A high count of eosinophils, a type of white blood cell, is often a marker of allergic and inflammatory conditions, particularly those affecting the gastrointestinal tract, such as Eosinophilic Esophagitis (EoE). While the exact trigger can vary by individual, a common strategy is to eliminate the foods most frequently associated with these reactions to identify specific triggers.
The Six-Food Elimination Diet (SFED)
For many people with eosinophilic disorders, especially EoE, a six-food elimination diet (SFED) is a cornerstone of management. This diet removes the most common food allergens, which are known to drive inflammation in the esophagus and other parts of the digestive system. These six food groups are:
- Dairy: This includes cow's milk, cheese, yogurt, and other products containing milk proteins like casein and whey.
- Wheat: Found in bread, pasta, cereals, and many processed foods, wheat contains gluten, a common trigger.
- Eggs: The proteins in eggs can cause inflammation.
- Soy: Soybeans, soy milk, tofu, and other soy products are common culprits.
- Nuts: This category includes both peanuts and tree nuts (such as almonds, cashews, and walnuts).
- Fish and Shellfish: Both types of seafood can provoke an allergic response.
This diet is typically followed for a period of 6 to 8 weeks, after which foods are reintroduced one at a time to monitor for symptoms.
Understanding Common Food Triggers in Detail
Understanding the specific components within these food groups is essential for a successful elimination diet. Cross-contamination and hidden ingredients can cause flare-ups, so vigilance is key.
Dairy Products
Dairy is one of the most common triggers for eosinophilic conditions, especially in children. It's crucial to read labels, as dairy-derived ingredients like whey and casein can be hidden in many processed foods. For alternatives, consider fortified plant-based milks such as almond, oat, or coconut milk, ensuring they are free of any other potential triggers.
Wheat and Gluten
While wheat is a major trigger, for some, the issue may be gluten, a protein found in wheat, barley, and rye. Choosing certified gluten-free products is important, as regular oats are often cross-contaminated with wheat. Suitable alternatives include rice, quinoa, and other gluten-free grains.
Eggs and Soy
Eggs are a potent allergen and must be avoided entirely when on an elimination diet. Soy can be found in many processed goods, sauces, and even some vegetarian products, so careful label reading is required. Alternative options for eggs in baking include applesauce or ground flaxseed, while soy can be substituted with legumes or seed butters, depending on individual tolerance.
Nuts and Fish
Nuts, both peanuts and tree nuts, are common allergens and should be eliminated. Seeds like sunflower and pumpkin seeds are often tolerated and can be used as a substitute. For those avoiding fish and shellfish, protein sources like chicken, beef, or pork are viable alternatives.
Comparison of Common Elimination Diets
| Diet Type | Common Foods Excluded | Efficacy (Children) | Efficacy (Adults) | Common Trigger Foods (Example) |
|---|---|---|---|---|
| 1-Food Elimination (1FED) | Cow's Milk | 50% | 27% | Dairy |
| 2-Food Elimination (2FED) | Cow's Milk, Wheat | 44% | 40% | Dairy, Wheat |
| 4-Food Elimination (4FED) | Cow's Milk, Wheat, Eggs, Soy | 64% | 54% | Dairy, Wheat, Egg, Soy |
| 6-Food Elimination (6FED) | Dairy, Wheat, Eggs, Soy, Nuts, Fish/Shellfish | 73% | 71% | Dairy (most common), Wheat, Egg |
*Note: Efficacy rates are based on studies in eosinophilic esophagitis and may vary.
How to Manage the Diet and Identify Triggers
Working with a healthcare team, including a registered dietitian, is crucial for effectively managing an elimination diet. They can help ensure nutritional needs are met while potential triggers are identified.
The Reintroduction Phase
After the initial elimination period, a planned reintroduction of foods is necessary. Each food group is added back one at a time over a period of weeks, and any return of symptoms is carefully monitored. This process helps pinpoint the specific food or foods causing the reaction.
Other Inflammatory Foods
Beyond the six major allergens, other foods and substances may exacerbate inflammation and should be considered for reduction, including:
- Acidic Foods: Items like tomatoes, coffee, and alcohol can contribute to acid reflux, which can in turn increase eosinophil counts.
- Processed Foods: These often contain trans fats, preservatives, and high sugar content, all of which can increase inflammation.
Conclusion
Managing high eosinophils, particularly in the context of eosinophilic gastrointestinal diseases, often requires a careful, systematic approach to dietary management. For many, this involves an elimination diet focused on avoiding the most common allergens: dairy, wheat, eggs, soy, nuts, and fish/shellfish. By working with a healthcare professional, meticulously tracking food intake and symptoms, and thoughtfully reintroducing foods, individuals can identify their specific triggers and develop a sustainable, symptom-free diet. This targeted approach not only addresses inflammation but can significantly improve quality of life. For further resources, the American Partnership For Eosinophilic Disorders (APFED) offers comprehensive educational materials and support.
Additional Considerations for a High Eosinophil Diet
While elimination diets are effective, long-term adherence can be challenging. A registered dietitian can provide guidance on meal planning and ensure adequate nutrient intake, which is particularly important for children. Additionally, environmental allergens like pollen can also be a factor, so a comprehensive approach is often best.
Hidden Allergens
Be aware of hidden sources of allergens. For example, some processed foods may use whey or casein as thickening agents, and many sauces or spice blends can contain wheat or soy. Always read ingredient labels carefully and ask questions when dining out.
Addressing Nutritional Deficiencies
Highly restrictive diets can sometimes lead to nutritional gaps. A dietitian can help suggest fortified foods and supplements to ensure you are getting all necessary nutrients, such as calcium, vitamin D, and B vitamins, especially if dairy and wheat are eliminated long-term.
