Six Food Elimination Diet: Food Substitutes

Enjoy Recipes Even with EoE!

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 milk
  • Eggs
  • Peanuts & tree nuts
  • Seafood (fish & shell fish)
  • Soy
  • Wheat

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
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:

  • Quinoa
  • Buckwheat
  • Gluten-free oats
  • Brown rice
  • Millet

Quinoa and brown rice are particularly popular as wheat substitutes.

Cow's Milk

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 milk
  • Fortified hemp milk
  • Flax 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
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 Flour
  • 3 Tablespoons Water
  • Stir until egg-like

Chia Seed Substitute for 1 Egg – Great for Leavening

  • 1 Tablespoon Chia Seed
  • 1/3 Cup of Water
  • Stir and set for 15 minutes.

Agar Agar Substitute for 1 Egg – Great for Binding

  • 1 Tablespoon of Agar Agar
  • 3 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
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:

  • almonds
  • cashews
  • macadamia nuts
  • Brazil nuts
  • pine nuts
  • pistachios
  • walnuts

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
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
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 peas
  • Coconut milk
  • Clive juice
  • Plum 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.

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Article Sources
  • 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
  • Kids With Food Allergies. (n.d.). Recipe Substitutions for Soy Allergy. http://www.kidswithfoodallergies.org/page/soy-allergy-recipe-substitutions.aspx

  • 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.
  • 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