What Foods Should You Eliminate During An Elimination Diet?
If you’ve ever thought about doing an elimination diet to pinpoint food sensitivities, you may have googled what to eliminate.
Where do you even start?
Everyone has their own opinions and suggestions.
Some say removing gluten or nightshades, dairy or histamines from their diets changed their lives.
Does that mean you should give up all those foods?
Let me explain:
Everyone has their own unique, individual inflammatory foods. Doing what worked for someone else may not work for you.
Our gut microbiome, our experiences, stress levels, environments and food choices all impact our gut and the way our bodies view our food.
What we eat impacts our body’s response to stressors. Foods like sugar and alcohol are incredibly inflammatory and can trigger a pro-inflammatory response in the body. More inflammation in the body makes them more reactive to everyday or usually benign stressors.
But sometimes it’s more than these obviously inflammatory foods, sometimes we have inflammatory responses to seemingly innocuous foods.
A food sensitivity is, very simply, just that- an immune response to an innocuous food.
The foods that our bodies react to can be anything. For whatever reason, the immune system has that particular kind of food pegged as a bad guy and is sending out the troops.
Why do an elimination diet?
The purpose of the elimination diet is to pinpoint your personal inflammatory foods by eliminating potential villains and replacing them one at a time to determine which of them truly is the culprit.
(Want to take out the guesswork? The Mediator Release Test (MRT) can help).
Finding your personal triggers takes some serious detective work, good notes and more than a little luck and guesswork.
The good news?
I’ve got a cheat sheet to help with the guesswork.
Most people cite foods from the list of the most common culprits for their food sensitivities, although some foods tend to be more common for symptoms like migraines, IBS or fibromyalgia.
Let’s start with the usual suspects.
The ones that cause the most problems for the most people.
Gluten containing grains
Glutamates (like MSG)
Sugar (especially free fructose and simple sugars like those found in candy, sweets and processed foods)
Amines (histamine, phenylethylamine and more).
Highly processed/fast food
Seems like a big list, right?
But simple things can help you eliminate many of these foods (and remember- an elimination diet is always meant to be temporary).
Reducing overall inflammatory load in your diet
Focusing on whole foods means fewer inflammatory foods and more foods that heal the inflammation:
Inflammatory diets are low in omega-3 fats, antioxidants and fiber (like those found in fruits and vegetables) and high in refined starches, sugar and trans-fat- most of which can be found in highly processed foods.
This study published in 2018 found “the immune system reacts similarly to a high fat and high calorie diet as to a bacterial infection” and went on to say that the immune system continues to be more aggressive long after your last fast food/processed food meal was eaten.
Removing highly processed foods and opting for a diet of whole foods can not only prevent your immune system from reacting to your dinner like it would to E. coli, it can also help eliminate many of the other commonly cited culprits- artificial sweeteners, simple sugars (sugar found in fruits is just fine!), added glutamates and alcohol.
One other thing to consider: if you’ve got GI issues, lettuces and other raw vegetables can be an irritant on the GI tract. Removing lettuce and cooking all your veggies can help reduce this issue.
This may be a good place for you to start.
But specific foods also impact different diseases.
So, onto the more nitty gritty:
*Migraines not your problem? Skip ahead to IBS, Fibromyalgia or Arthritis
Many of the usual suspects listed above can trigger migraines, but there are also a lot more specific foods that have been known to cause problems.
Topping that list?
In studies looking at dietary triggers for migraines, it’s the most commonly listed trigger.
But caffeine is not the only one that pops up multiple times:
MSG, citrus fruits, aspartame and other artificial sweeteners, cocoa, dairy, nitrates, histamine and alcohol are all part of that group as well.
One of these studies (done in children with migraines) noted the effects of the foods were cumulative, meaning a one time exposure to the food wasn’t enough to trigger a reaction, but rather the effect of foods over time.
If you’re trying to prevent migraines, another thing to consider removing is tannins. Although evidence is anecdotal at this point, tannins have been strongly linked to migraines in some individuals.
Where can you find tannins? Grapes and their skins are notorious sources of tannins (red wine is as well), tea, red skinned apples and pears, unripe berries and almonds (blanched almonds have had the skin removed- the skin is where the tannins can be found, once blanched they should be safe).
Chocolate also contains tannins, another reason to try removing it during the initial elimination phase.
Another risk factor: not eating regularly.
Skipping meals or going long periods without meals can increase the risk of migraine, or worsen migraine symptoms.
Try eating 4-5 smaller meals throughout the day to prevent blood sugar levels from dropping drastically and potentially triggering a migraine.
The bottom line for your migraine elimination diet:
- Try cutting out caffeine, but don’t do it all at once, work your way down over the course of two weeks or so.
- Remove dairy (a common trigger on its own) to also reduce the amount of free glutamates and amines you’re eating (keep reading to learn more about amines and where to find them).
- Focus on a real food diet free of processed foods to cut out artificial sweeteners and colorings and reduce free glutamates and amines.
- Eliminate citrus fruits, gluten containing grains, cocoa, tannins and alcohol.
Remember, an elimination diet is a tool to help identify food sensitivities and is only temporary. For more on the in’s and out’s of an elimination diet, look here.
Foods to eliminate with IBS
If IBS has you feeling miserable, I’ve got you covered too!
Common food triggers for IBS include:
- Artificial sugars (including diet drinks/foods)
- High fructose corn syrup and other foods high in free fructose (agave, honey, fructose, molasses)
- Fatty/fried foods,
- Gluten containing grains
- Cruciferous vegetables (broccoli, cauliflower, cabbage, Brussels sprouts)
- Onions, and beans (unless vegetarian/vegan)
Timing can also make a difference: try smaller, more frequent meals. Eat them slowly and try not to rush through them.
Going gluten free may also be beneficial- this study found elements in wheat and gluten may cause flare-ups even without celiac disease.
Another review article notes going gluten free provided relief from diarrhea (in IBS-D), abdominal pain and bloating in those with no celiac disease.
If the gut is inflamed (and that's likely with IBS) the epithelial barrier between the intestines and the body can be weakened and allow food particles, bacteria and more to pass through and into the body- this is more commonly known as leaky gut.
If gluten is not sufficiently broken down in the small intestine undigested peptides remain. The undigested peptides can sneak through that leaky barrier and trigger an immune reaction.
An immune reaction is bad news.
Immune mediators become involved during an immune reaction and when they become involved it’s all out war in the gut. This can lead to IBS flare-ups, pain and changes in motility.
Another common bit of advice with IBS: eat more fiber. Or, eat less fiber.
If you have IBS fiber can be tricky.
Because fiber and IBS are not simple terms, but broad umbrella terms that cover a lot of ground and fiber tolerance varies greatly from person to person.
We have to break it down a bit further:
Fiber is broken down into two kinds- insoluble and soluble fiber.
Soluble fiber is found in oats, berries, beans, nuts and apples.
Insoluble fiber is found in whole grains like whole wheat and rice, fruit/veggie peels and seeds.
We’ve also got to break down IBS:
If you’ve got diarrhea predominant IBS (IBS-D), soluble fiber can help decrease diarrhea, whereas insoluble fiber supplements may exacerbate symptoms.
The bottom line for fiber: everyone reacts differently to fiber.
Overall, it’s an incredibly beneficial nutrient so include whichever kind you can and as much as you can tolerate. Increase slowly- too much too fast can cause constipation and worse. A food diary can be an invaluable tool to help you pinpoint what kind of fiber and how much bothers you.
Cruciferous veggies and onions also made the list- why?
Despite the fact they pack plenty of nutritious vitamins, minerals and antioxidants these veggies are often problematic for those with IBS.
Cruciferous veggies- broccoli, cauliflower, Brussels sprouts, kale, cabbage, bok choy and more- have an indigestible starch known as raffinose.
Raffinose passes through the digestive tract until it reaches the colon. From there, bacteria in the colon break it down (ferment it) and one of the byproducts is gas. These gas forming vegetables tend to cause bloating and pain.
Once the digestive system has calmed down, try adding them back to your diet cooked and in small (½ cup) amounts to see how they impact you.
The bottom line for your IBS elimination diet:
- Cut out caffeine by working your way down over the course of two weeks or so.
- Ditch inflammatory alcohol.
- Remove artificial sugars from your diet (including diet drinks/foods) and foods high in free fructose (high fructose corn syrup agave, honey, fructose, molasses, dried fruit, apples, pears, mango, papaya and melon)
- Remove dairy, fried/fatty foods, cruciferous vegetables and onions. Be sure to cook your veggies, at least initially.
- The list may seem long, but focus on what you can have and when you make your diet a real food diet free of processed foods and remember, it will all be worth it when you’re feeling better.
- Texture of foods can also impact IBS symptoms- try consuming nuts, seeds and legumes in a smooth texture first. Try hummus and smooth nut/seed butters.
- Avoid spicy foods and GI irritants cayenne pepper and black pepper.
- Other things to consider, depending on how you think they affect you: consider removing foods high in insoluble fiber (high fiber cereals, pastas and breads, popcorn, nuts, seeds) and increasing soluble fiber like that found in oats.
Remember, an elimination diet is a tool to help identify food sensitivities and is only temporary. For more on the in’s and out’s of an elimination diet, look here.
In the absence of quality studies on the diets impact on fibromyalgia, we must turn to experts for their experiences and evidence.
Based on anecdotal evidence from my fellow LEAP dietitians (who have seen the power of reducing inflammation through diet), we know reducing inflammatory foods can make a world of difference in pain and fatigue levels.
The most commonly cited culprits?
- Artificial sweeteners
- Free glutamates
- Free glucose
This review study found removing excitotoxins (aspartame and MSG) and gluten (even without celiac disease) positively impacted fibromyalgia symptoms.
A second study agrees, finding going gluten free (even without celiac) had “remarkable clinical improvement” in fibromyalgia symptoms.
Other studies back up the removal of excitotoxins. This study from 2012 found removing aspartame and MSG reduced pain and symptom levels by 30% or greater in the vast majority (84%) of participants.
But remember, these recommendations can vary from person to person- a third study found removal of excitotoxins had little to no impact on symptoms.
The way you react to different foods or additives is completely individualized- foods that impact the majority of people may not impact you, and vice versa.
That’s what makes the MRT so valuable- personalized results so you know exactly what foods are safe for your body.
This article looked at the impact of free fructose and fibromyalgia (keep reading to learn more about what the heck free fructose is). They ultimately recommend reducing fructose, lactose (dairy), and artificial sugars in the diet.
They noted unabsorbed fructose in the gut leads to gas and prevents the absorption of the amino acid tryptophan.
This study concluded a raw vegan diet with no alcohol, caffeine, animal foods (including dairy), refined sugars/corn syrup or refined grains reduced pain (however, please note the study was done by someone with a vested interest in a raw vegan diet helping people- he had written a book on it).
I’m not saying go raw vegan (unless that’s your jam), but look at what else was eliminated:
- Processed foods
- Artificial sugars and many other types of sugar
- Many free glutamates.
And sometimes it’s not about what you take away, but what you add.
With fibromyalgia, I’m talking about vitamin D.
This meta-analysis found a link between low Vitamin D levels and fibromyalgia which led researchers to conclude a prophylactic supplement of vitamin D may help decrease pain.
The bottom line for your fibromyalgia elimination diet:
- Gradually remove caffeine
- Skip the artificial sugars and reduce the amount of free fructose you eat.
- Avoid gluten containing grains
- Pass on the dairy
- Stay away from foods with MSG and reduce the amounts of free glutamates in your diet.
- Focus on a whole foods based diet with plenty of vegetables, lean meats, whole grains and lower fructose fruits.
Again, this is a temporary state- after a few weeks, begin challenging yourself with these foods- one at a time- and see how your body reacts.
Ready to keep going?
We’ve discussed a lot of trigger foods. Some of the foods listed above (like citrus fruit, alcohol and dairy) may be self explanatory, while some of the others are not.
Keep reading for the full scoop on all these inflammatory foods that may be triggering symptoms.
What are "amines"?
Let’s start with amines- tyramine, histamine, phenylethylamine and others.
Amines are chemicals produced as bacteria reacts with protein in aged foods. They are also a common migraine trigger.
They can create strong smells and flavors.
Some are intentionally produced to add a richer flavor to cheese, wines, aged meat and more or for fermentation like in beer, kimchi or sauerkraut.
Some are not so intentionally produced… leftovers and spoiled foods for example.
The amount everyone can tolerate is different. Start by cutting out amines as much as possible for the initial phase of your elimination diet.
- Purchase the freshest meats possible and use them or freeze them the same day.
- Prepare starchy foods like grains right before eating them. Don’t refrigerate and reheat them.
- Avoid anything fermented, pickled or overripe.
For more on amines, where they can be found and how to avoid them, read this article.
The bottom line about amines:
Eating fresh food, including meats, poultry, fish, grains and produce will help cut down the amine load. Cutting out dairy will also reduce your amine intake.
What is glutamate?
The other commonly cited migraine trigger and fibromyalgia trigger is the amino acid glutamic acid or glutamate.
You’ve probably heard of at least one kind of glutamate: monosodium glutamate, or MSG.
While our brains need glutamate, we do not need to eat it, our bodies make enough on their own.
As an amino acid, many protein foods contain glutamate- and that’s fine. In food it’s known as bound glutamate. When we eat it in unprocessed protein food sources it won’t cause problems.
The problems (and migraines) start when free glutamate is consumed.
Free glutamate is no longer attached to other amino acids. Without them, glutamate is more rapidly absorbed.
Although some foods are high in free glutamate (fermented foods, aged cheeses and some vegetables), processed foods commonly contain high amounts of free glutamates (it’s cheap and imparts a nice savory flavor).
To reduce your free glutamate in food watch out for the following on ingredient lists:
- Glutamate (including monosodium glutamate and monopotassium glutamate)
- “Hydrolyzed” anything, including hydrolyzed vegetable protein and hydrolyzed yeast
- Yeast extract
- Autolyzed yeast
- Soy extract
- Protein isolate.
Here is a list of foods high in free glutamines (pdf).
What about gluten?
Another common migraine, IBS and fibromyalgia trigger?
Gluten. And gluten containing grains wheat, barley, spelt, kamut and rye.
To reduce inflammation in the diet, I recommend eliminating gluten containing grains- at least during the elimination phase of the diet.
Once you’ve cleared wheat, gluten and/or gluten containing grains, like everything else, re-introduce them.
One important disclaimer:
If you suspect gluten is causing a problem, check with your doctor and eliminate the possibility of celiac disease before going gluten free- this helps prevent false negatives.
Gluten is a hot button topic and has been for quite a while. While often demonized, I don’t recommend removing gluten unless it truly does bother you- whether it’s because of celiac or non celiac gluten sensitivity.
Foods like pasta and bread are often considered pantry staples. They are also traditionally made with wheat, a gluten containing grain. Often, when people go gluten free rather than remove these foods altogether, they simply swap out the wheat versions of pasta and bread for gluten free versions of pasta and bread.
These substitutes are usually highly processed, low glycemic foods which may actually increase inflammation and be doing more harm to your gut.
So, why do I recommend giving up gluten and gluten containing grains here?
When dealing with IBS, migraine and fibromyalgia, erring on the side of caution- and looking at common triggers, like gluten- can be the difference between pain and relief.
If you do choose to remove gluten, be sure to replace it with high quality whole grain products. You may be surprised to learn many whole grains are gluten free! Try quinoa, amaranth, brown rice, buckwheat, certified gluten free oats, and more.
What is free fructose?
Another common trigger we have touched on is free fructose.
Wondering what the heck is free fructose?
You’re not alone.
Here is a quick primer:
Carbohydrates are made up of saccharides, or sugar molecules. The more complex the carbohydrate, the more saccharides are part of it. More saccharides means the body works harder to break down the carbohydrate.
Sugars are made of only 1-2 saccharides (monosaccharides and disaccharides) while more complex carbs like starch, fruit or whole grains are made up of thousands. This is why it takes longer to break down complex carbs.
Think of legos- a chain of two legos is pretty easy to take apart. However, a long chain of 100 legos takes a while to break apart into individual legos.
Examples of these simple one saccharide (monosaccharide) sugars are glucose, fructose, galactose, and more. These are combined in various ways to make up other carbohydrates.
One in three adults with IBS symptoms cannot effectively absorb high amounts (25-50g) of fructose. When fructose is not absorbed completely, it ends up in the colon where it rapidly ferments.
And that means gas, bloating, discomfort and more.
Fortunately, when paired with glucose (another monosaccharide), fructose is more readily absorbed and not as likely to ferment in the gut.
What does all this mean for you?
During the elimination phases reduce foods high in free fructose (the foods that are not balanced with glucose to help with absorption). When you are ready to challenge with fructose try having a spoonful of honey (a high fructose sugar) between meals and see how it affects you.
Foods high in free fructose:
- Fruits: apples, pears, mango, papaya, watermelon, honeydew melon and dried fruits.
- Sweeteners: honey, agave, high fructose corn syrup, corn syrup solids, molasses, golden syrup, fructose.
- Alcohol: port, sherry, other fortified drinks.
Stone fruits, berries and bananas all contain a balance of fructose and glucose- so enjoy them instead during the elimination phase of your diet! This article has more information on fructose as well as a more comprehensive food guide.
These examples are simply the most common triggers for the issues that can be related to food sensitivities.
They may or may not work for you, you may have many of the above triggers or none of them. Remember that everyone is different. Keeping a food diary can help you to identify foods that trigger an inflammatory response in your body.
Working with a dietitian and taking the MRT blood test can help you pinpoint your food sensitivities faster and more accurately.