Practicalities of the Six Food Elimination Diet

snackI never wanted to write a recipe blog.

Now I feel that I have an obligation to share the practical, actionable things I could do to make tolerable the previously-unthinkable diet my daughter had to endure during the summer and early fall of 2010. As I say that, I am assaulted in my mind by the knowledge that right this moment, mothers are at their stoves faced with the dilemna of how to make a meal out of rice, bananas, and apples — not because they didn’t make it to the store or because they’re low on money, but because those are the only foods their child is able to eat without serious illness. Eosinophilic esophagitis can — and sometimes does — rob families of the very basic ingredients of any normal meal.

I write this knowing that to call it hard is to make it relative to a normal diet — and in that case, it really was hard. In relation to a diet with even more restrictions, it was easy. Relative to the fat-free diet Sammi would need to follow four years later, it was also easy. In the moment, however, for us, and for other families managing it after an unrestricted diet, it was daunting. We were given a packet of information from the gastroenterology practice that assumed, for one thing, that we ate meat, which we did not and which Sammi’s doctor did not want us to begin doing, lest we contaminate the experiment of this elimination diet entirely. So we started with the foods she could eat, and quickly learned which of the newly forbidden foods (dairy, egg, soy, nuts, and wheat) we could substitute with analogous items on her “yes” list.

One day, tired of using recipes to make the ingredients I would use in other recipes (imagine a precise blend of flours to make a gluten-free flour blend, or the chemistry experiments I did to make something that would approximate a matzo ball), I threw a handful of finger foods on a platter in the living room and told my kids that it was lunch. Hearts of palm, baby corn, olives, cubed soy-free nut-free gluten-free vegan cheese, dried plaintain, and rice crackers. It bought me an hour before I had to start conjuring dinner out of vegetables and rice, again.

And it was hard.

It was never not-hard.

I didn’t want to write a recipe blog, but it was exceedingly difficult finding recipes that worked without fish, dairy, egg, soy, nuts, and wheat — a diet also known as the “six food elimination diet” because it also forbids fish/shellfish (something we didn’t have to test, since she’d never eaten either of those foods). The best things we discovered during that time were soups and rice & bean dishes, and also the Easy Whole Grain Flatbread (using any flour — we liked it with chickpea flour) by Mark Bittman. You can also find some links to products we could use on my Food That Helped page. We were not thrilled about adding junk foods with artificial flavors and colors to Sammi’s diet, but there was so little we could give her that qualified as a treat — and precious little that didn’t make her feel freakish among her new friends in kindergarten. If a packet of Betty Crocker Fruit Snacks would help, we bought them.

If you have come across this page because your child is on a restricted diet, the steps you need to take to determine whether a packaged product is safe for him/her are:

  1. Check the ingredients. Read them at least twice, checking for derivatives of the off-limits food, too.
  2. Check below the ingredients for a statement about shared equipment and/or facilities with your off-limits item. Sammi was allowed to eat products made in the same facility with her forbidden foods, but not products made on shared equipment with those forbidden foods. Find out what your doctor recommends.
  3. If there is no “shared equipment/shared facility” listing on your product, or if what your child is restricting is not one of the top-eight allergens (wheat, dairy, egg, soy, peanuts, tree nuts, shellfish, regular fish), call the manufacturer. Most food/beverage companies now have a customer service person dedicated to allergy issues. You need to ask about the production facilities and the content of their “natural flavors” if they list any in their ingredients.

It is an exhausting experience. I got quicker at identifying foods we could use, and I came up with a handful of reasonable meals during that time, but it was nearly a full-time job. The most important meal that we created, with much trial and error, was a replacement for Sammi’s favorite food: macaroni and cheese.

It wasn’t the same, but it was close.

Six-food-elimination-diet people: hang in there.

Macaroni & Cheese, Sort Of

1 lb Tinkyada brand gluten-free noodles
3 cups Pacific brand oat milk
1 small onion, minced
1/2 tsp pepper 1/2 tsp dried thyme
1 bay leaf
4 tbsp Soy-Free Earth Balance margarine
3 tbsp brown rice flour
3 cups Daiya brand shredded cheddar cheese (or two packages Daiya cheddar “wedge”)

Cook the pasta until just before it’s done. Drain quickly. Work fast.

While it’s cooking, melt the soy-free earth balance in a saucepan. Add the brown rice flour and mix well, then slowly add the milk and onions, whisking all the time. Add the bay leaf. Cook until thickened a little — maybe five minutes. Remove the bay leaf. Add the cheese, stirring until melted.

Add the cooked, drained pasta to the cheese sauce in the saucepan and mix together. Pour into a lightly-greased casserole dish and broil for 2-4 minutes, until the top is browned.

 

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26 thoughts on “Practicalities of the Six Food Elimination Diet

  1. […] an hour before it’s done baking, I can make a pot of rice, and dinner is done. In a time when I often had to make the ingredients in order to assemble the recipe for dinner itself, this was a blessing indeed. *Dairy-free […]

  2. […] the first day of kindergarten, Sammi was still in the midst of the six-food-elimination-diet. There was no peanut-butter-and-jelly sandwich in her lunch — no goldfish crackers, no […]

  3. […] methodology of the six-food-elimination-diet to treat eosinophilic esophagitis is this: the top six most common food proteins are eliminated from the diet for six to eight weeks. […]

  4. […] meal has survived the six-food-elimination diet for eosinophilic esophagitis (substitute Daiya shredded cheese); the GERD reflux diet (eliminate the tomatoes); and the fat-free […]

  5. […] my daughter Sammi had the final endoscopy in a series of eight, each one marking a phase of her six-food-elimination diet for eosinophilic esophagitis. Each scope after the first one — the one that provided the […]

  6. […] kid. No medicine. No waiting for breakfast. No endoscopies, no visits to the gastroenterologist. No restrictive diet. No ingredient reading. Just Sammi. I didn’t know how to be her mother, without the pills and […]

  7. […] has been four years since the end of her six-food-elimination-diet, and when I asked her about it recently, she said she can’t remember it. She remembers the […]

  8. Julie aprahamian

    I was wondering what was causing the problem was it one of the six foods? My son will be starting this 6 elimination diet today for the same issue is your daughter he is 10 years old

    • Julie, I wish I could tell you that we found a food and eliminated it permanently and that it solved the problem. Sammi’s situation turned out to be a lot more complicated. There was never a food identified as the cause of the eosinophils in her esophagus. It turned out to be a structural issue.

  9. […] ten endoscopies, a year of restricted diets, nearly six years of medication to block acid production in her stomach, and dozens of trips to […]

  10. […] elaborate nests on the couch for Sammi to sit in and watch movies as she recovered. When we had a ridiculously complicated diet to follow, Ronni carefully hid her box of “not safe for Sammi” snacks where Sammi could […]

  11. […] in those months. After sixteen times putting my daughter under general anesthesia, after the crazy diets and the dangerous practices I’d followed for her, I had begun to wonder if I had used up all […]

  12. my son has been on the six food elimination diet since the summer. just had a follow-up scope today and his condition has gotten worse. he is 3. has had multiple issues related to his mouth since introducing solid foods – swallowing, choking, chewing, even speech delay – just think it’s all related somehow. anyhow, how did you discover the structural issue?

    • BJN, we discovered it via a barium esophagram, also known as a swallow study. I wrote about it here: Holding Things. I’m so sorry your son is struggling and that the elimination diet didn’t help. What are they proposing as next steps? Have they done a swallow study?

  13. […] the endoscopies, accepted the diagnosis of eosinophilic esophagitis, and diligently followed the six food elimination protocol. We read labels, scoured our kitchen, protected her from potential allergens like fierce […]

  14. […] with half-a-gram of fat or less per serving size. When I went to the store and began flexing my label-reading skills again, I realized that the nutritionist had put several items on the list that didn’t follow […]

  15. […] but twice as much as was allowable for her at the time. As we had before with other difficult, medically-required restrictive diets, we dug deep and did a lot of research. Here are some tips that I hope will help others manage this […]

  16. […] we started this round of therapy, Sammi was allowed an unrestricted diet — no longer in the six-food-elimination or allowed only fat-free food — and I suspected that though she was not eating enough […]

  17. […] Sammi, the sunshine of this blog’s title, began the first and most restrictive phase of her six-food-elimination-diet for eosinophilic esophagitis, and the summer after her aortopexy surgery, when I took her for […]

  18. […] And then Sammi, my younger daughter, was born with a host of medical issues that took years to unravel. For many holidays during the years when her health changed our entire family’s diet, the connection of faith and ritual to food became tenuous. How do we define the sabbath without a challah? For that matter, how do we define a challah? According to Jewish law, a challah to be used for religious purposes has to be made of wheat, barley, spelt, oat or rye. What, then, of my gluten-free challah during Sammi’s six-food-elimination diet? […]

  19. […] It doesn’t matter what you need to avoid; I found this strategy equally useful for the six food elimination diet, the GERD diet, and a fat-free diet for chylothorax. Just like the parenting advice I’d […]

  20. […] laughed, softly, thinking of endoscopies and cardiac surgeries and anesthesia and elimination diets and medications and said, “Me too, […]

  21. […] responds to only a handful of imperfect treatments. The treatment we chose for her was called the Six Food Elimination Diet, a set of food restrictions that required her to avoid anything with dairy, soy, eggs, nuts, fish, […]

  22. […] esophagus, the patches that were keeping her from swallowing well. For ten months, she’s been avoiding a list of common allergens — dairy, soy, egg, nuts, and wheat — and undergoing tests to see if the culprit could […]

  23. […] required that she cut out dairy, eggs, soy, nuts, meat, and gluten. During my deep-dive into specialty cooking for what I called the “joy-free” diet, I dreamed in recipes and grocery store trips. Along the way, I picked up several dozen grey hairs, […]

  24. […] no nuts, no broccoli, no cinnamon — not to mention the years when my own child was on the six-food-elimination-diet or the chylothorax diet. I’ve managed, in most cases, to offer at least two tasty options to […]

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