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Elimination Diets for Food Sensitivities: How Strict Do I Have to Be?


“How strict do I have to be on the elimination diet?”

This is the most common question asked by people on an elimination diet for food sensitivity. The answer (unlike the diet and lifestyle change) is simple: very strict, because the greater the adherence to the diet, the better the health outcomes.

This effect, greater diet adherence = better health outcomes, can be seen across many different diets, including:

  • gluten free
  • dairy free
  • six food elimination diet
  • few foods diet
  • oligoantigenic diet
  • DASH diet
  • Mediterranean diet
  • carbohydrate-controlled diet
  • low glycemic index diet
  • low FODMAP diet
  • cardiometabolic diet
  • anti-inflammatory diet
  • ketogenic diet
  • calorie-restricted diet
  • lacto-ovo-vegetarian diet
  • vegan diet
  • Healthy Eating/Alternative Healthy Eating Index (a diet quality diet)

In general, when comparing these diets to their studied health outcomes, the ‘stricter’ the person adhered to the diet (highest adherence), the better their outcomes compared to the people who were the least strict (lowest adherence).

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Getting better results

Studies of diet adherence report that people with the best adherence (compared to people with the worst adherence) have better outcomes or lowered incidence and risk of many diseases and conditions, including:

  • diabetes and gestational diabetes
  • ear infection
  • eosinophilic esophagitis
  • epilepsy
  • cancer risk
  • cardiovascular disease risk
  • heart attack (first, recurrent, and/or fatal heart attack)
  • hyperlipidemia
  • hypertension
  • infant birth weight
  • migraine
  • neurogenerative disease risk
  • rheumatoid arthritis
  • reflux
  • urinary tract infections

That said, it can be hard to follow an elimination diet (or any restricted diet) for a number of reasons. Elimination diets vary in terms of duration and intensity.

Diet ‘adherence’ often decreases as the elimination diet eliminates more foods and becomes more restrictive, or the longer the duration of the elimination phase.

Why do some people fail?

Barriers to diet adherence include:

  • poor understanding of diet
  • lack of diet education
  • lack of access to allowed foods such as gluten, dairy, and/or egg substitutes etc.
  • higher cost of food substitutes
  • palatability of food substitutes
  • challenges in complying with elimination diet while accommodating needs/preferences of other family members and caregivers
  • resisting temptation to eat eliminated foods
  • social, psychological, and cognitive restraints

However, people who need an elimination diet should reconsider the question, “How strict do I have to be?”

Rather, the question should be reframed to “How committed to my health am I, and how well do I want to be?”

Lastly, to make it easier to adhere to a elimination diet (or any other type of therapeutic diet), seek help!

If you have a problem with your electricity you seek an electrician. Car problem? A mechanic. Taxes? An accountant. Legal problem? An attorney. Food? Same. Seek a qualified registered dietitian, nutritionist, or health coach to provide expert guidance for the best outcomes!

For more information about food sensitivity testing available through Vibrant Wellness, explore our cutting-edge Food Zoomers. They detect true food sensitivities at the peptide level, eliminating common problems found in other food sensitivity testing methods.