What foods should you avoid if you have eosinophilic colitis?

October 5, 2025 •

4 min read

According to studies, eosinophilic colitis is often triggered by food allergies, with common culprits being milk, soy, and eggs. Knowing what foods should you avoid if you have eosinophilic colitis is key to managing symptoms, reducing inflammation, and improving overall gut health.

Quick Summary

Eosinophilic colitis often requires dietary changes to manage symptoms. Common trigger foods include dairy, wheat, soy, eggs, nuts, and seafood. An elimination diet can help identify specific triggers, which vary among individuals. Consulting a healthcare provider or dietitian is crucial before beginning any dietary treatment.

Key Points

Common Triggers: The most common foods to avoid with eosinophilic colitis include dairy, wheat, soy, eggs, fish/shellfish, and nuts, often targeted through a six-food elimination diet (6FED).
Elimination Diet Strategy: An elimination diet involves removing potential trigger foods for 6-12 weeks, followed by a reintroduction phase to pinpoint the specific food(s) causing the inflammation.
Personalized Triggers: While common allergens exist, individual triggers can vary widely, and not everyone will react to all six foods.
Elemental Diet Option: For severe or persistent cases, an elemental diet using amino-acid formulas might be necessary to achieve remission.
Read Food Labels: Carefully check all food labels for hidden ingredients from trigger food groups, such as casein (dairy) or soy flour (soy).
Consult a Professional: Always work with a gastroenterologist and a dietitian to properly and safely manage your diet and nutrient intake.

Understanding the Link Between Food and Eosinophilic Colitis

Eosinophilic colitis (EC) is a form of eosinophilic gastrointestinal disorder (EGID) characterized by inflammation of the large intestine caused by an accumulation of eosinophils. Unlike typical food allergies, which cause an immediate reaction, EGIDs often involve a delayed allergic response, making food triggers challenging to identify without a structured approach. For many individuals, dietary modification is a central component of managing the condition and can lead to significant symptom improvement.

The Six-Food Elimination Diet (6FED)

For many years, the six-food elimination diet (6FED) has been the gold standard for identifying and treating food triggers in EGIDs. This approach involves the complete and temporary removal of the six most common food allergens, which are:

Dairy products (including milk, cheese, and yogurt)
Wheat (and sometimes all gluten-containing grains like barley and rye)
Soy (including soy milk, tofu, and edamame)
Eggs
Fish and Shellfish
Peanuts and Tree Nuts

After a period of 6 to 12 weeks on the elimination diet, your doctor will perform a follow-up endoscopy to check for reduced inflammation. If the colon has healed, food groups are reintroduced one by one, with follow-up endoscopies to pinpoint the exact culprit.

Common Culprit Foods to Avoid

While the 6FED is a comprehensive starting point, trigger foods can vary widely between individuals. However, some foods are more commonly implicated in causing flares. Here is a breakdown of the most frequent triggers and considerations for avoiding them.

Dairy Products

Cow's milk protein is one of the most common triggers for eosinophilic gastrointestinal diseases. Avoiding dairy means eliminating all milk-based products, including cheese, butter, yogurt, and products containing milk solids or casein. Plant-based alternatives, such as oat, rice, and nut milks (if tolerated), can be used as substitutes.

Wheat and Gluten

Wheat is another frequent trigger and is often eliminated alongside other gluten-containing grains like barley and rye, although some patients only react to wheat itself. Avoiding wheat involves more than just bread and pasta; it requires careful label reading to avoid hidden sources in sauces, soups, and processed foods.

Soy

Soy is a common allergen and can be a significant trigger for some with EC. This requires avoiding soy milk, tofu, edamame, and other soy-based products. Check food labels for ingredients like soy lecithin, textured vegetable protein (TVP), and soy flour.

Eggs

Eggs are a major allergen and are frequently removed during an elimination diet. Remember that eggs can be hidden in baked goods, sauces, and dressings. A variety of egg substitutes are available for cooking and baking.

Nuts

Peanuts and tree nuts (such as almonds, cashews, and walnuts) are included in the 6FED. Although less common triggers for some than dairy and wheat, they are essential to eliminate initially. Seeds like sunflower and pumpkin seeds are often tolerated as alternatives.

Seafood

Both fish and shellfish are part of the initial elimination phase. This includes all types of fish, crustaceans, and mollusks.

Comparison of Elimination Diet Approaches

Different dietary strategies exist for managing EC, ranging from highly restrictive to more targeted approaches. Here is a comparison of some of the most common methods:


Feature	Six-Food Elimination Diet (6FED)	Step-Up Approach	Elemental Diet
Initial Foods Eliminated	Dairy, wheat, soy, eggs, nuts, and seafood.	Starts with the most common culprits, usually dairy and wheat (2FED).	All solid foods removed; nutrition from an amino-acid based formula.
Restrictiveness	Very high, requires strict label reading and meal planning.	Lower initial restriction, but increases if symptoms persist.	The most restrictive, requiring replacement of all food intake.
Effectiveness	High rate of remission in both children and adults when done properly.	Can be as effective as 6FED for many, but may require more endoscopies to find the right combination.	Highly effective, especially for severe cases, with remission rates up to 90%.
Patient Compliance	Can be challenging due to the restrictive nature and time commitment.	Generally higher compliance due to less initial restriction.	Very low compliance due to poor taste and lifestyle disruption; often a last resort.

How to Manage Your Diet and Identify Triggers

Working with a healthcare provider, such as a gastroenterologist and a registered dietitian, is crucial when navigating an elimination diet. They can help you create a balanced meal plan that avoids potential triggers while ensuring you receive all necessary nutrients. Here are some steps for a successful elimination process:

Read Labels Meticulously: Ingredients can be hidden in unexpected products. Familiarize yourself with all the names for the foods you are avoiding (e.g., casein for dairy, soy flour for soy).
Keep a Food and Symptom Diary: This helps you and your doctor track progress and identify specific reactions during the reintroduction phase.
Reintroduce Foods Methodically: During the food challenge phase, reintroduce one food at a time, with a waiting period (typically a week or two) in between to monitor for any delayed symptoms.
Look for Alternatives: Experiment with safe food substitutes to maintain a varied diet. For example, use rice or corn-based products instead of wheat, or choose nut-free spreads.

Conclusion

Managing eosinophilic colitis involves a careful, personalized approach to diet. Identifying and avoiding food triggers, most commonly dairy, wheat, soy, eggs, nuts, and seafood, is essential for reducing inflammation and alleviating symptoms. The six-food elimination diet is a proven strategy, though other step-up or elemental diets may be appropriate depending on the individual's needs. The key is to work closely with a healthcare team to create a sustainable plan that supports your digestive health and quality of life.

Disclaimer: This article provides general information and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment related to your specific health conditions.

Frequently Asked Questions

While triggers can vary, studies show that cow's milk (dairy) is one of the most common food triggers for eosinophilic gastrointestinal disorders.

A six-food elimination diet (6FED) is a therapeutic strategy that removes the six most common food allergens—dairy, wheat, soy, eggs, peanuts/tree nuts, and fish/shellfish—to help reduce eosinophilic inflammation.

Typically, an elimination diet is followed for 6 to 12 weeks. After this period, an endoscopy is performed to assess whether inflammation has decreased.

No. Many commercially available food allergy tests are not reliable for identifying the specific, delayed food sensitivities that trigger eosinophilic conditions. A medically supervised elimination diet with endoscopies is the most accurate method.

If symptoms persist on a 6FED, a healthcare provider might consider other dietary interventions, such as an elemental diet, or explore other treatment options.

An elemental diet is the most restrictive approach, where all food is replaced by a special amino-acid formula. It is often used for severe cases or when other elimination diets fail.

No. The goal of the elimination diet is to identify your specific triggers. Once identified, you only need to avoid the food(s) that cause your symptoms, though lifelong avoidance may be necessary for some.