By Dr. Sheena Wu, ND

The elimination diet is a short-term diet with the purpose of identifying food sensitivities that may be contributing to negative symptoms or conditions.  It temporarily removes potentially sensitizing foods and reintroduces them back into the diet to observe any potential influence or effect it has.


What is food sensitivity?

Although often used interchangeably, food sensitivity is not the same as food allergy.

Food allergies, mediated by the IgE antibodies, occur soon after being exposed to specific foods, with symptoms of allergic response ranging from hives to anaphylactic shock.  The elimination diet will not impact food allergies.

Food sensitivity is a “delayed hypersensitivity” that involves non-IgE immune-mediated reactions, where the reactions of food exposure occur from 2 hours to 3 days following ingestion of the specific food.

The signs and symptoms of food sensitivity can be relatively milder in comparison with food allergies, such as vague digestive symptoms of gas and bloating, diarrhea, constipation, abdominal pain, nausea, and more.  However, food sensitivities can also cause inflammation, which in turn can contribute to a wide array of symptoms and chronic health conditions, including autoimmune, mental health, fatigue, IBS, migraines/headaches and more.


What to expect in an elimination diet?

In general, the elimination diet is divided into two phases – the Elimination phase, and the Reintroduction phase.  These phases together will take around 6 weeks.

  • Elimination – Week 1-3 (can be up to 6 weeks)
    • Eliminate all known or suspected sensitizing foods
    • During this time, it can be expected that the chief complaint and/or associating signs and symptoms significantly improve if not resolved
  • Reintroduction – Week 4 (or more)
    • Gradually add back the eliminated foods into the diet, one food group at a time with sufficient amount and frequency; observe for any change, aggravation, or new onset of symptoms
    • Repeat the reintroduction for each of the eliminated foods – specific food sensitivities can be identified


Role of food sensitivity tests

Food sensitivity tests use blood samples to test for potential sensitivities against a specific list of foods.  Current studies did not show strong evidence that these tests accurately identify food intolerance on their own.  False positives can occur with foods consumed regularly, with no actual intolerance.

Food sensitivity tests can act as a guide by removing some of the guessing game with potentially intolerant foods.  An elimination diet guided by food sensitivity tests is most effective in providing an accurate and comprehensive list of sensitivities and intolerances.

However, these tests can be costly, with the price increases with the number of food groups tested.  It is not an absolute requirement for the identification of food sensitivities, and it will be the patient’s decision whether to take them

An important note – It is imperative to go through the test results with a practitioner to better understand their meaning and significance, regardless of whether to combine them with the elimination diet


Pros and Cons

  • Pros
    • There is no cost on the diet itself (without a food sensitivity test)
    • Other symptom improvements – food sensitivities can contribute to a wide range of symptoms, successful removal of food triggers can improve many symptoms at once (as long as they are caused/contributed to by the food) – many of the symptoms can be transient, going unnoticed until they are gone
    • Accuracy – Provides the most accurate information that encompasses all individual differences
    • Valuable information – With a better understanding of one’s own body, the patient can then make informed decisions in achieving their health goals
  • Cons
    • A lot of time and effort – it requires planning and commitment over the span of weeks, if not months, to adhere to a diet that can be very restrictive
    • It may only provide symptom relief – food sensitivities can sometimes be a symptom and not a cause, eg IBS can be triggered by certain foods and exhibit symptoms of sensitivity, the elimination diet will only provide symptom relief, but the cause/IBS will still need to be addressed – which is why it is important to work with a healthcare provider when undergoing with this diet
    • Can be very restrictive – depending on the food groups eliminated, there can be a tendency for weight loss or nutritional imbalance – Working with a Naturopathic Doctor can help ensure proper nutrition, discuss alternatives, and potential supplementation to ease the process

The elimination diet does not have to be overwhelming.  To learn more about elimination diets and how they can address your digestive symptoms and gut health, schedule an appointment with one of our Naturopathic Doctors.