What To Eat and What Not To Eat
Eosinophilic Esophagitis (EoE) is a chronic immune condition causing inflammation of the esophagus, the tube the connects the mouth to the stomach. Those with EoE may discover specific foods that worsen the condition. If left untreated, EoE can cause esophageal strictures and fibrosis, leading to serious health consequences. This article reviews EoE from a dietary standpoint to help answer the question, "What should I eat (or not eat) if I have Eosinophilic Esophagitis?"
Food Allergy vs. Food Sensitivity
With increasing incidents in physical reaction to foods, many do not understand the difference between a food allergy and a food sensitivity.
A food allergy is an IgE-mediated immune reaction that may result in hives or difficulty breathing and may be life-threatening. Frequent sources of food allergies are nuts, shellfish, and certain fruit. These allergies may be life-threatening and should be managed in conjunction with your physician.
What is a Food Allergy?
- Immediate reaction.
- IgE-mediated immune response.
- May affect several organs.
- Occurs even with the lowest vulnerability to trigger food.
- Happens each time a trigger food is consumed.
- Potential to be life-threatening.
What are Food Allergy symptoms?
- Rapid onset of symptoms
- Flushed skin or rash
- Tingling or tingling sensation in the mouth
- Face, tongue, or lip swelling
- Vomiting and/or nausea
- Abdominal cramps
- Coughing or wheezing
- Dizziness and/or lightheadedness
A food sensitivity is an IgG-mediated immune response that may be associated with unwanted symptoms such as bloating, abdominal pain and pain -- just to name a few. A typical laboratory (like one from Everlywell) test checks for 96 different common food sensitivities and speeds them from Low Reactivity to Top Reactivity. This permits you to better understand how your body reacts to different foods and how you might correct eating habits so.
What is Food Sensitivity?
- Reactions may happen as fast as one hour or up to 48 hours after trigger food is ingested.
- May be accompanied by an IgG-mediated immune reaction.
- A reaction is most commonly dispersed to the digestive tract or intestinal inflammation.
- Occurs when trigger foods have been struck frequently or in massive amounts, but not each time the trigger food is ingested.
- Frequently overlooked or misdiagnosed.
Food Sensitivity Symptoms
- Fuzziness, difficulty thinking
- Dry and itchy skin
- Bloated stomach after ingestion
- Joint pain
- Difficulty losing weight
- Respiratory issues
- Depression and mood swings
- A runny nose
- A headache
- Trouble sleeping
- Dark circles under eyes
What is Eosinophilic Esophagitis (also known as EoE)?
Let's begin with: What are eosinophils? You will find a selection of diseases involving eosinophils known as eosinophilic gastrointestinal diseases (EGID). The most typical type of EGID is eosinophilic esophagitis. Eosinophils may also infiltrate other areas of the gastrointestinal tract such as the stomach, small intestine, and colon.
In those with EoE, eosinophils are found in massive quantities in the esophagus where they do not usually live, and release chemical mediators that promote inflammation. Normally eosinophils protect the entire body, but when raised and found in the incorrect place in the body, their reaction causes injury.
Some consider EoE a specific type of allergy. However, EoE presents differently than classic IgE allergy, and it is a reaction mediated by another kind of white blood cell known as mast cells, not eosinophils. Both Allergists and Gastroenterologists may take part in the identification and care of those with EoE.
EoE prevalence has improved over the past twenty years and allegedly impacts 0.03% of the US population. It is most commonly present in women in comparison to other cultural groups and affects men more than girls. EoE is a lifelong disease that could possibly be handled but doesn't have a cure.
Symptoms of EoE change over an individual's lifespan and might pose as follows:
- Young children-- failure to thrive, gastroesophageal reflux symptoms
- School-aged children-- stomach pain or vomiting
- Elderly adolescents & Adults-- food impaction, dysphagia (difficulty swallowing)
The classic EoE symptoms include:
- Regurgitation (of food or sour fluid)
- Difficulty swallowing
- Choking on food
- Poor digestion
- Poor weight gain/weight loss
Though a number of these symptoms may mimic those of gastroesophageal reflux disorder (GERD), there is an important distinction to remember. Individuals with EoE may trial reflux disease drugs like proton-pump inhibitors (PPIs) such as Prevacid or Nexium with little to no dependence development. A 2-month PPI trial is a part of the EoE diagnosis process, however, a negative PPI reaction doesn't necessarily signal the presence of EoE.
Identification includes a number of data points accumulated by the doctor. A thorough medical history, as well as a 2-month PPI trial and an esophageal endoscopy and biopsy, are part of the workup. The endoscopy reviews the appearance of the esophagus such as the existence of eosinophils. Additionally, the biopsy must show >15 eosinophils per high-powered field (HPF) in the absence of other causes.
Average IgE-mediated food allergy ends in symptoms such as hives, swelling, vomiting, diarrhea, stomach pain and at times anaphylaxis. EoE symptoms only impact the esophagus; therefore, appears quite different than an allergy. However, approximately 50 percent of people with EoE have environmental and food allergies and should be tested to rule this out.
Many times, the most common food allergens will be the same foods that trigger EoE.
What Diet Should You Follow If You Have Eosinophilic Esophagitis (EoE)?
Together with topical steroids and dilation, diet therapy is the first-line therapy for those who have EoE. But, this question is somewhat complex.
Some with EoE have food allergies, while others don't. It is vital to eliminate all positively identified food allergies in the diet. Even if IgE food allergies test negative, preventing certain foods helps improve symptoms. Within this scenario, endoscopy findings frequently show no change in inflammation on evaluation. This finding could translate to imply that some foods are irritating, but not always the root cause of this EoE. It can be confusing, but the process to identify food allergies vs. food sensitivities has become much easier.
It's hard to identify problematic foods because of delayed symptom reaction that generally happens in those with EoE. This sort of reaction differs from an IgE-mediated food allergy that produces a rather immediate reaction. Because of this extra sophistication, a few plans have been created to help tailor to individuals needs:
6 Food Elimination Diet
This elimination program eliminates the six most frequently sensitive foods in the diet for about 8 months or until a person has significant symptom reduction.
This approach is typically effective, but the most challenging part is the reintroduction process. I suggest trying this plan out for only a couple weeks to find out if it helps your symptoms. If not, then proceed on to another diet plan in this list.
This strategy is a bit more challenging to implement. The individual is limited to a diet that only comprises the meals likely to trigger a response. Pick out a few of the safest foods from every food category (i.e. fruits, vegetables, proteins, grains, legumes, etc.). Due to this restrictive nature of the diet, it shouldn't last more than 14 days before undergoing the reintroduction procedure.
I usually use the LEAP protocol to help design the oligoantigenic plan. Using the outcomes of MRT food sensitivity testing, I am able to determine which foods promote a heightened immune reaction. Typically, this plan works really well! But, if this does not produce desired results, it is time for your last and least desired option.
When all else fails, then some attempt an elemental diet. An elemental diet is fundamentally a nutritional formula one consumes in replacement of real food to find out whether foods bring about EoE symptoms. The formulas contain all the essential calories and macro/micronutrients one may need, but honestly, don't taste great and are pretty pricey. Formulas like Vivonex and Tolerex are utilized for adults, with separate options for children. Food is slowly reintroduced after just a couple of days with this formula.
Reintroduction of Food
After achieving symptom relief, start the food reintroduction process. Bring one food back into the diet in increasing portions throughout the day. Once testing these new foods, make sure to wait a few days and up to a week to see if you have any reactions. Check that food off your list and move onto the next one. If the food triggers symptoms, eliminate it from the diet and think about retesting at a later time.
Eosinophilic Esophagitis demands individualized diet treatment to help alleviate symptoms. Although it is important to stay away from all of the diagnosed food allergies, lots of people with EoE don't have food allergy symptoms. The goal is to eat a variety of healthy foods without negative symptoms and prevent any unnecessary dietary restrictions over the long run. Inflammation is your enemy when you have EoE.
Here is a simple checklist you can do to step through as well: