20 Apr 09 DIET FOR APPENDIX V: BUTTER

Margarine is the obvious substitute for butter, but some brands (eg Flora) contain small amounts of milk solids. The brands that do not are mainly available from healthfood shops. They include: Granose, Tomor and Vitasieg.

If you hate the taste of margarine, there are other possibilities. One is tahini, or ground sesame seeds – quite a strong taste, but a pleasant one. Sesame can readily provoke allergy or intolerance, however, so it should not be eaten too often. Sunflower spread is similar. Both are available from healthfood shops.

Another alternative is clarified butter, which can be tolerated by most milk-sensitive people. Make it by melting a pack of butter over a gentle heat, allowing it to cool a little and then pouring it carefully into a glass jar. The proteins in the butter will have settled to the bottom of the pan, and are visible as white granules – by pouring very slowly you leave these behind in the pan. Any that do get into the glass jar will settle to the bottom, and since you can see them through the side of the jar you can avoid eating them, keep clarified butter in the fridge as it is semi-liquid at room temperature. You can also buy this product at Indian groceries under the name ghee.

Clarified butter should only be used once you have completed the elimination diet, and know that you have to avoid milk – it should not be used during the elimination diet, as it still contains traces of milk protein and may confuse the result.

In sauces, creamed coconut makes an interesting substitute for butter, although it only suits certain foods. Try melting creamed coconut in orange juice over a low heat, adding ground almonds to thicken the mixture, salt and garlic – this gives a delicious rich sauce to accompany pork or chicken.

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Tags: Allergies

20 Apr 09 PREPARING FOR THE ELIMINATION DIET: YOU SHOULD NOT START THE DIET WITHOUT PLANNING

You should not start the diet without planning what you are going to eat for the first few days, and buying the things you need. Hunger is a very powerful urge, and unless you have plenty of allowed foods to hand, you may get so famished that you raid the biscuit jar or the bread-bin in a moment of weakness. To avoid such lapses, it is worth cooking up some meals in advance, so that you can have something ready within a few minutes. A freezer, or a fridge with a large ice compartment, is invaluable – you can cook your special meals in bulk and freeze them in individual portions. A supply of allowed ‘snacks’ in a cupboard is also helpful.

Packaged and tinned foods should be avoided if possible during these diets. You will find that most prepared foods contain excluded items anyway: it may not say ‘milk’ or ‘eggs’ on the ingredients label, but it could be there under another name. Even if there are no prohibited ingredients, you are still taking something of a gamble, because you have no idea what sort of processing methods have been used, and how these might affect you. And it is not unknown for labels to omit an ingredient. So it is much better, at this stage, to stick to simple home-prepared foods because you know exactly what has gone into them. Tinned foods should be avoided at first because the lining of the cans, a golden-coloured phenol resin, contaminates the food slightly. Some food-intolerant people are sensitive to this.

From the point of view of food preparation, making two lots of food can be a nuisance, and some people solve the problem by putting the whole family on the diet, at least for the exclusion phase. Doctors using the elimination diet have often observed unexpectedly good results in another family member, as a result of this. There are numerous reports of fatigue, moodiness, headaches, runny noses and other minor problems, that had previously been taken for granted, suddenly clearing up. Sceptics will claim that this could well be psychosomatic, or a result of healthier eating habits, and at present there is no scientific evidence either way. But there is certainly no harm in other adults joining in Stages 1 and 2 of the diet. Children should only be included if they have some identifiable medical or behavioural problem, and consultation with your doctor is essential. Children may need a calcium supplement if milk is excluded.

Stage 3 of the diet is a different matter. It is unlikely that anyone with minor health problems, or no acknowledged health problems, would benefit from it, although a few might do.

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Tags: Allergies

20 Apr 09 THE EXORPHIN PUZZLE: ENDORPHINS — BUILT-IN PAINKILLERS

A good half of patients with food intolerance have cravings for the food or foods that make them ill, and eat such foods to excess. Addictive eating is an aspect of food intolerance that does nothing to improve its medical credibility – yet it cannot be ignored. Within the last few years, a possible mechanism for this strange behaviour has emerged, in the form of chemicals called ex-orphins. To understand what exorphins do (or might do) we must first look at the endorphins.

Endorphins — built-in painkillers

Pain is all about survival. We have specialized nerves, known as pain-receptors, to help us avoid damaging ourselves – on sharp objects, for example, or by overextending our joints. But there has to be a way of turning pain off, when it no longer serves a useful purpose. For that reason we have endorphins or natural opioids.

Endorphins are natural painkillers, released during intense pain, or strenuous exercise, or when some stressful event evokes our ‘flight or fight’ response (see pl44). There are receptors for these molecules on cells in the brain and when the endorphins bind to these, feelings of pain are reduced, and a sensation of well-being ensues. (In fact, there are about four or five different types of endorphin receptor, and they have different effects – although pain-blocking is the main one, there are others as well.)

Morphine, heroin and other opiates happen to mimic the endorphins and they bind to the same receptors – hence their use as drugs. They are addictive because they suppress the body’s natural ability to produce endorphins – so when they are stopped, the addict suffers agonizing withdrawal symptoms.

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Tags: Allergies

20 Apr 09 POTENTIAL ALLERGENS: INDUSTRIAL FUMES, DUST OR OTHER AIRBORNE PARTICLES IN THE WORKPLACE

Dust in factories manufacturing antibiotics is often implicated, and may lead to sensitivity to the same antibiotic taken by mouth, whether as a drug or in food. Similar problems affect insulin production.

Fumes released during the manufacture of plastics, polyurethane foam, varnishes, paints, adhesives, and synthetic fabrics may act either as allergens (when combined with a protein in the body) or as irritants. Isocyanates and phthalic anhydride are common offenders. Fumes released when plastics are heated or burned are also potential triggers. Phenylene diamine, used in the fur industry, and piperazine, a drug used to kill parasites, are other common causes of asthma. Enzyme manufacture, soldering (especially of electronic components), textile dyeing, beauty care and hairdressing are other high-risk occupations. The disease may begin soon after the first exposure, or it may take several months or years to appear – over a decade in some cases. The attacks may be delayed and not occur until the evening, when the patient is at home. Symptoms may clear up at weekends but not in everyone. Once someone has become sensitized, very small amounts – carried on the clothing of another person for example – may be sufficient to trigger an attack.

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Tags: Allergies

20 Apr 09 FOOD INTOLERTANCE: SUSAN’S STORY

A few months later, Susan read a magazine article about something called ‘food allergy’, which seemed to cause the sort of symptoms she had. She asked her doctor’s opinion about this and found he was very dismissive of the idea -as far as he could see, her symptoms were nothing like those of food allergy. Another year went past in which Susan became steadily worse. Then a new doctor joined the practice, and when she next rang for an appointment, it was suggested that she see him instead, as he had a special interest in patients like herself. When Susan went to see the other doctor, he explained that symptoms such as hers could sometimes be caused by food, although there were other potential causes as well. He went on to explain why his colleague had dismissed the idea of her having food allergy – the condition he treated was quite different and he preferred to use the name ‘food intolerance’. While he could not guarantee that this was her problem, it was certainly a possibility. He suggested that she try a special diet which avoided all the foods she normally ate. Susan began the diet on a Monday with high hopes, but by Tuesday she felt very ill indeed. Her tiredness was far worse, and she experienced a severe migraine attack – the worst one she had ever suffered – that lasted through Wednesday as well. On Thursday she felt completely ‘washed out’ from die migraine, and Friday was little better. In desperation, she rang the doctor, but he told her that this sort of reaction often occurred – in fact it was a positive sign that foods were the source of the problem, so she should persevere with the diet.

On Saturday, Susan woke up quite early before her alarm clock went off -which was most unusual, because she normally had great difficulty in waking up. As she got out of bed, she noticed that her knees did not give their customary painful twinge. She tried walking downstairs and then running up them again. To her amazement, she found that the pains she had endured for two years had suddenly vanished.

As the day went on, she realized that she felt altogether different – she was no longer tired, her head felt clearer, and there was no headache or migraine, unlike most weekends. Indeed she felt better than she had done for many years. Over the next few days, it became obvious that her bowels were also a great deal better.

When she returned to the doctor, Susan was jubilant – she simply couldn’t believe how much better she felt. Even her irritability, which she had thought was just part of her personality, had now vanished. The doctor explained that she must now reintroduce foods, one at a time, to see what effect they had. Over the next two months, she tried out all the foods she normally ate. Some of these had no effect, but others made her very ill – milk, wheat, rye, barley, yeast, oranges, lemons, beef and tomatoes were the main culprits. By avoiding all these foods, and adding some other, more unusual foods into her diet instead, Susan remained well. Migraines, which had previously afflicted her once or twice a week, were now a thing of the past.

After eight months, the doctor suggested that she try out some of the incriminated foods, to see what effect they had. She found that she still reacted to milk, but was fine on the other foods. The doctor advised her not to eat them more than once every four days. A year later, Susan discovered that she could now drink milk again without ill-effects. Interestingly, she discovered that she could also drink alcohol, in moderation, and eat chocolate, as they no longer seemed to trigger off migraines. By this stage, she had begun to forget what a migraine felt like!

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Tags: General Health