Elimination diets to identify food sensitivities have been shown to provide relief for a range of symptoms, health problems and chronic illnesses. This post details a step by step guide for how to reintroduce foods after elimination diet, including a food reintroduction chart and how to measure and document any reactions.
Disclaimer: This post is intended for informational purposes only. I’m not a qualified practitioner and I’m not encouraging anyone else to do an elimination diet. Elimination diets should only be performed under the supervision of a qualified medical practitioner. Please consult a qualified practitioner before considering and undertaking an elimination diet or making any changes to your current diet or treatment plan. This post contains affiliate links, meaning at no additional cost to you I earn commission if you click on a link and make a purchase. As an Amazon Associate, I earn from qualifying purchases. See my full disclaimer here.
Benefits of Elimination Diet For Food Sensitivities
Consuming foods you’re sensitive to can increase inflammation and contribute to numerous symptoms, such as digestive problems, headaches, dizziness and fatigue (1; 2). Elimination diets, where you eliminate all common food intolerances for a minimum of 28 days, is one of the best and most common ways to identify which foods you’re intolerant to (1; 2).
Removing all potential food allergens and inflammatory foods during Elimination Diet Phase 1 allows the immune system to calm down, inflammation to reduce and the body to heal, resulting in a reduction in symptoms and improvement in health. To then identify any foods you’re sensitive to, Elimination Diet Phase 2 involves food reintroduction, where the eliminated foods are reintroduced one at a time while making note of how you feel and any reactions that occur.
Related Post: Elimination Diet Phase 1 (Food List & Recipes)
Elimination Diet Phase 2
Similar to the elimination phase, there are many different approaches for how to reintroduce foods, which can make it overwhelming deciding which approach is best. Below is the method I used that worked well for me.
When do you start reintroducing foods?
Elimination Diet Phase 1 typically lasts at least 30 days. It’s recommended to start reintroducing foods when you’ve noticed a considerable improvement in your symptoms and health to allow you to easily notice any reactions when reintroducing foods (1; 2). The length of time will be unique to each individual. Using a journal is a great way of tracking progress and a medical practitioner can help advise on the best time to begin.
I know it can be tempting to want to continue with phase 1 when you feel considerably better. However, staying on phase 1 longer than necessary and continuing to avoid consuming such a number of food groups in the long term can lead to progress plateauing. It increases the risk of developing greater food intolerances and sensitivities, developing nutrient deficiencies or gut health declining due to the reduced diversity of foods consumed (1; 2).
FOODS I PERMANENTLY ELIMINATED
The following foods I didn’t attempt to reintroduce as they increase inflammation, stimulate the nervous system, which can worsen symptoms for those with autoimmune conditions like my dysautonomia and POTS symptoms, suppress the immune system and have been shown to have negative effects on health (1; 2):-
- Gluten
- Dairy
- Soy
- Refined sugar
- Alcohol
- Caffeine and chocolate
- Processed foods
- Vegetable oils
- Farmed fish and meat
Reintroducing foods after an elimination diet
For the remaining foods, I added one back in at a time, on average one every 7 days. It’s commonly recommended to eat a normal serving of each food on day one to see if you experience any reaction (1; 2). However I used and loved the approach by Will Bulsiewicz in his book Fiber Fuelled (UK Link/US Link) and The Alter Health Podcast, which is to see your gut like a muscle. You wouldn’t walk into a gym and initially try to squat 100kg, so they recommend starting with a small serving of each eliminated food and not trying to eat a typical serving straight away. For example, don’t initially try to eat half a tin of chickpeas or 80 grams/1 cup of tomatoes.
Therefore, the process I used was:-
DAY 1
I started with a very small amount, for example:-
- 1/2 tablespoon of seeds,
- 2 walnuts or,
- 10 grams/0.25 ounces of peas.
DAY 2
If I had no negative reactions after the first day, I increased the amount slightly:-
- 1 tablespoon of seeds,
- 4 walnuts or,
- 20 grams/0.5 ounces of peas.
DAY 3
If I still had no negative reactions after the second day, I increased the amount slightly again:-
- 1.5 tablespoons of seeds,
- 6 walnuts or,
- 30 grams/0.75 ounces of peas.
DAY 4-6
- I removed the food from my diet for the next 3 days and reverted back to consuming only the foods allowed during Phase 1 to see how I felt.
- If a certain food produced or worsened symptoms on day 1-3, then I eliminated that food from my diet again and once my symptoms had cleared up, tried reintroducing a different food.
DAY 7
If after 3 days of removing the food I still had no reaction, then on day 7 I tried adding a different food back into my diet, repeating the same process as above, for example:-
- 10 grams/0.25 ounces of sprouted buckwheat on the first day,
- 20 grams/0.5 ounces of sprouted buckwheat on the second day and,
- 30 grams/0.75 ounces of sprouted buckwheat on the third day.
Alternatively, I added the same food back into my diet, increasing the amount slightly again over each of the next 3 days, for example:-
- 2 tablespoons of seeds, 8 walnuts or 40 grams/1 ounce of peas on the first day,
- 2.5 tablespoons of seeds, 10 walnuts or 50 grams/1.25 ounces of peas on the second day and,
- 3 tablespoons of seeds, 12 walnuts or 60 grams/1.5 ounces of peas on the third day,
I repeated the above process for each food I wished to try and reintroduce back into my diet. At the end of the process I have a list of foods and the amount of each food I can tolerate and a list of foods I am potentially sensitive to and need to continue to eliminate or restrict at the moment. Some foods you may be able to eat everyday. Others, you may only be able to tolerate a small amount once a week. Certain foods you might have to eliminate completely.
Do you have to eliminate or restrict foods permanently?
In the future, once your gut has healed some more, you might be able to add eliminated foods back in again or increasing the amount of restricted foods successfully following the above process. I originally experienced bloating and gas when reintroducing beans and legumes but a few months later, once my health had improved and I’d healed more, I was able to successfully eat them without any side effects.
TIPS FOR FOOD REINTRODUCTIONS
1). Reintroduce the least inflammatory foods first
I used the below chart as a guide, which I adapted from Sarah Ballantine (3). It lists foods from most nutrient dense and least inflammatory and, therefore, less likely to cause a reaction in level 1 to those in level 4 which are less nutrient dense and potentially highly inflammatory and so more likely to cause a reaction. Starting with the least inflammatory and less likely to cause a reaction allowed me to increase the diversity of foods I was consuming and gave my gut more time to heal, increasing the likelihood of me being able to successfully reintroduce potentially more problematic foods in levels 3 and 4.
ELIMINATION DIET REINTRODUCTION CHART
Level 1
- Beans and legumes with edible pods (sugar snap peas, green beans, peas, mangetout, runner beans, snow peas)
- Egg yolks
Level 2
- Egg whites
Level 3
- Soaked and sprouted lentils, split peas and chickpeas/garbanzo beans
- Eggplant/aubergine
- Peppers
- Paprika
- Peeled potatoes
Level 4
- Chili peppers
- Nightshade spices
- Tomatoes
- Unpeeled potatoes
- All other remaining nightshades
- Soaked and sprouted beans and legumes
- Soaked and sprouted gluten free grains and pseudo grains
2). Try reintroducing as many different foods as possible
80% of our immune system is in our gut. One of the biggest determinants of gut health is the number of plant foods we eat, with each individual plant food feeding a different type of good bacteria in our gut (4). It’s recommended to eat 30 plants a week, however, the larger the number of different foods we eat, the higher the amount and diversity of good bacteria in the gut and the stronger our immune system (5).
3). Avoid reintroducing foods during high periods of stress, when sick and after a poor nights sleep
These factors can cause similar symptoms to food sensitivities, which makes it difficult to determine whether any negative reaction you experience is due to the reintroduced food or other external factors. Therefore, it’s recommended to wait until a less stressful period, you’ve had a better nights sleep and have recovered from any illness before reintroducing a food (2).
TRACKING REINTRODUCTION SYMPTOMS & REACTIONS
The reaction you experience when reintroducing a food could be instant or you could experience a delayed reaction up to 3 days after consuming it, which is why it’s recommended to only add one food back into the diet at a time, up to every 7 days (1; 2). For example, some of the reactions I experienced were:-
- Tomatoes – headache an hour after eating.
- Potatoes – increase in muscle and joint pain and heaviness in limbs the following day.
- Peppers – no noticeable symptoms until day 3, when my dizziness and tingling in limbs worsened.
Keeping a journal throughout the whole process is a great way of recording the foods and amounts of each food I had eaten and any symptoms to help make tracking which foods I could and couldn’t tolerate easier. In the journal, it’s recommended to note:-
- Day
- Time
- Food and amount of food eaten
- Drinks and amount of fluid consumed
- Sleep – how long it took to fall asleep, length of time slept for, how many times you woke during the night etc.
- Stress
- Exercise and movement – duration and intensity
- Work
- Any symptoms or reactions (physical, mental or emotional)
- Any other events happening that day (e.g. argument with partner, menstruation etc.)
Making note of additional factors helps you determine whether any symptoms and reactions you experience are due to the reintroduced food or dehydration, a lack of sleep, increase in stress or overexerting yourself etc.
Symptoms to watch out for
Symptoms and reactions can range in severity from mild to severe, including:-
- Rashes
- Dry skin
- Itching
- Joint/muscle pain
- Headaches or migraines
- Fatigue
- Brain fog
- Difficulty sleeping
- Changes in breathing
- Stomach pain or cramps
- Bloating
- Nausea
- Gas
- Acid reflux
- Indigestion
- Changes in bowel habits (diarrhea/constipation)
- Dizziness
- Nasal and chest congestion
- Runny nose or sneezing
- Anxiety
- Feeling low
- Increase in irritability
SOAKING AND SPROUTING GRAINS, LEGUMES, BEANS, NUTS & SEEDS
When reintroducing grains, legumes, beans, nuts and seeds, it’s recommended to soak and sprout them before consumption (6). These plant foods contain anti-nutrients, which can damage the gut and bind to the nutrients and digestive enzymes, preventing our body from absorbing them and increasing the stress on our digestive system, increasing the risk of digestive complaints like bloating and gas (6). Soaking and sprouting has the following benefits:-
- Reduces antinutrients,
- Releases the nutrients to maximise the protein, fibre, vitamin and mineral content,
- Increases the amount of these nutrients our body absorbs,
- Releases and increases the digestive enzymes, which aids digestion (6).
These benefits all make them easier to digest, increasing the likelihood of being able to successfully reintroduce them as there’s less risk of them irritating the gut and causing a reaction (6).
Related Post: 10 Tips To Improve Digestion Naturally
SPROUTING AT HOME
BEANS & LEGUMES
Beans and legumes can be sprouted at home in a sprouting jar (UK Link/US Link), such as by following these How To Sprout Chickpeas instructions. Make sure you buy organic ones designed specifically for sprouting as these have been tested to ensure they’re free from harmful bacteria:-
How To Sprout Beans & Legumes
- Place beans or legumes in a sprouting jar and cover with filtered water. Stir in 1 tablespoon of freshly squeezed lemon juice or raw apple cider vinegar for every 250 ml/1 cup of filtered water. Leave beans and legumes to soak overnight, or for at least 12 hours.
- Drain, rinse and drain the soaked beans and legumes and then leave them inverted in a sprouting jar covered with a tea towel.
- Rinse and drain 2-3 times per day.
- The sprouts are ready in 2-5 days, when you see a white root appear from them, which is the same size as the bean or legume.
- Rinse and drain once more, remove any unsprouted foods and leave the remaining sprouts to dry completely. They are then ready to be used.
SPROUTING NUTS & SEEDS
You can Activate Nuts and Seeds at home by soaking them in warm filtered water with sea salt for 4-8 hours prior to consumption as they are unable to be or very difficult to sprout. Like with beans and legumes, ensure you buy organic nuts and seeds, as artificial pesticides on conventional products prevent the nuts and seeds from being activated.
PRE SOAKED AND SPROUTED GRAINS, NUTS & SEEDS
You can also soak and sprout some grains, nuts and seeds at home like in this How To Sprout Buckwheat post. However, for convenience and to save time, you can buy grains, nuts and seeds already soaked and sprouted, like the following:-
Sprouted Recipes
Tests After Elimination Diet Reintroduction Phase
Tom O’Bryan recommends getting blood work done 6 months after reintroductions, as it’s possible to have no symptoms but have reactivated an immune response where you have elevated antibodies, meaning inflammation is developing and attacking healthy cells and tissues again (2).
Other Health & Chronic Illness Blog Posts
CONTACT ME & FOLLOW ME ON SOCIAL MEDIA
I hope this post was helpful. Has anyone else done an elimination diet? How did you approach the reintroduction phase? I’d love to hear your experiences. Leave me a comment below or message me on Instagram, Facebook, Twitter, Pinterest or YouTube.
If you found this post helpful, please share it on social media using the buttons below
You are so spot on with your comments and observations, Lucy! Well done. I still remember how impressed I was when I did my first elimination diet, and yes, that one month period is key. I see a lot of folks give in to temptation after a few weeks.
My trigger list is just like yours, only I will not give up my morning coffee and there is no way that one cup of coffee is causing the widespread inflammation that I have right now. We have to live a little, but I did give it up for two months back in 2012.
The other one that always gets me is soy. It’s in everything and we really have to check those ingredient lists. Since I am a mostly raw eater, any time I treat myself to a restaurant meal, I am always surprises by the amount of soy dishes on the menu. Tempe makes me extremely sick – vomity, malaise, and all around yuckiness. I still remember a raw restaurant owner telling me it’s impossible and so I tried it again. Same reaction! So I sent her my elimination list and said soy is a huge trigger. Not everything at her restaurant is safe as she claimed. As time went on, she heard the same from other customers. (Still friends, obviously. She listened.) There is always more to learn about food, isn’t there?
Thank you so much for your comment Carrie. It’s so hard not to give into temptation but it is so worth it when you stick to it. Like you said, it’s unbelievable the difference it makes when you remove foods you’re sensitive too from your diet. Sadly I can’t tolerate even one cup of coffee so I make do with my chicory alternative instead. I’m sorry to hear you’re struggling with wide spread inflammation, I hope you can find effective ways to manage it soon. Yes, I can’t tolerate soy at all, whenever I eat it I get instant dizziness. It’s frustrating isn’t it because the majority of restaurants have soy as a protein alternative for vegans. It’s why I rarely eat out these days. Definitely, diet is so complex and what is best for every person is different – there’s always something new to learn. Thanks again for getting in touch Carrie. Take care.
Thanks for the very helpful insight. I’ve always wondered about an elimination diet but I think it’ll mess up with my blood thinning meds too much so might be a bit tricky! Nutrition and food is so important for our well being though. Thanks once again!