Related Posts
Understanding how the Low FODMAP diet can help you manage your gut symptoms – Monash Fodmap
Understanding how the Low FODMAP diet can help you manage your gut symptoms (plus hints on surviving Christmas)- Monash Fodmap
An exploration of the low-FODMAP diet with Associate Professor Jane Muir
__________________________________________
Interest in the low-FODMAP* diet is exploding both in Australia and around the world. This highly effective, three-phased diet therapy reduces gastrointestinal symptoms in ~70% of people with irritable bowel syndrome (IBS).
This talk will introduce you to:
- The history of the FODMAP concept and why it was developed
- The evidence supporting this diet’s efficacy for controlling symptoms of IBS
- Measuring FODMAPs in foods and safe levels
- The three phases of the FODMAP program
- How to navigate the diet using the Monash University FODMAP diet app
- The link between FODMAP and gluten-free foods
- Other applications of the FODMAP diet
- Hints on how to survive Christmas while following a low FODMAP diet.
*FODMAP is an acronym invented by the team at Monash University that stands for Fermentable Oligo-, Di-, and Mono-saccharides And Polyols that represents a group of short-chain carbohydrates that can be poorly absorbed in the gut.
Jane Muir, PhD, Dietitian
Associate Professor Muir is currently the Head of Translational Nutrition Science in the Department of Gastroenterology, Central Clinical School, Monash University. She is a trained dietitian with a PhD in biochemistry and has over 25 years’ experience in the area of nutritional research. Over the last 15 years her major focus has been on the research and creation of the low-FODMAP diet.
Free From + Allergy Community
Welcome to the Free From + Allergy Community
As Australians are prioritising their health and wellbeing, they are turning to new products to suit their changing needs. This is having a profound influence on their daily life choices as they start to make conscious decisions that will better their life.
Discovering new intolerances, allergies and dietary requirements can be overwhelming and scary. Obtaining the right information can be time consuming as you search through the misleading information and try find what is right for you. Australians were longing for a community where they could connect with like-minded people to share, engage, inspire and learn about all things free from and allergy related.
We decided to create a digital platform for our community to come together and support one another on their health journeys. This is a one stop shop where you can go to connect and source information to help you on your journey and remove the isolation that you may be experiencing.
Introducing the Free From + Allergy Community!
This platform was created to bring together like-minded people together to share, engage, inspire and learn about all things free from and allergy related. We believe that by building a strong community, it will offer support and guidance to people who may be experiencing similar challenges in everyday life.
The Free From + Allergy Community Facebook group brings together industry professionals and everyday people that will share their knowledge and experience about allergies and intolerance’s. We encourage our community to ask questions and be active to help one another overcome food challenges that may make them feel isolated or alone.
Are you ready to join the community? We are ready to welcome you!
Everyone is welcomed, even if you’re not from Australia 😉
Join the community here and be apart of a supportive community.
Free From + Allergy Shows
Due to the significant impact corona has had within various industries, the Free From + Allergy team have had to postpone this show until 2021. We welcome you to join us for our virtual show on the 25/26 September.
Check out the content library where you can learn about various allergies and intolerances from health experts.
5 Tips For Catering For Someone With A Food Allergy – Nicole Rodda
5 Tips For Catering For Someone With A Food Allergy
In this short video, Nicole provides her top 5 tips for catering for someone with a food allergy. She will discuss the simple steps that can sometimes be overlooked and the effects that these can have on the overall outcome of the meal. This short video will provide practical advice to make catering for someone with food allergies a breeze.
Nicole
Nicole is an Accredited Practising Dietitian who strongly believes in establishing a positive relationship with food. Her passion for food comes from first-hand experience living with severe food allergies. Nicole is at risk of anaphylaxis to egg and dairy and also has oral allergy syndrome. She understands how a restricted diet can affect many aspects of your life and has great empathy for clients requiring specific diets.
Nicole is a member of Dietitians Australia and along with her University studies, has also completed the Monash University Low FODMAP diet course. You can get in touch with Nicole via her Instagram and Facebook pages, Life Beyond Allergies.
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Top 10 Tips on Managing Food-Related Stress
Top 10 Tips on Managing Food-Related Stress
Starting a new diet, changing your routine, and avoiding certain foods can all cause stress on our bodies. When you first find out you have an allergy or intolerance, it can create discomfort within and may cause feelings of overwhelm.
“How am I going to create new recipes and avoid these foods? How can I eat out? What if the place does not cater to my needs?”
So many questions start circulating in your head, resulting in a possible increase in stress levels.
Life can already be stressful enough, now add additional stress on top of your everyday stress and it can be all too much. It is important to become aware of your stress levels and have a tool kit of ways to help reduce or ease your levels. Below is a list of things we have found have helped reduce stress levels in the past and maybe of some benefit to you.
1. Relaxation Techniques
Stress-reduction techniques are a pivotal tool to help calm your nervous system down. There are many techniques to reduce stress and it is important to note what works for one may not work for another. Try a few out and see what works best for you.
For example, meditation is a common technique with so many benefits. There are apps now that make it easier to sit down and focus such as insight timer, calm, smiling mind… the list goes on!
Another method is self-hypnosis which is simple, effective and can be done anywhere (such as at your desk or in the car.) One simple technique is to focus on a word or phrase that has a positive meaning to you. Words such as “calm” “love” and “peace” work well, or you could think of a self-affirming mantra such as “I deserve calmness in my life” or “Grant me serenity”. Focus on your chosen word or phrase; if you find your mind has wandered or you become aware of intrusive thoughts entering your mind, simply disregard them and return your focus to the chosen word or phrase. If you find yourself becoming tense again later, silently repeat your word or phrase.
If you find it difficult to relax, don’t worry. Relaxation is a skill that needs to be learned and will improve with practice overtime. Even the best meditation teachers can struggle!
2. Avoid Caffeine, Alcohol, and Nicotine
Yes. You read that right… So many of us love that little hit all three give us, but what if we told you they could be adding to your stress levels? As caffeine and nicotine are stimulants, they increase your level of stress rather than reduce it. Alcohol is a depressant when taken in large quantities but acts as a stimulant in smaller quantities. Therefore, using alcohol to alleviate stress is not ultimately helpful. Our suggestion is to avoid, or at least reduce, your consumption of nicotine and any drinks containing caffeine and alcohol. Try to swap caffeinated and alcoholic drinks for water, herbal teas, or diluted natural fruit juices and aim to keep yourself hydrated as this will enable your body to cope better with stress.
You should also aim to avoid or reduce your intake of refined sugars – they are contained in many manufactured foods (even in savoury foods such as salad dressings and bread) and can cause energy spikes and crashes which may lead you to feel tired and irritable. Eating a healthy, well-balanced and nutritious diet will only benefit you and your stress levels.
3. Move Your Body
When in a stressful situation, it increases the level of stress hormones such as adrenaline and cortisol in your body. These are the “fight or flight” hormones which are designed to protect us from immediate bodily harm when we are under threat. However, the stress in the modern age is rarely remedied by a fight or flight response, and so physical exercise can be used as a surrogate to metabolize the excess stress hormones and restore your body and mind to a calmer, more relaxed state.
When you feel your stress levels rising, tension taking over your body, try to move your body. Go for a brisk walk in the fresh air, go for a run, attend a yoga or gym class, anything that gets your body moving. Regular physical activity not only works to decrease your stress levels but will also improve your quality of sleep and who doesn’t love a good night’s sleep!?
4. Increase Your Sleep
A lack of sleep is a significant cause of stress. Yet, stress can also interrupt your sleep as thoughts keep clouding our heads, stopping you from relaxing enough to fall asleep.
Rather than relying on medication, aim to maximise your relaxation before going to sleep. Set your bedroom up to be a tranquil oasis with no reminders of the things that cause you stress. Avoid caffeine during the evening, as well as excessive alcohol if you know that this leads to disturbed sleep. Stop any mentally demanding work several hours before going to bed so that you give your brain time to calm down (this also includes being off your phone or technology at least an hour before bed as the bright light affects your body clock). A warm bath or a calming, undemanding book can relax your body, tire your eyes and help you forget about the things that worry you (eg: all your allergies and intolerances). A little tip is to aim to get to bed roughly the same time each day so that your mind and body get used to a predictable bedtime routine.
5. Keep a Stress Diary
The power of writing is hugely underrated. The ability to be able to write out your thoughts/emotions and release some tension is a powerful skill that you can use throughout your entire life. It acts like a vehicle navigating your mind through the clouded thoughts. Keeping a stress diary is an effective tool as it will help you become aware of specific situations which cause your stress levels to increase. Note down the date, time and place of each stressful episode, and note what you were doing, who you were with, and how you felt both physically and emotionally. Give each stressful episode a stress rating (eg: a 1-10 scale) and use the diary to understand what triggers you into a stress state and how effective you are in stressful situations. This will enable you to become aware of your triggers and both avoid stressful situations and develop better coping mechanisms in the future.
6. Talk to Someone
We can all relate to this one. How good do you feel when you just talk to someone and unlock everything you’ve been holding in. Simply talking to someone about how you feel can be helpful. Talking can work by either distracting you from your stressful thoughts or releasing some of the built-up tension by discussing it. Often times you find that the person you’re speaking with has experienced something similar, and there is a sense of shared understanding, of belonging, of community.
Stress can cloud your judgement and prevent you from seeing things clearly. Talking things through with a friend, work colleague, or even a professional can help you find solutions to your stress and put your problems into perspective. If you are wanting to share some of your experience, the FFACOMMUNITY is here for you and can be a great place to do so. Everyone is welcome!
7. Learn to Say ‘No’
We have all been guilty of saying “Yes to something when we ought to have said “No”.Fear of missing out or disappointing someone is a huge driver of saying yes despite having little time to do it or having too much on. Learning to say “No” to additional or unimportant requests will help to reduce your level of stress and may also help you develop more self-confidence.
If you find saying “No” difficult, spend some time uncovering the deeper cause. . Many of us find it hard because we want to help, are trying to be nice and be liked. Whilst others have a fear of conflict, rejection or missed opportunities. It is important to remember that these barriers to saying “No” are all self-created.
You might feel reluctant to respond to a request with a straight “No” at first. So instead, think of some pre-prepared phrases to let other people down more gently.
Practice saying phrases such as:
“I am sorry, but I can’t commit to this as I have other priorities at the moment.”
“Now is not a good time as I’m in the middle of something. Why don’t you ask me again at….?”
“I’d love to do this, but …”
This can increase your confidence and can help build your self-worth and relationship with yourself.
8. Time Management
In many cases, we all feel overburdened by our ‘To Do’ list which is a common cause of stress. Accept that you cannot do everything at once and start to prioritise your tasks.
Make a list of everything you need to do in order of genuine priority. Note what tasks you need to do personally and what can be delegated to others. Keep track of the tasks that need to be done immediately, in the next week, in the next month, or when time allows.
By editing what might have started out as an overwhelming and unmanageable task list, you can break it down into a series of smaller, more manageable tasks spread out over a longer time frame, with some tasks removed from the list entirely through delegation.
Remember to create buffer times to deal with unexpected and emergency tasks, and to include time for your own relaxation and well-being.
9. Empower Yourself to Solve Your Own Problems
Stress can be triggered by a problem that may seem impossible to solve. Learning how to find solutions to your problems will help you feel more in control thereby lowering your level of stress.
One problem-solving technique involves writing down the problem and coming up with as many solutions as you can. Decide on the good and bad points of each one and select the best solution. Write down each step that you need to take as part of the solution: what will be done, how will it be done, when will it be done, who is involved and where will it take place. Another technique is asking someone else for their opinions or advice on the situation. They may be able to provide some guidance on the situation as they may have faced something similar before – we can always learn something from the experiences of others.
10. Rest When You Need to Rest
Listen to your body. Every day our bodies talk to us and provide signs to help us stay healthy. Start tuning in and listening to these signs. If you are feeling unwell, do not feel that you must carry on regardless. A short spell of rest will enable your body to recover faster which means you will be back on your feet in no time. It is when we continue to push on and deplete our bodies that we end up being out of action for longer than we would have been if we had listened to the signs initially.
Remember, stress is something everyone deals with in various ways. Everyday life is stressful and when you add intolerances and allergies to the equation it can make it difficult to manage. By incorporating, some of these techniques into your daily routine, it can help manage your stress levels and reduce the effects it has on our bodies.
Jump into our FFACOMMUNITY on Facebook and speak out about what may be causing you stress throughout your health journey. You never know, someone else in the community could have experienced a similar situation and found something to help them which ultimately could help you.
Lauren Minicozzi
Free From + Allergy Team
Method:
1- Soak almonds in boiling water for 30min + or until the skin can be easily peeled off (if you have brought a skinless nut skip this step).
2- Drain the nuts, peel them (skin should pop off if soaked for long enough) and rinse them.
3- Soak nuts in boiling water for 30min+ (note the longer you soak the more milk you will make with it).
4- Drain and rinse the nuts again.
5- Add nuts, water, salt and date to the blender and mix until creamy and smooth.
6- Pour mixture into nut milk bag and squeeze milk out of the bag into a bowl (transfer to a jar afterwards and use a funnel to help reduce mess).
7- Store in the fridge for 3-4 days (if it has a weird after taste, that is when you know it has gone rancid).
TIP** with the leftover nut pulp, you can dehydrate it and create a nutmeal with it and use for baking later! Alternatively, you can skip the dehydration process and use it in its damp form for baking.
There you have it. It may seem tedious to start with, but after a few goes you will see how simple and easy it is.
Do not let your goodbye to dairy mean goodbye to the foods and drinks you love. This nut milk recipe is a perfect replacement so you can have your childhood milkshakes again. You can have those warming creamy lattes again. You can welcome back your favourite cereal again!
Enjoy!
Lauren Minicozzi
Free From + Allergy Team
What Actually Are FODMAPs and who is the Low FODMAP Diet for?
What Actually Are FODMAPs and who is the Low FODMAP Diet for?
Heard about fructose malabsorption or lactose intolerance?
Seen a FODMAP Friendly food product on the grocery shelves? It’s likely you might know someone who modified their diet for these reasons. Perhaps you even follow or have been advised to follow a Low FODMAP Diet.
So what actually are these things called FODMAPs, what foods are they found in and why do some people go on a low FODMAP diet?
A diet low in FODMAPs (a “Low FODMAP Diet”) is a dietary protocol which has been scientifically proven for the management of uncomfortable digestive symptoms of Irritable Bowel Syndrome (IBS).
FODMAPs are certain types of sugars (short-chain carbohydrates) that can trigger uncomfortable digestive symptoms in people with a sensitive gut. They are found in a wide range of food and drinks such as milk, beans, onion, garlic, apples and wheat. FODMAPs are sometimes added to foods during processing as well.
Without getting too scientific, if we flashback to high school science for a moment (if you remember paying attention back then), you may have learnt about the main nutrients that make up food. One of these is carbohydrates (or carbs). Carbohydrates are made up of smaller sugar molecules joined together to make up a chain.
So, FODMAPs are various short carbohydrate chains. They are known to be poorly absorbed in the part of the digestive tract where most nutrients are absorbed (the small intestine) and instead continue to the large intestine (colon). This is where FODMAPs mostly have their effect, triggering symptoms like bloating, excess gas and pain.
The term FODMAPs stands for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols which are the scientific names of these different short-chain carbohydrates. Fermentable refers to the fact that these carbohydrates can be fermented by gut bacteria to produce gases. “Saccharide” is a scientific term for sugar and the prefix of the name indicated the length of these sugars, for example, “di” means two, so a disaccharide is made of two sugars.
What foods are the FODMAPs found in?
Oligosaccharides- Fructans and Galactooligosaccharides: Wheat, rye, barley, onion, garlic, legumes and fruit & vegetables.
Disaccharides- Lactose: Cow’s milk, yoghurt, ice-cream, custard, cream and some soft cheeses.
Monosaccharides- Excess Fructose: Certain fruits and vegetables including mango and asparagus, fruit juice, honey and high-fructose corn syrup.
Polyols- Sorbitol, Mannitol, Maltitol, Xylitol: Certain fruit and vegetables (cauliflower, mushrooms, stone fruit) and some low-calorie sweetened products such as sugar-free gums and mints.
What about pre-packaged foods?
Levels of FODMAPs in food vary depending on the portion size and the way the food is processed. Therefore, it can often be tricky to read food labels to work out if a food is low FODMAP. Many food companies are now registering their products for FODMAP friendly accreditation.
If you see the green FODMAP Friendly logo on any food products, then rest assured that product is suitable for consumption whilst following a low FODMAP diet at the packet serve size.
How do FODMAPs trigger IBS symptoms?
FODMAPs have 2 main features that influence how they trigger digestive symptoms:
1. By attracting water into the intestine. This can create pressure in the gut and can result in loose stools or diarrhoea.
2. They are rapidly fermented in the large intestine by bacteria that reside the gut (ie. the gut microbiome). The fermentation results in the release of gas which can cause the intestinal wall to stretch and expand. In people with a sensitive gut (ie. people with IBS), the stretching and expansion can trigger digestive symptoms including bloating, cramping, abdominal pain and constipation.
The Phases of the Low FODMAP Diet
The Low FODMAP Diet commonly involves three phases: elimination, reintroduction/challenging FODMAPs and maintenance/individualisation.
Phase 1: Elimination
In the elimination phase, all foods with high FODMAP levels are eliminated from the diet. The purpose of this step is to determine whether removing FODMAPs makes a significant difference in gut symptoms. This step usually lasts 2-4 weeks.
Phase 2: Challenge/ Reintroduction
The challenge phase is then commenced if symptom improvement is seen after the completion of the elimination phase. Challenging FODMAPs is a way of identifying which types of FODMAPs are tolerated and which are problematic. This phase is also essential for understanding the amount of FODMAPs you can tolerate, which is known as your individual “threshold”.
Doing these challenges helps to ensure that only problematic foods are limited long term and prevents the need for an over-restrictive diet which can limit a variety of plant-based foods in the diet. Each FODMAP is challenged with a specific test food one at a time and can take several months to complete all challenges.
Phase 3: Individualisation/personalisation
The individualisation/personalisation phase is the next stage once all the FODMAPs have been “challenged” and individual tolerance of each FODMAP has been identified. This looks like a long-term modified FODMAP diet, where well-tolerated high FODMAP foods are reintroduced and included in the diet and only the problematic high FODMAP foods (identified in the challenge phase) are limited.
The aim is to increase the variety in the diet as much as possible while balancing symptoms. Eating a diverse range of food (especially plant-based foods) is associated with positive long-term gut health and improves the social, cultural and mental factors that play a huge part in food enjoyment.
Generally, most people don’t react to all FODMAPs, but rather have one or two main FODMAP triggers. This means that the long-term personalisation phase of the diet provides much more variety than the initial elimination phase.
‘I think I might benefit from low FODMAP, where do I start?’
Before starting on the diet, it’s firstly important to actually make sure it’s IBS and not another gut-related condition. The symptoms of IBS (bloating, pain, constipation, diarrhoea, flatulence) can present identically to other serious gut conditions, mainly – Inflammatory Bowel Diseases (IBD), coeliac disease and even bowel cancer. That’s not to say the IBS itself isn’t serious, as of course, IBS can be very debilitating and greatly impact one’s quality of life. Although, it is very important to rule out these other conditions which can cause structural damage to the gut and other body parts. If you suffer from uncomfortable gastrointestinal symptoms then seeing a doctor is the first step to take to determine a diagnosis.
If you do have IBS, there may be other more simple strategies to implement before going straight to the low FODMAP diet. For instance, adequate hydration, dietary fibre intake, reduction of gut irritants (such as alcohol and caffeine) and incorporating stress-management strategies into your routine are all useful strategies for managing gut symptoms.
This is where seeing an Accredited Practising Dietitian trained in digestive health comes in to play. An expert dietitian can support you to find the best-individualised management approach. If that happens to be the low FODMAP diet, a dietitian will be able to guide you through the 3 phases while ensuring your diet provides all the nutrients you need and, importantly, that it is flavoursome and enjoyable.
Rebecca Ponsford
Accredited Practising Dietitian (APD) BNutrDiet(Hons)
Rebecca is an Accredited Practising Dietitian, graduated from Monash University in 2018.
She works predominately in the space of gut health and digestive disorders such as Irritable Bowel Syndrome.
She has expertise in the practical implementation of the Low FODMAP Diet and also has a strong interest in the link between mental health and gastrointestinal health. Rebecca is passionate about supporting people to achieve their health goals and develop healthy relationships with food where they can eat with ease.
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What are Eosinophilic Gastrointestinal Disorders (EGIDs)? – ausEE Inc
ausEE Inc. a charity dedicated to improving lives affected by eosinophilic disorders
What are Eosinophilic Gastrointestinal Disorders (EGIDs)?
Eosinophilic gastrointestinal disorders (EGIDs) occur when eosinophils (pronounced ee-oh-sin-oh-fills), a type of white blood cell, are found in above-normal amounts within the gastrointestinal tract.
Eosinophils are an important cell in your body. It has many roles including defence against parasitic infections (e.g. worms), and involvement in some forms of hypersensitivity and allergy. In some individuals, eosinophils accumulate in the gut potentially in response to drugs, food, airborne allergens and other unknown triggers. This infiltration can cause inflammation and tissue damage.
In EGIDs, if abnormal amounts of eosinophils are found in different regions it is called:
- oesophagus (eosinophilic oesophagitis)
- stomach (eosinophilic gastritis)
- duodenum (eosinophilic duodenitis)
- small intestine (eosinophilic enteritis)
- large intestine (eosinophilic colitis)
- throughout the gastrointestinal tract (eosinophilic gastroenteritis)
What is Eosinophilic Oesophagitis (EoE)?
Eosinophilic Oesophagitis (EoE) is the most common type of Eosinophilic Gastrointestinal Disorder (EGID). The exact cause of EoE in most individuals is unclear. In some, it appears to be due to an allergy to food(s) and/or aero-allergens.
The current estimated prevalence of EoE is 1 in 2,000 individuals and rising. People with EoE may have other allergic diseases such as IgE (immediate) food allergies, asthma, eczema and/or hay fever. EoE affects people of all ages, gender and ethnic backgrounds. In certain families, there may be an inherited (genetic) tendency. Males are more commonly affected than females.
In its most severe form, EoE may cause scar tissue (called fibrosis) in the oesophagus.
What are the symptoms of EGID & EoE?
The symptoms of eosinophilic oesophagitis vary from one individual to the next and can include:
- Feeding difficulty (such as needing to puree foods, being slow to chew foods, avoidance of textured foods)
- Difficulty in swallowing foods and/or regularly requiring a drink after eating
- A food suddenly becoming stuck in the oesophagus (called food impaction)
- Nausea, persistent vomiting and retching
- Abdominal or chest pain
- Reflux that does not respond to anti-acid medication
- Failure to thrive (failure to put on or loss of weight) due to inadequate intake
In other types of eosinophilic gastrointestinal disorders, symptoms depend on which part of the gut is affected (e.g. diarrhoea and bloody stools if the small or large intestine is involved).
How is EGID & EoE Diagnosed?
Endoscopy with biopsies are the only way to confirm the diagnosis of an EGID and EoE at present. The diagnosis cannot be based upon symptoms alone.
Endoscopy – a gastroenterologist performs an endoscopy by using an endoscope (a tube with a light and camera at the end) to look at the GI tract and take small biopsies, usually from the upper oesophagus, lower oesophagus, stomach and duodenum. The oesophagus may look visually normal, but when the tissue is examined under a microscope, an abnormal accumulation of eosinophils can be detected. It is also possible that the endoscopist could visually detect rings or furrowing, thickened folds and white plaques.
Biopsy – the biopsies taken are later reviewed by a pathologist. A high number of eosinophils (counted per high power field under the microscope) suggest the diagnosis of EGID. Eosinophils can normally be found in small numbers in all areas of the GI tract except the oesophagus. GERD/GORD (acid reflux disease) is associated with low numbers of eosinophils in the oesophagus. With eosinophilic oesophagitis, the number of eosinophils seen is much higher and remains elevated despite treatment with acid reflux medication. A minimum of 15 eosinophils per high-power field are required to make the diagnosis of EoE.
What is the Treatment for EGID & EoE?
There is no cure for EGID and EoE, but the goal of treatment is to eliminate the eosinophils in the affected area, thereby alleviating symptoms and reducing inflammation to minimal safe levels. Treating specialists should discuss the treatment options with patients/families and tailor treatment to the individual. EGIDs are chronic diseases that require ongoing monitoring and management.
Treatment options for EoE include:
- Elimination diet/elemental diet
- Antacid medications/Proton pump inhibitors (PPIs)
- Corticosteroids (usually topically administered)
- Oesophageal dilation
An Elimination diet is one common treatment option. It is important to speak with a qualified Allergist/Gastroenterologist, and have a Dietitian experienced in food allergy before undertaking an elimination diet. The elimination diet is tailored to the individual. Some individuals may be able to identify specific food(s) that trigger symptoms, but most cannot. More than one food may be involved. Some doctors may suggest removal of up to 6/8 common food allergens (milk, egg, soy, wheat, peanut/tree nut, shellfish/fish). Recent studies indicate milk, egg, wheat and soy are the most common food triggers of EoE, and hence some specialists may recommend removal of these 4 food triggers only. There is no test (skin prick test, blood test or patch test) that can reliably indicate the specific food trigger(s) in EoE. With any elimination diet it is important to ensure diet is balanced, growth is maintained and that there is a plan in place to re-assess.
An Elemental diet consists of only a special medical food called an elemental formula, which contains amino acids (the building blocks of proteins), fats, sugars, vitamins and minerals. They provide all the nutrition a person needs if enough is taken. Some individuals need a feeding tube to ensure they are getting enough of the formula or to give the oesophagus a rest. The patient is placed on the formula alone for a number of weeks and will then have a repeat endoscopy to see if there has been improvement. If the condition has improved, then foods are slowly introduced back into the diet and a repeat endoscopy is often performed to ensure ongoing control with food reintroduction.
Medication can be used alone and/or along with dietary management. The most common medications used in EoE are swallowed corticosteroids, often a fluticasone puffer (which is swallowed) or budesonide ampoules (which are made into a slurry) are used. These medications coat the oesophagus and assist in getting rid of eosinophils. Acid reflux medications may also be used. The doctor will determine which, if any, medications are appropriate for each individual.
Oesophageal dilation can be used in people with severe narrowing or strictures of the oesophagus to provide instant relief, and secondly in those with long-standing symptoms who have tried diet or medications and have not improved. Whilst dilation is relatively safe, this treatment is less convenient as it involves an endoscopic procedure and is best used in carefully selected cases only.
References:
1. Australasian Society of Clinical Immunology and Allergy (ASCIA) Available at: www.allergy.org.au
2. Cincinnati Center for Eosinophilic Disorders (CCED) Available at: www.cincinnatichildrens.org
3. American Partnership for Eosinophilic Disorders (APFED) Available at: www.apfed.org
4. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference
Available at: www.gastrojournal.org/article/S0016-5085(18)34763-2/fulltext