3.2 Food Intolerance and Food Allergy

Pages 100-130 from The Food Intolerance Handbook
Copyright (c) Sharla Race. All rights reserved.

3.2 FOOD INTOLERANCE AND FOOD ALLERGY

The Seven Step Plan

The Seven Step Plan is a simple and easy to use system for identifying food intolerance problems. It is designed to help you take things at your own pace and to place as little stress on your body as possible.

Step 1: Decide to take some action

In many ways this step is the hardest. Change is something that is constantly happening within and around us yet our naturally tendency is to resist change. This is a normal human response but one we need to be aware of when reviewing our diet and health

In respect of health, we are more used to being told what to do rather than choosing a course of action for ourselves. If a doctor says there is nothing wrong with us, then, despite our symptoms, we accept the diagnosis and often interpret it as meaning that there is nothing that can be done. As you are reading this book and have reached this stage. You are probably fed up with being ill, overweight or depressed and you will probably have already tried many other avenues of help. Please don't despair—I managed to find a route to better health after more than thirty six years of being ill and miserable. If I can do it then I have every faith that others can also do it.

I am, however, not offering a quick fix—I wish I could—rather a slow evaluation of your situation and a move towards finding the diet that works for you which, when found, will change your life.

What you most need to know and remember is that the only true expert on you is yourself. Your instincts may have become a little clouded but they are still there and will re-emerge to help you. I used to laugh when I read advice like “listen to your stomach” or liver or some other organ—I couldn't differentiate one from another. I also could not trust my inner voice about whether a food was good for me or not—it was all simply food, in the shops and therefore safe. It was not something I thought about except in terms of whether it was “healthy”.

The self-preservation instinct does re-emerge when you start to remove the layers of toxins and you do come to be able to listen to what your body is saying, whether it is because it needs something different or needs you to stop eating something. This will happen for you but for now trust more in observation and logic than feelings.

However, we are not going to completely ignore feelings. Before you decide to take some action you need to be clear about what it is you are trying to change. Your overall goal will be to find the ideal healthy diet for you but the other details will be very specific to you. Start by writing out how you feel about your health and how you feel about what you have read so far in this book.

This will be useful for you to later look back on—as you get better you will begin to forget how awful things were and having something in writing will boost your confidence and help you keep going. If you don't know where to start then take a pen and some paper, sit somewhere quiet, take a few slow deep breaths, and simply begin to write. Don't worry if you start writing gibberish. Just let the words flow—this is for your eyes only.

Why bother? Not feeling well, whether physically or mentally, takes a massive toll on us especially if we simply have to get on with all the usual demands of life—work, family, housework, social commitments etc... You will have strong feelings about your health and it is better to get these out than to keep them locked inside. You may be surprised at what you discover.

Later... Take some more paper and list all your symptoms. For each symptom note any diagnosis and treatment and how effective it has been. Identify the symptoms that just do not seem to change no matter what you do (and this can include changes you have made in your diet). Now decide that you want to take some action. Write a note to yourself promising yourself that you are going to do the best you can to make yourself better by changing your diet.

Step 2: Simplify your diet

Food, even in its simplest form, is a complex substance. Combine a whole range of foods and additives together and you increase the complexity.

If you are sensitive to any foods or food chemicals you need to find out which ones. To find out you will have to test foods. In order to test foods you will need to eat them in their simplest, most natural form possible. The more complex your diet the harder it will be to unravel a food intolerance problem. It is essential that you simplify your diet.

Reactions to products such as chocolate, a chicken salad sandwich, steak pie, oven ready chips (fries), or lentil burgers tell us nothing. We need to know which ingredient in these products brought about the reaction. If we don't then it is likely that our problems will recur. To clarify let us look at a couple of examples.

A reaction to milk chocolate could be a reaction to milk, cocoa, cocoa butter, vegetable fat, a flavouring (usually some form of vanilla –natural or manmade), the type of sweetener used, or soya (in the form of lecithin).
A reaction to a shop bought chicken salad sandwich will leave you unsure as to whether the problem was one of the ingredients in the bread that was used, the chicken, one of the salad ingredients, one of the ingredients in the margarine, or one of the ingredients in the salad dressing.

You need to simplify your diet. If, for example, you had made the chicken salad sandwich at home you would have known exactly what went it and you could have left out the dressing so that the sandwich contained fewer ingredients.

The complexity of ready-made food is astounding. If I make shepherd’s pie at home it will contain minced beef, onions, possibly some herbs, potato and oil. Yet if I buy a ready-made one it will also contain a mix of food additives that are there to ensure the food maintains its structure, texture and taste. It may also contain a stock that has many ingredients and thickening agents. Suddenly my body is faced with having to digest and deal with thirty plus chemicals rather than just a few.

If you don't simplify your diet you will find it very difficult to identify problem foods, will find yourself getting very confused and eliminating foods that are okay for you whilst eating others that are not. This is a very common problem. Save yourself time and misery by truly simplifying your diet before testing for food intolerance problems.

By far the easiest way to simplify your diet is to reduce the amount of processed food you eat and to eliminate, as much as you can, food additives. Your goal should be to eat your usual diet in as natural a form as possible. Ideally you would remove all processed food and all additives but we live in a busy world and even with the best of intentions you will find this difficult but aim to get as near to it as you can—don't sell yourself short.

We have become very dependent on processed food and at first it is daunting to consider breaking this dependency. Make the change gradually. Do not make any drastic change to your diet—simply try replace the more complex foods with similar ones with fewer ingredients. There are lots of ways in which you can do this. For example:

Plain crisps often contain only potatoes, vegetable oil and salt. Flavoured crisps are far more complex as they include a variety of flavourings and colours.
Breakfast cereals can contain colours and preservatives. Choose a similar one that contains fewer ingredients or make your own muesli from ingredients purchased at a health food shop.
Cereal bars are often seen as a healthy option but many contain artificial flavours rather than real fruit, sugar and can be high in fat. Choose bars that only contain cereals and fruit.
Chocolates can be packed with added flavourings, colours, emulsifiers, raising agents, biscuit pieces and other ingredients. Choose ones that have the fewest number of ingredients. A simple chocolate bar will have far fewer ingredients than one that has been flavoured or had other things added.
Sweets (candies) can be extremely complex products but there are now some on the market that contain very few, or no, artificial colours and flavours. The brighter, more unnatural the colour the greater the number of additives.
Fizzy drinks can often be a cocktail of chemicals—check the labels and choose the one with the least or, if you feel ready, change to drinking mineral water or try adding a small amount of fresh fruit juice, such as orange or lemon, to some sparkling mineral water). Try avoid all artificial sweeteners.
Nuts can be bought in their original form without added oils, salts and flavourings.

A few tips:

Go as natural as you can.
Cook your own meat and do not buy processed meats like salamis and sausages. If you absolutely have to eat these products search out the ones with the fewest ingredients.
If you eat yoghurt then buy the natural variety and add your own fruit.
Avoid tinned vegetables and fruit—stick with fresh or use frozen.
Never buy ready-made meals as these are incredibly complex. Buy the ingredients instead and make your own (if you're not a cook then buy a cook book and you'll soon be on a journey of discovery to the true taste of food).
Dishes requiring sauces are easy enough to make if you take the time to find out how. A tomato based sauce using tomatoes, onion, garlic and a sprinkling of herbs takes only minutes longer to prepare than a shop bought one.
If you eat sandwiches for lunch then make your own rather than taking your chance at the sandwich bar or eating too much in a cafe or restaurant. If you are interested in losing weight this will also help you reduce your calories without trying—most of us do not use the amounts of margarine and dressings that a commercial outlet does.
Margarines can be highly coloured—choose the one with the smallest number of ingredients and preferably one that tells you which type of oils are actually used. The term “vegetable oil” can mean one or a combination of many different types.
If you have a freezer, cook meals ahead and freeze them.
If you have to eat away from home choose the simplest menu option and avoid sauces.
Always have a low additive snack food or fruit with you.
Avoid buying food on impulse.

The easiest way of helping yourself is to plan ahead. Sit down and work out the meals you will eat for the week and buy accordingly. If you leave the decision until half an hour before you need to make a meal your options will be limited and you are more likely to succumb to heavily processed food.

Takes too much time? It doesn’t really. If you don’t plan and prepare you probably spend more time each day waiting for your food to be cooked at take-outs or rushing around supermarkets trying to decided what to have.

Still seems difficult? Don't worry and don't panic. I am not expecting you to make a total change overnight. Gradually decrease the amount of processed food in your diet. Do not, however, change the basic structure of your diet. Eat the same type of foods you were eating only in a more natural and simpler form. So if you are vegetarian do not suddenly start eating meat. If you have never eaten nuts then do not start. If you have always avoided lettuce do not start eating it. And so on.

Food additives

I am frequently asked why I am so keen that you reduce the number of additives as surely these are safe. Well, yes some maybe but some may not be. Each country has regulatory bodies that deal with the safety and regulation of how additives are used in food. The quotes below from the UK government are a typical official view.

Additives allowed in the UK are "considered safe for almost everyone... There are a few additives to which a few people may react badly. But this is not good enough reason to ban such additives: substances in everyday food like milk, wheat, oranges or strawberries upset far more people. The value of the additive to everyone is weighed against the upset it may cause to a small number of people".[MAFF (Ministry of Agriculture, Fisheries and Food). About food additives. Booklet 2 in food sense ser, 1997.]

So safe for some but not safe for all. The truth is that you can be intolerant of any additive or group of similar additives. As it is rarely possible to test these in isolation from food it is far better to begin your food intolerance testing with real food. As Hannuksela and Haahtela point out, food additives seldom provoke true allergic (i.e. measurable) reactions. Intolerance is more likely to take place and this type of individual intolerance may change and fluctuate from time to time.[Hannuksela M, Haahtela T. Hypersensitivity reactions to food additives. Allergy 1987;42(80:561-75.]

Additives have been implicated in a wide range of health problems including behaviour problems, bloating, headaches, gastrointestinal problems, respiratory difficulties, and skin problems. Antico and Di Berardino found additives to be a frequent cause of skin complaints.[i] Leira and Rodriguez found them implicated in migraines.[ii] Novembre et al saw them induce symptoms in other organs including the joints and central nervous system, symptoms included over activity, concentration and learning difficulties, and depression.[iii] Rowe and Rowe found they caused hyperactivity in some children.[iv] Kanny et al demonstrated a link between additives and dermatitis.[v]
[i] Antico A, Soana R, Clivio L, Baioni R. Irritable colon syndrome in intolerance to food additives. Minerva Dietol Gastroenterol 1989;35(4):219-24.
[ii] Leira R, Rodriguez R. Diet and migraine. Rev Neurol 1996;24:534-8.
[iii] Novembre E, Dini L, Bernardini R, Resti M, Vierucci A . Unusual reactions to food additives. Pediatr Med Chir 1992;14(1): 39-42.
[iv] Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125(5Pt1):691-8.
[v] Kanny G, De Hauteclocque C, Moneret-Vautrin DA Sesame seed and sesame seed oil contain masked allergens of growing importance. Allergy 1996;51(12):952-7.

Even the additives that are classed as “natural” have been implicated in health problems. For example, Ebo et al describe the case of a fifty-eight year old man who experienced four episodes, in three years, of severe anaphylaxis with urticaria, angioedema and finally loss of consciousness within a few minutes after eating a sandwich or toast with Gouda cheese. Testing confirmed that the problem was annatto (E160b).[Ebo DG, Ingelbrecht S, Bridts CH, Stevens WJ. Allergy for cheese: evidence for an IgE-mediated reaction from the natural dye annatto. Allergy 2009 Oct;64(10):1558-1560.]

Scurlock et al outline the case of a young girl who experienced anaphylaxis after eating gummy bears. She was tested for allergy to the various ingredients but all results were negative. The authors concluded that she was reacting to the added "natural and artificial flavors" but because the manufacturers would not disclose the ingredients within these it was not possible for them to identify the exact culprit. The authors write: "Currently, vendors are reluctant to reveal the variable components of these flavorings. In light of the potentially life-threatening complications that can ensue from consumption of these products, cooperation with industry and improved labelling of all ingredients is essential”.[Scurlock AM, Althage KA, Christie L, Burks AW, Jones SM. Anaphylaxis after ingestion of gummy bears. J Allergy Clin Immunol 2002;1(10).]

The list goes on and on... Food additives can cause serious problems for some people. They also make your diet incredibly complex and that is why I want you to reduce them. Basically if it was not something you would place in your food when cooking at home then avoid it. Not only will you simplify your diet but you will also discover how food is supposed to taste. You need to be aware that many additives are present in food but are not listed amongst the ingredients (this may vary from country to country).

Some of the ways in which additives are hidden in food as well as other labelling problems are listed below:

Some food ingredients need only be identified by a generic term (such as oil or spices) and additives used in such ingredients need not be named.
Additives contained in ingredients of a food rarely need to listed unless they perform a technological function in the final foodstuff.
Flavourings do not have to be individually listed only the term “flavouring” need appear. There are more than 3000 flavourings in use. You will have no idea which one has been used, what it is made from or how it was produced.
Terms such as “vegetable oil” and “sugar” can be potentially misleading. “Sugar” could be cane, beet or corn sugar and could change over time as the manufacturer decides which is the best option for him to use (usually the cheapest ). Vegetable oil could be rapeseed, corn, soya, sunflower and so on–it is probably best to use an oil that is just, for example, sunflower or olive oil.
Modified starch frequently appears on labels but we have no knowledge of the source and this could again vary from batch to batch depending on economic factors at the time of manufacture.
Additives are manufactured substances but their identifying name and number provide us with no indication as to the origin of the substance. This can cause problems for some individuals. For example: Anyone sensitive to aspirin is best avoiding azo dyes which are often used in the production of food colourings. Someone with a lactose intolerance may need to avoid, among others, E325 which is the sodium salt of lactic acid.
Some food and drinks are exempt from listing their ingredients including: alcoholic drinks and some, including beer, lager, cider and wine, can contain a number of additives; bakery items such as bread, cakes, pastries and cookies; take-away and fast foods. Consume any of these foods and you will not know what you are eating.
Additives used as processing aids need not be listed. These include powders and greases to stop foods sticking, anti-caking agents to stop powders forming lumps, acids that produce raising agents, and bleaches. In theory only a residue will remain in the food you bought but you will not know what has been used or how much of it has been left behind in the product you're eating.
The term “allergen free” is misleading as it only means that the food does not contain the substances on the current list of excluded allergens. The current EU list is: gluten containing grains, crustaceans, eggs, fish, peanuts, soybeans, milk, most nuts, celery, mustard, sesame seeds, lupin, molluscs, and sulphur dioxide and sulphites at certain concentrations.

The complexity of any processed food is further increased by hidden additives—the sausages with fifteen listed ingredients could in reality contain more than thirty different substances. If you bought some mince and rolled it into sausage shapes you would be providing your body with a less complex product to digest with just two ingredients—the meat and the oil you fry the “sausages” in.

The comfort of added vitamins could also, rather than helping, be hurting. BHT and BHA are frequently found in margarines and other vitamin-fortified foods. Feingold identified vitamins A, D and E as frequently containing BHT, one of the substances he identified as being linked with hyperactivity.[Feingold B, Feingold H. The Feingold cookbook for hyperactive children and others with problems associated with food additives and salicylates. Random House, 1979.]

It is also the case that for many additives there is a safe daily intake level known as the “Accepted Daily Intake” or ADI for short. Even if you knew the amounts you would not be able to gauge the amount you were ingesting as the amount per serving is not declared on labels and many substances do not have to declare the amounts available. For example, sulphites (E numbers 220 to 228) are frequently used in wines, beers and ciders—drink too much and you could exceed the ADI.[i],[ii] Likewise with antioxidants such as BHA, BHT, TBHQ and gallates—these are all commonly used in foods that contain fat, such as crisps and chips, and they do have ADIs.
[i] Hanssen M. E for additives. Thorsons 1991.
[ii] Simon R A. Adverse reactions to food and drug additives. J Imm All Clinic NA 1996;16(1):137-76.

Certainly as an individual, you would not be able to calculate the amount of BHA, for example, that you had ingested. Even if the exact amount was stated on each item and you did the calculation according to your weight and the other foods you had eaten that day that contained BHA you would still not have a complete picture. How much had you taken in from ingredients that had not been listed? Was there any on the packaging and if so what amount was likely to have migrated into the food you ate? Had any been used as a processing aid?

The scientist would say that you don’t need this information as the amounts are negligible. But the reality is that these amounts can cause problems especially if they ingested daily on a long term basis and when you are trying to identify a food intolerance problem having these type of additives in your diet can seriously cloud the results for you.

Do you really want to be eating cocktails of chemicals whose effects we know so little about? If your answer is "no, but it is easier, convenient and probably okay", I know exactly how you feel.

Make the changes that you can but be aware of the potential problems. I will, later in this book, explain how to use a food diary that may help you pick up on some of these hidden problems.

As you make the changes you may begin to experience some improvements. If you do please make a note of them as the information could prove valuable later. And remember, even if you start to feel much better, this is only the beginning, better things are yet to come. If, however, you find yourself becoming more irritable, tired and feeling stressed stop and think before you revert back to your normal diet. Your body could just be detoxifying and this can take time.

Additives are thought to accumulate in the body so it can take some time for the body to eliminate them.[Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125(5Pt1):691-8.] If you have had a problem with some food additives then your body could be experiencing withdrawal and this, not the change in your diet, could be making you feel ill. Persevere but please remember to eat the more natural versions of what you were eating rather than introducing foods unfamiliar to your body.

You need to stay at this stage for at least two weeks but you can stay here for as long as you like or need. If the improvements have been startling you may decide not to continue with the following stages, you can always do so later. If you have felt ill then you need to give yourself time to build up your strength and allow your body to continue with its elimination of built up toxins and healing before continuing with specific food tests. If there has been little or no change then press on to the next stage.

Step 3: Know what you are eating

Food intolerance is difficult to diagnose and, at the moment, the only accurate way is to eliminate foods from your diet and then reintroduce them. If you are doing this for more than one food or for any food chemical you will get confused. Don't assume you will be able to remember what you've eaten or how you felt—you won't.

Keep a food diary and keep it diligently. Not only will it help you keep track of the food you've eaten and how you felt but it will also help you monitor changes. I recently found one of my very early food diaries and was quite shocked at how ill I had been and also how complex my diet used to be. I had forgotten and it was a very helpful reminder especially as I was going through a bad reaction at the time.

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. This is understandable. If you have never witnessed for yourself a food reaction then you will be sceptical. One way of helping present the evidence to your doctor is by use of a food diary—he may still be sceptical but at least you have it down on paper and are not just waxing lyrical about the changes that have taken place. If you are going to use your food diary as evidence for your doctor do endeavour to keep it as clear and concise as possible. The more professional it looks the more he is going to be inclined to read it and, hopefully, accept your findings.

You can download a free print for yourself Food Diary from the Food Can Make You Ill Web site: www.foodcanmakeyouill.co.uk. You can also make your own—buy a notebook or paper and a binder. You will need one page for each day. Divide the day into three segments. Draw a line down the centre of the page, dividing it in two. List the food you eat on the left side and your symptoms on the right hand side. See the example page below.

As you need to list all the ingredients in every meal, you will find it easier if, at the back of your notebook, you keep a list of any complex foods that you eat and their ingredients. For example, if you eat muesli then in your complex foods list add “muesli” and list the ingredients fully—oats, wheat flakes, coconut, sunflower seeds, almonds, sultanas, hazelnuts and so on. Then when you eat muesli you only need to write “MUESLI”.

Why so detailed? It can be extremely difficult to identify some food intolerance problems and a very detailed food diary can provide you with the clues that you need. By the way, a complex food is any one that contains more than one ingredient such as muesli, soup, biscuits, sauces, pastries. You should also note the brand name of the product. The example page lists all the complex foods in block capitals.

Use your diary fully. List all ingredients of every meal and their scores (when applicable). Make a note of any medication you may be taking. Write down any changes whether positive or negative—include all physical and mental changes. If you get a cold, flu or tummy upset write it down so that you can try separate it from any other changes. Write down anything you feel is significant. For example, if you had a headache after being stuck in traffic for two hours note down that the journey was the probable cause.

Write up your diary every day. If you forget or find yourself too ill to do it then don't punish yourself or give up on the idea. Simply write down what you can remember and also why you didn't write it at the time—this could be vital information as many mental symptoms can be produced by food intolerance, most classically brain fogging and confusion.

Step 4: Develop a strategy

At this stage you need to decide on which you foods or food chemicals you are going to test. If you already have suspicions about certain foods then start with those. Check back over your food diary and see if any type of pattern is emerging—do remember that problems with food can manifest many hours, even days, after being eaten.

If you are still uncertain read through the sections on food chemicals and food problems. It is likely that at least one of these will leap out at you. If it doesn't think about the foods that you eat and have eaten in the past. Are there any you feel you just cannot live without? Unfortunately, this probably indicates a food addiction whose underlying cause is usually an intolerance problem. Remember any food can cause problems.

You may have refused certain types of food as a child but been made to eat them because they were “good for you” (children who are “picky” eaters could be signalling a food intolerance problem). You may know that some foods give you stomach problems or a hangover effect but because you enjoy them or they are “good for you” you keep on eating them.

Make a list of the foods or food chemicals you want to test and prioritise them—put the one you think is the most likely culprit at the top of your list and the reason why. Do not be tempted to try to eliminate more than one food or food chemical at a time. Rather than speeding up the process this will lead to confusion and cause additional stress to the body. Please, also, do not be tempted to fast and then introduce one food at a time. This places enormous stress on the body, leads to confusing results and the slow process of reintroducing foods can lead to a diet that does not sustain health. There is a time and place for fasting and this isn't it.

I receive many requests from people asking me where they should start and it is impossible for me to direct them, or you, to the specific food, foods or food chemicals that may be causing them or you a problem. You are a unique individual and what causes you a problem may be totally okay for someone else. As I've said before although a food may cause a certain type of reaction in some people it will not always cause this symptom.

However, I do understand how difficult starting out on this journey can be and I accept that you may need some further guidelines so, if you are truly uncertain as to where to begin, use the check list below to guide you. Find your main symptom and then read the corresponding sections in the book and see if any “speak” to you.

Acid reflux: caffeine, capsaicin.
Anxiety: caffeine, MSG, salicylate.
Asthma and breathing difficulties: benzoates, histamine, lectins, milk, MSG, sulphur and sulphites.
Behaviour problems: gluten, milk, salicylates, wheat.
Catarrh and sinus problems: milk, salicylates.
Depression: caffeine, gluten, grains, salicylate, sugar, wheat.
Fatigue: caffeine, MSG, wheat.
Gastrointestinal problems: amines, capsaicin, gluten, grains, lectins, legumes, milk, oxalic acid, purines, sulphur and sulphites, wheat.
Gout: purines.
High blood pressure: tyramine.
Hyperactivity: caffeine, salicylate.
Joint pain: gluten, lectins, purines, serotonin, solanine, wheat.
Kidney/bladder stones: oxalic acid, purines.
Migraines: amines, caffeine, histamine, phenylethylamine, serotonin, sugar and sweeteners, tannins, tyramine.
Mood swings: gluten, MSG, salicylate, solanine, sugar, tyramine, wheat.
Mouth problems: capsaicin, fruit, histamine.
Panic attacks: caffeine.
Restless legs: caffeine, grains, salicylate.
Skin problems: benzoates, fish, fruit, grains, histamine, milk, peanuts, salicylate, wheat.
Sleeping problems: caffeine, gluten, milk, salicylate.
Tics: caffeine, salicylate.
Tinnitus: salicylate, sugar and sweeteners.

If you still remain uncertain as to where to start then consider testing wheat and/or milk. I only suggest these as they are two foods that are often consumed many times a day. A “holiday” from either of them will not do you any harm. If there is any other food that you have eaten each and every day of your life then that food could also go on your suspect list. Dr Mumby identifies three main allergens for adults: wheat, dairy produce, and instant coffee. He writes: “If one were simply able to persuade the entire population to give up just these three foods, the change in the health of the nation would be dramatic”.[Mumby K. Food Allergies and Environmental Illness: the complete guide to. 1993 Thorsons.]

Be gentle, take it slowly.

At this stage you need to consult your doctor. Dr Michael Tettenborn a consultant paediatrician at the Frimley Children's Centre in Surrey, suggests that many doctors have been turned against dietary management because some people have made excessive claims about its potential impact and that their scepticism is fuelled by the range of tests in use by non-medical practitioners.[Tettenborn M. Health Doctors "allergic to truth about food". BBC News on-line Tue Oct 13 1998.] Bearing this in mind I have outlined a strategy that you can use in preparing for your appointment:

Make a list of the symptoms that concern you with details of how long these have been a problem.
List any treatments you have tried and their outcomes.
Make a few notes for yourself as to why you want to test for food intolerance—this will help give you confidence when talking to your doctor (we all get nervous and if you are unwell your self confidence will be low).
Take the food diary you will be using—this will show your doctor how he can follow your progress. The food diary is going to be your way of presenting evidence.
If you want to take additional information along with you make sure it is information that is acceptable to your doctor. Many doctors are suspicious of information obtained on the Internet so ensure that you know the source of what you are presenting. Details of articles in medical journals are going to carry more weight than somebody's home page.
Remember that your doctor is an individual who has been trained in medicine—he is there to help not hinder you. If you are not happy with your doctor you always have the option of changing to another one.
Remember it is okay to ask questions, make suggestions and take notes.
If your doctor is obviously pushed for time then suggest you make an appointment for a longer session later.
Remember your doctor is a human being like you. He, like you and I, is not perfect. Your doctor does not know everything but then neither do you or I. Respect and co-operation are better than hostility and antagonism.

As unravelling illness can be a complex process I advocate the path of co-operation with the medical profession but I am also very aware that you may meet resistance. If at all possible seek help from another doctor or an alternative practitioner. If you do decide to go ahead with testing on your own please take extreme care when testing foods—it is always best to have someone else, who understands what you are doing, present just in case you have a severe problem. NEVER stop medication without your doctor's consent.

Once you have decided on your strategy then decide when you are going to begin the next step—eliminating the suspect foods. You can repeat the next three steps as many times as you need and at your own pace, returning to step two whenever you need.

Step 5: Eliminate suspect foods

The key to successfully eliminating a suspect food lies in planning. Know when you are going to start and know, in detail, what you are going to eat. It is essential that you plan your meals carefully so that you do not unwittingly eat any of the test food.

You may have read about other elimination diets that involve periods of fasting or insist that you stop drinking tea and coffee and stop smoking. The approach outlined in this book asks that all you do is eat your newly simplified diet and eliminate only the food, in all its forms, that you are testing. If you try to eliminate other foods or drinks or try stop smoking at the same time you will make it virtually impossible for yourself to identify what substance is causing what problem.

One food or food chemical at a time.

Elimination diets that ask you to remove a range of foods at one time may, at first, seem like the easiest and most straightforward option. Although avoiding a host of foods at one time may in fact be just as easy as avoiding one, the difficulties arise at the time of testing. Reactions can be delayed and confusing and tests may need to be repeated.

It is also possible to misread results as a study by Bethune et al showed. They reported on how three individuals had self-diagnosed a carbohydrate intolerance and had gone on to develop increasingly restrictive diets as their symptoms kept on reappearing. They found that carbohydrate restriction can disturb glucose metabolism and that this may be interpreted falsely as food allergy.[Bethune CA, Gompels MM, Spickett GP. Physiological effects of starvation interpreted as food allergy. BMJ 1999;319:304-305.] Mumby confirms this and advises against remaining on a very low carbohydrate diet for too long. Although these type of diets can help correct low blood sugar problems they can then go on to reproduce the symptoms if the body is not able to convert sufficient protein into carbohydrate.[Mumby K. Food Allergies and Environmental Illness: the complete guide to. 1993 Thorsons.]

These type of blood sugar problems can cause a variety of symptoms many of which mimic allergy problems as well as sometimes being caused by them. These include cravings for sweet foods, feeling tired, anxiety, shaking and inner trembling, depression, irritability, difficulty concentrating, light-headedness, and joint pain. If eating relieves the symptoms at least temporarily then you are likely to have a low blood sugar problem. It is not just eating too little carbohydrate that can cause this it can be that you are simply not eating enough—a risk for anyone changing diets especially if you are keen to lose weight. Make sure that you are eating enough and regularly. Don't worry about the calories as, once your diet settles into one which works for you, the excess weight will gradually fade away without you having to make any effort.

Make sure you check all the labels of any food or drink you are going to consume to ensure it is free of the test food. Eating out could cause problems so phone ahead to the restaurant to see if they can cater for you. Take “safe” snacks with you whenever you go out just in case you need them. It is horrendously frustrating to find yourself needing to eat and not being able to find something that is okay—you are left with the option of potentially making yourself ill or running the risk of low blood sugar problems. It is not a comfortable place to be in.

The length of time that any food or food chemical needs to be eliminated from the diet varies. Generally, for a single food, four to seven days is a reasonable guide. To reduce the impact of a food chemical you need at least seven days, preferably ten to fourteen.

If you have been reacting to the food you have eliminated you can expect a sudden weight loss. This is linked with fluid retention. Breneman found that it is possible to retain as much as 4% of your body weight as fluid as a result of a food sensitivity. This weight is gained within six to eight hours after ingestion and lost within eighteen to twenty four hours after the food has been removed from the diet.[Breneman J. Basics of Food Allergy. Charles C Thomas 1978.] You could also find yourself with a headache and feel tired. This is the body detoxifying itself and nothing to worry about. Drink lots of water and rest as much as you can. You may find you suddenly feel amazing and then just as suddenly feel wretched—again this is just detoxification.

And of course, you could just start feeling much better. Be meticulous about keeping your food diary and you will be able to track your progress over time.

Step 6: Test suspect foods

You have now gone the required number of days without eating the test food and the time has come to find out if you have a problem. One very clear indicator is that you have had a noticeable improvement in your symptoms. If this is the case you may want to delay testing for a few more days to ascertain the extent of the “recovery”.

Use the strategy agreed with your doctor—this may involve medically supervised allergy tests. If you have been advised to simply reintroduce the food but the change in your symptoms has been dramatic it is best that you recheck with your doctor before testing the food.

If you are testing a single food then choose the time at which you test with care. If you have a busy day planned you do not want to be dealing with unpleasant symptoms at the start of the day.

Eat a reasonable amount of the test food in its simplest most natural form and wait. Some reactions occur immediately or within the first thirty minutes. Common responses are mild swelling in the mouth, headache, feeling disorientated, stomach irritation, a feeling of heaviness and/or lethargy. If you have any of these responses do not continue with the test. You have an intolerance problem to that food.

If nothing happens then continue with your day and note any changes as they occur. Leave at least a few hours before eating any more of the test food. Delayed responses are not uncommon and include a return of your previous symptoms, skin rashes, blood sugar problems, and bloating (hands, feet, abdomen, face, as well as more generally). Reactions can be delayed for as much as thirty six hours.

Testing for a sensitivity to a food chemical is a little more complicated as unwanted reactions tend to occur only after your individual tolerance level has been exceeded. You will need to resume eating foods that have higher amounts of the chemical and carefully note your symptoms over a few days.

Do not attempt to eliminate/test any other food for at least five days. You need to give yourself this amount of time to be sure there is no problem. If after this time you have not experienced any unwanted symptoms then you can assume that the test food is safe. If the test has been inconclusive then you may need to repeat it. Other factors such as illness do have an effect and need to be taken into account. You should also know that it is quite possible to tolerate a food in one form but not another. For example: boiled eggs may be okay but not fried, raw cabbage may make you feel ill but when cooked there is no problem, beef steak may be okay but beef mince could leave you feeling uncomfortable, milk in yoghurt may lead to no symptoms whilst milk on its own causes problems. Test the food in its various forms to be sure you are not unnecessarily eliminating foods from your diet.

Step 7: Review

Was the test food a problem or not? If it was a problem then eliminate it from your diet—you can always retest later. If it wasn't a problem then you can include it in your diet but remember to keep it simple if you are planning further tests. If you have found yourself getting confused then eliminate the test food again and eat your simplified diet for a few days before testing again.

Decide on whether to continue with another test and plan accordingly. Repeat steps 5 to 7 as often as you need and over as long a time period as is appropriate to you.

If your problems continue to remain after food testing then you may like to consider checking your environment for other possible causes—it is not uncommon to react to fragrances and chemicals commonly found in the home, school or work place. Again this is a very hidden problem and only comes to light after you have removed the offending chemical from your environment. It may also be worth exploring whether you have a nutritional deficiency of some sort as these have also been linked with a wide range of conditions and symptoms.

Next - 4.1 Food chemicals