A Nurse's Perspective of Starting SFED

Two of the esophageal nurses at Mayo Clinic Rochester undertook the six food elimination diet. They dove in and followed complete elimination, followed by each food re-introduction. While they didn’t have to sample their esophagus at each step, they did get a firsthand look at what the diet is all about and its challenges and rewards. Here’s what Kari, RN and Sarah, RN have to say about their experiences:

1. How did you go about starting the SFED?
   • Kari: We started the diet on a Tuesday. Unfortunately, I wasn’t able to get to the store for groceries until Thursday, so the first two days were exceptionally challenging. Upon looking at what was in my pantry, I realized there wasn’t anything I could eat!
   • Sarah: I took on an “adventure” perspective. I wanted to answer the question, “How can I help patients get started to increase success and lower stress?” I also quickly realized that I’d need to find appropriate substitutions to my staple foods.
2. What was grocery shopping like? Did you try any new foods?
   • Kari: I spent a lot of time at the grocery store reading labels. Finding foods was very challenging and I quickly learned that some of the foods are hidden. Soy and wheat are in a lot of things! Once I found a few things I knew were SFED-safe, I found myself eating the same things over and over again.
   • Sarah: My goal was to find some foods to rely on, but to expand with a new food every couple of days to broaden my horizon. During that first shopping experience, I realized the importance of planning ahead. You need to have a well thought-out grocery list. Chocolate coconut milk, although difficult to find, was a major treat!
3. Did you go out to restaurants? Was it easy or difficult to find something on the menu that was SFED-friendly?
   • Kari: It was very difficult. I’d say next to impossible, because you don’t really know what’s hidden in the food itself, or how it’s prepared. My first experience eating out I had a grilled chicken breast with no bun, a baked potato with salsa (no butter) and bacon bits, and corn.
   • Sarah: The first weekend after we decided this I was on a weekend trip with lots of eating out. That was very challenging and I have to admit I probably cross-contaminated. Like Kari said, you don’t really know exactly what’s in the food or exactly how it’s being prepared. The people I was with kept remembering this too, and would make comments such as “Oh, that’s right, you can’t eat that.” That stinks to hear all the time. I also noticed the workers and servers were getting irritated with me when I asked all kinds of questions, trying to be compliant.
4. Let’s talk about food re-introduction. Things got easier then, right?
   • Kari: Not necessarily. The first few foods tend to “go” with other foods that were still out. For example, when fish was added I thought about having a tuna sandwich, however mayo (eggs) and toast (wheat) were still out. As the foods were re-introduced, it did get easier again.
   • Sarah: Agree with Kari on this one. At first, I didn’t really care if I had any fish, but I tried to include it at least 3 times per week like patients need to. However, I just kept thinking about all the other foods I still couldn’t have! In the midst of adding foods, eating out was still challenging since not everything was back in yet.
5. What would be your most helpful tip for someone just starting out?
   • Kari: Make a plan before you go shopping. I am not one to preplan my meals very well and this diet makes that necessary and I found I was very hungry that first week and shopping experience. Plan on making as many of your meals and snacks as possible so you know exactly what is in your food. Use available tools, like an app on your phone. And prepare yourself for the emotional changes on the diet.
   • Sarah: We had the luxury of knowing that we will not have to eliminate anything when this is done. This is a long process and much more intense for patients. I identified I may have a dysfunctional relationship with food, so be aware of possible addiction feelings and emotions towards that! Use your resources, and remember that your support team will get used to your new eating habits too.

Have you already gone through SFED, or are thinking about it as a treatment option? What are your concerns? What helped you on that first shopping experience? Share your best tip or ask a question for others below!