Elimination Diet

How was the elimination diet developed?

The elimination diet is also known as the exclusion diet or oligoantigenic diet. The first record of an elimination diet was in 1926 when Dr. Albert Rowe published Elimination Diet and the Patient’s Allergies (1). It has grown in popularity as people have become aware of the connection between food and their symptoms. It is commonly recommended by dieticians, nutritionists and naturopathic doctors. The list of foods to be eliminated has also evolved as more commercial products have become available with less of an emphasis on whole foods.  

What is the elimination diet?

The elimination diet is a short-term look into your health. The purpose is to identify and remove possible food intolerances that might be causing or contributing to your symptoms. You temporarily eliminate foods that might be related to your symptoms and then reintroduce them one at a time and see how you react.

It is easy to see the relationship between the food we eat and how our digestive systems function. Most of us have foods we don’t handle as well as others. We usually see this in the gas, bloating, stool changes or abdominal pain that occurs after eating foods we are sensitive to. Food intolerances can be related to many other symptoms that are more subtle too.

All the food you eat is broken down by various parts of your digestive system and the smaller components become the building blocks for every cell in your body. It makes sense then, that if you are eating something that is causing inflammation in your gut, the symptoms could show up in any other system. This can include your skin, brain, lungs, joints and many others. Food intolerances are experienced differently by everyone and the elimination diet can help you figure out how each food affects you.

What is inflammation?

Inflammation is your body’s natural response to some sort of injury. It is your body’s way of healing itself. Inflammation actually comes from your immune system.

We usually think of inflammation as an immediate response to injury. If you break a bone, for example, you experience pain, heat, redness, swelling, bruising and loss of function. These reactions come from a set of reactions called the inflammatory cascade. Inflammatory messengers called cytokines are released from the injury site and call out to the immune system. The immune system sends white blood cells to remove damaged tissue. Your immune system also sends cells that help heal the damaged tissue and return you to normal function. This all causes disruption in normal functioning which is why you feel worse for a while before you feel better. This response occurs and resolves quickly and is known as acute inflammation.

Chronic inflammation can occur over several months or years. The inflammatory cascade is similar but is less noticeable and takes place over a longer period. If the body is exposed to a chronic irritant, it creates a long-term inflammatory immune response. This reaction has been linked to heart disease, cancer, autoimmune diseases, joint pain, fatigue and mental health concerns. 

But what does inflammation have to do with your digestive system? 

Your digestive system is meant to be a closed system. We are supposed to selectively absorb the nutrients we need from food and eliminate the rest. The cells of the intestines are held very close together by connections called tight junctions. It is these tight junctions that keep the digestive system separate from the rest of the body. Inflammation in the gut may cause these junctions to become leaky. When this happens, food particles that are supposed to be confined to the digestive system become exposed to the external environment. Your body can recognize these particles as foreign and trigger your immune system to respond. It is estimated that 70% of your immune system is found in your gut which means there is potential for a huge inflammatory response! This can lead to a chronic state of inflammation with a variety of symptoms including

·        Fatigue

·        Low mood

·        Brain fog

·        Digestive dysfunction

·        Disordered sleep

·        Skin conditions

·        Asthma

·        Seasonal allergies

·        Hormonal imbalances

·        Autoimmune disease

What is the difference between food intolerances and food allergies?

It is important to note the differences between food allergies and food intolerances. Your immune system is made up of proteins called antibodies. These molecules are always on the lookout for foreign invaders like bacteria, viruses, fungi and parasites. There are several types of antibodies, each with different jobs. They create unique reactions when they come across something that shouldn’t be in the body.

Food allergies come from a reaction in the IgE portion of the immune system and cause a release of histamine. Allergic responses occur soon after being exposed to specific food and symptoms can include

·        Hives

·        Swollen tissues (throat, tongue, hands, feet, etc)

·        Difficulty breathing

·        Wheezing

·        Shortness of breath

·        Loss of consciousness

·        Death

These include anaphylactic reactions and usually require emergency medical care and the use of epinephrine or an Epipen. Allergic reactions to food can be life threatening. The foods most commonly responsible for food allergies are shellfish, seafoods, tree nuts, soy, peanuts, wheat, eggs and milk.

Food sensitivities or intolerances are typically less severe and the symptoms can be experienced differently by different people. These reactions are thought to involve the IgG and IgA portions of the immune system and originate in the digestive system. They cause the release of inflammatory markers called cytokines that circulate throughout the body contributing to a variety of symptoms related to chronic inflammation. This inflammation can be present long term and can contribute to chronic health conditions. The elimination diet focuses on food intolerances and is not thought to have an impact on food allergies.    

How do I know which foods are causing inflammation? 

Certain foods have been found to be more inflammatory than others. Foods that are eliminated include wheat and other gluten-containing grains, dairy products, eggs, nightshade vegetables, soy products, red meats and all processed foods. These foods are related to increased inflammation in the body, especially within the digestive system. Many people notice an improvement in their symptoms after eliminating these foods for even a short amount of time. 

By eliminating these inflammatory foods for a period of time, you create a new baseline for how you feel. Many people don’t know how bad they feel until they start to feel better! After a few weeks, the eliminated foods are reintroduced one at a time and your reaction to each food is documented. The reintroduction period is very important. Foods need to be reintroduced one at a time and spaced correctly to get accurate results. If you introduce multiple foods at the same time or too close together, you won’t know which foods are causing which reactions. It usually takes a few weeks to reintroduce all the eliminated foods. This helps you determine which foods are contributing to your symptoms, how severe your sensitivity is and what reactions you can expect if you are exposed to these foods in the future. You can then find replacements for the foods you should be eliminating so you can avoid them as much as possible. Some people find it helpful to track their symptoms in a journal and keep a food log so they know exactly what symptoms have changed, how quickly and how much. This way you can gather the most information possible from the reintroduction phase.   

The elimination diet is restrictive in nature but is not meant to deprive you. The focus should not be on calories and you should not be hungry throughout this process. You are encouraged to eat regularly throughout the day and to eat when you’re hungry. The benefit comes from eating good quality food that is not contributing to inflammation in your body. 

Although there a number of food allergy tests available, the results may not be reliable and they can be expensive. The elimination diet is inexpensive and gives you a good idea of how you as an individual react to specific foods and what to expect when you are exposed. This is important because sometimes the food you eat isn’t easy to control. The chances of you being exposed at some point is high, even if you’re being careful and making a conscious effort to eat well. It also empowers you to take control of your health and the food you put into your body every day. 

Who might benefit from an elimination diet?

An elimination diet is a good place to start for people dealing with a variety of health concerns. Unless you identify and eliminate the foods that are creating inflammation at the level of your gut, the inflammation will continue. Any other treatments will only mask the symptoms and won’t treat the inflammation at its root. Many people notice positive changes after only a few weeks. Your cells are constantly turning over and replacing themselves. If they are able to do this with a lower resting level of inflammation, many of your body’s systems are able to function better.

Food intolerances can contribute to many digestive symptoms including

·        Constipation

·        Gas

·        Bloating

·        Abdominal pain

·        Stool urgency

·        Diarrhea

Food intolerances can also be linked to many non-digestive health concerns including

·        Acne

·        Rosacea

·        Psoriasis

·        Asthma

·        Chronic sinus congestion

·        Arthritis

·        Fatigue

·        Brain fog

·        Headaches/migraines

·        ADD/ADHD

·        Anxiety

·        Depression

·        Weight issues

The elimination diet may also be beneficial for people who are not experiencing obvious health issues. It focuses on eating whole foods that have not been highly processed. It eliminates the sugars, salts, preservatives and other chemicals that are known to have a negative impact on health. It focuses on fruits and vegetables, good fats and healthy proteins which are all part of a healthy diet. 

What can you eat on the elimination diet?



Foods to eliminate 

(** if eliminating nightshades)

Foods to include

Dairy products

Milk, yogurt, ice cream, butter, cheese, cottage cheese, cream, modified milk ingredients

Rice, oat, almond or coconut based products


Wheat, corn, barley, spelt, rye

Brown rice, oats, quinoa, buckwheat, millet


Red meats (beef, pork, veal), cold cuts, sausages, hot dogs, soy products, bacon, canned meats, eggs

Peas, lentils, beans, fish, chicken, turkey, wild game, lamb, duck


Peanuts and peanut butter

Walnuts, almonds, hazelnuts, pecans, cashews, sesame seeds, pumpkin seeds, sunflower seeds


Tomatoes**, peppers**, white potatoes**, eggplant**, okra**, Goji berries** 

All other vegetables including sweet potatoes  



Oranges, processed fruit products with added sugar or preservatives

All other fruits in their natural form


Butter, margarine, shortening, salad dressings, mayonnaise, spreads

Olive, flax, safflower, sesame, almond, sunflower, walnut, coconut, avocado, pumpkin


Soft drinks, juices, alcohol

Water, herbal teas, green teas, carbonated waters


Refined sugar, white/brown sugars, high fructose corn syrup, cane sugar

Brown rice syrup, raw unpasteurized honey, pure maple syrup, agave, molasses


cayenne pepper**, paprika**, chili powder**, chocolate, ketchup, relish, soy sauce, BBQ sauce, teriyaki

Vinegar, salt, pepper, all other spices

There are many resources available to make adhering to the elimination diet easier. All vegan recipes will eliminate eggs, dairy and meat products. Paleo recipes will eliminate grains, dairy and sugars. It may be difficult to find commercial products that eliminate all of your potential sensitivities. The more real food you can eat, the better! If you make the food yourself with whole foods, you know exactly what you’re consuming and you can substitute for your sensitivities whenever you need to.

What makes the eliminated foods inflammatory?

Some foods are more inflammatory than others. There are many potential reactions to foods and everyone is different.


Grains make up a large portion of the North American diet. They have been linked to many inflammatory health conditions including obesity, Type 2 diabetes, metabolic syndrome, autoimmune conditions, dementia, cancer and arthritis.

Wheat has been consumed for thousands of years, but industrialized farming has changed its properties and how it works in our bodies. Processing has allowed grains to be used in many different forms and store easily for long periods. This is why modern grains have become staples in our diets. Manufacturing also removes many of the vitamins, minerals and nutrients that wheat and other grains are thought to contain. Ancient grains don’t seem to cause inflammation in the same way as modern wheat and other processed grains do. This is likely because modern grains are recognized as very different than the grains our bodies processed thousands of years ago.      

Modern grains are also exposed to many fertilizers, pesticides and chemicals. When you eat grains, these toxins are consumed and can have a detrimental effect on the body. The agriculture industry has also manipulated the genetics of grains to yield larger crops that are resistant to drought, pests and disease. These genetic advances are too fast for our bodies to keep up with. The body is usually able to break them down but that doesn’t mean it should. Modern grain processing techniques also raise the gluten content in many grains, especially wheat.

What’s the deal with gluten?

There has been a lot of controversy surrounding gluten in the past few years and gluten-free diets have become very popular among health-conscious individuals. Gluten is a group of proteins found in grains such as wheat, rye, barley and spelt. Gluten is actually made up of 2 proteins; gliadin and glutenin. Gliadin is thought to be the more inflammatory component (4).

Gluten is responsible for the stickiness of dough and the consistency of many grain products. When flour is mixed with water the gluten proteins give the dough elasticity. It also allows bread to rise when baked and gives it its fluffy texture (5).

Many people are able to tolerate gluten very well. Other people have various degrees of sensitivity to gluten. Celiac disease is a severe form of gluten intolerance and is actually an autoimmune reaction to the gluten proteins. When the body views gluten as an invader, the immune system attacks it as well as the lining of the intestines (6). This damage to the intestinal cells can cause nutrient deficiencies and many digestive issues (7) such as abdominal pain, bloating, diarrhea, weight loss and foul-smelling stools (8). Symptoms can also occur outside the digestive system including fatigue, skin conditions, mood disturbances or anemia (8). Celiac disease can be difficult to diagnose due to the variety of symptoms it can present with. Rates of diagnosis have been increasing in the past decade but it has been estimated that up to 80% of people with Celiac disease remain undiagnosed (9).

Not everyone with a gluten sensitivity will test positive for Celiac disease. Many people have non-celiac gluten sensitivity. The symptoms are similar to Celiac disease but are typically less severe. This diagnosis is controversial since it relies on a patient’s report of their symptoms. It is difficult to determine if they are reacting to gluten or other molecules. We also know the digestive system can be affected by emotions and conscious thought so it is possible a person’s symptoms are psychologically created. One study found less than 15% of those who reported a gluten intolerance actually reacted negatively to gluten (10). Another study found digestive symptoms improved in non-Celiac patients who ate a gluten-free diet but were unsure what caused this improvement (11). Some people just feel better when they are eating a gluten-free diet. This is difficult to quantify or prove but we cannot discount a patient’s subjective experience.

Celiac disease is diagnosed through laboratory tests. Blood tests that screen for the Tissue Transglutaminase (tTG) Antibody determine if antibodies to the gluten molecules exist in the body. If positive, this is usually followed by analyzing a biopsied sample of the small intestine. This looks for damage to the intestinal cells and can only be done if the patient is currently eating gluten. For those who think they may be sensitive to gluten but not have Celiac disease, an elimination diet can be helpful. Eliminating gluten from your diet will remove the inflammation gluten may be causing and your symptoms should improve. If your symptoms return after reintroducing gluten, you may have a gluten sensitivity. If your symptoms don’t change after removing gluten or putting it back in, you are likely reacting to something else.

A common misconception is that gluten-free food is always healthy. Gluten-free alternatives have become readily available as the popularity of gluten-free diets has grown. Many products replace gluten with corn, binders, fillers, sugars and artificial flavours to mimic the taste and texture of gluten-containing grains such as wheat. These products are often highly processed. Eating foods that are naturally gluten-free is generally a better option. This includes fruits and vegetables, meats and animal products, nuts, seeds, oils and gluten-free grains including quinoa, rice, flax, millet, buckwheat, arrowroot, amaranth and oats.   

There is a lot of controversy surrounding dairy and it is still unclear whether it’s good or bad for you. There may be a grey area and an elimination diet can help you determine how it affects you as an individual. Dairy is found in milk, yogurt, cream, cheese, butter and ice cream. Hidden sources of dairy include products that contain whey, casein, modified milk ingredients and ingredients that include “lact“ such as lactulose, lactoglobulin and lactalbumin.  

Many people are intolerant to dairy and find they feel better when they eliminate it from their diets. Lactose intolerance is estimated to affect about 75% of the world’s population (12). This is thought to be an adaptive response to not drinking breastmilk past infancy (12). Dairy contains lactose which is broken down by the enzyme lactase. Most people lose this enzyme as adults while others have adapted to keep producing it (13). People with lactose intolerance notice digestive symptoms when they consume dairy. These symptoms include nausea, vomiting, diarrhea, gas, bloating and abdominal pain shortly after eating dairy products. Some people with lactose intolerance can eat dairy products if they take a lactase supplement. People who do not tolerate dairy even when ingesting lactase enzymes may be reacting to one of the other proteins in dairy including whey and casein. 

These reactions support the argument that humans are not meant to consume dairy. We are the only animal that consumes the milk of another animal. We are also the only mammal that consumes milk beyond infancy. Cow’s milk in particular seems to be more of an issue than goat or sheep’s milk. The nutrients in cow’s milk is meant to turn a calf into a half-ton mammal. This is very different than the nutrition profile that humans require which is another argument for why some people can’t tolerate it.

Agricultural practices also influence the quality of the dairy we consume. Many dairy products come from grain-fed animals that are exposed to hormones, antibiotics, pesticides and other chemicals. Dairy products undergo lots of processing to make them safe for human consumption. This changes the makeup of dairy molecules and may further explain why some people feel better removing it.

Dairy intolerance can cause many symptoms. Digestive symptoms such as abdominal pain, gas, bloating, diarrhea and constipation are common. Other systems can also be affected and symptoms can include headaches, asthma, poor immune function, skin conditions, sinus congestion, fatigue and mental health concerns. These symptoms should improve after removing dairy and will likely return when dairy is reintroduced.  

Egg intolerance is fairly common, especially in children (1). This occurs when the body cannot digest one or more of the proteins found in eggs. You can be intolerant to the egg yolk, the egg white or both. Most people react to the egg white, specifically the protein albumen (11). Symptoms often involve the digestive system and include abdominal pain, gas, bloating, nausea, vomiting and bowel changes. Other symptoms can include asthma, headache, mood changes and skin conditions such as acne or eczema.

Some people are able to eat small amounts of eggs without experiencing symptoms. It may also make a difference if the egg is cooked or raw. Cooking an egg changes the makeup of its proteins. This may make those proteins more easily digested in some people.

Eggs can be found in mayonnaise, meringues, baked goods, marshmallows, nougat, pastas, salad dressings, foamy toppings, custards and ice creams. It is important to check ingredients labels on packaged foods for ingredients with “ovo”, “ova” or “albumin”.

Nuts and seeds contain lots of anti-inflammatory Omega 3 fatty acids but peanuts may be an exception. Peanuts are grown in the ground so they are more likely to contain molds. The mold particles can be recognized by the immune system as foreign and trigger an inflammatory response. Molds also release compounds called mycotoxins that are meant to stop animals and bugs from eating them. Although they are rarely found in food in an amount to make you seriously sick, these toxins may trigger inflammation. Eliminating all sources of peanuts including peanut butter, peanut oil and products that contain peanuts may be helpful.


Many processed foods contain sugars, salts and artificial chemicals that cause or contribute to inflammation in the body. The relationship between sugar and inflammation has been well documented (17, 18, 19). Sugar has been linked to inflammatory conditions such as obesity, diabetes, cancer, metabolic syndrome, autoimmune conditions and many others. Eliminating artificial sugars can be difficult. Using natural sugars can provide flavour to your food without the inflammatory effects of sugar. Adding naturally sweet foods like raw honey, pure maple syrup, agave nectar, molasses, dates, bananas, applesauce and other fruits makes your food tasty and keeps you satisfied.  

Natural spices also add flavour to your food to keep it interesting and enjoyable. Spices also have many health benefits. Ginger can improve digestion, turmeric provides anti-inflammatory support and cinnamon can help control blood sugar just to name a few. Spices also have antioxidant properties which help protect your cells from damage caused by free radicals. These are much better options than the artificial flavours found in many packaged foods.



Nightshade vegetables are part of the Solanaceae plant family. These include white potatoes, tomatoes, eggplant, peppers, okra, Goji berries and cayenne pepper as well as others that are less commonly eaten in North America. These vegetables contain compounds called alkaloids which are thought to contribute to inflammation in some people. Common symptoms of nightshade sensitivity include digestive dysfunction (15), heartburn (16) and joint or nerve pain.

It may take a few months for nightshade elimination to have a noticeable impact on your symptoms since alkaloids can build up in your system over time. Your immune system may react to these alkaloid compounds causing inflammation. Since it may take more time to notice the effects of nightshade elimination, you may wish to eliminate them independently of the other foods. For this reason, nightshade elimination is considered optional.    

What do people typically experience on an elimination diet?

Some people find the elimination diet more difficult than others. If you normally eat a fairly healthy diet, it won’t be too difficult to eliminate many of the inflammatory foods. If you are used to eating lots of processed foods or you eat out regularly, these changes might be a bit more challenging.

At the beginning, some people find they feel tired and lethargic, have more headaches than usual, notice their skin quality is worse or generally don’t feel well. This usually doesn’t last long, and is likely a sign that your body is detoxing. We are all exposed to a number of toxins every day in the food we eat, the products we use, the water we drink and the air we breathe. When you are eating food that works for your body, your detox organs including your liver, kidneys, skin, lungs and intestines all start to work better too. Eliminating inflammatory foods helps promote these detox pathways. Most people feel much better once their bodies have gotten rid of the toxins that aren’t supposed to be there. Make sure you are drinking plenty of water and getting regular physical activity to support your detox processes.

It has also been suggested that sugar acts similarly to addictive drugs in the brain (3) so if you’re used to eating lots of processed foods with added sugar in them, your body will go through a withdrawal phase. Eating natural sugars found in fruits may help curb your cravings and make this process easier.

It is important to be aware of the changes occurring in your body. Most people notice their symptoms start to improve gradually as they continue the elimination diet. Improved energy, better quality sleep, fewer skin issues, less intense joint and muscle pain, more regular bowel movements and less gas and bloating are just some of the changes you might see. Weight loss is also possible even though this is not a calorie-restricted diet. Inflammation is thought to be at the root of stubborn weight issues since it triggers the body’s stress response and causes cortisol imbalances. This promotes fat storage and may be a factor in fat tissue that is held around the midsection in particular. Improved digestive regularity can also promote weight loss because fecal matter can be left in the intestines if you are not eliminating the food mass you eat every day with regular bowel movements. Bloating is generally improved as well. This doesn’t change the number on the scale but it changes the appearance of the abdomen and how your clothes fit.

For people who don’t have specific health concerns, they generally just feel better overall when they are eliminating inflammatory foods. Sometimes they can’t quite put their finger on it, but they notice when they are eating better.    

Tips for Successfully Completing the Elimination Diet


The elimination diet is not easy, but it is doable if you consciously make an effort to prioritize your health.

Prepare yourself – The most difficult part of the elimination diet is the lack of convenience. You need to ensure your meals and snacks are prepared ahead of time because most convenient foods are not elimination diet friendly. Take some time to prepare several dishes that can be left in the fridge or frozen so you’ve always got something on hand. This is helpful for when your schedule is busy and you don’t have time to cook.

Stock your fridge and pantry – If you keep good food in your house, it will be much easier to put good food in your body. Having elimination diet friendly food readily available will make adhering to the diet much easier.

Clear out your kitchen – Get rid of the foods you will be eliminating before you begin the elimination diet so they will be less tempting during the process. This is especially critical for the first few days when your cravings will likely be more intense.

Ask for help – Enlist the help of friends, family members and coworkers to make you successful. If everyone in your house is following the same dietary restrictions it will be much easier and you won’t feel deprived. Telling others about your goals also helps keep you accountable and will increase your rate of success.

Track everything – Record your food intake and symptom patterns throughout the elimination and reintroduction phases. This will help you identify your food intolerances more accurately. This also helps you recognize your struggles and let you develop strategies to overcome them.     


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