Dietary Strategies: What Is the Diet for Hypereosinophilic Syndrome?

October 15, 2025 •

4 min read

While there is no single diet for everyone with hypereosinophilic syndrome, dietary strategies are a critical component of managing eosinophilic gastrointestinal diseases. A personalized diet focuses on identifying and eliminating food triggers to reduce inflammation caused by an overabundance of eosinophils in the body.

Quick Summary

Different dietary approaches, like elimination and elemental diets, can help manage hypereosinophilic syndrome symptoms by identifying and removing food triggers. Consulting a healthcare professional or registered dietitian is crucial for creating a safe and effective dietary plan tailored to individual needs.

Key Points

Elimination Diets: Systematically remove common food allergens like milk, wheat, soy, and eggs to identify and avoid triggers for HES-related inflammation.
Elemental Diet: In severe cases, a diet of amino acid-based formulas can be used to treat HES and induce remission by completely removing food protein triggers.
Individualized Approach: The best diet depends on the individual's specific food triggers, which can vary greatly, making a personalized plan essential.
Nutritional Guidance: Working with a registered dietitian is crucial to prevent nutritional deficiencies that can occur with restrictive elimination diets.
Common Triggers: Cow's milk and wheat are among the most frequently identified food triggers for eosinophilic conditions.
Supportive Foods: An anti-inflammatory diet rich in fruits, vegetables, lean proteins, and healthy fats can support overall health.

Understanding the Role of Diet in Hypereosinophilic Syndrome (HES)

Hypereosinophilic syndrome (HES) is a group of rare disorders characterized by a persistent increase in eosinophils, a type of white blood cell, in the blood and other tissues. When these cells accumulate in organs like the gastrointestinal tract (EGIDs), they cause inflammation and damage. While diet is not a cure, it is a key management strategy, particularly for patients with EGIDs, as food allergies and sensitivities are known to provoke immune responses and drive the disease.

Common Dietary Approaches for Managing HES

Dietary therapy is an evidence-based method to help reduce inflammation in eosinophilic conditions. Several approaches may be recommended, often starting with the least restrictive option and progressing as needed under medical supervision.

Empirical Elimination Diets: These diets remove the most common food allergens regardless of allergy testing results. The goal is to see if symptoms improve. If they do, foods are reintroduced one by one to identify the specific triggers. Common options include:
- Six-Food Elimination Diet (6FED): This involves removing milk, soy, wheat, eggs, peanuts/tree nuts, and fish/shellfish for about six weeks. This has shown success in a high percentage of patients.
- Four-Food Elimination Diet (4FED): A less restrictive option that targets the most frequent culprits: cow's milk (dairy), soy, eggs, and wheat.
- One-Food Elimination Diet (1FED): Focusing on removing just one food, typically milk, which is a major trigger for many.
Elemental Diet: In severe cases or when elimination diets fail, an elemental diet may be used. This involves consuming nutritionally complete, amino acid-based formulas instead of whole foods for a period of weeks. Since amino acids are the basic building blocks of protein, they do not trigger allergic reactions like whole proteins do.
Targeted Elimination Diet: This is a personalized diet plan based on specific food triggers identified through allergy testing. However, allergy testing is not always reliable for these conditions, so empirical elimination is often the preferred starting point.

Foods to Avoid and Foods to Embrace

While trigger foods vary by individual, there are general categories to be mindful of during an elimination phase. Conversely, an anti-inflammatory diet rich in certain nutrients can support overall health and immune function.

Trigger foods often implicated in HES

Dairy: Cow's milk is a very common trigger.
Wheat/Gluten: Wheat and gluten-containing products can be a source of inflammation.
Eggs: A frequent allergen that is often eliminated.
Soy: Soy and soy products are a common trigger.
Nuts and Seafood: Peanuts, tree nuts, fish, and shellfish are also common triggers.
Processed Foods: Artificial additives and preservatives can worsen inflammation.

Foods to include in your diet

Fruits and Vegetables: A variety of colorful, fresh produce provides antioxidants and essential vitamins.
Lean Proteins: Sources like skinless poultry, certain fish, tofu, and legumes are good options.
Gluten-Free Grains: Alternatives to wheat like quinoa, brown rice, and millet are often well-tolerated.
Healthy Fats: Avocados, olive oil, and seeds can offer anti-inflammatory benefits.
Herbs and Spices: Turmeric and ginger have natural anti-inflammatory properties.

Comparing Elimination Diet Approaches


Diet Type	Common Foods Excluded	Pros	Cons
Elemental Diet	All whole foods; rely on amino acid formulas	Highly effective in inducing remission; avoids all food protein triggers	Very restrictive; requires medical supervision; long-term use can be challenging
6-Food Elimination	Milk, soy, wheat, egg, nuts, fish/shellfish	High rate of remission (~70-74%); identifies specific triggers upon reintroduction	Highly restrictive initially; requires multiple endoscopies during reintroduction phase
4-Food Elimination	Milk, soy, egg, wheat	Less restrictive than 6-FED; easier to follow	Lower remission rate than 6-FED; may not identify all triggers
1-Food Elimination	Milk	Least restrictive empirical diet; similar efficacy to 6-FED in some adults	May not be effective if other triggers are present; requires endoscopy to confirm results

Practical Tips for Managing Your HES Diet

Beyond simply avoiding certain foods, effective dietary management requires a strategic approach and support. It is crucial to work with a healthcare team, including an allergist and a registered dietitian, to ensure you meet nutritional needs while managing your condition.

Keep a Food Diary: Track everything you eat and any symptoms that arise to help pinpoint specific food triggers.
Stay Hydrated: Especially for those with gastrointestinal symptoms, adequate hydration is key. Smoothies and soups can help if swallowing is difficult.
Read Labels Carefully: Cross-contamination and hidden ingredients, particularly in processed foods, can cause reactions.
Plan Ahead: Meal prep can help ensure compliance and reduce the stress of finding safe food, especially at social events.
Understand Cross-Contamination: Be aware of food handling, particularly when dining out, to prevent exposure to triggering ingredients.

Conclusion

For individuals dealing with hypereosinophilic syndrome, particularly those with EGID involvement, diet is a powerful tool for managing symptoms and reducing inflammation. The journey to finding the right diet is highly individualized and often involves systematic elimination and reintroduction under the guidance of a medical professional. While a six-food elimination diet is common, a less restrictive one- or four-food diet, or even an elemental diet, may be appropriate depending on the patient's specific needs and severity of the condition. Always remember that any dietary modification should be part of a comprehensive treatment plan supervised by your healthcare team.

Frequently Asked Questions

The most effective diet is highly personalized. Elimination diets (like 6FED or 4FED) or, in severe cases, an elemental diet are common options. The most successful approach identifies and removes the specific food triggers for that individual, a process best guided by a healthcare professional.

Food triggers are often identified through an empirical elimination and reintroduction process. You remove common allergens (like milk, wheat, soy, eggs, nuts, and seafood) for a set period, then reintroduce them one by one while monitoring symptoms and conducting biopsies to see which foods cause inflammation.

While no single food can guarantee a reduction, an anti-inflammatory diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats can support the immune system. Some spices like turmeric and ginger have anti-inflammatory properties that may be beneficial.

The 6FED is a dietary approach that removes six of the most common food allergens: milk, soy, wheat, eggs, peanuts/tree nuts, and fish/shellfish. It is often used for a trial period (e.g., 6-8 weeks) to see if symptoms improve, followed by a reintroduction phase.

An elemental diet consists of nutritionally complete formulas made from amino acids, the simplest form of protein. It is used when other diets fail or for severe cases, as it ensures no food proteins are consumed that could trigger an allergic reaction and inflammation.

Yes, hidden allergens and cross-contamination can occur frequently, especially in processed foods, packaged goods, and restaurant meals. Reading labels carefully and being vigilant about food preparation is critical, particularly during an elimination phase.

Standard allergy skin prick testing is not always reliable for identifying food triggers in eosinophilic gastrointestinal diseases. This is why empirical elimination diets, which use patient response and biopsies as the ultimate indicator, are often the preferred diagnostic method.