What I eat affects how I feel: consider an elimination diet for chronic pain

The Internet is full of dietary advice, much of which has as much basis in opinion as fact. I won’t try to define for you what constitutes healthy eating, but I can share an effective strategy for testing your own diet that could potentially improve your health and well-being.

You could feel healthier within weeks, and it is free

Twice in my life, I have undertaken “elimination diets.” I credit this process with measurably reducing symptoms that were severely impacting my quality of life. In my case, I was able to reduce migraine headache symptoms from daily to just a few episodes per year. More recently, I shifted constant, debilitating joint pain and fatigue associated with autoimmune disease to a still regular, but less incapacitating, condition.

In both cases, I was able to stop taking some preventative prescription drugs and take fewer pain relieving drugs (an objective and measurable result.) I also made myself feel better (a subjective improvement in my well-being.)

You don’t need to spend an extra penny to try it, and you should know within a month if it is going to work for you.

What is an elimination diet?

An elimination diet is not designed to eliminate weight and/or fat. This isn’t a weight loss diet. I think of it as a health gain diet; you could also consider it a symptom loss diet. I prefer to focus on the positive.

Reduce foods you eat to a “safe” list

Put simply, an elimination diet involves first reducing your diet to a limited list of foods known to be inoffensive. By inoffensive, I mean foods that are not commonly allergenic or irritating to the system. At this stage, you would eliminate any food you think might be triggering your own symptoms.

Re-introduce different foods one at a time

After a period (typically around three weeks) on the very restrictive diet, you re-introduce new foods one at a time into your meals and see if symptoms recur or increase. If you feel worse, you remove the offensive (or “trigger”) food again and go on to the next test food. Ideally, you wait a day or two after being “triggered”/negatively affected so your body can return to a neutral state.

Continue this process until you have tested the foods you prefer

You continue this process until your diet includes everything you prefer to eat (excluding trigger foods!) Speaking again from my own experience, it took me a few months to recover from almost daily migraines; I experienced profound relief on day four of my elimination diet for autoimmune disease symptoms.

Elimination Diet food picture - 1

I began with a low-fat, vegan diet of exclusively cooked foods, mostly vegetables. Olive oil was my only fat. I included rice, quinoa, and black beans. I avoided foods that I previously ate the most frequently.

What foods are safe to start an elimination diet?

The first time I did an elimination diet, my primary care doctor gave me a “migraine diet” that I used as a starting point. On my second go ’round, I consulted with a nutritionist recommended by my regular physician to compile a food list for myself based upon a website and a book I regarded as trustworthy.

I used the book, The Elimination Diet by Segersten and Malterre. I borrowed it from my library and read the whole thing, but you don’t need the book to try this technique. This couple does offer many useful resources as free printables on their website, however, and they do a nice job providing a thorough blueprint for those who don’t want to do a lot of planning for themselves.

The point of this intervention is to find out, for yourself, how specific foods affect you.

If you don’t know which foods to start with, begin with a recommended diet from a professional—either your own health provider, or a list from a book or website whose credentials you trust.

An elimination diet is a short-term experiment

Perhaps the most vital thing to know about this diet is that it is never meant to be permanent. I hate the experience of working through an elimination diet, especially those early, very limited weeks, but I like the results enough to commit to a few weeks of deprivation to feel much better.

If you undertake this process and finish up with a long list of foods you plan to permanently eliminate, I strongly encourage you to consult a dietician or doctor to ensure your nutritional needs will be met. In my case, only a few key foods seem to be responsible for a majority of my current symptoms.

Look beyond the usual suspects

Perhaps the most interesting thing I learned in my most recent elimination diet phase was that two common foods I’d barely suspected give me the most trouble. I won’t name them because it’s easy to label foods as “bad” and then proselytize for others to avoid them.

Please do your own experiment and find your own best diet. My two “bad foods” are not any of the foods so popularly demonized these days. (Hint: neither of them is a grain or gluten!)

Your long term diet should be healthy and sustainable

I’ve learned that other foods—some of which are commonly listed as likely triggers—affect my symptoms, too, but they do so in a more gradual, symptoms-building-up sort of way.

For example, I can include some dairy and some organic wheat in my diet and live pretty comfortably. I don’t eat freely of these foods, limiting them to special occasions, but I enjoy life a lot more. Allowing these, in moderation, means more excitement and variety in my meals, which is another factor in long term, emotional well-being.

The myth of “the” healthy diet

My two dietary interventions happened about 20 years apart and resulted in the adoption of somewhat different “ideal diets” each time. The biggest similarity between the two situations was the process.

Did I misinterpret my results the first time I did an elimination diet? Have my needs changed? Has food itself changed? All of these are possible.

It is really difficult to do great studies on human nutrition. To put it very simply, this is because:

  1. There’s no expensive product to market afterwards, so no one wants to pay for long term, well controlled studies of large groups, and
  2. People have really complex lives so it’s hard to design great studies that give straightforward results.

For this reason, I take every bit of nutrition advice with a grain of salt, and I try to stay very open-minded as new research is published. I think it is likely that different people have unique dietary needs based upon lifestyle and genetics, the same way we are susceptible to different injuries and diseases. I think we probably need different nutritional inputs at different stages of life.

I also believe that the adoption of modern, processed foods has likely affected human health in currently unknowable ways. After all, “traditional diets” sustained us for thousands of years, and they differed around the world. What are the odds that one very specific diet could optimize health for all individual human beings?

In the USA, our doctors typically receive little to no training in nutrition. They can advise us when we need to lose weight, or tell us to “eat a healthy diet,” but they aren’t necessarily in a better position than we are ourselves to create a specific blueprint for what we should feed ourselves.

I advocate this particular approach to health through nutrition experimentation because I have personally experienced success with it, twice. It is also free, costing more in time and commitment than financial outlay. You will have to do some planning to successfully undertake an elimination diet.

I don’t believe that we are responsible for every ailment that befalls us. Sometimes, we get hit with an unlucky break, in health as with the rest of life. But here is an opportunity to shift the odds back in our favor by putting in a bit of effort.

If you are suffering, consider trying an elimination diet. The most you have to lose is a little time—and the enjoyment of a few favorite meals—over a few weeks. What you stand to gain is good health.

Have you tried, or considered, an elimination diet? What were your results?

7 thoughts on “What I eat affects how I feel: consider an elimination diet for chronic pain

  1. I’ve also recently eliminated certain foods from my diet. I didn’t have any severe health issues, just some unwelcome side-effects. Still it has changed the way I look at food. I’m now much more conscious of what I put in my trolley at the grocery store.

  2. I had horrible acid reflux, which was fixed by a few months of a strict elimination diet omitting carbs (especially sugar and bread) and oils but heavy on steamed vegetables and meat/fish.

    • My question to you would be: how long did you maintain this strict diet?

      I really fear the trend toward “orthorexia.” It’s a proposed medical diagnosis of “A fixation with healthy or righteous eating.”

      Americans like to make “religious” decisions about diet when they should make scientific ones.

  3. Thanks for this informative post! I am currently trying an anti-inflammatory diet (I have rheumatoid arthritis). It consists of fresh fruits, veggies, lean meats, very little dairy (a tad of parmesan here and there), almonds … no sugar, no gluten, no processed food. I have not been on it very long so I can’t share experience with any long term affects, but I have noticed in the past that my pain increases the day after a night of pizza or ice cream. I am not sure that diet alone will control my disease, but I do believe it will make a difference.

    • I started out on a low-fat, vegan diet (also excluding all gluten and dairy) because SOME of the studies on RA remission followed those rules. I felt that I’d rather begin super strict and have more clarity as to whether it would help.

      It did help, so much that it was obvious in only four (4!) days that I had less pain.

      It’s also possible that it was total calorie reduction that did most of the work, but that’s another discussion. I would’ve begun with a medically supervised fast, because there’s so much good evidence that it works to ease RA, but none of my doctors would supervise it.

      • I have also considered a fast, but currently it’s not possible as I take meds that require food. Your suggestion that total calorie reduction possibly plays a role is also very interesting!

      • Personally, I wouldn’t fast without medical supervision, especially when sick enough to require meds, so I hear you.

        Funny thing was, I didn’t restrict calories in purpose, but couldnt force myself to eat more of my allowed foods. I didn’t hate the foods, but didn’t find them scrumptious, either. With no animal products, that meant eating five times a day, as much as I wanted, was about 750-800 calories per day!

        Adding turkey in week four, then coconut in week five, brought me back up to a more sustainable 1200-1600 range and added immensely to my enjoyment of food.

        I tracked my food to see trends, but the tracker happened to count calories, which is why I have such firm numbers.

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