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Elimination Diet: How To and Is It Right for You?

author image Maggie Moon, MS, RDN
Maggie Moon, MS, RDN, is a registered dietitian nutritionist based in Los Angeles, and author of "The MIND Diet" (Ulysses Press, 2016). She holds a Master of Science degree in Nutrition and Education from Columbia University. Connect with her at maggiemoon.com.

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Elimination Diet: How To and Is It Right for You?

Do you have a hunch that something in your diet is preventing you from feeling your best? It may be a sign that you have a food sensitivity, and a qualified health professional can help you know for sure. Not all food sensitivities are easy to test for, and that’s why clinicians may use an elimination diet as part of the diagnosis process. Lily Nichols, RDN, CDE, CLT, of PilatesNutritionist.com attests, “Elimination diets remain the gold standard in confirming food sensitivities.” Strange as it may sound, it’s important not to dwell on the “elimination” part of the process. Elimination diets should be about finding the foods that work best for your body.

Why Would You Try an Elimination Diet?
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If you’re experiencing consistent symptoms, including stomach upset, skin rashes or fatigue, an elimination diet might be right for you. By eliminating some foods for a short-term period, you can identify “trigger foods” that may be causing these side effects. More importantly for the long term, an elimination diet helps identify the foods that will nourish and delight without negative side effects. Elimination diets are unique to the individual, therefore there is no one “best” elimination diet. An elimination diet may not be right for you if you know you have a food allergy that causes anaphylaxis, in which case you should be working closely with your health care team, including a qualified dietitian, to manage your condition.

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What Is the Elimination Diet?
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Briefly, the elimination diet includes five steps: assess, plan, avoid, challenge and change. The assessment phase includes keeping and analyzing a food and symptom tracker. The plannning phase involves preparing yourself, your household and your kitchen for what you’re about to do. The avoidance phase is when you eliminate all of the trigger foods identified in the assessment phase. This is the phase when you are putting a lot of your preparation and planning into action. The challenge phase is when you start to reintroduce foods, one at a time, back in to your diet to determine whether they are safe for you. The change phase is when you incorporate changes to the way you will eat for the long term so that you can keep your symptoms at bay. Your diet during the change phase is the foundation for an ongoing maintenance diet.

Related: 16 Steps to Spring-Clean Your Kitchen

Step 1: Assess
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The process starts by keeping a food and symptom tracker. Two to four weeks should be long enough to capture both immediate and delayed reactions. Record everything that passes your lips and any symptoms that develop. This is your baseline data. It should be an accurate reflection of your current diet, so eat the way you normally would. Then it’s time to evaluate your food and symptom tracker, looking for patterns in the foods you eat and the types of symptoms that arise. What foods do you eat the most often? What foods are you eating before symptoms show up? Typical allergens include eggs, fish, milk, peanuts, shellfish, soy, tree nuts and wheat. Common food intolerances can include sulfites, MSG, nitrates, etc. Keep in mind that symptoms can show up within a few hours of eating (e.g., stomach cramps, diarrhea, hives), but some may be chronic (e.g., fatigue). Using this data, make a list of your potential symptom-triggering foods, aka “trigger” foods, which will be used in the next steps.

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Step 2: Prepare Yourself and Your Kitchen
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It’s important to go through all the preparation steps rather than jumping right into the elimination diet. You’re more likely to succeed if you have a plan and are ready to face the ups and downs of an elimination diet. An elimination diet is not easy, and you must prepare yourself mentally. For example, know that sometimes symptoms flare up and seem worse at the start of an elimination diet before they improve. Acknowledge that there will be difficult times, but that they will be temporary, and the end results will be worth it. You also need to physically prepare your kitchen. If it’s possible, clear out all the trigger foods in the house. If that’s not possible, at least keep trigger foods separated. For example, store the off-limits pantry items out of sight and create a separate space in the refrigerator and freezer for your elimination-diet foods.

Related: 16 Steps to Spring-Clean Your Kitchen

Step 2 (continued): Prepare Others
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Prepare members of your household, and assure every¬one that it is temporary. The changes to your diet will affect the people in your home, so talk to them about what you’re doing and why, and tell them how it will change the eating dynamics at home for a while. Talk about why you need to eat special meals that are different from everyone else’s, why you’ll have special foods in the pantry and refrigerator for the next few weeks or why you need to eat at home and not at restaurants for the time being. If you cook for your household, it may mean cooking two meals or having someone else cook for the rest of the household. At this stage, it can also be helpful to create meal plans and grocery lists of allowed foods.

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Step 3: Avoid Certain Foods
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This is the step that gives the elimination diet its name: It’s time to eliminate and track. Now that you are ready, work your way through your meal plans, and be sure to track what you eat and your symptoms. Note how often and how severe symptoms are. Track how you are feeling overall each day: tired, energized, achy and so on. If you are still having symptoms after two to four weeks, it’s time to look at your food and symptom tracker and eliminate more foods, starting with your most commonly eaten foods. Try this for one week. If your symptoms have improved, move to the next step; if not, repeat the process by cutting out more foods. If this still does not clear up your symptoms, you may want to consider the possibility that food is not behind your symptoms after all.

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Step 4: Challenge
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After the elimination period, it’s time for the challenge and track phase. It is important to keep up with your food and symptom tracker at this time because this is when you will get the best picture of what foods are causing your symptoms. It’s also important to add back one food at a time into your diet. For the food challenge, you will be eating a small amount of the potential trigger food in the morning and then monitoring for symptoms. If there are no symptoms, you will increase the amount you eat at lunch and again monitor for symptoms. If again there are no symptoms, you will increase the amount of the food even more at dinner. For the following three days, you will go back to the original elimination diet, monitoring for any delayed symptoms. If all is well, you can add this food to your “safe” list, but keep it out of your diet until all the food challenges are done. If symptoms did develop, go back to your baseline elimination diet until symptoms improve before testing the next food. Repeat until all your trigger foods have been tested.

Related: 12 Foods That Will Help You Fall (and Stay) Asleep

Step 5: Change
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Use your elimination diet as the foundation for your maintenance diet, adding the foods that you’ve newly discovered as “safe” and eliminating for the long term any foods you discovered contribute to your symptoms. Think about seeing a specialist (e.g., a gastroenterologist, allergist or registered dietitian specializing in food sensitivities) to confirm any food allergies or intolerances. A registered dietitian can also help ensure you are getting all the nutrients you need on your maintenance diet. Finally, you may wish to test trigger foods every once in a while. Some allergies and intolerances aren’t necessarily forever. It’s possible to reintroduce a trigger food back into the diet at some level after you’ve let the body heal. Consider repeating challenges every six months. Here are five delicious recipes to consider, depending on your trigger foods.

Related: 20 Foods to Always Buy Organic

RECIPE 1: Kale, Avocado and Hemp Seed Salad With Pickled Onions
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This recipe is incredibly flavorful and is a great example of the worlds of flavor that are possible outside of the major eight allergens (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soy). This is more proof that an elimination diet is not about eliminating foods, but is ultimately about finding the right foods for you. Think of it as an opportunity to enjoy great food. Recipe courtesy of Rachel Begun, M.S., RDN, special diets expert and certified natural chef. CALORIES: 530

Related: See Complete Recipe and Nutritional Info in LIVESTRONG.COM’s Calorie Tracker

RECIPE 2: Grilled Chicken With Basil-Garlic Pesto
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Grilled chicken is a snap and super healthy, and pesto is simple and delicious (plus, you can save leftovers in ice trays and use them for recipes later in the following days and weeks). According to the “Food Lover’s Companion,” a pesto is made with fresh basil, garlic, pine nuts, Parmesan or Pecorino cheese and olive oil. However, pesto can actually be made with any of a number of herbs, and we can adapt the classic ingredients to make it elimination-diet friendly. CALORIES: 409

Related: See Complete Recipe and Nutritional Info in LIVESTRONG.COM’s Calorie Tracker

RECIPE 3: Sweet and Savory Grain-Free Granola
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Once you’ve figured out what you can and can’t eat in order to feel your best, then it’s time to explore all the great-tasting and healthful foods that will work for you. If gluten, wheat or other grains are giving you trouble, try this healthy and hearty granola recipe, courtesy of Rachel Begun, M.S., RDN, special diets expert and certified natural chef. CALORIES: 388

Related: See Complete Recipe and Nutritional Info in LIVESTRONG.COM’s Calorie Tracker

RECIPE 4: Chopped Pork Loin With Wild Rice, Sweet Potato and Shredded Brussels Sprouts
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This dish is great any time of year, but its rich textures and deep flavors are perfect on a brisk day in fall. Wild rice is earthy and strong enough to stand up to the flavor of Brussels sprouts, and sweet potato has that satisfying mouthfeel and touch of sweetness that complements the pork. This recipe is from my book, “The Elimination Diet Workbook” (Ulysses Press, 2014). CALORIES: 556

Related: See Complete Recipe and Nutritional Info in LIVESTRONG.COM’s Calorie Tracker

RECIPE 5: Steamed Artichoke With Olive Oil and Lemon Dipping Sauce
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A steamed artichoke is a simple, beautiful thing. When fully cooked, some of the outer leaves may still be tough; simply discard them and go for the more tender outer leaves that have more “meat” on them. When you get to the inner leaves, some will be so tender you can eat them whole. Last but not least, remove the fuzzy choke to reveal the prized artichoke heart. This recipe is from my book, “The Elimination Diet Workbook” (Ulysses Press, 2014). CALORIES: 98

Related: See Complete Recipe and Nutritional Info in LIVESTRONG.COM’s Calorie Tracker

What Do You Think?
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Do you think you’d benefit from an elimination diet? What would be the most challenging part for you? Would you seek out a qualified health professional to coach you through the process? In addition to food allergies and sensitivities, there is something to be said for eliminating “junk” from the diet. Are you simply interested in resetting your palate and sharpening your senses to sugar, salt and processed foods through a few weeks of simple eating? Thinking about optimal health (versus food sensitivities), what kinds of foods would you be willing to cut out today?

Related: 10 Surprising Flat-Belly Foods

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