The Elimination Diet for Food Intolerance

food intolerance
Which food makes you sick?. Lendon Flanagan/Getty Images

If you have nagging symptoms that you suspect may be related to the food you are eating, you're not alone. About 16% of Americans report they are sensitive to some type of food. That is, they have a food sensitivity or food intolerance, but aren’t sure which food ails them.

It’s a confusing situation to be in, as a food intolerance or sensitivity can be difficult to pinpoint, especially when you consider all the different foods you eat everyday and the host of ingredients they contain.

Enter the elimination diet.

What is it?

An elimination diet is designed to help individuals feel better by identifying the foods that are causing disruptive symptoms. In other words, it’s a diet designed to figure out what food ails you.

Sometimes referred to as a “cleanse” or “detox diet,” the elimination diet was initially used in medical practice in the 1920’s.

Because food carries a host of ingredients that must be processed through the digestive tract, it makes sense that food, which may be poorly tolerated, can cause anything from inflammation to intolerance and even chronic disease.

In fact, an intolerance to one food can cause a host of symptoms, including abdominal pain, anxiety, asthma, bloating, constipation, chronic congestion, coughing, diarrhea, eczema, gas, hives, irritable bowel syndrome, joint or muscle pain, vomiting, wheezing and more.

Because there is no one test that can determine which of the many different foods an individual eats is causing symptoms, the elimination diet has emerged as a way to track down the food culprit.

Who should use it?

Individuals who are experiencing symptoms that suspect they are related to food may consider an elimination diet. This is not for people with traditional (IgE-based) food allergies or food allergy symptoms—they should be working with healthcare professionals, including an allergist and a registered dietitian on a routine basis.

A true food allergy requires total elimination of the food allergen from the diet.

The elimination diet is for individuals who have adverse symptoms, suspect they are due to one or more foods and are looking for a step-by-step approach to identifying those foods.

The elimination diet can be self-managed by adults with guidance from a healthcare professional or a book, such as The Elimination Diet Workbook by Maggie Moon. For pregnant or nursing moms, infants and children, professional guidance by a medical doctor and healthcare team should be sought to guide the diet.

How does it work?

If you need help pinpointing the foods causing symptoms, you will use a diagnostic elimination diet, which is a short term diet aimed at finding the cause of your symptoms. The elimination diet can also be used therapeutically, or for the long term, to keep symptom-causing foods out of the diet, once they are identified. This diet should be assessed for nutritional adequacy by a nutrition professional.

According to the Guidelines for the Diagnosis and Management of Food Allergy in the United States: Summary of the NIAID-Sponsored Expert Panel Report, elimination diets can identify foods causing an allergy and can help confirm or positively identify a food allergy when usual lab tests are inconclusive.

The elimination diet can also be used to diagnose specific disorders related to food such as food-protein-induced-enterocolitis syndrome (FPIES), food-protein-induced-allergic proctocolitis, allergic contact dermatitis, systemic contact dermatitis, and eosinophilic esophagitis (EoE).

Once trigger foods are identified by the elimination diet and removed, an individual’s symptoms should disappear or be significantly improved. This is a big relief for many and the main benefit of the elimination diet. Other benefits include eating healthier, possible weight loss, or a retrained palate (ie, less preference for sweets or salty foods).

How is it implemented?

The elimination diet includes 5 general phases: assess, plan, avoid, challenge, and change.

Assess: keep a food and symptom record

Plan: prepare you, your house, your kitchen and your grocery lists for the elimination diet

Avoid: follow a diet that eliminates targeted food, or a diet that eliminates the most common food allergens and foods causing intolerance

Challenge: reintroduction of food, one food at a time, noting symptoms

Change: a new way of eating without the foods that cause symptoms; this is a diet for the long term

If you think an elimination diet would help you, contact your healthcare professional and discuss your options for pursuing it.


Moon, M. The Elimination Diet Workbook. Ulysses Press 2014.

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