What is an Elimination Diet?
An Elimination diet (ED) can be very beneficial to people who are have gastrointestinal (GI) problems. Elimination diets are helpful whether or not you have a firm diagnosis of Inflammatory Bowel Disease (IBD), Irritable Bowel Syndrome (IBS), or a possible food allergy, like Celiac disease.
The main purpose of an Elimination diet is to help you, and your doctor, understand if a particular food or food additive is causing some or all of your symptoms. I started my first ED ten years ago and found that I had sensitivities to foods like oranges, caffeine, melons, beef, cow’s milk, spicy foods, additives and preservatives, and caffeine. About six months ago, I started having problems with severe bloating and gas after meals. I tested negative for Celiac disease but by doing another ED, I found I was intolerant to gluten. After completely eliminating gluten from my diet, my symptoms have disappeared.
Doing an Elimination diet is not easy, but it is extremely useful. My best piece of advice is: do not start an ED during the holiday season or when you will be on vacation or away from home for a prolonged period of time. You need to be very strict about what you eat during your ED and if you have a family with children it is best to discuss with them what you are doing and why. If you can convince the whole family to participate in the diet it could be useful to see if anyone else exhibits food sensitivities or allergies. That said, it is always best to do an ED under the supervision of a doctor, and any child under 16 years of age must be supervised by a doctor while on an ED.
Before you start on your ED keep a journal for at least a week where you take note of your symptoms - both physical and mental - when the symptoms come and when they are not present. Continue to keep your journal during your ED as well. This will help you visually see what foods cause symptoms vs. what foods do not cause problems. It is also a good idea to write down how you are feeling each day, what kind of bowel movements you are having and their frequency, etc. You can then take your journal into your next doctor’s visit and have a reliable source of information for you and your doctor to review.
So, how do you start the diet? Your doctor should give you a comprehensive list of what is and is not allowed while on an ED, here is an overview:
ALLOWED foods on the Elimination diet include:
- All vegetable EXCEPT corn
- Only the following meats - fresh fish, water-packed fish (tuna, salmon), lamb, duck, organic turkey and chicken (no hormones, no preservative), wild game.
- All fruits EXCEPT citrus fruits (oranges, lemons, limes) - eat fresh fruits, unsweetened, frozen or water packed, and natural (unsweetened) diluted juices.
- Grains such as Brown or White Rice, Oats, Millet, Barley, Amaranth, Quinoa, Potato flour,
- Split peas, lentils, and Legumes
- Walnuts, almonds, pecans, cashews, sunflower seeds, pumpkin seeds, sesame seeds, almond butter, and tahini
- Bottled, spring, or distilled water, herbal tea, seltzer, fresh vegetable juice, unsweetened fruit juice
- Allowed sweeteners include: Stevia, brown rice syrup, blackstrap molasses, and agave nectar
- Allowed condiments include: vinegar, all spices (salt, parsley, rosemary, dill, thyme, turmeric, cumin, cinnamon, pepper, etc.)
Foods that must be EXCLUDED on the diet include:
- Oranges and orange juice
- Milk, eggs, cheese, yogurt, cream, cottage cheese, butter, ice cream, frozen yogurt, and non-dairy creamers.
- Wheat (this includes bread, pasta, crackers, etc. unless they are gluten-free), corn (and all corn-related products like corn chips, corn starch, corn syrup, evaporated cane juice, etc.), barley, spelt, kamut, rye, and triticale.
- Pork (and all products made from pork like bacon, sausages, hot dogs), beef, veal, deli meat/cold cuts, canned meat, shellfish
- All soy products (soy milk, soybean, soy sauce, tempeh, tofu, soy yogurt, etc)
- Peanuts and peanut butter
- Butter, margarine, salad dressing, mayonnaise, spreads, processed oils, and shortening
- Caffeine (this includes coffee, tea, soft drinks), and alcohol
- White sugar, brown sugar, turbinado sugar, honey, maple syrup, high fructose corn syrup (and any products that uses it), and evaporated cane juice.
- Ketchup, mustard, relish, BBQ sauce, teriyaki sauce, etc.
- Chocolate - white, milk, or dark
I know the diet is hard, remember I’ve done this twice, but no matter how tempted you are to cheat, just a little, don’t It will undo all the hard work you’ve put into the ED previously and you’ll have to start over. Stick with the diet knowing that this is the best and most reliable way to figure out if a food or foods are causing your symptoms and discomfort.
Different doctors and nutritionists recommend different time periods for how long you should stay on the ED before adding back previously eliminated foods. Personally, I’ve always been told to stay on the ED for at least one month to give my body an appropriate amount of time to fully eliminate the offending foods from my body and to give my body time to adjust and begin to heal. Talk to your doctor about his or her specific ED requirements.
When you are allowed to add back previously eliminated foods you must add them back one at a time so that you can tell if you are having an adverse reaction to each food. If you add more than one food at a time and have a reaction you won’t know which food caused the problem. I love sharp cheddar cheese so that was the first food I added back into my diet, but you can choose what food to add when. Once you add back a food and have no adverse reaction to it you can keep it in your diet while you continue to add in other foods. Remember to note how you feel after eating each new food - this not only includes how you feel physically but also how you feel emotionally. If you are going to experience symptoms from a food you might notice it within a few minutes, a few hours, or even the next day.
As with so many other parts of IBD and IBS no two people react to an Elimination diet the same way. Some people report feeling great during the elimination period. They are full of energy, sleeping well, have a decrease in muscle or joint pain, and generally feel well. Other people report the opposite feeling tired, headachy, restless, lightheaded, or with stiff joints, or odd bowel patterns. Either path is normal as the body “detoxes” and readjusts to new eating patterns. However, if you experience any new symptoms that are severe or particularly bothersome you should call your doctor or their nurse immediately for guidance.
As I mentioned before, young children should not embark on an Elimination diet without the express consent and knowledge of their physician. An ED can be risky in young children, especially over prolonged periods of time and could impede a child’s growth and/or development.
Everyone, adults and children, should consult with your doctor before starting an Elimination diet, as well as while you are on the ED.
If you would like to read more about my personal experience with the Elimination diet you can read my book, Living with IBD & IBS: A Personal Journey of Success - www.ibdandibs.com
Elizabeth wrote for HealthCentral as a patient expert for Digestive Health.