, Volume 31, Issue 6, pp 765–770 | Cite as

The Six-Food Elimination Diet for Eosinophilic Esophagitis Increases Grocery Shopping Cost and Complexity

  • W. Asher Wolf
  • Kevin Z. Huang
  • Raquel Durban
  • Zahra J. Iqbal
  • Benjamin S. Robey
  • Farah J. Khalid
  • Evan S. DellonEmail author
Original Article


The six-food elimination diet (SFED), where dairy, wheat, eggs, soy, nuts, and seafood are avoided, is an effective treatment for eosinophilic esophagitis (EoE). Patient-related costs of this approach, however, are unknown. We aimed to assess the cost of and ease of shopping for an SFED compared to an unrestricted diet. A dietitian with expertise in EoE generated menus meeting dietary requirements for a week’s worth of meals for the SFED and an unrestricted diet. We compared prices and the number of missing items for both diets at standard and specialty grocery stores. The average weekly price of the SFED at a standard supermarket was $92.54 compared to $79.84 for an unrestricted diet (p = 0.0001). A patient shopping at a standard grocery store needed a higher proportion of items from a second store compared to an unrestricted diet (32 vs. 3 %, p = 0.0001). The prices of the SFED and unrestricted diet using a specialty supermarket were comparable ($106.47 vs. $105.96, p = 0.81), as was the percentage of items requiring a trip to a second store (6 vs. 2 % items, p = 0.03). Shopping at a specialty grocery store increased weekly grocery costs by $13.93 (p = 0.04) for the SFED and $26.12 (p = 0.03) for the unrestricted diet. In conclusion, for patients shopping at standard grocery stores, the cost of an SFED is higher, and an SFED requires more items from a second store. These differences disappear at specialty grocery stores, but costs were significantly higher. This cost and logistical burden can inform patients when selecting dietary therapy.


Six-food elimination diet Dietary therapy Eosinophilic esophagitis Targeted elimination diet Cost analysis Deglutition Deglutition disorders 


Author Contributions

WAW: Data analysis, drafting of the manuscript, critical revision of the manuscript, KZH: Data acquisition, drafting of the manuscript, critical revision of the manuscript, RD: Technical expertise, critical revision of the manuscript, ZJI, BSR, and FJK: Data acquisition, critical revision of the manuscript, ESD: Study concept and design, study oversight, critical revision of the manuscript.

Funding and Grant Support

This research was funded in part by T32 DK07634 (WAW), T35 DK007386 (KZH), K23 DK090073 (ESD), and R01 DK101856 (ESD).

Compliance with Ethical Standards


Dr. Wolf has received support from Nestlé Corporation to attend educational events. Dr. Dellon has received research funding from Meritage, Miraca Life Sciences, Receptos, and Regeneron, and has been a consultant for Aptalis, Novartis, Receptos, Regeneron, and Roche. None of the other authors have any relevant disclosures, and there are no potential conflicts related to this manuscript.

Supplementary material

455_2016_9739_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • W. Asher Wolf
    • 1
  • Kevin Z. Huang
    • 1
  • Raquel Durban
    • 2
  • Zahra J. Iqbal
    • 3
  • Benjamin S. Robey
    • 1
  • Farah J. Khalid
    • 3
  • Evan S. Dellon
    • 1
    Email author
  1. 1.Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and SwallowingUniversity of North Carolina School of Medicine, UNC-CHChapel HillUSA
  2. 2.Asthma & Allergy SpecialistsCharlotteUSA
  3. 3.Department of Medicine, Brody School of MedicineEast Carolina UniversityGreenvilleUSA

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