Seven Food Elimination diet Information for patients and families Read this brochure to learn: . What 7 foods are the most common allergens . How the Seven Food Elimination Diet works . How to reintroduce foods into your diet What is the Seven Food Elimination diet? The Seven Food Elimination diet is used to learn what foods may be causing your eosinophilic esophagitis symptoms, such as difficulty swallowing. In this diet you stop eating 7 foods that are the most common causes of allergic reactions. They are called allergens. You remove the 7 allergens from your diet for a short time. Next, you slowly add foods back to your diet and watch for symptoms such as difficulty swallowing. If you get symptoms, you will know that you are reacting to that allergen. What 7 allergens need to be removed from my diet? Wheat Dairy products and cow’s milk Soy Peanuts Tree nuts Eggs Seafood 1 How does the diet work? The diet will take at least 13 weeks. For the first 6 weeks you stop eating foods that contain any of the 7 allergens. Then you will reintroduce 1 new food every week. At first, you will only add small amounts of each food. If you do not react to that food, you can eat a little more of that food each day. Each time you reintroduce a new food, pay attention to how your body reacts. Keep a food diary to help you keep track of what foods cause digestive problems. In this diet, you add foods to your diet in a specific order. Here is the order you should follow: 1. Seafood 2. Eggs 3. Tree nuts 4. Peanuts 5. Soy 6. Dairy products 7. Wheat Watch for symptoms of intolerance such as difficulty swallowing. 2 What will my meals look like in Weeks 1 to 6? For 6 weeks, remove all 7 allergens: wheat, dairy, soy, peanuts, tree nuts, eggs and seafood. Here is a sample menu to guide you through these weeks. Sample menu for weeks 1 to 6 Breakfast: ¾ cup oatmeal (use oats that are not contaminated) 1 cup non-dairy beverage (rice, hemp, oat or coconut) 1 banana Snack: ½ cup applesauce ¼ cup unsalted pumpkin seeds Lunch: 1 cup chili or bean soup (dairy-free) 2 rice cakes Carrot and celery sticks with 2 tablespoons of vegan dressing 1 pear Snack: 1 cup non-dairy beverage (rice, hemp, oat or coconut) Rice crackers with ¼ avocado Dinner: 3 ounces roast chicken ½ sweet potato 1 cup brown rice Green salad: leafy greens with chopped tomatoes, cucumbers and bell peppers ½ cup mixed berries 3 How to add foods back to your diet Start with small amounts, such as an allergen listed in the ingredients of a packaged food. If you do not have any symptoms, slowly increase the amount of allergen. Do this until you are eating a small amount of the allergen. For example, when you are reintroducing eggs, here are the steps you will take: 1. In week 8 start with a food that contains traces of egg (such as baked goods). 2. Next try a food that contains more egg (such as egg noodles). 3. Lastly, try a hardboiled egg. If you get symptoms, you know you are reacting to the last food you reintroduced. Stop eating that food. Continue without adding any new foods until your symptoms go away. When your symptoms are gone, reintroduce the next food on the list. 4 Watch out for allergen cross-contamination! Cross-contamination when an ingredient (food allergen) is transferred to a product that does not normally contain that ingredient. When this happens, a food that should not contain the allergen could be dangerous to someone who is allergic. Cross-contamination can happen when: Manufacturers use the same production and packaging equipment for different food items Equipment in retail stores is shared. For example, a deli slicer could be used for both cheese and meat, or scoops in a bulk food store could be used for wheat flour and almonds To prevent cross-contamination: Read labels to make sure that the packaged foods has not been made in close contact with the allergen. Try to not buy food items from shared spaces such as deli counter, bulk food bins, self-serve stations at grocery stores and restaurants. Do not use the same equipment or utensils that are used when food is prepared at home or in restaurants. At restaurants, ask if the utensils and items used to prepare foods are in contact with allergens. Do I need to take supplements with this diet? This diet eliminates some foods that are part of a healthy, balanced diet. While you are following this diet you should take: Vitamin D (1000 IU per day) Calcium (500 mg twice a day) 5 Where are the top 7 food allergens found? The following lists identify common food and non-food sources containing the top 7 allergens. Please use these lists as a guide of which items to avoid. The information below is adapted from Health Canada. It is important to know that these lists are not complete and may change. Food and food products purchased from other countries, through mail-order or the Internet, are not always produced using the same manufacturing and labeling standards as in Canada. 1) Seafood Possible food sources of seafood Deli meats (bologna, ham) Dips, spreads, kamaboko (cured imitation crab or lobster meat) Ethnic foods (fried rice, paella, spring rolls, Nuoc Mâm) Fish mixtures such as surimi (imitation crab or lobster meat) Garnishes (antipasto, caponata, caviar, roe) Gelatin, marshmallows Hot dogs Pizza toppings Salad dressings Sauces (fish, marinara, steak, Worcestershire) Soups Spreads (taramasalata) Sushi Tarama (salted carp roe) Wine 6 Other names for seafood Fish: Anchovy, bass, bluefish, bream, carp, catfish (channel cat, mudcat), char, chub, cisco, cod, eel, flounder, grouper, haddock, hake, halibut, herring, mackerel, mahi-mahi, marlin, monkfish (angler fish, lotte), orange roughy, perch, pickerel (dore, walleye), pike, plaice, pollock, pompano, porgy, rockfish, salmon, sardine, shark, smelt, snapper, sole, sturgeon, swordfish, tilapia (St. Peter's fish), trout, tuna (albacore, bonito), turbot, white fish, whiting Crustaceans: Crab, crayfish (crawfish, écrevisse), lobster (langouste, langoustine, coral, tomalley), prawns, shrimp (crevette) Shellfish: Abalone, clam, cockle, conch, limpets, mussels, octopus, oysters, periwinkle, quahogs, scallops, snails (escargot), squid (calamari), whelks Non-food sources of seafood Fish food Lip balm, lip gloss Pet food Nutritional considerations Seafood is a good source of protein. Replace it with other protein foods such as meat and poultry. Seafood is a good source of folate, vitamin B12, zinc and iron. To make sure you are getting these important nutrients, choose • leafy green vegetables • beans and lentils • meat and poultry • fortified cereals 7 What will my meals look like in Week 7? Here is a sample menu for week 7, when you introduce seafood. Sample menu for week 7 Breakfast: 2 slices toasted rice bread (egg-free) with 2 ounces turkey bacon, lettuce and tomatoes (BLT) 1 cup non-dairy beverage (rice, hemp, oat or coconut) 1 apple Snack : 2 slices rice cheese Wheat-free crackers (such as Mary’s Crackers®) Lunch: Tuna pasta salad: 3 ounces canned tuna, 1 cup brown rice pasta (such as Tinkyada®), chopped green onions, celery and tomatoes 1 cup mixed greens 2 tablespoons vinaigrette dressing Snack: ½ cup grapes or ¼ cup raisins ¼ cup unsalted pumpkin seeds Dinner: 2½ ounces roast beef 1 cup baked potato wedges ½ cup green beans ½ cup melon 8 2) Egg Possible food sources of egg Alcoholic cocktails or drinks Baby food Baked goods and baking mixes (breads, cakes, cookies, doughnuts, muffins, pancakes, pastries, pretzels) Battered or fried foods Confectionery (candy, chocolate) Cream-filled pies (banana, chocolate, coconut) Creamy dressings, salad dressings, spreads (mayonnaise, Caesar salad dressing, tartar sauce) Desserts (custard, dessert mixes, ice cream, meringue, pudding, sorbet) Egg or fat substitutes Fish mixtures (imitation crab or lobster meat) Foam or milk topping on coffee Homemade root beer, malt drink mixes Icing, glazes (egg wash on baked goods, nougat) Lecithin Meat mixtures (hamburger, hot dogs, meatballs, meatloaf, salami) Orange Julep®, Orange Julius® (orange juice beverages) Pasta (egg noodles) Quiche, soufflé Sauces (Béarnaise, hollandaise, Newburg) Soups, broths, bouillons Non-food sources of egg Anesthetics such as Diprivan® Craft materials (propofol) Hair care products Certain vaccines such as MMR Medicines (measles, mumps and rubella) 9 Other names for egg Albumin, albumen Ovoglobulin Conalbumin Ovolactohydrolyze proteins Egg substitutes such as Ovomacroglobulin ® Egg Beaters Ovomucin, ovomucoid Globulin Ovotransferrin Livetin Ovovitellin Lysozyme Silico-albuminate Meringue Simplesse® Ovalbumin Vitellin Alternatives to eggs In baked goods, any of the following can replace 1 egg: 1 tablespoon (15 mL) vinegar Half a banana, mashed. Use in cakes, muffins and quick breads 1 tablespoon (15 mL) ground flax mixture. Use in recipes where milk is called for, such as pancakes, muffins and cookies 1 o Mix /3 cup ground flaxseed with 1 cup water. Bring mixture to a boil. Simmer for 3 minutes, then refrigerate. 1 tablespoon (15 mL) cornstarch. Use in custards and other recipes where egg acts as a thickener Nutritional considerations Eggs are a good source of protein. Replace them with other protein foods such as meat and poultry. Eggs are a good source of folate, vitamin B12, zinc and iron. To make sure you are getting these important nutrients, choose • leafy green vegetables • beans and lentils • meat and poultry • fortified cereals 10 What will my meals