I use elimination diets a lot to uncover food sensitivities and intolerances. They are the gold standard when it comes to these types of conditions. However, there is a lot of confusion and misuse of elimination diets, especially in the autoimmune space. This confusion can lead to food fears, disordered eating and unintended consequences like more inflammation. Below I explain how to do an elimination diet in the way that it was intended – a short term exploration of potential food reactions.
The Misunderstanding of Elimination Diets
Elimination diets are for short term use only. Period. They should NEVER extend past 6 weeks. In fact, 4-6 weeks is the longest any elimination diet should be for the elimination phase, in which all foods you plan to eliminate are eliminated.
I know this contradicts some elimination diets like the Autoimmune Protocol (AIP) which allows for up to 3 months of an elimination phase. However, 6 weeks is enough time to tell if you react to any of the eliminated foods. In one of the first AIP research studies, some participants reached clinical remission within 6 weeks of a step-down elimination diet. And that was even before they reached the full elimination baseline.
Lastly, the goal of elimination diets is to figure out your food sensitivities. Removing these foods should result in an obvious drop in symptoms within a couple of weeks, if not days. Once you see an improvement in symptoms, it is time to add foods back in. Long term elimination of foods is not helpful for many reasons. First, long term restriction negatively affects the gut microbiome. Restriction also develops food fears and can lead to disordered eating tendencies. Lastly, long term restrictions increase your risk of developing nutrient deficiencies.
Phases of Elimination Diets
There are 3 distinct phases of an elimination diet: Elimination, Reintroduction, and Personalization.
Elimination Phase:
This phase begins with the elimination diet. However, it is important to choose the correct eliminations for your condition. If you are dealing with autoimmune diseases, the autoimmune protocol or specific carbohydrate diet are good options to consider.
Start your elimination phase when you are ready and prepared. This means that you want to choose a time frame (generally 4-6 weeks) with few social engagements and/or no travel. You have also planned out meals and snacks, cleaned out your pantry, and have done the grocery shopping. You never want to start anything without having a plan.
Establish a symptom tracking method. This could be in a journal, on your phone, or a validated symptom survey. You need something to help you see positive (or negative) changes. Pick a few metrics that are relevant to your condition and develop an objective way to measure them. For instance, a number scale is a consistent and straight forward way to measure certain symptoms like pain, energy and quality of sleep.
It is important to be patient. Change doesn’t happen overnight. Look for subtle changes that you may not expect. Maybe you’re sleeping better or have a bit more energy throughout the day. Or maybe that stomachache that you thought was normal isn’t there anymore.
Reintroduction Phase:
The reintroduction phase begins after the 4-6 week elimination phase. This is the phase that adds eliminated foods back into your diet to test tolerance. Reintroductions are usually the hardest phase to deal with, and the most underestimated when people try to do elimination diets on their own.
The key point to remember is food sensitivities are usually temporary. They don’t act like allergies. In most cases, your body can adjust, adapt and tolerate foods after taking a break from them.
However, take your time reintroducing foods. A 3-5 day reintroduction schedule is ideal and works like this: Try the new food on day 1, and then don’t eat it again for the next 2-4 days. If something doesn’t feel right, take it out of your diet but try it again at some point in the future! Remember, reactions and flares are not always related to food. You could be dealing with more stress, poor sleep or a change in the environment. That is why it is important to keep testing foods that didn’t work in the past.
Symptom journals are really helpful for this phase, as are food journals. And if this feels overwhelming, definitely reach out to a registered dietitian for help.
Personalization:
Personalization is the final phase of elimination diets. By this phase you have figured out what foods don’t work for you. Now it is time to find alternatives that can replace the triggering food. For instance, if yogurt isn’t working for you, find a dairy free alternative that contains probiotics. This phase protects you from nutrient deficiencies and other imbalances that come from needing to avoid certain foods in the long run.
When used properly, elimination diets are fantastic tools for understanding food reactions. If you need support with starting or managing an elimination diet, please contact me for help. Additionally, follow me on my socials (Instagram, Facebook and YouTube) for more tips to living with your autoimmune condition.
