Practical Tips for implementing a six-food elimination diet (SFED)

Following a six-food exclusion diet (SFED), which involves avoiding all foods containing the six most common food allergens in the United States, can be challenging for families to implement. It is used to treat some food allergy conditions and eosinophilic gastrointestinal conditions, such as eosinophilic esophagitis.

As a dietitian and researcher who works with patients receiving this recommended treatment, I thought it would be insightful for me to experience what our patients go through, especially as we are currently doing a clinical trial investigating diets excluding one food (avoiding milk) vs. six foods (SFED – avoiding milk, egg, wheat, soy, nuts and seafood) for six weeks.

When cooking:

 Breakfast

IMG_7527Oatmeal

I am a fan of oatmeal (make sure to use the gluten free option), served with blue berries and Daiya® milk-free yogurt on the side.

Pancakes

Some mornings, I did alternate oatmeal with pancakes baked with Bob Red Mills® 1-to-1 flour mix, which substitutes directly and in the same amount as the wheat flour for whichever recipe you are using. I replaced the milk in a standard recipe with a suitable milk replacement (Living Harvest® Tempt Hempmilk, So Delicious® Coconut Milk, Good Karma™ Flaxmilk, Suzie’s® Quinoa milk Beverage) and used VeganEgg® as the egg replacer. Sometimes, in order to increase the protein content of the pancake, I replaced the egg with mashed banana and used a high-protein milk substitute.

High-protein milk substitutes

One of the few high-protein milk substitutes that I found that is free from all the allergens, including no mention of “may contain statements”, is the Orgain® range of products. I have successfully used these to make pancakes, cereal bars, high-protein milk shakes, cappuccinos, and lattes. They come in different flavors and also taste fine by themselves. It is an easy way to start the day whether you are dealing with a fussy eater or a child with food aversions.

 Lunch

Salads

I love salads and baked potatoes, but a balance of protein, carbohydrates, and fat is important for a healthy diet. Extra care is needed to make a SFED or any restricted diet a balanced diet. Sometimes I added rice or quinoa to the salad rather than eating the potato to get my carbohydrates. For protein, I usually added chicken or strips of steak. Ham or turkey slices are also an option for those who like them. Another quick but filling lunch was rice crackers with a salad and avocado.

I can suggest two different types of salad dressings:

  • mixing olive oil and vinegar
  • diluting Just Mayo® with a bit of water

Sandwiches

I am not much of a bread eater, but I did miss eating a sandwich! To solve this problem, I used Bob Redmills® bread mix and added the VeganEgg® to make SFED-friendly bread to use for sandwiches.

Dinners
Mexican

While following the SFED, I prepared Mexican meals often, using steak/chicken strips, corn tortillas, guacamole, and tomato/onion sauce, because it had a good balance of nutrients while still being flavorful.

Spaghetti bolognaise

My children adore spaghetti bolognaise. Preparing this dish with a wheat-free pasta and homemade tomato sauce allowed me to only have to make one meal – a huge bonus!
Staple meals
You could also prepare simple meals consisting of beef or chicken, rice or quinoa pasta or potato, and a salad and/or vegetable.

Personal Meal Substitution for a non-SFED Meal

Having a planned stand-by is incredibly helpful. When the rest of my family wanted to eat something that was difficult to substitute with all the necessary ingredients or when they were eating fish, I usually melted a suitable dairy-free cheese (Daiya® Provolone cheese) over corn tortillas and added a fresh green salad.

 Snacks on-the-go:

I often packed leftover quinoa pasta or rice pasta from the night before with a tomato-based sauce. I used nutritional yeast as a replacement for parmesan cheese on occasion. However, hummus (see recipe) with some vegetable sticks was my saving grace. I also often ate sunbutter as a dip for wheat-free cereal fingers (see recipe – a cereal bar cut long and slim like fingers rather than bars).CA9CA6CA-0225-458D-B353-8CC20256D3E7.jpg

 

Published by carinaventeronline

Allergy Specialist Dietitian/Chair International Network of Diet and Nutrition in Allergy/Fellow of the British Dietetic Association/Always learning, writing and teaching/Always another question

One thought on “Practical Tips for implementing a six-food elimination diet (SFED)

  1. Always another question, that’s for sure. I love reading science and practical out workings of that as you’ve posted here Dr Venter. I’m signing up to your blog.
    Kindest regards
    President Williams

    Liked by 1 person

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