Eosinophilic oesophagitis: the milk does the trick
Eliminating certain foods can help cure eosinophilic oesophagitis. But it is often unclear which to eliminate or abstain from. Researchers compared elimination diets of different foods, versus those where only cow's milk was avoided.
The effects of elimination diets on eosinophilic oesophagitis
- Both elimination of six foods, and elimination of cow's milk led to remission of eosinophilic oesophagitis.
- The difference between the two approaches was not pronounced.
- Excluding cow's milk products from a diet can be a first successful therapeutic approach for eosinophilic oesophagitis.
Elimination diet: what is it and what does it do?
The fact that an elimination diet helps with eosinophilic oesophagitis has been known for some time and has been described in medical literature for several years. But what exactly is it? There are different approaches. For example, the consistent omission of a food, such as cow's milk, is already considered an elimination diet. But there is also the possibility of carrying out the elimination experiment with several food groups.
Up to now, no studies looked at which of these strategies was more helpful against eosinophilic oesophagitis. A recent study addressed this very knowledge gap.
One versus six: Why is the number of omitted foods relevant?
The correct implementation of an elimination diet is extremely complex and time-consuming. For example, it is important that the relevant food or foods are completely removed from the diet. This is not always easy and requires close reading of ingredients and, in most cases, not eating out, or eating convenience foods.
Logically, if a good result can be achieved with the abstention of only a single food, this significantly increases the quality of life of the affected person.
Giving up one or six foods: which is better?
The study authors compared the outcomes of people with eosinophilic oesophagitis who gave up one or six foods. To do this, they randomised 129 patients into two groups: the first gave up cow's milk, while the second eliminated wheat, eggs, soy, fish and shellfish, peanuts and nuts in addition to cow's milk.
After six weeks, the participants were examined and their disease status evaluated. The result: in both groups, histological remission occurred in more than 30 percent of the cases. The people who followed a stricter diet, i.e. abstained from six foods, had a significantly higher probability of achieving remission.
A strict elimination diet for all?
Overall, however, the difference between the two groups was not large enough to recommend a strict elimination diet for all patients. Even abstaining from cow's milk is associated with such a significant improvement in symptoms and histology that this can be recommended as a first measure. The implementation is much easier than the stricter variant.
Just giving up cow's milk can make a significant difference for patients with eosinophilic oesophagitis. Although people who followed a stricter elimination diet had higher chances of remission, it is recommended to start with giving up milk before considering more restrictive diets.
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- Kliewer KL, Gonsalves N, Dellon ES, Katzka DA, Abonia JP, Aceves SS, Arva NC, Besse JA, Bonis PA, Caldwell JM, Capocelli KE, Chehade M, Cianferoni A, Collins MH, Falk GW, Gupta SK, Hirano I, Krischer JP, Leung J, Martin LJ, Menard-Katcher P, Mukkada VA, Peterson KA, Shoda T, Rudman Spergel AK, Spergel JM, Yang GY, Zhang X, Furuta GT, Rothenberg ME. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol. 2023 May;8(5):408-421.