Eosinophilic Esophagitis (EoE) is a condition that is continuing to get more and more attention in the medical community, which means the public is learning more about it too. Management of EoE can be done either with medication or nutrition. Medications have known long-term side effects. Nutritional management has been shown extremely effective, but may be difficult to follow for some families.
Medications used to manage EoE are all steroids. To date, no medication for eosinophilic esophagitis has FDA approval. Steroids have been shown to be effective in managing EoE for more than half of patients. However, steroids may not be the best long-term solution for everyone. Many families who choose to use steroids may mix the medication recommended by their physician with Neocate Nutra. This is because Neocate Nutra thickens, so can help to coat the esophagus with the steroid. This use of Neocate Nutra was even studied by a medical team and you can read about their published research.
This research has concluded that Neocate Nutra is an effective and palatable mixing agent to create a thick budesonide mixture for families who prefer not to use the recipe that calls for a powdered artificial sweetener. The cost of the mixture when using an artificial sweetener vs. Neocate Nutra is comparable.
Nutritional Management Options for Eosinophilic Esophagitis
As EoE is a chronic condition, management with nutrition is often discussed and preferred by many families over steroids. Here are nutritional management options for EoE:
- Elemental Diet – A diet consisting almost exclusively of amino acid-based (or elemental) products.
- Elimination Diets – The removal of allergens from the diet.
- Tailored Elimination – Elimination of specific allergens based on allergy testing
- 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 has been gaining in popularity because it bypasses extensive food allergen testing needed for the Tailored Elimination diet. As you may know, allergy tests (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, and some allergens may be missed (‘false negatives’). So what the 6 Food Elimination diet proposes is that, off-the-bat, patients eliminate the top 6 food allergens. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study1 found a 74% success rate when using this type of nutrition management for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies.) Researcers are also looking into 4 Food Elimination diets.
Advantages and Disadvantages to consider
The advantages of using the 6 Food Elimination diet approach are that you can 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 management are that it may unnecessarily remove foods from the diet, and many process foods are out, meaning the diet often involves a lot of preparation and careful reading of ingredient lists.
Eliminating so many foods can increase the risk of patients being deficient in one or more nutrients. Also, as many of you may know, it is hard just to remove milk and soy from your diet. Try eliminating SIX different allergens that are found in many foods while maintaining your nutritional status! For this reason, many medical teams that manage patients with EoE encourage their patients to supplement the 6 Food Elimination diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®.
Supplementing with formula can help ensure the patient is getting all the protein, vitamins and minerals they need per day while ensuring that no allergic reactions will occur with 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.
Research has found a 74% success rate for the 6 Food Elimination diet. It’s possible that symptoms will persist after starting the 6 Food Elimination diet. If this happens, your medical team can help you decide the next best step. This may include a careful review of your diet, possibly eliminating more foods, or starting with a more “allergen safe” diet management such as an Elemental diet. After a few weeks on the Elemental diet, most teams will work with you to start reintroducing solid foods to figure out which ones may be contributing to your symptoms.
I hope this helped to shed some light on this nutritional management options for EoE. Every person will have their own treatment plan that works for them. Is anyone following an elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?