5.4 Individual Foods

Pages 282-308 from The Food Intolerance Handbook
Copyright (c) Sharla Race. All rights reserved.

5.4 INDIVIDUAL FOODS

Sugars and sweeteners

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.[Grant EC. Food allergies and migraine. Lancet 1979;1(8123):966-9.] 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.

Artificial Sweeteners

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.[Starr, JH. Sweet Poison. New Horizon, 2004.]

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.[Maher TJ, Wurtman RJ. Possible neurologic effects of aspartame, a widely used food additive. Environ Health Perspect 1987;75:53-7.]

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.[www.food.gov.uk/safereating/chemsafe/additivesbranch/sweeteners/55174]

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

Vegetables

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.[Muhlemann RJ, Wuthrich B. Food allergies 1983-1987. Schweiz Med Wochenschr0 1991;121(46):1696-700.] Quirce et al found various symptoms including bronchial asthma, urticaria and Quinckes oedema associated with a reaction to potatoes.[Quirce S, Diet Gomez ML, Hinjosa M Cuevas, Rivas MF, Pujana J et al. Housewives with raw potato-induced bronchial asthma. Allergy 1989;44:532-36.]

Hoffman et al found that ten out of the twenty five eczema sufferers in their study reacted to avocado.[Hoffman D, Yamamato F, Ceiler B, Haddad Z. Specific IgE antibodies in atopic eczema. J Allergy Clin Immunol 1975;(55)256-67.] Lybarger identified respiratory, nasal and skin reactions to garlic.[Lybarger JA, Callagher JS, Pulver DW, Litwin A, Brooks A, Bernstein IL. Occupational asthma induced by inhalation and ingestion of garlic. J Allergy Clin Immunol 1982;69:448-54.] Garlic has been linked with causing contact dermatitis and asthma.[Perez-Pimiento AJ, Moneo I, Santaolalla M, de Paz S, Fernandez-Parra B, Dominguez-Lazaro AR . Anaphylactic reaction to young garlic. Allergy 1999;54(6):626-9.] Celery has been found to cause anaphylaxis, angioedema, and urticaria.[Ortoloni C, Pastorello E, Luraghi MT, Della Torre F, Bellani M, Zanussi C. Diagnosis of intolerance to food additives. Ann Allergy 1984;53:587-91.] In a study by Mylek migraines for some individuals were triggered by cabbage.[Mylek D. Migraine as one of the symptoms of food allergy. Pol Tyg Lek 1992;20-27;47(3-4):89-91.]

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.[Babu BNH; Venkatesh YP. Clinico-immunological analysis of eggplant (Solanum melongena) allergy indicates preponderance of allergens in the peel. WAO Journal 2009;2(9):192-200.]

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.[i],[ii],[iii]
[i] Jesenak M, Rennerova Z, Babusikova E, Havlicekova Z, Jakusova L, Villa MP, Ronchetti R, Banovcin P. Food allergens and respiratory symptoms. J Physiol Pharmacol. 2008 Dec;59 Suppl 6:311-20.
[ii] Zacharisen MC, Elms NP, Kurup VP. Severe tomato allergy (Lycopersicon esculentum). Allergy Asthma Proc. 2002 Mar-Apr;23(2):149-52.
[iii] 3. Vandenplas O, Sohy C, D'Alpaos V, Nootens C, Thimpont J, Weigand D, Scheurer S. Tomato-induced occupational asthma in a greenhouse worker. J Allergy Clin Immunol. 2008 Dec;122(6):1229-31.

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.[Vozza I, Ranghi G, Quaranta A. Allergy and desensitization to latex. Clinical study on 50 dentistry subjects. Minerva Stomatol. 2005 Apr;54(4):237-45.]

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.[Zuberbier T, Pfrommer C, Specht K, Vieths S, Bastl-Borrmann R, Worm M, Henz BM. Aromatic components of food as novel eliciting factors of pseudoallergic reactions in chronic urticaria. J Allergy Clin Immunol. 2002 Feb;109(2):343-8.]

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.[Riffelmann F, Wenzel M. Tongue swelling and angioedema due to rocket (Eruca sativa) Allergologie 2009;32(8):303-305.]

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.[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.]

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.[Abrams EM, Becker AB, Gerstner TV. Anaphylaxis related to avocado ingestion: a case and review. Allergy Asthma Clin Immunol 2011 Jun 10;7(1):12.]

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.[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.] 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.[Jones VA, Workman E, Freeman AH, et al. Crohn's disease: maintenance of remission by diet. Lancet 1985;2:177-180.]

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.[Mylek D. Migraine as one of the symptoms of food allergy. Pol Tyg Lek 1992;20-27;47(3-4):89-91] 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.

Wheat

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[Speer F. Multiple food allergy. Ann Allergy 1975;34:71-6.] has wheat listed in the top ten most allergenic foods and Andre et al[Andre F, Andre C, Colin L, Cacaraci F, Cavagna S. Role of new allergens and of allergen consumption in the increased incidence of food sensitivity in France. Toxicology 1994;93(1):77-83.] 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[i],[ii] for some people and even asthma.[iii],[iv] Twelve per cent of one hundred and two children who were allergic to pollen were also allergic to wheat.[v]
[i] Egger J, Wilson J, Carter CM, Tuner MW, Soothill JF. Is migraine food allergy? A double-blind controlled trial of oligoantigenic diet treatment. Lancet 1983;2:865-869.
[ii] EC. Food allergies and migraine. Lancet 1979;1(8123):966-9.
[iii] Sandiford CP, Tee RD, Newman-Taylor AJ. Identification of crossreacting wheat, rye, barley and soya flour allergens using sera from individuals with wheat-induced asthma. Clin Exp Allergy 1995;25(4):340-9.
[iv] Williams AJ, Church SE, Finn R. An unsuspected case of wheat induced asthma. Thorax. 1987;42(3):205-6.
[v] De Martino M, Novembre E, Cozza G, deMarco A, Bonazza P, Vierucci A. Sensitivity to tomato and peanut allergies in children monosensitized to grass pollen. Allergy 1988;43:206-13.

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.[Corinne A. Keet MD, MS; Elizabeth C. Matsui MD, MHS; Gitika Dhillon MD; Patrick Lenehan BS; Melissa Paterakis BS; Robert A. Wood MD. The natural history of wheat allergy. Annals of Allergy, Asthma and Immunology 2009, vol. 102, no. 5, pp. 410 – 415.]

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.[Hanakawa Y, Tohyama M, Shirakata Y, Murakami S, Hashimoto K. Food-dependent exercise-induced anaphylaxis: a case related to the amount of food allergen ingested. Br J Dermatol 1998;138(5):898-900.]

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.[Sandiford CP, Tee RD, Newman-Taylor AJ. Identification of crossreacting wheat, rye, barley and soya flour allergens using sera from individuals with wheat-induced asthma. Clin Exp Allergy 1995;25(4):340-9.]

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.[Varjonen E, Petman L, Makinen-Kiljunen S. Immediate contact allergy from hydrolyzed wheat in a cosmetic cream. Allergy 2000;55(3):294-6.] 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.

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