Eating & Running With EoE (eosinophilic esophagitis) on a 6-Food Elimination Diet
My nutrition during the virtual Boston Marathon.
On Friday, Oct 8 I headed out the door at 8 am to run a figure eight loop around my neighborhood and collect 26.2 virtual Boston Marathon miles. The day was perfect - mostly sunny with puffy clouds, blue skies, and in the low 70s. But I was going into these miles a little differently.
Five weeks prior to virtual Boston, I suffered a painful and scary food impaction episode at home. A piece of meat got lodged in my esophagus. This was not the first time. I have had many food impaction ordeals since 1996. Long story short, I have had over 20 endoscopies and a few diagnoses: GERD, hiatal hernia, esophageal diverticula, and Schatzki's ring, In 2007, I was diagnosed with esophageal stricture suggestive of EoE (eosinophilic esophagitis). A few years later, in addition to eosinophilic esophagitis, I was diagnosed with possible Barrett's esophagus.
On Christmas Eve 2017, I landed in the ER after Singapore noodles got lodged in my esophagus. After an emergency endoscopy to push the food into my stomach, I was sent home. After that I experienced several food impaction episodes at home that resolved themselves. The one I had in September 2021 was the scariest and most painful with distressing retching every 10 to 15 minutes. The pressure on my chest was overwhelming and made it difficult to talk.
My husband Jon drove me to the ER thirty minutes away as I retched some more into a supermarket plastic bag. After an excruciating 6-hour wait in the ER for an OR to open up, I got an endoscopy. Biopsies were once again taken. I was admitted overnight for observation. A week later, I met with my GI doctor. Because PPIs (proton-pump inhibitors) like Prilosec had not worked in the past and had only succeeded in depleting my body of B12, I opted for the 6-food elimination diet route.
At this appointment to go over my biopsies results and my history, I began to understand what doctors and researchers don't really know much about - why eosinophils (white blood cells) migrate from the bone marrow to the esophagus to cause so much damage. One of the consequences of abnormally high eosinophils in the esophagus is food impaction, which can be life-threatening.
According to the medical literature and EoE websites, eosinophilic esophagitis is an autoimmune disease of the esophagus. Its cause(s) are unknown. Researchers have yet to pinpoint the cause. Some speculate EoE is caused by environmental allergens or by an immune/allergic reaction to certain foods. I have no environmental allergies. I am not aware of any food allergies but my six-week, 6-food elimination diet, and a follow-up endoscopy will hopefully shed some light.
There is no definitive treatment or cure for the many eosinophils (white blood cells) that build up in the esophagus and cause damage, inflammation, and food impaction. EoE is a rare disease but growing in prevalence, affecting 1 out of 2,000 people. This population includes adults and children. My son also has EoE and a history of food impaction.
After I met with my GI doctor, I met virtually with a GI dietician two days later. She guided me through the 6-food elimination diet. For the next six weeks, I could not eat dairy, eggs, soy, wheat, fish, and tree nuts including almond flour, a big part of our mostly Paleo diet. No more homemade Paleo bread, almond dark dark chocolate chip cookies, almond butter, almond milk, and pizza made with almond flour. No more eating eggs before a training run, and no more salmon, sardines, and all seafood.
The GI dietician gave me three PDFs containing the Oregon Clinic 6-food elimination diet, along with the Kaiser Permanente EoE food elimination diet and sample meal plans. Both listed foods to avoid, what to eat, brand names to purchase, and a reminder to read food labels and ingredients very carefully.
What I can have, or can I?
Armed with 14 printed pages of the diet secured in protective sheet covers, Jon and I went up and down the aisles at ShopRite and Whole Foods in search of the only foods I could eat the next six weeks. We purchased non-dairy coconut ice cream, coconut milk, coconut yogurt, and plant-based cheese. I can still consume all vegetables and fruits, beans, and snacks that can only contain olive oil or sunflower oil. I can eat quinoa, and lard which we use in our Paleo cooking. I bought gluten-free tortillas. I didn't read the ingredients label in super tiny print carefully. When I got home, I discovered they contain soy. So many food items contain soy and tree nuts. But I was excited when I found Lay's potato chips that are made with sunflower oil!
I like a challenge so I was ready to take on this new diet to learn if I am allergic to dairy, eggs, soy, wheat, fish, and tree nuts so that I can be spared future food impactions, if indeed, they are the cause of abnormally high eosinophils inflaming and damaging my esophagus. While I can get some protein with pork, beef, and chicken, I'm not able to continue to have my protein shakes. My vegan protein powder contains soy and tree nuts.
I'm the baker in the family and Jon is the chef. These are some of our dinner dishes on this new diet, and an eggless coconut flour cake. The frosting is made with coconut milk, cocoa, vanilla extract, confectioners sugar, and dark chocolate chips that contain no soy and no milk
Clockwise: Yuca, mushrooms, onions, carrots sautéed in olive oil in a corn tortilla wrap; seasoned fried pork chop in olive oil, sautéed black beans, mushrooms, peppers, corn, and onions, and avocado; eggless coconut flour cake; ground beef, black beans corn, tomatoes, and non-dairy cheese on a corn tortilla wrap; mixed salad, sautéed tomatoes, pieces of steak, onions, and yuca.
Everything was going well until it wasn't. Four weeks into the new diet and two weeks before my next endoscopy, and seven days before virtual Boston, I experienced another frightening food impaction incident at home. Another anxious retching ride to the ER. Thankfully, four hours later a small amount of chickpea spaghetti and a tiny piece of chicken finally worked their way into my stomach and relieved the pressure on my chest. I could speak normally again.
I made the decision to eat only baby food but I remembered hearing in the news about toxic arsenic in baby food so I crossed out that idea fast. I settled on eating only homemade puréed foods until until my next endoscopy. And while Jon's savory cooking did not look appetizing puréed, it tasted delicious. But more important, I have not had another food impaction experience.
Sautéed & puréed seasoned chicken, black beans, chick peas, corn, red onions, romaine, and cilantro.
By now, I had mastered eating puréed foods. I would apply this skill to my nutrition during the virtual Boston marathon. My aid station atop our driveway offered me, unlike salted potato pieces at aid stations during ultras, very soft mashed potatoes made with coconut milk, olive oil, and sea salt. The bananas that I'm accustomed to eating during a training run or an ultra were whipped into a smoothie with pineapple and coconut milk. I had a jar of apple sauce, cut slices of avocado, a couple of small cans of Pepsi, seltzer, and Nuun hydration. I was alone so I was extra careful with my chewing and swallowing. And I did not eat and run simultaneously. Gels have never been an option for me; they make me nauseated.
Except for sporadic toe, foot, and leg cramps beginning at about mile 15.7 on my BAA app and Garmin watch that slowed me down to the virtual finish, on this beautiful day in our quiet neighborhood filled with chirping and singing birds, a squirrel or two, a couple of friendly feral felines, the faint roar of an occasional airplane overhead, a passing car or two, the elegant heron dancing in the air across the lake, the ducks and geese resting in the waters, and a young male fishing in the lake near the turtles lounging on a tree log at the edge of the lake and basking in the sun, my 26.2 meditative miles were peacefully uneventful.
On Sunset Drive, .2 miles from my house.
I'm not a marathoner or a speedy runner. The older I get, the slower I am. But I have a lot of endurance. I'm most at home running grueling ultra events. But I'm glad I participated virtually in a little bit of history, along with so many fellow runners world-wide, on the 125th anniversary of the Boston Marathon, an event I will never qualify to run.
I'm glad I was able to spend time running 26.2 healing miles for my EoE and damaged esophagus. Would I have run a few minutes faster if I had not been on this 6-food elimination diet and had not experienced cramps the last 10 miles? Maybe. But I adapted and kept moving on this medically necessary diet.
I look forward to receiving my finisher's medal and adding it to my collection that began 33 years ago when I ran my first road race - a 5K charity run in October 1988. In the meantime, I've been enjoying fudgy brownies made with only pumpkin purée and melted organic bitter-sweet cacao dark chocolate chips that are soy, wheat, gluten, dairy, eggs, and tree nuts free.