% free of everything on your elimination list.
The trouble is many foods are listed on ingredient labels under different names. Sugar, for example, has 61 different names it can be listed under (see the full list here).
Knowing all the names of your inflammatory foods is key to successfully avoiding them.
For more on the sneaky names foods can be hiding under read this or use our sign up for my elimination diet course to get a cheat sheet.
What about organic?
While organic and conventionally grown produce have the same nutrients, conventionally grown produce has a higher risk of pesticide contamination.
To reduce inflammation in the body, aim to buy organic as much as possible (this includes meats/proteins as well).
If that's not financially feasible for you, no worries. Be smart about which fruits and veggies you buy organic and which ones you buy conventionally grown.
The Environmental Working Group puts out two lists every year- one is known as the “Dirty Dozen”, the other is the “Clean Fifteen”
The dirty dozen lists the twelve fruits and vegetables most likely to be contaminated by pesticides (purchase these organic).
The clean fifteen is the opposite- it lists the 15 fruits and vegetables least likely to be contaminated by pesticides (save your money and buy these conventionally grown).
Knowing which produce is just fine when conventionally grown and which to purchase organic can help you prioritize your hard earned dollars.
So, go organic when and where possible, but aim for at least 4 cups of vegetables in each day.
Cooking Secrets for Success
Bring snacks with you- you never know when hunger may strike or you may end up stuck somewhere longer than expected.
- Make “energy balls” by stirring together nut butter, gluten free oats, rice syrup and nuts/seeds of choice (try adding cinnamon & vanilla or other spice combos).
- Check out the Pinterest page for simple snack ideas.
Cook in bulk and freeze half of what you make. This will come in handy when you’re hungry, tired or simply don’t have time to cook from scratch.
- Keep a pot of soup/stew on hand, and/or a pot of quinoa/rice.
- Have heartier veggies chopped and ready to be sauteed, roasted or grilled.
- Use your crockpot to prep meals and have them ready to eat when you're home from work.
Keep it simple- eat simple, whole foods prepared simply
- Eat simply- soups, sauteed veggies and cooked grains or beans will be your best friend.
- Try stir fried chicken with veggies over brown rice. Make a sauce of almond butter, rice vinegar, cilantro, garlic (if tolerated) and ginger.
- Grill or roast meat and serve with grilled or sauteed veggies and quinoa.
Stay hydrated! Aim for 2-3 liters of water a day.
- Add fresh fruit (grapes, melon, berries) or a splash of 100% juice to your water.
- Add fresh herbs like basil or mint for even more flavor.
- Try sparkling or mineral water.
- Here is a list of infused water ideas (keep in mind you may need to sub based on your personalized elimination list).
Looking for ideas/recipes?
- We've got a cookbook for you to download.
- Check out our Pinterest page full of ideas.
Step Three: Adding Foods Back
At this point you should be feeling better.
Your symptoms should have improved, you should have more energy and be feeling like you again.
Your inflammation should be calmed down significantly.
Now that your gut integrity has been restored the time has come to start adding foods back into your diet.
But, also a little scary right?
Because if you’re feeling better for the first time in a long time, it can be hard to willingly disrupt the newfound peace. It can be scary to add back foods that could potentially retrigger the symptoms you’re finally free of.
Try not to worry too much- I’ll do my best to help you through this part as painlessly as possible.
We’re going to go nice and slow, introducing foods one at a time. If you feel any signs of your old inflammation returning, stop eating that food and move on.
Keys to Success in Step Three
The two keys to success in step three can be summed up as follows:
First: keep a thorough food diary. The more details you add, the better. Pretend someone who has never met you is trying to recreate exactly everything you ate and drank in a day- give them enough details to do so.
Second: move slowly, introducing only one new food at a time and break it down as much as possible. Don’t introduce dairy as a whole, first introduce plain yogurt and see what happens, then work your way up to milk.
I’ll talk more indepth about how to introduce some of the food/food groups shortly.
However, let’s go back to the food diary again.
The single most important tool you have at your disposal as you reintroduce foods is your food diary.
How to Use a Food Diary
Write down everything you eat and be detailed- what time did you eat it? How hungry were you? how much did you eat? What was the brand name? Did you make it at home? What was the recipe? When did you make it? If it was leftovers, how did you reheat it? Did you add any seasonings to it? The more details you add, the better.
Do the same thing with everything you drink- what was it? What was in it? How much did you drink? What time did you drink it?
Keep track of any medications you take and the time you take them.
In short: if you consume if it, write it down.
Keep track of other things as well, like how you’re feeling (got a cold? Note that and rate its severity. Allergies bothering you? Note it.) also keep track of the weather, daily events and any stressors in your life.
Remember, things like stress, seasonal allergies or smoke from nearby fires can add to your bucket as well.
If a food that has never triggered a reaction before suddenly does, environmental stressors may be playing a role- your food diary is how you’ll be able to track that and find any correlations.
Do I sound like a broken record?
Keeping a scrupulous food diary is that important.
HINT: keep your food diary with you (or on your phone- whatever will work for you! Several apps exist that can help you track your food and symptoms) and write everything down as it happens. Trying to remember everything later can be difficult and you are likely to forget something.
How to Re-Introduce Foods (Correctly!)
Remember to move slowly and only introduce one food at a time.
Note the new food in your food diary.
Judge how your body reacts and keep track of any symptoms you notice in your food diary, the time they occur and rate them from 1-10.
What kind of symptoms should you be on the lookout for?
Symptoms of food sensitivities include: bloating, GI issues, IBS flare-ups, rashes, joint pain, fibromyalgia, headaches/migraine, or return of other symptoms you had prior to going on the elimination diet.
Because your inflammation has quieted, any return of inflammation related to a trigger food should be obvious and occur quickly. However, it is important to give your body time react if it's going to.
Now that you’ve (more than) gotten the gist of the food diary, let’s discuss reintroducing foods- the right way.
What kind of time frame are we looking at?
Introduce one new food every three days.
On the first day, eat just a little at breakfast or first thing in the morning (note the amount and the time in your food diary).
If you do notice a return of symptoms, don’t eat any more of the food and give your body the next two days to recover and heal any new inflammation. Keep that food on your list of “avoid” foods for now (try challenging again in 3-6 months).
But, if you're still going strong after challenging a food at breakfast, eat some more at lunch and dinner.
Eat more (an amount you would usually eat) at lunch. Note any return of symptoms in your food diary.
So far so good?
Up the ante at dinner- have a larger than normal amount of the food and see how it impacts you (noting, of course, everything in your food diary).
Then the waiting game begins… wait two full days to see if you notice the return of any symptoms. Remember, a food may not trigger a reaction right away. Food sensitivities are often delayed, one of the many reasons food sensitivities are nearly impossible to identify on your own.
If, after three days, you’re still feeling good and have not noticed a return of symptoms, that food is probably ok.
Write it on your list of “safe” foods.
At this point, consider adding it back into your diet full time, or simply note the food is safe and leave it out until you’ve finished the challenge portion of the elimination diet.
Keep a list of both the foods that trigger reactions and those that do not trigger a reaction.
For many of these foods, it doesn’t matter when you reintroduce them, add them back in any order based on your personal preference.
However, some of these foods should be introduced more strategically. Usually that means introducing them from least likely to trigger symptoms to most likely to trigger symptoms.
The Right Order to Re-Introduce Foods
If one of the foods least likely to trigger symptoms proves to be troublesome, either proceed to challenge the reamining foods in the group with extreme caution OR scrap the particular group for another 3-6 months and really let the inflammation quiet before trying again.
If you opt for the latter, after 3-6 months, try the food again. Again, challenging from the food least likely to be bothersome to the food most likely to trigger symptoms.
What are the foods that should be introduced in a certain order?
- Caffeine: start with decaf coffee (which does still has some caffeine), and then move up to regular caffeinated coffee.
- Dairy: start with yogurt, the dairy product least likely to cause a reaction (and choose plain yogurt- no additives or sugars). From there add in cheese (only introduce one kind of cheese at a time. Start with your favorites). If you remain symptom free after cheese, move on to milk (add in whey, casein etc. anywhere after cheese). If possible, start with grass fed dairy to reduce the number of variables you could react to. Giving dairy another go? Consider trying A2 milk- it has different proteins that most milk sold in the US so you are less likely to react to it.
- Soy: start with unfermented soy like soybeans (edamame) and soy milk before moving on to fermented soy products like tofu or soy sauce. Also, note soy sauce is made with wheat, so be sure to challenge wheat before challenging this “combination” food.
- Grains: start with the gluten containing grains (barley, rye, and/or spelt or kamut) before moving on to wheat. The order you reintroduce the gluten containing grains doesn’t matter but be sure to try at least one of them before adding wheat back to your diet. Here’s why: Gluten may not bother you but wheat could. If you start with wheat and have a reaction you won’t know if the gluten or the wheat is triggering the reaction. If you’re ok on the gluten containing grains, test wheat. Now, if the wheat triggers a reaction you'll know wheat- not gluten- is likely the culprit.
- Be sure to test foods one by one before moving on to combination foods- challenge the peanuts and the wheat separately before having a peanut butter sandwich.
- Save the premade sauces and foods- these often have a combination of potential triggers so make sure you've tried the ingredients individually first. Keep reading labels so you’ll know which potential triggers a sauce or food contains.
- Increase your fiber intake slowly (grains and veggies have fiber). If you’re not used to eating a lot of fiber adding too much too fast can actually kill the healthy bacteria (not to mention, it can also, ahem, back you up pretty good). Adding fiber slowly prevents the die-off (and backup) and helps with short chain fatty acid production (this is a good thing).
- Do not reintroduce foods you know you are allergic to! Introducing known food allergies can lead to anaphylactic shock. If you suspect a food allergy, talk to your doctor and get it confirmed.
- If you have arthritis: continue to avoid nightshades vegetables for three months before challenging those.
You may not introduce all the foods on the “avoid” list during this phase because, let’s face it, you may not want to (MSG and shortening, I’m looking at you), you may have personal or religious reasons to avoid something, it may be a food you just don’t like, or a food you don’t consume and don’t plan on consuming regularly.
Never had kamut? Never planning to? No problem, you don’t have to challenge it. No need to run out and purchase a food you have no interest in eating.
Do challenge the foods you often incorporate into your regular, daily life and the foods you want to incorporate into your regular life.
If you don’t try all the foods on your list, that’s ok!
But if you come across a food you have not challenged yet in the future (your neighbor brings kimchi or spelt cookies to a potluck), be sure note the food you ate and note if you noticed a reaction.
Keep in mind an elimination diet is a learning diet- keep learning from your trials and errors (or successes!).
Challenged all the foods?
Got your list of “avoid” and “safe” foods?
Time to move over to step four!
If you’re not feeling any better, it may be time to go back to step one.
Give your elimination diet at least 3 weeks. While you may initially notice your symptoms are getting worse, overall they should have improved within the 3 week window. If not, stop the diet, see your doctor to rule out more serious problems (remember, never self diagnose!) and talk with your dietitian about a new combination of foods.
Or, learn more about the MRT- the blood test that gives you insight into which foods are safe and which trigger inflammation in the body.
Step Four: Creating a Long Term Diet
You made it through the first three steps of an elimination diet.
Compared to those, this one should be easy peasy.
But just because this step is easier doesn’t mean it’s any less important.
Because unlike the first three steps, this one is long term.
We're talking all about balancing life and foods that won’t trigger inflammation.
We'll also discuss making sure you’re getting the nutrients you need.
Building a Balanced Diet
If you’ve eliminated items like dairy, nightshades, or grains, you may need to make up for the nutrients found in those items with other foods you eat.
If you’ve found a long list of foods you're continuing to keep out of your diet, foods you feel ignite inflammation and trigger symptoms in your body getting adequate nutrition is especially important.
A good multivitamin can help cover a lot of the potential pitfalls, but you should be especially mindful of a few nutrients:
Calcium- if you’ve given up dairy you need to find a way to include this essential mineral that strengthens bones, regulates blood pressure and helps with muscle and nerve function. If you notice muscle cramps or irregular heart beats, it could indicate a calcium deficiency.
Make sure you’re getting plenty of calcium by eating dark leafy greens, broccoli, fortified non dairy milks, fortified tofu, canned fish (with bones- that’s key), beans, molasses, almonds and seaweed.
Folate- most breads, cereals and other wheat products are fortified with folate, a B-vitamin that keeps blood healthy and prevents neural tube defects in unborn babies. If you’ve given up gluten containing grains like wheat make sure you’re getting adequate folate to avoid mouth sores, fatigue and changes in your skin, hair and nails.
The good news is folate can be easily found in other places. Eat plenty of dark leafy greens (especially spinach), brussels sprouts, asparagus, nuts, beans/peas, whole grains (besides the gluten containing grains), dairy, meat (especially liver), poultry and seafood to ensure you’re getting enough.
Lycopene- if you’ve given up tomatoes and tomato products you may be missing out on this antioxidant linked to a reduced risk of certain cancers including prostate and breast cancer, heart disease and even sun burns (among many others).
Eat enough lycopene by eating a variety of red fruits and veggies- think watermelon, pink grapefruit, apricots, papaya and pink guavas.
The Bottom Line: Eating a balanced diet with an emphasis on whole foods that includes plenty of veggies, fruits, whole grains, healthy fats and lean proteins reduces your risk of nutrient deficiency.
Keeping your risk of deficiency down will help make sure you continue to feel your best.
You just got your inflammation down. You just started feeling better- you don’t want to lose that feeling!
Keep that good feeling going by preventing deficiencies, keeping inflammation at pay and taking care of your gut!
Keeping Inflammation at Bay
Let’s discuss keeping your inflammation down for the long haul.
That means long term gut maintenance.
Simple changes to your diet can keep your gut inflammation free. And when your gut is inflammation free your symptoms- migraines, IBS, fibromyalgia and more- stay at bay.
Of course, continuing to avoid the foods you have identified as triggers will help.
But maintaining gut integrity requires more than avoiding some foods, it requires active nuturing.
First, stay focused on real, whole foods. Although you may have found some processed foods you are able to tolerate they should never become your norm.
One study found highly processed, high calorie, high fat food (like fast food) not only induces inflammation in the gut, it also makes your immune system more aggressive in the long term (that can mean more food sensitivities).
Keep up the meal prep habits you established back in step two to ensure you always have healthy meals and snacks ready to go so you’re not tempted to pull through the drive thru after a long day.
A probiotic is another "must" to keep your gut happy, healthy and inflammation free.
Probiotics help populate your gut with healthy, anti-inflammatory bacteria. These can go a long way to helping rebuild gut integrity and keeping your bucket from overflowing.
Here’s what to know about choosing a probiotic:
Look for a “kitchen sink” spore based variety with many different strains of bacteria including lactobacillus and bifidobacterium (avoid probiotics with only lactobacillus. An over abundance of lactobacillus can lead to stimulation of autoimmunity).
A probiotic is recommended for everyone, but may be especially useful for IBS.
This review article noted those with IBS tend to have lower amounts of anti-inflammatory species of bacteria (and more of the inflammatory species). They postulate the depletion of the anti-inflammatory bacteria can contribute to low grade inflammation- a probiotic can increase the good guys and decrease the inflammation.
Not interested in taking a supplement?
Increase the amount of fermented foods you eat- yogurt, kimchi, sauerkraut, fermented pickles, kombucha, kefir, sourdough bread, etc (however, please note these foods are also sources of amines- if you have an amine intolerance a supplement would likely be better). Read labels to make sure these are truly fermented foods and not just pickled.
Another part of keeping those friendly bacteria alive and well is fiber.
Fiber- and other indigestible carbohydrates- are what are known as “prebiotics.” Prebiotics feed the good bacteria in the gut. Eating a variety of high fiber foods can help ensure your gut microbiota is well-fed and healthy.
Peppermint is another supplement recommended for those with IBS. Look for an enteric coated peppermint oil during IBS flare ups.
If you’ve got inflammation in your gut, chances are you’ve also got a problem with your gut barrier function. Taking L-glutamine and zinc together can not only help reduce the inflammation associated with leaky gut, but also improve gut barrier function- making your gut stronger than ever.
If you’ve got an autoimmune disorder like arthritis or fibromyalgia have your vitamin D level checked and then consider adding a vitamin D supplement to your routine (along with that probiotic). Vitamin D deficiency is linked to autoimmune disorders.
Vitamin D, along with vitamin K and magnesium (they also all work together in the body) can help with generalized pain and overall gut health.
As you navigate your new normal avoiding foods you have sensitivities to keep in mind food sensitivities can change over time. This can be attributed to stressors, how often you eat certain foods, hormonal changes and more.
This has two implications:
First, you may develop new food sensitivities. If you suspect a new food is bothering you, try going through the elimination diet again.
Secondly, it also means food sensitivities you have identified may go away. With time you may be able to reintroduce foods that previously bothered you.
If you have stayed symptom free for at least 3 months the inflammation in your gut has gone down considerably and as a result your gut integrity is better. Often three months is enough to reduce the incidence of food sensitivities.
After three months, consider challenging again with the list of inflammatory foods you’ve created.
Go back to step three and follow it again using the foods you’ve still got on your “avoid” list and keeping your food diary again.
Pay attention to your body and how it’s feeling. Oftentimes malaise, pain and food sensitivity symptoms can sneak up slowly and we don’t notice until it's too late and we’ve forgotten what a pain free life can be like.
You may have to do more than one elimination diet in your lifetime as your food sensitivities change, your hormones change and life happens.
Don’t get discouraged and remember: living with less pain is possible.