Six Food Elimination Diet Food Substitutes

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 Fields
bibi.barbie / 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 and 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 an SFED diet, that you should also exclude barley and rye. This rumor, however, has very limited and inconsistent research to support it. Because barley and rye have similar proteins as wheat, you should discuss whether elimination is best for you with your healthcare provider 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

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 (second 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 an SFED.


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 Water
  • Stir and set for 15 minutes.

Agar Agar Substitute for 1 Egg – Great for Binding

  • 1 Tablespoon Agar Agar
  • 3 Tablespoons Water

Ripe Bananas Substitute for 1 Egg – Great for Moisture

  • 1/2 Cup Mashed Bananas

Applesauce Substitute for 1 Egg – Great for Moisture

  • 1/4 Cup Applesauce (unsweetened)

Mashed Potatoes Substitute for 1 Egg – Great for Binding

  • 2 Tablespoons Mashed Potatoes (White or Sweet)

Peanuts and 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:

  • 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 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.


Close-Up Of Soy Beans
Tharakorn Arunothai / EyeEm / 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 an 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.

2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. UW Health. The six food elimination diet for eosinophilic esophagitis.

  2. Kliewer KL, Venter C, Cassin AM, et al. Should wheat, barley, rye, and/or gluten be avoided in a 6-food elimination diet?J Allergy Clin Immunol. 2016;137(4):1011–1014. doi:10.1016/j.jaci.2015.10.040

Additional Reading
  • Kids With Food Allergies. (n.d.). Recipe Substitutions for Soy Allergy.

  • People for the Ethical Treatment of Animals. (n.d.). Egg Replacements.

  • United States Department of Agriculture. (2016). Frequently Asked Questions (FAQs).

  • 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

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.