Elimination Diet

Medically Reviewed by Jabeen Begum, MD on November 29, 2023
6 min read

An elimination diet is a meal plan that avoids or removes certain foods or ingredients so you can find out what you might be sensitive to or allergic to. 

It isn’t about weight loss. You aren’t out to cut extra calories or drop some extra pounds. 

The most common reason for an elimination diet is because you and your doctor think certain foods may be the reason for your allergy symptoms. You’ll need to partner with your doctor on this and make sure that you still get all the nutrients you need.

Don’t do it if you have a serious food allergy or have had a severe allergic reaction called anaphylaxis. If you have, you need to know your trigger food as soon as possible so you can avoid it. Talk with your doctor about that. Blood and skin tests can identify some food allergies. You may need them before you can safely try an elimination diet on your own.

There are two parts to an elimination diet: 

  • The elimination (avoidance) phase
  • The reintroduction (challenge) phase

Elimination phase

The first step is to stop eating the suspicious foods. You’ll need to read food labels carefully and ask how foods are prepared at restaurants. Keep a food diary and write down everything you eat, and note how you feel after you eat them. 

Continue in this phase for at least 2 to 4 weeks. Wait for your symptoms to go away for at least 5 days before you move on to the next phase. Your doctor will watch you while you try this.

Foods to consider avoiding while on an elimination diet: 

  • Citrus
  • Milk
  • Eggs
  • Wheat and gluten, including rye, barley, and malt vinegar
  • Shellfish
  • Soy

Remember to consider food additives. Some are known to trigger allergy symptoms in some people: 

  • Things that end in -amine (histamine, tyramine, octopamine, and phenylethylamine)
  • Artificial food colors (tartrazine and dyes derived from coal tar)
  • Aspartame (artificial sweetener)
  • Butylated hydroxyanisole and butylated hydroxytoluene (preservatives)
  • Lactose and other disaccharides
  • Monosodium glutamate(flavor enhancer)
  • Nitrate and nitrites (preservatives)
  • Sulfites, benzoates, and sorbates (preservatives)
  • Tragacanth or agar-agar (thickeners or stabilizers) 

You may not need to avoid all these foods at the same time. If you suspect you feel bad after eating dairy products, you might just start with avoiding those. 

Make sure you eat other foods that provide the same nutrients as the food you need to avoid. For example, if you're supposed to eliminate dairy products temporarily, you'll want to look for foods that are fortified with calcium. (Soy can be a good source, but check to see if it's allowed on your plan.) A dietitian can help you make your shopping list.​​​​​​​

Reintroduction (challenge) phase

After you’ve eliminated possible food allergy triggers, you’ll slowly add those suspicious foods back, one at a time. Wait 3 days each time you add a new food to give your body time to react so you'll know if it's causing any allergy symptoms. 

Follow your doctor's advice, but it's a good idea to try a small amount of each food on the first day you bring it back. Gradually eat more each day for the remaining  2 days. In your food diary, note any symptoms that you get as you add each food back in. This process helps you know exactly which foods are a problem for you.

If you bring back a food and you have any of the following symptoms, get emergency medical help and stop the elimination diet until your doctor says it's safe to resume: 

The last step is to once again stop eating the problem foods, one at a time. The list should be smaller this time. The goal is to see if your symptoms clear up for good.

Keep in mind that you could be sensitive to a food but not allergic to it. Still, the elimination diet can help you know which foods you’re better off avoiding.

If your symptoms disappear after you stop eating a specific food or ingredient, your doctor should order blood or skin tests to confirm the food allergy diagnosis. Some, but not all, food allergies can be diagnosed this way. 

There are several types of elimination diets. Your doctor can design one that’s right for you. 

Some common types are: 

Simple (modified) diet. This basic elimination diet involves avoiding just one food or, sometimes, the two most common food allergy triggers: wheat (including gluten items) and dairy. Instead, eat gluten-free foods and brown rice, millet, buckwheat, or quinoa. 

Moderate intensity diet. You’ll avoid several groups of food all at once. On this diet, you stop eating or drinking:

  • Alcohol
  • All animal and vegetable fats
  • Certain fruits and veggies
  • Chocolate
  • Coffee, tea, and soft drinks
  • Dairy
  • Eggs
  • Legumes
  • Nuts
  • Wheat
  • Yeast products

Some fruits and vegetables have proteins that are very similar to those in certain pollens. So if you're allergic to pollen, a food with similar proteins could set off an allergic reaction in your mouth. It's called oral allergy syndrome.

For instance, people with a ragweed allergy might have symptoms when they eat melons or tomatoes. People with grass allergies may react to peaches or celery. In some people, drinking alcohol – especially beer or wine – can trigger nasal congestion.

Ask your doctor if any foods are likely to trigger your allergy symptoms and what foods you need to stay healthy. For example, instead of skipping animal protein entirely, you could try lamb or poultry, which don't often cause allergies.

Strict, few foods diet. This is the strictest type of elimination diet. You can only eat a selected group of foods. It isn’t a nutritious diet, so you don’t want to follow this plan for long. The only foods allowed on this level 3 strict elimination diet are: 

  • Apples or apple juice
  • Apricots
  • Asparagus 
  • Beets 
  • Cane or beet sugar 
  • Carrots 
  • Chicken 
  • Cranberries 
  • Honey 
  • Lamb 
  • Lettuce 
  • Olive oil 
  • Peaches 
  • Pears
  • Pineapple
  • Rice (including rice cakes and cereal)
  • Safflower oil
  • Salt
  • Sweet potatoes
  • White vinegar

No matter what type of elimination diet you choose, remember to drink lots of water to stay hydrated. 

An elimination diet can make you aware of your specific food allergens – the ingredients you’re sensitive to – and may help identify a specific food allergy. 

Elimination diets can help uncover the cause of symptoms such as persistently dry, itchy, skin (dermatitis) and stomach discomfort.

Knowing your food triggers and staying away from them is the safest way to manage a food intolerance or allergy. Carefully following an elimination diet with your doctor’s help can allow you to create a healthy and safe personal meal plan. 

Adding foods back to your diet might be risky if you are allergic to them. Sometimes, small amounts of a food might be OK but larger portions could cause problems. You might have a severe food allergy reaction. If you eat a type of food and get a rash, throat swelling, or breathing trouble soon after, seek medical help right away. 

Some foods may actually help with your allergies or related symptoms. Ask your doctor if you should try them and see. These include:

Warm fluids. Whether you're sipping tea or eating chicken soup, warm fluids help break up congestion in your airways, making it easier to cough up mucus.

Fish. Will a tuna sandwich stop your sneezing? Probably not. But some studies suggest that healthy omega-3 fatty acids – found in fish like tuna, salmon, and mackerel – could lower the risk of getting allergies. Other studies have disagreed.

Yogurt. Some research shows that healthy bacteria called probiotics – found in yogurt – may slightly reduce pollen allergy symptoms in kids. More research needs to be done.

Honey. Taking a teaspoon of honey is a common treatment for allergies. Does it really work? Studies haven't shown any benefit. But since it's low-risk, you could try it and see. Don't give honey to kids under 1 year old.