Eosinophilic Esophagitis Treatment with the Esophagitis Diet

Say that 3 times fast…Eosinophilic Esophagitis Treatment with an Esophagitis Diet. This autoimmune condition has been on the rise, especially in children.

Overall, most autoimmune disorders, especially those tied to the gut (think Crohn’s disease, ulcerative colitis and eosinophilic esophagitis) have been on the increase.  The scare thing is that this rise has been playing out in children more so than adults.  I have no doubt that our sterile “hygienic” lifestyles are to blame.  The combination of antibiotics and vaccinations to try to wipe out every possible communicable disease, coupled with antibacterial wipes, lotions, facial tissues and toilet paper (ok..maybe not toilet paper, but only because they couldn’t find a good market for it…), has left our immune systems dysfunctional.

Another strong player in the autoimmune circuit is food allergies.  Actually, let me correct that.  When I think of allergies, I think anaphylactic shock from peanuts, skin prick testing and allergy shots.  What seems to play a larger role is food sensitivity.  Allergies are hard-wired into our immune system, but sensitivites come and go based on the overall health of the individual.

Eat a food you’re sensitive to day in and day out for years and you’re systems not going to be very happy with you.  Avoid that food for several weeks and your immune system begins to calm back down.

So how do we determine if we are sensitive to a food?  I can tell you that I’m not a big fan of skin scratch testing or even bloodwork such as a RAST panel.  Blood allergy testing can get very expensive (it’s easy to rack up a $1,000 bill).

I prefer elimination diets.  Approximate cost?  $0.  Accuracy?  Pretty darn high if done correctly.  High enough to be considered the gold standard for allergies and sensitivities.

Basically, in an elimination diet, you avoid all commonly sensitive foods (principally dairy, wheat, eggs, corn and soy) for 2 weeks.  If you begin to feel better in this time period (based on whatever symptoms caused you to try the elimination diet in the first place), you reintroduce one of these foods at a single point and check for symptoms to return within a few days.

This is considered elimination with subsequent food challenge.

So what does this have to do with the tongue twisting eosinophilic esophagitis? 

Researchers have already determined that food allergies play a huge role in flare ups and symptoms of esophagitis in children.  I remember writing a blog on the relationship between celiac disease and reflux esophagitis in March of 2003, almost a decade ago.  This is not new news.

So, since the relationship between food allergies in children is well established, someone decided to ask if the same relationship was present in adults.  What brilliant thinking from the researchers, because most GI docs don’t make too many recommendations on food elimination diets.

In this particular study looking at food elimination diets in adult with eosinophilic esophagitis, the results were nothing short of shocking:

• Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%)
• The number of eosinphils (white blood cells related to allergy) dropped 76% with the diet
• Symptom scores decreased in 94% of those on the program (yes–you read that right–94%, as in “almost all”)
• After food reintroduction, eosinophil counts returned to pretreatment values
• Foods most problematic were wheat (60%) and milk (50%), soy (10%), nuts (10%), and egg (5%)
• Skin-prick testing predicted only 13% of foods (in other words, just short of worthless)

Realise that NONE of the patients in this study realized that they had food allergies / sensitivities prior the program.  Which also means that their gastroenterologists likely never brought the subject up.

Remember that 94% of patients complained of heartburn, despite being put on acid suppressive drugs like Nexium or Prilosec.  This means that ACID WAS NOT THE PROBLEM.

Did I mention that acid was not what was causing the reflux symptoms in these patients?

So, by giving acid suppressive drugs, not only did their physicians completely disrupt healthy digestion, but they did not address the real problem.  These food allergies, left to run rampant for decades create the chronic inflammation associated with other diseases such as osteoporosis, dementia, cancer, heart disease and stroke.

So, if you deal with reflux, regardless of whether is it eosinophilic esophagitis or not, have you identified any foods that contribute to your symptoms?