Overview of the Elimination and Challenge Diet

An elimination and challenge diet is an effective way to determine a food sensitivity. Some possible symptoms that can occur on a food challenge include the following:

  • Headache (may be brief or prolonged)
  • Nausea, stomachache, sharp abdominal pain
  • Sore throat, stuffy nose, runny nose, itchy nose or eyes
  • Skin rash or itching, facial flushing, red ears
  • Sleepiness, insomnia, fatigue, apathy
  • Irritability, depression, anxiety
  • Excitability (feeling hyper or "buzzed")
  • Aching or twitching muscles

Symptoms associated with food challenges may not be the same symptoms experienced before the elimination process. For example, before the elimination and challenge diet began, a patient's symptom was chronic sinus pain, but a stomachache occurred during the challenge. This does not mean that the food group being challenged was not causing the sinus pain. It is just that the body and immune system react differently when the offending agent is removed and then reintroduced.

Option 1

For 2 to 6 weeks, eliminate all suspect foods and focus diet on fresh fruits, vegetables, potatoes, yams, animal protein (fish, poultry, lamb), and nonglutenous grains (rice, buckwheat). Eat organic foods whenever possible.

After 2 to 6 weeks of maintaining a strict elimination diet, there should be relief from symptoms. Weight may also be lost. Now begin the challenge. Start with the food group that is least problematic. Challenge a specific food group for one day only. Eat several servings of that food group throughout the day. Then do not eat that food again for at least 48 hours while continuing to eat only elimination diet foods. If symptoms do not return after 48 hours, go on to the next suspected food group. However, feel free to wait more than 48 hours. Waiting a week between food group challenges is optimal. This increases the accuracy of the diagnosis. Remember to challenge only one food group at a time.

Continue this process until the problematic food group is determined. In most cases, reactions occur within 48 hours. Rarely do symptoms appear several days or weeks later.

Option 2

Maintain a regular diet and eliminate only the food group that is believed to be causing the symptoms. Eliminate all items in that food group for at least 1 month. If the symptoms disappear before the end of the month, continue to abstain from that food group for another week before starting the challenge.

To do the challenge, eat several servings of the suspect food group during a 24-hour period. Then return to the elimination diet and do not eat the suspect food group for at least 48 hours. More often than not, immediate reactions occur if there is a sensitivity.

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

Published: 01 Jan 2001

Last Modified: 28 Sep 2015