Elimination diet

The Elimination diet is a diagnostic method for determining food intolerance when allergological tests have not provided sufficient information. In the elimination diet, food is left out on a daily basis according to a fixed scheme and then added back to the menu in order to be able to trace back reactions of the body to its consumption.

What is the Elimination Diet?

Allergological tests do not always provide enough information about a food intolerance to one or more foods. A more certain diagnosis, however, is possible with the elimination diet. It is divided into two phases, the elimination and the provocation phase.

During the elimination process, potentially incompatible foods are all removed from the menu. Only some permitted foods may be eaten. In this way, the elimination diet ensures that the patient does not react to food that may still be in the digestive tract. Instead, he only eats foods that he can definitely tolerate, as there are no known intolerances to them. During the elimination phase, a lot of weight can be lost due to the loss of water. This already indicates that there is an intolerance.

As soon as the provocation phase is initiated after a few days, it can become apparent what the patient is intolerant of. During this phase of the elimination diet, one potentially intolerable food is consumed every day. It is important that the consumption takes place in the early morning so that the body has a full day to react. The patient documents his symptoms and observations over the next few days. With the help of this documentation, the doctor can determine after the provocation phase whether there is any intolerance to one of the foods tested. The elimination diet takes about a month through these two phases.

Function, effect & goals

An elimination diet is used to diagnose intolerance to a number of foods. It is used when other methods have not provided sufficient information. The patient can do it himself, but the elimination diet is only really meaningful if it has taken place under observation by the doctor.

An elimination diet can determine intolerance to a total of 20 different substances. It can of course be expanded to include additional foods at any time. The elimination diet typically tests for intolerance to alcohol, coffee, tea, cow's milk, soy products, wheat (gluten), citrus fruits, eggs or rice, among other things. If the patient reacts with symptoms on the day of the elimination diet that they ate one of these foods, then it can be said quite clearly that this is a reaction from their body to that very food.

During both phases of the elimination diet, he receives a symptom questionnaire from the doctor, on which the typical signs and complaints due to intolerance are noted. The patient can then indicate on a scale from 1 to 10 to what extent they perceived a symptom if it should have occurred. The doctor can then evaluate the questionnaire and know what the patient has reacted to and whether there are any connections. The elimination diet can therefore provide a reliable diagnosis on the one hand, but it can also provide information for further examinations, for example in order to identify cross-allergies or to reveal several parallel intolerances at the same time.

Following the elimination diet, these results are used for advice from a dietician or nutrition specialist, as the person affected must react naturally to the diagnosis and change their diet.

Risks, side effects & dangers

An elimination diet is a relatively low-risk method of determining intolerance or allergies to certain foods. There is a risk that the patient does not follow the elimination diet conscientiously, misinterprets their symptoms, or does not adequately document them.

At best, the symptom questionnaire is carried out at all times so that a note can be made immediately if a symptom occurs. If this is forgotten, the doctor then works with falsified results. It is also important in an elimination diet that the foods to be tested are eaten early in the morning. The only exception to this is the alcohol test, which is usually followed on the last day of the elimination diet. This can of course be drunk in the evening. However, if the other foods are consumed too late in the day, the patient may be asleep when symptoms occur, or they may not appear until the next day, when the next food is tested. This would also falsify the results.

If this happens, you should, at best, consult your doctor immediately. This delays the elimination diet by a day and the food eaten too late from the previous day is tested again. A rare danger of the elimination diet is allergies to the tested foods. Every allergy, no matter how slight, poses a certain risk. It can happen at any time that the person's body reacts unusually violently to contact with the allergen. That may end in shock.

Most of the time, allergic reactions to a food are recognized during an allergy test, so that they are no longer included in the elimination diet. However, if symptoms such as severe redness and itching of the skin, shortness of breath, increased heartbeat, and feelings of anxiety occur, the patient should go to the emergency room immediately and indicate that they are on an elimination diet.