What is an Elimination Diet?
Elimination diets can help identify food allergies and sensitivities. Let’s see what this looks like in practice.
An elimination diet involves changing the foods that a person eats to see if certain undesired symptoms are related to the consumption of those foods (Ly et al., 2017). Typically, every effort is made to remove all potentially harmful foods from one’s diet for a period of time. Then foods are reintroduced into the diet one at a time, with a period of time to observe whether the original physical or mental symptoms return. If those symptoms return in the wake of adding a food, it can be reasonably assumed that the food is partially or fully responsible for the symptoms one is experiencing. With this new knowledge, the person doing the elimination diet is able to decide whether they want to continue avoiding that food or try to eat it in amounts that will not have adverse effects on their health.
“The elimination diet:
Remove anger, regret, resentment, guilt, blame, and worry.
Then watch your health, and life, improve.”
― Charles F. Glassman
The primary purpose of elimination diets, from their introduction, was to both diagnose and serve as treatment for potential food allergies (Rowe, 1944). Eventually, doctors realized that psychological and behavioral symptoms that could reflect food sensitivities, as well as food allergies, could be identified through elimination diets (Singh & Kay, 1976).
There is a lot of research attesting to the benefits of using elimination diets to treat certain physical conditions. For example, it is clear that people who have atopic dermatitis (better known as eczema) show reductions in their eczema and have fewer inflammatory markers in their blood after beginning elimination diets that remove the foods they are known to be allergic to (Agata et al., 1993).
Other researchers (Hart, 2018) have found that elimination diets reduce the symptoms of irritable bowel syndrome as well as joint pain, respiratory problems, and migraine. In fact, even some people with depressed mood experience benefits from changing their diets (Karakula-Juchnowicz et al., 2017).
The benefits of elimination diets are not reserved for people with chronic medical issues or mental health disorders. Elimination diets have been applied with people such as a elite athletes as well, and the participants in those studies, after removing from their diets foods to which they might have been sensitive, have performed better at their sports and appeared healthier on several measures of physical health (Kostic-Vucicevic et al., 2016).
While there are ample benefits to elimination diets, they are not easy to undertake, requiring discipline and effort. Elimination diets are often implemented with children, and families with children who are undergoing elimination diets typically find the whole process stressful and challenging (Meyer et al., 2017). After all, many of the most common allergens, such as peanuts, wheat, dairy, and eggs, are present in many foods that children—and adults!—enjoy.
Here is an example of the procedure used in one study to determine whether children with attention-deficit/hyperactivity disorder experience fewer mental health challenges if certain foods are removed from their diets (Bosch et al., 2020):
First, all known common food allergens are removed from the children’s diets for five weeks. This means that they do not eat milk, eggs, wheat, fish, or peanuts and nuts, among other foods. Then, every two weeks a new food is introduced into the diet, and the parents are asked to observe whether the child’s mental health symptoms change for the better or for worse. After those fourteen days have passed, the food is removed from the diet again.
If eating the food seemed to coincide with worse mental health symptoms, the food may be kept out of the child’s diet indefinitely, but if it did not, it is decided that the food will be added back to the child’s diet after the elimination diet process is complete. For a whole week, the child’s diet is then returned to the baseline of the elimination diet. Then, another food that was eliminated is reintroduced, and the parents watch for symptom changes again. This process is followed until all foods removed have been tested in this way, which means it can take up to a year or more (Bosch et al., 2020). Since some research suggests that children who go on elimination diets experience nutritional deficiencies and changes in growth patterns because of these amended diets (Isolauri et al., 1998), it is important to also monitor the rest of a child’s well-being during an elimination diet.
Elimination diets are not something to undertake lightly. One research study found that implementing an elimination diet where four or more foods are removed adds significant time and expense to one’s eating routines (Sheedy et al., 2022). Additionally, eliminating foods that do not need to be eliminated can actually make us more susceptible to developing an allergy or sensitivity to that food (Elizur et al., 2017).
For these reasons, it is recommended to move slowly and consult with a medical professional regarding any elimination diet you may try. There is a careful balance to strike between reducing one’s unpleasant symptoms and creating new issues through introducing nutritional deficiencies to one’s life. Elimination diets hold so much potential for helping us live healthier lives; they just have to be implemented with a lot of intentionality.
● Agata, H., Kondo, N., Fukutomi, O., Shinoda, S., & Orii, T. (1993). Effect of elimination diets on food-specific IgE antibodies and lymphocyte proliferative responses to food antigens in atopic dermatitis patients exhibiting sensitivity to food allergens. Journal of Allergy and Clinical Immunology, 91(2), 668–679.
● Bosch, A., Bierens, M., de Wit, A. G., Ly, V., van der Velde, J., de Boer, H., . . . & Rommelse, N. N. (2020). A two arm randomized controlled trial comparing the short and long term effects of an elimination diet and a healthy diet in children with ADHD (TRACE study). Rationale, study design and methods. BMC Psychiatry, 20(1), 1–16.
● Elizur, A., Bollyky, J. B., & Block, W. M. (2017). Elimination diet and the development of multiple tree-nut allergies. Pediatric Research, 82(4), 671–677.
● Hart, G. R. (2018). Gut microbiota, IgG-guided elimination diet and sports performance. BAOJ Nutrition, 4, 052.
● Isolauri, E., Sütas, Y., Salo, M. K., Isosomppi, R., & Kaila, M. (1998). Elimination diet in cow’s milk allergy: risk for impaired growth in young children. The Journal of Pediatrics, 132(6), 1004–1009.
● Karakuła-Juchnowicz, H., Szachta, P., Opolska, A., Morylowska-Topolska, J., Gałęcka, M., Juchnowicz, D., . . . & Lasik, Z. (2017). The role of IgG hypersensitivity in the pathogenesis and therapy of depressive disorders. Nutritional Neuroscience, 20(2), 110–118.
● Kostic-Vucicevic, M., Marinkovic, D., Dikic, N., Stojmenovic, T., Andjelkovic, M., Nikolic, I., . . . & Malic, T. (2016). O-35 Is there connection between food intolerance and sports performance in elite athletes? British Journal of Sports Medicine, 50(suppl.), A20.
● Ly, V., Bottelier, M., Hoekstra, P. J., Arias Vasquez, A., Buitelaar, J. K., & Rommelse, N. N. (2017). Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. European Child & Adolescent Psychiatry, 26, 1067–1079.
● Meyer, R., Godwin, H., Dziubak, R., Panepinto, J. A., Foong, R. X. M., Bryon, M., . . . & Shah, N. (2017). The impact on quality of life on families of children on an elimination diet for Non-immunoglobulin E mediated gastrointestinal food allergies. World Allergy Organization Journal, 10, 8.
● Rowe, A. H. (1944). Elimination diets and the patient’s allergies; a handbook of allergy. Lea & Febiger.
● Singh, M. M., & Kay, S. R. (1976). Wheat gluten as a pathogenic factor in schizophrenia. Science, 191(4225), 401–402.
● Sheedy, K., Patel, N., Porter, J., & Silva, H. (2022). Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis. Nutrition & Dietetics, 79(2), 238–246
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