How To Do An Elimination Diet

Have you been handed what feels like a prison sentence: to go on an elimination diet? Or maybe you’ve heard about them and wonder if they might help you resolve your health issues. Whatever your motivation, the idea of starting one seems daunting at best.

There is much debate on the effectiveness of food sensitivity and allergy tests. For instance, one testing company may tell you to stay away from food X, whereas another will tell you it’s fine. Given such disparaging results, it should come as no surprise that these tests haven’t been scientifically validated.

Elimination diets are suggested because they are a great way to test for food allergies and sensitivities where you are the subject in the experiment. They typically involve eliminating common allergens such as dairy products, wheat, soy, eggs, corn, etc. for a given period of time to see how you react once you add those foods back in. Having done an elimination diet myself, I initially wondered how on earth I would undertake one. Here are some tips to help you navigate what can be challenging terrain.

Have a plan
The most important part of an elimination diet is probably planning it. When will you start it and how long might it last? Some elimination diets are longer than others, so know what you’re getting yourself into first. While the length of the elimination phase is fixed and known in advance (usually about 4 weeks), the period where foods are reintroduced could possibly double in duration. That is, if you’re reintroducing dairy over three days and you have no negative reactions to it, you can reintroduce another food (say soy) on the fourth day. But, if you notice any reactions to dairy, then you will need to revert back to the elimination diet on the fourth, fifth and sixth day. Only on day seven can you reintroduce soy. This is done in order to get the dairy out of your system so that any reactions to soy are not really reactions to dairy, in disguise.

Eating out
Eating out is a challenge, but certainly not impossible. Nothing should be left to chance. When I went on an elimination diet, I looked at menus beforehand and came up with some go to places near me. I happened to be traveling for part of it, so that included places along the way. Some websites listed ingredients and the cooking processes they used. At times I had to ask lots of questions. Fortunately, most restaurants have a binder with the ingredients of all their menu items. Ask to see these lists whenever possible. When that’s not possible, ask detailed questions. For instance, if asking about added sugars in foods, give examples like honey, maple syrup, coconut sugar, agave, etc. Assume that those you ask know nothing about food and nutrition. Otherwise, you may get off course, not even know it, and unknowingly sabotage your elimination diet.

You will also have to be okay with being that “picky eater” that asks lots of questions and holds up the line. I recommend framing it as an allergy so that it’s taken seriously and not left to chance. If you believe you have food sensitivities or allergies, then remember that this temporary inconvenience will help you in the long run. But despite all the questions in the world, some restaurants are just impossible on an elimination diet. In cases like this, preparing and packing foods can be a lifesaver.

When in doubt, don’t
When you’re not able to obtain information about ingredients, you should assume that a given food contains something you can’t have. Go simple when you order. Something as healthy sounding as teriyaki sauce may contain: soy, sugar, wheat and corn among other things. Be sure to always ask about seasonings, sauces, marinades, cooking oils, etc. so you know for sure. Additionally, things like salads are usually a safe bet, but salad dressings can be tricky. For example, despite the simpleness of oil and vinegar, consider that the vinegar may have more than just one ingredient (usually sugar).

Reading labels
While nutritional labels are easy to read and understand, they may contain foreign-sounding ingredients. Not to single out sugar, but it can go by many names including: molasses, caramel, dextrose, sucrose, cane juice, sucanat, etc. Sadly, it’s not unusual for the food industry to make sugar seem like it’s something else given it’s vilification. A quick Google search of ‘what is X?’ can go a long way. At the same time, remember that anything and everything is on the internet so try to find a reputable source whenever possible.

Making mistakes
I went out to dinner during my elimination diet and asked a ton of questions. I ordered chicken that was breaded but the crust was made from plantain. Having gone through my list of things I can’t have, the cashier confirmed that it was just chicken with a crust made of plantain, so I ordered it and enjoyed it. However, after a few bites, I began to wonder how the plantain was bound to the chicken. Then I realized that eggs are commonly used to help foods stick together. I asked another employee who confirmed that my chicken’s crust contained eggs. Boy was I misinformed!

Getting back on track
I could’ve easily thrown in the towel and complained about how hard this diet was when I accidentally had some egg with my chicken. Instead, I was almost three weeks in and had just over a week before I began reintroducing foods, including eggs. I decided to treat this as the mistake that it was, getting right back on track. I let my nutritionist know and she was happy to hear that I realized what happened and corrected course right away. By the time I would’ve reintroduced my first food, the eggs would be out of my system. As strict as an elimination diet is, mistakes may happen and they aren’t the end of the world.

Holidays
I didn’t fully understand the elimination diet when I began it. I believed that I would introduce one food, note any reactions, add the next food, notice any reactions until I brought them all back. I fantasized about pizza once the day came to reintroduce both wheat and dairy. However, what I didn’t realize was that I would have to remove the first food before I reintroduced the second food, and that I’d have to go back to elimination mode if I had any reactions after three days of exposure to an offending food. So, an elimination diet that began on the first of October that “should’ve” been completed before Thanksgiving took me well into December.

Thanksgiving is a food-based holiday so it required much planning and forethought. I was fortunate to have a supportive friend who had many dietary restrictions herself. She knew exactly what I needed to avoid and even offered to show me ingredient lists. I appreciated the accommodations but was also ready to bring my own Thanksgiving meal had I not had such ease. In the end, the meal was delicious and I didn’t feel like I was on an elimination diet at all!

One at a time
Finding foods that contain just the ingredient that I was testing in the re-introductory phase proved difficult. Very often, they would contain other offending ingredients which would produce a confound. One example that comes to mind is bread. I was testing wheat and figured that bread would be an easy way to test it. After spending 10 minutes in the bread aisle at the supermarket, I quickly learned that most breads contain sugar while some contain eggs. I did eventually find some focaccia bread that contained few ingredients. I certainly didn’t expect this to be so difficult and had similar challenges when introducing other foods in isolation. So whenever possible, test the purest form of a given food. That is, if testing eggs, ideally just eat eggs instead of trying to find foods that might contain eggs.

Good luck
Hopefully these tips will help you if an elimination diet is indicated. I’d love to hear about any challenges or successes you’ve had, or to answer any questions you might have about elimination diets…