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Digestive Health: Eosinophilic Esophagitis Nutrition Guidelines (553)

Digestive Health: Eosinophilic Esophagitis Nutrition Guidelines (553) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition


The Six Food Elimination Diet for Eosinophilic Esophagitis

What is eosinophilic esophagitis (EoE)?
Eosinophillic esophagitis or ‘EoE’ is a chronic inflammatory disorder of the esophagus where
there is the presence of many special white blood cells, called ‘eosinophils.’ EoE is triggered by
allergens in foods and likely also environmental allergens that are breathed in or swallowed.
Long term treatment of EoE includes topical swallowed steroids or a special diet.
Symptoms of EoE can include:
In Adults In Children
ξ Trouble swallowing ξ Trouble swallowing
ξ Food impaction ξ Nausea and vomiting
ξ Reflux ξ Pain in abdomen

Why are the foods I eat important with EoE?
EoE is a different kind of allergic reaction compared to other food and environmental allergies,
but can share the same triggers. Elimination diets aim to remove likely triggers from the diet to
improve the medical condition. The goal then is to add back in safe foods to improve diet variety
and tast. A dietitian can help counsel you on a diet treatment for EoE. This is to make sure you
are still getting the nutrition you need as you cut out several foods from your diet.

What is the Six Food Elimination Diet? (DHC Swallowing Clinic Preferred EoE Diet)
This diet is used to see if one or more of the most common food allergens is a trigger for your
EoE symptoms. It works very well. It also may be cheaper, and easier to follow than other diet
options for EoE. Below are steps to complete the diet:
1. Take the top 6 most common food allergens out of your diet for 6 weeks (milk products,
eggs, wheat, soy, peanut/tree nuts, and fish/shellfish).
2. At 6 weeks into the diet, we will review symptoms. We also perform an EGD
(Esophagogastroduodenoscopy) with biopsy to retest the esophagus for inflammation or
3. These foods are then brought back into the diet, one at a time, for a 2 week trial each. You
are evaluated again after each food is brought back into your diet. The diagram on page 4
shows the complete process.
***To make sure the diet works well, you should follow up with the dietitian half way through
and when you finish the diet trial.


Common Foods and Ingredients of Food Allergens:
These are the most common allergens and should be clearly labeled by law on all products.
Foods Ingredients
ξ Butter ξ Cow’s milk ξ Casein ξ Lactulose
ξ Cheese ξ Pudding ξ Diacetyl ξ Recaldent
ξ Cream ξ Sour Cream ξ Lactalbumin ξ Rennet Casein
ξ Custard ξ Yogurt ξ Llactoferrin ξ Tagatose
ξ Half and Half ξ Goat’s Milk ξ Lactose ξ Whey
Foods Ingredients
ξ Eggs ξ Surimi ξ Albumin ξ Globulin
ξ Eggnog ξ Egg Substitutes ξ Lysozyme ξ Ovovitellin
ξ Mayonnaise ξ Beware of
baked goods,
ξ Ovalbumin
ξ Meringue ξ Lecithin
Foods Ingredients
ξ Bread ξ Most Flours ξ Bulgar ξ Kamut
ξ Couscous ξ Pasta ξ Durum ξ Matzoh
ξ Crackers ξ Pizza Crusts ξ Einkorn ξ Semolina
ξ Instead purchase gluten/wheat free
items made from potato, rice, tapioca
ξ Emmer ξ Spelt
ξ Farina ξ Triticale
Foods Ingredients
ξ Edamame ξ Soy Sauce ξ Soy ξ Textured Vegetable
Protein ξ Miso ξ Tamari ξ Soy Flour
ξ Natto ξ Tempeh ξ Soy Fiber ξ May be in
vegetable gums,
starches, and broth
ξ Shoyu ξ Tofu ξ Soy Protein
ξ Soybean ξ Quorn
Nuts and Tree Nuts
Food Ingredients
ξ Avoid all nuts ξ Lychee ξ Nut Meal ξ Nut Extracts
ξ Seeds okay ξ Nut Meat ξ Nut Paste
ξ Nut Milk ξ Peanut Oil
Seafood and Shellfish
Food Ingredients
ξ Avoid all fish ξ Crab, Crayfish ξ Check imitation fish
ξ Krill ξ Lobster ξ Fish Stock/Sauce ξ Surimi
ξ Barnacle ξ Shrimp, Prawns ξ Seafood flavoring ξ Bouillabaisse


So what can I eat?
 Chicken  Rice (Brown, Wild, White)  Fruits and vegetables
 Beef  Potato (Russet, Red, Sweet)  Barley and rye
 Game Meats  Quinoa  Seeds
 Turkey  Millet  Oils (olive, sunflower, canola)
 Lamb  Amaranth  Most coffee and tea
 Pork  Buckwheat  Rice or coconut milk
 Beans
 Lentils
 Some gluten-gree labeled foods
 Gluten-free oats
 Vinegar
 Foods with allowed ingredients
 Most people allergic to soy can safely eat soy lecithin

Sample Menu
Day One Day Two
Breakfast Gluten free oatmeal with berries, side
of breakfast meat.
Smoothie with coconut milk, banana,
peaches, spinach, ground flax seeds.
Lunch Green salad with chicken, black
beans, quinoa, salsa, and avocado
Hummus and veggies on bread with
allowed ingredients, side of fruit
Dinner Pot roast with potatoes, carrots, and
side green salad
Black bean tacos on corn tortilla, side of
grilled veggies
Snack Fruit, rice cake with sunflower butter Plain potato chips, rice milk ice cream

Nutrition Tips for the Six Food Elimination Diet
ξ Always read food labels. Foods must say whether they contain the top food allergens.
This is found in a “Contains Statement” (i.e. “Contains wheat and eggs”). Some food
labels have a “May Contain” statement. In this case, you should call the manufacturer to
find out more. When in doubt, avoid the product.
ξ We suggest a hypoallergenic daily multivitamin during the diet trial. Make sure it does
not contain the top six food allergens.
ξ Aim for the best diet variety that you can. This will help you get all the vitamins and
minerals your body needs to function.
ξ Avoid cross contamination. This happens when a food comes into contact with another
food. Reduce the chance of this happening by washing your hands often, avoiding bulk
bins, and taking special care in the kitchen (like using a separate toaster for your bread).
Risk of cross contamination is high at restaurants. It may be best to avoid restaurants
while on this diet.


The Detailed Process:
EoE diagnosed

Failed trial of PPI (Proton Pump Inhibitor)

Trial Steroid Therapy, Consider Diet

Elimination of 6 most common food allergens

EGD (Esophageogastroduodenoscopy) after 6-8 weeks

Introduce 1-2 least likely offending food groups (usually seafood and nuts)

EGD after 4-6 weeks

Introduce 1-2 more offending food groups (usually eggs and soy)

EGD after 4-6 weeks

Introduce milk products

EGD after 4-6 weeks

Introduce wheat products

EGD after 4-6 weeks


These resources may be helpful to you:

Teach Back
What is the most important thing you learned from this handout?
What are changes you will make in your diet/lifestyle, based on what you learned today?

If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.

Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s Hospital
(AFCH) can be reached at: (608) 890-5500

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770

Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 1/2017 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department
of Nursing. HF#553