How to Do an Elimination Diet to Find Out if You Have a Food Sensitivity
Updated: Jan 23
When you are working on healing the body, gut health is important. In naturopathic medicine finding and removing a food sensitivity is "removing an obstacle to cure." You can take all the supplements and vitamins on the market, but if there's a food that your body doesn't tolerate well it will cause inflammation and make you feel unwell. Removing it from the diet is the best way to go and an elimination diet can help you find out which foods are contributing to your symptoms.
What is an elimination diet?
The purpose of an elimination diet is to see if certain foods are having a negative impact on your health. Certain foods are completely avoided for at least 4 weeks, and then you evaluate how you feel. By eliminating a food for a month, you're reseting the digestive system so that when you eat the food again or "rechallenge" it you're more likely to know if it makes you feel bad.
I've recommended an elimination diet for a lot of patients because so many diseases are connected to gut health and it can be useful when we're trying to figure out if certain foods are contributing to their symptoms. Sometimes we'll do a food sensitivity panel before starting the diet to narrow down which foods might be the culprits so they don't need to take out all the common food triggers. A food panel can be expensive so some opt to not get it, but the elimination diet can be a very useful tool on its own.
Signs that you might have a food sensitivity
Gut health affects how the whole body feels so symptoms can be varied if you have a food sensitivity.
frequent infections, ear infections, sinus congestion
rash, eczema, psoriasis, canker sores
gas and bloating
constipation, diarrhea, intestinal cramping
joint or muscle pain or swelling
brain fog, difficulty concentrating
What are common food sensitivities?
If you don't do a food panel before the elimination diet it can be helpful to know that there are certain foods that people are more likely to be sensitive to. The most common ones I've seen are eggs, dairy (cow) and gluten. I think these are three food groups to definitely take out if you do an elimination diet.
cow dairy - milk, hard cheese and soft cheese, cottage cheese, sour cream, yogurt, whey, casein
eggs - includes the white and yolk, lecithin (often made from egg yolk)
gluten - found in wheat, barley, rye, spelt, bulgar, farina, semolina, and may be found in non-gluten free oats
corn - products derived from corn, dextrose, corn starch
soy - tofu, tempeh, miso, TVP (textured vegetable protein)
nightshades - these are vegetables in the potato family. They include potatoes, tomatoes, peppers, cayenne, and eggplant.
citrus - this food group contains foods that may cause a release of histamine, which can make rashes or eczema worse. Fruits include lemons, oranges, grapefruits, and limes. Strawberries and pineapples may also cause this histamine reaction.
What can you eat?
I know doing an elimination diet is hard. It takes a lot of motivation to stick with it and planning before you start. There are a lot of things to take out of the diet, but there are also a lot of foods that you can eat so try to focus on this when you're shopping or meal planning.
dairy substitutes - milk, yogurt, and cheese don't have to come from cow's milk. You can get these from almonds, coconuts, hemp, hazelnut, rice or goat.
grains - any grains and flours that don't contain gluten are okay such as quinoa, rice, millet, gluten free oats, tapioca, sorghum, and potato. Buckwheat is also okay and doesn't contain wheat! You can find cereals, crackers, and pasta made from these.
fruits - all fruits are okay, unless you're eliminating citrus fruits
vegetables - all vegetables are fine unless you're eliminating nightshades.
nuts and seeds - all of these are fine, unless you're eliminating peanuts. Nuts and seeds provide healthy fats and nutrients. They can also be used to make nut butters and sauces. Eat walnuts, almonds, cashews, pistachios, pumpkin seeds, flax, sesame seeds, and sunflower seeds.
meat - try to choose grass-fed, good quality beef, poultry, pork, fish, and lamb.
beans, lentils, split peas - these provide a great source of fiber and protein so eat them liberally
condiments - use oils, spices, vinegars, herbs and dressings to flavor your foods. Look at labels to make sure they don't contain any "hidden" corn, dairy or gluten.
beverages - water, sparkling water, tea
How to re-introduce foods and test them
Once you're done with the elimination part of the diet it's time to re-introduce or "rechallenge" the foods you took out for all those weeks. This part is important to do carefully because you've just done a difficult diet for weeks and now you get to see if the foods you took out are negatively contributing to your health.
Test foods one at a time in a methodical manner so you don't get confused as to what is causing symptoms. The best way to go about this is to eat the food in its pure form. For instance, to test corn you could use corn kernels or corn tortillas, but make sure there's no wheat in the tortillas. Testing with a slice of bread would not be a good choice because it could contain wheat, dairy or egg.
Eat a serving of the food, such as a glass of milk or a bowl of cream of wheat cereal and see how you feel. If symptoms appear, then consider yourself to be intolerant. If no symptoms appear, eat it 1-2 more times that day. Sometimes you might feel symptoms right away or within hours, but they may also be delayed and take a couple days.
If you have a return of symptoms stop eating the food and wait for your symptoms to go away before testing the next one. You want to get yourself back to neutral before you try the next one.
Here are some ideas for what to use for testing:
wheat - flour tortillas, cream of wheat, noodles (not egg noodles)
dairy - Some people can tolerate a few dairy foods so test them individually. Use milk, butter, yogurt, hard cheese, soft cheese, sour cream, cottage cheese and buttermilk.
corn - corn on the cob, corn tortillas. Make sure the food doesn't contain wheat.
soy - soy nuts, tofu
eggs - use hard boiled eggs to test the yolk and white separately
The purpose of an elimination diet is to see if certain foods are having a negative impact on your health and how you feel. Foods are completely avoided for at least 4 weeks and then you eat the food again or "rechallenge" it to see if it makes you feel unwell. Symptoms of a food sensitivity include fatigue, headaches, infections, skin issues, poor digestion, joint or muscle pain, depression, anxiety, and brain fog. Common foods to eliminate include dairy, eggs, gluten, corn, soy, citrus, nightshades and peanuts. There are many foods you can eat when on this diet so try to focus on this as you plan and grocery shop. After doing an elimination diet for 4 weeks you need to methodically introduce the foods back into your diet to see if they are contributing negatively to your health.
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In health, Dr. Jamie
This website is not intended for the purpose of providing medical advice. All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
Olsen, Natalie. “Low-Histamine Diet: Which Foods Should I Avoid?” Healthline, Healthline Media, 2018, www.healthline.com/health/low-histamine-diet.