Imagine eating a delicious meal only for hours or days later to feel its effects. Constipation, diarrhea, headache, flatulence, indigestion, the list goes on. If you’re anything like me, you don’t even have to imagine the symptoms. However, there is a chance you haven’t considered these symptoms to result from food.

Some people hear the phrase “elimination diet” and instantly cringe. I get it; who wants to stop eating the foods they love? Unfortunately, an elimination diet is sometimes the key to understanding why we struggle with our health. Whether it’s the symptoms already mentioned, gut issues, heartburn, migraines, eczema, or even acne, they can all result from the foods we’re eating, even without us realizing it.

No one wants to live life uncomfortably. I know I didn’t, which is precisely why, in 2022, I embarked on a 66-food elimination diet. You read that right, SIXTY-SIX! That wasn’t even counting my already strict plant-based lifestyle. To say I was a bit overwhelmed is an understatement. But, hopefully, by the end of this post, you’ll see elimination diets aren’t too bad, especially if they’re planned well.

What is an Elimination Diet

Elimination diets are a diagnostic method allergists and registered dietitians have used for decades. They usually last five to six weeks and are performed after a suspected food allergy or sensitivity. We may suspect a food allergy or sensitivity when symptoms occur following the consumption of certain foods. Additionally, food sensitivities can sometimes be narrowed down with special tests through companies like Check My Body Health or EverlyWell. There are three types of elimination diets, with different intensities, including:

• Simple elimination diets avoid one or two common food triggers, such as gluten and dairy. In their place, it’s usually recommended to eat gluten-free alternatives like brown rice, cassava, millet, buckwheat, quinoa, and plant-based dairy alternatives (2).
• Moderate elimination diets avoid several food groups. During this type, alcohol, animal products, chocolate, coffee, tea, soft drinks, legumes, nuts, wheat, etc. may be discontinued (2).
• Strict elimination diets avoid most foods and are usually done when someone has done a food sensitivity test (2).

Food eliminations usually aren’t forever; they last long enough to pinpoint the potential sensitivity/allergy. If a sensitivity or allergy is found, some people have luck reversing them, while others need to eliminate them permanently, such as those with celiac disease. According to Precise Nutrition:

“Elimination diets help you to collect and analyze empirical evidence, using experimentation and observation based on what happens in your body as you change what you eat. If your headaches disappear after you’ve removed certain foods only to suddenly resurface when you reintroduce chocolate, that’s a powerful clue (3).”

Without an elimination diet, we can only speculate what foods are causing unwanted symptoms. Elimination diets help narrow it down and verify assumptions, especially when symptoms such as headaches or migraines occur outside the gut. Of course, when dealing with triggers, sometimes, no symptoms are present or are delayed by a few days. In other words, the goal is to remove potential triggers long enough to get them out of our body and then reintroduce them to see if any symptoms occur.

Allergies Vs. Sensitivities

Food allergies, sometimes called food hypersensitivities, are severe and potentially life-threatening medical conditions affecting approximately 32 million Americans. An allergic reaction is nearly immediate and is caused when the immune system overreacts to a normally harmless food protein (allergen), also known as an IgE immune response (4). The eight major food allergens include (5):

• Milk
• Eggs
• Fish
• Shellfish
• Tree nuts
• Peanuts
• Wheat
• Soybean

Typically, food allergies cause one or more of the following symptoms: (6):

• Tingling or itching in the mouth
• Hives, itching, or eczema
• Swelling of the lips, face, tongue, throat, or other parts of the body
• Wheezing, nasal congestion, or trouble breathing
• Abdominal pain, diarrhea, nausea, or vomiting
• Dizziness, lightheadedness, or fainting
• Constriction and tightening of the airways
• A swollen throat or the sensation of a lump in your throat that makes it difficult to breathe
• Shock with a severe drop in blood pressure
• Rapid pulse
• Dizziness, lightheadedness, or loss of consciousness

On the contrary, food sensitivities, sometimes called food intolerances (e.g., lactose intolerance), typically aren’t life-threatening but are uncomfortable. Food sensitivities affect approximately 20 percent of the world’s population and occur when a person has difficulty digesting a particular food (7). Food sensitivities can have a delayed response time up to a few days after consumption and usually result in increased levels of IgG class antibodies (8). The top eight major food intolerances are (9):

• Dairy
• Gluten
• Caffeine
• Salicylates
• Amines
• FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols)
• Sulfites
• Fructose

Of course, these aren’t the only sensitivities. Many individuals have issues with soy, food coloring, monosodium glutamate (MSG), and other additives. For example, I identified methylcellulose, vanilla, gluten, and sunflower seed sensitivities during my elimination diet.

Typically, food sensitivities cause one or more of the following symptoms (10):

• Abdominal pain
• Diarrhea
• Gas
• Bloating
• Headaches or migraines
• Heartburn
• Nausea
• Upset stomach

If these symptoms sound like something you’ve experienced without identifying a cause, you may want to consider an elimination diet. I know elimination diets seem overwhelming; no worries, we’ll discuss how they work, and then I’ll share what I did to prepare for mine.

How Elimination Diets Work

Elimination diets are typically done in three phases and involve removing all potential food sensitivities before individually reintroducing them. The key to an elimination diet is waiting enough time between each food reintroduction to notice potential symptoms and ensuring that every symptom is tracked, no matter how minor they may seem.

Phase 1: Planning

The first phase is dedicated to determining which foods should be eliminated. Create a list of foods/ingredients acceptable to eat and foods/ingredients that aren’t. It’s important to figure out meal ideas and plan ahead. No one wants to start an elimination diet feeling overwhelmed, restricted, or like they can’t eat anything.

Phase 2: Avoiding

The second phase is dedicated to avoiding all the foods being eliminated and typically lasts four weeks. Avoiding the foods for four weeks allows the body time to recover/reset from potential triggers and diminish symptoms. It’s important to remain strict with the foods consumed during this time.

Phase 3: Reintroducing

The third phase may take quite a while, depending on how many foods are being reintroduced. When reintroducing foods, it’s important to introduce one new food every four days to ensure the body has enough time to show symptoms. Believe it or not, unwanted symptoms can take up to three days to appear. Just to reiterate: one day to consume the food and three days for symptoms to appear.

Again, and I can’t say this enough, it’s crucial to remain strict. Ensure everything is tracked, including moods, symptoms, sleep intake, supplements/medications, bowel movements, beverage intake, food intake, and anything else experienced. A great way to keep track of this information is a food sensitivity journal. Once foods are confirmed safe or unsafe, write them down and reintroduce another food, but only after the three days of symptom-waiting are up. Even if symptoms appear on day one of eating, it’s essential to wait three days for symptoms to subside before reintroducing the next food.

How to Prepare for an Elimination Diet

When planning my 66-food elimination diet, I admit I was a bit overwhelmed. My elimination diet took approximately eight months, but I couldn’t have done it without extensive planning. So, without further ado, here are the steps I took to ensure I had a successful elimination diet:

• Step 1: I took two food sensitivity tests: one from EverlyWell (you can view my results here) and another from Check My Body Health (you can view my results here).
• Step 2: Upon receiving my detailed analysis reports, I printed them out and put them in sheet protectors to create a 1-inch binder to reference my results quickly.
• Step 3: I bought a food sensitivity journal that allowed me plenty of space to track all the food I would consume during my elimination diet. The journal also had room to record my mood, symptoms, bowel movements, water intake, and sleep. I also really enjoyed the information about food sensitivities, allergies, and intolerances in the front of the journal.
• Step 4: I cross-referenced my potential food sensitivities from both tests and typed a list. I saved this list on my phone and stapled a printed copy to the inner front cover of my journal to ensure easy access at all times.
• Step 5: I started working on a meal plan. Due to the extensivity of my results, I decided to go from plant-based to whole-food plant-based for the duration of my elimination diet. I then carefully strategized my meal plan to ensure each meal had the nutrients my body needed to function while avoiding deficiencies and remaining full throughout the day.

The results of my elimination diet weren’t what I expected. Of the 66 foods I eliminated, all but four were successfully reintroduced. Since completing my elimination diet, I have focused on my gut health, written The Importance of Gut Health, and successfully reintroduced all of my confirmed food sensitivities, except methylcellulose and animal products (I never reintroduced, but they did come up as a sensitivity). Long story short, with hard work and dedication, you may be able to heal your gut and successfully reintroduce your food intolerances, too!

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