An elimination diet can be a useful tool in controlling unpleasant symptoms of gastrointestinal disorders, such as irritable bowel syndrome (IBS) and Gastroesophageal reflux disease (GERD). Often the symptoms can be intense, painful, and even confusing when you’re not sure what’s triggering you.
First of all, you should not embark on an elimination diet without consulting your doctor, who can refer you to a dietitian to guide you through the process. There is a risk of developing nutritional deficiencies with any major dietary change and it is important to ensure that you are following the diet effectively for best results. Many foods contain ingredients you might not necessarily expect, which could derail your elimination diet. Therefore, keeping a food diary and working with a dietitian can make this process easier.
What is an elimination diet?
There are several reasons why someone might try an elimination diet. If you’re experiencing troubling gastrointestinal symptoms, you may want to cut out certain foods to help pinpoint the cause of your problems.
Common elimination diets include low FODMAP diet, or the Six Food Elimination Diet, which usually take place over several weeks or months. The Journal of Gastroenterology and Hepatology (opens in a new tab)advises not to exceed six weeks in the elimination stage, especially for the low FODMAP (Oligo-, Di-, Mono-saccharides and Fermentable Polyols) diet, as you can negatively affect your gut microbiome.
“An elimination diet is a method of identifying foods to which a person is intolerant or sensitive,” says Rachel Clarkson, a Doctify (opens in a new tab)-revised dietitian and nutritionist, and founder of The DNA Dietitian (opens in a new tab). “A person can start an elimination diet to help identify problematic foods in their diet that are causing symptoms.
Rachel Clarkson, RD, MSc, PGDIP, BSc
Rachel Clarkson is an HCPC Registered Registered Dietitian and Specialty Nutritionist. She trained at King’s College London in the UK and completed further clinical training at Royal Marsden, St Thomas’s Hospital and Imperial College Trust. She recently published her epigenetic research from King’s College London in a peer-reviewed medical journal and continues her professional development with courses on topics such as the low FODMAP diet for the management of IBS.
“The duration of an elimination diet can vary depending on the type and number of foods eliminated and then reintroduced or challenged. One of the most widely used and scientifically supported elimination diets is the low FODMAP diet. This diet excludes foods containing compounds called FODMAPS that cause digestive symptoms in people with IBS.This elimination diet can take 10 to 16 weeks for the three phases: elimination, reintroduction, and customization.
Foods high in FODMAPs include certain vegetables like onions and garlic, certain fruits (especially stone fruits), beans, and lentils.
“Reviewing trigger foods or ingredients that may make symptoms worse will be helpful, so completing a food and symptom diary may be a smart approach,” adds Kim Plaza, nutritionist at Bio-Kult.
How to Follow an Elimination Diet
If you think you have a particular trigger food (like dairy or gluten), it’s worth cutting it out for a few weeks to see if your symptoms improve. However, if you are unsure what your trigger foods may be or if you have been diagnosed with a particular condition that could benefit from a broad-spectrum elimination diet, you should follow the steps below under the direction of a physician.
“This phase typically lasts 2 to 6 weeks during which all potentially problematic foods are eliminated from the diet,” Clarkson explains. “At the end of this phase, the symptoms should be completely gone.”
A Nutrients (opens in a new tab) Review review indicates that the low-FODMAP diet in particular significantly reduced bloating and pain in subjects. A clinical trial reported in the Journal of Allergy and Clinical Immunology (opens in a new tab) also found that an elimination diet achieved remission in 43% of study participants with eosinophilic esophagitis, regardless of age.
The reintroduction phase consists of systematically testing each group of foods eliminated.
“This phase can take between 4 and 8 weeks, depending on how many foods are being challenged,” Clarkson explains. “During this phase, individuals should continue to eliminate all problematic foods, adding the food that is being challenged to assess whether it is causing the problematic symptoms. Each potentially problematic food is tested individually and the quantity is gradually increased to understand if the person is intolerant to this food and in what quantity the symptoms begin to appear.
The final phase of an elimination diet is where the results of dietary challenges are reviewed and discussed, Clarkson explains.
“Additionally, other challenges may be prescribed in which more than one problematic food is introduced at the same time. Finally, the use of supplements, digestive enzymes or probiotics can be discussed. »
What can you eat on an elimination diet?
It is advisable to cook your meals with raw ingredients at this stage, so that you know exactly what you are consuming. Often processed foods contain flavorings, such as onion or garlic powder, which can trigger symptoms even in small amounts.
- Unprocessed meat and fish (no shellfish)
- rice foods
- Dairy-free fats, such as vegetable oils
- Low FODMAP fruits and vegetables
What can’t you eat on an elimination diet?
The most common food triggers are often the first to eliminate to test symptom response:
- Wheat and rye
- Nightshade vegetables (eg potatoes, tomatoes and peppers)
- Nuts and seeds
- Alliums (onions and garlic are high in FODMAPs and cause irritation in many people)
- Citrus fruits (these can be triggers for people with acid reflux and GERD)
Plaza also says heavily processed foods can be problematic. “Processed foods that contain lots of hidden sugars, sweeteners, additives and emulsifiers are likely to negatively impact bacteria living in the gut, leading to increased inflammation and worsening of IBS symptoms,” she says. . “Many people notice a rapid improvement in their digestion simply by cutting out processed foods and switching to whole, homemade foods instead.”
What are the benefits of an elimination diet?
According to Clarkson, identifying your trigger foods can help you make the best decisions for your body. “The main benefit of an elimination diet is being able to identify which foods are causing the symptoms and how much of those foods are causing the symptoms,” she says. “It’s a great benefit because it empowers you to make the best choices for your body and helps you understand your body on a deeper level.”
Are there any risks of an elimination diet?
On an elimination diet, you must ensure that you always receive the recommended daily amount of each nutrient, and as such, you must do so under the supervision of a professional.
“There can be risks in eliminating food groups for an extended period of time,” says Clarkson. “Working with a healthcare professional can ensure you are performing the elimination diet correctly and in the safest way.”
This article is for informational purposes only and is not intended to offer medical advice.