Between June of 2010 and May of 2011, my daughter Sammi progressed through the six food elimination diet for a rare inflammatory disorder called eosinophilic esophagitis. In an effort to determine which — if any — of the most commonly allergenic foods might be irritating the tissue inside her esophagus, her gastroenterologist asked us to remove dairy, eggs, soy, wheat, and all nuts from her diet, which was already vegetarian. One by one, we added foods back in as endoscopies and biopsies guided us as to the foods that seemed to be safe for her.
On this blog, the most popular post is called Practicalities of the Six Food Elimination Diet. It was my first effort to write the content that I wish I could have read while Sammi was on this diet — a lot of empathy and even more practical, straightforward advice on where to start. So much information on elimination diets online focuses on adults who can, for the most part, understand that what they’re doing is for their own good. Adults can sit in front of uninteresting, repetitive meals for weeks on end and make their peace with it. Children often don’t have that same ability.
As I’ve seen how popular that original post of mine has become, I’ve wanted to add to it, to provide more information to families who are struggling to feed their children with both attention to the restrictions of the diet and with love and compassion. To that end, I wanted to share a typical day for Sammi — who was five years old at the time — when she was on the full elimination.
Many, many cereals are now safe for the six-food-elimination diet (also referred to in shorthand as SFED). For the most part, the ingredients likely to make a cereal off-limits are nuts and wheat, and occasionally dairy in the case of cereals with yogurt-covered fruit or with “cream” flavorings. While surely by now there are more options than what you see below, we found that these cereals were totally safe:
POST Fruity Pebbles
POST Cocoa Pebbles
GENERAL MILLS Lucky Charms
ENVIROKIDZ Koala Crisp
EREWHON Crispy Brown Rice Cereal
Instead of dairy milk, Sammi used either rice milk or oat milk in her cereal. Neither was fantastic, but both were passable.
Other options included coconut yogurt with berries added; smoothies made with bananas, coconut yogurt, and berries; and oat bran hot cereal (which was not nearly as boring as it sounded!) made with oat milk, brown sugar, and a pat of soy-free margarine.
Sammi began kindergarten on this diet, and so her first lunchbox meals were a challenge. Because she didn’t mind, for the most part she had the same thing every day:
- A corn tortilla, warmed on the stove, filled with refried black beans and Daiya brand shredded cheese
- A small plastic container of raspberries, blueberries, or chopped mango
- A small plastic container of chopped avocado with salt
- A small plastic container of Enjoy Life brand chocolate chips
Sometimes, if I’d had the forethought and energy to prepare at the beginning of the week, I would make spring rolls. Using rice paper wrappers (which you have to soak for a few seconds in a bowl of water to soften them), I would roll up a bit of sweet potato, some basmati rice, a few leaves of spinach, and a slice of avocado. This could substitute for the tortilla wrap.
Sammi and I often stayed after school on the playground for some extra time in the sun. When I did that, the easiest thing for us to bring was Glutino’s Pretzels, which are designed for the gluten-free crowd but accidentally perfect for the SFED. They had the added benefit of being fun for more kids than Sammi, a snack she could share without having to explain much.
Similarly, Betty Crocker brand fruit snacks are safe for this diet and, while certainly not health food, extra convenient for the park.
With extra time for preparation, I could make popcorn on the stovetop and — for special occasions — even caramel corn. There are lots of recipes for this online, including this one from Golden Barrel.
Finally, the obvious snacks that work for everyone are fruits and vegetables. Clementines are nice and portable; cherries, bananas, and sliced cucumbers were also favorites. Sammi has never liked apples, but that would work for most kids, too.
Without question, dinner was the biggest challenge each day. Making enough food for all four of us, since we had agreed to eat what Sammi ate when we were together, meant that dinners were often complicated and sometimes expensive. In the end, the best things we found to eat were often things that didn’t require substituting “-free” ingredients, but rather foods that were already, in their natural state, free from the things Sammi needed to avoid. Some of the items below stand alone as their own dinner, and some can be mixed and matched to form a full meal from a few dishes:
- Black bean tostadas, which I had discovered years earlier at a very unique social gathering
- Gluten free pasta with standard spaghetti sauce or a sunflower-seed based pesto
- Many lentil dishes served with basmati rice
- All kinds of soups: chickpea, black bean and vegetable, butternut squash, cauliflower and potato, and many more.
- Hummus with tortilla chips and lots of raw vegetables for dipping, or with this flatbread recipe made with chickpea flour
- King Arthur Gluten Free Pizza Crust Mix, substituting flax meal and water for the eggs, baked and topped with tomato sauce, Daiya cheese, olives, mushrooms, sun-dried tomatoes, pineapple, peppers, spinach, fresh tomatoes, etc. The picture you see at the top of this post is of the first time we made this pizza. I was so grateful that I wrote to King Arthur Flour to thank them!
In a pinch, though, one of the best things we did was give up on a healthy, well-balanced dinner every so often, and make chocolate chip pancakes. Using the pancake mix from a company called Really Great Food, and mini chocolate chips made by Enjoy Life foods, we could slap together a meal that made Sammi and her big sister Ronni jump for joy. Adding a bowl of sliced strawberries assuaged my guilt a little, too.
Readers who find their way to this post or Practicalities of the Six Food Elimination Diet because you’re navigating this diet yourselves, please add your own favorites in the comments. In the years since Sammi went through this process, I know that more options have emerged. If you’ve found something that’s awesome for your kid, please let other parents know. And for those of you out there who are not sure how you’re going to get through another bizarre meal, hang in there. I know you’re out there, and I know how hard it is. It will get easier on some days, and it will seem awful on others. The time will pass. Either your child will improve — which will encourage you to keep going — or you’ll have answers that guide you forward.
In the meantime, stay in touch. Ask me for help in recreating your child’s favorites. Ask other parents in Facebook groups for eosinophilic esophagitis. Call the dietitians in your local gastroenterology practice. Open a cookbook and try to think outside the box. Most importantly, try to take it one meal at a time and — trust me on this one — order some of that pancake mix.