What are the 6 food elimination diets and how do they work?

According to a 2023 study published via PubMed, the six-food elimination diet (6FED) successfully induced remission in over 50% of adult patients with Eosinophilic Esophagitis (EoE), making it a significant therapeutic tool. But what are the 6 food elimination diets, and what do they entail? This approach involves temporarily removing six of the most common food allergens to pinpoint triggers and alleviate symptoms associated with a range of conditions.

Quick Summary

The 6FED is a diagnostic dietary approach that removes dairy, wheat, soy, eggs, nuts, and fish/shellfish to identify food sensitivities and allergies. It involves an elimination phase and a reintroduction phase, often used to manage conditions like eosinophilic esophagitis and IBS under medical supervision.

Key Points

• What are the 6 food elimination diets?: A diagnostic diet removing dairy, wheat, soy, eggs, nuts, and fish/shellfish to identify food triggers for conditions like EoE.

• Elimination Phase: A temporary 4-8 week period where the six target foods are completely removed from the diet to allow symptoms to subside.

• Reintroduction Phase: Eliminated foods are systematically added back one by one to monitor for adverse reactions and pinpoint specific triggers.

• Medical Supervision is Key: Especially for severe symptoms, known allergies, or in children, a doctor or dietitian should oversee the process to ensure nutritional needs are met and manage risks.

• Beyond 6FED: Other elimination diets exist, including low-FODMAP for IBS and less restrictive 2- or 4-food diets for EoE, tailored to specific conditions.

An elimination diet is a diagnostic tool used to identify foods that cause adverse reactions, sensitivities, or allergies. The six-food elimination diet (6FED) is a comprehensive version of this approach, specifically designed to identify triggers for conditions such as Eosinophilic Esophagitis (EoE), a chronic allergic disease of the esophagus. By removing the six most common food allergens, this dietary strategy provides a systematic way to determine which foods, if any, are causing inflammation and discomfort. This article will delve into each of the six food groups removed, explain the process, and provide a comparative overview of different elimination strategies.

The Six Foods Removed on a 6FED

The 6FED targets the most frequently implicated food allergens and involves their complete removal for a period of several weeks. The six food groups include:

• Milk and Dairy: This includes all products derived from cow's milk, such as milk, cheese, yogurt, butter, and whey. Given that it is one of the most common triggers for EoE, eliminating dairy is a cornerstone of this diet.
• Wheat and Gluten-Containing Grains: Wheat is a major allergen and is removed in this diet. It is important to note that this extends beyond bread to many processed foods containing wheat flour, spelt, kamut, and other related grains.
• Soy: A common allergen, soy is found in many products, from soy milk and tofu to soy sauce and vegetable protein fillers. Careful label-reading is essential to avoid hidden soy ingredients.
• Eggs: All forms of eggs and egg-containing products are eliminated, including yolks, whites, and ingredients like mayonnaise. Many prepared foods, sauces, and baked goods contain egg, requiring careful review.
• Peanuts and Tree Nuts: This group includes peanuts (a legume), and a wide variety of tree nuts like almonds, walnuts, cashews, and pecans. Due to the risk of cross-contamination, many people also avoid products with 'may contain nuts' warnings.
• Fish and Shellfish: All fish and shellfish are eliminated, including finned fish like salmon and tuna, and crustaceans and mollusks like shrimp, crab, and clams. Hidden ingredients like fish sauce and oyster sauce must also be avoided.

The Two Phases of the 6FED Process

The 6FED is not a permanent lifestyle change but a short-term process with a clear structure to identify trigger foods. It is typically conducted under the supervision of a healthcare professional, such as a gastroenterologist or registered dietitian, especially for children or those with suspected severe allergies.

Phase 1: Elimination

• This phase lasts for a set period, typically 4 to 8 weeks, during which all six food groups are completely removed from the diet.
• The goal is to allow the body to heal and symptoms to subside, establishing a baseline of relief.
• A food and symptom journal is crucial during this time to track any changes.

Phase 2: Reintroduction

• If symptoms improve during the elimination phase, the food groups are reintroduced one at a time.
• Each food group is tested over a period of several days while monitoring for symptoms.
• If a food group causes symptoms to return, it is identified as a trigger and should be avoided long-term. If no reaction occurs, it is generally considered safe to eat.
• An endoscopy may be performed before and after the elimination phase to objectively measure inflammation in the esophagus for EoE patients.

Comparison of Elimination Diets

The 6FED is one of several elimination diet protocols. Other versions, often used for different conditions, may be less restrictive. Here is a comparison:

Feature	6-Food Elimination Diet (6FED)	Low-FODMAP Diet	4-Food Elimination Diet (4FED)
Primary Purpose	Identify triggers for EoE and food allergies.	Manage symptoms of Irritable Bowel Syndrome (IBS).	Identify triggers for EoE, less restrictive than 6FED.
Foods Eliminated	Dairy, wheat, soy, eggs, peanuts/tree nuts, fish/shellfish.	Fermentable carbohydrates (FODMAPs), including some fruits, vegetables, grains, and dairy.	Dairy, wheat, eggs, and soy/legumes.
Mechanism	Removes the most common allergenic proteins and compounds causing immune reactions.	Reduces poorly absorbed short-chain carbohydrates that ferment in the gut.	Removes the most prevalent EoE triggers based on research showing milk and wheat are most common.
Approach	Top-down: Remove all six major groups, then reintroduce sequentially.	Follows a strict elimination, then challenges specific FODMAP subgroups.	Starts with four common allergens, potentially moving to 6FED if ineffective.
Intensity	High, removing many staple foods.	Moderate, requires detailed label-reading for many hidden FODMAPs.	Moderate, less restrictive than 6FED.

Benefits and Risks of an Elimination Diet

Engaging in an elimination diet can provide valuable insights but is not without considerations. While beneficial, it requires discipline and should ideally be supervised by a healthcare provider to minimize risks.

Potential Benefits

• Symptom Reduction: Can significantly reduce or eliminate symptoms of conditions like EoE, IBS, migraines, and skin issues.
• Identify Triggers: Helps pinpoint the exact food(s) responsible for adverse reactions, leading to a personalized and sustainable long-term diet.
• Reduced Inflammation: Removing inflammatory trigger foods can lead to an overall reduction in systemic inflammation.

Potential Risks

• Nutrient Deficiencies: Restricting multiple food groups can lead to inadequate intake of essential nutrients like calcium, fiber, and certain vitamins.
• Disordered Eating: The restrictive nature can sometimes trigger or worsen disordered eating patterns.
• Reactions Upon Reintroduction: In some cases, reintroducing a previously eliminated food can lead to a more severe reaction due to increased sensitivity.

Expert Guidance and Long-Term Strategy

Successfully completing an elimination diet requires a strategic, methodical approach. Consultation with a healthcare provider is essential, particularly when dealing with suspected allergies or complex health issues. A dietitian can help create a balanced meal plan that provides adequate nutrition and guidance during the reintroduction phase. The long-term goal is not endless restriction, but a customized, sustainable diet based on identified triggers.

For more information on treating EoE with elimination diets, including the one-food approach, review the findings presented by the National Institutes of Health.

Conclusion

Understanding what the 6 food elimination diets are is the first step for individuals seeking relief from unexplained allergic or inflammatory symptoms. This structured diagnostic tool removes dairy, wheat, soy, eggs, nuts, and fish/shellfish to systematically identify specific food triggers. By following the elimination and reintroduction phases with expert guidance and careful monitoring, it is possible to gain control over symptoms and establish a healthier, personalized dietary regimen. However, the process is intensive and should always be undertaken with professional medical supervision to ensure safety and nutritional adequacy.

Frequently Asked Questions

How long does a 6 food elimination diet take to work?

The elimination phase typically lasts 4 to 8 weeks. If symptoms improve, the reintroduction phase begins, which can take several more weeks as each food group is tested individually.

Do I need to avoid all six foods if I only suspect one is a problem?

For an initial, comprehensive diagnosis like with EoE, all six common allergens are typically removed at once. This ensures that all potential triggers, including less obvious ones, are identified during the reintroduction phase.

What if my symptoms don't improve during the elimination phase?

If symptoms persist after the elimination phase, it may indicate that the trigger is not among the six foods or that other underlying issues are present. In this case, consult your doctor for a re-evaluation.

Can I do a 6FED without a doctor's help?

While some people do it independently, it is highly recommended to seek medical supervision. A doctor or dietitian can ensure nutritional needs are met and provide guidance, especially concerning the reintroduction of potentially allergenic foods.

What is the difference between a food allergy and a food sensitivity?

A food allergy is a severe, often immediate immune response, while a food sensitivity or intolerance can cause delayed or less severe symptoms like bloating or fatigue. Elimination diets help identify both types of reactions.

How can I ensure I get enough nutrients on a restrictive diet?

A dietitian can help create a balanced meal plan with substitutions. For instance, using fortified dairy-free milks and other alternative proteins can help prevent deficiencies.

What is the next step after identifying my trigger foods?

After identifying trigger foods through reintroduction, the long-term goal is to maintain a sustainable diet that avoids those specific triggers. A doctor or dietitian can help develop a personalized eating plan.