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How to Build an Elimination Diet Meal Plan for Healing

Written by Dr. Michael Ruscio, DC on September 24, 2021

Written by Dr. Michael Ruscio, DC on September 24, 2021 — Reviewed by Aimee Gallo

Your Guide to Improving Chronic Symptoms With a Simple Elimination Diet

• What Is an Elimination Diet?|
• Why It Works|
• What to Eat|
• Simple Elimination Diet Meal Plan|
• Elimination Diet Recipes|
• Troubleshooting|
• Making It Easy|

If you’re experiencing chronic, unexplained symptoms, one of the best things that you can try is an elimination diet. And while cutting out multiple food groups and figuring out how to eat when going out or at parties can feel daunting, after working with many patients in our clinic, we have found a few ways to simplify the process and help you have success with your elimination diet meal plan. 

What Is an Elimination Diet?

When you use an elimination diet, you generally remove common foods that cause food allergies, sensitivities, or food intolerances to see if your symptoms improve. 

An elimination diet has three phases: elimination, reintroduction, and maintenance. This article will help you figure out what to eat during the elimination phase, where you remove foods. For more information about the other phases, please read our article, Use an Elimination Diet to Heal Your Gut, Brain, and Skin. 

There are many different options for the framework of your elimination diet meal plan, including Paleo, low-FODMAP, AIP (autoimmune) Paleo. At our clinic, we start most people out on a Paleo diet because it removes the most common foods that cause food sensitivity or food intolerance, but it is not as restrictive as many other diets so it is a bit easier to start with. In fact, many of my patients see a large improvement in symptoms after using a Paleo diet for just a few weeks. 

Why Elimination Diets Work

An elimination diet can help you to improve both gastrointestinal and non-gastrointestinal conditions for three main reasons:

1. Elimination diets can help you figure out what specific foods may be causing an immune system response [1, 2].
2. Elimination diets can show us any foods that do not agree with our particular gut bacteria, causing our gut microbiome (the bacteria and other microbes that live in your digestive system and create a stable ecosystem) to be imbalanced [3, 4].
3. Elimination diets can help you discern if you have a lack of digestive enzymes where you are unable to break down certain sugars or proteins from foods (such as in the case of lactose intolerance). This can cause a variety of symptoms, from stomach pain to eczema. These symptoms may be improved by removing foods your body can not digest [5].

Regardless of exactly why a food is causing symptoms, the end result is a lot of stress on the body and gut, as well as an increase in inflammation resulting in symptoms, such as digestive issues like stomach pain and bloating, as well as eczema, migraines, and brain fog. 

An elimination diet removes foods that potentially drive stress and inflammation, which gives the gut and body time to relax, reset, and often repair. Letting the gut and body rest and relax creates a better gastrointestinal environment for reintroducing foods after about three to four weeks. 

What to Eat on a Paleo-Based Elimination Diet

A Paleo diet is modeled after what our Paleolithic ancestors ate, before we had agricultural crops (grains and beans). It is suggested that our digestive system has not evolved enough to be able to digest grains and legumes very well, and thus they often trigger food sensitivities in many people. A Paleo diet is therefore a more biologically appropriate diet for humans. 

A Paleo diet is also inherently lower in carbohydrates because it does not include typical high carbohydrate foods such as pasta, bread, rice, sweeteners, and desserts. It also moderates intake of fruits and nuts. 

The simplest way to think of a Paleo diet is that you eat whole foods including meat, vegetables, and some fruits, nuts, and seeds. You do not eat grains, dairy products, or processed foods. 

Here is a more detailed list of what you eat on a Paleo diet: 

Here is a more detailed list of eliminated foods you should not eat on Paleo diet: 

Some people in the Paleo community avoid certain foods, like white rice or white potatoes, while others don’t. Many people do not eat Paleo starchy carbohydrates such as sweet potatoes, carrots, and parsnips. All of these options are higher in carbohydrates, so if you want to eat them, moderate the amount and see how you feel. 

Simple Tips For Your Paleo Elimination Diet Meal Plan

People often start an elimination diet because they’re not feeling well. When we’re not feeling well, it can seem like making major life changes takes too much effort. 

To make these changes as easy as possible, remember these three simple principles:

1. Rethink what makes a meal. Breakfast does not need to be eggs or cereal, and dinner can be eggs.
2. Few items, many variations. Prepare a few staple items that you can then put together in multiple different ways for a variety of meals. 
3. Decrease the barrier to entry. Many people get overwhelmed having to put together items at every meal. That’s why most of the meals below can be made as single servings and then all you have to do is take it from the fridge and reheat it. Extra tip: Any meal that you can make as a single serving, make a few extra and freeze them so that you always have backup food should you be too tired to cook.

Let’s put these principles into practice.

Here is a list of a few things you can keep on hand, which can be made into many different Paleo-friendly meal options. If you’re following a different or more restrictive framework for your elimination diet, you can still use these for inspiration, and modify as needed. 

• Vegetables roasted in olive oil, garlic, and salt. The best Paleo vegetables to roast are sweet potatoes, carrots, parsnips, and brussels sprouts.
• Pre-cut broccoli and cauliflower
• Bagged coleslaw mix (without the dressing)
• Cherry tomatoes (do not use if you can not eat nightshades)
• Spring mix or other salad greens, just not romaine lettuce as it is mostly water
• Frozen cauliflower rice
• Shredded chicken thighs or chicken breast. Cook up 1-2 pounds of boneless skinless (because that is easiest to shred) chicken in an instant pot or slow cooker with some bone broth, salt, and pepper and then shred it with a fork. If cooking is not your thing, pick up a roast chicken from the grocery store, but check ingredients to be sure it is Paleo. You can also make pulled pork by cooking pork shoulder the same way. 
• Ground meat (beef or pork) cooked with Paleo seasoning of your choice, such as taco seasoning or sausage seasoning 
• A dozen regular eggs and a dozen hard-boiled eggs
• Packaged items: Paleo meat stick or meat bar, such as from The New Primal or Epic (Always confirm that the ingredients are Paleo.)
• Condiments: extra virgin olive oil, apple cider vinegar, mayonnaise made with avocado oil, Paleo barbecue sauce, dairy-free pesto sauce
• Seasonings: Paleo-friendly taco seasoning and sausage seasoning (check for any grains or sugars in seasoning mixes to be sure they are Paleo friendly.) 
• Drinks: Sparkling water (without sugar or juice), full-fat canned coconut milk (great to add to coffee instead of creamer), lemon juice to add a splash to water, coffee, tea 
• Sweeteners: Maple syrup and coconut sugar in moderation

Elimination Diet Recipes

Now let’s look at how we can put these items together for any meal with a few sample elimination diet meal plan ideas.

Remember, rethink what a meal is. You can actually eat any of these meals any time of day. 

Breakfasts:

• Reheat the roasted vegetables in a pan, and then add a few sunny-side up eggs on top of them.
• Make a breakfast taco with taco seasoned ground meat, spring mix, and a vinaigrette dressing of olive oil and apple cider vinegar. 
• Cook up a breakfast hash with sausage seasoned ground meat and roasted veggies. 

Lunches:

• Make BBQ chicken and coleslaw by adding a Paleo barbecue sauce to some shredded chicken and mixing the shredded coleslaw mix with some mayonnaise and a dash of apple cider vinegar. Make this freezable by putting the BBQ chicken with roasted veggies instead of coleslaw.
• Create a chicken salad with the shredded chicken and mayonnaise, and put that on top of mixed spring greens and cherry tomatoes.

Dinners:

• Pesto chicken and faux rice can be made by reheating frozen cauliflower rice in a pan with olive oil, garlic, sea salt, and pepper. Remember not to overcook cauliflower rice because that’s when it gets watery. Add some shredded chicken to the cauliflower rice, top with pesto sauce, and heat it all together. Make a salad with spring greens, cherry tomatoes, olive oil, and apple cider vinegar.
• Plate ground meat with cauliflower and broccoli. Reheat the ground meat while you steam the cauliflower and broccoli. Add olive oil, sea salt, and pepper to the veggies after they are steamed, and put that with the ground meat. 

On-the-Go or Fast Snacks:

• Prepare hard boiled eggs with raw broccoli and cauliflower.
• Make un-deviled eggs by cutting hard boiled eggs in half and topping them with a little mayo and salt. Have cherry tomatoes on the side. 
• Eat a meat stick or bar. 

Tips for Eating Out:

• Stick to restaurants that have either burgers or a selection of whole cuts of meat as well as veggies.
• A good rule of thumb is to order meat or fish with steamed or roasted vegetables or a burger with toppings and no bun on top of a salad.
• Salads topped with meat or fish are a good option, but ask for olive oil and vinegar on the side rather than a pre-made salad dressing. 
• Order steak or chicken that is not made with an extra coating or sauce. Most often these will be grilled or roasted options. 
• If they can use olive oil for cooking vegetables, then ask for that, but don’t obsess about oils or condiments if a restaurant only has vegetable oil.
• When going to family or friends’ homes, it is okay to bring your own food if that is easiest. 

While the list of foods above may seem like just a few, you will only be on the diet for a short period of time. An elimination diet usually only lasts for three to four weeks before you begin the reintroduction phase — unless symptoms aren’t improving and you need to transition to a more restrictive diet. 

In the reintroduction phase, you reintroduce one (healthy) food at a time every three days or so, and monitor yourself for changes in symptoms. If a food seems to trigger symptoms, you may need to continue to avoid it. 

Troubleshooting Elimination Diets

For some people, a Paleo diet isn’t enough. You’ll probably notice within the first two weeks of your elimination diet if your symptoms do not start getting significantly better. If you’re not getting better, you may have trouble with one of these two most common issues: fermentable carbohydrates and/or nightshades. 

Most often in our clinic, if a Paleo diet isn’t working, we move on to a low-FODMAP diet where you remove fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These types of carbohydrates are fermented by your gut bacteria. 

If you have a bacterial overgrowth, feeding gut bacteria with fermentable carbs like FODMAPs may cause gas, bloating, diarrhea, and brain fog. A Paleo diet removes most of these FODMAPs such as beans and wheat, but others, such as broccoli, brussels sprouts, pears, and onions are Paleo-friendly, and you may need to try eliminating those. 

Nightshades are also another common food sensitivity, and you may have heard of the AIP diet, or, autoimmune Paleo diet. This is an egg-free and nightshade-free diet. Common nightshades are peppers, eggplants, potatoes, and tomatoes. Some spices are made from nightshades too, such as paprika, cayenne pepper, chili powder, and crushed red pepper.

Making an Elimination Diet Easy

While eating in a new way can seem like a lot to figure out, the elimination phase of your diet only lasts for a few weeks, and the potential long-term benefits are almost always worth it. To make it even easier, implement your diet in the simplest way possible, as described here. 

If you love cooking, then you can research more detailed Paleo recipes. But for many people, it’s easiest to make a few simple food items that you can put together in many different ways. 

Don’t stress if you eat once at a restaurant that uses vegetable oil, or if you can’t find grass-fed meat. Do the best you can with what you can handle. 

I hope this article helps you feel more confident about starting your elimination diet meal plan. If you’re unsure about going it alone, you can reach out to our providers to work with one of our health coaches who can help guide you.