Elimination Diet

What Is It, Benefits, Foods to Include and Avoid, and More

Author:Lily Guo

Editors:Alyssa Haag,Józia McGowan, DO,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:Stacy Johnson, LMSW

What is an elimination diet?

An elimination diet aims to identify and eliminate potentially harmful foods while providing the body with adequate nutrition. An elimination diet involves temporarily removing certain foods from one’s diet to help identify any foods that may be causing adverse reactions or other health problems (e.g., digestive issues, skin problems). The individual may also document their daily dietary intake using a food journal as part of an elimination diet. This can help clinicians determine potential trigger foods and ensure that food restrictions do not contribute to nutrient deficiencies or inappropriate weight loss. 

Individual with abdominal pain.

How are foods reintroduced on an elimination diet?

Following an elimination diet for a certain amount of time, typically several weeks, foods are gradually reintroduced one at a time. This is done to carefully monitor any potential reactions to each food as it is added to the diet. Reintroducing food should be done carefully and under a healthcare provider's or qualified dietitian's guidance, as some individuals may have severe reactions to certain foods. Clinicians have suggested the rule of threes, where a food or food group is eliminated for three weeks, then reintroduced during all three meals of one day, consuming increasing quantities with each meal. The individual should wait three days before another food or food group is reintroduced. It is common for symptoms to worsen for a few days after reintroduction before they improve. It is important to note that foods that trigger an allergic reaction should not be reintroduced. 

Excited Mo character in scrubs
Join millions of students and clinicians who learn by Osmosis!
Start Your Free Trial

What conditions can benefit from an elimination diet?

An elimination diet may benefit individuals with certain health conditions or symptoms related to food sensitivities and intolerances (e.g., digestive issues, such as bloating, gas, and constipation; skin conditions, such as atopic dermatitis and acne). An elimination diet may also be helpful for individuals who have gastroesophageal reflux disease (GERD), migraines, or joint pain.  Sometimes, an elimination diet may be part of a broader treatment plan for conditions such as irritable bowel syndrome (IBS) or celiac disease. Those with eosinophilic esophagitis (EoE), an immune-mediated inflammatory condition resulting in esophageal dysfunction, can also benefit from an elimination diet. Further, nutrition impacts neurodevelopment, cognition, and behavior and could play an essential role in neurodevelopmental disorders such as attention deficit hyperactivity disorder (ADHD) and autism. The benefits of an elimination diet have been shown in treating these early-onset neurodevelopmental disorders. 

It is important to note that an elimination diet can exacerbate or activate eating disorders, such as anorexia or bulimia nervosa. Additionally, those prone to malnourishment or at high risk for nutritional deficiencies (i.e., the elderly or those with limited food resources) should be cautious in proceeding with an elimination diet and speak with a healthcare professional before starting an elimination diet. 

How does an elimination diet affect these conditions?

An elimination diet can improve symptoms of certain health conditions by removing potentially problematic types of foods from one’s diet. By eliminating these foods, the body may be able to heal and function more effectively, leading to a reduction in symptoms. For example, removing gluten from the diet can help improve digestive symptoms and damage to the intestines in individuals with celiac disease. Additionally, removing dairy can help reduce the severity of eczema in some individuals.

Individuals with autism spectrum disorder have an increased risk of immune system responses to casein and gluten, and ADHD is associated with a non-IgE-mediated reaction to food. It has been hypothesized that foods that induce high IgG levels (e.g., milk, egg, soy, shellfish) could worsen symptoms. In both cases, eliminating the foods that mediate these immune system responses can be beneficial. Nonetheless, the specific effects of an elimination diet will vary depending on the individual and their health condition.

What foods are best on an elimination diet?

The foods included in an elimination diet will depend on the individual and their health needs. An elimination diet should focus on whole, unprocessed foods free from common allergens and irritants. This may include fresh fruits and vegetables, lean proteins, whole grains, and healthy fats. Meats typically acceptable in a ‘low-intensity’ elimination diet (i.e., elimination of only one or a few key foods) include beef, chicken, lamb, pork, and turkey.  Grains and starches in a low-intensity elimination diet include barley, corn, oats, rice, sweet potatoes, and yams. Most fruits, vegetables, salt, spices, sweeteners, and vegetable proteins are allowed. As elimination diets increase in intensity, more foods are considered restricted. 

What foods should be avoided on an elimination diet?

It is essential to avoid processed foods and foods commonly known to cause reactions, such as gluten, dairy, soy, peanuts, corn, eggs, processed foods, and fried foods. Specifically, it has been suggested that dairy, eggs, soy, and wheat may exacerbate eczema in children, while pollen-related foods (e.g., fruit, nuts, vegetables) may worsen eczema in adults. GERD can be managed by decreasing the consumption of alcohol, chocolate, coffee, cow’s milk, saturated fat, orange juice, spicy foods, tea, tomato juice, and peppermint/spearmint. Individuals with eosinophilic esophagitis have been shown to benefit from a specific, six-food elimination diet that removes milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish. Those with irritable bowel syndrome may benefit from avoiding dairy, eggs, and wheat. Additionally, individuals suffering from migraines may benefit from eliminating foods with monosodium glutamate (MSG), histamine, tyramine, phenylethylamine, nitrites, and aspartame (e.g., soy sauce, processed and cured meats). Individuals with autism spectrum disorder have been shown to benefit from a gluten-free, casein-free diet (e.g., products containing wheat, oats, barley, or rye) and milk and dairy products. Those with ADHD may benefit from eliminating food additives, such as artificial food coloring, flavors, fragrances, preservatives, and sweeteners. Lastly, those with rheumatoid arthritis may avoid corn, dairy, and nightshade vegetables (e.g., bell peppers, eggplant, potatoes, and tomatoes). A healthcare provider or dietitian can help create elimination diet plans tailored to each individual. 

What are the most important facts to know about an elimination diet?

An elimination diet involves temporarily removing certain foods from one's diet to identify foods that may be causing adverse reactions or other health problems. An elimination diet aims to identify and eliminate harmful foods while providing the body with adequate nutrition. An elimination diet may benefit people with a food allergy, food intolerance, eczema, celiac disease, or irritable bowel syndrome, among other conditions. The foods included in an elimination diet will vary depending on the individual and their health needs. In general, the diet focuses on whole, unprocessed foods. A clinician or qualified dietitian should carefully plan and monitor an elimination diet.

Quiz yourself on Elimination Diet

2 Questions available

Quiz now!

12 Flashcards available

Quiz now!

Watch related videos:

Mo with coat and stethoscope

Want to Join Osmosis?

Join millions of students and clinicians who learn by Osmosis!

Start Your Free Trial

Related links

Atopic dermatitis
Gastroesophageal reflux disease (GERD)
Irritable bowel syndrome

Resources for research and reference

Baspinar B, Yardimci H. Gluten-free casein-free diet for autism spectrum disorders: can it be effective in solving behavioural and gastrointestinal problems? Eurasian J Med. 2020;52(3):292-297. doi:10.5152/eurasianjmed.2020.19230

Cucinotta U, Romano C, Dipasquale, V. Diet and nutrition in pediatric inflammatory bowel diseases. Nutrients. 2021;13(2):655. Published 2021 Feb 17. doi:10.3390/nu13020655

Gazerani, P. Migraine and diet. Nutrients. 2020;12(6):1658. Published 2020 Jun 3. doi:10.3390/nu12061658

Gonsalves NP, Aceves, SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1-7. doi:10.1016/j.jaci.2019.11.011

Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The role of diet and nutrition in migraine triggers and treatment: a systematic literature review. Headache. 2020;60(7):1300-1316. doi:10.1111/head.13836

Katta R, Kramer MJ. Skin and diet: an update on the role of dietary change as a treatment strategy for skin disease. Skin Therapy. 2018;23(1):1-5.

Ly V, Bottelier M, Hoekstra PJ, Arias-Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets' efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067-1079. doi:10.1007/s00787-017-0959-1

Millichap JG, Yee, MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. 2012;129(2):330-337. doi:10.1542/peds.2011-2199

Rakel D. Integrative Medicine E-Book. Saunders; 2012.

Zalewski A, Doerfler B, Krause A, Hirano I, Gonsalves N. Longterm outcomes of the six-food elimination diet and food reintroduction in a large cohort of adults with eosinophilic esophagitis. American Journal of Gastroenterology. 2022;117(12):1963-1970. doi:10.14309/ajg.0000000000001949