Goitre, thyroid enlargement, has been linked with over consumption of naturally occurring goitrogens in vegetables. The vegetables include Brussels sprouts, broccoli, cabbage, cauliflower, kale, mustard, radish, rapeseed, soya beans, and turnip. It appears that cooking reduces the goitre effect of these vegetables.
Red wine is often implicated in adverse reactions. The suspects have included sulphites, salicylates and histamine. Armentia introduced us to a new problem for some people by identifying allergic reactions, in some individuals, to Hymenoptera insects that fall into the wine when grapes are collected and pressed. [373]
Linamarin is found in cassava (manioc), an important vegetable in some parts of the world yet also inherently toxic. Linamarin can be converted to hydrocyanic acid and lead to toxic cyanide effects. Neurological disorders and thyroid enlargement have been found in people who eat large amounts of cassava that has not been adequately processed. To reduce toxic cyanide effects, cassava must be correctly processed by soaking, boiling, drying, and fermentation.
Sometimes it is very difficult to identify the food culprit that is causing health problems. An example of this difficulty is when moulds are present in food either as a result of the way the food is processed or because of contamination.
Flavour-enhancing moulds are added to traditional foods such as dry sausage, salami, Spanish ham, and French cheese in Central and Southern Europe. [374]
In Northern Europe, the addition of moulds to meat products is not permitted but there are studies that have found contamination by Penicillium, Cladosporium, and Eurotium moulds in equipment and raw materials used during the manufacture of meat products. For example: In order to determine the mycobiota in processing areas of fermented sausage and liver pâté, filamentous fungi were isolated from air, equipment and raw materials in the processing areas of two fermented sausage processing plants and two liver pâté processing plants.
A total of three hundred and thirty six samples were examined. The diversity of filamentous fungi in the processing areas was high; at least seventeen different genera were identified. The main isolated genera were identified as Aspergillus, Botrytis, Cladosporium, Epicoccum, Eurotium, Penicillium, Phaeoacremonium and Phoma.
Of these, Penicillium and Eurotium were the most important for contamination of fermented sausage, whereas Penicillium and Cladosporium were most important for liver pâté. In total, sixteen Penicillium species were identified. Sorensen et al concluded that Penicillium species are the most important contaminants of the meat products because of their high prevalence in the production environment, their presence on meat products and their toxinogenic properties. [375]
Occupational respiratory diseases due to prolonged or repeated exposure to organic dust containing moulds (rhino conjunctivitis, asthma, hypersensitivity pneumonitis, and organic dust toxic syndrome) among food industry workers is well documented but food allergy to mould proteins is rare, with very few reports in the literature - two examples are given below.
Morriset et al presented two cases of recurrent angioedema after eating dry fermented sausages. These type of sausages are coated with various Penicillium strains and testing showed positive reactions in both cases to Penicillium. [376]
Bobolea et al presented the case of a twenty-four year old man diagnosed with rhino conjunctivitis and asthma due to allergy to pollens, mites, and moulds at the age of nine years. In the past year he had experienced two episodes of facial angioedema immediately upon eating a few slices of dry sausage, which he had previously tolerated. The symptoms subsided in less than six hours. He had avoided the sausage since then and tolerated all other types of meat products.
A range of tests were carried out. Skin prick tests were positive for grass pollen, house dust mites, and moulds (Alternaria alternata, Penicillium notatum, Mucor racemosus, and Pullularia, Stemphylium, Helminthosporum, and Fusarium spp.), and negative for all the food allergens tested. The prick-by-prick test was positive for the outer sausage skin and negative for the sausage meat.
The microbiologists isolated Penicillium and Mucor spp. in the sausage skin. A further test led to angioedema of the lips, tongue, and soft palate within five minutes. The diagnosis was facial angioedema after dry sausage ingestion due to IgE-mediated allergy to Penicillium and Mucor spp. The man was advised to avoid all products commonly contaminated with moulds such as dry fermented sausages, Spanish ham, foie gras, and French cheeses such as Roquefort and Camembert. [377]
If you eat fermented cheese or sausages and have problems you have been unable to link with a specific food it may be worth arranging for allergy tests to moulds.
Myristicin is found in nutmeg and carrots and can cause blurred vision, chest pressure, dry mouth, flushing, hallucinations, nausea, palpitations and a sense of impending doom. It is unlikely that you will be able to consume enough carrots to cause a problem but nutmeg poisoning has been reported.
Flyvholm et al reviewed the nickel content of food as it is now thought that flare of hand eczema can occur after oral nickel exposure. The incidence of nickel allergy in the Danish population is thought to be 10% for women and 2% for men. Intake of nickel from the diet is estimated to be on average 150 micrograms per person per day. [378] Anderson et al found that nickel in tap water can also influence flare of hand eczema. [379] Nielsen et al found quite clear links between diet and flare of hand eczema due to nickel content. [380]
Vegetables and grains supply the average diet with nickel. Cocoa and chocolate, soya beans, oatmeal, nuts and legumes also have a very high nickel content. Consumption of these foods in large amounts can increase the nickel intake to 900 micrograms per person per day or more. It is possible for flare of hand eczema to take place within the range of 600-5,000 micrograms. It would be necessary to establish the individual threshold.
Nickel content does vary. Joneja’s review of nickel levels in common foods has the highest as being buckwheat, oats, dark chocolate, peanuts, walnuts, flaxseed, cocoa powder, tea, and legumes. [381]
Avoiding canned and processed foods would seem to be helpful as Smart and Sherlock found high concentrations in canned vegetables, sugars and preserves (also in bread and cereals) and suggest that nickel content can increase as a result of food processing. [382]
Nitrates and nitrites have been used for centuries to preserve meat. The problem with them occurs when nitrate combines with certain other compounds in the digestive system it forms nitrosamines which are thought to be powerful cancer causing chemicals. There have been studies that have linked the regular ingestion of nitrates with some forms of cancers especially in the intestines. [383]
Nitrates have also been linked with less serious forms of sensitivity. For example, a case of severe itching was found to be caused by nitrates - a forty-year old woman experienced severe itching on the arms and back. Testing after an elimination diet established that nitrates were the cause; within three hours of ingesting sodium nitrate the itching emerged and remained for four days, nitrate intolerance was diagnosed. [384]
Many processed and cured meats contains added nitrates. The additives to avoid are:
E249 Potassium nitrite
E250 Sodium nitrite
E251 Sodium nitrate
E252 Potassium nitrate
Phenolic compounds are found in a wide range of foods. These are natural substances that colour and flavour foods. The fact that they are toxic could be nature's way of protecting itself against micro-organisms and aiding the dispersal, and germination, of the seeds. Generally our body eliminates these toxins with no difficulty but for some people they cause problems. The discovery of phenolic compounds led Dr Robert Garner to devise a neutralisation technique using dilutions of these substances to stop his own allergic reactions. Some examples of phenols are:
Eugenol found in almond, beef, carrot, celery, cheese, milk, orange, pea, soya bean, tomato.
Piperine found in beef, beet sugar, cheese, chicken, cow's milk, grape, lamb, onion, pea, potato, soya bean, tomato, yeast.
Cinnamic acid is one of the better known ones, its precursor in most plants is phenylalanine. Cinnamic acid gets its name from oil of cinnamon where it was first discovered. Its presence may reach as much as 13 mg/100g in such foods as apples or 14 mg/100g in sweet cherries and 14.5 mg/100g in grapes (68). [385]
The amount and concentration of phenols varies greatly from plant to plant. How they affect health is complex as it is influenced by their interaction with each other and with other chemical compounds. As yet it is not clearly known which phenols are beneficial, which are harmful and which may lead to sensitivities.
The food additive “calcium propionate” has been linked with some migraine headaches and skin rashes.
A report in 2002 also linked it with behaviour problems (irritability, restlessness, inattention, and sleep disturbance) in children. [386]
The propionates, listed below, are quite frequently found in bread and other products made with flour.
E281 Sodium Propionate
E282 Calcium Propionate
E282 Potassium Propionate
Tin plate is commonly used in the construction of metal cans for foods. If the tins are not adequately lined when used for acidic foods such as tomato juice and fruit cocktail then tin intoxication can take place. Tin is poorly absorbed and hence the early symptoms are bloating, nausea, abdominal cramps, vomiting, diarrhoea and headache within thirty minutes to two hours. [387]
Testing of individual foods does contain an element of risk which is why I advice that you carry out these tests in conjunction with your doctor. Even if you have been given the go-ahead to test a food at home I would advise that somebody is with you for at least the first two to three hours after testing - if you have a severe reaction they can obtain medical help for you. Remember, anaphylaxis can be life threatening.
The other advantage of having someone present is that we are not always very good at noticing changes within ourselves. Although you will know if you have a headache, rash or stomach ache easily enough, a change in how you are speaking or behaving is not always easy to detect. These behaviour changes are difficult to spot because if you have been reacting in the same way to a particular food for many years the change may not seem unusual to you, in fact it may feel familiar and “safe”.
If you already avoid a food then do not test it. You are probably avoiding it for a very good reason. This of course does not apply to foods that you have never tried.
It is impossible to provide a full list of potential symptoms for each food as any food can cause any problem - it is very much an individual specific response. In some cases it has been possible to draw up a list of the type of symptoms that have been reported but these lists are only telling us some of the recorded symptoms. Please remember that:
Any food can cause any symptom.
When testing a food eat it in its most simple form. For example, testing milk by eating ice cream is not okay, nor is testing hazelnuts by eating a chocolate bar containing them. Keep it simple. In the examples given above simply drink some milk or eat some hazelnuts on their own. If at all possible use organic foods for testing - this is to avoid conflicting results due to pesticides. If you cannot find an organic version do still carry out the test and if you are uncertain of the results simply repeat the test.
Chocolate is commonly seen as an allergenic food but very few actual “allergies” to chocolate have been documented. It would appear that most chocolate allergies are usually linked with one of the other ingredients such as milk, peanuts and eggs or with a sensitivity to a food chemical such as caffeine, tyramine or phenylethylamine.
Maslansky and Wein reported on three people who reacted to an allergy test for chocolate using cocoa capsules. One reacted with urticaria, another with fatigue and gastric bloating and one with nausea and cramp. Only one of the three was sensitised to cocoa as detected by allergy skin testing. [388]
Merret et al tested to see if food allergy was a major cause of migraine. Their findings were that allergies could not often be detected and concluded that the food intolerance associated with migraine headaches was not related to the conventionally defined allergic mechanism - the adverse reaction was being caused by another factor such as a food chemical intolerance. [389]
Adverse reactions that have been linked with chocolate include:
Abdominal cramps and pain, Angioedema, Asthma, Bronchial complaints, Coughs, Dermatitis, Diarrhoea, Flushing, Headaches, Hypotension, Itching, Migraine, Nausea, Red ears, Rhinitis, Sneezing, Urticaria, Vomiting.
An actual intolerance or allergy to chocolate or cocoa would have to be an intolerance of either cocoa mass or cocoa butter yet these are rarely checked independently of other ingredients. Eating a chocolate bar or drinking hot chocolate is not the way to test for a “chocolate” intolerance - if you have a problem with either product it would simply mean that you could not eat that particular brand of chocolate bar or hot chocolate drink.
Intolerance problems with chocolate can be caused by any ingredient or naturally occurring chemical. In respect of ingredients it could be any of the following:
Artificial sweeteners, butter, cocoa mass, cocoa butter, emulsifiers (usually lecithin - soya or egg), flavourings (usually vanilla - natural or man-made), grains (such as wheat, oats and rice), lactose, milk or milk powder, nuts, vegetable oils, peanuts, sugar.
In respect of a food chemical it could be any of the following:
Caffeine and theobromine, histamine, phenylethylamine, serotonin, tyramine.
Perhaps the simplest way of testing if chocolate is a problem is to eliminate chocolate in all its forms from your diet for at least seven days. Make sure that you check all confectionery for cocoa.
If you eliminate all forms of chocolate and cocoa powder from your diet for at least seven days you will then be able to test it by first making a drink using cocoa powder, a milk and sugar or other sweetener that you know you are safe with. Make sure the cocoa powder is just that and does not contain any additional ingredients.
If you are free of any adverse reactions then you may wish to try your usual chocolate - if there is a problem then the ingredients will provide you with a list of suspects to test more fully. It is not unusual for people to react adversely to flavourings that are artificial such as vanillin.
If you find that you seem to be okay with chocolate and then your symptoms reappear it is probably worth checking the information on the different food chemicals as the problem could be as a result of a build up.
See also: Grains.
Corn is an increasing problem as it has now crept into a large number of processed foods so, although you may eat no actual corn, your diet could in fact be very high in it. Speer listed corn amongst the top ten allergens. [390] It has been linked with migraines, [391, 392] and atopic dermatitis [393] in some children. Symptoms that have been reported include
Anaphylaxis, Angioedema, Breathing problems, Dermatitis, Diarrhoea, Hives, Itching eyes and nose, Low blood pressure, Migraines, Mouth swelling.
It is a problem that is now being noticed in young children as it is found in products designed for babies. Although increasing numbers of people report having problems with corn it is still not accepted as being a major allergen by many doctors. If you have a sensitivity to corn it is a mute point as to whether it is an allergy or an intolerance as both effectively require the same treatment - avoidance.
There is little evidence to suggest cross-reactivity between corn and other cereals [394] but it has been noted that rice and corn antigens do show some similarities. [395] Because of its versatility, corn has crept into many products and, depending on your degree of sensitivity, they may all need to be avoided. You would need to avoid anything that contains the words “corn” or “maize”. Check all processed foods, including sweets and candies, as corn appears in products ranging from sweets to processed meats.
All of the following either do or could contain corn, always check the label carefully and if full details are not give, as in the case of “starch” then err on the side of caution:
Baking powder, cakes and pastries, candies, caramel flavour, cereals, chewing gums, corn, corn alcohol, corn extract, corn flakes, corn flour, corn meal, corn oil, corn starch, corn syrup, dextrin, dextrates, dextrins, dextrose, flavour enhancers, flavourings, fructose, glucose, grits, HVP, hydrolysed corn, invert sugar or syrup, maize, maltodextrin, malt syrup, marshmallow, modified starch, mono and di-glycerides, MSG, polenta, powdered sugar, processed meats, ready meals, starch, tacos, tortillas, vegetable oil, vegetable protein
The easiest way to begin testing for a corn sensitivity is to eliminate it entirely from your diet, in all its forms, for at least five days and then to eat some in the most natural form you can find. If you have had an improvement in your symptoms do beware of an unpleasant reaction when testing - you may be safest having an allergy test before attempting to eat any. If, on testing, you have no immediate symptoms then continue to add more corn-based foods into your diet stopping immediately if there is a reaction.
It is quite possible to be able to tolerate some corn but some individuals cannot tolerate any corn at all. If you fall into this group then please be aware that corn finds its way into many non-food products and that sensitivity can take place from both inhalation, ingestion and contact.
Some of the non-food products that may contain corn include:
Adhesive on stamps and envelopes, Aspirin, Bath and body powders, Cartons that are used for fruit juices and milk, Cosmetics, Cough syrups, Medicines, Ointments, Paper cups and plates, Plastic wrap, Soap, Suppositories, Toothpaste, Vitamin C, Washing powders.
Check all the products that you use - if need be contact the manufacturer to find out for certain. The symptoms caused by these forms of corn contact are wide ranging: For example Crippa and Pasolini found allergic reactions to the corn-starch powder used as glove-lubricant-powder, symptoms included breathing difficulties, rhinitis, angioedema, and asthma. [396]
If you find that you have improved greatly and then seem to have started to get ill again do not suspect that you have developed a new problem. Before you embark on any new tests double and triple check everything that you use, corn creeps into so many products that it can take quite some time before you have wholly identified all the sources that you come into contact with. Note also that corn can appear in alcoholic drinks including some beers and wines.
Reactions to eggs are quite common, especially amongst children. Reported symptoms include:
Allergic rhinitis, Anaphylaxis, Angioedema, Asthma, Catarrh, Dermatitis, Diarrhoea, Gastrointestinal symptoms, Hives, Migraine, Nausea, Oral allergy syndrome, Respiratory difficulties, Urticaria, Vomiting.
Rowntree et al found that 65% of children with persistent eczema and respiratory tract symptoms had a problem with eggs. [397] Guariso [398] found that for some migraine sufferers the trigger food was eggs, as did Egger. [399] Langeland in a study of eighty four children allergic to eggs, found that pruritis and exacerbations of atopic dermatitis were the most common symptoms.[400]
It has also been associated with inhalation of tame bird dander and known as “bird-egg syndrome”. Maat-bleeker et al present the case of a woman who developed an egg allergy as a result of inhaled allergen sensitisation from a parrot. [401] Mandallaz et al suggest that “bird-egg syndrome” is to do with the individual developing a sensitisation to egg-yolk livetins. [402]
Although egg intolerance has often been associated with children, it can arise at any age. Egg allergens are well known with those in egg white often being the most common. Holen and Elsayed identified ovalbumin as the most allergenic portion of egg white, followed by ovomucoid, ovotransferrin and lysozyme [403] Allergies are also possible to the proteins in egg yolk.
Problems with eggs can arise at any age. Unsel et al describe the case of a fifty-five year old woman who experienced repeated episodes of eyelid and lip swelling; itching of the throat, ears and eyes; redness and watering of the eyes; hoarseness, shortness of breath, wheezing, and coughing. The episodes began when she was fifty-three and had resulted in many visits to the emergency department. The cause was only identified when the women herself realised that the symptoms appeared soon after she ate egg or egg-containing products such as cake or pastry. Allergy tests confirmed that she did have an allergy to egg. [404]
Celakovská et al report on the case of a woman who at fifty-three developed severe atopic eczema. Allergy testing confirmed that one of the problem foods was egg. She had not experienced any problems with egg when younger but the allergy identified at age fifty-three was still present six years later. [405]
If you have always eaten eggs you will not know if they are causing you a problem. There is a much repeated story that well illustrates this point. Dr Rinkel suffered from chronic catarrh, fatigue and headaches. As his symptoms got progressively worse he began to follow advice on dietary changes and tested eggs by eating six in quick succession - rather than a worsening of symptoms he felt better. [406]
The key factor in this case was that Dr Rinkel had been eating lots of eggs each day over a long period of time. Later he eliminated eggs completely from his diet. Within a couple of days he began to feel better. On the fifth day he ate a piece of cake and fell unconscious. The cake had, of course, contained eggs. Dr Rinkel went on to become a leading allergy specialist.
The easiest way of assessing egg intolerance is to remove egg in all its forms from the diet for at least four days and then test. Avoiding eggs means avoiding it in all its forms, as whole egg, egg white, egg yolk, powdered or dry egg, so check sauces, cakes and all processed food. The following terms may also indicate the presence of egg:
Albumin, Apovitellin, Binder, Coagulant, Emulsifier, Globulin, Lecithin, Livetin, Lysozyme, Mayonnaise, Meringue, Natural flavourings, Ovalbumin, Ovomucoid, Ovaglobulin, Ovomucin, Ovomucoid, Ovotransferrin, Ovovitellin, Seasonings, Vitellin.
Products to check carefully include:
Baked goods, baking mixes, breakfast cereals, cakes, creamy fillings, egg noodles, fat substitutes, french toast, batters, bouillon, candy, custard, ice cream, soufflés, sherbets, lemon curd, macaroni, malted drinks, marshmallows, processed meat and fish products, puddings, salad dressings, sauces, soups.
The severity of egg sensitivity varies. Some people are at serious risk from anaphylactic shock and must avoid egg in all its forms, others can eat small amounts of egg, for example, in baked goods. Should you find you only react to hard boiled eggs I suggest you read the section on the naturally occurring food chemical Tyramine.
Eggs creep into a range of foods and other goods and may not always be listed. For example:
* In some countries, including Japan and Switzerland, lysozyme is used in medications.
* The egg used could have been in such small amounts that the manufacturer is not obliged to list it as an ingredient as may be the case with a glazing agent on baked goods. Freemont et al found lysozyme was an unlabeled additive in cheese preparation . [407]
* Egg components may also, according to Steinman, be found in cosmetics, shampoos and medications. [408]
Some points to note:
* Intolerance can be of the whole egg, egg white or egg yolk.
* Some studies have found that egg is less allergenic when cooked.
* Many vaccines are based on egg - check with your doctor before agreeing to any injection.
* It is also possible to react to other bird eggs. Langeland found cross-reactivity between hen egg white and that of turkey, goose, duck and seagull. [409]
* Many egg intolerant people can quite safely eat chicken but others experience problems.
Reactions to seafood are not uncommon and usually occur within six hours of eating. Shellfish in particular have been found to cause problems with shrimp being considered a highly allergenic food. Sicherer identifies shellfish and fish as one of the most common foods that causes problems for both children and adults. [410]
The type of fish available to you will, to a large extent, be determined by where you live. You should know that reactions have been recorded for most varieties. For example, Pascual et al, in a study from Spain, found that fish allergy was present in 22% of all people with a diagnosis of food hypersensitivity. They looked at the allergenic significance of the type of fish most commonly eaten in the area which were flatfish such as sole and hake. They found hake to be the most allergenic. [411]
Symptoms range from mild to life-threatening. Even tiny amounts of fish substances can trigger a reaction in some people. Symptoms can include:
Anaphylaxis, Bloating, Brain fogging, Breathing difficulties, Hives, Itching, Light headedness, Nasal congestion, Nausea, Stomach problems ranging from heartburn to diarrhoea, Wheezing.
Oehling et al found that the most frequent skin manifestation of fish intolerance was atopic dermatitis. [412] In a study of forty eight people with crustacean allergy, the most frequent cause of symptoms was shrimp (thirty three cases) followed by squid (twenty four cases). The most frequently found symptoms were:
Urticaria/angioedema (39 individuals),
Asthma (18 individuals) and
Rhinitis (14 individuals). [413]
It is possible to misinterpret a reaction to fish, such as tuna and mackerel, as an allergy when it might be due to a histamine sensitivity (see the section on Histamine). It is also possible to react to another ingredient in a fish product and so misdiagnose the cause of the problem: for example, Asero presented the case of a nineteen-year old man who experienced several episodes of angioedema of the penis and scrotum within two hours of eating canned tuna. The angioedema was found to be due to tartrazine that had been added to the tuna. [414]
Some people react solely to shellfish, any fish with high levels of histamine, or any single type of fish whether it be salmon, trout, cod, hake, herring, tuna, swordfish and so on. In a study, by Bernihisee-Broadbent et al, of people allergic to fish a number of double blind challenges to different fish species were carried out. Most of those in this study were found to be able to safely eat a different species of fish than the one they were allergic too. [415]
Other studies have, however, shown that cross-reactivity does take place. [416] Tanaka et al found reactions often took place to groups of fish and they classified seafood allergens into four groups: [417]
Salmon, sardine, horse mackerel and mackerel.
Cod and tuna.
Octopus and squid.
Crab and shrimp.
Hansen et al set out to test cross-reactivity of four species of fish - cod, mackerel, herring, and plaice - in adults with codfish allergy. Reactions were found to take place to all four types of fish and their study suggests that cross-reactivity to different fish species in adults with cod fish allergy exists, and that cod, mackerel, herring and plaice share a common antigenic structure. [418]
DeMartino et al found that some individuals with a codfish allergy could tolerate other species of fish but were more likely to react to the other species than those with non-fish allergies. [419]
Chen et al outlined the case of a forty-two year old woman who experienced itching wheals, flushing, abdominal cramps, bronchospasm, and shock approximately thirty minutes after eating kingfish (Spanish mackerel) caviar salad. She developed acute respiratory failure and profound shock. She had previously experienced acute urticaria after consuming shrimp, but did not recall any problems related to fish, milk, or chicken egg. Testing revealed that the anaphylactic reaction the woman experienced was to the kingfish caviar. [420]
They note that roe is an extremely rare cause of anaphylaxis and only one case of Russian Beluga caviar-induced anaphylaxis and one case of salmon caviar-induced anaphylactic shock have been reported in the literature pre 2009.
As fish is one of the foods that tends to provoke a very quick reaction it is unlikely that you would need to carry out any test unless you suspect histamine may be a problem or you eat fish every day. If you suspect histamine - follow the guidelines in that section. If you eat fish every day then try eliminating it from your diet for seven days to ascertain if there is a problem. Arrange for an allergy test under medical supervision.
Avoiding fish is not too difficult as it rarely creeps into non-fish dishes but do take care in restaurants where cross contamination is possible especially if the same oil is used for frying fish as well as other products such as potatoes. If you are only allergic to one form of fish you also need to be careful when eating out in case there has been cross contamination or substitution.
Shellfish, in particular, may appear in a variety of dishes and a waiter may not always be aware of their presence - ask him to check with the chef.
Lin et al gave details of a four-year old boy who had an anaphylactic reaction whenever he contacted food prepared with fish. His symptoms included intense itching in the throat and eyes, generalised urticaria, facial angioedema, coughing, wheezing and dyspnea. He reacted to several different types of fish including cod, tuna, salmon, trout, and eel, also to chopsticks contaminated with fish preparations. They suggest that the best treatment for fish allergy is avoidance which may also have to include avoiding inhalation of cooking vapours. [421]
Monti et al describe the case of a child allergic to fish who reacted with facial urticaria and angioedema after a kiss. [422]
Any fruit can cause problems. Skin rashes, as often seen with strawberries, are a common reaction but by no means the only one. Other symptoms can include itching and swelling of the mouth, tongue and lips, and breathing problems.
It is possible to be sensitive to any individual fruit, to a number of fruits or to one of the naturally occurring chemicals found within fruit. One indicator that may help you identify a problem with fruit is seasonal fluctuation of symptoms. Do you always get rashes in the summer months? And, if yes do you at the same time eat large amounts of any of the summer fruits?
If you eat a lot of dried fruits then you could be sensitive to sulphites or salicylates - check out the respective sections. Problems with a range of fruit and vegetables is most likely to indicate a sensitivity to salicylates so if you suspect that you are reacting to a range of fruits then do please read the section on Salicylates before testing any individual fruit. You may find it useful to know that the only fruits that are very low in salicylate are peeled pears and bananas.
Citrus fruits contain high concentrations of chlorogenic acid which has been thought to be responsible for allergic type reactions. If you know you have a problem with any one citrus fruit you might want to consider eliminating them all for a few days and then testing. You would need to avoid all the following: clementine, grapefruit, lemon, lime, mandarin, orange, pomelo, satsuma, tangelo.
If you suspect a single fruit or summer fruits then eliminate them accordingly for at least four days and test by eating them in their most natural state which means fresh not tinned, frozen or cooked. If you do have problems with some fruits and experience an improvement in symptoms and then, later, have a return of symptoms check whether your problem is in fact one of salicylate sensitivity.
All fruits have at some point been implicated in negative reactions. Two and a half hours after eating red currants a forty-seven year old woman had symptoms including generalised urticaria, dysphagia, dyspnoea, pruritis of the palms and soles, hypotonia, and tachycardia. [423]
Oranges have been implicated in migraines [424] although this could be as a result of a tyramine sensitivity. Zhu et al report that oranges are considered to be common allergenic fruits in China. They analysed the allergic histories of twenty six orange sensitive people. Their analysis suggested that clinical symptoms of some orange-allergic subjects were different from other fruit allergies but similar to nut and other oil plant seed allergies. Interestingly they found the major allergenic components of orange reside in orange seeds instead of orange juice. [425]
Urticaria and colitis have been noted as reactions after eating papaya. [426] The oral allergy syndrome has been found to be provoked by bananas. [427] Ortoloni detected pear allergy in 22% of those with hay fever and oral allergy syndrome after eating fruit. [428] Kleinheinz et al reported on the case of a nineteen-year old woman who experienced two allergic reactions five to fifteen minutes after drinking fruit juice. Testing identified that the culprit in the fruit juice was dragon fruit. [429] Raap et al describe the case of a twenty-six year old man who developed itchy skin, urticaria, severe swelling of his lips and tongue and breathing problems within fifteen minutes after eating lychee. 430]
A French study identified ten cases (nine women, one man) of severe mango anaphylaxis. [431] A twenty-five year old man developed severe swelling of his lips, a cold sore on the inside of his lower lip, swelling of the face, and red patches on his face and ears. He had previously experienced two episodes of poison oak dermatitis. Mango contact allergy was diagnosed - he had used his teeth to peel a mango on each of the two previous days. [432]
Damian et al present four instances of Pomegranate allergy:
A nineteen-year old man who experienced angioedema of the upper lips and tongue. The symptoms appeared a few minutes after eating fresh pomegranate.
A thirteen-year old boy who had an episode of widespread urticaria and angioedema of the lips after ingestion of the fresh fruit.
A thirty-one year old woman who experienced an episode of urticaria within twenty minutes eating fresh pomegranate.
A twenty-three year old woman who complained of an episode of angioedema of the face and lips, itching of the throat, abdominal pain, and widespread urticaria, which developed approximately an hour after eating pomegranate fruit.
The reactions were confirmed as allergies using skin prick testing. [433]
Think of a fruit and someone, somewhere, will have had a negative reaction to it.
There have also been recorded instances of cross-reactivity with pollen. Ortoloni et al found cross-reactivity with almond, cherries, peaches and birch pollen in individuals with an identified birch pollen allergy. [434] Dreborg and Foucard found an association between apple, potato, carrot and birch pollen. [435] Anderson and Dreyfus found that some ragweed sensitive individuals experienced itching within the mouth when eating melons and bananas. [436]
Kim and Hussain examined the prevalence of food allergy in one hundred and thirty seven latex allergic people. They identified forty nine potential allergic reactions to foods in 21.1% of the people. The foods responsible for those reactions included:
Apple, apricot, avocado, banana, carrot, cherry, kiwi, loquat, peach, strawberry, tomato, and watermelon.
The reactions included:
Anaphylaxis, Angioedema, Asthma, Diarrhoea, Local mouth irritation, Nausea, Rhinitis, Urticaria, Vomiting.
They were unsure as to whether there was cross-reactivity or not.
Other studies have found strong links between latex allergy and certain foods most notably fruits. Brehler et al noted cross-reactions with avocado, banana, chestnut, fig, kiwi, mango, melon, papaya, passion fruit, peach, pineapple and tomato. [437] These findings have been confirmed by others. [438,439] It is also possible that anyone with allergic reactions to these foods could possibly go on to develop a sensitivity to latex.
There have been few reported cases of fig allergy and those that have been reported have been linked with cross-sensitisation to weeping fig. Antico et al found that oral allergy syndrome to fig followed by respiratory symptoms can be present in individuals not sensitised to weeping fig or having the latex-fruit syndrome. They confirmed that different parts of the fig can have different allergenicities and called for improved commercial fig extracts to be used for the diagnosis of this type of allergy. [440]
Trehan and Meuli note that mango contact allergy is more common in those with a history of poison ivy and poison oak dermatitis - these plants are closely related and mango sap contains the same uroshiol allergen. [441]
See also Corn, Gluten, Wheat.
The grain most likely to cause you food intolerance depends on where you live. For example, in Europe wheat is a common problem and buckwheat is often recommended as an alternative, whereas in Japan buckwheat is a major food intolerance problem. These population-based problems arise as a result of the frequency with which any one food is eaten.
Any symptom could be related to a grain sensitivity. Aside from diagnosed coeliac conditions, grains have been particularly linked with digestive system problems (bloating, abdominal pain, diarrhoea, constipation) and skin complaints.
Please note that it is a common misconception that an intolerance to cereals is always indicative of coeliac disease. In their study, Kaukinen et al found that intolerance to cereals is not a specific sign of overt or latent coeliac disease. [442]
Links between alcoholism and food intolerance, especially grains, have been found. The difficulties in giving up alcohol for some people have been misread as a problem with alcohol when in fact the problem has been with a grain. Intolerance of any food can lead to overwhelming cravings and when a product, like an alcoholic drink, contains a number of ingredients then it is not always possible to know, without thorough testing, which ingredient it is that is causing the problems. Wheat and corn have been particularly implicated in this way. [443]
Rasanen et al explored the role of cereal allergy or intolerance in children with atopic dermatitis. On oral provocation, eighteen children exhibited a positive response to wheat, three to rye, one to barley, and one to oats. Cereal-induced symptoms were dermatologic, gastrointestinal, or oropharyngeal, and their onset after provocation was immediate in eight cases and delayed in fourteen cases with one experiencing both immediate and delayed reactions. They also concluded that there was little direct link between cereal allergy and coeliac disease. [444 ]
Other symptoms that have been reported include:
Anaphylaxis, Angioedema, Behaviour changes, Cloudy thinking, Depression, Fatigue, Irritability, Joint pain, Muscle cramps, Skin rashes, Tingling numbness in the legs.
There are some that argue our bodies have never adapted to grains and that we should as a matter of course exclude them from our diet. The theory behind this argument is that our bodies were never designed to deal with cereals. The diet of our stone-age ancestors certainly did not include grains - they did consume carbohydrates but obtained these from fruits and vegetables. Our dependence on grains arose when settled agriculture developed and they are now an accepted part of our diet and even appear very high on the list of “healthy” foods that we should be eating.
Sadly, for some people this type of reliance on grains leads to a host of unwanted symptoms that can go undetected throughout their lifetime. A condition known as carbohydrate intolerance has also been noted and a diet excluding these used to be the main treatment for coeliac disease before the discovery of the role of gluten. [445]
If you find that you are reacting to a number of grains you may like to try a grain free diet for a few weeks and see if that helps. Certainly a spell on a grain free diet will be an education for anyone willing to try it. For some people the changes have been dramatic whilst others find they cannot manage on this type of diet. Remember that you are unique so don't expect something that works for some people to necessarily work for you. If you are a vegetarian or vegan you would not be advised to try this type of diet as you may not be able to obtain sufficient protein for your body's needs.
The biggest hurdle to living with a grain sensitivity is that we live in societies that place so much focus on carbohydrate but, as many are discovering, a diet low in carbohydrates can be extremely beneficial. If you suspect a grain sensitivity you need to eliminate that grain in all its forms from your diet for at least five days before testing. You may find a reduction in some of your symptoms or a general sense of well being.
How you react on testing the grain will probably determine whether you then continue to include it in your diet or not.
It is often thought that if you have a reaction to one grain then others are often also a problem, this is not necessarily the case. Jones et al explored the degree of intra botanical cross-reactivity among cereal grains and related grasses with the aim of better defining the prevalence of multiple grain hypersensitivity. One hundred and forty five people with cereal and/or grass allergies were involved in the study, 80% had reactivity to only one grain so don't assume that just because one grain is a problem for you that all the others will also be a problem. [446]
To test for a grain sensitivity, exclude all foods containing the grain you are testing for at least seven days and then eat it in its most natural form. Testing of grains should always be in their simplest forms - make something at home.
Don't eliminate a food without thorough testing. Wheat and other cereals are at their most nutritious in whole grain form but it is possible to be intolerant of whole grains and yet be quite comfortable with their more refined counterparts. So, if you find yourself unable to eat, for example, whole-wheat then test an organic white flour. I am suggesting an organic flour used in a simple product such as a pancake as this will eliminate the risk of misreading a test - a white loaf will contain preservatives, raising agents and may have been treated with bleaching agents all of which can give rise to problems.
Problems have been reported in respect of all grains and pseudo grains. Some examples are given below. For information on wheat, corn, or gluten please see the individual entries.
Rice has often been seen as one of the least allergenic foods but it can nevertheless cause some people serious problems. A study in France found that 17% of five hundred and eighty people with adverse reactions to food were sensitive to rice. [447]
A study in Finland of sixteen wheat sensitive children with atopic dermatitis found that 67% were also sensitive to rice. [448] Lezan et al reported on the case of a woman with rhinoconjuctivitis, asthma and urticaria as reactions to rice. [449]
Symptoms have included asthma, atopic dermatitis, contact urticaria, diarrhoea, eczema, and vomiting. Adults appear to be six times more likely than children to be sensitive to rice. [450] Two studies confirmed rice allergy as the cause of rhinitis and asthma in some individuals. [451,452]
González-Mendiola et al linked a case of asthma to the inhalation of vapours from boiling rice. [453] Nambu et al identified rice powder inhalation as the cause of a seven year old girl’s asthma and rice powder, used in the making of rice cakes, as the cause of her conjunctivitis. They also found that eczema in a three-year old boy was caused by eating rice. [454]
If you have a problem with rice then do try it in various forms - you may find that whilst white rice is okay you cannot eat brown rice, can tolerate rice noodles but not rice cakes and so on.
Barley can cause problems when eaten or when the dust is inhaled. It is also a cereal that is often used in the production of alcoholic drinks such as beer and can be the “allergic” ingredient when an adverse reaction is experienced. [455]
Exposure to dust from barley has been implicated in breathing problems and skin complaints amongst farm workers. [456] Atopic dermatitis in one child was found to be caused by barley. [457]
A man who sneezed continuously for more than three decades, eventually discovered that he had a mild oat allergy. [458]
Exposure to oat dust has been implicated in breathing problems and skin complaints amongst farm workers. [459]
Atopic dermatitis in one child was found to be caused by oats. [460] The use of oats in ointments and creams is beginning to cause problems for some people - DePaz et al report on the case of a seven-year old girl who developed urticaria from a cream that was being used to alleviate her dermatitis. Testing established that the problem ingredient was oats. [461]
Some individuals with irritable bowel syndrome were found to have a sensitivity to oatmeal. [462]
Atopic dermatitis in three children was found to be caused by rye. [463] Rye is often studied alongside wheat and often not separated out as an allergen in its own right yet Baker’s asthma has been found to be caused by only rye flour in some individuals. [464,465 ]
Buckwheat is often substituted for grains as it is not taxonomically related to wheat and other cereal grains but it is not without problems. Occupational exposure to buckwheat flour has been associated with rhinitis, conjunctivitis, contact urticaria, and occupational asthma.
Davidson et al present a case of an individual developing urticaria and hypotension after eating buckwheat. Like all foods, it can cause problems for some individuals. They did find that there appeared to be no cross-reactivity between buckwheat and wheat. [466]
Varga et al note that buckwheat is known to cause severe anaphylactic reactions in susceptible adults but that it is rarely seen in children. They report on the case of a seven-year old boy who developed a grade III anaphylactic reaction after eating a cake that contained buckwheat flour. IgE testing confirmed that the boy was allergic to buckwheat. [467]
It is easy to forget about herbs and spices when assessing food intolerance but given their frequent use and the fact each is chemically complex and different they cannot be ignored. It is possible to be intolerant of any herb or spice or even a group of them. Spices in particular can cause respiratory problems when inhaled.
Virtually all herbs and spices have, at some time, caused someone problems. A few examples follow:
Kauppinen et al identified twelve people who reacted to parsley with urticaria and angioedema. [468] A young woman experienced acute rhino conjunctivitis, facial swelling, itching in the mouth and ears, and red itchy palms and soles within five minutes of eating potatoes with a sauce containing parsley and sweet oil. Testing showed that parsley was the culprit. [469]
A seventeen-month old boy developed urticaria, conjunctivitis, facial swelling, and a severe cough immediately after eating venison prepared in a marinade containing a variety of spices. Testing confirmed allergies to cayenne and black pepper. [470]
Benito et al tested for reactions to various herbs. They found positive reactions to oregano, thyme, hyssop, basil, marjoram, mint, sage and lavender. [471]
Reider et al report on instances of allergic reactions, including anaphylactic shock, to camomile and suggest that the incidence and risk of camomile allergy has been underestimated. Some individuals with a sensitivity to camomile were also sensitive to mugwort and birch pollen. [472] Andres et al report on the case of a thirty-eight year old man who experienced severe anaphylaxis with urticaria, breathing problems and swelling within one hour after drinking camomile tea. Allergy tests confirmed that the trigger was camomile. [473]
Rhinoconjunctivitis and gastrointestinal problems were experienced as reactions to aniseed. [474]
Miller et al [475] presented fourteen cases of cinnamon-induced stomatitis and Siqueira et al presented the case of a fifty-three year old man with allergic inflammation in his mouth that was found to be caused by cinnamon in chewing gum. [476]
Ebo et al describe the case of an individual who worked in a spice factory. He had to be treated for anaphylaxis after a meal that contained coriander. He also demonstrated urticaria, angioedema, rhino conjunctivitis and broncho-spasm during handling coriander and fenugreek. On testing he was found to be allergic to both coriander and fenugreek. [477]
Gonzalez-Guitiernez et al presented the case of a patient allergic to the spice anis. [478 ]
Aziz and Dioszeghy describe the case of a woman who developed extreme swelling on one side of her tongue and ulceration after eating mint chocolate. The culprit was identified as being the mint in the chocolate. [479]
Chiu and Zacharisen give details of what they believe to be the first case of confirmed dill allergy. The patient developed oral pruritis, tongue and throat swelling, urticaria, vomiting and diarrhoea after eating foods cooked with dill. The person concerned also experienced reactions after smelling food prepared with dill. [480]
If you use a lot of herbs and spices in your cooking and, after having tried other tests, are still experiencing problems then consider trying a week free of them all. Then introduce them one at a time to see if there is any noticeable reaction. It would be impossible to list all the components of each herb and spice, even if they were all identified, so we are left with an “eliminate it and see” approach.
Should you find that you react to a number of herbs and spices then I suggest you try the low salicylate diet just in case you are in fact salicylate intolerant. Some of the more common herbs and spices are listed below:
Anise, basil, bay, borage, cardamom, caraway, camomile, chilli, cinnamon, clove, coriander, cumin, curry powder, dill, fennel, fenugreek, ginger, marjoram, mustard, nutmeg, oregano, paprika, parsley, pepper, peppermint, rosemary, sage, tarragon, thyme, turmeric, vanilla.
If you do find yourself sensitive to any herb or spice check labels of all processed foods and beware those that use the terms “spices” or “seasonings” as these two terms could indicate the presence of the herb or spice you are trying to avoid. It may also be necessary to check products such as toothpaste, medications, supplements and toiletries - it is surprising how many herbs and spices crop up in somewhat unusual places.
See also Lectins, Peanut, Saponins, Soya.
All members of the legume family have been found to cause food intolerance symptoms. However, it is not the case that because you cannot tolerate, say, haricot beans, that all the others will also be a problem. The two main types of legumes are:
Those that we know as common foods such as peas, beans, soya and peanuts.
Those whose seeds or gum are used as thickeners and stabilisers in prepared foods such as locust bean gum from the carob tree.
Peanut and soya, two of the most commonly known allergens, are members of this food family and they are given sections of their own.
Legumes are an important source of protein and their consumption is very frequent in the Mediterranean region and in some Asian and African countries. In some of these regions, lentils and chickpeas are one of the main food allergens. In India legumes are the most important allergy. [481] Lentils seem to be the most common legume implicated in paediatric allergic children in the Mediterranean area. [482]
Darco et al tell us about three individuals who developed asthma and rhinitis after exposure to raw but not cooked green beans. [483] Ewan describes the case of an individual so sensitive to peas that even sitting at a table with people who were eating peas induced periorbital oedema. [484]
Orhan and Karakas report on a case of a seventeen-year old boy who had four episodes of exercise-induced anaphylactic reaction after eating lentils and two episodes of anaphylaxis after eating chickpeas. [485]
Legumes are also used as food additives due to their emulsifying properties and can be present in many manufactured foods. These hidden food allergens have the potential of causing adverse reactions in anyone with a legume sensitivity.
Gums also cause problems and cannot be ignored. Lagier et al found occupational rhinitis and asthma to guar gum amongst workers in pharmaceuticals and carpet manufacturing. One of these individuals, after eating ice cream and salad dressing containing guar gum experienced angioedema. [486] Danoff et al reported on a case of anaphylaxis after eating a hamburger containing tragacanth gum. [487]
There is a significant degree of cross-reactivity among legumes, the clinical relevance of which seems to be dependent on the dietary habits in different communities. In Spain, the consumption of several legumes is frequent and, therefore, clinical allergy to more than one species in children is common. Clinical manifestations include skin, digestive and respiratory symptoms. [488] Some of the most common legumes are listed below:
Acacia gum, adzuki bean, alfalfa, black eyed bean, black turtle bean, borlotti bean, broad bean, butter bean, cannellini bean, carob, chick pea, fava bean, fenugreek. flageolet bean, garbanzo bean, green bean, guar gum, gum arabic, haricot bean, lentils - all forms, lima bean, liquorice, locust bean gum, masur bean, mung bean, navy bean, pea, peanut, pinto bean, red kidney bean, snap bean, soya bean, string bean, tragacanth gum, wax bean, white bean.
One clear way of knowing if you have a problem with legumes is if you have ever changed to a vegetarian or vegan diet and at the same time seen an increase in health problems. The occasional attack of flatulence does not count!
One of the reasons that legumes seem to cause problems is because of their high lectin content. Lectins are carbohydrate binding proteins present in many plants. One of the legumes with a very high concentration of these is the red kidney bean. See the section on Lectins for further details. If you are going to eat beans please make sure you follow the guidelines for soaking and cooking very carefully. This could minimise your risk.
The only way of checking for a legume sensitivity is to eliminate them all from your diet and then test them individually. It could be that you eat very few so the test will not take very long but if you are a vegan or vegetarian the process could be lengthy and the results could have serious repercussions for your diet. Eliminate the chosen legume for at least five days and then test it in a simple meal - not a processed food.
Anybody needing to avoid all legumes will also need to check foods for gums that may have been produced from legumes. The gums currently allowed for use as food additives in the EU are listed below. They do not all come from legumes but, if you have a problem with one of them, it is probably worth removing them all and then, if you feel the need, trying some foods that contain the others over a period of time - the reason being that we do not know which chemical, protein or substance is the actual problem and it may be found across the range of gums that have a similar structure or function within food.
E410 Locust bean gum
E412 Guar gum
E413 Tragacanth
E414 Acacia gum (gum arabic)
E415 Xanthan gum
E416 Karaya gum
E417 Tara gum
E418 Gellan gum
Margarine is not a natural food product yet, over the last few decades, has come to be seen as healthier than butter. If you are intolerant of butter then this may very well be the case but if you are not then take a close look at margarine before continuing to use it.
Margarine is a complex processed product. Not only does it contain a number of ingredients, the oils that are used have been chemically changed by the process that converts the oil to an acceptable spreadable product. The process of hydrogenation changes not only the physical form of the oils, but also alters the way they are metabolised by the body. The structure of the fatty acids is altered, or destroyed, and you are often left with trans fatty acids which are definitely not good for the body. So if you want to eat margarine avoid one that uses hydrogenated oils. This, however, is not the end of the potential problems.
Despite popular belief, margarines vary enormously in content from each other in the following ways: the types of oil used (some now do declare which oils are used but many don't), the type and number of preservatives used, the use of artificial and, so called, “natural” colours, and the quality and source of the added vitamins.
It is possible to be intolerant of one of the oils being used or of one of the preservatives the oil was treated with before being converted into margarine. You could have a problem with one of the added preservatives. Do not be lulled into assuming that a natural colour is necessarily any safer than any other - if you are sensitive to it then it will cause you a problem. The added vitamins may have been treated with preservatives and you will not know which ones.
A further difficulty with some margarines is that some contain milk products which, of course, could cause problems for anyone with a milk intolerance.
It is quite likely that during other tests you have already either excluded margarine or changed brands. If this is the case and you are symptom free then no further testing will be necessary. If you are still having problems quite simply remove margarine from your diet and do not replace it with butter for at least seven days. If there is improvement but it is slow in taking place then do not test it for at least another seven days. (It can take time for the accumulated preservatives to diminish in their impact on your body.)
Testing is straightforward - use some of your usual brand and wait and see. If no immediate reaction takes place then use it more regularly and closely monitor your health. If the brand you have been testing is a problem then choose another brand but make your choice carefully - go for the most natural and the one with least number of ingredients.
Whether you change brands, switch to butter or stop using any form of spread will depend on how you have responded to the tests.
If you find yourself intolerant of them all then don't despair - alternative spreads such as nut butters are available and oil can be substituted for butter and margarine in many forms of baking.
See also Amines, Moulds, Nitrates.
Meat has become the main source of protein for many people but it is not without its problems. Like any food, it is possible to be intolerant of any one meat but it is also possible to misinterpret meat problems due to naturally occurring food chemicals and additives in processed meats. There is little point in testing meats you have an aversion to or never eat unless your diet is so restrictive that you need to find foods you can incorporate.
If there is a single meat that you eat every day then consider testing it as it may be masking an intolerance problem. Also, if your diet is very high in meat products and you have health problems then you may want to consider a period without meat or with a lot less meat. Although high protein/low carbohydrate diets work for some, others need low protein/high carbohydrate diets.
It is possible to react to all forms of meat from a single animal or just to certain parts. It is possible to have a sensitivity to one meat only or to more than one. As always, it depends on the individual.
Llatser et al tell us of a woman who reacted with anaphylaxis to pork gut and kidney but was able to tolerate pork meat. [489] Hjorth and Roed-Peterson found a range of symptoms in people sensitive to beef including contact urticaria in people handling beef; and chronic diarrhoea, migraine and stomach ache after ingestion. [490]
Kelso et al found that some individuals who are allergic to one form of bird meat, such as chicken, turkey, dove or quail, may also be allergic to others including game birds. [491] Ayuso et al found cross-reactivity between beef, venison, lamb and milk and they suggest that pork rather than lamb should be included in hypoallergenic diets. [492] It is not always the case that if you are allergic to beef that you will also have problems with milk or vice versa.
A twenty-one year old woman suffered from chronic recurrent dermatitis on her lower arms. Her symptoms were always worse in the evening and during the night, and reduced noticeably over weekends. When on holiday, her dermatitis completely cleared within seven days. Various tests were carried out and eventually the culprit was found to be salami skin - the woman worked in a delicatessen store where she regularly cut and sold salami sausages. [493]
A twenty-year old man experienced itching, facial hives, lip swelling, heartburn, problems with swallowing and breathing difficulties fifteen minutes after eating chicken. [494] A forty-two year old woman with a history of occupational inhalant allergy to pork developed rhinitis, asthma, and conjunctivitis thirty minutes after eating chicken. Skin tests were positive to chicken meat. [495]
Reactions to beef have been implicated in a range of conditions. For example:
Jenkins et al found that food allergy was a major cause of infantile colitis; beef was a problem for one of the children studied. [496]
In a study of twenty seven people with chronic diarrhoea of unknown origin, Read et al found that, for one person, the cause was an allergy to beef.[497]
Lagrue et al found links between certain foods and idiopathic nephrotic syndrome (kidney disease) - one of these foods was beef. [498]
Grant found that for some migraine sufferers the triggering food was beef. [499]
Fiocchi et al estimated that beef allergy has an incidence of between 3.28% and 6.52% among children with atopic dermatitis, and may be as much as 0.3% in the general population. [500]
Allergies to raw beef have been identified amongst meat workers, usually leading to contact dermatitis. [501]
Cross-reactivity with milk has been noted [502] and Ayuso et al found cross-reactivity between beef, venison, lamb and milk. [503]
Different forms of cooking can also affect the degree of sensitivity. For example, Werfel et al found that some of those allergic to beef were able to tolerate well-cooked beef but not medium-rare and rare beef and suggested that specific IgE antibodies to heat-labile beef proteins could be the reason. [504]
To test for a meat intolerance remove all products containing the meat you are testing from your diet for at least five days. Then eat some of the meat in its most simplest form - if there is no reaction then try it in a different form. For example: if you test beef as roast beef, then try it as steak and then try it as mince.
Monitor your reactions - the method of cooking alters the chemical make-up and you may be able to eat it in one form but not another. It is not an uncommon mistake to assume that you have a problem with meat when in fact the problem lies more in the form you are eating it in. Processed meats are far higher in natural (and manmade chemicals) than, say, a joint roasted in its own juices. Grilling, stewing, barbecuing and frying all increase the amine content of meat If you suspect a problem with meat check the section on Amines.
The complexity of processed foods can give rise to misleading diagnoses. For example, sausages will contain many ingredients other than meat. A negative reaction does not necessarily mean a problem with the meat, the reaction could be caused by any one of the ingredients.
Continuing with the above example, caseinates are often found in sausages which, if you are milk intolerant, could cause problems. The spices in sauces and some processed meat products such as salamis can also lead to a wrong diagnosis. A reaction to these foods could indicate a salicylate sensitivity.
If you eat meat choose to eat it in its simplest form
Problems with milk are extremely common. Milk contains a number of proteins, such as casein, that can lead to allergies. Milk also contains lactose which many people cannot digest and this also leads to problems.
Lactose is the sugar in milk and it requires the enzyme lactase to digest it. Lactose intolerance is quite common and some have suggested that it arises because we were never intended to consume milk after infancy. There are tests available to identify both milk protein allergy and lactose intolerance - your doctor will be able to advice on these if you wish to find out more.
For many the relief obtained from a milk free diet is so extensive that they simply give up all forms of milk. Milk is in fact not a natural food. It is produced by females for their young and was never intended as a food for those beyond infancy. Do you know of any animal that habitually drinks the milk of another animal especially when it is grown up?
The main symptoms linked with milk problems are recurring digestive problems such as excessive gas, bloating, cramps, pain, diarrhoea, constipation, and recurring catarrhal problems. It has also been linked with: Arthritis, Asthma, Chest complaints, Colds, Dermatitis, Ear problems, Hyperactivity, Irritability, Learning difficulties, Migraine, Sinusitis, Sleep disorders.
Rousquet et al reported that between 7 and 29% of asthma sufferers have a milk sensitivity. They also found it was often a cause of rhinoconjuctivitis in young children and may be implicated in serious otitis media. [505] Elimination diets worked for migraine sufferers in a study by Mylek and the food most usually implicated was cow's milk. [506]
Kahn et al in a study of one hundred and forty six children referred for sleep disturbance identified fifteen whose sleep problems were resolved within five weeks of starting a diet free from cow's milk. In a subsequent challenge, the sleep disturbances returned within four days of reintroducing the cow's milk. [507]
In children the two major symptoms that appear early on are gastrointestinal upsets and dermatitis. Some children appear to grow out of a milk allergy but some don't. James and Sampson found that those who retain a sensitivity to milk often have a decrease in skin disorders but an increase in gastrointestinal and respiratory symptoms. [508]
To test for a milk sensitivity avoid all milk, foods made from milk, and foods that contain milk products. Give yourself at least five milk free days before testing. If you can manage it, live without milk for two weeks and experience the effects fully.
Milk causes many people problems solely because it is consumed many times every day. Giving yourself a holiday from it will be an interesting, and hopefully, beneficial experience.
If milk has been causing you problems, the good news is that you should notice an improvement quite quickly. If your symptoms disappear or if you test and have a negative reaction then decide on a strategy:
As some people are sensitive to the chemicals the cow has ingested or been treated with, it is always safest to start your test with an organic milk. If you find you have a problem, your options are:
* to give up milk completely,
* test various products to see what you can tolerate (for example, you may be able to eat yoghurt and cheese but not drink milk; milk in baked products may be okay but not on its own; evaporated milk may be okay but not whole milk) or
* find out if your problem is lactose intolerance and take digestive enzymes to help if you wish to continue with milk.
What you decide to do will depend in part on how addicted to milk you are, not so much physically but by habit. At the outset giving up milk seems very strange and awkward because it seems to be everywhere and even your daily tea and coffee has to taste different. All of these problems can be overcome but it does take time to make the adjustment. Unless you have an allergic response to milk, there is nothing wrong with testing out how much milk in its different forms you can tolerate. If your unpleasant symptoms return this will provide you with the motivation you need to give it up completely.
You can try alternative milks such as goat and sheep - some people can tolerate these, others can't. There are also soy, nut, rice and oat milks now available. Initially you may find these unpalatable (your taste buds are still expecting cow's milk) but you will soon adapt or learn to do without.
Soya milk is often used as a substitute for cow's milk and was considered safe for children intolerant of milk. This is no longer thought to be the case. Lee and Heiner found that about one-fourth of those sensitive to cow's milk went on to become allergic to soy protein. [509]Various alternatives exist - check with your doctor as to which is the safest option for your child.
Reactions to cheese only may indicate a sensitivity to food chemicals such as tyramine and histamine rather than to milk - see the section on Amines.
If you need to avoid milk in all its forms, the foods and ingredients you need to avoid will probably include: Milk in any form including dried milk, butter, buttermilk, casein, caseinate (all forms), cheese, cream, curds, custard, ghee, hydrolsates, ice cream, lactalbumin, lactose, milk chocolate, natural flavouring, rennet, sour cream, whey, white chocolate, yoghurt.
Gern et al reported casein as a cause of allergic reactions for some individuals who had been eating so called “non-dairy” products. [510] Casein and caseinates appear in a wide range of processed foods as they are used as extenders and tenderisers and, also, to nutritionally fortify certain foods so check labels carefully. They can be found in foods ranging from meat and fish products, coffee whiteners, salad dressings and bakery glazes.
Meats purchased from deli counters can pose a problem arising from cross contamination if cheese and other milk products are stored and/or sliced nearby. Bread, cakes and pastries from bakeries or bakery counters in large stores are generally not required to have ingredients labels - before buying any item that does not carry a label, check with a member of staff whether the item is milk free. To be 100% safe you would need to do this every time you make a purchase as ingredients do change.
You will need to carefully check any processed food including:
Meats and breads, desserts, and margarine.
Non-dairy products including ice creams.
Sweets and any snack foods.
Beware also of the terms “emulsifier” and “protein” as these may be milk based.
Brown sugar flavouring, caramel flavours, and high protein flour may all indicate the presence of milk protein.
Many people are very concerned about a milk free diet for fear of not getting sufficient amounts of calcium. It is quite possible, as vegans have proved, that the body's calcium requirements can be met from other foods. Foods that are high in calcium include canned salmon with bones, sardines, greens, broccoli, and tofu. You can also ask your doctor if you should take a calcium supplement.
If you are lactose intolerant and want to continue using milk you may have some options to total avoidance although this will depend on the degree of your sensitivity:
* Digestive enzymes could help.
* Some people can tolerate small amounts of lactose such as that found in ½ cup of milk.
* Foods containing lactose are sometimes better tolerated if eaten with other foods.
* It is possible that you can tolerate cooked milk products but not, for example, milk on your cereal.
* Eating smaller amounts of lactose food over a day rather than one single large amount may be easier for you.
* You may be able to eat some products like yoghurt without difficulty.
It will be a case of experimentation until you find the level that is acceptable to you - balancing any occurrence of symptoms with the amount and type of milk that you eat.
See also Lectins, Legumes.
Peanut allergy is a serious and usually a life-long allergy affecting both children and adults. Sicherer identifies peanuts as one of the most common foods that causes problems for both children and adults. [511] It is essential that individuals with peanut allergy avoid even the slightest exposure to peanuts to prevent life threatening reactions. One of the commonest manifestation of peanut allergy is acute hives (or urticaria) following exposure.
Some people develop severe swelling and breathing problems leading to anaphylaxis. Deaths from peanuts have been reported. Some individuals are so sensitive that they will develop symptoms if they kiss someone who has eaten peanuts or eat out of a food utensil which has been in contact with peanuts. This is why many products now carry the warning that there may be traces of peanut - this means that the same machinery has been used to make the product you are buying as well as for one containing peanuts.
It had been thought that peanut oil was safe for those allergic to peanuts but some studies have identified the allergen within these oils and hence it could pose a serious problem for some individuals. [512,513]
The majority of peanut sensitive individuals are not allergic to tree nuts such as pecans, walnuts or almonds but some will have multiple sensitivities that may include tree nuts. A study by Loza and Brostoff found that 50% of individuals allergic to peanuts reported allergic reactions to other nuts as well. [514] Ewan's study of sixty two people varying in age from eleven months to fifty-three years found peanuts to be the commonest cause of allergy (47 cases), brazil nuts came in second (18 cases), followed by almond (14 cases) and hazelnut (13 cases). [515]
Multiple allergies appeared progressively with age with the commonest symptom being angioedema. Ewan concluded that children with peanut allergy are at increased risk of developing allergy to tree nuts. Interestingly only four of the sixty two reacted to other legumes (peas, lentils, beans and soya) and one of these did not react to peanuts.
Peanut allergy has rather over shadowed lesser problems. It is quite possible to be intolerant of peanuts without being allergic or at risk of anaphylaxis. However, because of the potential risks I am not advocating a peanut test at home. If you suspect peanuts as a problem please discuss testing with an allergist or doctor. If an allergy test is negative and you still believe that peanuts are a problem then eliminate them from your diet and test them but still ensure that someone is present who understands what needs to be done in case of anaphylaxis (this advice is based on the fact that allergy tests are not always 100% reliable).
Avoiding peanuts is not totally straightforward as the oil, in particular, is used in a variety of oriental dishes. It is essential that you check labels extremely carefully. Peanuts and peanut derivatives can also be found in biscuits, breakfast cereals, ice cream, soups, and sweets. Beware the terms “flavouring” and “vegetable oil”. Restaurant meals and takeout meals also need to be treated with extreme caution. Remember that staff when checking ingredients may make assumptions that ingredients such as “vegetable oil” are safe.
Non-food hazards can also present themselves especially in the form of body and massage oils; watch out for the terms peanut or arachis oil. Words to look out for include:
Arachis oil, groundnuts, mixed nuts, monkey nuts, peanut, peanut butter, peanut extracts, peanut flour, peanut oil, vegetable oil.
Also, be suspicious of natural flavouring and hydrolysed vegetable protein (HVP).
The types of food that peanuts appear in include:
Baked goods, cereals, chilli, chocolate bars, crackers, egg rolls, frozen desserts, Indian food, kebabs, marzipan, spaghetti sauces, soups, sweets.
Nuts and seeds present a hidden danger for many. Because of their versatility they are found in a wide range of processed foods and restaurant meals including meat dishes, breakfast cereals, sweets, spreads, sauces and desserts. Sicherer identifies tree nuts as one of the most common foods that causes problems for both children and adults. [516]
Nut and seed allergies usually present in childhood but intolerance can develop at any time especially as they are now, often inadvertently, consumed in greater and more regular quantities. A sensitivity to more than one could indicate a more general problem with salicylates and/or amines.
All varieties of seeds and nuts have at some time been implicated in a food intolerance or allergy problem. Reactions to nuts and seeds have included:
Abdominal cramps, Anaphylaxis, Angioedema, Breathing difficulties, Coughing, Dermatitis, Diarrhoea, Eczema, Facial swelling, Gastrointestinal problems, Hypotension, Rhinoconjuctivitis, Tingling in the mouth, Urticaria, Vomiting.
Guariso found that some young people's migraines were triggered by hazelnuts. [517] Ewan's study found allergies to brazil nut alone, brazil nut plus other nuts, almond, almond plus other nuts, hazelnut, hazelnut plus other nuts, walnut, cashew nut. [518]
Sicherer et al in a study of those with peanut and tree nut allergies found that out of one hundred and twenty two people:
Sixty eight had reactions only to peanut.
Twenty to only tree nuts.
Thirty four to both .
Of those reacting to tree nuts, thirty-four had reactions to one nut, twelve to two nuts, and eight to three or more nuts. The most common tree nuts to cause reactions were walnut, pecan and almond. Eighty nine percent of the reactions involved the skin (urticaria, angioedema), 52% the respiratory tract (wheezing, throat tightness, repetitive coughing, dyspnea), and 32% the gastrointestinal tract (vomiting, diarrhoea). [519]
Coconut has been implicated in skin problems. [520] Allergy to coconut was identified in a three-year old boy - he experienced abdominal pain, vomiting, oral allergy syndrome, and swelling of the eyelids immediately after oral contact with a coconut sweet. One year later, after eating a small portion of fresh coconut, he suffered sudden abdominal pain, vomiting, oral allergy syndrome, and swelling of the eyelids. [521]
Like the pistachio nut, the cashew nut contains oleoresins similar to those found in poison ivy and oak which can lead to contact dermatitis, stomach problems and other allergy type symptoms. The problems seem to manifest more in adults than in children. Meysman et al describe how one individual experienced severe anaphylaxis, angioedema, hypotension and shock after eating yoghurt and muesli. Investigations identified that the near fatal allergic reaction was caused by a pine nut allergy. [522]
Cross-reactivity between tree nuts and other foods and pollens have been recorded. Eriksson et al found coconut hypersensitivity in twenty two (out of three hundred and eighty) birch-pollen allergic individuals and 26% reported reactions to walnut. In respect of hazelnuts, they found those with birch-pollen allergy more often reported hypersensitivity to hazelnuts (53%) than those without pollen allergy (7%). [523]
Vocks et al found the degree of cross-reactivity among kiwi, sesame seeds, poppy seeds, hazelnuts, and rye grain was found to be very high in the people studied but the degree and exact type of cross-reactivity varied. [524]
Eating large amounts of hazelnuts can lead to an increase in nickel intake which potentially could lead to aggravating symptoms usually identified by the individual as being caused by nickel. [525]
Caubet et al describe three cases of severe snack seeds allergy in children:
A six-year old girl experienced oral itching, swelling of the lips and face, vomiting, and breathing problems within five minutes after eating a handful of sunflower seeds.
An eleven-year old boy experienced an anaphylactic reaction within a few minutes after eating pumpkin seeds.
A seven-year old boy experienced two episodes of generalized urticaria and facial swelling and a third episode with angioedema, wheezing, and acute breathing difficulties within fifteen minutes after repeatedly consuming small amounts of sunflower seeds. [526]
I don't know whether nuts and seeds are potentially more allergenic than other foods but, because of the large number of reported cases of anaphylactic shock, I do not recommend testing nuts and seeds when on your own. If you suspect nuts or seeds are a problem please discuss testing with an allergist or doctor. If an allergy test is negative and you still believe that some nuts and/or seeds are a problem then eliminate them from your diet and test them but ensure that someone is present who understands what needs to be done in case of anaphylaxis (this advice is based on the fact that allergy tests are not always 100% reliable)
Some of the more common nuts and seeds:
Almond, brazil, cashew, coconut, hazelnut (or filbert), macadamia, pecan, pine, pistachio, poppy seed, pumpkin seed, sesame seed, sunflower seed, sweet chestnut, walnut.
You can eliminate and test each nut and seed separately or eliminate them all and then introduce them one by one during the testing phase. Remember that reactions to more than one of those high in amines or salicylate could indicate a much more general problem. Those that are particularly high in these are noted below (full details can be found in the relevant chapters).
Those high in salicylate are almonds, brazil nuts, desiccated coconut, macadamia nuts, pine nuts, pistachio, sesame seeds, walnuts.
Those high in amines are brazil, hazelnut, pecan, and walnut.
Sicherer et al found that accidental ingestions are common and occur most frequently outside of the home. Some of the ways in which accidental ingestion took place were as a result of:
Sharing food
Hidden ingredients
Cross contamination. [527]
Particular attention needs to be drawn to sesame seeds as allergic reactions to sesame seeds in the west have become increasingly commonplace since their introduction into processed food including burgers at many fast food outlets and the increase in the number of “exotic” meals now being eaten both in restaurants and as ready-made meals.
Anaphylaxis, angioedema, atopic dermatitis, allergic rhinitis, and bronchial asthma have all been caused by sesame seeds. Other reactions are possible and, even, likely. Remember that these vary from individual to individual. My husband, on testing sesame seeds experienced a total high which a few hours later had changed into overwhelming feelings of depression, fuddled thinking, tiredness and overall ill health. Until that time he had not known that sesame seeds caused any problems. It took more than three days for the symptoms to abate.
If sesame seeds are a problem, extreme vigilance is needed with processed and restaurant food as sesame can often be a hidden ingredient. Kagi and Wuthrich reported on a case of anaphylaxis that was caused by sesame seed in a falafel burger. [528] Food cooked in oil must always be suspected as reactions including anaphylaxis have been reported from sesame oil. [529,530]
Sesame oil finds its way into other products such as ointments and absorption through the skin can also lead to problems. Sesame oil, as a constituent of a zinc oxide liniment, was found to be the cause of contact dermatitis in fifteen out of ninety eight people with leg ulcers who had been using the liniment. [531,532]
Malten found in one hundred cases of leg ulcers, eleven people showed positive patch test reactions to a paste containing 40% sesame oil and a higher proportion showed positive reactions to 100% sesame oil. [533]
Reactions to soya have become more widespread mainly due to the increasing use of the soya bean in processed food. If you are shaking your head and saying you never eat any - check the foods you most commonly buy that are pre-prepared especially bread. Soya, and the emulsifier lecithin, are commonly used in processed foods ranging from soups to chocolate, and most mass produced bread contains soya. For many it truly is a hidden problem.
It is easy to be blasé about the safety of ingredients that appear to play a very small role in a food such as soy lecithin in bread but the reality is that soy lecithin has caused an anaphylactic reaction in a child [534] and so, for some people, is potentially very dangerous.
A thirty-eight year old man developed an anaphylactic reaction with flushing, generalized urticaria, conjunctival redness, and breathing problems three hours after eating cold Chinese noodles. He had avoided natto for the previous year as he had once experienced anaphylactic reactions half a day after eating natto. Skin prick tests were strongly positive for natto and the soup of cold Chinese noodles. The tests were also positive for poly gamma-glutamic acid (PGA), which is a major constituent of natto mucilage, an ingredient of the noodle soup.
The man was diagnosed with late-onset anaphylaxis to PGA contained in natto and the cold Chinese noodle soup. The delayed reaction was thought to be due to a delayed absorption of PGA which has to biodegrade to peptides sufficiently small enough to be absorbed in the bowel. Inomata et al note that PGA has recently been applied to a wide range of fields such as foods, cosmetics, and medicine and that anyone with a sensitivity to PGA of natto should avoid not only natto but also other materials containing PGA. [535]
Sensitivity to soya has led to cases of asthma, rhinitis, urticaria, angioedema, and digestive problems. [536] The symptoms experienced will vary from individual to individual but all of the following have been noted:
Abdominal pain, Acne, Anaphylaxis, Angioedema, Anxiety, Asthma, Bloating, Breathing difficulties, Colitis, Conjunctivitis, Dermatitis, Diarrhoea, Eczema, Heart palpitations, Hives, Hypotension, Itching, Lethargy, Mouth sores, Rhinitis, Urticaria, Vomiting, Wheezing.
In the last few years there has been much publicity about the health benefits of soya. You should know that some researchers now believe that soya products increase the risk of thyroid disease and suggest that only small amounts are eaten.
To test for a soya sensitivity you need to eliminate it from your diet in all its forms for at least five days and then test it in its most natural form. Food terms that indicate the presence of soya include:
Edamame beans, HVP, lecithin, miso, natto, shoyu sauce, soy bean sprouts, soya flakes, soya milk, soya protein, soy sauce, soya flour, tamari, tempeh, tofu, TVP, yuba.
You also need to avoid foods containing vegetable oil that do not state which oils are used.
Some people can tolerate soya oil but as cases of anaphylaxis have been reported it is best avoided. [537] Watch out for hidden soya, including lecithin, in processed foods. This requires very diligent label checking as it is found in so many foods - never assume something is safe. The following terms may also indicate the presence of soya:
Bulking agent, emulsifier, flavourings, hydrolysed vegetable protein (HVP), protein, protein extender, stabiliser, starch, textured vegetable protein (TVP), thickener, vegetable broth/protein/stock, vegetable starch, vegetable gum.
If you find you only react to fermented soya products you may in fact have an amine sensitivity rather than one to soya (see the section on Amines).
One of the hardest aspects of a soya sensitivity is avoiding the hidden soya so if you find you are very sensitive you will need to check and double check all foods not prepared by yourself - do not trust anyone else to check for you.
Like many other foods, soya is also present in many non-food items. If you are very sensitive to soya these may also cause you a problem. Steinman lists some possible non-food sources of soya including:
Adhesives, blankets, body lotions and creams, dog food, enamel paints, fabrics, fabric finishes, fertilisers, flooring materials, lubricants, paper, printing inks, soap. [538]
Falleroni and Zeiss report on a case of a six-year old boy who reacted to soy bean dust from a bean bag. [539]
Sugar is primarily used as a sweetening agent in the form of sucrose. It is probably the most overused food in the Western world. Not only does it appear in soft drinks and sweets but is now commonly found in sauces, yoghurts, low-fat meals, tinned vegetables and processed meat products. The amount we consume without realising it is frightening.
Blood-sugar problems have frequently been linked with the over consumption of refined cereals and sugar. Other problems are also quite possible. Grant found that for some individuals migraines were caused by cane sugar. [540] Sugar intolerance can lead to:
Anxiety, Depression, Food cravings and over eating, Hyperactivity, Irritability, Migraines, Mood swings, Nervous tension, Pre Menstrual Syndrome.
If you have any of the above symptoms and fuel your energy needs with sugary foods then try a sugar free diet for a couple of weeks and see what happens - the changes can be dramatic. Sugar has been blamed for a lot of ills which may not be justified. It is quite possible that problems that seem to have been caused by sugar have in fact been caused by other ingredients.
It is rare that we eat sugar in its most natural form and if you look at the ingredients in shop bought candies, sweets, and confectionery you will invariably find a number of food additives especially colours which have been linked with problems such as hyperactivity.
To test for a sugar problem eliminate it in all its forms. Don't be tempted to replace it with other sweeteners as these can also cause problems - avoid all sweeteners such as syrups, treacles and artificial sweeteners. You can expect to experience cravings. Make sure you plan ahead and have substitutes that you can eat such as plain crackers, crisps or fruit.
This planning aspect is vital especially if you suffer from depression as you may find the symptoms increase for a while. Treat yourself gently, rest as much as you can, take light exercise (more if able) and eat wholesome food.
Test sugar in its most natural form - simply as sugar. If you can find an organic brand choose that for preference. Avoid testing a complex product as this will not be helpful in clearly identifying a sugar problem. If you experience a sudden high and then have a change in mood for the worse - you probably have a sugar problem. It is possible that you can tolerate some sugar but you will have to experiment until you find a level that is acceptable to you.
One of the problems with sugar today is that if you read the label of any sweet biscuit, cereal, pastry, cake or candy you will find some terms other than sugar - these include glucose, syrup, fructose. Unless these originate from an accepted allergen, the source is unlikely to be mentioned. So problems can emerge for two reasons:
You can be sensitive to the food substance that the “sugar” is made from.
The way the type of sugar is metabolised by your body may not work for you giving rise to various problems.
The testing method above relates specifically to cane sugar but can be used for any type of sweetener - simply eliminate the sweetener from your diet and then reintroduce it but never substitute an alternative sweetener during the days when you are avoiding a sweetener. Some of the types of sweeteners that are readily available include.
Agave syrup, cane sugar in various forms, date syrup, fructose, glucose, honey, mannitol, maple syrup, rice syrup, sorbitol, stevia.
It seems to be the case that adding sweetness to food is always contentious whether it is seen as bad for the teeth, the cause of illnesses, or linked with obesity. What does change is the “bad guy”. When I was writing the first edition of this book there was great concern over the use of the artificial sweetener Aspartame. Ten years later the spotlight is on High Fructose Corn Syrup. By the time you are reading this there may be another sweetener making the headlines.
If you use a sweetener, whether natural or not, you will need to choose the one that is best for your body and mind.
In respect of artificial sweeteners, I am tempted to say don't test these just eliminate them but that is a decision you must make for yourself. My own personal concern with these is to do with their chemical complexity - my body has enough to sort out without dealing with these as well. Having said that there are very good reasons why some people need to use these type of products.
If you use an artificial sweetener and suspect that it is causing you a problem then eliminate it from your diet for a minimum of two weeks. If you find that your health is improving then prolong the length of time before trying it again. Make sure you check all sweetened items in your diet and be cautious about eating foods if you are unable to check the ingredients list.
Artificial sweeteners are manufactured products to help give you the illusion of sweetness without the calories. In many countries they have been passed as safe to eat but evidence is continually emerging of potential health problems. The most common one used is “Aspartame” which has been found to cause a diverse and bewildering array of symptoms.
Much of this evidence is anecdotal and not accepted by many but if you recognise your symptoms and know you consume large amounts of aspartame on a regular basis then you would be well advised to take the test. It is usually suggested that you eliminate all products with artificial sweeteners for a period of sixty days and monitor your health. If there is a dramatic improvement then you have probably identified the culprit. If there is no change then the choice is yours - to continue or not. [541]
Maher and Wurtman write that aspartame is consumed, primarily in beverages, by a very large number of Americans, causing significant elevations in plasma and, probably, brain phenylalanine levels. Anecdotal reports suggest that some people suffer neurologic or behavioural reactions in association with aspartame consumption. Since phenylalanine can be neurotoxic and can affect the synthesis of inhibitory monoamine neurotransmitters, the phenylalanine in aspartame could conceivably mediate neurologic effects. [542]
The reported symptoms include both physical and emotional and behavioural symptoms and these include:
Abdominal Pain, Anxiety, Bloating, Blood Sugar Problems, Brain fog, Breathing difficulties, Burning eyes or throat, Chest Pains, Chronic cough, Chronic Fatigue, Confusion, Depression, Diarrhoea, Dizziness, Excessive Thirst or Hunger, Flushing of the face, Frequent infections, Headaches/Migraines, Heart palpitations, Hives, Hypertension, Inability to concentrate, Insomnia, Irritability, Itching, Joint pains, Memory loss, Muscle spasms, Nausea, Palpitations, Seizures, Tingling sensation in limbs, Tinnitus, Urticaria, Vision problems, Weight gain.
There is a group of people who cannot safely consume aspartame. These are the sufferers of the inherited disease phenylketonuria (PKU), who are unable to metabolise the amino acid phenylalanine effectively, leading to the accumulation of potentially harmful levels. PKU is a serious, metabolic disorder, affecting 1 in 10,000 individuals and if untreated, it can cause serious brain damage. [543]
No artificial sweetener currently on the market is without drawbacks or potential health hazards. If you decide to use them then reduce the amount you consume. If you have any problems with them, or are concerned about the problems they may cause, then give them up - your body and mind will thank you. The ones currently classed as food additives in the EU are:
E950 Acesulfame K
E951 Aspartame
E952 Cyclamic acid and its Na and Ca salts
E953 Isomalt
E954 Saccharin and its Na, K and Ca salts
E955 Sucralose
E957 Thaumatin
E959 NeohesperidineDC
E 961 Neotame
E962 Salt of aspartame - acesulfame
E965 Maltitol (i) Maltitol (ii) Maltitol syrup
E966 Lactitol
E967 Xylitol
E968 Erythritol
See also MSG, Salicylate, Solanine, Sulphur and Sulphites.
Reactions to vegetables are not as well documented as, for example, reactions, to milk or nuts. This does not mean that they are “safe”. The complexity of a single vegetable is immense and unwanted reactions can occur to any single vegetable or group of vegetables or naturally occurring chemical such as salicylate, solanine, sulphur and MSG found within them.
Adverse reactions to single vegetables is usually noticed early on in infancy and the vegetable is simply avoided. If you always avoid a particular vegetable then do not bother to test it unless you really feel you want to run the risk of an adverse reaction.
If you can think of a symptom then someone somewhere will probably have experienced it as a result of a sensitivity to a vegetable. Muhlemann and Wuthrich in a study of two hundred and twenty nine people with allergies found the most common food allergens to be amongst vegetables with 44.5% reacting to celery and 14.4% to carrots.544 Quirce et al found various symptoms including bronchial asthma, urticaria and Quinckes oedema associated with a reaction to potatoes. [545]
Hoffman et al found that ten out of the twenty five eczema sufferers in their study reacted to avocado. [546] Lybarger identified respiratory, nasal and skin reactions to garlic. [547] Garlic has been linked with causing contact dermatitis and asthma. [548] Celery has been found to cause anaphylaxis, angioedema, and urticaria. [549] In a study by Mylek migraines for some individuals were triggered by cabbage. [550]
Babu and Venkatesh tested six people allergic to aubergine to establish how many parts of the aubergine were implicated. All showed positive skin prick tests to peel, pulp, raw, and cooked aubergine extracts. They concluded that aubergine has allergens in all of its edible parts with a preponderance in the peel. [551]
Tomatoes, officially classed as a fruit, yet commonly known as a vegetable are a food that is eaten widely. Unfortunately, for people with a tomato sensitivity, they are found in many processed food products. Reported adverse reactions to tomatoes include anaphylaxis, urticaria, angioedema, dermatitis, oral allergy syndrome, rhinitis, stomach problems, and asthma. [552,553,554 ]
Not all reactions to tomato can be classed as allergic. Tomatoes are high in a number of naturally occurring chemicals including salicylate and solanine. For some people the amount they eat simply needs to be reduced, or, for some, tomatoes need to be wholly eliminated. Reactions to tomatoes, for some people, are further complicated by cross-reactivity with latex. [555]
In thirty three people with chronic urticaria and pseudo allergic reactions to food, tests were performed with field-grown tomatoes. Seventy six percent reacted to tomato. The researchers tested for salicylates, histamine, and other components, and attributed the reactions to aromatic volatile ingredients in food, which are novel agents that elicit pseudo allergic reactions in chronic urticaria. Histamine, salicylate, and a direct mast-cell histamine release were not involved in this reactivity to naturally occurring pseudo allergens. [556]
Riffelmann and Wenzel reported on the case of one person who had three reactions within three months after eating mixed salad. The symptoms were tongue swelling and angioedema of the lips. Tests for a sensitivity to lettuce were negative but were found to be positive to rocket. [557]
The authors of a French study note that shitake mushrooms are the second most eaten mushroom in the world. In Asia, toxic adverse effects due to picking or consumption of shiitake mushrooms are well known. As consumption of these mushrooms is increasing in the West there is concern that a similar pattern may emerge. Herault et al outline the case of a seventy-eight year old woman who experienced an extensive rash, diagnosed as dermatitis, all over her body including her face and scalp. The rash appeared two days after she had eaten a large amount of raw shitake mushrooms. [558]
After eating guacamole dip with chips, a fifteen-year old boy developed coughing, wheezing, nasal stuffiness, generalized urticaria and swelling around the eyes. The reaction was treated as an anaphylactic reaction and skin testing confirmed an allergy to avocado which is the primary ingredient of guacamole. As anaphylaxis to avocado is often linked with latex sensitization, tests for latex sensitivity were also carried out but these were all negative. [559]
Cabbage is often seen as a safe food - rarely allergenic and, of course, good for you. The truth is that cabbage has been implicated in a range of health problems. Eriksson found that some adults who had an acetylsalicylic acid (aspirin) intolerance were also intolerant of other foods including cabbage. [560] In 1985, Jones et al, induced remission in twenty patients with active Crohn's disease by dietary changes. In some of these patients symptoms were found to be triggered by the Brassica family of vegetables which include cabbage, broccoli, and cauliflower. [561]
Elimination diets worked for migraine sufferers in a 1992 study by Mylek and although the food most usually implicated was cow's milk, other problem foods included cabbage. [562] Some people find they can tolerate cabbage only when cooked. In respect of food chemicals, cabbage is low in amines and salicylate, contains natural sulphur which may be a problem for someone with a severe sensitivity to sulphites, is high in naturally occurring goitrogens, and pickled cabbage is high in histamine.
The biggest problem with vegetables is that we are told they are good for us and so many of us make ourselves eat them against our own innate wisdom. If you have ever tried to eat a diet high in vegetables and have felt worse then you could have a food chemical problem. There is no easy way of suggesting where you start. Read the food chemical sections especially the symptoms and see if any spring out at you.
For example, if you have a lot of joint pain then it may be useful to try the solanine test. Alternatively, if you dislike or feel ill after eating aubergine, then the histamine test may be useful. If you have a problem with a large number of vegetables, and fruit, then consider checking for a salicylate sensitivity.
Reactions to individual vegetables, as shown above, have been reported. If you suspect a vegetable (and are sure it is not a food chemical problem) then remove it from your diet for four days and then test it. Make sure the test vegetable is fresh not frozen or tinned and preferably organic. Don't add a sauce to it.
Some people have tried eating diets high in raw vegetables and have often after an initial improvement felt much worse. This is not necessarily indicative of a sensitivity. It could be, quite simply, that your body cannot handle raw vegetables - try cooking them. The cooking process changes the vegetable and, in many cases, removes or reduces the allerginicity.
The high chemical content of vegetables can also lead to problems of misdiagnosis. It is quite possible to test a vegetable, react badly to it, eliminate it totally, feel better and a few days or weeks later experience a return of all the symptoms. If this happens it is indicating that it was not the individual vegetable but one of the chemicals - read the lists and see if you need to do a further test.
A further problem is the one-off reactions that can occur often leading to quite strong adverse reactions after eating a vegetable you are usually okay with. This is more likely to be caused by pesticide contamination. It is safer when testing vegetables to at first eat them in their organic form.
See also: Gluten, Grains.
Wheat frequently causes problems mainly because we eat so much of it. It is not unusual to eat some wheat at every meal - in cereal at breakfast, sandwiches at lunch, biscuits as a snack, and pasta or bread with the evening meal. Speer [563] has wheat listed in the top ten most allergenic foods and Andre et al [564] found wheat to be one of the most common allergenic foods.
Reactions to wheat tend to fall into three groups:
* A sensitivity to gluten.
* Intolerance of or allergy to wheat more generally.
* Problems with whole-wheat.
If you have any stomach problems, skin problems, and/or arthritis you should consider testing wheat. Blood sugar problems, especially if your main snack foods contain wheat, could be another indicator. Wheat has also been found to cause migraines [565,566] for some people and even asthma. [567,568] Twelve per cent of one hundred and two children who were allergic to pollen were also allergic to wheat. [569]
Wheat allergy is one of the most common food allergies in children but little data is available regarding its natural history. Corinne et al studied one hundred and three children who all had a history of wheat allergy. Their main aim was to identify the length of time that the allergy lasted. They found that the rates of resolution were 29% by four years, 56% by eight years, and 65% by twelve years. Whilst higher wheat IgE levels were associated with poorer outcomes, many children with even the highest levels of wheat IgE did outgrow wheat allergy. They concluded that the median age of resolution of wheat allergy is approximately six and a half years. But, in a significant minority, wheat allergy persists into adolescence. [570]
If you have a problem with wheat do not assume that you have a gluten sensitivity. Not all problems with wheat are related to gluten. Test each of the gluten grains individually to see if you can tolerate them - there is no point in limiting your diet unnecessarily. There are now lots of cookbooks to help people with wheat and/or gluten problems so it should not pose too many problems with finding alternatives.
To test for a wheat sensitivity exclude all foods containing wheat for at least seven days and then eat it in its most natural form. Testing of grains should always be in their simplest forms - make something at home like a very simple pancake. If you test wheat in the form of bread and experience a reaction you will not know whether you are reacting to the wheat, a preservative, raising or bleaching agent.
It is possible that whilst wheat combined with yeast or other raising agent may be a problem, wheat in other recipes may be okay. Don't eliminate wheat without thorough testing. Although wheat, and other cereals, are at their most nutritious in whole grain form it is possible to be intolerant of whole grains and yet be quite comfortable with their more refined counterparts. So, if you find yourself unable to eat whole-wheat, test an organic white flour. I am suggesting an organic flour used in a simple product such as a pancake as this will eliminate the risk of misreading a test if you eat a product with a large number of ingredients.
Symptoms, even with wheat, can be dose related. Hanakawa et al reported on the case of a twenty-four-year-old Japanese woman who had suffered for two years from attacks of urticaria, breathing irregularities, and temporary loss of consciousness due to a sudden fall in blood pressure - all of which were associated with exercise after the ingestion of wheat. On testing with varying amounts of wheat in different forms they were able to identify the amounts at which reactions took place: for example, exercise following ingestion of 64g, but not 45g, of bread induced generalised urticaria for this individual. [571]
Wheat is the main ingredient or can be found in most of the following:
Bread crumbs, bran, bulgar, cereal extract, coffee substitutes, couscous, crackers, durum wheat, enriched flour, farina, flour, gluten, gluten flour, gram flours, high protein flour, HVP, modified food starch, natural flavouring, pasta, semolina, spelt, soy sauce, starch, vinegar made from grain, wheat bran, wheat germ, wheat germ oil, wheat starch, white flour, whole wheat.
Alcoholic beverages such as beer and whiskey.
You may find that you are only sensitive to wheat but if you find that after some respite from symptoms they begin to re-emerge you may want to consider testing other grains as some degree of cross-reactivity has been noted. For example, some individuals with wheat induced asthma also reacted to rye, barley and soya flours. [572]
If you find you are very sensitive to wheat, it is also important to check that you are not using non-food products that contain some wheat. Varjonen et al report on a case of contact urticaria caused by hydrolysed wheat in a body cream. [573] Wheat germ oil is sometimes used as a carrier oil for massage oils - to be on the safe side check all creams, ointments, lotions, shampoos, conditioners and similar products.
How easily you adapt to your new diet will depend on a number of factors including:
* The degree of improvement you've experienced.
* How motivated you are
* Whether you have identified all your food intolerance problems.
* How long you were ill for and how severe your problems were.
* How restricted your diet has become.
* The amount of support you have.
If there has been any improvement please do not give up on yourself - keep going. One of the things that quite commonly happens is that there is some major improvement and then things seem to get a little sluggish and you start to doubt the wisdom of your new diet. Give it a chance.
The older you are the longer you have been putting your body under stress. Your body's first reaction is likely to have been one of celebration and joy and now, after the party is over, it is taking time to recover. Trust it and let it heal in its own time. If you return to your old diet you will simply set yourself back. It is possible, and very useful, to re-test foods but if you had an adverse reaction do not re-test for at least six months. Hopefully, as your body recovers it will be able to tolerate more foods over time. If an allergy has been diagnosed and the reactions you experienced were very severe your wisest course of action will be to always avoid the food.
There are cases where people find they have become intolerant of virtually all foods. I suspect that this is more to do with an undiagnosed food chemical intolerance rather than a problem with the foods themselves. However, if you find that this is happening then rotate the foods that you can eat and gradually introduce others. You rotate foods by never eating the same food on more than one day in any four day cycle.
If you have been carrying large amounts of excess weight you will have found this diminishing. If this is the case you will probably experience times of extreme hunger - do not starve your body, feed it. This seems to be part of an adjustment process and I doubt you will gain any weight. After a few days the need for extra food will subside and if you still need to lose weight it will once again begin to diminish. Avoid the temptation to speed up this process - you will only place extra stress on your body. It doesn't need it. Feed it the right foods for it, and your mind, and your weight will adjust quite naturally.
When you have identified a food intolerance problem you may want to find out more about your condition. The internet is a wonderful place for accessing this information but what you need to try avoid doing is overwhelming yourself with information. At first limit yourself to a couple of sites and gradually build up your store of information. If you want to explore the medical literature you will probably, at some point, find conflicting articles. Personally I am very wary of any articles or research, regardless of who is responsible for it, that categorically states that a particular food is not a problem or that a specific condition is never caused, or at least made worse, by food intolerance. Remember that:
* The individual doctor or researcher may have specific interests that “colour” their work.
* Research is often funded by large corporations including pharmaceutical companies and food manufacturers.
* The research may have been limited to a very small number of cases.
* Food intolerance is often simply not accepted.
* The overall evidence is clear - any food can lead to any symptom.
So search, read and discuss - information is liberating. But, in the final analysis, trust your own results from your own eliminating/testing. The only person who can help you stick to your diet is you. You can help yourself in a number of ways:
* Plan your meals - get really organised.
* Eat regularly and so avoid getting hungry and being tempted to eat the wrong foods.
* Buy cookbooks that provide you with recipes you can use and experiment with.
* Congratulate yourself on having done so well.
* Build in treats that you know you can tolerate.
* Make contact with others with a similar problem.
Be extremely cautious about any processed food or food prepared by others. The easiest way of getting caught out is by trusting someone who says "It's safe - I checked". Ask for a list of the ingredients and check for yourself. If this seems like overkill take note of the following case reported by Schwartz. [574]
A child with a known milk allergy was given chicken soup in a hospital and the result was a nearly fatal case of anaphylaxis. The sodium caseinate that was in the soup had not been recognised by the staff as being a milk protein. More worryingly, they had also perceived reactions to milk as relatively harmless.
Don't assume that because you understand your problems that everyone else will - they won't.
You will have setbacks - accidental ingestion of the food or substance you can't tolerate. The best advice I can give is treat yourself gently. The reaction will pass so don't give in to any cravings that might come. Eat the foods that are safe, rest and learn from the experience.
You've simplified your diet, carried out food tests using the elimination diet and are feeling better. You're quite confident that you know what causes your problem and are careful to avoid the problem foods. Then, inexplicably you have a reaction and find that, no matter how hard you think back and check the food you've eaten, there is no way in which you could have eaten one of your problems foods. You have introduced some new foods but all the ingredients listed are ones you know you are okay with. Have you found a new food problem?
It is possible but, before you put yourself through the rigors of further eliminating and testing, re-check the foods you have introduced. If any of these are processed products remove them from your diet for at least seven days and then try again. If you have a reaction again then the likely culprit is a hidden ingredient that is probably on your NO list. How did this happen? Quite simply legislation may permit a manufacturer not to list an ingredient constituting less than a specific percentage of the total product. You can, if you so choose, write to the manufacturer to verify your own results.
This was demonstrated very clearly in a report by Enrique et al in respect of eggs. They cite the instance of a twenty-five year old woman who had been diagnosed with an egg allergy and told to avoid all forms of egg protein. Two months later she experienced a further reaction after eating a strawberry and cream candy. No egg compound was stated on the candy label. Tests confirmed that it was the candy she was reacting to and also identified the presence of ovoalbumin, which is added to candies as a binder, and this was confirmed by the manufacturers. [575] Cantani reported on similar problems with milk. [576] Other possible forms of contamination are listed by Steinman including: Manufacturing plants using the same equipment to make different products such as milk ice cream and dairy free ice cream; the use of the same oil to cook different foods; “natural” flavours; ingredient switching that involves use of a different oil, nut, sugar, herb or spice; binders and emulsifiers which are not defined. [577]
The move towards wanting to eat organic food seems to arise naturally as part of wanting a healthier diet. Certainly, when one reads about the potential health problems that can be caused by pesticides it seems like the only logical step to take but is it always the right way to go? I ask this question because when no pesticides are used the plant produces more of its own natural toxins so some vegetables and fruit will at times have a higher salicylate content than those grown with the use of pesticides. I am not advocating eating non-organic food but I am raising this issue especially for anyone with a salicylate sensitivity. If you are salicylate sensitive and have found that some of your problems have become worse after switching to organic food this could be the reason why.
One of the areas I have not covered in this book is that of botanical families and the reason for this is I tend to find these mislead people. As Barnes Koerner and Sampson say "Although it is often helpful to think of foods in certain botanical families, no clinical evidence supports consistent broad intra-botanical or intra-species cross-reactivity". [578]
Sometimes the problem is misread and the true problem is in fact a food chemical one. I think the safest approach is never to assume that you will react to all members of a botanical family rather to test of each of the foods individually and if you find you react to them all then first check that you do not have a salicylate or other food chemical sensitivity.
Biochemical individuality is about far more than the foods you can tolerate. It very much deals with the amount of each nutrient that your body needs. For example, some people need far more B6 than others. To assess your individual needs on this level you would need medical help and it may not be forthcoming. Many doctors still believe that the RDA (recommended daily allowance) for vitamins and minerals is more than adequate for all and that we all need the same amounts. Others disagree strongly saying that the RDAs will simply stop the occurrence of diseases such as scurvy (lack of vitamin C) or pellagra (lack of B3).
In 1969 Linus Pauling introduced us to “Orthomolecular Medicine” which focuses on using naturally occurring substances like vitamins, minerals, trace elements, enzymes and amino acids to treat illness and maintain health. Doctors embracing this approach had some startling successes including the treatment of schizophrenia with B vitamins by Dr Hoffer and others. But, sadly this approach has never been embraced more generally by the medical profession. This is not because it does not work or is in some way flawed.
There is a great deal of evidence to indicate that existing diets do not provide adequate amounts of vitamins and minerals even by RDA standards. Werbach's [579] survey of nutritional influences on illness includes a section on nutritional deficiencies. To give you an overview of the type of problems that exist, I will summarise a selection of the findings:
* An American study found that the majority of the US population, especially adult women, were obtaining levels of calcium below the Recommended Dietary Allowance.
* Chromium deficiency is common in western diets relying on high intake of refined foods.
* Iodine deficiency is common in many countries.
* Magnesium intake is often low. Vitamin B3 is often deficient in elderly people.
* Selenium is frequently inadequate in Western diets.
* Thousands of people develop vitamin A deficiency each year.
* Vitamin C intake is often below recommended daily amounts.
* Zinc is commonly inadequate in Western diets.
There are also vitamins and minerals that can help people with food related problems. Some examples follow:
* Vitamin C can help reduce a reaction which raises the blood histamine level and may also reduce MSG sensitivity.
* Vitamin B12 may help reduce sulphite sensitivity.
* A magnesium deficiency may increase allergic reactions and lead to symptoms similar to chronic fatigue syndrome.
* Calcium supplementation may reduce allergic reactions.
* Vitamin B6 may reduce MSG sensitivity.
* A molybdenum deficiency may lead to sulphite sensitivity.
* Vitamin B3 may slow down the release of histamine.
* Vitamin B5 may reduce allergic reactions particularly those involving the nasal passages and help in cases of chronic fatigue.
Getting adequate vitamins and minerals is essential not just to maintain health but also to reduce the impact of allergic reactions on the body. Philpott says that vitamins C, B6 and B3 "have the most important value in preventing such maladaptive reactions". [580] A poor diet that doesn't provide us with the full range of vitamins and minerals that we need can also lead to illness both physical and mental. Some examples follow:
* Vitamin B1 deficiency can lead to irritability, depression, confusion, and an acute sensitivity to noise.
* Diets low in pantothenic acid can make some people depressed, withdrawn and irritable.
* Low potassium levels can lead to fatigue.
* A good quality multi vitamin and mineral supplement with additional vitamin C would seem to be essential for all of us especially if we have been ill or are getting older.
* Older readers should note that studies have shown that many older people do not absorb adequate amounts of many essential nutrients. Supplementation may be the way to remedy this.
Some links between an excess of iron and the development of cancer cells has been found which is why some vitamin companies now produce multi vitamin and mineral supplements that exclude iron. Supplements of individual vitamins and minerals should be taken with great care as many of them rely on other vitamins and minerals to be of any benefit and some in large doses can be toxic. Some examples of problems follow:
* Evening primrose oil can exacerbate temporal lobe epilepsy and may exacerbate mania.
* High doses of folic acid may decrease levels of B12.
* High doses of iron can lead to stomach problems.
* Manganese intoxication can lead to irreversible movement and other neurological disorders. It can also lead to high blood pressure in some people over forty.
* Too much selenium has been associated with hair loss, thickened, fragile nails, nausea and fatigue.
* Exceptionally high doses of Vitamin A can lead to birth defects.
* Large doses of vitamin B6 can lead to neurological symptoms.
* Very large doses of vitamin C can lead to diarrhoea.
Find out as much as you can before you supplement with single vitamins and minerals - it is generally thought that the safest option is to only take individual vitamins and minerals alongside a multi. Pregnant women should seek medical advice as some supplements can be harmful to the foetus.
Be very cautious about the preparations you buy - you really do need to look for quality and you do need to be sure that any supplement you buy is safe for you. If the label is confusing then check with the manufacturer. And if you start to feel worse after taking any supplement - stop taking it immediately. Never start taking more than one supplement at a time - if you have a reaction you will not know which supplement is to blame.
Beware of hypo-allergenic supplements as these may not be safe for you. If you feel unsure of how to go about boosting your system with vitamins and minerals consult a nutritionist and/ or read some of the very good books on the market.
Ideas for other ways in which you can boost your system follow. By making sure that you eat as much fruit and vegetables as you can you will help keep your system balanced towards alkalinity which will also help you feel better. Increase the amount of exercise you take, relax more and do things that interest you. Ill health affects all aspects of our lives and we need to start to put the balance back.
Having said that - don't go mad and try to do too much! This will over tire you and then frustrate you if you find yourself ill again. Gently build up your activities and take lots of rest. Some people have found great help from taking digestive enzymes - find out if these could help you. Various herbs, such as echinacea, can help boost the system but take them with care (reactions to herbs are not unusual) especially if you are salicylate sensitive. You may also like to consider using a water filter to reduce the amount of chlorine and other water contaminants being ingested.
In an article on the detoxification enzyme systems, Liska explores the complex process involved in the body's ongoing battle to deal with toxins. "These mechanisms exhibit significant individual variability, and are effected by environment, lifestyle, and genetic influences". Impairment of these systems could lead to the development of conditions such as Parkinson’s Disease, Fibromyalgia, Chronic Fatigue Syndrome, and other immune system disorders. [581]
It has been suggested that the difficulties some individuals experience with food chemicals and food additives is due to some impairment in this detoxification system that predominantly takes place in the liver. Some individuals have seen improvement in their sensitivities as a result of using supplements to help the liver. Amongst these “cysteine”, a sulfur amino acid is used by the body to manufacture glutathione which plays a vital role in the body's ability to eliminate toxins.
Also, ensure your diet is as high as it can be with fruit and vegetables as many of these, including cabbage and Brussels sprouts, encourage enzyme activity. This effect of vegetables and fruits could in part explain why they seem to protect against certain cancers. And look after your gut. The gastrointestinal tract provides a physical barrier to many unwanted products and, after the liver, is the second major site in the body for detoxification. You need to have a healthy gut so eat well and ensure that you have a good supply of healthy bacteria. If you have had gastrointestinal problems, or still have them, you may find some of the acidophilus supplements useful.
Carl Pfeiffer says that "Every thought and feeling we have can alter, and is altered by, the chemistry of our body". [582] If you have been ill for a long time and are now experiencing better health do not be surprised if, after the initial relief and joy, you experience some feelings of anger and grief about the time you have lost and that you may have been misdiagnosed for many years. By all means look at these feelings, write them out, talk them through with a friend or counsellor but do not get stuck in them
The simple truth is that although improvement in your condition may have been a long time in coming it has arrived. For many people the answer may never appear. Consider yourself lucky, focus on the positive feelings and look to the future. The past, no matter how right or wrong elements in it may have been, has now gone. As you recover, focus on the present and when you feel stronger turn your attention to the future remembering that now you are free of chronic ill health there are many things you can once again dream of doing and actually begin to do.
But please don't make the mistake of rushing into a whole range of new activities. If you were ill for a long time you need to allow yourself time to recover. Release your imagination, explore ideas, rest and try to take pleasure from the moment, the here and now. Getting healthier is an amazing experience, take the time to savour it and the fact that you have been the one to bring it about.
When you feel ready to embark on your new life be gentle with yourself. List all the things you want to do and prioritise them. Don't try do them all at once - you'll exhaust yourself. By being clear about your goals you'll achieve them more easily and with less effort. As you throw yourself into new activities do remember to take the time to monitor your diet and health. As your body and mind changes you may need to make adjustments in your diet.
You may have found yourself, rather than feeling inspired, feeling lost, cast adrift with little idea of what to do next, as if everything that seemed real and solid before has changed. This is most likely to arise if you had been having many psychological symptoms that have now improved or disappeared. The best advice I can give you is to take some time to get to know yourself.
Enjoy the process. Don't assume that just because you did something before in a certain way that you have to continue doing so. You have changed and you can now choose what you do and how you respond. You may find it useful to take some time to explore what your dreams are. A couple of brain storming exercises might help. Firstly write out fifty things you enjoy doing and then write out fifty things you really want to do. Let your imagination fly.
Remember, it was not your fault you were ill. You have always tried to do the best for yourself. Celebrate your achievement.
You may find it useful to make contact with others with a similar problem. How you do this will depend on you as an individual and also where you live. Some options include:
* Support groups - check in your area or with a national organisation that deals with your condition.
* On-line through discussion forums.
* Reading books and articles. If books are out of print then ask at your library - in the UK many can be borrowed via the British lending library.
* One to one - if you know someone else with similar problem arrange to meet regularly.
Support can also come from family, friends and work colleagues but don't expect them to understand if you don't explain it to them. Anybody who has seen you have a reaction will probably be understanding but some of those who haven't may be very sceptical and may even hinder you.
Have patience with others and do try to avoid evangelising - rather than helping this often has the effect of putting people off. I always try to remember what I was like before I knew about my food intolerance problems - basically I knew nothing about allergy or food intolerance and really wasn't very interested. You can't change others so don't be hurt if people don't follow your advice or don't believe you.
Your biggest source of support is always going to be yourself.
Nobody else can control what you eat but you. Become your own best friend and stop worrying about what anybody else thinks.
Here are a few suggestions to help make your life a little easier.
Plan your meals ahead so that you always have food available that you can eat.
Use your freezer - make up extra batches of meals for the days when you just can't be bothered.
Never trust food given to you by others unless you know for definite that they understand what your problems are. Even then you would be better to check by asking for details of the ingredients.
Prepare a list of foods that you can eat (rather than ones you can't) that you can give to others or restaurants to help them in preparing a meal for you.
If you are making a long journey always take more food with than you think you will need - unexpected delays can turn into nightmares if you don't have food and drinks with you that are safe for you.
Take time out to invent or discover new recipes - this will help you stop getting bored with the food you eat.
If you buy any processed food - ALWAYS check the ingredients as these do change.
Use the word “allergic” rather than “food intolerant” with people you don't know - allergy is more accepted and most people will understand that this means you have a problem.
Don't assume that anybody cooking for you will know what foods contain salicylates, MSG, sulphur, additives, milk, wheat etc...
Eat as balanced and varied diet as you can.
Avoid defining yourself as allergic or food intolerant (or any other label). Remain the person who you are. You are not your condition or illness.
Never forget that what works for you may not work for anyone else - avoid converting and being converted to particular diets and/or supplements.
Take advice but then check it out for yourself - nobody has all the answers. The best expert on you is always you.
If reactions affect your mind prepare to deal with them. Have strategies in place for avoiding contact, explaining your behaviour, making yourself feel safe. You may also find it useful, when well, to write yourself a note which 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 as sometimes this helps minimise the effects of the anxiety.
Be gentle with yourself.
We have reached the end of Change Your Diet and Change Your Life. I hope you have found the information useful and that you are well on the way to finding the ideal diet for you.
Health, after life itself, is our most precious possession. Without it we are limited and restricted in what we do and even in how we think.
Never give in on finding the answers to your health problems. Work with your doctors but remember they do not know everything and do not have all the answers.
Always do the very best you can for yourself and remember you are a unique individual.
I wish you well.
Sharla