6-Food Elimination for Eosinophilic Esophagitis
Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish.
Unfortunately, there is no accurate test to identify food allergies connected with EOE. Elimination diets help to identify food allergies and improve your condition.
How to do an elimination diet
Step 1. Plan
Work with your healthcare team to identify which foods might be causing symptoms. Plan a time to start the diet when you know you can be successful. Prepare yourself by having the foods you will need on hand and prep as much as possible in advance.
Step 2. Eliminate
Remove all 6 foods from your diet for 4-6 weeks without any exceptions. It is important to read food labels and use caution when dining out, since you have less control over the ingredients in restaurants.
Step 3. Challenge
If your symptoms have not improved after 4-6 weeks, follow up with your health care provider.
If your symptoms have improved, start the challenge phase with ONE of the foods you stopped eating at a time. As you do this, write down your symptoms.
Symptoms of a failed food challenge may range from mild reflux, or pains, to severe cramps, vomiting, or difficulty swallowing – even food impaction. Any of these changes after reintroducing a food should be written down and considered a reaction. It is common for EOE food reactions to be delayed for hours or even days from exposure.
Challenge Instructions:
- Introduce ONE new food per week. (Dairy, wheat, soy, eggs, nuts, or seafood/shellfish)
- Add 1 serving of the food in the morning. (Example: glass of milk or 1 slice of bread)
- If you don’t notice any symptoms, eat 2 larger portions in the afternoon and evening.
- Over the next 3 days, continue to eat at least 1 serving of the food per day.
- If the food does not cause symptoms, it is considered safe.
- Wait to add the safe food back into your diet until the other food challenges are complete.
Dairy Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • Milk (cow, goat, and sheep) • Buttermilk • Condensed milk • Cream/artificial cream • Evaporated milk • Butter, butter oil • Ghee • Margarine • Cheese • Ice Cream • Yogurt • Sour Cream • Some mayonnaise and some salad creams Ingredients that contain dairy: • Casein (curds), Hydrolyzed casein • Caseinates, calcium or sodium caseinate • Lactoglobulin • Lactoalbumin • Lactose • Milk powder • Milk protein • Milk sugar • Milk solids, Non-fat milk solids • Modified milk • Whey, Whey solids, Hydrolyzed whey, Hydrolyzed whey protein, Whey protein | • Coconut, hemp, oat, or rice milk • Dairy-free yogurts • Dairy-free cheeses • Coconut ice cream • Hemp products • Coconut milk products | • Milk: Pacific Foods, So Delicious, Rice Dream, Blue Diamond • Yogurt: Coconut Dream, Good KARMA, So Delicious yogurts • Cheese: Daiya • Frozen Dessert: Haagen-Dazs Non-Dairy, So Delicious, Coconut Bliss • Butter: Earth Balance, Smart Balance |
Wheat Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • Bran • Bulger • Couscous • Durum • Einkorn • Emmer • Farina • Farro • Flour (wheat – all purpose, cake, enriched, graham, pastry) • Gluten • Hydrolyzed wheat protein • Kamut • Semolina • Spelt • Wheat (berries, bran, grass, malt, starch) Ingredients may contain wheat: • Artificial/natural flavoring • Caramel color • Dextrin • Food starch*, gelatinized starch, • Glucose syrup • Hydrolyzed or textured vegetable protein • Maltodextrin • Monosodium glutamate • Oats • Soy sauce, shoyu, teriyaki • Beer • Bouillon cubes • Brown rice syrup • Candy, Licorice • Deli meats, hot dogs, sausage, imitation fish • Communion wafers • French Fries • Gravy, sauces, soups • Seitan | • Gluten-free foods Wheat substitutes: • Amaranth • Arrowroot • Barley • Beans / legumes • Buckwheat • Corn • Oats (gluten-free) • Potato • Quinoa • Rice • Rye • Tapioca | • Grains: Bob’s Red Mill • Breads: Canyon Bakehouse, Udi’s, Food for Life, New Cascadia Traditional • Cereals: Nature’s Path, Arrowhead Mills, GF Chex • Crackers: Blue Diamond Nut Thins (contain dairy), Mary’s Gone Crackers, Glutino • Pasta: Barilla, POW • Wraps: Rudi’s, Mission |
Egg Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • Eggs (yolks, whites, dried, powdered, and solids) • Egg substitites (e.g. EggBeaters) • Eggnog • Egg noodles • Egg sauces (hollandaise, bernaise) • Baked goods (bagels, some breads, cookies, cakes, donuts, muffins, pancakes, waffles) • Batters • Caesar dressing • Cream fillings • Custard-type desserts • Crepes • French toast • Frostings (some) • Ice cream (some) • Malted milk mixes (Ovaltine) • Mayonnaise • Meatloaf, meatballs, sausages, bologna • Meringue • Mousse • Pastas (fresh) • Puddings • Soups (noodle/consume, egg drop, wonton) • Tartar sauce Ingredients may contain egg: • Albumin • Binder • Coagulant • Gobulin • Lecithin (unless soy) | • Egg-free foods Egg substitutes (1 egg): • ¼ cup applesauce • ¼ cup mashed banana • 1 Tbsp ground flax + 3 Tbsp water • 1 tsp baking soda + 1 Tbsp vinegar • 2 Tbsp arrowroot powder + 3 Tbsp water | • EnerG egg replacer • OrgraN • Bob’s Red Mill Gluten Free Vegan Egg Replacer |
Soy Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • Edamame • Miso • Natto • Shoyu • Soy (soy cheese, soy flour, soy ice-cream, soy milk, soy nuts, soy yogurts) • Soy sauce, tamari • Soya • Tempeh • Textured Vegetable Protein (TVP) • Tofu, bean curd | • Soy sauce substitute, Coconut Aminos • Soy lecithin is OK • Refined soybean oil is OK | • Coconut Secret Coconut Aminos (soy sauce substitute) |
Peanuts & Tree Nut Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • All tree nuts (walnut, almond, hazelnut, cashew, pistachio, Brazil nut) • Nut butters • Natural nut extract • Nut meal, past, meat, pieces • Cold pressed, expeller or extruded peanut or tree nut oils | • Pine nuts are usually tolerated • Coconut and coconut products • Pumpkin, sesame and sunflower seeds • Sunflower seed spread • Heat-pressed peanut oil is OK | Peanut butter alternatives: • SunButter • Once Again Organic Sunflower Seed Butter • 88 Acres • Don’t Go Nuts Spread Bars: • Enjoy Life • go Raw • Made Good • 88 Acres |
Fish & Shellfish Elimination
| Foods to Avoid | What to Eat | Brand Examples |
|---|---|---|
| • All fish • All crustacea (shrimp, crab, lobster) • All mollusks (oysters, clams, mussels, scallops) Remember that finned fish and shellfish are not related. Being allergic to one does not mean that you must avoid both. | • Poultry • Beef • Bison • Pork • Lamb • Venison • Elk • Beans • Lentils • Pea protein |
Reading a Food Label
Dairy Example:
There are three ways dairy may be indicated on a label. See examples below:
- Within ingredient list in parenthesis ( )
INGREDIENTS: CASEIN (MILK), DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
- Within ingredient list in BOLD.
INGREDIENTS: MILK CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
- As a separate statement after the ingredient list. See example below:
INGREDIENTS: CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR CONTAINS: MILK
Sample Menus: 6-Food Elimination Diet
| Day 1 | Day 2 | |
|---|---|---|
| Breakfast | Breakfast sausage or ham with 1 banana or apple and 2 Tbsp sunflower seed butter | Smoothie: unsweetened coconut or hemp milk, banana, blueberries, greens, pea or collagen protein powder |
| Lunch | Green salad with chicken, black beans, salsa, and avocado | Chicken salad, lettuce, GF wrap, side of olives and grapes |
| Dinner | Pot roast with potatoes, carrots, and green beans | BBQ chicken, sweet potato, and slaw or side salad |
| Snack | GF crackers with avocado and salsa | Veggie sticks with hummus Fruit with sunflower seed butter |
| Day 3 | Day 4 | |
|---|---|---|
| Breakfast | GF Oatmeal (prepared with milk alternative) blueberries, hemp seeds Coffee (w/ coconut creamer) | Allergen free waffle with 100% pure maple syrup, berries Milk alternative |
| Lunch | Rice with beans, grilled vegetables, GF corn chips, lettuce, salsa, cheese substitute | GF wrap with chicken, vegan mayonnaise, avocado slices |
| Dinner | Grilled pork chop, GF pasta with vegetables Baked apple with cinnamon | Beef tenderloin, rice, olive oil, steamed broccoli Orange |
| Snack | Allergen free pretzels and hummus Coconut milk ice cream | Seed mixture with allergen free chocolate Mini rice cakes with sunflower seed butter |
Resources
American Academy of Allergy Asthma & Immunology
American Partnership for Eosinophilic Disorders
American College of Gastroenterology
