Extremely picky eating is a challenge facing many parents, and even more commonly, parents of children on the autism spectrum, PANS and PANDAS. While in some cases, picky eating, or at its most extreme, Avoidant Restrictive Food Intake Disorder (ARFID), can be attributed to mineral deficiencies or sensory sensitivities, often the root cause is more complex and requires in-depth investigation and a holistic approach to support.
My latest blog post examines a little-known condition that, for some children, may be a significant contributory factor in restrictive eating behaviours. Eosinophilic Oesophagitis (EoO) is a complex interplay of food allergies and swallowing disorders, identified as a chronic immune condition. It is characterised by the accumulation of eosinophils- a type of white blood cell involved in the body's immune response- in the oesophagus (the tube that carries food from the mouth to the stomach). Over time, this build-up can lead to chronic swelling, scarring and strictures in the oesophagus. The trigger may be a food or an environmental allergen such as pollen or inflammation caused by long-term acid reflux. About 50% of individuals with EoO also have seasonal allergies or asthma.
Risk factors
A number of factors appear to influence the development of EoO. These include:
- Antibiotic use in infancy
- Preterm and/or C-section birth
- Absence of breastfeeding
- Maternal smoking
- Group B Streptococcus (GBS) exposure
- Imbalance in the body’s microbial communities
- Seasonality - incidence increases in spring and summer months
- Climate - more common in temperate than tropical regions
- Urban environment
Symptoms and diagnosis
In infants with EoO, we may observe feeding difficulties, picky eating, and failure to thrive, while older children may experience nausea, vomiting, pain, heartburn, and reflux. Adults with EoO may have difficulty swallowing solid food, the feeling of a persistent lump in the throat, and even food impaction in the oesophagus. Heartburn, chest pain, coughing and abdominal pain frequently co-occur.
EoO may be diagnosed with medical tests including upper endoscopy, biopsies, blood tests, as well as dietary assessments.
Support for recovery
In my blog post, I examine the multi-factorial approach that may be necessary to manage symptoms and support recovery from EoO. Click on the link above for the deep dive, or read on for a summary of key points.
Dietary modifications are key. It is essential to identify and eliminate trigger foods. Dairy is a primary trigger in a staggering 74% of cases. It is important to look at not only IgE-mediated immune reaction (true allergies) but also an IgG response which is indicative of a food intolerance. There are many different therapeutic diets that may be considered, depending on the severity of the presentation.
Medical treatment: In some cases, short-term use of medications may be necessary. These may include stomach acid suppressants or steroid anti-inflammatories. Dilation procedures may also be considered if the oesophagus has become severely constricted.
Reducing Inflammation: The swelling and discomfort associated with EoO are caused by inflammation. Alongside dietary strategies to remove foods that trigger the inflammatory response, natural anti-inflammatory compounds such as curcumin, boswellia and Palmitoylethanolamide (PEA) may be beneficial. Soothing substances such as aloe vera, slippery elm, and marshmallow root can be extremely helpful in relieving symptoms.
Regulate the immune response: We use Micro-immunotherapy - a powerful tool in re-calibrating a hyper-reactive immune system to respond appropriately in the longer term.
Support Gut Health: Imbalances in the gut, including microbial and yeast overgrowth and parasitic infections, can contribute to systemic inflammation. Supporting gut health positively influences overall well-being and is vital for maintaining a healthy immune response that is key to long-term management of and recovery from conditions like EoO. At Brainstorm Health, we take a comprehensive approach to restoring optimal gut health and microbiome balance, underpinned by thorough testing to precisely identify imbalances for each individual we work with.
Check out my blog post for more insights into this complex and debilitating condition that may lie at the heart of some of our kids’ extreme picky eating and to learn how a holistic approach can support long-term healing and a healthier, happier life.
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Please note that we do not diagnose or treat illnesses
at Brainstorm Health, but we can help you advocate for the right medical
diagnosis from qualified doctors if necessary.
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