Ear, Nose & Throat Treatment Print Six Food Elimination Diet: Food Substitutes Enjoy Recipes Even with EoE! By Kristin Hayes, RN Updated April 09, 2019 More in Ear, Nose & Throat Treatment Diagnosis Coping ENT Disorders Pediatric ENT Disorders The six food elimination diet (SFED) is one of the most popular diets if you have eosinophilic esophagitis (EoE). To help identify foods that cause an exacerbation of your symptoms associated with EoE, this diet eliminates the 6 most common allergens that have been associated with causing eosinophilic esophagitis: Cow’s milkEggsPeanuts & tree nutsSeafood (fish & shell fish)SoyWheat These 6 foods are commonly cooked within restaurants or in the average home and are contained in much if not most of the food Americans eat on a regular basis. We will discuss substitutes you can use to alter recipes into EoE-friendly recipes to improve your quality of eating. Wheat Wheat. LEONELLO CALVETTI/Getty Images Wheat is one of the most common allergens, or triggers, associated with eosinophilic esophagitis in both children (2nd most common trigger) and adults (most common trigger). Wheat includes 4 proteins that may cause the allergic reaction associated with symptoms of EoE. The 4 proteins are: albumin, globulin, and gluten (gliadin & glutenin). Unfortunately there is limited and conflicting research as to how other grains that include these same proteins react with eosinophilic esophagitis. You may have heard that if you are following a SFED diet, that you should also exclude barley and rye. This rumor however has very limited and inconsistent research to support it. Because barely and rye have similar proteins as wheat, you should discuss whether elimination is best for you with your doctor or dietician. These grains are also often packaged in the same factories with wheat and may have some wheat in them. You should be careful with some gluten-free products on the market, as they have been refined in a manner that eliminates their nutritional content of iron, B vitamins, and trace minerals. Wheat Substitutes In recipes, you can swap wheat flour with these flour sources:QuinoaBuckwheatGluten-free oatsBrown riceMillet Quinoa and brown rice are particularly popular as wheat substitutes. Cow's Milk Cow's Milk. Monty Rakusen/Getty Images Cow’s milk has been identified as another of the most common triggers associated with eosinophilic esophagitis in both children (most common trigger) and adults (2nd most common trigger). The protein in milk that causes reactivity with EoE is known as casein. Aside from cow’s milk, other foods that commonly have the same protein includes: cheeses, ice cream, coffee creamer, whey protein, chocolate, and marinades. Milk Substitutes Good substitutes that you can use to avoid cow’s milk but maintain similar nutritional value are:Fortified rice milkFortified hemp milkFlax milk It is important to take notice that almond milk or cashew milk cannot be used as a substitute for cow's milk, as they are both tree nuts that are eliminated from a SFED. Eggs Cracking an egg. Adam Gault/Getty Images Replacing egg can be a little trickier due to the number of reasons we use eggs in food preparation. Here are a few ideas that you can use to replace eggs in your cooking needs. Flaxseed Flour Substitute for 1 Egg – Great for Binding 1 Tablespoon Flaxseed Flour3 Tablespoons WaterStir until egg-like Chia Seed Substitute for 1 Egg – Great for Leavening 1 Tablespoon Chia Seed1/3 Cup of WaterStir and set for 15 minutes. Agar Agar Substitute for 1 Egg – Great for Binding 1 Tablespoon of Agar Agar3 Tablespoons of Water Ripe Bananas Substitute for 1 Egg – Great for Moisture ½ Cup of Mashed Bananas Applesauce Substitute for 1 Egg – Great for Moisture ¼ Cup of Applesauce (unsweetened) Mashed Potatoes Substitute for 1 Egg – Great for Binding 2 Tablepoons of Mashed Potatoes (White or Sweet) Peanuts & Tree Nuts Assortment of nuts. Christian Senger/Getty Images Peanuts and tree nuts are difficult to replace in cooking recipes. Tree nuts include many different types of nuts. Here are a few of the more common tree nuts that should be eliminated: almondscashewsmacadamia nutsBrazil nutspine nutspistachioswalnuts Peanuts and tree nuts are usually used for taste and texture rather than a basic need for the recipe. These can usually just be skipped in the recipe, or you can try replacing with rice cereal or a gluten-free whole grain. If you are looking to replace the nutritional value, you can use seeds that include: chia, flax, and hemp. Seafood Seafood platter. Image Source/Getty Images Fish and shellfish are great sources of protein and Omega-3 fatty acids, which are good for the health of your heart. Like peanuts and tree nuts, you are unlikely to find a similar replacement for the seafood. However for the protein, you can use other low-fat meats like poultry. Likewise, as a replacement for the Omega-3 fatty acids, you can increase your consumption of flaxseed and canola oil. Soy Soybeans. Tetra Images/Getty Images Soy is difficult to match in taste and you may have to add salt. However, there are a few options for replacing soy in recipes. Soy Substitutes Chick peasCoconut milkClive juicePlum vinegar Substituting Foods Ensuring that you maintain a well-balanced diet will ensure that you do not suffer from malnutrition while following a SFED diet. Using allergen food substitutes in your cooking will allow you to still use your favorite recipes. Finding which substitute works best for you is a very personal choice. Experiment with these suggestions to find what you like best. Food Allergen-Free Substitutes for Your Kitchen Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Kids With Food Allergies. (n.d.). Recipe Substitutions for Soy Allergy. http://www.kidswithfoodallergies.org/page/soy-allergy-recipe-substitutions.aspx People for the Ethical Treatment of Animals. (n.d.). Egg Replacements. http://www.peta.org/living/food/egg-replacements/ United States Department of Agriculture. (2016). Frequently Asked Questions (FAQs). http://www.ars.usda.gov/Main/docs.htm?docid=6233#omgea Doerfler, B., Bryce, P., Hirano, I. & Gonsalves, N. (2015). Practical approach to implementing dietary therapy in adults with eosinophilic esophagitis: the Chicago experience. Dis Esophagus. 28(1):42-58. doi: 10.1111/dote.12175 Kliewer, K.L., Venter, C., Cassins, A.M., Abonia, J.P., Aceves, S.S., Bonis, P.A. … Rothenberg, M.E. (2015). Should wheat, barley, rye, and/or gluten be avoided in a 6-food elimination diet? Journal of Allergy and Clinical Immunology. J Allergy Clin Immunol. pii: S0091-6749(15)01726-1. doi: 10.1016/j.jaci.2015.10.040.