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Elimination Diet

Symptoms and conditions that have failed to respond to conventional medical therapy may resolve when a person follows the IFM Elimination Diet. Specific foods or foods eaten frequently may be related to a long list of health conditions, including digestive problems, headaches, chronic sinus drainage, low energy, depression, mood swings, eczema, skin irritations, joint aches, asthma, weight gain, and others. People may suffer from these symptoms for long periods of time without realizing that they can be connected to the foods they are eating. Often it isn’t until a food is removed that the connection between symptoms and foods can be made.The Elimination Diet removes common foods that may be causing symptoms and, with reintroduction, helps patients identify the foods that may be triggering their symptoms.

Often, symptoms that have failed to respond to conventional medical therapy will resolve by following the Elimination Diet. After the initial period of eliminating foods, many chronic symptoms should improve or disappear. When the burden on the immune system is decreased, the body has an opportunity to heal. During the elimination period, it is important to make sure that the diet is still enjoyable and nutrient-dense.The road to optimum health starts with decreasing the burden on the immune system while ensuring adequate nutrition.

After completion of the three-week Elimination Diet, patients will undergo a food reintroduction process.The goal is to expand the variety of healthy foods available to an individual for daily intake. Reintroduction involves adding back one food at a time and observing whether that food is associated with negative symptoms. Foods that continue to provoke symptoms (physical, mental, and emotional) are avoided for an additional three to six months, at which time reintroduction is attempted again. Once the gut is healed, many foods that initially caused sensitivities may

be reintroduced into a meal plan without symptoms. Healing the gut, and being able to successfully reintroduce foods is important, as eating the same few foods day after day does not provide the body with the full array of phytonutrients necessary for overall health. A diet with a large diversity of foods helps ensure that the body gets essential nutrients and is especially important for those who have digestive issues.

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Starting Elimination Diet

Stop eating any foods that produce a clear negative reaction or if lab testing shows any foods showing inflammatory response or immune mediated reactions. 

Potential reactions include diarrhea or constipation, fatigue, depression, anxiety, gas, bloating, abdominal pain, headache, muscle or joint pain, skin irritations or break outs, insomnia, sinus congestion or runny nose, itching, or flushing.

Most common culprit foods are dairy, gluten, eggs, corn and soy. 

Examples of dairy products and grains that are avoided on the Elimination Diet are shown in the table below. Note that all products containing these foods as ingredients are also excluded from the plan.


*Oats, even those that are labeled as gluten-free, are often processed in the same facility

as gluten-containing grains and can become contaminated with gluten during processing. Additionally, even certified gluten-free oats that are never exposed to gluten can cause symptoms in some patients with celiac disease and gluten intolerance, as the protein structure found in oats is similar to that of gliadin. For this reason, patients should follow their practitioner’s advice when reintroducing oats back into their diets.

Food Substitutions

The following is a list of substitutions for foods that are avoided while on the Elimination Diet.


Types and Amounts of Foods to Re-Introduce


*It is not uncommon to react to only one type of shellfish, such as shrimp, but not others, so it is wise to challenge each separately.

Reintroducing Foods Associated with Symptoms

Remove from the diet foods that provoke symptoms for 3 three to six months.

Then slowly reintroduce challenging foods. 

Introduce only one food at a time  for one day, followed by a 24-hour observation period. If no reactions occur, proceed to the next food in that group. If symptoms occur, wait until all symptoms clear, then test the next food in that group. 

Consult with a healthcare practitioner if there are questions when reintroducing foods.

IMPORTANT: When there are symptoms after challenging a food, it is advisable to stop eating that food immediately and allow symptoms to completely clear before introducing the next food.The “problem” food can be tested again after testing the rest of the challenge foods.

High histamine, nightshades and fermented foods are to be avoided initially in the Elimination phase


Frequently Asked Questions

What do I eat in place of bread?

Rice cakes and tortillas made from rice or hemp can be an acceptable substitute for a sandwich. It might also be a good idea to eat less grain carbohydrates during this three-week period. Use a large lettuce leaf as a substitute “wrap” for vegetables or meats.

Can salt be used on this diet?

Taste food before sprinkling salt and use it sparingly. Look for salt-free seasonings if salt restriction is the goal, and choose sea salt over refined, iodized salt. Local health food stores offer a variety of these products.

What additional spices or flavorings can be used?

All spices and herbs are encouraged as they not only enhance the natural flavors of food but contain powerful phytonutrients with antioxidant and anticancer properties. Experiment with herbs and spices—try some new ones. Fresh herbs should be added near the end of cooking, while dried herbs should be added near the start of cooking.

Which condiments should be used?

All types of vinegar are allowed (balsamic, ume plum, unflavored rice, apple cider, herb-infused) and help enhance the flavor of vegetables.The following condiments contain added sugars or other ingredients that are not used on this program, so must be avoided: chocolate, ketchup, relish, chutney, soy sauce, tamari, barbecue sauce, teriyaki, and sweet and sour pickles. Please check all labels on any prepared food if there is uncertainty about acceptability.

Legumes usually cause gas and bloating. What can be done?

Legumes are desirable because they are high in protein, fiber, vitamins, and minerals.Try to increase intake slowly over the course of one to three weeks. Soaking beans for 30 minutes up to 6 hours (or overnight) before cooking and then discarding the water may also cut down on some of the gas that many people experience. Rinsing canned legumes is helpful for removing carbohydrates that cause gas. Certain legumes may produce more of a response than others. Lentils and green peas, for instance, are easier for some people to tolerate. If there is difficulty in digesting these foods, there is the possibility of being sensitive to them. A Functional Medicine practitioner can help patients determine whether a food sensitivity is present.

Can canned vegetables be used instead of fresh vegetables with this diet?

Fresh and frozen vegetables are preferable because they retain more of their vitamins and generally have less added salt. Canned legumes (chick peas, black beans, kidney beans, etc.) and tomatoes are generally acceptable, but rinse the legumes well before using. Be sure to buy only BPA-free cans.

What can be used in place of butter on vegetables and potatoes?

Ghee (clarified butter) can be used in place of regular butter. Also, extra-virgin, cold-pressed olive oil and organic virgin coconut oil have distinctive flavors that work well with vegetables.

What do I do if I am uncertain whether a food reaction has occurred?

If there is uncertainty as to whether a food reaction was experienced, it is best to challenge that food again. Be sure that there are no unusual circumstances on a challenge day. For example, if you are having any symptoms, such as a headache, it is best to delay the reintroduction of the food. Be sure that enough of the food is eaten to get a good challenge. If no reaction happens the second time, then that food is more than likely not a trigger food.

If all trigger foods are avoided for 3 months, how does one know when it is fine to eat them again?

After three months, try to challenge the foods again. If there is a reaction, try again after another three to six months. Other reactions may be “fixed” – no matter how long one avoids that food, the reactions will still occur.These are most likely to be the true food allergies.

If a food is re-challenged and found to be acceptable, how often may it be eaten?

The answer is different for everyone. Even if you have no reaction on re-challenging, it may be worthwhile to wait at least four days before trying it again. It is probably best to eat the food only a couple of times a week. If a minor

reaction is experienced, wait a week between each time you eat it.This is not an exact science, so judgment and body awareness must be utilized.

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