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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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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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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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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07 Apr 09 UNDERSTANDING ALLERGY: A NOTE ABOUT SKIN MEDICATIONS
Your dermatologist may feel that your problem calls for a topical ointment or oral medication of some kind. Dr Fisher cautions that preservatives such as parabens and ethylenediamine and other common ingredients of topical salves are common causes of allergy and can therefore prolong rather than heal the disease. Another doctor tells of one person with skin allergy who was treated with one medication after another by many doctors, with no relief – until parabens were considered. ‘Within twenty-four hours of application of a parabens-free cream, his skin began to heal for the first time in seven years,’ says William F. Schorr, dermatologist at the Marshfield Clinic in Marshfield, Wisconsin (Journal of the American Medical Association).
Dr Schorr points out that benzocaine, widely used for dishpan hands and other irritating skin problems, is a very common cause of allergy. In fact, he strongly advises against use of any topical ending in ‘caine’. So if treatment calls for a topical medication, it’s important that doctors prescribe only creams that are free of potent allergens.
For a similar reason, doctors strongly discourage people with any kind of skin allergy from buying over-the-counter medicated lotions.
You should also stay away from corticosteroid creams or ointments – they may cause a non-allergic-type inflammation, further compounding skin problems. Yet some dermatologists are rather quick to prescribe oral doses of corticosteroids, like prednisone, for allergic skin problems. Non-drug approaches may make steroids unnecessary, says Dr Schorr.
‘It has been my experience . . . that it is rarely necessary to treat the average patient with contact dermatitis with systemic corticosteroids,’ Dr Schorr states. The one exception, he says, is poison ivy, poison oak or poison sumac, common in the United States. They’re such intense allergens that the disease continues to spread long after the initial contact. And the blisters and swelling produced can keep you out of work or school for longer than most people can afford. Under those circumstances, Dr Schorr sees little risk in a ten-day to two-week course of prednisone, in decreasing doses (Minnesota Medicine).
Another exception to the no-drug rule may be antihistamines prescribed to be taken in the evening. They prevent you from scratching in your sleep, which would delay healing.
Overall, though, you should try non-medical means of relief if at all possible. There certainly are enough tried-and-true means available. Total relief, however, is only possible if you stay away from the allergy-provoking items. After you’ve got the itching under control, the next step is to find out what started it in the first place.
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07 Apr 09 ABOUT INSECT ALLERGIES. REACTIONS TO INSECT STINGS AND BITES
Most people suffer only momentary discomfort when stung by a bee: a pin prick of pain; a red welt at the site of the sting surrounded by a paler, whitish area; and maybe a fierce itch. In a couple of days, all is forgotten.
Allergic people (and 1 out of 250 people is allergic to insect bites or stings) don’t get off so easily. The area around the sting may swell and remain swollen for up to a day. That’s no real cause for concern unless the swelling persists or the whole arm or leg swells. Then you need to see a doctor – if for no other reason than to determine whether or not you are at risk for a reaction that involves your whole body (doctors call it ’systemic’) and may even be life threatening.
That type of reaction can begin mildly enough: a dry cough, itching and swelling around the eyes, sneezing, wheezing and widespread hives. And if you’re lucky, that’s where the symptoms stop. But in 4 out of 1,000 people, the pulse becomes rapid, the skin pale or flushed, and blood pressure falls -followed by constricted breathing, and possibly abdominal cramps, diarrhoea, nausea, vomiting, chills, fever and loss of consciousness – all within fifteen minutes of the sting. That’s anaphylactic shock; unfortunately, it kills forty people a year. So even the first mild symptoms should be treated as an emergency if you’ve had a severe reaction at any time in the past.
A few individuals suffer not only an immediate reaction but a second, delayed reaction ten to fourteen days later. Symptoms can include a headache, general malaise, fever, lymph gland discomfort and painful joints.
Allergic and non-allergic reactions to insect stings and bites
Normal
Momentary pain. Redness at site of sting or bite, surrounded by a whitish zone or red, hivelike spot. Itching. Irritation. Warmth. All traces of discomfort disappear within a few hours
Unusual amount of swelling, pain and redness at the site. Again, symptoms vanish in a few hours.
Allergic, or general systemic reaction
First-degree symptoms: Itching around the eyes. Dry hacking cough. Widespread hives. Constriction of chest and throat. Wheezing. Nausea. Vomiting. Abdominal pain. Dizziness.
More severe: Difficulty in breathing. Hoarseness and thickened speech. Difficulty in swallowing. Confusion. A sense of impending disaster.
Anaphylaxis: Cyanosis (skin turns blue). Blood pressure falls. Incontinence. Unconsciousness or collapse.
Toxic reaction to multiple stings or bites
Headache. Diarrhoea. Faintness. Fever. Drowsiness. Swelling. Unconsciousness. Convulsions.
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07 Apr 09 ALLERGY: SMOG BY ANY OTHER NAME IS STILL HARD TO BREATHE
Sooner or later, we all have to venture outdoors – and deal with outdoor pollution. Certain areas are particularly bad. In Denver, they call it ‘the brown cloud’. Everybody else calls it smog.
Depending on the chemicals that form it, smog comes in two general types: London smog or Los Angeles smog. Los Angeles smog is typical of warm, sunny climates with heavy traffic. Its main ingredients are ozone, a toxic cousin of oxygen, plus nitrogen dioxide and the petroleum-produced chemicals known as hydrocarbons. London smog develops in industrialized cities and supplies its own brand of irritants. Either way, you can suffer anything from eye irritation, breathing problems and blurry vision to coughing, choking and fatigue – even if you’re not allergic. Needless to say, smog is downright dangerous for asthmatics. Your doctor may be busiest – and hardest to reach – during an episode of heavy air pollution. It’s important to be able to weather an attack on your own.
What to do during an air pollution episode
1. Try to stay indoors in a clean environment. Air conditioning (if available), air filters and face masks can be helpful.
2. Avoid smoking and smoke-filled rooms.
4. Avoid unnecessary physical activity.
5. Avoid exposure to people with colds and respiratory infections, if at all possible.
6. If air pollution doesn’t seem to let up – or if it begins to worsen – you may have to leave the polluted area temporarily until the air clears up.
7. If you are under a doctor’s care for asthma or other allergies, ask him for specific instructions. Know what medication, if any, you should use. Know what symptoms should prompt you to call your doctor. Know when and where to go to a hospital.
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07 Apr 09 UNDERSTANDING ALLERGY: TIPS FOR PREVENTING MOULD AND MILDEW
Get rid of dampness. A wet basement can be a sign of cracked or defective mortar, cracks
in the walls or inadequate drainage.
Check your rainspouts. If your basement seems particularly damp after it rains, the roof downspouting could be depositing water too close to the foundations. In that case, extend the leader spout to carry the rainwater farther away and downhill from the house.
Use only light, washable rugs instead of heavy carpeting, especially in basements or other areas prone to dampness or water leaks. Wet carpeting is a lush haven for mould growth.
Vent your clothes dryer to the outdoors to help reduce excess moisture.
Keep things clean. Never hang clothes in the wardrobes after they’ve been worn. Keep wardrobes, dresser drawers, bathrooms, and refrigerators as clean and dry as possible.
Spread out damp towels and washcloths in the bathroom. Stretch out wet shower curtains.
Circulate the air. When natural breezes are absent, use electric fans.
Sprinkle borax powder in mould-prone areas, like the bottom of the rubbish bin. This natural mineral compound happens to be a simple, effective anti-mould agent.
Avoid wallpaper. It’s a haven for mould, especially in the bathroom. If you have your heart set on wallpaper, add borax or boric acid to the paste to retard mould growth.
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07 Apr 09 UNDERSTANDING ALLERGY: THE PESTICIDE-FREE DIET
Allergy to pesticides (which may be petroleum-based chemicals) is related to allergy to food additives, and can make the task of isolating exactly what a person is allergic to even more difficult, especially when that person is very sensitive.
‘A person may eat some grapes today and they don’t bother him. But three days later, he may eat grapes that were sprayed with chemicals, and those grapes bother him,’ said Dr Falliers.
Dr Theron Randolph tested patients who swore they were allergic to peaches. After eating peaches from the supermarket, one patient developed a rash and welts, another had an attack of asthma, and a third a headache. When they ate peaches picked from an abandoned orchard where the fruit wasn’t sprayed, all three felt perfectly fine.
Tree fruits – such as peaches, apples and cherries – are sprayed with more chemicals, more often, than almost any other crop. But virtually no commercial produce escapes the blizzard of pesticides (insect and rodent killers), herbicides (weed killers) and fungicides (mould inhibitors). And once food has been sprayed, no amount of washing will get rid of it. Paring does no good, either. Chemicals penetrate the skin of the growing fruit or vegetable and infiltrate the pulp itself. So if you are chemically sensitive and you suspect allergy to chemical food sprays, eating only organically grown produce may be the only way to achieve total relief. Shop around for a local supplier or track down the nearest co-op.
Avoiding pesticides is one of many good reasons to plant a home vegetable garden – plus a couple of fast-growing dwarf fruit trees, even if you have just a few square yards of available space. Canning, freezing or drying your harvest gives you a year-round supply of non-allergenic fruits and vegetables at the right price: low.
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