Elimination Diets: What You Need to Know

Whether it’s your best friend or a few people you overheard chatting at your cycling class last week, you’re bound to know or have known someone who has tried an elimination diet. While people turn to elimination diets often as a way to find relief from unfavorable gastrointestinal (GI) symptoms, it’s important to know the risks this diet style carries before trying it out for yourself.

Readers, take note: There are often more pieces to the puzzle of gut health than what’s on your plate!

What Is an Elimination Diet?

An elimination diet is a meal plan that purposely removes a food or ingredient suspected of causing unfavorable side effects (such as bloating, diarrhea, constipation, gas, and others) for a particular individual. The food is typically removed for a period of time, usually two to four weeks, to monitor symptoms.

When done under medical supervision, an elimination diet is similar to a research experiment, conducted under strict conditions to ensure outside variables are kept to a minimum. For instance, if an elimination diet is being used alongside a blood and skin prick test to rule out food allergies, you would not want to eliminate both peanuts and tree nuts at the same time.

Oftentimes some of the foods are reintroduced briefly at the end of the diet to see if the symptoms return. If they do, that’s an indication they should be avoided or limited depending on the individual’s particular case.

Why Have Elimination Diets Become Mainstream?

Like it or not, we live in a diet-obsessed culture that has become smitten with all types of diets, including elimination diets. According to the 2015-2018 National Health and Nutrition Examination Survey (NHANES), 17.1% of Americans over the age of 20 were on a special diet on any given day.

Whether it’s an Instagram influencer who touted her success from removing dairy from her diet and dropped 10 pounds or the middle-aged woman on Facebook who healed her gastrointestinal issues by eliminating bananas, there’s bound to be a social outlet where you are subconsciously receiving messages about the benefits of self-prescribed and implemented elimination diets.

In an effort to find relief from mild to severe gut symptoms, people often turn to such diets to gain a sense of control over a situation that feels like it has become out of control. While most can certainly relate to wanting to help your body feel it’s best, this is unfortunately not always the case when it comes to implementing an elimination diet without the proper medical oversight.

Before you decide to jump on an elimination diet bandwagon, it’s important to understand just why these diets have become so popularized in the media.

“For those troubled with digestive distress, it is common to believe that what you are eating is triggering the discomfort. The truth is, diet may contribute to digestive distress, but there are many other non-diet triggers of gut symptoms,” says Kate Scarlata, MPH, RDN, digestive health expert. “For example, stress can incite gut symptoms, too. Because the gut and brain are highly linked and communicate with each other, feeling anxious may increase intestinal motility, resulting in a quick trip to the loo. Feeling angry? You may experience sensations of bloating and belly fullness.”

Alissa Rumsey, MS, RD, the owner of Alissa Rumsey Nutrition and Wellness and the author of Unapologetic Eating, echoes Scarlata. “I’ve had a lot of clients who have had health professionals tell them to try an elimination diet without doing much else to investigate what may have been causing their gastrointestinal issues. While some people have success using these diets to identify food intolerances, if the doctor doesn’t screen the person for disordered eating (which I find doesn’t happen most of the time), cutting out all these foods can mask or exacerbate underlying eating problems. Often the symptoms can be reduced or eliminated through minimizing restriction, eating more consistently and reducing stress and anxiety.”

Risks of Self-Prescribed/Implemented Elimination Diets

Given the gut-brain relationship that scientists are continuing to uncover through research, it’s important to note that one’s emotions significantly impact GI health and that the symptoms you may be experiencing are not necessarily just related to what’s on your plate. Before you dive headfirst into an elimination diet without proper medical oversight, understand that you may be setting yourself up for a rollercoaster ride that doesn’t end with identifying your true cause of symptoms, but rather masking what else is going on.

“Elimination diets should never be the default response to digestive symptoms. Strict elimination diets often make people more anxious and stressed around food. This can make digestive symptoms worse, triggering gas, stomach pain, bloating, and/or diarrhea,” Rumsey warns. “If you have any history of dieting or restricting, then eliminating foods could actually cause symptoms to worsen in the long run. Many GI symptoms are often a result of food restriction (including waiting too long to eat), stress and anxiety, and/or a diet that includes too many high-fiber, raw, “clean” foods.”

Rumsey and Scarlata note that physicians rarely screen for eating disorders or disordered eating in a healthcare setting prior to recommending an alternative treatment like an elimination diet, which may actually make a disorder worse and can potentially lead to nutrient deficiencies.

“While food may cause some people digestive issues, we have to consider the fact that 98% of people with eating disorders also have concurrent GI issues,” Rumsey says. “Disordered eating is way more common than most people realize — a survey done back in 2008 found 3 out of 4 women have some form of disordered eating. Jumping into an elimination diet without proper screening for eating disorders or disordered eating can be really dangerous. Eliminating food groups can worsen both disordered eating and gastrointestinal symptoms.”

Who Should Consider an Elimination Diet

While elimination diets aren’t typically warranted for the average individual experiencing GI discomfort, that is certainly not the case when prescribed and guided by a trained medical professional who can help ensure a person’s nutrient needs are met through foods they can tolerate safely.

“Using elimination diets for digestive complaints has become more commonplace in the healthcare setting because we have scientific research that shows elimination diets can work,” Scarlata says. “When utilized in the right person with the right diagnosis, these diets can improve debilitating gut symptoms, improve quality of life and in some cases, heal the gut.”

There are several situations where this sort of dietary change is a no-brainer, according to Scarlata.

“Eating a gluten-free diet with a new diagnosis of celiac disease is a must. A gluten-free diet is the only treatment for this immune-related condition. In general, elimination diets might be considered in individuals that do not have a history of disordered eating and present with gut inflammation and/or severe food-related symptoms. In my experience working as a digestive health dietitian, I have seen first-hand the health benefits of a low-FODMAP diet. Diet change can truly be life-changing for many living with irritable bowel syndrome.”

While it’s not unheard of for someone who also has a history of disordered eating to seek treatment for a true GI condition, Scarlata notes that a less restrictive diet approach is necessary. Working with a trained dietitian on implementing lifestyle changes can help alleviate some of the GI symptoms patients are experiencing. In some cases, mindfulness tactics like breathwork, meditation and mindful movement can make a bigger impact than the food alone.

What You Need to Know

Before embarking on an elimination diet for yourself, consider your work-life (and gut-brain) relationship. Evaluate if there are stress reduction measures you can consider implementing into your daily schedule to help lower anxiety and improve your mood. And, as always, speak with your healthcare team to help discuss other options and treatments that may be best for you individually.