Managing allergies

Allergy in one form or another affects at least forty per cent of the population at some point in their lives, and more and more potential allergens are emerging every day. Allergies take numerous guises. They may affect the respiratory system and cause asthma, which is reported to affect three million people in the UK-one in seven children cranes an inhaler: Our guts can react silently of violently to allergens in our food, causing bloating, vomiting, diarrhea. or anaphylactic shock, which can be fatal. The member of cases of people suffering severe reactions (for example from nut allergy) is small compared to the number of people whose bodies do not tolerate wheat, dairy products, Eras and other foods.

Most people experience disconfirm and other symptoms, which, while inconvenient are not life-threatening. Simply by avoiding the offending foodstuffs they are able to feel perfectly well . you through the jungle of how to reduce the risk of developing a food allergy, how to identify an allergy or intolerance and how to adjust your diet accordingly.

 What are allergies and intolerances?

Although there is a physic logical difference in the body’s response to allergies and intolerances. the symptoms are similar. The immune system is designed to rid the body of bacteria, viruses, microscopic parasites, cancer cells anything that has no business being inside us Allergies and intolerances are what happens when the system becomes oversensitive to certain foreign substances Usually allergies are more severe than intolerances, but both can be measured by looking at symptoms and reactions within the blood. In this chapter I shall group them in terms of their treatment, referring to them both as food sensitivities

If you suffer from symptoms such as diarrhea, constipation, bloating of the stomach. eczema or other skin conditions and rashes, migraine, irritability or extreme tiredness, you may well have a food sensitivity. Other less common symptoms include asthma, recurrent ear infections, and swelling of the lips, mouth and tongue. Seek immediate attention in cases of swelling of the throat as this can cause breathing difficulties. If you have any of the above symptoms it is worth exploring your food intake, to see if any relief can be gained. With all these symptoms, I suggest that you also consult your doctor to rule out any non-food cause Sometimes aversions or cravings are signs of food sensitivity for instance some people who

don’t like milky products are diagnosed as being sensitive to lactose found in milky foods). Others find the opposite they crave the thing to which they are sensitive. I therefore look for any out of the ordinary food liked or dislikes Your body’s reaction to an unwanted food has three likely causes.

• The release of histamine, this substance is overproduced by the body when it is faced with a food which is rich in an unwanted substance. A severe histamine reaction normally occurs with food allergies, rather than intolerances. Shell. fish is a well-known example, some people cannot eat certain types of shellfish without being violently sick, An enzyme defects. This is when the body does not produce sufficient enzymes, substances that break down various foodstuffs, such as lactose, the sugar found in dairy products. The symptoms are sickness, diarrhea and gut pain. Some people completely lack a particular enzyme, whereas others just seem to have small amount of the enzyme. This can account for why some are able to eat small amount of the offending food on occasions.

• Irritant affect. The gut can become irritated by certain foods, such as spices or monosodium glutamate (MSG). Our digestive system undergoes natural changes throughout our lives. When we are born it is immature and, at first, cannot handle solid food. Elderly people may find that their body becomes poorer at dealing with certain foods. In addition, a food sensitivity can occur at any age as the result of an accumulation of foods or toxins, which the body rejects once a specific threshold is reached. For other people, hormonal changes can drastically affect the bowel.

These may be natural hormonal changes that are most pronounced during puberty and later middle age, or artificially introduced, for example in women taking a contraceptive pill or hormone replacement therapy. In the latter cases it is worth asking your doctor to change your prescription, a simple adjustment of the hormones sometimes does the trick Some people have a mild food sensitivity and can eat a small amount of the offending item without experiencing any symptoms, whereas others with an extreme sensitivity need to remove the offending item completely from their diet in order to avoid serious symptoms. While a sensitivity should be treated seriously, becoming obsessive and neurotic about what you eat will not help you. Genuine food allergies and intolerances can make life difficult.

You need to see a reputable health professional who can make an accurate diagnosis and offer constructive advice as to how to eat healthily and how to avoid the potential allergens. I see far too many people who have either received an incorrect diagnosis, or have diagnosed themselves and are eating very unbalanced diets. I also see children whose parents are so worried that they might have or develop a food allergy that they restrict their child’s diet to such an extent that the child becomes malnourished and unhealthy.

Why are more people suffering from allergies and intolerances?

Our grandparents didn’t seem to have them, so what has changed:

It may be that we are increasingly aware of food allergies and their symptoms, so that more people are receiving a correct diagnosis for symptoms that in the past would have been missed or not taken seriously. Alarmingly, more people are diagnosing themselves as having an allergy when they don’t, they are either suffering from another medical condition that should be treated differently or they have a psychological problem that manifests itself as symptoms that seem to respond to changes in the diet. However, it is undoubtedly true that food allergies and intolerances are increasing, for a number of reasons

• We are eating fewer fresh foods and more foods that have been highly processed and contain additives, preservatives and pesticide and other chemical residues from the production process. Our bodies aren’t equipped to deal with these high levels of foreign substances.

• We push our bodies to work and play hard, stress is rife and the gut takes the brunt of the strain

• We are not giving our bodies enough time to recover from illnesses. In the past we would have taken to our bed and allowed our body to recover in its own time. Now we expect our body to get better immediately and bombard it with drugs

• Antibiotics interfere with the natural balance of flora in the gut. Some people believe that the use of antibiotics in the production of meat and other livestock and vegetables can also cause the gut to become florally unbalanced.

• We are not feeding our bodies the correct nutrients. People have lost confidence in their ability to choose wholesome unprocessed food, and are skipping meals.

Food allergies and intolerances are one of the most common ways the body exhibits a very simple message: that it cannot cope with the stress and strain of modern living. However, dietary changes can make a great deal of difference:

How to avoid developing a food allergy or intolerance

One of the major worry’s parents have with their children is how to reduce the likelihood of their developing a food allergy. Allergies and intolerances are bad enough for adults, who can understand why they are avoiding something and how to avoid it, let alone for children, who want to cat what everyone else cats. Luckily there are positive steps you can take.

The most sensitive time for the digestive system is the first eighteen months of life, as this is when the gut is not particularly well developed and the immune system can have problems dealing with allergens. Babies who develop allergies Carly in life often grow out of them once their bodies become mature enough to cope, which is usually around two years of age.

There is a great deal of research to show that breastfeeding helps to reduce the risk of developing a food allergy, as the baby’s immature immune system is much more likely to react favorably to breast milk than cow’s milk protein. This is particularly true in families with a strong history of food allergies, rhinitis, asthma or eczema. When your baby is relying on breast milk, you shouldn’t restrict your own diet unless your baby has symptoms such as profuse diarrhea, vomiting, rashes or swelling of the eyes or lips or you have a family history of allergies to food.

If you notice any symptoms. the way to react is to remove the most common food allergens one by one from your diet for a week or two, to see if things improve Because the gut is so sensitive, it is best not to rush the weaning process, start your child on solid food between the ages of four and six months, introducing common allergens one at a time, in small amounts. The most common food triggers are cow’s milk and dairy products, eggs, fish (especially shellfish), nuts, foods containing gluten, and some fruits.

• It is best to continue to breastfeed or use a modified infant formula until your child is one year old, or at least until the baby is taking drinks from a cup. Whole fat pasteurized cow’s milk, provided it is fresh and has been kept in a refrigerator, can be given occasionally, for instance used in mashed potatoes after your child is six months old.

Yoghurts and cheese can also be introduced after the age of six months, but try them a little at a time to see whether the child reacts adversely However, if you or your partner has a history of asthma, eczema or hay fever it is best to discuss the introduction of cows’ milk with your doctor or dietitian specializing in this field; they may advise you to use an alternative a such as goats’ milk or soya milk. Some children are sensitive to these milks also: seek the advice of a professional.

Some questions have been raised over the level of pasteurization that milk receives. If you want to be extra careful, I suggest that you boil the milk and let it cool before giving it to your child.

• Avoid giving egg whites before the age of one year. Cooked egg yolks may be given once your baby is stabilized on a mixed diet at the age of eight or nine months.

• Fish are best introduced after the age of eight months, a little bit at a time. It is best to avoid shellfish for the first couple of years. • Nuts in any form, whether ground or as peanut butter, should be avoided for the first eight months. Remember that older children can easily choke on whole nuts.

Although some manufacturers are beginning to label foods containing nuts. many products are not labelled. Mothers can be alarmed to find that the most obscure things can contain the potential allergen. For example, the cream they rub on their nipples when they are sore from breastfeeding can contain peanut oil, as do several brands of formula milk. New research seems to show a correlation between pregnancy and nut allergies peanut oil-based creams and mats consumed during pregnancy are thought to increase the risk of nit allergen in children.

It is thought that this applies particularly in families where allergies are rife. I don’t want you to think Oh no, not another thing I can’t car but if allergies concern you, see your doctor.

• If you have a family history of gluten sensitivity, it is best to avoid all forms of gluten until your baby is at least six months old. As a safeguard I normally suggest that ALL babies avoid gluten for the first six months. Gluten is found in products containing wheat rye, barley and oats. Alternatives include: rice, millet and potato Hours, which are useful in thickening sauces and making bread and cakes car; buckwheat and rice noodles. Read the labels on ready-made baby foods as many contain gluten.

• Some babies have an adverse reaction to berry and citrus fruits such as straw berries, raspberries, oranges and tangerines Since these fruits are rich in vitamin C, an essential growth and development vitamin, it is important to find another source in fruits such as blackcurrants, kiwis and rosehips (in the form of rosehip juice). Pears, apples, peaches, apricots, especially stewed or poached, pureed and mixed with yoghurt, are easy fruits to feed your child. Look at your consumption of the suspect fruits, as it may be that you are passing on antigens that upset your baby.

Identifying food sensitivities

I cannot stress enough the importance of keeping a detailed food diary Noting everything that you or your child eats, including details of ingredients of ready-made foods, will enable you to start deciphering the most likely causes of your symptoms. Write down all symptoms such as bloating, skin condition, mood swings, energy levels.

I tell my patients to imagine I am a parrot on their shoulder taking notes of everything that is happening in their body and mind. Some people find that their bodies react differently at different times of the month. Women can experience bloating and skin rashes during their premenstrual week and have absolutely no problems during the rest of the month. Extreme work pressures can bring out symptoms which stay away when people are relaxed at home.

If your symptoms seem to come and go, keep the diary going for a few weeks, so that you can pick up patterns over a wide spectrum of situations If you are keeping a diary for a child, try to get hold of information about what they eat outside the home as well as what you are feeding them. You should also try to keep secret the fact that you are recording their behavior symptoms.

A useful first step would be to analyze your diet to make sure it is well balanced and contains all the nutrients your body needs A number of symptoms occur for no other reason than that there is something not quite right about your eating habits or general life style are you drinking plenty of water and eating at least five portions of fresh fruits and vegetables a day, or do you regularly skip meals, drink too much tea or coffee, or rely on sweet snacks?

A healthy lifestyle is a lot easier to manage than an exclusion diet of any sort. If you are reasonably happy with your diet and suspect that a particular item may be causing problems, try removing the item from your diet for one or two weeks. You will need to check labels carefully if you suspect you are allergic to an additive.

If your symptoms disappear, you can probably assume that you have a sensitivity related to this item. If they persist, seek professional advice before proceeding any further, as once you start removing more than one food, things can become complicated, Give your body a chance to improve; a week or two is usually the sort of period you should allow. A day or two won’t normally give you a realistic result, although some people notice dramatic results in a few hours.

Treating food sensitivities

Once you have found that you are sensitive to a particular food, you need to make sure that your body is not going to become malnourished by removing it Psychologically you also need to ensure that you are not going to feel deprived. Find other foods that provide the same or similar beneficial nutrients without the offending ingredients. Also, seek the advice of a dietitian who will check whether you require any vitamin or mineral supplements.

This is especially important with growing children. By far the most common food sensitivities I see are cow milk protein and lactose; egg, wheat and gluten; additives. Do not experiment with food allergens if your symptoms are very severe, and if your child has an allergy, don’t tackle it alone. Always seek professional advice.

EATING OUT

Eating out can be difficult for people with food sensitivities, as it is hard to know what has gone into the food. Remember that simple food such as fish, good quality meat, pasta, rice and unadulterated food is less likely to contain hidden ingredients. Try to choose restaurants where the food is prepared fresh, and not somewhere where you can have your meal in two minutes: the likelihood is that the food in fast-food restaurants has a lot of additives and preservatives. In restaurants never be afraid to ask how things are cooked and tell them that you are allergic to something. You could even ask the chef to make a sauce without cream, for instance, if you are milk sensitive. Most good restaurants will take your requests seriously.

Milk sensitivity

There are two main types of milk cow milk protein and lactose Both symptoms such as bloating, sickness, stomach and abdominal headaches, aggravate skin complaints such as eczema. Some scientists believe that half the world’s population is unable to tolerate Children are commonly lactose sensitive until their gut becomes more mature, around two years of Lactose sensitivity mainly due to a deficiency in the body’s production of the enzyme that digests lactose, the sugar found in all milk products, particularly sheep’s and milk.

Without sufficient lactase, lactose cannot be broken down and absorbed by the body, and therefore there is a build-up of undigested lactose in the gut. If you are lactose sensitive, you need to avoid all of milk, other than soya milk. This includes cream, butter, cheese, skimmed milk powder and products containing any of the above as well lactose, and whey, which might be present in baked and processed products such as biscuits and cakes.

You need to look out for foods monosodium glutamate as these frequently contain Cows’ milk protein sensitivity is slightly less common than lactose sensitivity, but it can occur at any age. In this case the sensitivity is not due to an enzyme deficiency, the body is unable to tolerate any form of However, it may be able to tolerate goats’ milk and products made from such as yoghurt and of course the many delicious and milk cheeses.

Many food manufacturers refer to milk protein and lactose-free pro ducts ‘milk-free’. All products marked should be suitable for both lactose and cow’s milk protein sensitive Always consult a doctor or dietitian if you suspect that your child is lactose sensitive, it is vital that you do not deprive their body of essential nutrients such as calcium and protein once you remove milk and milk products from the diet. The adult body also needs calcium throughout life, and there are a number of ways to obtain it in a varied and balanced diet.

Soya milk and soya products such as margarine, cheese and are often calcium-enriched. Other foods include oily fish such as sardines, anchovies, mackerel, pilchards, green leafy vegetables such as spinach and sesame seeds and tahini (sesame seed paste, used to make hummus). almonds and dried However, these foods, especially the green leafy vegetables, contain that stop the body from absorbing calcium efficiently. This means that you need to a lot of them to meet your daily requirement for calcium. See them as an added not an equivalent – you will probably need to take calcium supplement.

It vital that you don’t choose calcium lactate this is obtained from lactose. There are plenty of other types, such calcium so asks your dietitian or pharmacist. Many cheeses contain only a trace of lactose, which makes the manageable for adults with mild lactose intolerance. You may like to include some of the blew in your diet to see whether your body reacts adversely. Lower lactose cheeses include Brie, Camembert, Edam, Gouda, soya cheese and vegetarian Cheddar.

Egg sensitivity

Egg sensitivity is slightly less common than milk sensitivities, but it is more often associated with severe symptoms. Some people suffer from pleasant bouts of diarrhea, others from acute and chronic episodes of constipation and stomach cramps. Egg sensitivity can also aggravate eczema, cause mood swings and disturb sleep If you suspect that you have an egg sensitivity, you need to avoid eggs, foods containing whole egg, egg yolk, albumin, egg lecithin and dried egg. Some people may be sensitive to either egg yolk or egg white, but not both. People with mild sensitivity may find they can tolerate small amounts of egg, or can tolerate cooked eggs.

I suggest that you avoid all eggs for your trial period, and then if you conclude that there is an intolerance, re-introduce yolks or whites only and see what happens. Avoiding egg and its derivatives is relatively straightforward as long as you steer clear of store-bought biscuits, cakes, meringues, mayonnaise, egg pasta and other manufactured foods unless they are free of the offending ingredients. If in doubt, check the label.

This doesn’t mean that cakes and biscuits are completely out of bounds but you will have to look quite hard for suppliers and recipes Apple flapjacks  are one idea for an easy egg-free biscuit; instead of apple purée you could use chopped dried apricots, figs or raisins. You can also enjoy shortbread and other biscuits, fruit desserts, pies and tarts, as long as the pastry is not made with egg. I wouldn’t recommend the egg replacers on the marker, as the result is less than ideal.

Wheat and gluten sensitivity

These sensitivities are very common, and the severity and symptoms vary greatly. Some people simply feel that by avoiding the ingredient as much as possible they feel more energized, less bloated, or have less pain with rheum toad arthritis, Others need to avoid offending foods completely or risk severe pain, diarrhea, or internal bleeding, symptoms often associated with coeliac disease The first step in managing a wheat or gluten intolerance is to establish whether your sensitivity is to wheat or gluten. Wheat is a graph, whereas gluten is the protein found in wheat and other grains: oats, rye and barley.

If you are sensitive to wheat, you may be able to eat oats, rye and barley, If gluten is the offender, you must avoid all sources of gluten. If you are sensitive to gluten, you need to avoid wheat, barley, oats and rye grains and products containing them. You additionally have to avoid products containing flour, starch, food starch, edible starch or modified starch, unless the label clearly states that it is gluten-free. In practice this means avoiding bread, Crackers, cakes, biscuits, pasta, sauces containing flour and stuffing’s made with bread.

You need to look at labels to see whether bread is used as a filler’: sausages, salamis, pates and other meat products commonly fall into this group. Mustard powder white pepper, gravy thickening, stock embeds and pickles sometimes contain gluten. Soy sauce usually contains wheat, but tamari, the Japanese naturally brewed soy sauce, does not Many baby foods and infant formulas contain gluten. The Coeliac Society products that are free from gluten produces a list of The above sounds a long and forbidding list, but think positive.

Rice and potatoes are gluten-free, and rice and potato flours can be used in cooking you can also use soya four, buckwheat flour and corn flour Rice cakes can by an alternative snack to bread and crackers. Instead of pasta, base meals on rice and, potatoes think of risotto, paella, Chinese and Thai rice and rice noodle dishes, stuffed jacket potatoes, fishcakes, potato gratis, hot pots and potato bakes You might like to look some Italian cookbooks, as there are a number of traditional Italian cakes made with rice, cornmeal (polenta) or chestnut flour, available from Italian delicatessens.

If you are allergic to wheat but not gluten you will be able to use nets and rye: make oat crumble toppings, oat muffins oatcake or rye bread (pumpernickel) snacks. Try not to see wheat or gluten allergy as a handicap. Look for ways round it and think of all the things you can eat that will not make you ill. This is especially important for children, instead of making them feel isolated and different from their friends, look for treats that they can all eat.

GLUTEN-FREE SAUCES

You can use potato Hour as a direct replacement for the wheat flour in a white or béchamel sauce. Potato flour is a little more inclined to thicken in lumps if you stop stirring or have the heat too high. I use an electric hand blender in the saucepan as I heat the sauce gently. Sauces can also be thickened at the last minute by whisking in a little arrow root dissolved in about 2 tablespoons of water Don’t forget the reduction method for making sauces. Good quality stock, or stock and wine, or a sweet juice such as orange, apple or strawberry, can be left to simmer gently in an uncovered saucepan until it reduces down to a thick syrupy consistency, the flavors are then concentrated in the syrup. If you like you can whisk in a little more wine, some fresh cream or yoghurt, just before serving. Fish stock reduces beautifully, and is delicious if you add cream and some chopped fresh herbs such as dill, parsley or coriander.

GLUTEN-FREE BREAD

Be aware of the difference between breads labelled ‘yeast-free’ and ‘gluten-free”. Yeast-free breads may contain wheat or gluten Gluten-free bread doesn’t contain supportive characteristics of gluten, which means that it tends to be heroin and denies. I think that the shop-bought versions are a where bear at nice homemade. Try long your own the recipes are not difficult, especially if you have a food processor or blender.

Its lest eaten fresh and wart from the oven, but is also delicious toasted, and it freezes well The secret to making delicious gluten-free bread is to use a wide variety of sources of starch Millet, sorghum and buckwheat flours are good for baking especially when combined with rice or grain flour. Sweet chestnut fear is of my favorites for making a light, soft, sweet bread. Apple, banana or cite. beaten to a puree, help to make the bread lovely and smooth textured.

The lack of gluten prevents the carbon dioxide produced by the yeast in normal bread from being retained in the usual way: instead the use of bicarbonate of soda and Tartaric acid helps the loaf rise. Sprinkling seeds such as pumpkin, sesame and poppy seeds on top of the breads gives a crunchy variation in texture,

DRINKS

Beers are gluten free as long as they are not home-brewed or cloudy beers. Wines and spirits do not contain any gluten. Malted milk drinks, milk shakes and milk drinks from vending machines usually contain gluten. If it is modified starch (used to thicken milk drinks), some people can tolerate this small amount – it depends on the severity of the allergy.

COELIAC DISEASE

A severe intolerance to gluten is known as coeliac disease. This condition can be diagnosed only by a surgeon taking a small nip of the lining of the intestine and studying it under a microscope. If coeliac eat gluten, their gut becomes inflamed, which results in severe pain, diarrhea and in some cases severe malabsorption problems. Babies double up with pain and in extreme cases the malabsorption cotises growth retardation The good news is that once you remove gluten from the diet, the gut frequently returns to normal. It is generally necessary to avoid all forms of gluten for life, but some people may be able to tolerate some oat or rye-based products.

The gluten content of these is lower than wheat, but you should ask for professional guidance before you experiment. In some cases, the reaction can be so severe that the body goes into shock. It is especially important to remember this when dealing with young children with coeliac disease. The nutritional management of coeliac disease is the same as for gluten intolerance you just have to be that bit more careful to avoid gluten.

Additive sensitivity

There are thousands of different additives in foods. As a fast-track society wait imports food from all over the world, we couldn’t survive without some of them. However, in today’s over processed food world, when packets and tins take up for more supermarket spice than fresh food court exposure to additives is much greater than the body can reasonably be expected to tolerate Nobody benefits from eating additive Billed foods, but some people experience severe reactions to food additives Symptoms include headaches, rashes and other skin complaints, mood swings and depression.

The most common culprits are the antimicrobial preservatives Sulphur dioxide and its related sales, or sulphonyls (E220-1227), yellow and dyes (atrazine/E102, Yellow 2G/E107, Sunset yellow/E110) and the flavor enhancer monosodium glutamate (621). All these additives have to be declared on food labels either in their true name or as an E number. In the US sulphonyls have been banned for use on fruits and vegetables, but that is not yet the case in Europe.

If you suspect that you have a sulphatic sense trinity, look at the following list of foods, as they frequently contain sulphonyls: • Wines, cider and beer

• Canned and bottled soft drinks

• Dried potatoes, including packer mashed potato, crisps and savory snacks. French fries used in the catering trade have usually been dipped in metal sulphatic solution

• Dried fruits and vegetables. Most dried fruits are treated with Sulphur dioxide; this does not have to be declared on the label. However, dried fruit that has not been treated will usually be labelled uncultured, so hunt these out.

• Fruit salad, fruit juices, glacé cherries

• Canned soups and sauces, readymade meals, sausages

• Frozen prawns

• Cod may be treated with sulphonyls to bleach and preserve it. Remember, the simpler and fresher you keep your diet and the less you rely on processed foods, the fewer additives you will consume. Whenever you remove items from your diet you need to make sure you are still eating healthily and getting all the nutrients you need, but where it is an additive you are invest gating, this is relatively easy, you just need to focus on fresh, unprocessed foods. For example, instead of a readymade chicken dish in a sauce full of additives and preservatives,

Antibiotics

Both long and short courses of antibiotics can render the gut temporarily or permanently intolerant to a particular food. Many people cannot tolerate milk, lactose, wheat or gluten during or immediately after taking a course of antibiotics. Thus, sometimes results in a permanent food sensitivity, but more commonly, if you allow your body a couple of weeks to recover from the infection and the antibiotics, you should find you can start to reintroduce these foods in small amounts and your gut will tolerate them.