What are the six foods in the elimination diet?

Up to 20% of people worldwide may experience a food intolerance. To help identify common trigger foods, many turn to an elimination diet, which focuses on systematically removing and reintroducing foods to pinpoint reactions. Specifically, what are the six foods in the elimination diet that are most often targeted?

Quick Summary

A standard elimination diet removes six common food allergens—dairy, wheat, soy, eggs, nuts, and fish/shellfish—for a set period. These are reintroduced one by one to determine which foods cause adverse symptoms and identify an individual's specific dietary triggers.

Key Points

• Identify Triggers: The 6-food elimination diet targets dairy, wheat, soy, eggs, nuts, and fish/shellfish to identify personal food sensitivities and allergic triggers.

• Follow a Multi-Phase Process: A successful elimination diet involves careful planning, a 2-6 week elimination phase, and a systematic reintroduction phase to pinpoint problematic foods.

• Avoid Hidden Ingredients: Many processed foods contain hidden sources of the six target food groups, so careful label reading is essential during the elimination phase.

• Focus on Approved Foods: During elimination, center your meals around nutrient-dense, whole foods that are not on the restricted list to ensure you maintain a balanced diet.

• Consult a Professional: Working with a doctor or registered dietitian is vital for nutritional guidance and safety, especially when managing severe allergies or planning reintroductions.

• Track Your Symptoms: Maintaining a detailed food and symptom diary is crucial for accurately correlating specific foods with your body's reactions during the reintroduction phase.

Understanding the Elimination Diet Process

An elimination diet is a short-term eating plan used to identify foods that may be causing adverse symptoms. It involves two main phases: a period of elimination where certain foods are removed, followed by a reintroduction phase to test the body's reaction to each food individually. This process is considered the gold standard for identifying food sensitivities and is backed by decades of use by allergists and dietitians. The six-food elimination diet (6-FED) is a popular, highly targeted approach used frequently in clinical practice, especially for conditions like Eosinophilic Esophagitis (EoE). By focusing on the most common food allergens, this method provides a structured way to discover a person's unique dietary triggers and achieve symptom relief.

The Six Key Food Groups to Eliminate

Based on clinical practice and common allergens, the 6-FED focuses on removing the following six food groups:

1. Milk (Dairy): This includes all cow's milk products, such as milk, cheese, yogurt, and butter. It's one of the most common allergens, with many processed foods containing milk proteins or whey. The goal is to eliminate all forms of dairy to test for a possible cow's milk protein allergy or lactose intolerance.
2. Wheat: Wheat and other gluten-containing grains (barley, rye, spelt) are widely present in breads, pastas, cereals, and baked goods. Gluten sensitivity or celiac disease can cause a range of symptoms, making wheat a primary suspect for elimination. Avoiding wheat requires careful label reading, as it can be hidden in many sauces and processed products.
3. Soy: Soy is a common allergen found in products like tofu, soy milk, edamame, and soy sauce. It can also be a hidden ingredient in many processed foods, including certain sauces, baked goods, and vegetarian meat substitutes. Eliminating soy can be challenging but is necessary to determine if it is a trigger food.
4. Eggs: Eggs are a staple in many diets but are also a very common allergen. They are used in countless recipes and processed foods, including mayonnaise, sauces, and baked goods. Egg elimination requires finding suitable egg-free substitutes for cooking and checking ingredient lists for hidden egg derivatives like albumen.
5. Nuts (Tree Nuts and Peanuts): This category includes both peanuts and tree nuts (e.g., almonds, cashews, walnuts). Given the potential for severe allergic reactions, strict elimination is necessary. This also requires vigilance regarding potential cross-contamination in food preparation and checking for ingredients like nut flours or oils.
6. Fish and Shellfish: This final group includes all types of finned fish (like salmon and cod) and shellfish (crustaceans and mollusks like shrimp, crab, and clams). Allergies can be specific to one or both types of seafood, so eliminating the entire category is standard practice to test for reactions. Avoiding fish and shellfish means checking for ingredients like fish sauce or oyster sauce in recipes.

The Three Phases of an Elimination Diet

To successfully identify trigger foods, the process must be followed meticulously through three phases:

• Phase 1: Planning and Preparation: Before starting, it is crucial to consult a healthcare professional, like a dietitian, to ensure nutritional needs are met. Keeping a food diary for a week or two beforehand helps establish a baseline of symptoms. In this phase, you will remove all six target food groups and their derivatives from your diet. Pantry and label cleanup is essential to prevent accidental consumption.
• Phase 2: Elimination: This phase typically lasts between 2 and 6 weeks. During this time, the body is given a chance to clear out any inflammatory reactions from the eliminated foods. Symptoms like bloating, rashes, headaches, or fatigue may start to subside, providing valuable insight. If symptoms do not improve after 4–6 weeks, it may be necessary to explore other potential triggers or medical conditions.
• Phase 3: Reintroduction: After the elimination period, you will reintroduce one food group at a time, typically over 2-3 days. It is important to monitor for any return of symptoms, such as digestive issues, headaches, or skin changes. If a reaction occurs, that food is noted as a trigger and removed again. This phase systematically identifies which foods are safe and which are problematic. Read more on the reintroduction process here.

Comparison of a Six-Food and Low-FODMAP Elimination Diet

Feature	Six-Food Elimination Diet (6-FED)	Low-FODMAP Diet
Primary Goal	To identify common allergens (milk, wheat, soy, eggs, nuts, fish/shellfish) causing inflammatory or allergic reactions.	To identify carbohydrates (FODMAPs) that may trigger Irritable Bowel Syndrome (IBS) symptoms.
Targeted Foods	Specific protein-based allergens or inflammatory foods.	Fermentable Oligo-, Di-, Monosaccharides, and Polyols (short-chain carbohydrates).
Typical Candidates	Individuals with suspected allergies, eosinophilic esophagitis (EoE), or chronic inflammation.	Individuals with Irritable Bowel Syndrome (IBS) or Small Intestinal Bacterial Overgrowth (SIBO).
Process	Elimination of 6 major food groups, followed by systematic reintroduction of each group.	Elimination of high-FODMAP foods, followed by systematic reintroduction to assess tolerance.
Duration	Elimination phase typically 2-6 weeks; reintroduction adds several more weeks.	Elimination phase typically 2-6 weeks; reintroduction phase follows.
Main Symptoms Addressed	Wide range of allergic or inflammatory symptoms (rashes, bloating, headaches, etc.).	Predominantly gastrointestinal issues (gas, bloating, diarrhea, cramping).

Benefits and Risks of an Elimination Diet

Benefits:

• Pinpoints Triggers: A well-executed elimination diet is highly effective at identifying specific food sensitivities or intolerances that are causing symptoms.
• Improves Health: It can lead to significant improvements in various health conditions, including digestive issues like IBS, skin problems like eczema, and chronic inflammation.
• Empowers Personalization: The process provides valuable insight into your body's unique reactions, allowing you to create a personalized, long-term eating plan.

Risks:

• Nutritional Deficiencies: Restricting multiple food groups for an extended period without professional guidance can lead to nutrient deficiencies. It is vital to work with a healthcare provider to ensure a balanced diet.
• Social Challenges: The restrictive nature of the diet can make social dining and eating out difficult, potentially leading to social isolation.
• Disordered Eating: In some cases, focusing heavily on restriction can lead to food anxiety or trigger disordered eating patterns. This is another reason professional supervision is crucial.
• Risk of Anaphylaxis: For individuals with confirmed or suspected severe food allergies, reintroducing a food can cause a dangerous anaphylactic reaction. A medically supervised challenge is essential in these cases.

Tips for a Successful Elimination Diet

• Prepare Adequately: Plan your meals, clear your pantry, and read labels carefully to avoid hidden ingredients before you begin.
• Maintain a Food Diary: Consistently log everything you eat and any symptoms that arise. This is critical for accurately identifying triggers during the reintroduction phase.
• Focus on Approved Foods: Shift your mindset to what you can eat, exploring new recipes with allowed fruits, vegetables, lean proteins, and gluten-free grains to maintain variety.
• Seek Professional Guidance: Work with a doctor or registered dietitian throughout the process to ensure nutritional adequacy and safety.
• Listen to Your Body: Pay close attention to subtle changes in energy, mood, and digestion. Your body’s feedback is the most important data point.

Conclusion

Understanding what are the six foods in the elimination diet and following the process correctly can be a life-changing step toward better health. The standard 6-FED targets dairy, wheat, soy, eggs, nuts, and fish/shellfish—some of the most common allergens. By systematically eliminating and then reintroducing these foods under professional supervision, individuals can pinpoint their specific triggers and create a more personalized, anti-inflammatory diet. While the process requires dedication and careful planning, the potential benefits of reduced symptoms and increased well-being make it a valuable diagnostic tool for many.

Frequently Asked Questions

Why are dairy, wheat, and soy so commonly eliminated?

These foods contain some of the most common allergens and inflammatory proteins. Dairy and wheat are staple foods in many diets, and the body can become sensitive to them from frequent consumption, while soy is a common allergen often found in processed foods.

How long does the elimination phase of the diet last?

The elimination phase typically lasts for a minimum of 2 to 4 weeks but can be extended up to 6 weeks, depending on the severity of symptoms and the individual's response.

Can I do a 6-food elimination diet without a doctor?

While some people do this independently, it is highly recommended to perform a 6-FED under the supervision of a doctor or registered dietitian. This is especially important for individuals with known allergies, as reintroducing foods can be dangerous.

What happens if I accidentally eat an eliminated food?

If you have an accidental slip-up, don't panic. Observe your body's reaction and note any symptoms in your food diary. If the reaction is minor, you can continue the diet. If it was a significant reaction, you might need to wait for symptoms to resolve before continuing reintroductions or restart the elimination phase.

How do I reintroduce a food group safely?

Reintroduce one food group at a time over several days. Start with a small amount on the first day, increase the amount on the second and third days, and monitor for any symptoms before moving to the next food group. Wait for symptoms to subside before testing another food.

Are all elimination diets the same?

No, there are many types of elimination diets. The 6-FED is specifically for the six common allergens, while others like the low-FODMAP diet target different food components, such as fermentable carbohydrates, primarily for people with IBS.

What are the first signs of a food sensitivity?

Symptoms can vary widely but may include bloating, headaches, fatigue, joint pain, skin rashes, or digestive issues like gas, constipation, or diarrhea.