At this stage you need to decide on which you foods or food chemicals you are going to test. If you already have suspicions about certain foods then start with those. Check back over your food diary and see if any type of pattern is emerging - do remember that problems with food can manifest many hours, even days, after being eaten.
If you are still uncertain read through the sections on food chemicals and food problems. It is likely that at least one of these will leap out at you. If it doesn't think about the foods that you eat and have eaten in the past. Are there any you feel you just cannot live without? Unfortunately, this probably indicates a food addiction whose underlying cause is usually an intolerance problem. Remember any food can cause problems.
You may have refused certain types of food as a child but been made to eat them because they were “good for you” (children who are “picky” eaters could be signalling a food intolerance problem). You may know that some foods give you stomach problems or a hangover effect but because you enjoy them or they are “good for you” you keep on eating them.
Make a list of the foods or food chemicals you want to test and prioritise them - put the one you think is the most likely culprit at the top of your list and the reason why. Do not be tempted to try to eliminate more than one food or food chemical at a time. Rather than speeding up the process this will lead to confusion and cause additional stress to the body. Please, also, do not be tempted to fast and then introduce one food at a time. This places enormous stress on the body, leads to confusing results and the slow process of reintroducing foods can lead to a diet that does not sustain health. There is a time and place for fasting and this isn't it.
I receive many requests from people asking me where they should start and it is impossible for me to direct them, or you, to the specific food, foods or food chemicals that may be causing them or you a problem. You are a unique individual and what causes you a problem may be totally okay for someone else. As I've said before although a food may cause a certain type of reaction in some people it will not always cause this symptom.
However, I do understand how difficult starting out on this journey can be and I accept that you may need some further guidelines so, if you are truly uncertain as to where to begin, use the check list below to guide you. Find your main symptom and then read the corresponding sections in the book and see if any “speak” to you.
Acid reflux: caffeine, capsaicin.
Anxiety: caffeine, MSG, salicylate.
Asthma and breathing difficulties: benzoates, histamine, lectins, milk, MSG, sulphur and sulphites.
Behaviour problems: gluten, milk, salicylates, wheat.
Catarrh and sinus problems: milk, salicylates.
Depression: caffeine, gluten, grains, salicylate, sugar, wheat.
Fatigue: caffeine, MSG, wheat.
Gastrointestinal problems: amines, capsaicin, gluten, grains, lectins, legumes, milk, oxalic acid, purines, sulphur and sulphites, wheat.
Gout: purines.
High blood pressure: tyramine.
Hyperactivity: caffeine, salicylate.
Joint pain: gluten, lectins, purines, serotonin, solanine, wheat.
Kidney/bladder stones: oxalic acid, purines.
Migraines: amines, caffeine, histamine, phenylethylamine, serotonin, sugar and sweeteners, tannins, tyramine.
Mood swings: gluten, MSG, salicylate, solanine, sugar, tyramine, wheat.
Mouth problems: capsaicin, fruit, histamine.
Panic attacks: caffeine.
Restless legs: caffeine, grains, salicylate.
Skin problems: benzoates, fish, fruit, grains, histamine, milk, peanuts, salicylate, wheat.
Sleeping problems: caffeine, gluten, milk, salicylate.
Tics: caffeine, salicylate.
Tinnitus: salicylate, sugar and sweeteners.
If you still remain uncertain as to where to start then consider testing wheat and/or milk. I only suggest these as they are two foods that are often consumed many times a day. A “holiday” from either of them will not do you any harm. If there is any other food that you have eaten each and every day of your life then that food could also go on your suspect list. Dr Mumby identifies three main allergens for adults: wheat, dairy produce, and instant coffee. He writes: “If one were simply able to persuade the entire population to give up just these three foods, the change in the health of the nation would be dramatic”. [240]
Be gentle, take it slowly.
At this stage you need to consult your doctor. Dr Michael Tettenborn a consultant paediatrician at the Frimley Children's Centre in Surrey, suggests that many doctors have been turned against dietary management because some people have made excessive claims about its potential impact and that their scepticism is fuelled by the range of tests in use by non-medical practitioners. [241] Bearing this in mind I have outlined a strategy that you can use in preparing for your appointment:
1. Make a list of the symptoms that concern you with details of how long these have been a problem.
2. List any treatments you have tried and their outcomes.
3. Make a few notes for yourself as to why you want to test for food intolerance - this will help give you confidence when talking to your doctor (we all get nervous and if you are unwell your self confidence will be low).
4. Take the food diary you will be using - this will show your doctor how he can follow your progress. The food diary is going to be your way of presenting evidence.
5. If you want to take additional information along with you make sure it is information that is acceptable to your doctor. Many doctors are suspicious of information obtained on the Internet so ensure that you know the source of what you are presenting. Details of articles in medical journals are going to carry more weight than somebody's home page.
6. Remember that your doctor is an individual who has been trained in medicine - he is there to help not hinder you. If you are not happy with your doctor you always have the option of changing to another one.
7. Remember it is okay to ask questions, make suggestions and take notes.
8. If your doctor is obviously pushed for time then suggest you make an appointment for a longer session later.
9. Remember your doctor is a human being like you. He, like you and I, is not perfect. Your doctor does not know everything but then neither do you or I. Respect and co-operation are better than hostility and antagonism.
As unravelling illness can be a complex process I advocate the path of co-operation with the medical profession but I am also very aware that you may meet resistance. If at all possible seek help from another doctor or an alternative practitioner. If you do decide to go ahead with testing on your own please take extreme care when testing foods - it is always best to have someone else, who understands what you are doing, present just in case you have a severe problem. NEVER stop medication without your doctor's consent.
Once you have decided on your strategy then decide when you are going to begin the next step - eliminating the suspect foods. You can repeat the next three steps as many times as you need and at your own pace, returning to step two whenever you need.
The key to successfully eliminating a suspect food lies in planning. Know when you are going to start and know, in detail, what you are going to eat. It is essential that you plan your meals carefully so that you do not unwittingly eat any of the test food.
You may have read about other elimination diets that involve periods of fasting or insist that you stop drinking tea and coffee and stop smoking. The approach outlined in this book asks that all you do is eat your newly simplified diet and eliminate only the food, in all its forms, that you are testing. If you try to eliminate other foods or drinks or try stop smoking at the same time you will make it virtually impossible for yourself to identify what substance is causing what problem.
One food or food chemical at a time.
Elimination diets that ask you to remove a range of foods at one time may, at first, seem like the easiest and most straightforward option. Although avoiding a host of foods at one time may in fact be just as easy as avoiding one, the difficulties arise at the time of testing. Reactions can be delayed and confusing and tests may need to be repeated.
It is also possible to misread results as a study by Bethune et al showed. They reported on how three individuals had self-diagnosed a carbohydrate intolerance and had gone on to develop increasingly restrictive diets as their symptoms kept on reappearing. They found that carbohydrate restriction can disturb glucose metabolism and that this may be interpreted falsely as food allergy. [242] Mumby confirms this and advises against remaining on a very low carbohydrate diet for too long. Although these type of diets can help correct low blood sugar problems they can then go on to reproduce the symptoms if the body is not able to convert sufficient protein into carbohydrate. [243]
These type of blood sugar problems can cause a variety of symptoms many of which mimic allergy problems as well as sometimes being caused by them. These include cravings for sweet foods, feeling tired, anxiety, shaking and inner trembling, depression, irritability, difficulty concentrating, light-headedness, and joint pain. If eating relieves the symptoms at least temporarily then you are likely to have a low blood sugar problem. It is not just eating too little carbohydrate that can cause this it can be that you are simply not eating enough - a risk for anyone changing diets especially if you are keen to lose weight. Make sure that you are eating enough and regularly. Don't worry about the calories as, once your diet settles into one which works for you, the excess weight will gradually fade away without you having to make any effort.
Make sure you check all the labels of any food or drink you are going to consume to ensure it is free of the test food. Eating out could cause problems so phone ahead to the restaurant to see if they can cater for you. Take “safe” snacks with you whenever you go out just in case you need them. It is horrendously frustrating to find yourself needing to eat and not being able to find something that is okay - you are left with the option of potentially making yourself ill or running the risk of low blood sugar problems. It is not a comfortable place to be in.
The length of time that any food or food chemical needs to be eliminated from the diet varies. Generally, for a single food, four to seven days is a reasonable guide. To reduce the impact of a food chemical you need at least seven days, preferably ten to fourteen.
If you have been reacting to the food you have eliminated you can expect a sudden weight loss. This is linked with fluid retention. Breneman found that it is possible to retain as much as 4% of your body weight as fluid as a result of a food sensitivity. This weight is gained within six to eight hours after ingestion and lost within eighteen to twenty four hours after the food has been removed from the diet. [244] You could also find yourself with a headache and feel tired. This is the body detoxifying itself and nothing to worry about. Drink lots of water and rest as much as you can. You may find you suddenly feel amazing and then just as suddenly feel wretched - again this is just detoxification.
And of course, you could just start feeling much better. Be meticulous about keeping your food diary and you will be able to track your progress over time.
You have now gone the required number of days without eating the test food and the time has come to find out if you have a problem. One very clear indicator is that you have had a noticeable improvement in your symptoms. If this is the case you may want to delay testing for a few more days to ascertain the extent of the “recovery”.
Use the strategy agreed with your doctor - this may involve medically supervised allergy tests. If you have been advised to simply reintroduce the food but the change in your symptoms has been dramatic it is best that you recheck with your doctor before testing the food.
If you are testing a single food then choose the time at which you test with care. If you have a busy day planned you do not want to be dealing with unpleasant symptoms at the start of the day.
Eat a reasonable amount of the test food in its simplest most natural form and wait. Some reactions occur immediately or within the first thirty minutes. Common responses are mild swelling in the mouth, headache, feeling disorientated, stomach irritation, a feeling of heaviness and/or lethargy. If you have any of these responses do not continue with the test. You have an intolerance problem to that food.
If nothing happens then continue with your day and note any changes as they occur. Leave at least a few hours before eating any more of the test food. Delayed responses are not uncommon and include a return of your previous symptoms, skin rashes, blood sugar problems, and bloating (hands, feet, abdomen, face, as well as more generally). Reactions can be delayed for as much as thirty six hours.
Testing for a sensitivity to a food chemical is a little more complicated as unwanted reactions tend to occur only after your individual tolerance level has been exceeded. You will need to resume eating foods that have higher amounts of the chemical and carefully note your symptoms over a few days.
Do not attempt to eliminate/test any other food for at least five days. You need to give yourself this amount of time to be sure there is no problem. If after this time you have not experienced any unwanted symptoms then you can assume that the test food is safe. If the test has been inconclusive then you may need to repeat it. Other factors such as illness do have an effect and need to be taken into account. You should also know that it is quite possible to tolerate a food in one form but not another. For example: boiled eggs may be okay but not fried, raw cabbage may make you feel ill but when cooked there is no problem, beef steak may be okay but beef mince could leave you feeling uncomfortable, milk in yoghurt may lead to no symptoms whilst milk on its own causes problems. Test the food in its various forms to be sure you are not unnecessarily eliminating foods from your diet.
Was the test food a problem or not? If it was a problem then eliminate it from your diet - you can always retest later. If it wasn't a problem then you can include it in your diet but remember to keep it simple if you are planning further tests. If you have found yourself getting confused then eliminate the test food again and eat your simplified diet for a few days before testing again.
Decide on whether to continue with another test and plan accordingly. Repeat steps 5 to 7 as often as you need and over as long a time period as is appropriate to you.
If your problems continue to remain after food testing then you may like to consider checking your environment for other possible causes - it is not uncommon to react to fragrances and chemicals commonly found in the home, school or work place. Again this is a very hidden problem and only comes to light after you have removed the offending chemical from your environment. It may also be worth exploring whether you have a nutritional deficiency of some sort as these have also been linked with a wide range of conditions and symptoms.
Food chemicals are compounds found in food that either occur naturally or have been added during the manufacturing process.
As plants produce toxins to protect themselves from spoilage and from being eaten by predators, you cannot avoid the naturally occurring chemicals in food. You can avoid food additives but only if you avoid all forms of processed food. A food chemical, natural, or manmade, becomes a problem for some people when it is eaten in large amounts, is eaten on a regular basis, or the body cannot detoxify it due to illness or a deficiency in the metabolic pathways.
The complexity of each individual plant is immense and any one of its constituent chemicals can, potentially, cause problems for someone sensitive to it. Emsley and Fell estimate that there are about half a million natural chemicals in the food we eat. [245] Only a few of these have been identified and even fewer have been tested, analysed and their implications for health understood.
This section of the book looks at some of the natural chemicals, as well as some of the manmade versions which have often been produced to mimic those produced by nature. The information presented is based on the research done to date and will provide you with an overview of the main chemicals that have been identified as causing problems for some. The key factor to understanding how these chemicals can affect you is to understand that they are most likely cumulative in the body and will generally only cause you a problem if you exceed your own individual tolerance level.
See also Histamine, Phenylethylamine, Serotonin, Tyramine.
Amines are naturally occurring chemicals in certain foods which, like salicylates, are cumulative in the body. Over a period of time these can build up in your system causing reactions that mimic allergies. Amines are produced in food as a result of protein breakdown and/or fermentation which means they are often highly concentrated in processed foods.
If you noticed a substantial decrease in your symptoms when you simplified your diet you may want to consider testing to see if you have an amine problem. If you also regularly suffer from constipation then the amine problem could be more pronounced.
Naturally occurring amines are generally thought to act in the body as neurotransmitters and the term “biogenic amines” is now frequently applied to these. These “biogenic” amines include amongst their number - histamine, phenylethylamine, serotonin and tyramine. Each of these is dealt with separately as each has been found to have clearly defined symptoms in certain individuals. [246,247] Some people, however, seem to have a more general sensitivity to amines. Diets low in food chemicals usually include amines in this more general way.
Cooking certain foods, in particular meats, at high temperatures produces a set of amines that were not present before. One group of these is heterocyclic amines (HCAs). More than seventeen different types of HCAs have been found in meat cooked at high temperatures. Stewing, barbecuing and frying appear to produce the most HCAs. Gravies made from meat juices, therefore, also have a high amine content.
The other form of amine produced by cooking is polycyclic aromatic hydrocarbons (PAH). These are formed by the browning of carbohydrate based foods such as bread and are also found in foods such as smoked and grilled meats and coffee. A sensitivity to these amines can often be misinterpreted as an intolerance specific to one type of food. For example, if toast doesn't agree with you it is easy to think that wheat is the problem; if a grilled steak upsets you then you might think you have a problem with beef.
What everybody should know is that various studies have linked these types of amines with cancer. The rule of thumb here is do not overcook food and always eat your food as fresh as possible. Pickling, smoking and other forms of preserving all increase the number of amines.
There is no specific list of symptoms indicated for amines but migraines that don't respond to other treatments may be relieved by a diet low in amines. The key to testing for an amine intolerance is to reduce the amount of amines in your diet, and hence your body, over a period of two weeks. Stick to your simplified diet as much as possible but eliminate all the high amine foods.
Re-think your cooking style. Avoid over cooking anything and avoid meat cooked in sauces as these will have a high amine content. Never eat anything that has been burnt and avoid toasted breakfast cereals. After two weeks, eat some of your most favourite high amine foods and monitor your response. Remember that amines are cumulative in the body.
Some people may immediately get a reaction such as a headache or digestive problems and others will only get similar symptoms after their level has increased - this can take up two weeks so keep your food diary up to date.
At the end of the testing time, if you have felt no better at all then you are unlikely to have an amine problem. If there has been a little improvement you may want to consider reducing your level even further and seeing if that increases the improvement. You should, however, also note that individuals who are intolerant of one chemical in food often are intolerant of another so you may need to test some of the other food chemicals.
If you have had a substantial improvement then you are amine sensitive and need to now work on establishing the level of amines you can generally tolerate. At this stage you may find your tolerance is very low but that over time this may change.
Establishing the amine content of food is quite difficult as it can be greatly affected by the way food is stored, processed and cooked. Avoiding the foods in the list below for a week or two should be enough to give you an idea as to whether you are especially sensitive to amines or not.
All forms of processed meats including sausages, pâtés, bacon, salamis, deli counter cuts.
All forms of processed fish including fish cakes and fish fingers.
All smoked, salted and pickled meats and fish.
All offal including kidneys, liver and brains.
Game and other meat that has been “matured”.
Cheese (whilst some very mild cheeses may be okay it is easier, at this stage, to avoid them all)
Fermented bean products such as tofu, tempeh, bean curd, miso, soy sauce, tamari.
Pickled vegetables such as sauerkraut, gherkins and piccalillis.
Cocoa, dark chocolate, milk chocolate high in cocoa solids.
Meat extracts, gravies, sauces, yeast extracts.
Chocolate flavoured drinks, cola type drinks, vegetable and fruit juices.
Beer and wine.
See also Salicylate.
Benzoic acid occurs naturally in many berries, fruits, herbs and spices (such as cinnamon and cloves), vegetables and tea. The existence of benzoic acid in its natural form has been known since at least the sixteenth century. The body generally excretes benzoic acid as hippuric acid in the urine within nine to fifteen hours after ingestion but it's presence in the body can temporarily inhibit function of digestive enzymes and may deplete amino acid glycine levels.
In around 1860 it was produced synthetically from compounds derived from coal tar. Today, one of the ways it is commercially manufactured is by the chemical reaction of toluene, a hydrocarbon obtained from petroleum, with oxygen in the presence of cobalt and manganese salts as catalysts.
The commercial form is used in the food manufacturing process as a preservative and also has widespread non-food uses. The use of derivatives such as benzoyl peroxide for bleaching flour (at the time of writing, not allowed in the UK) is an example of how this can become a hidden sensitivity as bleaching agents rarely have to be declared on products they have been used in. The intakes from natural sources are low in comparison with potential intakes from food additive uses. Symptoms of benzoate sensitivity have included:
Angioedema, Asthma aggravation, Gastrointestinal problems, Hyperactivity, Itching, Numbing effect in the mouth, Recurrent urticaria, Rhinitis, Skin sensitivity.
Jacobsen writes that people with asthma, chronic urticaria-angioedema, rhinitis, and purpura may be predisposed towards benzoate and paraben sensitivity. [248] Wuthrich and Fabro found benzoate sensitivity in some individuals suffering from asthma, rhinitis, and urticaria. [249] Juhlin et al examined the sensitivity of aspirin-intolerant people to p-hydroxybenzoate and sodium benzoate by oral provocation testing; urticaria was induced in five of seven people. [250]
Michaelsson and Juhlin's study of fifty seven people with recurrent urticaria or angioedema found that 52% reacted to sodium benzoate and/or p-hydroxybenzoic acid. [251] August reported that thirty three out of eighty six people with chronic urticaria gave positive reactions to tartrazine and sodium benzoate. [252] Gibson and Chancy found that 52% of people studied with chronic idiopathic urticaria had a benzoate sensitivity. [253]
Ortolani et al found 21% of a patient group with chronic urticaria-angioedema were intolerant to benzoic acid. They also noted a high incidence of cross-reactivity to aspirin. [254] Chafee and Settipane found that sodium benzoate might have been responsible for the provocation of asthma in a patient who had taken a dye-free vitamin supplement preserved with benzoate. Investigations showed a sensitivity to tartrazine; the reaction to the supplement could have been due to the fact that tartrazine and benzoates have the same aromatic ring structure and carbohydrate group and hence are viewed as virtually the same by the body. [255]
Asero wrote about the case of a seventy-five year old woman who, for six years, had suffered from severe itching but with no evidence of a rash. She had been treated with various anti-histamines but none had resolved the problem. Various skin prick tests were carried out but all were negative. After following an elimination diet for ten days, the itching had reduced in severity by 80% and had totally disappeared a week later. Further tests were carried out and it was discovered that the culprit was sodium benzoate. [256] Reactions to this group of additives have been observed in people with an aspirin or salicylate sensitivity and should be avoided by anyone with this condition.
If you suspect a problem with benzoates, the food additives you need to avoid are:
E210 Benzoic acid
E211 Sodium benzoate
E212 Potassium benzoate
E213 Calcium benzoate
E214 Ethyl p-hydroxybenzoate
E215 Sodium ethyl p-hydroxybenzoate
E218 Methyl p-hydroxybenzoate
E219 Sodium methyl p-hydroxybenzoate
You may also need to limit your intake of foods in which benzoates occur naturally. Now this is not totally straightforward as, just like with amines and some other naturally occurring food chemicals, there is no definitive list for benzoate levels in food. It is generally thought that high levels occur in the following: [257]
Most fruit berries but especially strawberries and raspberries.
Tea.
Herbs and spices especially anise, cinnamon, clove, nutmeg, and thyme.
Condiments such as soy sauce.
If you suspect benzoates are causing you a problem then eliminate them as best as you can from your diet for at least two weeks. If there are signs of improvement then continue to avoid them for a further two weeks before testing. Partial improvement with a reaction after testing could indicate that you need to check non-food substances for benzoates and also avoid these but if this does not work then testing for a salicylate sensitivity is probably indicated as both salicylates and benzoates have similar chemical structures.
Esters of para-hydroxybenzoic acid, more commonly known as parabens, are used widely in medications and cosmetics. In fact, benzoates can be found in a variety of non-food products including medicines, perfumes, cosmetics, toothpaste, lice treatments, resin preparations, in the production of plasticisers, in dyestuffs, synthetic fibres, as a chemical intermediate, as a corrosion inhibitor in paints, a curing agent in tobacco, as a mordant in calico printing and in insecticides. Some exposure may also result from inhalation of auto exhaust, tobacco smoke and other combustion sources.
Caffeine is one of three dietary methylxanthines, the other two being theobromine and theophylline. All three are readily absorbed from the gastrointestinal tract and distributed throughout the body, metabolised in the liver and excreted in the urine. Theobromine is weak in comparison to caffeine, and theophylline is only found in small concentrations in food so the only methylxanthine dealt with in this book is caffeine.
Caffeine naturally occurs in the leaves, seeds or fruits of at least sixty three plant species world-wide. The most familiar sources of caffeine in our diet are through drinks such as coffee, tea and cola. The amount of caffeine in any product varies depending on the plant variety used and also how it was prepared.
Caffeine is so readily available in coffee, tea and chocolate that we have come to accept it as harmless but the truth is that caffeine is a powerful drug that affects both your body and your mind. It has the strange quality of at first decreasing the heart rate and then increasing it about an hour after intake. It, also, has a powerful effect on the nervous system and can, in small doses, help improve concentration but the reverse takes place with a higher dose.
Even a relatively moderate amount, two to three cups of tea a day, leads to observable effects and caffeine abuse can result in symptoms that mimic mental illness. Children, because they have smaller bodies, are at greater risk from caffeine toxicity, and insomnia in children could be linked to the amount of cola drinks they consume. [258,259] How much caffeine you can tolerate will depend on a number of factors including the amount you consume, how often you consume it, and your individual metabolism.
Some people seem to experience no noticeable effects whilst others have uncomfortable symptoms after just a small amount. Products containing caffeine are often used to boost energy which takes place as a result of caffeine's ability to stimulate adrenal gland activity. This constant abuse of the adrenal glands can, however, lead to a state of burn out where the adrenal glands quite simply become exhausted. Fatigue, although it can have many causes, can often be the result of diminished adrenal function. If this is the case, no amount of additional coffee or chocolate will help.
The speed at which your body is able to eliminate caffeine depends on factors such as age, state of health and your own unique biochemical make-up. The rate at which it is cleared is decreased by liver disease, pregnancy and oral contraceptives. Women taking oral contraceptives have been found to have significantly lower rates for breaking down caffeine than women not using these contraceptives and men. [260]
Fluoroquinolines, drugs used to treat bacterial infections, impair caffeine and theophylline metabolism leading to a greater concentration in the body. [261] Other medications, including theophylline, can also cause a problem as these can add to the stimulant effects of caffeine-containing foods and drinks.
Sadly, caffeine is habit forming and tolerance develops so that more and more is required to obtain the desired effect. Silverman et al found that even consuming smaller regular doses of caffeine can lead to addiction. [262] A variety of conditions have been linked with a caffeine sensitivity. Charney et al, in a placebo controlled study of people with panic disorder or agoraphobia with panic attacks found that caffeine significantly increases anxiety, nervousness, fear, nausea, palpitations, restlessness and tremors. These effects all correlated with plasma caffeine levels. [263]
Observations made by Davis and Osorio suggest that caffeine may precipitate tics in susceptible children. [264] Greden found that caffeine in large quantities of tea and coffee could produce symptoms that mimic anxiety and panic disorders. [265] Even caffeine induced urticaria has been noted. [266,267] In one case a sixteen year old woman had experienced episodes of generalised urticaria for about eight years. They appeared to be linked with ingestion of cola drinks. The episodes had at times been severe enough to require emergency treatment. Various ingredients were tested using the skin prick test but were all negative. A double blind, placebo-controlled, oral challenge test, was performed with a regular cola drink and a decaffeinated cola-drink. The regular cola-drink provoked itching and urticaria on her body and legs within ten minutes. The caffeine-free cola-drink elicited no adverse reactions. A skin prick test confirmed that caffeine was the trigger. [268]
The symptoms that have been linked to a caffeine sensitivity or to a high intake of caffeine include:
Agitation, Anxiety, Blood Sugar Problems, Depression, Disorientation, Dry mouth, Headache, Heartburn, Increased need to urinate, Insomnia, Irritability, Nausea, Palpitations, Panic Attacks, Restless legs syndrome, Rhinitis, Stomach problems, Sweating, Tinnitus, Tremors, Urticaria.
It is quite possible that regular headaches or migraines are linked with caffeine withdrawal. If you have any of the above symptoms and consume large amounts of caffeine then consider testing for caffeine sensitivity. The only way of assessing sensitivity is to eliminate all caffeine from the diet for ten days, reassess the situation and then reintroduce it if you choose too. If you consume large amounts of caffeine and are concerned about the effect of withdrawal symptoms then reduce the amount that you use over a period of ten days until you are as caffeine free as you can manage. Make a list of how much caffeine you consume and draw up a reducing strategy. Choose the best option for you. The foods you need to eliminate/reduce are all forms of:
Coffee, tea, chocolate and cocoa, cola drinks, guarana, mate and any other soft drinks that contain caffeine.
To be on the safe side also check any medications, supplements and tonics. Any prescribed forms of medication containing caffeine should be continued until you have discussed them with your doctor and been given permission to reduce or stop taking them.
You will either find that you very quickly begin to feel calmer and less stressed or will begin to experience withdrawal symptoms. Do not be alarmed if you find yourself feeling ill. All of the following have been linked with caffeine withdrawal: low attention span, depression, nervousness, problems sleeping, mood swings, and irritability. Drink lots of water and be gentle with yourself and let your body do the job of detoxification.
The positive changes you are looking for are an increase in energy but less manic, fewer sleeping problems, increased ability to concentrate, more relaxed, less irritable and nervous, and a peaceful sense of well being. If you experience any of the above then you really should question the sense of returning to using any products containing caffeine.
Replacements in the form of decaffeinated coffee and tea, caffeine free drinks and carob bars are all now readily available and make acceptable substitutes. If you do return to using caffeine products ensure you keep them to a minimum in your diet - if you don't then before you know it all the symptoms will have returned. For example, some people may get away with two cups of coffee and a bar of chocolate, or three cups of tea, or two cans of cola and some may not be able to tolerate any at all.
If you have gone through withdrawal then the safest course of action is to quite simply say NO to caffeine. This also applies to anyone that has or is suffering from anxiety or depression as the intensity of both of these states can be exacerbated by caffeine.
The amount of caffeine in various products is a matter of some dispute. For example, some studies show no caffeine in chocolate, others have shown a large amount. As caffeine has definitely been found in chocolate and cocoa it is safest to eliminate it at this time. Also please note that even decaffeinated drinks may still contain some caffeine albeit in small amounts.
One example of estimated amounts of caffeine in products comes from a UK survey: [269]
Non decaffeinated cola drinks 33 to 213 mg/l
Low caffeine colas less than 0.2 mg/l
Energy drinks 0.5 to 349 mg/l
Standard tea products 95 to 430 mg/l
Instant and ground coffee 105 to 340 mg/l
Decaffeinated instant coffee 10 to 11 mg/l
Chocolate products 5.5 to 710 mg/kg
(highest levels in chocolate bars)
Be cautious if your caffeine intake is mainly from cola drinks and your preference is for the diet free variety as these tend to be higher in caffeine than full sugar colas. [270]
Rozin et al found that a chocolate bar contains 20mg of caffeine compared to 80-100mg in a cup of coffee. This relatively low dose in comparison with other sources of caffeine, such as coffee and cola drinks, which are not craved to the same extent, suggests that caffeine is not the major reason that chocolate is craved. However, if you are extremely sensitive to caffeine it could be a problem. [271]
The genus “capsicum” encompasses several species including chilli peppers, red peppers, and paprika. Capsaicin is the most important biologically active compound within these and it is known for providing pain relief in conditions such as arthritis and neuralgia. It can also have an adverse effect if you are sensitive to it.
The most common adverse reaction is a burning sensation in the mouth but others have also been noted. Serio et al outline a case of plasma cell gingivitis linked with exposure to capsaicin. [272] Myers et al found it led to a significant increase in gastric acid secretion as well as mucosal bleeding. [273] Evidence of nausea, vomiting and abdominal pain after ingestion have also been noted, and exposure in the workplace has led to cases of coughs being linked with its inhalation and to contact dermatitis.
To test for a sensitivity eliminate all of the following from your diet for at least five days:
Bell pepper, cayenne, cherry pepper, chilli, cone pepper, green pepper, hot pepper, paprika, red chilli, spur pepper, sweet pepper, tabasco.
Be very careful with any pre-prepared meals and sauces or restaurant food as some of these may contain capsaicin under the term “spices”. After the elimination period, test by eating whichever one you used to eat most often in as simple a form as possible. If you get a reaction then wait another five days before trying a different food from the list.
The reason for testing more than one is to ensure that the problems you are experiencing stem from capsaicin and not the individual food. If you experience no reaction then capsaicin is unlikely to be a problem for you.
See also: Grains, Wheat.
Gluten is made up of a number of proteins including gliadin and naturally occurs in a number of grains.
Gluten has been linked with a number of conditions most notably dermatitis herpetiformis and coeliac disease. Atherton states that there can be no real doubt that dietary gluten is responsible for most, if not all dermatitis herpetiformis. [274] Feighery writes that coeliac disease is an inflammatory disease of the upper small intestine and results from gluten ingestion in genetically susceptible individuals. Treatment consists of permanent withdrawal of gluten from the diet resulting in complete remission. [275]
Other conditions have also been found to be linked with gluten sensitivity. These include Crohn’s disease, diabetes, irritable bowel syndrome, and rheumatoid arthritis. [276] In one study, twenty individuals who had suffered from recurrent aphthous ulcers, some for more than eleven years, were given a gluten-free diet to follow. Five of these became ulcer free and when challenge tested with gluten the ulcers returned. [277]
Mental symptoms that respond to no other treatment may also benefit from a gluten-free diet. In the book Brain Allergies, Philpott and Kalita note that "After years of observing maladaptive mental reactions to foods, most orthomolecular-ecologic psychiatrists would agree that gluten is the most frequent and severe symptom reactor of all foods". [278]
Braly and Hoggan explore the links that have been found between gluten sensitivity and various “brain disorders” including ADHD, autism, depression, epilepsy, multiple sclerosis, schizophrenia, senility, and sleeping problems. Whilst links are being found the authors acknowledge that a great deal more research needs to be done so that links between brain disorders and diet are taken seriously. [279]
The gluten grains are barley, rye and wheat. Oats are also included and on a gluten-free diet should at least in the first instance be excluded but then tested as some gluten sensitives have found them safe. There are tests available that will establish if you have a gluten sensitivity but you can also exclude gluten from your diet to see if there is any improvement. The difficulty is that if you see an improvement you will not know if it is because of a grain sensitivity (to one or more of those excluded) or a gluten intolerance. Given this difficulty you would be advised to test the grains individually over a period of time to ensure that you are clear about what it is that is causing you problems, this will help prevent you limiting your diet unnecessarily.
If you need to eat a gluten-free diet you will need to avoid all foods that contain wheat (including spelt, triticale and kamut), rye, barley and possibly oats. Alternatives will need to be found for bread, cakes, pastries and biscuits. It is also essential that you check all processed foods, including meats, to avoid accidental ingestion.
Although oats are often excluded on a gluten-free diet there is increasing amounts of evidence that they are in fact tolerated by many individuals with a measurable gluten sensitivity; it is also now possible to buy oats that are certified as being gluten free. Janatuninen et al, in a study of adults with coeliac disease, compared the effects of a gluten-free diet including oats with a conventional gluten-free diet. They concluded that adults with coeliac disease can consume moderate amounts of oats without adverse immunological effects. [280]
Hallert et al carried out a review of published reports in 1999 and also presented details of their own experience at including oats in the gluten-free diets of adults. They found oats to be safe and well tolerated by adults with coeliac disease and dermatitis herpetiformis, though the risk of wheat contamination of commercial oat products was a cause of concern. [281]
Reunala et al carried out a study to ascertain the tolerance to oats by individuals with dermatitis herpetiformis. Eleven individuals on gluten-free diets with the condition were challenged daily with 50g oats for six months. A control group comprised of eleven people with dermatitis herpetiformis on a conventional gluten-free diet were also studied. Eight of those challenged with oats remained symptom free, two developed a transient rash, and one withdrew because of the appearance of a more persistent but mild rash. It should be noted that three of the eleven controls also developed a transient rash. Various tests were conducted to measure the impact, if any, of the oats, and the conclusions were that oats do not affect gluten sensitive small bowel mucosa and indicate that dermatitis herpetiformis is not activated by eating oats. [282]
Given this evidence the wisest course may be to, at first, exclude oats along with the other grains and then, once the condition has been stabilised, to test oats but only those classed as gluten-free.
Although gluten is now seen as the cause of coeliac disease this was not always the case. As Gottschall tells us, prior to 1952, coeliac disease was being treated as a carbohydrate intolerance problem by a specific carbohydrate avoidance diet. She argues that the gluten-free diet does not work for all sufferers because of the continued use of carbohydrates. It is certainly the case that straightforward avoidance of gluten does not work for everyone. [283]
It cannot be disputed that gluten-free diets help many people but the reality is that for some individuals with dermatitis herpetiformis and/or coeliac disease removal of gluten is not the answer or at least not the whole answer. A study by Faulkner-Hogg et al found that some individuals with coeliac disease who did not wholly improve on a gluten-free diet were sensitive to salicylate. On testing, salicylate was found to provoke diarrhoea, headache, nausea and flatulence. [284]
Braly and Hoggan recognised that some coeliac patients continued to have symptoms even after following a strict gluten-free diet. Their symptoms improved or disappeared when their other food sensitivities were identified. The most common problem foods were found to be milk, soy, corn, egg, citrus fruit, and seafood. [285]
An Australian study set out to explore why some people with coeliac disease continue to have symptoms even when following a gluten-free diet. Thirty nine adults who had persistent gastrointestinal symptoms despite adhering to a gluten-free diet were evaluated. They discovered that twenty two were consuming a gluten-free diet as defined by the WHO/FAO Codex Alimentarius (Codex-GFD) in which foods containing up to 0.3% of protein from gluten-containing grains can be labelled as “gluten free”. The remaining seventeen were following a “no detectable gluten diet” as defined by Food Standards, Australia.
All thirty nine followed the “no detectable gluten diet” during the study. For five, of the twenty two who made the change in diet, symptoms disappeared and were reduced for a further ten. Food elimination diets were then tried with thirty-one of the participants leading to further improvement for twenty four of them. The three most common problems were soya, amines and salicylates. They argue that if symptoms persist after following a “no detectable gluten diet” then other food sensitivities should be explored. [286]
The way food is labelled varies from country to country. In the UK, January 2012 saw the introduction of new rules on how food can be labelled with claims about gluten. The law covers all food, whether it is in a packet on a supermarket shelf, on a menu in a restaurant, or at a deli counter. This means that any food making claims about gluten content has to stick to strict low levels. These rules mean that food can be labelled as:
Gluten-free - these foods are suitable for people with coeliac disease (they can have no more than 20 parts of gluten per million).
Very low gluten - small amounts of these foods can be eaten by most coeliacs, but they should get advice from a dietitian or health professional about how often they can eat them. (These foods must contain no more than 100 parts of gluten per million, and must contain ingredients that have been specially processed to reduce their gluten content, so this labelling will be mostly found on specialist products).
The phrase “suitable for coeliacs”, can only be used alongside the terms “gluten-free” or “very low gluten” and can’t be used on its own. [287]
To avoid gluten you need to very carefully check the ingredients of all foods. Some of the terms that might indicate the presence of gluten include:
Baking powder, barley, barley grass, barley malt, beer, blue cheese, bran, bread, bulgar, caramel, cereal, couscous, dextrins, durum, farina, flour, groats, gum, HPP (hydrolyzed plant protein), HVP (hydrolyzed vegetable protein), kamut, malt, matzo, miso, MSG (monosodium glutamate), mustard powder, oats, pearl barley, rice malt, rye, semolina, soy sauce, spelt, starch, stock cubes, teriyaki sauce, TPP (textured plant protein), triticale, TVP (textured vegetable protein),wheat, wheatgerm.
The addictive nature of some foods and food chemicals is not something that there is general agreement about yet it is something that undeniably exists. One of the difficulties seems to be when a food, or aspect of a food like gluten, is reduced in the diet but not fully eliminated and this constant small amount in the body seems to lead to cravings for products that contain the food or food chemical. Braly and Hoggan make specific reference to the addictive nature of gluten and the problems this causes some individuals when first attempting to eat a gluten free diet. [288]
The same authors also note that a powerful tobacco addiction can indicate a sensitivity to gluten. They write that smoking “can amount to a form of neurochemical ‘self-medication’ for those who have problems with gluten”. For individuals affected in this way, attempting to stop smoking before they have dealt with their gluten problem can lead to depression and mood disturbances.
See also Amines.
Histamine is a biogenic amine that occurs in many different foods. At extremely high concentrations, usually as a result of food spoilage, it can lead to poisoning. In some individuals smaller concentrations can lead to food intolerance which is often misinterpreted and can lead to the wrong food being eliminated.
The problems associated with an overload of histamine were first recorded in 1830 when crew members of a vessel became ill with severe headaches, flushing, bloating, diarrhoea and shivering after eating bonito, a member of the Scomberesociade fish family. The illness was called “scombroid poisoning”. As other types of fish were also found to cause similar symptoms, research was conducted to find the common link. That common link turned out to be histamine. [289]
Histamine poisoning differs from histamine sensitivity. In cases of histamine poisoning the person is likely to have eaten a contaminated form of fish and experienced a reaction almost immediately. The symptoms, usually a combination of sweating/shivering, rashes, flushing, burning sensation in the mouth, stomach pains, diarrhoea and headache, last for about twelve hours and then abate.
Histamine sensitivity is unlikely to result in such severe symptoms and may not abate as quickly. The body already has a supply of histamine which it stores in a safe form for use when needed. Food too high in histamine swamps the body's defences. If the body becomes flooded with histamine in a “non-safe” form problems can arise. The body has to act to clear it and fast and in some individuals this clearance mechanism is slow and, whenever their tolerance level is breached, unwanted symptoms arise. 290]
The suspected cause is a deficiency of diamine oxidase in the small intestine resulting in diminished histamine degradation in the gastrointestinal tract, and thus absorption. [291] A sensitivity to histamine can produce allergy type symptoms which no allergy test will recognise. Histamine is heat stable - cooking does not remove it.
Wantke's study in 1993 found that sensitivity to histamine in food and drink could result in bronchial asthma, headache, and urticaria. He also found the ingestion of food rich in histamine brought about a recurrence of atopic eczema in those affected. [292] Doeglas et al identified histamine intoxication after eating cheese in some individuals; the symptoms included nausea, vomiting, urticaria, headache, difficulty swallowing and thirst. [293]
Ingestion of 25 to 50mg of histamine can trigger headaches, and 100-150mg can lead to flushing. [294] However, figures such as these can only ever be estimates. Scombroid toxicity has been identified after ingestion of only 2.5mg of histamine. [295]
Histamine sensitivity can lead to a range of symptoms including:
Abdominal cramps, Angioedema, Asthma like symptoms, Bronchial asthma, Burning sensation in the mouth and throat, Conjunctivitis, Diarrhoea, Difficulty swallowing, Dizziness, Eczema, Flushing, Headaches, Low blood pressure, Migraines, Nausea and vomiting, Palpitations, Peppery taste in the mouth, Rhinitis, Shortness of breath, Skin itching, Sneezing, Urticaria.
Testing for a histamine sensitivity is advisable in cases of chronic headaches, migraines and skin complaints that don't respond to other solutions. A common indicator of a histamine problem is if you know that red wine always gives you a headache. The key to testing for histamine sensitivity is to ensure you eat your food as fresh as possible. Then totally avoid all the foods on the list below. As so many cheeses are implicated I would suggest that you avoid all cheese for the duration of the test which should be at least seven days.
After seven clear days eat a meal containing one of the foods on the list that you would ordinarily eat (not cheese) and monitor your reaction. If you have unpleasant symptoms within a few hours you would be advised to avoid foods high in histamine. If you have no problems then you can gradually reintroduce the foods but keep a food diary and monitor your progress - it could be that you can tolerate a reasonable amount but not too much. When you are secure in establishing your tolerance then reintroduce cheese (not one of those listed).
The reason for postponing the testing of cheese is that it is possible to have a hidden milk sensitivity and this would cloud the results of the histamine test. Should you find that you have a problem with a cheese not on this list I recommend that you test for milk intolerance.
More detailed information on histamine content of food is difficult to come by as measurement is not a straightforward process due to variations in food affected by factors such as storage and fermentation. The list below, compiled from various sources including Joneja [296] and Maintz [297], is, therefore, not a definitive list and the amounts of histamine in foods included will vary considerably.
Fish: Anchovy, herring, mackerel, sardine, salmon, tuna.
Cheese: Blue, camembert, cheddar, emmental, gouda, harzer, mozzarella, parmesan, provolone, roquefort, swiss, tilsiter.
Meat: All dried or cured meats such as hams and salamis.
Vegetables: Aubergine, sauerkraut, spinach, tomatoes.
Alcohol: Beer, champagne, red wine, sparkling wine, white wine.
Other: Tamari, soy sauce, tomato ketchup.
More generally avoid any food that has been smoked, pickled or fermented.
You will need to use a food diary to monitor your responses. Some foods without a significant histamine content have been thought to trigger a histamine release. [298] Foods with this capacity include:
Egg white, crustaceans, chocolate, strawberries, tomatoes and citrus fruit.
How long the effects of histamine will last depends upon its metabolism in the body. Under “normal” circumstances, histamine is rapidly converted to its inactive metabolites by either histamine methyltransferase or diamine oxidase (DAO). [299] It has also been found that eating a histamine containing meal and taking drugs that inhibit DAO can produce symptoms so check with your doctor about any medication that you are taking.
Once you have established your level of histamine tolerance, adjust your diet to accommodate it. You will need to ensure that you never eat too many foods high in histamine in succession but if you are able to tolerate some you will be to included these in your weekly meal plan. Histamine-intolerant women often suffer from headaches that are dependent on their menstrual cycle and from dysmenorrhoea. [300]
See also Legumes.
Lectins are a class of proteins, chiefly of plant origin, which bind specifically to certain sugars and cause agglutination of particular cell types. It has now been found that lectins are toxic and/or inflammatory, resistant to cooking and digestive enzymes, and present in much of our food. Initially it was thought that lectins only caused digestive problems that often mimicked the symptoms of food poisoning but it is now believed that some of these leave the gut and affect other organs in the body leading to more widespread symptoms.
Many lectins are powerful allergens in their own right, such as prohevin, the principle allergen of rubber latex, but it is also possible to be more generally sensitive. One of the most commonly known lectins is phytohaemagglutinin which is found in beans.
Gilbert reports on a case of a hospital holding a "healthy eating day" which resulted in illness. The canteen served a dish containing red kidney beans which was chosen by 31 customers. Over the next few hours cases of severe vomiting and diarrhoea were reported. All had recovered by next day. Investigations showed no signs of traditional food poisoning but the beans were found to contain an abnormally high concentration of the lectin phytohaemagglutinin. [301]
Ordinarily, phytohaemagglutinin is only a danger after consumption of raw or undercooked kidney beans. The reactions experienced after eating beans in this state are classed as a form of poisoning not intolerance. In these situations, the symptoms usually appear within one to three hours and are marked by extreme nausea, followed by vomiting, abdominal pain and diarrhoea. Some people have been hospitalised but recovery is usually rapid.
Phytohaemagglutinin is found in many species of bean but it is found in highest concentrations in the red kidney bean. Soaking the beans reduces the number of lectins but adequate cooking is still required. Whilst white kidney beans have fewer of these lectins, soaking does not reduce the number significantly so they too are not to be eaten raw. [302]
Some people find that, even when cooked correctly, red kidney beans cause problems most notably abdominal discomfort. The only solution is to avoid the beans. Information on testing for a sensitivity to beans can be found in the section on Legumes.
The different ways in which we deal with lectins has also been linked with blood groups types. [303] And, reviewing the available research, Freed suggested that it was possible that insulin dependent diabetes, rheumatoid arthritis, and peptic ulcers could all be triggered by problems with lectins. The avoidance of large numbers of lectins in diets such as the “stone age” diet could be the reason why some people notice an improvement in their symptoms especially in reducing respiratory symptoms as without lectins in the throat the lining provides a more effective barrier to viruses.
Freed goes on to offer an explanation as to how disease such as rheumatoid arthritis and diabetes can often develop after illnesses such as flu. Basically, the protective coating of our cells can be stripped away during illness leaving us open to the damaging effect of lectins. [304]
Lectins are increasingly being implicated in auto immune illnesses, coeliac disease, arthritis, and some forms of diabetes. As Hamid and Masood write “The involvement of lectins in our health and their relationship to degenerative disease is still an emerging science”. [305] At the moment there are no comprehensive lists regarding types of lectin and levels in food nor is there detailed information on the possible benefits or otherwise of specific lectins.
One of the strongest indicators of a lectin problem is if you develop health issues after changing to a diet high in legumes. I suspect it is also an area to consider if rheumatoid arthritis is not responding to other treatments.
Lectins are found in most plant foods but certain categories of food have been identified as causing more problems than others. In a possible order of potential problems, these are given below:
Legumes including peanuts and soy.
Cereal grains especially wheat.
Potatoes and tomatoes and other members of the deadly nightshade family (see the section on Solanine).
If you suspect a problem with lectins the best place to start would be with removing legumes from the diet. If there is a problem, symptoms should begin to disappear within a few days.
Establishing detailed information on lectin content of plant foods is not straightforward - not all plants have been tested, tests have been done in different ways, and we still do not know which lectins are beneficial. A study by Ramona et al found lectin concentration HU/mg in the sixteen foods analysed as follows: [306]
Red kidney beans 360
Red lentils 360
Chick peas 180
Pinto beans 180
Soya beans 87
Black eyed peas 44
Porridge Oats 17
Banana 13
All bran cereal 5.6
Digestive biscuits 5.6
Potato 5.5
White rice, wholemeal bread, white spaghetti all had less than 1.3.
In respect of grains, lectin activity has been found in wheat, rye, barley, oats, corn and rice but not in millet or sorghum. [307]
MSG, monosodium glutamate, is the sodium salt of a naturally occurring amino acid - glutamic acid. Glutamate is essential to life and is found in cells throughout our body. It occurs in two forms, naturally in food and as an added flavour enhancer. Most of the glutamate our bodies receive is in a “bound” form and is gradually released as enzymes digest the protein food that it is part of. MSG, on the other hand, is a form of “free” glutamate that is instantly available to us and it is too much of this type that can lead to problems.
The degree of sensitivity experienced depends on the individual. Some people can tolerate vast amounts, others find themselves shaking and in an anxiety state after very little. The “toxic” reactions experienced by some people are generally because of an overload of MSG in its form as a flavour enhancer.
MSG intensifies some flavours and lessens others. It is an ideal additive for food manufacturers to “adjust” the taste of highly processed food and you can, without realising it, be ingesting quite large amounts of MSG. Generally made from the fermentation of corn, sugar beets, or sugar cane, MSG is a potential problem for anyone with an intolerance of these foods.
MSG has been linked with a number of conditions. It has been found to bring on asthma in some individuals, with the asthma developing anywhere from one to two hours to as long as twelve hours after ingestion. [308,309] More general concerns have been expressed about damage being caused to the nervous system and brain cells which can contribute to the onset of serious illnesses, like Parkinson’s disease and dementia, in later life. [310]
Squire reported on a case of a fifty-year old man whose recurrent angioedema of the face, hands and feet was related to MSG intake. The angioedema occurred sixteen to twenty four hours after ingestion of MSG. [311] Botey et al reported on four children whose urticaria was caused by MSG. Symptoms developed between one and twelve hours after the MSG challenge was given. [312]
A condition that became known as “Chinese Restaurant Syndrome” was identified in the late 1960s and linked MSG with a collection of symptoms including headaches, stomach pains, breathing problems, nausea and thirst. [313]
In summary, the various symptoms and conditions that have been linked with MSG sensitivity are listed below. These have been combined from a number of sources including the review in Joneja’s book. [314]
Anxiety, Asthma, Balance problems, Behavioural problems, Bloating, Blood pressure changes, Blurred vision, Breathing difficulties, Burning sensation in the back of the neck and forearms, Changes in heart rate, Chest pain, Depression, Diarrhoea, Difficulty focusing, Disorientation, Dizziness, Extreme dryness of the mouth, Facial tightness, Flu-like achiness, Flushing, Headache, Hyperactivity, Insomnia, Irritable bowel, Joint pain, Lethargy, Light-headedness, Loss of balance, Mental confusion, Migraine, Mood Swings, Nausea, Numbness or paralysis, Panic attacks, Paranoia, Rapid heartbeat, Runny nose, Sciatica, Seizures, Shortness of breath, Skin rashes, Sleepiness, Slurred speech, Stiffness, Stomach cramps, Urinary and prostate problems, Wheezing.
Fatigue has been noted as a side effect of too much MSG. As this often occurs up to twelve hours after ingesting MSG it is sometimes difficult to link the symptoms to the cause (a food diary will help). If you frequently eat food containing large amounts of MSG, such as some forms Chinese takeout, then you may have a hidden MSG problem.
MSG does seem to set away an addictive response and hence cause food cravings. One of the difficulties with diagnosing if you have an MSG sensitivity is that it is often an ingredient that is hidden. You will need to follow the avoidance process very carefully.
To test for MSG sensitivity avoid all foods containing added MSG for at least five days. Avoid the additives:
E621 Monosodium glutamate
E622 Monopotassium glutamate
E623 Calcium diglutamate
E624 Monoammonium glutamate
E625 Magnesium diglutamate
Unfortunately this is not a straightforward process. These additives creep into many foods and it is probably best if during these five days you avoid eating any restaurant or take-out food and preferably only eat what you cook yourself. The foods to check carefully include:
All ready meals.
Snack foods such as cheese and spicy flavoured crisps, chips, tacos.
Soya products, mainly soy sauce, miso, tamari, tempeh.
Most sauces, gravy mixes, and stock cubes.
Meat and yeast extracts, pastes and pâtés made from fish and meat.
Be aware of hidden MSG. It is possible that any of the following may contain MSG:
Autolyzed yeasts, bouillon, barley malt, broth, calcium caseinate, flavourings (including those listed as natural), HVP (hydrolysed vegetable protein), HPP (hydrolysed plant protein), kombu extract, malt extract, seasonings, sodium caseinate, textured protein.
At the end of the five days, eat a meal that you would previously have eaten containing MSG and wait - an “immediate” reaction can take up to twelve hours to present itself.
Some people react immediately on eating any MSG whilst for others it is dose related - whereas one meal containing MSG may cause no problems, a second meal followed by a snack food with high levels can produce the symptoms. It is a cumulative process - you may be able to eat it once a week but not over a number of days in succession. If a large, for you, amount of MSG is ingested it is possible that the initial reaction will be severe but of short duration. You should not be fooled into thinking this is the only reaction you will get.
Monitor yourself carefully over the next few days and notice any additional changes such as bloating, rashes, mental confusion, false energy and headaches. If reactions have taken place you will be able to keep your MSG levels very low simply by avoiding it in its additive form. Some people’s sensitivity is great enough to warrant that they also avoid foods that are very high in naturally occurring free glutamates.
Emsley and Fell list some of the foods with the highest amounts of naturally occurring MSG as follows (highest first):
Kelp, parmesan cheese, peas, tomatoes, corn, potatoes, spinach, chicken, carrots, beef, mackerel, pork, eggs.
Swain et al [315] list the following foods as being high in natural glutamate:
Vegetables: broccoli, mushroom, silver beet, English spinach, tomato, vegetable juice.
Fruit: grape, plum, prune, raisin, sultana.
Animal protein: processed meats.
Dairy: strong tasting cheese.
Condiments: miso, soy sauce, tempeh.
Don’t forget that if you are attempting to lower your overall levels of MSG that you need to ensure that you are not taking in any of it in additive form (check the lists in the earlier part of this section).
If you had no reaction to added MSG but reacted to some of the foods in which it occurs naturally then you may have a problem with another food chemical such as salicylate rather than MSG.
Oxalic acid and oxalates are naturally occurring toxins in many foods. They are generally dealt with in the gastrointestinal tract and removed from the body in the faeces as calcium oxalate. In some people oxalates have been detected in the urine indicating that absorption from the gastrointestinal tract has taken place. It appears that this absorption takes place when calcium in food is tied up with other dietary components.
A build up oxalic acid can lead to kidney and bladder stones. Other symptoms that have been linked with high oxalic acid levels include abdominal pain, diarrhoea and sore throats. Plant leaves, especially rhubarb, beet tops and spinach, have the highest concentrations: the concentration is so high in rhubarb leaves that they have been classed as poisonous.
It is not possible to provide a full list of foods containing oxalic acid but the ones listed below have all been found to contain it.
Beer, beetroot, blackberries, broad beans, celery, cocoa powder, gooseberries, green peppers, leeks, parsley, peanuts, pears, potatoes, red currants, runner beans, sorrel, spinach, strawberries, tea.
An average serving of each of these provides about 15mg of oxalate. Rhubarb has the highest amount, followed by spinach, beetroot, and cocoa powder. Star fruit [316] and high doses of ascorbic acid [317] have also been linked with oxalic acid problems. No oxalates have been identified in cereals, cheese, eggs, and most other fruit and vegetables. [318]
If you suspect an oxalic acid problem the general advice is to avoid the foods high in oxalate, limit your fat intake and increase your calcium intake. Do discuss these changes with your doctor first.
See also Amines.
Phenylethylamine, derived from the amino acid phenylalnine, has been associated with changes in mood, behaviour and co-ordination. Emsley and Fell state that "there is no evidence that the body treats phenylethylamine as anything other than a chemical to be removed". [319] Cases of chocolate “allergy” have in fact turned out to be a problem with phenylethylamine. It appears that some people simply do not have sufficient quantities of the enzyme that breaks this amino acid down and prepares it for removal from the body.
Reactions to phenylethylamine have included:
Abdominal cramps, Diarrhoea, Dizziness, Flushing, Headache, Low blood pressure, Nausea, Respiratory problems, Urticaria.
The symptoms often appear to mimic an allergic reaction but when tested no allergy is identifiable. The phenylethylamine in chocolate could be one of the causes of chocolate related migraines.
Sandler et al identified a headache occurrence rate of 50% in those suffering from migraines when exposed to phenylethylamine as opposed to 6% of those receiving a placebo. It could be that some people are unable to fully metabolise phenylethylamine so leaving it in their systems longer and strengthening its effect on the vascular system. [320] Some migraine sufferers and children diagnosed with hyperactivity have been found to have elevated plasma phenylanine. [321]
Phenylethylamine is highly concentrated in high-protein foods such as meat and dairy products especially cheese. To reduce the level of the free form that is most likely to cause problems you would need to avoid all:
Processed meat and fish products, meat extracts, cheese, chocolate, wines and beer.
Products sweetened with aspartame.
To test for a problem with phenylethylamine avoid all the above foods, including aspartame, for at least two weeks and then reintroduce them gradually. Keep a food diary and remember that problems with phenylethylamine are probably dose related so a single test of, say, some processed meat is unlikely to provide a reaction unless you are extremely sensitive (do also remember that processed meats often contain other ingredients that can cause problems).
By carefully recording what you eat over a period of time, as well as any symptoms you experience, you should be able to see a pattern emerge that shows you how much food high in phenylethylamine you can tolerate before symptoms arise. If you use products containing aspartame please also read the section in Sugars and Sweeteners.
If there has been some improvement but symptoms, especially migraines, continue to persist then consider testing for a tyramine sensitivity - the foods that need to be avoided are very similar.
The production of uric acid is a normal bodily function. It is a waste product of digestion and is excreted via the kidneys as urine. In some individuals the removal of uric acid is impaired and it accumulates in the body eventually leading to unwanted symptoms.
Foods that contain the compound purine can raise the uric acid levels in the body leading, if you are susceptible, to conditions such as gouty arthritis or joint pain. These conditions are generally recognisable by their accompanying sudden and severe attacks of pain, redness and swelling of joints. The condition has been found to be helped by eating a low purine diet.
Gout generally comes on very suddenly with pain, swelling, warmth and redness usually in one joint. It has been commonly been associated with the big toe but can in fact afflict any joint. Some types of kidney stones can also be caused by uric acid build up and autism in some children has also been linked with an inability to correctly metabolise purines. [322]
Other problems have also been linked with purines. Moss reported on a study of the relationship between the consumption of alcohol, purines and boron, and the incidence of irritable bowel syndrome or frequent diarrhoea. The findings showed that individuals on diets high in alcohol, purines and boron had a higher prevalence of irritable bowel syndrome or frequent diarrhoea. The relationship was found to be significant. [323]
You will find it useful to test for purine sensitivity if:
* you have recurring gout like symptoms,
* only recently had a gout like episode but are also overweight and drink alcohol, or
* have irritable bowel syndrome that has not fully responded to other forms of dietary intervention.
It should be noted that not everyone with gout will have a purine sensitivity. As gout has become more prevalent there is now more awareness of the condition and many treatment protocols include some degree of dietary changes. If you have been given a diet to follow because of gout please do not stray from it without checking with your doctor first.
To test for a purine sensitivity, reduce the number of high purine foods in your diet for at least two weeks. Increase your intake of fruit and vegetables (choosing from those not on the lists) that you can eat as these increase the alkalinity of the blood and can help in the removal of excess uric acid. Avoid alcohol. High purine foods include:[324]
Meat especially red meat and offal, such as liver and kidneys, heart and sweetbreads.
Game, including pheasant, rabbit, and venison.
Seafood especially mussels, crab, shrimps and other shellfish, anchovies, herring, mackerel, sardines, sprats, whitebait trout, fish roe, caviar.
Yeast containing foods and beverages such as Marmite and beer.
Mushrooms and fungal proteins such as mycoprotein (Quorn), asparagus, cauliflower, spinach, lentils and soya beans.
For some the relief will be quite sudden but for others it can take time for the body to deal with removing the excess uric acid. If after a fortnight you are noticing some improvement you should maintain the diet. To actually test for a purine sensitivity is difficult as it is affected by the build up of uric acid to a level that is a problem for the individual - in some the response can be sudden, in others it can take weeks.
Persevere and monitor your success. As always with food testing, keep a food diary. It might be worth noting that strawberries, oranges, tomatoes and nuts, even though they are not high in purines, have triggered gout in some people. [325]
The other food that has increasingly been linked with gout is fructose. [326] Fructose rich drinks such as sugar sweetened soda and orange juice can increase serum uric acid levels and, hence, the risk of gout. [327] It is therefore probably best to also exclude these types of drinks. There will be a temptation to switch to sugar-free varieties but until you are sure that you need to eliminate the sugar drinks it would be best to stick to drinking water. Artificial sweeteners are often very complex products and adding them into your diet at this stage may lead to confusion with results of food testing.
The word “salicylate” is derived from the botanical name for the willow family “salicaceae” In 1838 salicylic acid was isolated from willow bark and, by 1899, acetylsalicylic acid was synthesised and marketed as aspirin. We come into contact with salicylate in two forms: In man-made substances such as medicines, solvents and perfume fixatives, and in its natural form in vegetables, fruit, spices, herbs and plants.
In nature, salicylates appear to exist as a natural preservative or insecticide protecting the plant and elongating its life span. The work of Anne Swain and others in Australia in the mid 1980s demonstrated the extent to which salicylate is present in food. [328] Virtually every meal we ever eat contains some salicylate and for most people this causes no problem but for an individual who is salicylate sensitive the consequences for their long-term health can be disastrous. The brain is often seriously affected as an overdose of salicylate first stimulates and then depresses the central nervous system leading to emotional and behavioural problems.
It has been particularly linked with hyperactivity as a result of the work of Dr Feingold in the 1970s. The results of research carried out by Williams et al support the theory that some food additives and industrial chemicals induce intolerance because of their aspirin-like properties. [329] A study of aspirin allergy by Speer et al found that 90% of those with aspirin sensitivity were also sensitive to inhalants, food or other drugs. [330] Others, including Thune and Granholt [331] have also found a cross-reactivity with aspirin. So, if you have an aspirin sensitivity consider testing salicylates more generally.
Many of the symptoms that arise as a result of salicylate intolerance mimic those of allergy but a reaction to salicylate is not an allergy. There is no simple method of testing to establish salicylate sensitivity - the most usual is the administration of an elimination diet followed by some form of challenge testing.
Salicylate is cumulative in the body and symptoms will only arise when the tolerance level of the individual has been exceeded. A large number of symptoms and conditions have been linked with salicylate and these are outlined below.
Abdominal pain, Aching legs, Asthma, Bed wetting, Bladder Problems, Dermatitis, Dizziness, Ear Infections, Eye muscle disorders, Fatigue, Headaches, Hives, Hypoglycaemia, Nasal polyps, Persistent cough, Physical sluggishness, Poor physical co-ordination, Psoriasis, Rhinitis, Sinusitis, Sleep disorders, Skin problems, Speech difficulties, Stomach irritation, Swelling of face, hands, feet, Tics, Tinnitus, Urticaria.
Accident proneness, Anxiety and agitation (no reason), Bouts of excessive energy followed by fatigue, Confused thinking, Depression, Distraction, Dyslexia, Excessive or constant talking, Hyperactivity, Impatience, Lack or loss of concentration, Memory problems, Mental sluggishness, Mood swings, Needing to be left alone, Nervousness, Poor self-image, Sudden bouts of paranoia, Sudden highs, Suicidal thoughts, Temper flare ups, Unpredictability, Workaholism
Check the symptom list. How many of the symptoms do you currently have or have frequently had before? The greater the number the more likely you are to be sensitive. Have you had periods of times when you have experienced clusters of the symptoms? Salicylate sensitivity is generally a life-long condition and a pattern of symptoms and behaviour will be noticeable. Do spices, herbs or vegetables make you feel ill or do you have an aversion to them? This is not necessarily an indicator as we have often been conditioned about our responses but think back to childhood and how you responded to these at that time.
The only way to determine if you are salicylate sensitive is to reduce the level of salicylate in your system and the only way of doing this is to eat food containing no salicylate or very low levels. Once the body has eliminated the stored salicylate it is then possible to reintroduce foods containing a higher level and to assess the extent of any reaction.
If you suspect that salicylates may be a problem for you and you are taking any medication containing aspirin or another form of salicylate DO NOT undertake this test. Check ALL your medicines first and if in doubt ask your doctor. Ideally, all medications should also be additive (especially colour) free. If you are taking a salicylate medication then consult your doctor before even considering this test.
Please do take the above advice seriously. Aspirin, and other salicylate based drugs, contain a very concentrated form of salicylate. If you stop taking them, reduce the overall salicylate level in your system, and then take one you could be putting your life at risk. Death can result from anaphylactic shock.
As salicylate is cumulative in the body you need to lower your level over a period of at least two weeks. During this time you must be absolutely certain that you do not expose yourself to any high levels. Choose your fortnight with care as meals away from home will be very difficult to deal with. You can eat any amount of the foods listed as safe. If you are currently a vegetarian do not suddenly start eating meat, if you know that lettuce or one of the other foods makes you ill or you have an aversion to it then don't eat it - stick to foods you are used to eating, you can (if you want to) try the other ones later.
To make it easier for you the foods have been allocated a number so that you can keep score of how much salicylate you are eating - the score relates to an average portion. Your maximum allowance during this fortnight is FIVE a day and it is essential that you do not exceed this amount on any day. Keep a food diary and write down the total score for each day. Your food diary is going to become an incredibly important ally in unravelling your food sensitivities. Use it fully.
None of us are perfect and if you slip up don't beat yourself up about it. Correct it. If you find that on one day you unwittingly had a score of ten then make sure the next day's score is zero. Do not do the reverse - this means that if, for example, on the Friday, you scored three you must not increase Saturday's score to seven. KEEP TO FIVE. If you have slipped up on more than two consecutive days you will probably need to start your fortnight again.
At the end of the fortnight you will need to decide on the next stage. The degree of your sensitivity, your age, your overall health and the speed at which your body can detoxify will all have influenced what took place. You will probably find yourself in one of the following categories:
* There was no noticeable change.
* There was a gradual improvement in symptoms.
* There was no change at first then you had two or three days of feeling wonderful followed by days of being generally unwell and very tired - not too dissimilar to flu symptoms. Unless you have contracted a virus this is probably detoxification and nothing to be unduly concerned about.
* There was a substantial improvement in symptoms.
If you had no improvement in your symptoms then it is unlikely that you are salicylate sensitive. You can test this by eating as many foods from the high lists as you like. If after a fortnight these cause you no problem you can safely assume that you do not have a problem with salicylates. If there was a gradual improvement then you are probably salicylate sensitive. You can try to increase your salicylate level gradually. Increase your score allowance to ten a day over a two week period. If your symptoms begin to get worse again drop your level to five for a few days and then increase slowly until you find the level you can tolerate.
If you can tolerate a score of ten a day then increase to fifteen a day, once again for two weeks, and keep on doing this until you reach the level at which your symptoms reappear. The easiest way of dealing with a return of symptoms is drop your level to five for a few days and then take it back up when you feel better.
If you had a few days of feeling great and then feeling generally ill and tired it is likely that you have some degree of salicylate sensitivity. To give your body a chance to detoxify it is safest if you stay at this level for at least a further two weeks.
Testing for salicylate content in food has been slow in taking place. The lists that follow are based mainly on the research carried out by Swain et al. [332] Other studies have taken place but none has tested the same number of foods. [333,334] The findings from the other studies are explored in more detail in the Salicylate Handbook. [335]
The other issues about salicylate levels is that the amount may vary from different crops and harvests, not all foods have been examined, results have not been retested and, in the future, newer methods of analysis may be discovered. Having said that, the lists are more than adequate for establishing if you have a salicylate sensitivity and, if you do, will also enable you to establish your level of tolerance.
You are welcome to try foods not on the lists but so as not to confuse the results it would be advisable to treat them as suspect and only introduce them at a later stage when you can clearly determine what is happening. The categories of food are safe, very low, low, moderate, high, very high and extremely high.
If you get a reaction, be gentle with yourself. If salicylates affect your mind you may find it useful, when well, to write yourself a note you can read when a reaction takes hold - it should explain what is happening and reassure you that it will pass. If you have someone who understands what is happening talk to them - sometimes this helps minimise the effects of the anxiety.
Increase the number of safe fruit and vegetables you can eat as this increases the alkalinity of your blood. Taking extra Vitamin C can also help. If your blood sugar has been affected, don't worry. Eat lots of small meals for as long as you need - include “safe” treats. If you need to rest then take the time do so. It will pass. The length and severity of reactions will vary from individual to individual but, as it takes time for the body to eliminate salicylate, you can expect to experience symptoms for at least a few days.
*****
Fruit: Banana, pear (peeled).
Vegetables: Bamboo shoot, cabbage (green/white), celery, dried green split peas, lentils, lettuce (iceberg), swede. Potatoes are fine but they must be of the old white variety and you must peel them.
Beans - dried (not borlotti). You may use canned beans but avoid any that have added ingredients such as sugar and salt.
Grains: Barley, buckwheat, millet, oats, rice, rye, wheat. To avoid additives and hidden preservatives, all bread, biscuits, cakes etc... should be home-made.
Seeds and nuts: Poppy seeds.
Sweeteners: Maple syrup, white sugar.
Meat, fish, poultry: Meat, fish, poultry and eggs are generally salicylate free but avoid liver and prawns and do not eat any processed meat.
Herbs, spices and condiments: Malt vinegar, saffron, sea salt, soy sauce.
Oils and fats: Cold pressed oils such as soy or sunflower. Butter. Margarine and processed rapeseed (canola), safflower, soya bean, sunflower oils although probably low in salicylate are likely to contain preservatives that may mimic salicylate reactions and are best avoided.
Dairy: Butter, cheese (not blue vein), milk, yoghurt - natural only but you can add your own fruit.
Misc: Carob powder, cocoa, tofu.
Beverages: Decaffeinated coffee, milk, ovaltine, home-made pear juice, soya milk, rice milk, water. Water should be the drink of your choice.
Fruit: Golden delicious apple without the peel (green variety only), paw paw, pomegranate, tamarillo.
Vegetables: Brussels sprouts, borlotti beans, chives, choko, garlic, green peas, leek, mung bean sprouts, red cabbage, shallot, yellow split peas.
Nuts and seeds: Cashew nuts.
Herbs, spices and condiments: Fennel - dried, fresh parsley.
Sweeteners: Golden syrup.
Meat and fish: Liver, prawns.
Fruit: Fresh figs, lemon, mango, passion fruit, persimmon, red delicious apple (peeled), rhubarb.
Vegetables: Fresh asparagus, beetroot, cauliflower, green beans, onion, marrow, potato - with peel, pumpkin, tomato, turnip. Frozen spinach.
Seeds and nuts: Hazelnuts, pecan, sunflower seeds.
Herbs, spices and condiments: Fresh coriander leaves.
Oils and fat: Ghee.
Beverages: Dandelion coffee, shop bought pear juice.
Fruit: Custard apple, kiwi fruit, loquat, lychee, pear with peel.
Vegetables: Aubergine - peeled, carrot, lettuces other than iceberg, tomato juice, mushrooms. Tinned asparagus, beetroot, black olives, sweetcorn.
Seeds and nuts: Desiccated coconut, peanut butter, walnuts.
Sweeteners: Molasses.
Beverages: Coco-cola, rose hip tea.
Fruit: Avocado, most other varieties of apples, cantaloupe melon, cherries, grapefruit, mandarin, mulberry, nectarine, peach, tangelo, watermelon.
Vegetables: Alfalfa sprouts, aubergine with peel, broad bean, broccoli, cucumber, tinned okra, parsnips, fresh spinach, sweet potato, tinned tomatoes and tomato puree, watercress.
Grains: Maize.
Seeds and nuts: Brazil nuts, macadamia nuts, pine nuts, pistachio, sesame seeds.
Herbs, spices and condiments: Yeast extracts.
Oils and fats: Almond oil, corn oil, peanut oil, sesame oil, walnut oil.
Beverages: Coffee.
Fruit: Fresh apricots, blackberry, blackcurrant, blueberry, boysenberry, cranberry, fresh dates, grapes, guava, orange, pineapple, plum, strawberry, sultana.
Vegetables: Chicory, chilli peppers, courgette, endive, tinned green olives, peppers, radish, water chestnut.
Seeds and nuts: Almonds, peanuts with skins on.
Sweeteners: Honey.
Herbs, spices and condiments: Basil, bay leaf, caraway, chilli powder, nutmeg, vanilla essence, white pepper.
Oils and fats: Coconut oil, olive oil.
Beverages: Peppermint tea.
Fruit: Dried apricots and dates. Currant, loganberry, prunes, raisin, raspberry, red currant.
Vegetables: Gherkins.
Herbs, spices and condiments: Allspice, aniseed, black pepper, cardamom, cayenne, celery powder, cinnamon, cloves, cumin, curry powder, dill, fenugreek, garam masala, ginger, liquorice, mace, mint, mustard, oregano, paprika, rosemary, sage, tarragon, turmeric, thyme, wine and cider vinegars.
Beverages: Cordials and fruit flavoured drinks, fruit and vegetable juices, tea.
*****
Alcohol varies in amount. Given the difficulty in fully ascertaining the ingredients of alcoholic beverages, it is best to avoid drinking alcohol during the first two weeks. The following list can be only be treated as a very basic guide to levels. The safest course of action would be to introduce your favourite drink as a test.
Gin, whisky and vodka are probably safe.
Beer, brandy, cider, and sherry have a high salicylate content.
Liqueurs, port, rum, and wine are extremely high in salicylate.
Living with salicylate sensitivity is not easy. To maintain a level of salicylate that you can tolerate in your diet, you really are going to have to take responsibility for your diet - you can never allow anyone else to make a meal for you without first ensuring that they have a full list of the foods you can eat (it is easier to give a list of foods you can eat than those that need to be avoided).
Some food additives can also be a problem not necessarily because they contain any salicylate but because some of them mimic salicylate in the body. For example, adverse reactions to tartrazine are common in people who also react badly to salicylate, [336] probably because both are similar in structure and are detoxified in the same way. Similar problems have been found with the antioxidants BHA and BHT. [337]
Establishing a salicylate tolerance level is not an easy process and it can lead to a restrictive diet which is why many doctors advice against following one. Depending on your age and other factors unique to you, you may find that over a period of time you will be able to tolerate more salicylate. I suspect that at first, for some of us, our bodies are so relieved to have a reduction in the toxin that they rebel at the input of any but when the body has had time to recover it is more able to deal with eliminating salicylate and then accepts more.
Sadly, salicylates are found in a whole range of everyday products and, depending on your sensitivity, you will have to watch out for them. Perry et al have estimated that 12-20% of the salicylate in skin preparations is absorbed into the bloodstream via the skin. [338] As some ointments can contain high proportions of salicylate the risk for a sensitive person is serious. Ensure that none of the high and very high foods, especially herbs and spices, are present. Make sure you avoid anything with the word salicylate or salicylic within it. Some of the substances you need to watch out for include:
Acetylsalicylic acid, Almond oil, Aspirin, Benzoic acid, Benzoate - any form, Beta hydroxy, Birch, Bisabolol, Bismuth subsalicylate, Camphor, Castor oil, Homosalate, Hydroxybenzoate, Hydroxybenzoic, Menthol, Methyl salicylate, Methylene disalicylic acid, Oil of wintergreen, Ortho-hydroxybenzoic acid, Oxylsalicylate, Salicylaldehyde, Salicylanilide, Salicylic acid, Salicylic alcohol, Sodium salicylate, Stroncylate, Willow.
Carefully check medications, vitamins and other supplements, herbal remedies, cosmetics, creams and ointments, deodorants, toothpaste, teething gels, soap, shampoo, household cleaning products, air fresheners, insecticides, washing powders. Beware of perfumes as salicylate is often used as a fixative. It is best to avoid using perfume and scented products. Fragrance and colour free products are increasingly available.
I suspect that some people who tried a low salicylate diet for themselves or their children have run into this problem - an improvement followed later by seemingly salicylate unrelated problems. The symptoms are the same as before but you know the tolerance level has not been exceeded. If this happens check your environment - at work, home, school, wherever you spend time.
Crinon in an article on the health effects of airborne solvent exposure tell us that chemicals known as solvents are part of a broad class of chemicals called volatile organic compounds. These compounds are frequently used in a variety of settings and off-gas readily into the atmosphere. As a result of their overuse, they can be found in detectable levels in virtually all samples of both indoor and outdoor air. Once in the body they can lead to a variety of neurological, immunological, endocrinological, genitourinary, and hematopoietic problems. [339] Some individuals also have metabolic defects that diminish the liver's clearing capacity for these compounds.
Perfumes and solvents can give you these reactions and with these it is very difficult to know if they contain salicylate or not. The only way of knowing is to trust your nose which at first can lead to many unwanted reactions. If it all sounds difficult then you're reading the situation correctly. The positive side, and it is a massive one, is the better health that follows. Salicylate causes so many problems within the nervous system that all aspects of your life are affected by it - reducing the level substantially can, for someone with a salicylate sensitivity, lead to many positive changes.
Saponins are a type of glycoside found in some plants. They are often particularly known for the soap-like foaming they produce when shaken in water.
Saponins occur in a wide variety of plant foods including soy and kidney beans and quinoa. Whilst some saponins are thought to have positive health benefits, they are also linked with adverse reactions in particular gastrointestinal reactions.
A large proportion of saponins can usually be removed by carefully washing the food in running water but some will inevitably remain in the food. There are many anecdotal reports of severe stomach cramping, vomiting and diarrhoea after eating foods like quinoa. We currently don’t know if these problems have been caused by incorrect preparation/cooking or as a result of a sensitivity to either the food or the saponins.
A study by Fenwick and Oakenfull found the food plants, of the ones tested, that were highest in saponins to be
Chickpeas, soya beans, lucerne (alfalfa) sprouts, navy beans, haricot beans, and kidney beans.
Tests showed that saponins were not destroyed by processing or cooking but that fermentation appears to make a difference - the saponin content of tempeh, a fermented soya bean product, was only half that of whole soya beans. [340]
If you suspect a problem with saponins then eliminate pulses and quinoa from your diet for seven days and monitor your progress when reinstating them into your diet - at this stage only add in ones that you ate before the test and please ensure that you follow preparation and cooking guidelines.
See also Amines.
The amine 5-hydroxytryptamine is what serotonin is known as in the world of science. Because of its actions as a neurotransmitter much has been written about the mood elevating qualities of serotonin but less has been written about the difficulties that an “excess” can cause for certain individuals.
Emsley and Fell cite the case of a fifty-two year old man who experienced one to two migraines a month and severe joint stiffness. After investigating his diet, which was high in meat, it was found that the cause of his problems was "a simple case of free amine overload due to a diet rich in tryptophan". Serotonin is produced from the amino acid tryptophan. [341]
The main symptom indicators would appear to be joint inflammation with no verifiable evidence of arthritis, and migraines not responding to other solutions. Other symptoms that have been noted include:
Abdominal cramps, Breathing difficulties, Burning sensation in the mouth and throat, Dizziness, Flushing, Generalised itching, Headache, Nausea, Urticaria, Vomiting and diarrhoea.
Fish, meat, herbs and dairy products are all potentially high in tryptophan and a simple reduction in the amount if these eaten may be sufficient in establishing if there is a problem. It will also help to eat the freshest possible fish and meat, to avoid processed foods, sauces, and strong tasting cheeses. Braverman lists the following foods as ones that contain tryptophan:
Avocado, cheese, chicken, chocolate, cottage cheese, duck, egg, granola, luncheon meat, oat flakes, pork, sausage meat, turkey, wheat germ, whole milk, wild game, yoghurt. [342]
If you eat a lot of the same type of meat, fish or cheese you may want to consider varying the sources of your protein and adjusting how often you eat any particular food. Moderate amounts of serotonin have also been found in :
Aubergine, black olives, broccoli, cantaloupe, cauliflower, dates, figs, grapefruit, honeydew melon, spinach. [343]
Keep a food diary and remember that problems with serotonin are probably dose related so a single test of one of the foods is unlikely to provide a reaction unless you are extremely sensitive. By carefully recording what you eat over a period of time, as well as any symptoms you experience, you should be able to see a pattern emerge that shows you how much food high in serotonin you can tolerate before symptoms arise.
Solanine is a toxic alkaloid found in certain vegetables most notably potatoes. It probably acts as a preservative in the plants that works by making itself poisonous to fungi and bacteria and so preserving the life of the plant. It has been implicated in serious cases of food poisoning and has even resulted in death. A toxic dose will usually result in severe digestive upset and, possibly, trembling, weakness, breathing difficulties and paralysis.
McMillan et al reported on seventy eight schoolboys who became ill after eating potato at lunch, seventeen of them required admission to hospital. It was eventually found that the potatoes eaten by the boys who became ill were from an old batch and were found to be high in solanine. The symptoms were gastrointestinal, circulatory, neurological and dermatological with some boys being far more ill than others. [344]
Vegetables containing solanine are all members of the deadly nightshade family. Everybody should know that eating potatoes that are green is dangerous and should be avoided. Always ensure that your potatoes are thoroughly peeled with all the sprouting parts removed and if the potato is green - throw it away. Solanine is not destroyed by heating.
Aside from the rather serious toxic aspect of solanine there is a lesser problem of sensitivity that affects certain individuals. Ordinarily the liver will break down solanine and help us dispose of it but in some individuals this is not the case and an excess of solanine leads to inflammation.
If you have any condition involving painful joints you might like to try a solanine free diet for a while - improvements can be dramatic. Identified symptoms include:
Arthritis, Confusion, Drowsiness, Gastrointestinal problems, Hallucination, Migraine, Painful joints, Skin problems, Stomach irritation, Trembling.
Testing for a solanine problem is relatively straightforward as so few foods are involved. Simply eliminate them all from your diet for two weeks. If there is an improvement you will then have to decide on whether you wish to test or not. If there has been no change then solanine is not a problem for you.
Be cautious if you are still eating any processed food as potato starch creeps into products as diverse as soup, cakes and ice cream. The foods which contain solanine are:
Aubergine
Cayenne
Chilli
Green and red peppers
Paprika
Potato
Tomato
If you have experienced an improvement but feel you cannot live without some of these foods then gradually reintroduce them and increase the amount you eat. If you keep a careful note in your food diary you should be able to find the amount you can get away with before your problems return or the discomfort becomes unacceptable to you.
One way of reducing the solanine level is by removing the outer layer by peeling - this method can certainly be used with potatoes and, to a lesser extent, with tomatoes.
“Sulphur” occurs naturally in a number of foods. “Sulphites” are sulphur based preservatives that are used to prevent or reduce discoloration of fruit and vegetables, prevent black spots on shrimp and lobster, inhibit the growth of micro-organisms in fermented foods such as wine, condition bread dough, and maintain the stability and potency of certain medications. Sulphites have been used since Roman times as preservatives in wine, sulphur dioxide was also used to sanitise wine and cider containers. Sulphites continue to be used in the wine making business in addition to their many other uses including the wet milling of corn to soften the kernel and facilitate the removal of corn starch.
A person can develop sulphite sensitivity at any point in life and no one knows, for definite, what triggers the sensitivity. Sulphites are broken down in the body by the same detoxification system that deals with other sources of sulphur in the diet such as amino acids like methionine and cysteine. In some individuals this detoxification system may not be working well and could give rise to a sulphite problem. Some countries have now prohibited the use of sulphites on fresh fruit and vegetables and insist on clear product labelling.
Sulphites have been most frequently linked with asthma. They are not generally seen as a cause of asthma but as a substance that can seriously exacerbate the condition. It has been estimated that between 5 and 10% of asthmatics are affected in this way. The Federation of American Societies for Experimental Biology (FASEB) in 1985 estimated that more than one million asthmatics are sensitive to or allergic to the substance.
Kochen in 1973 was among the first to suggest that the eating of sulphated food could cause bronchial problems. At the time he described the case of a child with mild asthma who repeatedly experienced shortness of breath, wheezing and coughing when exposed to dehydrated fruit that had been treated with sulphur dioxide. [345]
It became more accepted after work published by Baker et al, [346] and Stevenson and Simon, [347] both in 1981. Stevenson and Simon showed that challenges with potassium metabisulphite could produce significant changes in pulmonary function for some asthmatics. Other reported symptoms include flushing, tingling and faintness.
Problems with sulphites can result from ingestion, inhalation and topical application. Werth describes the case of an asthma sufferer who developed flushing, wheezing, and diaphoresis after inhaling vapours from a bag of dried apricots. In this case the person did not react to ingested sulphite when tested with a capsule of metabisulphite. [348]
Schwartz and Sher reported on a case in which breathing problems arose after an application of potassium metabisulphite solution to the eye during treatment for glaucoma. [349] Howland and Simon demonstrated that sulphated lettuce can trigger asthmatic reactions in asthmatics with a confirmed sulphite sensitivity. [350] Less serious reactions can include:
Abdominal pain and cramps, Chest tightness, Eczema, Headache, Hives, Itching, Localised angioedema, Minor breathing problems, Nausea and vomiting, Stomach ache, Throat irritation, Urticaria.
Changes in body temperature and heart rate have also been noted. [351] A typical low-grade reaction would be as follows: after a meal you would suddenly find yourself a little tight chested and feeling as if you are starting with a cold. The sensation would probably disappear within a few hours and, most likely, you would forget about it. The symptoms need not all be physical.
Randolph cites cases in which individuals experienced mental symptoms including tension, nervousness, and depression. He says that "Sulfur can bring on acute mental and physical symptoms". [352] A sulphite sensitivity could also be a hidden problem for some individuals with irritable bowel syndrome as sulphites can interfere with the process of bacterial fermentation.
If you suspect a sulphite sensitivity and have breathing problems do NOT under any circumstances take this test without medical consent and supervision. Anaphylactic shock has been recorded as a result of sulphite reactions.
Foods high in naturally occurring sulphur have given rise to a number of symptoms including:
Abdominal pain, Bloating, Constipation, Diarrhoea, Dizziness, Generally feeling unwell, Headaches, Lack of co-ordination, Nausea and vomiting, Respiratory problems, Sneezing, Tight sensation in the chest. Tremors, Visual disturbances.
It is possible to be sensitive to naturally occurring sulphur and not to added sulphites and vice versa. It has also been found that sulphites destroy vitamin B1 which can be a problem for anyone on a poor diet. In some countries it is now banned from foods high in B1 such as meat. Eberlein-Konig et al also found that sulphites can contribute to UVB sensitivity. [353]
As sulphite is a product that is added to foods it is impossible to provide a full list of foods containing sulphite. The following list, based in part on the re-examination of the GRAS status of sulfiting agents, is intended to serve only as a guideline - you must check labels of all foods for sulphite containing ingredients. [354]
Foods that are often very high in sulphites include:
Dried fruit, grape juice, lemon juice, lettuce, lime juice, molasses, sauerkraut juice, and wine.
Those that are often high in sulphites include:
Dried potato, fruit toppings, gravies, sauces, maraschino cherries, and wine vinegar.
Foods often with moderate amounts of sulphites include:
Corn starch, corn syrup, frozen potatoes, jams and jellies, maple syrup, mushrooms, pickles and relishes, sauerkraut, and shrimp.
Those often with low amounts of sulphites include:
Beer, coconut, dried cod, dry soup mixes, frozen pastries, gelatin, instant tea, malt vinegar, soft drinks, sugar, tinned potatoes,
Check all processed products including biscuits, crackers, enriched milk, meat and fish pies, pastes and ready meals, pies and pizza crusts, tortillas, any baked goods, any containing dried or processed fruit or vegetables, and all tinned foods. During the testing period avoid eating away from home especially in restaurants as in some countries sulphites are added to help keep food fresh.
These are the additives you need to watch out for:
E220 Sulphur dioxide
E221 Sodium sulphite
E222 Sodium hydrogen sulphite
E223 Sodium metabisulphite
E224 Potassium metabisulphite
E226 Calcium sulphite
E227 Calcium hydrogen sulphite
E228 Potassium hydrogen sulphite
E150(b) Caustic Sulphite Caramel
E150 Sulphite Ammonia Caramel
Unless you are extremely sensitive you will find that you can tolerate some sulphites. Your challenge will now to be find out just what you can get away with. Whilst establishing a safe level you would be advised to avoid take out, fast food and restaurant meals. Remember that exposure to sulphites can result from ingestion, inhalation and topical application.
If you have had any serious reactions in the past and you don’t know what has caused them DO NOT undertake this test at home - discuss the way forward with your doctor. Whilst rare, anaphylaxis has been linked with sulphites so testing is safest under medical supervision.
Check all medicines, supplements, creams, toiletries, cosmetics and ointments as some of these can also contain sulphites. If any of these have been prescribed for you by a doctor you must not take this test - explain your concerns with your doctor and ask for their advice on how to establish if you have a sulphite problem whilst still being able to take the medication that you need.
At this point do not be too concerned about the foods that contain sulphur naturally - a complete elimination will probably be unnecessary and would cause you problems with eating sufficient protein.
Eliminate sulphites for at least ten days before testing. Follow the testing protocol given to you by your doctor or, if he was given you the go ahead to carry out the test at home, eat one of the foods you would have previously eaten that contained sulphites. If you have no reaction, gradually increase the number of foods with sulphites. If you experience any form of reaction - immediately stop the test and eliminate them from your diet once again.
If you found that you do have a sulphite sensitivity and have made some improvement but are still experiencing problems you may also need to reduce the amount of naturally occurring sulphur in your diet as well. Foods that contain natural sulphur include:
Bran, broccoli, Brussels sprouts, cabbage, cauliflower, cheese, dried beans, egg yolk, fish, garlic, lentils, meat, molasses, nuts, onions, pasta, wheat germ.
You need to take great care with this type of dietary restriction as you need to ensure that you are eating sufficient protein. If after two weeks you continue to experience problems then it is likely that you have a problem other than sulphur. Before embarking on further tests double and triple check the foods that you are eating, writing to manufacturers if need be, as residual sulphite concentrations can be found in many foods. Also ensure that you are avoiding corn products in case of sulphite contamination during rehydration processes.
Tannins are naturally occurring chemicals found in a wide range of foods. It could be that, in a similar way to salicylates, they act as a form of natural protection for plants. They are also found in processed foods, medications and supplements where they are used as binders, coatings and preservatives.
The main symptom that has so far been linked with a tannin sensitivity is migraine.[355] So, if you suffer from migraines and no other test has worked, consider checking your tannin tolerance level.
As with most food chemicals, there is no definitive list of tannin levels in foods but the information in the lists below should help establish if tannins are a problem. The easiest way of testing for a tannin sensitivity is to remove all tannin foods, listed below, for two weeks and then gradually reintroduce them. You will need to keep a food diary to be able to closely monitor how you react and you should bear in mind that reactions may be delayed and may also be the result of a cumulative effect.
Legumes: The redder ones appear to have more than whiter beans but, for the test period, remove them all. It is worth noting that tannins tend to be more concentrated in the outer layers. [356]
Fruit: Berries such as blackberry, blueberry, cranberry, raspberry, strawberry. [357,358,359]
Nuts: Black walnut, cashew, English walnut, pecan, pistachio. [360]
Herbs and spices: It would appear that many herbs and spices contain tannins including cinnamon, cloves, cumin, tarragon, thyme, vanilla. As it is not currently possible to identify which are high and which are not, avoid all herbs and spices for the testing period.
Additives: You will need to avoid all added colours and flavourings as tannins can be used in the production of colours, flavour modifiers, and flavours such as butter, caramel, fruit, brandy, maple and nut. [361]
Cocoa: Cocoa powder and chocolate in all its forms. [362]
Misc: Any smoked foods.
Cheese: Avoid any cheese that has an added colour.
Beverages: Apple cider, beer, coffee, fruit juices, guarana, mate, tea, wine (especially red). [363]
If you have found yourself to be very tannin sensitive, you need to know that there are non-food products which may also give you a problem. Tannins are a sub-group of phenolics which are found in fragrances, paints, solvents, cleaning materials and the like.
Do not let this concern you at this stage. Continue with a low tannin diet and if you later get a re-occurrence of migraines then consider checking on the products commonly used, by yourself and others, in your home, work and social environment. This type of delayed reaction is not uncommon (often referred to as unmasking). Do not panic or necessarily suspect other foods. Keep a diary of all products used and how you feel in different places and you should soon be able to identify the primary culprits.
See also Amines.
Tyramine is produced from the amino acid tyrosine by enzymes produced by bacteria in both the gut and in food. In food, these bacteria increase in number, especially in ripe, fermented, some cooked, and badly stored food.
Tyramine, unlike some other amines, appears to serve no useful purpose in the body. Sadly, it is present in a large number of foods and in susceptible people can lead to high blood pressure, migraines, sleepiness and mood changes. It has been particularly linked with migraines because as a vasoactive amine it affects the blood vessels in a way which leads to changes in blood pressure and produces headaches.
Smith et al used double-blind placebo controlled challenges with forty five individuals with food induced migraine. Out of ninety four tyramine challenges, 80% resulted in a migraine. [364] Peatfield reports on a study of 577 people attending the Princess Margaret Migraine Clinic from 1989 to 1991 who were questioned about dietary triggers of their headaches. Of the 429 who had migraines, 16.5% reported that headaches could be precipitated by cheese or chocolate, and nearly always both. [365]
A sensitivity to alcohol, especially red wine and beer, was also found. They found that there was a definite statistical association between sensitivity to cheese/chocolate and to red wine and also to beer and concluded that cheese/chocolate and red wine sensitivity, in particular, have closely related mechanisms, in some way related more to migraine than to more chronic tension-type headache (no food sensitivities were reported in this category). They did not make the link between these food problems and tyramine but it seems likely to have been the cause.
Ghose and Turner found that women may become more sensitive to the effects of vasoactive amines such as phenylethylamine and tyramine in the perimenstrum. [366] So migraines at this point may be more likely to arise and could be misread as being caused by foods such as chocolate. The headache producing properties of tyramine are not restricted to individuals sensitive to an excess of it. Studies have shown that 100-125mg of tyramine leads to 90% of people experiencing a headache.
Tyramine sensitivity is an example of how easy it is to misread food intolerance - if your problem is tyramine and you test cheese (high in tyramine) in isolation then the migraines may abate. You will think the problem is the cheese and eliminate it from your diet. Your migraines may abate and then return leading to confusion because you thought you had identified the problem. At this point it is easy to get into a cycle of identifying and blaming other foods as well and limiting your diet unnecessarily because what has in fact happened is that your tyramine intolerance level has been exceeded. The problems caused by food chemicals has been grossly underestimated. They are difficult to ascertain because of their cumulative effect and the simple fact that we will all have different tolerance levels.
Tyramine can cause problems for people taking MAO (monoamine oxidase) inhibitors as monoamine oxidase in the gastrointestinal tract normally metabolises dietary monoamines such as tyramine. When this is blocked by drugs then more are absorbed into the body leading to symptoms such as palpitations, severe headaches and high blood pressure.
If you suffer from recurring migraines you may like to consider testing tyramine. Other implicating symptoms may also include:
High blood pressure, Palpitations, Agitation, Nervousness and Circulation problems.
The key factor in this test is to eat food as fresh as possible as the ageing, fermenting and ripening processes all increase the amount of tyramine.
To test for a tyramine sensitivity, avoid all tyramine foods listed below for at least seven days and then eat one of the foods from the list you most commonly eat but not cheese. If you immediately get a reaction then tyramine is a problem - stay of all tyramine foods for at least two weeks before trying again. On the second test try a different food from the list. Testing of cheese should only take place once you have established if you have a tyramine problem or not. The reason for this is a reaction to cheese could indicate a hidden milk intolerance problem rather than a problem with tyramine.
If on the first test there is no adverse reaction add a tyramine food each day. If you get no reactions over the next seven days then you are probably okay. If a reaction does occur then you are probably tyramine sensitive to some degree. In this case eliminate them all again and then gradually increase the number that you eat until you are able to gauge what amount you can tolerate. Full analysis of foods for tyramine has not been conducted but some information is available as it is a food chemical that must be avoided by anyone taking MAOI drugs if they are to avoid potentially serious reactions. There is no definitive list; the one below has been compiled from a number of sources including Joneja [367], Emsley and Fell, [368] and Diamond. [369] If your doctor has provided you with a list of foods to reduce or avoid then please stick with that list only.
Cheese: All cheese except for cottage cheese, cream cheese and ricotta cheese. Watch out for biscuits and snacks containing cheese.
Yeast: Brewer's yeast, sour dough, yeast extracts, yeast leavened breads made with fresh yeast (those made with baker’s yeast are probably okay), yeast vitamin supplements, yeast found in processed foods.
Meat, poultry and fish: Avoid all game, liver pâtés, tinned, smoked, aged, pickled, fermented or marinated meat, fish and poultry products - this includes bacon, caviar, ham, hot dogs, leftovers, meat extracts, offal, pepperoni, salami and sausages. Buy fresh and eat within two days. Freshness is the key factor so be cautious in restaurants.
Fruit: Citrus fruit especially oranges, overripe bananas (also banana skins). You would be wise to avoid any overripe or spoiling fruit.
Vegetables: Aubergine, broad beans, green beans, bean pastes, fermented bean curds, fermented soya beans, mange tout, olives, pickles, sauerkraut
Condiments: Soy sauce, bean pastes, miso, teriyaki sauce.
Processed Food: Check the labels of any processed product to ensure avoidance of yeast and hydrolysed protein such as stock cubes, gravy, soup, sauces, stew mixes.
Beverages: Orange juice, tomato juice
Misc: Ginseng, tofu.
Alcohol: Beer including non-alcoholic brands. Wines including non-alcoholic brands. Whisky and liqueur.
MSG: It is probably also necessary to avoid all foods containing added MSG - check the section MSG for full details.
If you currently eat a lot of nut and/or seeds you might find it useful to also eliminate these from your diet during the testing period.
Tyramine has been identified in more than 200 foods. The foods with the highest amounts have been listed above. The following may require a limited intake - this will depend on the degree of your sensitivity:
Anchovies, avocados, beetroot, boiled eggs, buttermilk, caffeine, chocolate, colas, cream and cottage cheeses, cucumbers, curry powder, figs, fresh fish, lentils, mushrooms, pineapple, prunes, raisins, raspberries, raw onion red plums, salad dressings, sour cream, sourdough bread, spinach, sweet corn, tomato juice, yeast, yeast-leavened bread, vanilla extracts, yoghurt.
If you eat any of these try to eat them as fresh as possible. For the initial testing phase do not exclude them - just reducing your tyramine levels will probably be enough to provide an indication as to whether you have a problem with this amine or not. The fine-tuning can come later. This method will also prevent you from restricting your diet unnecessarily.
This section contains a brief outline of some of the other chemicals found in food that can cause some people problems.
Aflatoxin is a mycotoxin produced by certain moulds. It can be found in foods as varied as nuts, peanuts, corn, milk, and dried fruit. Strict regulations govern the amount of permissible aflatoxin in foods, and poisoning in “developed” countries is rare.
Carvone is a member of a family of chemicals called terpenoids. It is found naturally in many essential oils especially oil from seeds of caraway and dill. It is used in the production of flavours especially those that resemble spearmint, caraway, dill, mint and rye. It is also added to toiletries such as shampoos and hair conditioners.
One woman’s head dermatitis was found to be caused by carvone. [370] Carvone has been responsible for cases of inflammation of the lips when it has been present in toothpaste. [371]
Russo et al describe two cases of hypertension encephalopathy which resulted in pseudo hyperaldosteranism syndrome as a result of daily intake of low doses of liquorice. They propose that some people could be susceptible to low doses of glycyrrhizic acid because of a deficiency in a certain enzyme. [372]