2-Food Elimination for Eosinophilic Esophagitis (EOE)

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. Start by eliminating two of the most common food allergies; dairy and wheat.

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 dairy and wheat products from the diet for 4 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 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:

  1. Introduce ONE new food per week. (Dairy or wheat)
  2. Add 1 serving of the food in the morning. (Example: glass of milk or 1 slice of bread)
  3. If you don’t notice any symptoms, eat 2 larger portions in the afternoon and evening.
  4. Over the next 3 days, continue to eat at least 1 serving of the food per day.
  5. If the challenged food does not cause symptoms, it is considered safe.
  6. Wait to add the safe food back into your diet until the other food challenge is complete.

Dairy Elimination

Food 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, almond, or rice milk
  • Dairy-free yogurts
  • Dairy-free cheeses
  • Coconut or cashew 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, Ben & Jerry’s Non-Dairy
  • Butter: Earth Balance, Smart Balance

 

Wheat Elimination

Food 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: GF Barilla, POW
  • Wraps: Rudi’s, Mission

 

Reading a Food Label

Dairy Example: There are three ways milk may be indicated on a label. See examples below:
 
1. Within ingredient list in parenthesis ( )
  • INGREDIENTS: CASEIN (MILK), DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
2. Within ingredient list in BOLD.
  • INGREDIENTS: MILK CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
3. As a separate statement after the ingredient list. See example below:
  • INGREDIENTS: CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR CONTAINS: MILK

 

Sample Menu: Wheat and Dairy Free

  Day 1 Day 2

Breakfast

Breakfast sausage or ham, 1 banana or apple, 2 Tbsp sunflower seed butter  Smoothie: unsweetened milk alternative, banana, berries, greens, protein powder 
Lunch Green salad with chicken, black beans, salsa, and avocado  Tuna salad lettuce wraps, side of walnuts or olives and grapes 
Dinner Pot roast with potatoes, carrots, and green beans, olive oil  BBQ chicken, sweet potato, and slaw 
Snack Fruit or rice crackers with nut butter  Veggie sticks with hummus 

 

Resources

American Academy of Allergy Asthma & Immunology: https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis

American Partnership for Eosinophilic Disorders: https://apfed.org/resources/for-healthcare-providers-and-researchers/patient-handouts/

American College of Gastroenterology: http://patients.gi.org/topics/eosinophilic-esophagitis/