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Your Guide to Eosinophilic Esophagitis

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6 Foods to Avoid with Eosinophilic Esophagitis

Medically Reviewed By William C. Lloyd III, MD, FACS

One of the main eosinophilic esophagitis (EoE) triggers is food allergens. An effective way of managing EoE is changing your diet to determine which foods cause symptoms. Some of the most common food triggers are milk products, eggs, wheat, soy, peanuts and tree nuts, and seafood.

dairy products high in fat milk, butter and cheese

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition that can make it harder to swallow and easier for food to get stuck in the esophagus, the tube that carries food from your mouth to your stomach. With EoE, when you eat certain foods, your immune system will mount an allergic reaction, creating inflammation in the esophagus that can cause it to swell and narrow. Specific foods can make EoE worse, so your doctor may recommend you try removing problematic foods from your diet, at least temporarily, so you can identify your triggers and avoid symptoms. Often, this trial-and-error process is known as the six food elimination diet.

Common culprits for EoE

Six types of food tend to trigger an allergic reaction that worsens EoE symptoms:

  • Dairy products: This can include not just cow’s milk, but also foods like butter, cheese, cream, half and half, and yogurt. You should avoid anything with milk ingredients, such as casein, rennet casein, diacetyl, lactalbumin, lactose, lactulose, recaldent, tagatose, and whey.
  • Eggs: Make sure to stay away from anything made with eggs, like mayonnaise or meringue. Be especially aware of any baked goods or puddings, since it’s most likely eggs are in the ingredients list. On the label, look out for albumin, lysozyme, ovalbumin, lecithin, globulin, and ovovitellin.
  • Wheat: Avoid anything made with wheat, like bread, crackers, pasta, and pizza. You can likely eat gluten-free foods made from potato, rice, or tapioca. Be careful of wheat-containing ingredients like bulgar, durum, einkorn, emmer, farina, kamut, matzoh, semolina, spelt, or triticale.
  • Soy: Foods to avoid include edamame, miso, soy sauce, and tofu. Be cautious about eating plant-based meat replacements like veggie burgers and products that include textured vegetable protein.
  • Peanuts and tree nuts: All nuts may be off-limits, but seeds are generally safe to eat. Anything that contains nut milk, nut extracts, nut meal, or peanut oil should also be avoided.
  • Fish, including shellfish: Avoid any kind of fish. Shellfish are a part of this, too, which includes shrimp, crayfish, crab, lobster, scallops, oysters, mussels, and others.

The six food elimination diet

Many people with EoE try the six food elimination diet, in which you remove all of these foods from your diet for 6 to 8 weeks, and then slowly reintroduce one item at a time. Your doctor will create a plan for this process and guide you along the way. A few weeks after adding an item back into your diet, your doctor will perform an endoscopy to examine your esophagus and determine if inflammation has improved.

Your doctor may advise you to consult with a registered dietitian or nutritionist to ensure you’re getting adequate nutrition and guidance during what can be a long and challenging experience. If eliminating all six foods at once is too difficult, ask your doctor about the step-up elimination diet, an alternative that involves eliminating two foods at a time instead of all six.

It can be hard to give up foods you love, short-term or long-term, but there are still plenty of tasty options to be discovered and enjoyed.

The list of foods that are typically fine for people with EoE is extensive, and includes:

  • meat, like chicken, turkey, pork, and beef
  • white, brown, and wild rice
  • white and sweet potatoes
  • quinoa, buckwheat, and millet
  • fruits and vegetables
  • olive, sunflower, and canola oil

EoE can be difficult to live with, but with the right tools, you can feel empowered to take the next step of talking with your doctor about how your diet may need to change.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 May 19
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