Starting An Elimination Diet for Children With Eosinophil-Associated Diseases Such as Eosinophilic Esophagitis (EoE)
Real Talk: Eosinophilic Diseases
Release Date: 12/21/2022
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Host Holly Knotowicz, a speech-language pathologist who serves on APFED’s Health Sciences Advisory Council, talks with guest Laura Gearman, MS, RD, LD, CNSC about the use of dietary therapy to treat eosinophilic esophagitis (EoE).
Laura is a Registered Dietitian who specializes in pediatric nutrition. She is the Clinical Nutrition Manager and a Pediatric Dietitian at the University of Minnesota Masonic Children’s Hospital. She has contributed to multiple publications regarding pediatric malnutrition and nutrition support. Plus, she is a mom of two, including a six-year-old daughter who has EoE.
In this episode, Holly and Laura discuss working with children with EoE and their families. They explore elimination and elemental diets, and how to help children manage these special diets. They discuss misconceptions about these diets and when it is best to use them in the treatment of EoE.
Disclaimer: The information provided in this podcast is designed to support, not replace the relationship that exists between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.
Key Takeaways:
[1:09] Holly introduces today’s topic, Starting An Elimination Diet for Children With Eosinophilic Diseases Such as Eosinophilic Esophagitis (EoE), and today’s guest, Laura Gearman, a Registered Dietitian who specializes in pediatric nutrition.
[1:58] Laura knew from a young age that she wanted to work with children and was also very interested in cooking and the science of food. With those interests, becoming a pediatric dietician made a lot of sense. Through her master’s degree at Tufts, Laura got exposure to pediatric clinical work and she knew that’s where she wanted to be.
[2:32] For the past 12 years, Laura has been at the University of Minnesota Masonic Children’s Hospital, working with critically ill children, while raising her own two children.
[3:09] An elimination diet consists of eliminating many or all of the most common allergens including dairy, egg, wheat, soy, peanuts, tree nuts, fish, and shellfish. Some EoE care teams encourage a six-food elimination diet. Some elimination diets may start with removing dairy (milk) and/or wheat, which are common EoE triggers. Elimination diets take a lot of planning.
[3:38] First, the family needs education from a registered dietician familiar with EoE on what the elimination diet entails and what foods to avoid. Most importantly, education should be focused on what foods patients are still able to eat. Feeding children is instinctual and there is a lot of emotion involved in it.
[4:56] The main goal of an elimination diet is to identify which foods may be triggers for EoE. A lot of centers are moving toward eliminating just a couple of foods at a time. It’s a long process to find which items may be triggering symptoms of EoE. The elimination diet will continue to evolve.
[5:23] An elemental diet removes allergens and consists of an amino acid-based formula. It may include one or two simple foods, like lollipops. One or two low-allergen foods may be introduced to keep up oral skills. Formula comes in several flavors now. Children can experience fatigue of drinking.
[6:16] Some kids may require a feeding tube to administer the formula.
[7:18] An elemental diet could be used as a first-line treatment for someone with EoE as long as there are no medical contra-indications. It could be used if someone has failed diet therapy or medication therapy and are unable to get into remission with either of those.
[7:43] A lot of kids are unable to stay on an elemental diet because of fatigue, social reasons, the difficulty of obtaining formula, or not being covered by insurance. Some tube-fed children with EoE remain on an elemental diet because it works for them and they are in remission.
[8:33] Three months is typically the minimum length to be on an elimination or elemental diet to make sure there is enough time for any changes in the eosinophil count to occur.
[8:54] The way to start an elemental diet with children depends on their age. With younger children, you might mix the formula half-and-half with their beverage of choice as a transition. Be very upfront with the child, whatever their age. Kids can sense changes quickly. Explain the change, and how it will help the child.
[10:18] Laura discusses selective eaters versus adventurous eaters. Some people with EoE already avoid foods selectively that may be triggers to them. For adventurous eaters, you have a lot of options. It can be challenging to work with patients who are selective about textures. For example, oatmeal yogurt has a very different texture from regular yogurt.
[11:36] Education is huge. It takes more than the initial appointment to teach a family how to follow an elimination diet. The family needs written information to refer to and resources to go to, including APFED. Patients and their families are encouraged to ask questions.
[12:35] Misconceptions about dietary therapy include: 1. Diet therapy will cure the problem and everything will be fine. 2. Changing what I eat won’t work. 3. I can have pizza once a week. 4. I avoid all dairy, but I can still eat butter.
[13:23] Education is important. In order for an elimination diet to work, the patient must commit to following the diet.
[14:02] There is a learning curve to avoiding foods and finding hidden allergens. There can also be challenges in meeting nutritional needs, depending on how selective the child is with the foods they can eat. Parents may need to monitor what supplementation is needed for children with EoE who are eliminating whole food groups like dairy.
[14:51] For families that are undergoing an elimination diet without access to dietician services, Laura recommends getting information from their care team, especially written material the clinic may provide. Go to APFED.org to connect with other families.
[15:57] Elimination diets can be used in combination with medication.
[17:11] Laura’s daughter was diagnosed with EoE at age five. She is now six. She was diagnosed with a food allergy at age two after contact with tree nuts. Prior to her EoE diagnosis, she experienced frequent vomiting, as well as gagging and choking on food.
[18:50] When Laura’s daughter started drinking more water during meals to help her swallow, Laura realized that might have EoE.
[19:47] Laura’s daughter is on a milk-only-elimination diet. She is not yet in remission. They are deciding on the next step, either more elimination or moving on to trying medication.
[20:19] Laura’s family works together to manage the daughter’s diet. Each family member has a job, which helps. They all take part in shopping and looking for foods to incorporate into meals and pack as snacks and lunches for school and activities. Laura’s husband does the cooking. It takes planning.
[22:05] Laura talks about the diet a lot with her daughter. They have a medical/allergy/asthma play kit that they use to play with dolls. They have play food for the dolls and talk about which items have dairy and which don’t. Working through play is important for kids to learn.
[23:45] Laura explains how her work with her daughter has influenced her work as a pediatric dietician. She says you don’t have any idea what it’s like to live it until you do. It has given her more empathy for the families she works with because she understands their day a little bit better.
[25:19] Holly thanks Laura for sharing her experiences on this podcast. Laura and Holly share resource links for listeners to learn more about EoE.
Mentioned in This Episode:
American Partnership for Eosinophilic Disorders (APFED)
APFED on YouTube, Twitter, Facebook, Pinterest, Instagram
American Academy of Allergy, Asthma, and Immunology
Real Talk: Eosinophilic Diseases Podcast
This episode is brought to you thanks to the support of our Education Partners Bristol Myers Squibb, GlaxoSmithKline, Mead Johnson Nutrition, Sanofi, and Regeneron.
Tweetables:
“For the past 12 years, I’ve been at the University of Minnesota Masonic Children’s Hospital, working with mostly critically ill children, but also children in other settings, and I have learned a lot … as a pediatric dietician, [with] kids … to feed.” — Laura Gearman, MS, RD
“A lot of centers are moving toward eliminating just a couple [of foods] at a time. We know it’s a long process to find which items may be triggers [for EoE].” — Laura Gearman, MS, RD
“When you’re first learning about [EoE], it’s just so challenging.” — Holly Knotowicz
“Working through play is so important for kids to learn.” — Laura Gearman, MS, RD
“I think you don’t have any idea what it’s like to live [with EoE] until you do.” — Laura Gearman, MS, RD