What is the Sfed diet? A Therapeutic Guide to the Six-Food Elimination Diet

October 4, 2025 •

3 min read

According to the American Gastroenterological Association, the six-food elimination diet (SFED) has shown success in approximately 70% of patients with eosinophilic esophagitis (EoE), an immune-mediated inflammatory condition. So, what is the Sfed diet and how is it used to manage the inflammatory response triggered by certain food groups? This article explores the purpose, process, and implications of this specialized nutritional approach.

Quick Summary

The SFED is a medical nutrition therapy used to identify and remove specific food triggers for eosinophilic esophagitis by eliminating six common food groups in a multi-phased approach.

Key Points

Purpose: The SFED is a medical nutrition therapy primarily used to identify food triggers for eosinophilic esophagitis (EoE) by systematically eliminating common allergens.
Eliminated Foods: The diet removes the six most common food allergens: milk, wheat, soy, eggs, peanuts/tree nuts, and fish/shellfish.
Two-Phase Process: It consists of a strict elimination phase (4-8 weeks) to allow healing, followed by a careful reintroduction phase to test for triggers.
Medical Supervision Required: Due to its restrictive nature and the need for repeated endoscopies, the SFED must be overseen by a medical team, including a gastroenterologist and a dietitian.
Alternative to Medications: For many, the SFED offers an effective non-pharmacological approach to managing EoE and its associated symptoms like difficulty swallowing and chest pain.
Compliance Challenges: The diet is notoriously difficult to maintain long-term due to its social and planning challenges, and potential nutritional risks exist without proper guidance.

What is the Sfed Diet and Its Primary Purpose?

The six-food elimination diet, or SFED, is a highly structured dietary intervention primarily used to manage eosinophilic esophagitis (EoE), a chronic inflammatory allergic disease of the esophagus. It involves removing the six most common food allergens for a period, followed by systematic reintroduction to identify triggers. Unlike traditional allergy tests, which are often unreliable for EoE, the SFED empirically targets likely triggers.

The Two Phases of the SFED

The SFED has two phases: elimination and reintroduction. Both require supervision from healthcare professionals like a gastroenterologist and a registered dietitian.

Phase 1: Elimination

This phase removes the following six food groups for about six to eight weeks:

Milk and dairy products
Wheat and other gluten-containing grains
Soy and soy products
Eggs and egg-containing foods
Peanuts and tree nuts
Fish and shellfish

The goal is to allow the esophagus to heal and symptoms to improve. Strict adherence, including checking for hidden ingredients and preventing cross-contamination, is necessary.

Phase 2: Reintroduction

After the elimination phase, an endoscopy with biopsies is performed. If inflammation has subsided, food groups are reintroduced one at a time over weeks, with endoscopies to check for returning inflammation. This process helps identify specific food triggers.

Navigating the SFED

Following the SFED requires careful planning. Reading food labels is crucial due to hidden ingredients. Focusing on whole, unprocessed foods and home cooking is recommended. Keeping a food and symptom journal is helpful for tracking reactions during reintroduction.

Foods to enjoy on the SFED include:

Safe Grains: Quinoa, rice, millet, buckwheat, corn, and teff.
Allowed Proteins: All meats, legumes (excluding soy), and seeds.
Fruits and Vegetables: All fresh, canned, frozen, or dried fruits and vegetables.
Fats and Oils: Avocado oil, olive oil, coconut oil, grapeseed oil, seeds, and seed butters.
Beverages: Water, coffee, tea, and alternative milks like rice or coconut milk.

Comparison of SFED with Other Elimination Diets

Other elimination diets are used for EoE, but the SFED is the most comprehensive empiric approach.


Feature	Six-Food Elimination Diet (SFED)	Four-Food Elimination Diet (FFED)	Targeted Elimination Diet (TED)
Eliminated Foods	Dairy, wheat, soy, egg, nuts, fish/shellfish	Dairy, wheat, egg, soy	Foods identified by allergy testing
Primary Use	Empiric treatment for EoE	Alternative for increased dietary adherence	Based on inconclusive skin prick testing
Dietary Burden	Very restrictive, high burden	Less restrictive than SFED	Least restrictive, but less effective
Effectiveness	High success rate, around 70% of patients	High rates, similar to SFED in some studies	Low effectiveness, especially in adults
Monitoring	Requires multiple endoscopies for reintroduction	Fewer endoscopies may be possible	Less reliable, can miss triggers

Potential Benefits and Challenges of the SFED

Benefits

Reduced Inflammation and Symptoms: Decreases esophageal eosinophil counts and improves symptoms.
Accurate Food Trigger Identification: Provides a definitive diagnosis of food triggers.
Non-Pharmacological Treatment: Offers a dietary alternative to medications.

Challenges

Nutritional Risks: Restrictive nature can lead to deficiencies without dietitian guidance.
Adherence Issues: Difficult to follow long-term.
Need for Multiple Endoscopies: Requires several invasive procedures.
Time Commitment: The process often takes months.

Conclusion

The SFED is an effective tool for managing eosinophilic esophagitis by identifying and eliminating specific food triggers. While challenging due to its restrictive and time-intensive nature, it can reduce inflammation, alleviate symptoms, and clarify dietary triggers. It should be undertaken with close medical supervision to ensure nutritional adequacy and proper disease management. Adherence is critical for success.

For more information on digestive health conditions like EoE, visit the American Gastroenterological Association's patient resource center(https://patient.gastro.org/six-food-elimination-diet-sfed/).

Frequently Asked Questions

SFED stands for Six-Food Elimination Diet, a therapeutic dietary approach used primarily to manage symptoms of eosinophilic esophagitis (EoE).

EoE is a chronic allergic inflammatory disease where a type of white blood cell, the eosinophil, builds up in the esophagus, leading to pain, difficulty swallowing, and other symptoms.

The six food groups eliminated on the SFED are milk/dairy, wheat, soy, eggs, peanuts/tree nuts, and fish/shellfish.

The elimination phase typically lasts six to eight weeks. The reintroduction phase can take several more months as each food group is reintroduced and monitored one at a time.

No, the SFED should not be attempted without medical supervision from a doctor and a dietitian. The process involves multiple endoscopies and strict dietary management to ensure safety and effectiveness.

Studies have shown that the SFED is effective for a significant number of patients, with some reports indicating success rates around 70% in reducing inflammation and symptoms.

Major challenges include the highly restrictive nature of the diet, the difficulty of managing meals in social settings and at restaurants, and the potential for nutritional deficiencies if not properly managed.