This traditional naturopathic procedure has been accurately diagnosing food-related symptoms for many years and continues to be the standard for identifying food sensitivities.

There are 2 ways to approach an elimination/challenge. The first and more difficult but more effective route is outlined as option #1 below. It involves eliminating all the major suspects that usually cause problems and then slowly, over time, adding them back into the diet one-by-one. It provides clear insight into the impact of foods.

The second option is reserved for those who already have a good idea about what foods are problematic for them. The suspected food group is eliminated until symptoms clear and then added back into the diet to determine if symptoms return.

Symptoms associated with food challenges may not be the same as those experienced before the elimination process. For example, patients who experienced chronic sinus pain prior to embarking on the elimination/challenge may find that upon challenging the suspect food causes stomach pain. This doesn't mean the food group being challenged does not cause sinus pain, rather that the body may react a bit differently when re-introduced to the offending agent.

Symptoms that can occur on a food challenge include: headache (may be brief or prolonged), nausea, sleepiness, irritability, depression, anxiety, excitability, stomach ache, sharp abdominal pain, sore throat, stuffy nose, runny nose, itchy nose or eyes, tightness in the chest, skin rash or itching, facial flushing, red ears, muscle twitching, insomnia, and fatigue. There are as many ways of manifesting sensitivities as there are people who suffer from them.

Elimination/challenge is the most effective way to determine food intolerance. It also provides an excellent opportunity to explore and understand your relationship with food.

Option #1

Option #1 involves an elimination that lasts from 2 to 6 weeks, followed by a challenge. The elimination involves managing your diet based on the following criteria.

Eliminate all suspect foods:

  • wheat products (e.g., pasta, bread, processed foods)
  • dairy products (e.g., milk, cheese, yogurt, cream)
  • corn products (e.g., tortillas, chips, polenta, cornstarch)
  • peanuts (peanut butter, peanut oil)
  • soy products (e.g., tofu, tempeh, soy milk, soy protein powder, soy oil)
  • glutinous grains (e.g., rye, barley, oats, spelt, kamut, seitan, hops)
  • beef
  • chocolate
  • sugar
  • nutrasweet/aspartame (artificial sweeteners)
  • food colorings/dyes
  • pesticides and chemical spoilage retardants (especially sulfites)

Maintain a diet based on:

  • fresh fruits and vegetables
  • potatoes
  • yams
  • animal protein (fish, poultry, lamb)
  • non-glutinous grains (millet, buckwheat, rice, amaranth)

If you have a choice, always choose organic foods. Otherwise, you could be ingesting pesticides, herbicides, fungicides, and/or formaldehydes.

Avoid sulfite-containing foods, which most include canned vegetables and fruits, wine, and canned tuna (albacore).

Read labels. Know that "vegetable protein" is either wheat or soy; thickening agents and stabilizers are either wheat or corn; and food starch is usually wheat or corn. It is much easier to avoid processed food while on the diet than to figure out all the additives in prepared foods.

After 2 to 6 weeks of maintaining a strict elimination diet, you should experience a relief from symptoms.


Begin your challenge with the food group you feel is the least likely culprit. Eat several servings from that food group throughout the day. For example, if you are challenging dairy, have milk with breakfast; include cheese, cream and yogurt in your lunch and dinner menus; drink milk at meals; and snack on dairy items. Then wait. DO NOT continue to add that food group to your diet. You only challenge for one day, then wait for at least 48 hours. Return to eating ONLY your elimination diet foods. If you do not experience a return of symptoms after 48 hours, go on to the next suspected food group.

Continue this process until you find the problematic food group. In most cases you will experience a return of symptoms within 48 hours. Rarely do symptoms appear several days or weeks later. If, however, you want to wait more than 48 hours, feel free to do so as this will only increase the accuracy of this test. A week between food group challenges is optimal. Only challenge one food group at a time.

Option #2

Maintain your regular diet, eliminating only the food group that you believe to be causing your symptoms. Eliminate ALL items in that food group for at least 1 month. If your symptoms disappear during this time, continue to abstain from that food group for 1 more week after symptom relief. If, for example, you find yourself symptom-free after just a few days of avoidance, you must still continue to avoid that food group for another week before you can effectively challenge.

When you challenge, follow the guidelines stated above: eat several servings of the suspect food group during a 24-hour period, then return to the elimination diet and wait. More often than not you will get immediate information about how your body is interacting with a problem food group.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Dec 2001

Last Modified: 18 Sep 2015