Eosinophilic Esophagitis (EoE) and the Six Food Elimination Diet

Posted 1.25.11 | Christine Graham-Garo

Eosinophilic Esophagitis (EoE) is a condition that is gaining more and more recognition. Unfortunately though, the treatment options for EoE are not black and white. EoE may be treated either with medication, which has known long term side effects, or nutrition therapy, which has been shown extremely effective, but may be hard to follow for some.

Medication treatment for EoE is the use of steroids. However, this is not a long term fix. As EoE is a chronic condition, treatment with nutrition therapy is often discussed. Here are nutritional therapy options for EoE:

  • Elemental Diet – A diet consisting of solely an amino acid-based (or elemental) products
  • Elimination Diets – The removal of allergens from the diet.
    1. Tailored Elimination – Elimination of specific allergens based on allergy testing
    2. Six Food Elimination – Elimination of 6 top allergens based on the most common allergens seen in EoE patients

The Six Food Elimination Diet

The 6 Food Elimination diet is interesting because it bypasses the need of extensive food allergen testing. As you may know, allergy testing (skin prick tests and blood tests) are not perfect. There are often false positives which can make the treatment plan more complicated and time consuming. So what the 6 Food Elimination diet proposes is that, off-the-bat, patients will eliminate the top 6 allergens seen in EoE patients. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study1 confirms there is a 74% success rate when using this type of nutrition therapy for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies)

Advantages and Disadvantages to consider

The advantages of using this nutrition therapy are that the EoE patients may still eat solid foods. It also eliminates the need for extensive skin and blood tests to check for food allergies. Important disadvantages to this diet therapy are that it may unnecessarily remove foods from the diet. This could increase the risk of the patients’ nutritional status. As some of you may know, it is hard just to remove milk and soy from your diet. Try eliminating 6 different allergens while maintaining your nutritional status! One way to ensure there are no risks for nutritional deficiencies is to supplement the diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®. This will help ensure the patient is getting all the protein and nutrients they need per day while guaranteeing that no allergic reactions will occur upon starting the elemental products. It is vital that EoE patients are monitored by a dietitian. The dietitian will help calculate how much of the elemental product the patient will need per day and also make sure the nutritional status of the patient is maintained.

Again, since there is a 74% success rate, if any symptoms persist after starting the 6 Food Elimination diet, see your doctor, as you may need a more “allergen safe” diet therapy such as an Elemental diet.

I hope this helped to shed some light on this nutritional therapy option for EoE. Every person will have their own treatment plan that works for them. Is anyone doing an Elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?


1 Kagawalla AF et al, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006:4(9):363-8

Read Comments (10)

  • 2012-08-08 | Roger Dudley

    Is it those foods only or foods that are based on those foods?i.e cheese?.Thanks

  • 2012-08-08 | Rob McCandlish, RDN

    Hi Roger,

    Great question. Generally, it’s those foods and any products that have ingredients derived from those foods. That’s because they can still contain the proteins, which are the root trigger for EoE symptoms. Here’s the link to our YouTube video that explains elimination diets in a nutshell:


    As always, we’d suggest checking with your healthcare team, in case they have specific recommendations.

  • 2013-04-04 | Melanie Hohman

    My son has severe food allergies, and while I was nursing him, we gave him Neocate which was extremely helpful.  It provided him where I couldn’t.  We then opened an allergy-friendly bakery called Sensitive Sweets in California.  We make custom cakes for children who are allergic to several foods, like my Bradley.

  • 2013-04-16 | Christine Graham-Garo

    Dear Melanie,
    So happy to hear that Neocate helped your son. It is soo amazing you started the bakery. What a great idea!  Do you have a website for the business? We would love to know more about it.
    PS. I really like the name of the bakery!

  • 2013-04-22 | Cecily R Bornemann

    My dr. just told me today that I need to be on this elimination diet.  It seems hard and I looked at everything I have in my house and I have a lot of things with Soy and Wheat in them.  Is there a website that you know of that offers meal planning for this diet?  I do have a dietician but I haven’t heard back from her about her helping me do this.

  • 2013-04-29 | kenny h.

    Maybe you guys can help me out or point me ibm the right direction. My niece has some health issues. The Dr. Say she has eoe. They have put her on med and she quite taking them cause of the suicidal effects of the med. They recently put her on this diet but its not working. She constantly in pain good days she’s on a 6 pain level. Does this sound like this condition? They really haven’t giving her a 100% diagnosis of EOE.

  • 2013-05-06 | Christine Graham-Garo

    Dear Cecily,
    Try starting here: https://web.emmes.com/study/cofar/EducationProgram.htm

    This webstie offers nice tools to help you get started. As far as a meal plan, I do not know where to find an apporpriate one. Usually working with your dietitian, he/she can construct one for you that fits your family’s preferences and lifestyle. Hopefully working with your RD will help with this. Best wishes!

  • 2013-05-06 | Christine Graham-Garo

    Dear Kenny,
    I would refer to your doctor for this. Have they scoped/taken a biopsy of her esophagus. That is usually the very first step to get a proper diagnosis of EoE. I would also recommend you see a Registered Dieitian for the elimination diet as they can help with the diet plan to ensure the allergens are being removed properly while maintaining nutrition status. The condiditon usually has symptoms of chest pain, vomiting, ect. See this website to learn more: http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis.aspx 
    I wish your family the best. I hope they get a solid diagnosis soon.
    Kindest wishes,

  • 2013-09-12 | Sarah N

    Hi, My daughter was recently diagnosed with EoE after an endoscopy.  Although skin allergy tests showed no known allergies, her GI suggested eliminating dairy anyway.  It helped a lot!!!  She cannot have any dairy or milk proteins whatsoever or she has stomach pain within a few days.  She is much better but not completely well.  It looks like we are going to have to do this elimination diet or at the very least, trial and error with another category like soy or eggs or wheat.  Those seem more likely based on the stats.  We are willing to try anything so she gets well for good.  This has been a difficult process but at least now we know she has EoE and that’s a start.

  • 2013-09-24 | Christine Graham-Garo

    Dear Sarah,
    Glad to hear taking out the milk has helped her feel better. Hopefully the elimination diet will go smoothly. It makes it much easier for everyone when there is an actual diagnosis. Then you can plan better and have a set goal to work towards!  Best wishes for your whole family. As always, if there are any questions about the diet or any of our products, feel free to call us at 1-800-Neocate. We are happy to help!

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