2.2 FOOD CAN MAKE YOU ILL
Evidence |
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More than 2000 years ago Hippocrates said "Let your food be your medicine and your medicine be your food". He, like many doctors down the centuries, accepted the link between food and illness. In the twelfth century, Maimonides stated that no illness that could be treated by diet should be treated in any other way. They understood that simple changes to the diet were sometimes all that was needed.
Despite overwhelming amounts of evidence accumulated by modern day doctors and researchers, this is not a view that has been embraced by Western medicine. The search remains focused on finding “cures” that have nothing to do with diet and doctors prescribe treatments that relieve symptoms rather than cure them. Yet, it seems that the basic truth that food can make you ill and a change in diet can make you well is continuously being rediscovered by doctors.
It is a sad fact that many people discover that they are food intolerant without the help of a doctor and when they present this information to the doctor they are not believed. As much as I find this highly annoying, I also find it understandable. Vickers and Zollman found that, although nutrition as a science has always been part of conventional medicine, doctors are not taught, and therefore do not practise, much in the way of nutritional therapeutics.[Vickers A, Zollman C. ABC of complementary medicine: Unconventional approaches to nutritional medicine. BMJ 1999;319:1419-1422.]
Dieticians in conventional settings tend to work mainly with particular patient groups such as those with diabetes, obesity, digestive, or cardiovascular risk factors. Apart from the treatment of severe nutritional deficiencies and rare metabolic disorders, other nutritional interventions generally fall outside the mainstream and have therefore come to be seen as complementary medicine.
Also, if you have never witnessed for yourself a food reaction then you will be sceptical. Doctors who begin to use elimination diets, a method of testing for food intolerance, are also at first taken aback at the range of symptoms and the number of foods that their patients claim they have a reaction too. But, in the words of Dr Mansfield: "People do not want to react adversely particularly to their favourite foods, and are more likely to ignore a minor reaction to a favourite food than to invent reactions that do not exist."[Mansfield J. Arthritis, Allergy, Nutrition and the Environment. Thorsons 1995] Obvious really.
In 1998 the British Allergy Research Foundation stated that there is now abundant evidence that conditions such as irritable bowel syndrome and asthma are linked to food allergies but that the connection is still not recognised by many GPs with the result that many people suffer years of misery before they are properly diagnosed (if they ever are). They estimated that one in four people suffers from some form of allergic disease and found evidence that food intolerance causes or exacerbates conditions such as asthma, migraine, nasal congestion, eczema, hyperactivity, irritable bowel syndrome and Crohn's disease. In respect of Crohn's disease, 50% feel better when a particular food is eliminated from their diet. By 2012, they were estimating that one in three Britons had an allergy.[http://www.allergyresearchfoundation.org/More-Allergy-Facts/ Jan, 2012.]
Studies looking at statistics in 2006 found that, since 1990, admissions to hospital, in the UK, for anaphylaxis have increased by 700%, for food allergy by 500%, for urticaria by 100%, and for angioedema by 40%.[Gupta R, Sheikh A, Strachan DP, Anderson HR (2006) Time trends in allergic disorders in the UK. Thorax,. doi: 10.1136/thx.2004.038844] In 1999 the BBC ran a mini series called "Allergy Alert". Their review of studies in different western populations showed at least 15% of the population to be allergic which in Britain means around eight million people.[http://news.bbc.co.uk/1/hi/health/440610.stm]
French Allergy researchers reported that multiple food intolerance in infants and young children is increasing. Moneret-Vautrin et al estimate that more than 40% of infants less than one year old could be affected. The most common food allergens are milk, egg, soya and wheat but other foods are also implicated.[Moneret-Vautrin DA et al. The multifood allergy syndrome. Allerg Immunol (Paris) 2000;32(1):12-5.] In the US, the Centre for Disease Control estimated that in 2007, approximately 3 million children under the age of eighteen were reported to have a food or digestive allergy in the previous year. They also noted that from 1997 to 2007, the prevalence of reported food allergy increased 18% among children under the age of eighteen.[http://www.cdc.gov/nchs/data/databriefs/db10.htm]
Figures vary according to the food and country, and the collection of statistics on allergies is not carried out in the same way in all countries. I could continue quoting figures but at best they are estimates and do not give a true picture of the ways in which food affects health. Part of the problem is with definitions. The focus of these statistics is usually allergies that can be observed objectively using scientific methods of testing. Yet, food intolerance which causes problems for countless people cannot be measured in this way.
Some doctors when quoting statistics will estimate far greater numbers because they are aware of food intolerance but others don't. So what is the truth? At the moment we don't know. I suspect that the number of people with food intolerance problems is far greater than ever suspected but until methods of identifying and classifying these cases is carried out we will not know for definite.
Before continuing, I would like to extend a very big thank you to the doctors, scientists, researchers and the individuals who have participated in the studies outlined below. Without this type of research there would be no hope at all of the medical profession exploring the role of food in illness and health. Maybe, just maybe, we are at stage three in the development of a new medical idea as put forward as a “joke” in Dr Mumby's book The Complete Guide to Food Allergies and Environmental Illness:[Mumby K. Food Allergies and Environmental Illness: the complete guide to. 1993 Thorsons.]
- You are mad.
- There might be something in it.
- There might be something in it but where is the proof?
- Of course, we knew all along.
The purpose of this section is to highlight some of the research that has been carried out that has identified food as the cause of ill health. It is by no means comprehensive, there are thousands of articles out there, but is presented here to give you an idea of the work being done and also to show you that many doctors do recognise that food can make you ill.
These are very brief summaries of just a small proportion of the studies and reports that can be found in the medical literature on the links between food and specific health conditions.
Acute Pancreatitis
Matteo and Sarles report on two cases of acute recurrent pancreatitis, lasting for eight and ten years, characterised by acute abdominal pain. They concluded that both cases were due to food allergy and that food allergy could, for some people, be the cause of acute recurrent pancreatitis. The problem foods, for these people, were beef, milk, potato, fish, and eggs.[Matteo A, Sarles H. Is food allergy a cause of acute pancreatitis? Pancreas 1990 Mar;5(2):234-7.]
A twenty-three year old with recurring episodes of acute pancreatitis and other symptoms (including red patches on the face, generalised itching and diarrhoea) found that root of the problem was cow’s milk.[de Diego Lorenzo A, Robles Fornieles J, Herrero Lopez T, Cos Arregui E. Acute pancreatitis associated with milk allergy. Int J Pancreatol 1992 Dec;12(3):319-21.] Another case of acute pancreatitis was found to be caused by an allergy to kiwi fruit.[Gastaminza G, Bernaola G, Camino ME. Acute pancreatitis caused by allergy to kiwi fruit. Allergy 1998 Nov;53(11):1104-5.]
Anorexia Nervosa
Stolze et al present the case of a woman who had suffered from weight loss, stomach problems, headaches, flushing and bronchial asthma for several years. The diagnosis had been anorexia nervosa. After following a diet low in histamine the woman experienced weight gain and an improvement in all her other symptoms. It therefore appears that the condition she had in fact been suffering from was histamine intolerance.[Stolze I, Peters KP, Herbst RA. Histamine intolerance mimics anorexia nervosa. Hautarzt 2010 Sep;61(9):776-778.]
Arthritis
Links between food and arthritis have been recorded in the medical literature as far back as 1917. Dr John Mansfield, a British doctor specialising in allergy and nutrition, states that most "forms of arthritis are environmentally and nutritionally induced."[Mansfield J. Arthritis, Allergy, Nutrition and the Environment. Thorsons 1995.]
Hicklin et al administered an elimination diet to twenty two people with rheumatoid arthritis. Twenty of the individuals (91%) noticed an improvement in their symptoms, and nineteen found that certain foods repeatedly caused a return or aggravation of symptoms.[Hicklin JA, McEwen LM, Morgan JE. The effect of diet in rheumatoid arthritis. Clin Allergy 1980;10:463.]
Ratner et al studied fifteen women and eight men with rheumatoid or psoriatic arthritis. The people were instructed to remove dairy products and beef from their diet. Seven people improved. The authors concluded that a diet free of dairy products and beef was of value in lactase-deficient women with seronegative rheumatoid arthritis or psoriatic arthritis.[Ratner D, Eshel E, Schneeyour A, Teitler A. Does milk intolerance affect seronegative arthritis in lactase-deficient women? Isr J Med Sci 1985;21:532-534.]
Panush et al outlined a detailed case study of a fifty-two year old woman whose inflammatory arthritis was severely exacerbated by milk.[Panush RS, Stroud RM, Webster EM. Food-induced (allergic) arthritis. Inflammatory arthritis exacerbated by milk. Arthritis Rheum 1986;29(2):220-6.]
Beri et al prescribed an “elimination and rechallenge” diet to twenty seven people with rheumatoid arthritis. Of the fourteen who completed the diet program, ten (71%) showed significant clinical improvement.[Beri D, Malaviya AN, Shandilya R, Singh RR. Effect of dietary restrictions on disease activity in rheumatoid arthritis. Ann Rheum Dis 1988;47:69-72.]
Darlington treated seventy people with rheumatoid arthritis by identifying and eliminating symptom-provoking foods. Of these seventy, 19% remained well and did not require any medications during follow-up periods (ranging from 1.5 to 5 years). The foods that most commonly caused symptoms were: corn (56%), wheat (54%), bacon/pork (39%), oranges (39%), milk, oats (37% each), rye (34%), egg, beef, coffee (32% each), malt (27%), cheese, grapefruit (24% each), tomato (22%), peanuts, cane sugar (20% each), and butter, lamb, lemon, and soy (17% each).[Darlington LG. Dietary therapy for arthritis. Rheum Dis Clin North Am 1991;7:273-285.]
Many studies deal with rheumatoid arthritis but there is also a large amount of anecdotal evidence that links gouty arthritis with a diet too high in purines, and arthritic and joint pain, more generally, has been linked with a diet too high in solanine.
See also Joint Pain.
See also Joint Pain.
Asthma
Asthma is a condition that has been studied extensively and individual foods, food additives and food chemicals have all been found to be responsible for some individuals' asthma.
Businco et al state that, currently, wheezing is considered unusual in food intolerant people but that cases of food-induced asthma have been observed particularly in children.[Businco L, Falconieri P, Giampietro P, Bellioni B. Food allergy and asthma. Pediatr Pulmonol Suppl 1995;11:59-60.] Food allergy may trigger allergic respiratory symptoms through two main routes: ingestion or inhalation.
Some examples of the available research linking food sensitivity with asthma are given below.
- Stevenson and Simon,[i] Stenius and Lemola,[ii] and Freedman[iii] all found that sensitivity to food additives such as metabisulfites, tartrazine, sodium benzoate, and sulphur dioxide acted as trigger factors for asthma in some individuals.
- Pelikan and Pelikan-Filipek found that out of one hundred and seven people with perennial asthma, sixty (56%) had an asthmatic response to ingestion of one or more foods.[iv]
- Allen et al found that MSG could provoke asthma and noted that the reaction to MSG was dose dependent and may be delayed up to twelve hours, after ingestion, making recognition difficult.[v]
- Eriksson found that 24% of adults with bronchial asthma and/or allergic hay fever had some kind of food sensitivity—hazelnut, apple and shellfish being the most common.[vi]
- Rousquet et al identified that between 7 and 29% of asthma sufferers had a milk sensitivity.[vii]
- Genton et al challenge tested individuals with asthma with a number of compounds including acetylsalicylic acid, sodium benzoate, sulfur dioxide, sodium glutamate and tartrazine. Over half of those in the study were found to be intolerant of at least one compound. For some of the group, a diet free of additives resulted in a marked improvement within five days.[viii]
- Pirson et al reported that a person working in a factory producing inulin from chicory developed rhinoconjuctivitis and asthma to the dust of dry chicory roots and oral allergy syndrome to raw fruits and vegetables. A provocation test with dry chicory induced acute rhinoconjuctivitis and an immediate asthmatic response. [ix]
[i] Stevenson DD, Simon RA. Sensitivity to ingested metabisulfites in asthmatic subjects. J Allergy Clin Immunol 1981;68:26-32.
[ii] Stenius BSM, Lemola M. Hypersensitivity to acetylsalicylic acid (ASA) and tartrazine in patients with asthma. Clin Allergy 1976;6:119-129.
[iii] Freedman BJ. Asthma induced by sulphur dioxide, benzoate and tartrazine contained in orange drinks. Clin Allergy 1977;7:407-415.
[iv] Pelikan Z, Pelikan-Filipek M. Bronchial response to the food ingestion challenge. Ann Allergy 1987;58:164-172.
[v] Allen DH, Delohery J, Baker G. Monosodium L-glutamate-induced asthma. J Allergy Clin Immunol 1987;80(4):530-7.
[vi] Eriksson NE. Food sensitivity reported by patients with asthma and hay fever. A relationship between food sensitivity and birch pollen-allergy and between food sensitivity and acetylsalicylic acid intolerance. Allergy 1978;33(4):189-96.
[vii] Rousquet J, Chanez P, Michel F-B. The respiratory tract and food hypersensitivity. In: Metcalfe DD, Sampson HA, Simon RA. (eds) Food Allergy: Adverse reactions to foods and food additives, 2nd ed. Blackwell Science 1997.
[viii] Genton C, Frei PC, Pecoud A. Value of oral provocation tests to aspirin and food additives in the routine investigation of asthma and chronic urticaria. J Allergy Clin Immunol 1985;76(1):40-5.
[ix] Pirson F, Detry B, Pilette C.Occupational rhinoconjuctivitis and asthma caused by chicory and oral allergy syndrome associated with bet v 1-related protein. J Investig Allergol Clin Immunol. 2009;19(4):306-10
Attention Deficit Hyperactivity Disorder
Kidd explains that the exact aetiology of ADHD, which often persists into adulthood, is unknown but that adverse responses to food additives and food sensitivities do play a role in the condition for some individuals.[Kidd PM. Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management Altern Med Rev 2000;5(5):402-428.] The pioneer in this field was Dr Feingold who in the 1970s identified sensitivity to food additives, and often salicylates, as the cause of hyperactivity in up to 50% of children so diagnosed.[Feingold B. Why your child is hyperactive. Random House 1985.]
Although Feingold has been much criticised, it is the case that links between food and behaviour had been previously noted. As early as 1922, Shannon had published information on the successful treatment of children with hyperactivity and learning disorders using an elimination diet; 30-50% of children improved.[Shannon WR. Neuropathic manifestations in infants and children as a result of anaphylactic reactions to foods contained in their diet. Am J Child Dis 1922;24:89-94.]
More recently, Schardt reviewed more than twenty double-blind studies that examined whether food dyes or ordinary foods worsened behaviour in children with ADHD or other behavioural problems. In the majority of the studies, the behaviour of some children worsened after consumption of food dyes or improved on an additive-free diet. Individual foods also caused problems for some children.[Schardt D. Diet and behavior in children. Nutrition Action Healthletter 2000;27:10-11. Washington, DC: Center for Science in the Public Interest.]
Kidd tells us that Feingold's original case histories covered 1,200 cases in which food additives were linked to behavioural and learning disorders, and implicated a vast number of additives yet subsequent research attempting to verify his work has focused on less than a dozen additives. "It is interesting to note that studies conducted in non-US countries produced results markedly more favourable to the Feingold interpretation, and that most of the US investigations were sponsored by a corporate food lobby group, the Nutrition Foundation." [Kidd PM. Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management Altern Med Rev 2000;5(5):402-428.]
As Boris[i] demonstrates, studies that eliminate a single additive tend to show little improvement whilst those eliminating a wider range are a great deal more successful.[ii],[iii] Up to 88% of ADHD children react to these substances in sublingual challenge testing, but in blinded studies no child reacted to these alone.[iv]
[i] Boris M. Food and chemical intolerance: Placebo-controlled studies in attention deficit disorders. In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[ii] Boris M. Food and chemical intolerance: Placebo-controlled studies in attention deficit disorders. In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[iii] Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72:462-468.
[iv] Murray MT, Pizzorno JT. Encyclopaedia of Natural Medicine. Rocklin, CA: Prima Publishing; 1998.
[i] Boris M. Food and chemical intolerance: Placebo-controlled studies in attention deficit disorders. In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[ii] Boris M. Food and chemical intolerance: Placebo-controlled studies in attention deficit disorders. In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[iii] Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72:462-468.
[iv] Murray MT, Pizzorno JT. Encyclopaedia of Natural Medicine. Rocklin, CA: Prima Publishing; 1998.
Carter et al found that on an elimination diet, fifty nine out of seventy eight children with hyperactive behaviour problems improved.[i] Data from two double-blind studies indicated that 73-76% of ADHD children respond favourably to food elimination diets.[ii] Maintenance on even more-restricted, low-antigen (oligoantigenic) diets raised the success rate as high as 82%. Invariably in these studies, reintroduction of the offending foods led to reappearance of symptoms.[iii],[iv],[v]
[i] Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, Taylor E. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69(5):564-8.
[ii] Crook WG. Sugar, yeast and ADHD: fact or fiction? In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[iii] Egger J, Carter CM, Graham PJ, et al. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet 1985;i:540-545.
[iv] Egger J, Stolla A, McEwen LM, et al. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet 1992;339:1150-1153.
[v] Swain A, Soutter V, Loblay R, et al. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2 :41-42
[i] Carter CM, Urbanowicz M, Hemsley R, Mantilla L, Strobel S, Graham PJ, Taylor E. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69(5):564-8.
[ii] Crook WG. Sugar, yeast and ADHD: fact or fiction? In: Bellanti JA, Crook WG, Layton RE, eds. Attention Deficit Hyperactivity Disorder: Causes and Possible Solutions (Proceedings of a Conference). Jackson, TN: International Health Foundation; 1999.
[iii] Egger J, Carter CM, Graham PJ, et al. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet 1985;i:540-545.
[iv] Egger J, Stolla A, McEwen LM, et al. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet 1992;339:1150-1153.
[v] Swain A, Soutter V, Loblay R, et al. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2 :41-42
A study by Boris and Mandel found that dietary factors may play a significant role in the condition of the majority of children with ADHD. Of the children tested, 73% responded favourably to an elimination diet. The children reacted to various foods, dyes and preservatives.[Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72:462-468.]
Breakey, in a 1997 review of key research, mainly from 1985-1995, on the relationship between food and behaviour concluded that the research has shown that diet definitely affects some children. But rather than becoming simpler the issue has become noticeably more complex. The range of suspect food items has broadened, and some non-food items are also implicated. Symptoms which may change include those seen in attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD), sleep problems and physical symptoms, with later research particularly emphasising changes in mood. The reports reviewed also show the range of individual differences both in the food substances producing reactions and in the areas of change.[Breakey J. The role of diet and behaviour in childhood. J Paediatr Child Health 1997;33(3):190-4.]
Kaplan et al conducted a ten week study in which all food was provided for the families of twenty four hyperactive preschool aged boys whose parents reported the existence of sleep problems or physical signs and symptoms. The diet used was far broader in scope than most that had been used in previous studies. It eliminated not only artificial colours and flavours but also chocolate, monosodium glutamate, preservatives, caffeine, and any substance that families reported might affect their child. The diet was also low in simple sugars, and, if the family reported a history of possible problems with cow's milk, it was dairy free. More than half of the boys showed improvement in behaviour and negligible placebo effects. In addition, several non-behavioural variables tended to improve including waking during the night and halitosis.[Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Dietary replacement in preschool-aged hyperactive boys. Pediatrics 1989;83(1):7-17.]
A review of thirty five years of research on the links between diet and ADHD by Stevens et al concluded that there is a subgroup of children with ADHD who improve if artificial food colours are removed from their diet. Some children also seem to be sensitive to common non-salicylate foods such as milk, eggs, and wheat, as well as salicylate containing foods.[Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE. Dietary sensitivities and ADHD symptoms: thirty-five years of research. Clin Pediatr (Phila). 2011 Apr;50(4):279-93.]
In 2007, McCann et al published their findings on the links between food additives and hyperactive behaviour in children.[McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Nov 3;370(9598):1560-7.] They had carried out a randomised double-blinded, placebo controlled trial to test whether the intake of artificial food colours and additives affected children’s behaviour. The tests involved children in two age groups: three year olds, and eight to nine year olds.
They found that a mix of additives commonly found in children’s food could exacerbate hyperactive behaviours such as inattention, impulsivity, and over-activity. Behavioural changes were noted in children who had been diagnosed with hyperactivity and also in children who had not. The additives used in this study were: E102 Tartrazine, E104 Quinoline Yellow, E110 Sunset Yellow, E122 Carmoisine, E124 Ponceau 4R, E129 Allura Red, E211 Sodium Benzoate.
At last there was a study that proved the link between behaviour and additives, and had been carried out in a way that was acceptable to the establishment. The editor of American Academy of Pediatrics Grand Rounds commented as follows: “The overall findings of the study are clear and require that even we skeptics who have long doubted parental claims of the effects of various foods on the behaviour of their children, admit we might have been wrong”.[Editor. ADHD and Food Additives revisited. AAP Grand Rounds. 2008; 19:17.]
It was quite strange watching official bodies and food manufacturers rushing to accommodate findings that literally weeks before they would have denied as being possible. In the UK food manufacturers began to make changes very quickly and the momentum increased so that from July 2010 a, European Union wide, warning has to be placed on any food or soft drink that contains any of the six colours—the label must carry the warning “may have adverse effects on activity and attention in children”. Action in various other countries is also taking place to try implement similar measures.
See also Behaviour
See also Behaviour
Autism
A number of studies have reported a worsening of neurological symptoms in autistic individuals after the consumption of milk and wheat. Lucarelli et al tested the effectiveness of a cow's milk free diet, as well as some other foods, in thirty six autistic people. They noticed a marked improvement in the behavioural symptoms after eight weeks on an elimination diet and concluded that there is a link between food allergy and infantile autism.[Lucarelli S, Frediani T, Zingoni AM, Ferruzzi F, Giardini O, Quintieri F, Barbato M, D'Eufemia P, Cardi E. Food allergy and infantile autism. Panminerva Med 1995;37(3):137-41.]
O'Banion et al studied the effect of particular foods on levels of hyperactivity, uncontrolled laughter, and disruptive behaviour in an eight-year old autistic boy. They found that, for this child, foods including wheat, corn, tomatoes, sugar, mushrooms, and dairy products produced behavioural disorders.[O'Banion D, Armstrong B, Cummings RA, Stange J. Disruptive behavior: a dietary approach. J Autism Child Schiz 1978 ;8(3):325-37.]
Waring and Klovrza on examining the low plasma sulphate levels found in many autistic children state that "the most useful advice that can be given to parents of autistic children is to try a gluten-free, casein-free diet for at least 6 months, also removing chocolate, bananas and citrus fruit".[Waring RH, Klovrza LV. Sulphur Metabolism in Autism. J Nut Env Med 2000;10:25-32.] Reichelt found that for some autistic children diets that were either gluten-free and milk-reduced or milk-free and gluten-reduced resulted in an improvement in some behaviour problems and also a decrease in epileptic seizures.[Reichelt R. Gluten, Milk Proteins and Autism: Dietary Intervention Effects on Behaviour and Peptide Secretion. J App Nutr 1990;42(1).]
Hyperactivity is often a condition that occurs in children with autism spectrum disorder (ASD) which has led to some parents using variations of the Feingold diet. Srinivasan notes that “Salicylates are a subgroup of phenols, and some parents notice that patients with autism have occasional problems with breakdown of phenols”.[Srinivasan, P. A Review of dietary interventions in autism. Ann. Clin. Psych. 21:4, Nov. 2009, 237-247.]
Behaviour
A survey of allergists in the US in 1950 found that more than half had noticed changes in personality when people known to have allergies were exposed to food triggers.[Clarke TW. The relation of allergy to character problems in children; A survey. Ann Allergy 1950;8:75-87.]
Schauss reported that when several Michigan detention centres reduced their inmates' milk consumption, the incidence of antisocial behaviour also decreased.[Schauss AG. Nutrition and antisocial behaviour. Int Clin Nutr Review 1984;4(4):172-7.]
Crook, in 1980, reported on cases where dietary changes have had startling results in children. The examples he cites include aggressive behaviour being triggered by red dye, peanuts, wheat, sugar, and milk; hostile behaviour induced by milk; hyperactivity and irritability by red colours, citrus fruits, and potatoes.[Crook WG. Can what a child eats make him dull, stupid or hyperactive? J Learn Dis, 1980;13:53-8.]
Swain et al found that eighty one out of a group of one hundred and forty children with behavioural disorders experienced significant improvement following the elimination of certain foods and food additives.[Swain A, Soutter V, Loblay R, et al. Salicylates, oligoantigenic diets, and behaviour. Lancet 1985;2 :41-42.] Novembre et al report on cases in which reactions to the food additives tartrazine and benzoate group led to a range of symptoms affecting the central nervous system including headaches, concentration and learning problems, depression and over activity.[Novembre E, Dini L, Bernardini R, Resti M, Vierucci A . Unusual reactions to food additives. Pediatr Med Chir 1992;14(1): 39-42.]
In a review paper, Hall notes that allergies of the nervous system have been found to cause diverse behavioural disturbances including headaches, convulsions, learning disabilities, schizophrenia and depression. Treatment includes using elimination and rotation diets. The observation is made that whilst some of the biological mechanisms have been established by research, others remain to be explored.[Hall K. Allergy of the nervous system: a review. Ann Allergy 1976;36(1):49-64.]
In 1986, Vlissides et al carried out a double blind study on the effect of a gluten-free versus a gluten-containing diet in a ward of a maximum-security hospital. Most of the twenty four individuals suffered from psychotic disorders, particularly schizophrenia. Out of the twelve who had a gluten-free diet, two improved and relapsed when the gluten diet was reintroduced.[Vlissides DN, Venulet A, Jenner FA 2. A double-blind gluten-free/gluten-load controlled trial in a secure ward population. Br J Psychiatry 1986;148:447-5.]
See also Attention Deficit Hyperactivity Disorder
See also Attention Deficit Hyperactivity Disorder
Breast Pain
A study in 1989 by Russell demonstrated a link between breast pain in women diagnosed with fibrocystic breast disease and caffeine intake. After the first year, 81.9% of the women involved had reduced their caffeine intake substantially and 61% of these reported a decrease or absence of breast pain.[Russell L C. Caffeine restriction as initial treatment for breast pain. Nurse Pract 1989;14(2):36-37,40.]
Chronic Fatigue Syndrome
In a paper, Allergy and the chronic fatigue syndrome, Straus concludes that allergies coexist with the chronic fatigue syndrome in more than 50% of people.[Straus SE, Dale JK, Wright R, Metcalfe DD. Allergy and the chronic fatigue syndrome. J Allergy Clin Immunol 1988; 81(5 Pt 1):791-5.]
In his book Chronic Fatigue Syndrome Dr Stoff outlines how food allergies and sensitivities are often a secondary problem that arises with CFS.[Stoff JA, Pellegrino CR. Chronic fatigue Syndrome: The Hidden epidemic. Harper-Collins 1992.]
There is also a great deal of anecdotal evidence of cases where individuals with debilitating CFS have had their symptoms reduced substantially, even eliminated, by a change in diet. Whether a cause or not, food sensitivities cannot be ignored by anyone suffering from CFS. Following general advice on a “healthy” diet will not be enough, sensitivities will need to be identified and accommodated in the diet.
See also Fatigue.
See also Fatigue.
Coeliac Disease
Coeliac disease has been accepted as a condition that is usually triggered by ingestion of gluten in grains such as wheat and rye. The symptoms vary in type and severity from individual to individual but can include diarrhoea, excessive wind, and/or constipation, persistent or unexplained gastrointestinal symptoms, recurring stomach pain, cramping or bloating, tiredness, headaches, weight loss mouth ulcers, hair loss, skin rash, depression, tooth enamel problems, poor muscle co-ordination.[http://www.coeliac.org.uk/coeliac-disease/what-is-coeliac-disease]
There are various testing techniques available to identify if the individual does in fact have coeliac disease. If the condition is confirmed then lifelong adherence to a gluten-free diet is central to the treatment of this disease.[Scanlon SA, Murray JA. Update on celiac disease - etiology, differential diagnosis, drug targets, and management advances. Clin Exp Gastroenterol. 2011;4:297-311.]
See also Colic and Colitis, Gastrointestinal Problems
See also Colic and Colitis, Gastrointestinal Problems
Colic and Colitis
Food allergy has been identified as one major cause of colitis in children which may become a lifelong problem leading to more serious conditions or resolve spontaneously.[i],[ii]
[i] Hill SM et al. Colitis caused by food allergy in infants. Archives of Disease in Childhood 1990;65:1.
[ii] Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT. Food allergy: the major cause of infantile colitis. Arch Dis Child 1984 Apr;59(4):326-9.
[i] Hill SM et al. Colitis caused by food allergy in infants. Archives of Disease in Childhood 1990;65:1.
[ii] Jenkins HR, Pincott JR, Soothill JF, Milla PJ, Harries JT. Food allergy: the major cause of infantile colitis. Arch Dis Child 1984 Apr;59(4):326-9.
Hill et al studied the role of food allergies and problems with additives in babies suffering from colic and found a link between food problems and colic in 39% of the babies studied. They suggest that treatment of healthy babies with colic would usefully include a low allergen diet and appropriate nutritional support.[Hill SM et al. Colitis caused by food allergy in infants. Archives of Disease in Childhood 1990;65:1.]
Enterocolitis is an inflammation of the colon and small intestine. A study by Mehr et al examined various triggering factors including food for children with acute food protein-induced enterocolitis syndrome. Thirty five children experienced sixty six episodes of food protein-induced enterocolitis syndrome—vomiting was the most common symptom, followed by lethargy, pallor, and diarrhoea The majority reacted to a single food but six reacted to two foods. The problem foods were rice, soy, cow's milk, vegetables and fruits, oats, and fish. They concluded that "misdiagnosis and delays in diagnosis for children with food protein-induced enterocolitis syndrome were common, leading many children to undergo unnecessary, often painful investigations".[Mehr S, Kakakios A, Frith K, Kemp AS. Food protein-induced enterocolitis syndrome: 16-year experience. Pediatrics. 2009 Mar;123(3):e459-64.]
See also Coeliac Disease, Gastrointestinal Problems
See also Coeliac Disease, Gastrointestinal Problems
Crohn's Disease
Rudman et al maintained four people with Crohn's disease on a gluten-free and lactose-free diet for twelve days, after which they were challenge tested. Within four to nine days of beginning the gluten challenge they all developed reactions including fever, abdominal pain, diarrhoea, and nausea. The reactions subsided within two to four weeks after discontinuation of gluten.[Rudman D, Galambos JT, Wenger J, Achord JL. Adverse effects of dietary gluten in four patients with regional enteritis. Am J Clin Nutr 1971;24:1068-1073.]
Jones et al was successful in inducing remission for some individuals with active Crohn's disease by dietary changes. The most frequent symptom-provoking foods were wheat, dairy products, brassicas (such as cabbage, broccoli, and cauliflower), corn, yeast, tomatoes, citrus fruits, and eggs.[Jones VA, Dickinson RJ, Workman E, Wilson AJ, Freeman AH, Hunter JO. Crohn's disease: maintenance of remission by diet. Lancet 1985,27;2(8448):177-80.]
Dermatitis Herpetiformis
Dermatitis herpetiformis has frequently been linked with the consumption of foods containing gluten and, sometimes, dairy products. Atherton states that there can be no real doubt that dietary gluten is responsible for most, if not all, dermatitis herpetiformis.[Atherton DJ. Diagnosis and management of skin disorders caused by food allergy. Ann Allergy 1984;53(6Pt2):623-8.]
Various other studies have found similar links.[i],[ii],[iii] However, Kadunce et al found that dietary factors other than gluten were also important in the pathogenesis of the skin lesions in dermatitis herpetiformis.[iv]
[i] Garioch JJ, Lewis HM, Sargent SA, Leonard JN, Fry L. 25 years' experience of a gluten-free diet in the treatment of dermatitis herpetiformis. Br J Dermatol 1994;131(4):541-5.
[ii] Fry L. Dermatitis herpetiformis. Baillieres Clin Gastroenterol 1995; 9(2):371-93.
[iii] Gawkrodger DJ, Blackwell JN, Gilmour HM, Rifkind EA, Heading RC, Barnetson RS. Dermatitis herpetiformis: diagnosis, diet and demography. Gut, 1984;25(2):151-7.
[iv] Kadunce DP, McMurry MP, Avots-Avotins A, Chandler JP, Meyer LJ, Zone JJ. The effect of an elemental diet with and without gluten on disease activity in dermatitis herpetiformis. J Invest Dermatol 1991;97(2):175-82.
[i] Garioch JJ, Lewis HM, Sargent SA, Leonard JN, Fry L. 25 years' experience of a gluten-free diet in the treatment of dermatitis herpetiformis. Br J Dermatol 1994;131(4):541-5.
[ii] Fry L. Dermatitis herpetiformis. Baillieres Clin Gastroenterol 1995; 9(2):371-93.
[iii] Gawkrodger DJ, Blackwell JN, Gilmour HM, Rifkind EA, Heading RC, Barnetson RS. Dermatitis herpetiformis: diagnosis, diet and demography. Gut, 1984;25(2):151-7.
[iv] Kadunce DP, McMurry MP, Avots-Avotins A, Chandler JP, Meyer LJ, Zone JJ. The effect of an elemental diet with and without gluten on disease activity in dermatitis herpetiformis. J Invest Dermatol 1991;97(2):175-82.
Eczema (and Dermatitis)
There are numerous studies linking eczema and dermatitis with food sensitivities. Atherton writes that foods appear to play an important provocative role in many instances of atopic eczema. The reaction often appears to be slow and insidious, is almost always unrecognised by the patient, and is not detected by skin testing or tests for IgE antibodies.[Atherton DJ. Diagnosis and management of skin disorders caused by food allergy. Ann Allergy 1984;53(6Pt2):623-8.]
Van Bever et al in a study of children with severe atopic dermatitis found the condition linked to reactions to eggs, wheat, milk, soya, and various additives including tartrazine, sodium benzoate, sodium glutamate and sodium metabisulphite.[Van Bever HP, Docx M, Stevens WJ. Food and food additives in severe atopic dermatitis. Allergy 1989;44(8):588-94.]
Soutter et al found that in sixty eight children with eczema, 79% had food allergies before the age of ten months and 23% at seven years of age.[i] Burks et al linked atopic dermatitis to sensitivities to a range of foods including egg, milk, soya, wheat, cod/catfish, cashew and peanut.[ii],[iii] Sampson and McCaskill studied one hundred and thirteen children with severe atopic dermatitis and discovered that 56% had food sensitivities—egg, milk and peanut were the most common culprits.[iv]
[i] Soutter V, Swain A, Loblay, R. Food allergy and food intolerance in young children. Asia Pacific Journal of Clinical Nutrition 1995;4(3):329.
[ii] Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, Zuerlein N. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998;132(1):132-6.
[iii] Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr 1988;113(3):447-51.
[iv] Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985;107(5):669-75.
[i] Soutter V, Swain A, Loblay, R. Food allergy and food intolerance in young children. Asia Pacific Journal of Clinical Nutrition 1995;4(3):329.
[ii] Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, Zuerlein N. Atopic dermatitis and food hypersensitivity reactions. J Pediatr 1998;132(1):132-6.
[iii] Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr 1988;113(3):447-51.
[iv] Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985;107(5):669-75.
Hanifin in his study of the links between diet and atopic dermatitis suggests that between 10 and 20% of children and 10% of adults have eczema that is aggravated by food. The most common culprits being eggs, milk, peanuts, seafood, wheat and soya.[Hanifin J M et al. Diet and atopic dermatitis. Western J of Med 1989;151:6.]
Veien et al carried out a randomised, placebo-controlled oral challenge with preservatives and food colourings on one hundred and one individuals with eczema of undetermined origin but who suspected that the intake of certain foods aggravated their dermatitis. Thirty seven reacted to one or more of the food additives but not to a placebo.[Veien NK, Hattel T, Justesen O, Norholm A. Oral challenge with food additives. Contact Dermatitis 1987;17(2):100-3.]
A six-year old boy’s hands became red, swollen and painful. The cause was found to be lime juice. The boy’s hands had been immersed in lime juice whilst he had been helping to make limeade.[Wagner AM, Wu JJ, Hansen RC, Nigg HN, Beiere RC. Bullous phytophotodermatitis associated with high natural concentrations of furanocoumarins in limes. Am J Contact Dermat. 2002 Mar;13(1):10-4.] A fifty-two year old woman had an eczematous rash at the side of her mouth and lips. The cause was discovered to be lime—she had been sucking the lime from her gin and tonic for up to 1 minute after finishing her drink.[Thomson MA, Preston PW, Prais L, Foulds IS. Lime dermatitis from gin and tonic with a twist of lime. Contact Dermatitis. 2007 Feb;56(2):114-5.]
A seventy-eight year old woman 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.[Herault M, Waton J, Bursztejn AC, Schmutz JL, Barbaud A. Shiitake dermatitis now occurs in France. Ann Dermatol Venereol 2010 Apr;137(4):290-293.]
Davies and Orton highlighted three cases of contact reactions to chapatti flour. One woman had a history of developing itchy weals on her hands immediately after handling chapatti flour. Prick testing to her chapatti flour as well as wheat flour and a scratch patch test to chapatti flour all produced positive weal and flare reactions. A thirty-six year old woman had a ten year history of hand eczema as well as sneezing within minutes of exposure to chapatti flour. Patch testing to her flour was negative, but scratch patch testing to chapatti flour and prick testing to wheat were both positive.
Another had a three year history of persistent hand eczema, affecting the palms of both hands and the fingertips. She experienced itching and burning of her hands immediately after handling chapatti flour. Skin prick tests to chapatti and wheat flour were both positive. These are all examples of contact reactions to the flour with none of the women reporting any symptoms after eating cooked chapatti.[Davies E, Orton D. Contact urticaria and protein contact dermatitis to chapatti flour. Contact Dermatitis 2009 Feb;60(2):113-114.]
See also Psoriasis, Urticaria.
See also Psoriasis, Urticaria.
Epilepsy
There have been studies that have shown improvement or recovery from epileptic seizures as a result of ruling out food sensitivities. These were usually most marked in individuals who had additional symptoms such as migraines and digestive problems.
A study of children by Egger et al identified forty two different foods that caused seizures and symptoms in forty five children who had epilepsy with recurrent headaches, abdominal symptoms, or hyperkinetic behaviour. Thirty six of these recovered or improved when their problem foods were removed from their diets.[Egger J, Carter CM, Soothill JF, Wilson J. Oligoantigenic diet treatment of children with epilepsy and migraine. J Pediatr 114: 51-58, 1989.]
Kinsman et al tried the ketogenic diet (high fat/low carbohydrate) with fifty eight epileptic children who required multiple medications. They found that seizure control improved in 67%, medication could be reduced in 64%, also greater dexterity and improved behaviour was noted in 36% and 23% respectively.[Kinsman SL, Vining EPG, Quaskey SA, Mellitis D, Freeman JM. Efficacy of the ketogenic diet for intractable seizure disorders: review of 58 cases. Epilepsia 1992;33:1132-36.]
Pelliccia et al explored the link between cow's milk allergy and epilepsy. Three children with cryptogenetic partial epilepsy and behavioural disorders such as hyperactivity and sleeping difficulties were placed on a milk-free diet. An improvement was observed in the children's behaviour and the electroencephalographic anomalies disappeared. Double blind oral provocation tests did not present an immediate reaction. Reactions occurred a few days after the test but, once placed on the diet again, they disappeared. They concluded that it was feasible that food intolerance could lead to the onset of convulsive crisis.[Pelliccia A, Lucarelli S, Frediani T, D'Ambrini G, Cerminara C, Barbato M, Vagnucci B, Cardi E. Partial cryptogenetic epilepsy and food allergy/intolerance. A causal or a chance relationship? Reflections on three clinical cases. Minerva Pediatr 1999;51(5):153-7.]
Fatigue
Fatigue is a very common symptom of food intolerance but has rarely been studied in isolation as it is usually one of a number of symptoms.
Randolph and Moss present the case of a male college student with unexplained fatigue and other symptoms such as irritability and nervousness. After a food testing protocol was carried out, it was found that his fatigue was always brought on by dairy products and eggs. In another case the incriminating foods were pork, milk, egg, potatoes, beets and beet sugar.[Randolph TG, Moss R W. An Alternative Approach to Allergies: The new field of clinical ecology unravels the environmental causes of mental and physical ills (revised edition). Perennial Library, Harper & Row 1990.]
A Japanese study by Kondo et al showed how traditional methods of testing were not successful in identifying sensitivities to cow's milk and buckwheat in individuals with allergy-tension-fatigue yet these substances were the cause of their fatigue.[Kondo N, Shinoda S, Agata H, Nishida T, Miwa Y, Fujii H, Orii T. Lymphocyte responses to food antigens in food sensitive patients with allergic tension-fatigue syndrome. Biotherapy 1992;5(4):281-4.]
See also Chronic Fatigue Syndrome.
See also Chronic Fatigue Syndrome.
Gallbladder Disease
Breneman conducted a study of sixty nine people with gallstones or post-cholecystectomy syndrome. They were all placed on elimination diets with foods being gradually reintroduced. All the people were relieved of their symptoms usually within three to five days. Egg was the most frequent offender (93%), followed by pork (64%) and onion (52%).[Breneman J. Allergy elimination diet as the most effective gall bladder diet. Ann Allergy 1968;26:83.]