Eosinophilic esophagitis (EoE) is a lifelong disease that comes back after periods of improvement. To keep symptoms at bay, you’ll need ongoing treatment. One way to help is by making changes to your diet.
When you have EoE, white blood cells called eosinophils build up in your esophagus and cause inflammation. Studies show a strong link between food allergies and these surges in white blood cells. If you avoid the foods you’re allergic to, you can reduce your EoE symptoms.
In order to know all the foods that may be causing an allergic reaction, you’ll need to take some -- or all -- possible culprits out of your diet and add them back in one at a time to see how your body reacts. Your doctor will call this an elimination diet. Some people only need to remove the most obvious suspects; others require a broader approach.
Any kind of dietary approach to EoE should happen under the guidance of health care professionals. Along with your GI doctor, your care team may include a:
- Registered dietitian
- Feeding and swallowing specialist
It may take a long time to figure out which foods are causing your flare-ups, and the process can feel extremely limiting. But, for many people, dietary changes provide real, long-lasting relief from EoE symptoms because they prevent the inflammation from happening in the first place.
Six-Food Elimination Diet
The most common method to pinpoint triggers of inflammation is the six-food elimination diet (SFED). This diet takes away the six most common causes of EoE reactions. They include:
- Fish and shellfish
- Peanuts and tree nuts
First, you’ll stop eating all these foods for 6 weeks. After this period, your doctor will do a procedure called an upper endoscopy. They’ll look at your esophagus using a small flexible tube with a camera on the end. And they’ll take a sample (or biopsy) of cells from the area to get a baseline reading on your inflammation. Then you’ll reintroduce one of the eliminated food groups every 2 to 4 weeks. You’ll have a biopsy with each new food group to see if it increases inflammation.
Studies show milk is the most common inflammation trigger and wheat follows closely behind. Dairy and wheat can be tough to avoid. Your dietitian can teach you how to choose and prepare delicious and nutritious foods that don’t contain these allergens.
Your dietitian will also discuss these important rules of thumb:
- Always read labels. Food manufacturers must state on their labels whether the product contains any common food allergens. Ask your dietitian about phrases like “May contain” and “Made in a facility that processes” to be sure you’re not accidentally putting an allergen into your system.
- Avoid cross-contamination. Be sure the foods you eat haven’t come into contact with foods you can’t eat. Wash hands, cutting boards, and utensils well. Avoid foods that come from a buffet or bulk bin.
- Take a rest from restaurants. To give the process the best shot at working, take a break from eating out for a while. You can’t be completely sure what’s in your food if you didn’t cook it yourself.
During the elimination diet, your dietitian may suggest you take a hypoallergenic multivitamin to be sure you get all the nutrients you need.
If your symptoms are severe, a skin prick food allergy test is negative, or other treatments haven’t worked for you, your doctor may recommend an elemental diet. It’s stricter than an elimination diet, because it removes all allergens instead of just the most common ones.
You’ll stop eating or drinking anything except for water and a special formula. Elemental formulas contain nutrients broken down into their most basic elements. That is, rather than the proteins found in whole foods, they contain only amino acids – the basic building blocks of proteins.
After about 8 weeks on a formula-only diet, your doctor will do an endoscopy to see if your eosinophil levels have gone down. If so, you’ll slowly add foods back into your diet while your doctor monitors your body’s response.
The elemental diet is the most effective dietary approach to EoE. Around 90% of people who try it see results. But it has some downsides:
- Many people struggle sticking to the liquid diet.
- It can take years to properly reintroduce all the foods you’ve cut out.
- Adults can drink the formula, but kids may need a feeding tube in order to get proper nutrition while they follow this diet.
- When it’s time to add food back into kids’ diets, they often have to have an endoscopy and biopsy to make sure it’s safe.
Photo Credit: Blend Images - Noel Hendrickson/ Getty Images
Mayo Clinic: “Eosinophilic esophagitis,” “Use of dietary strategies in treating eosinophilic esophagitis.”
CHOC: “Food Elimination Diet for Children.”
Children’s Hospital Colorado: “Eosinophilic Esophagitis (EoE) Diets for Kids.”
UW Health: “Food Elimination Diet for Eosinophilic Esophagitis (EoE).”
American Academy of Allergy, Asthma & Immunology: “Eosinophilic Esophagitis.”
Gastroenterology & Hepatology: “An Overview of Dietary Therapies for the Treatment of Eosinophilic Esophagitis.”