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Give this to your GP about food intolerance!

Members of our 14,000 strong Food Intolerance Network frequently complain about the lack of recognition of food intolerance.

“We did the rounds of GPs, paediatricians, psychologists, social workers, OTs and child health nurses, and all the interventions and treatments helped a little, but nothing led to any significant improvement.  Not once was diet mentioned beyond ‘does he eat well?’” – Ursula in [1341] and see this facebook thread Rants about seeing Health Professionals [1298]

The trouble is that GPs are not trained in diet and its effects and they are often reluctant to accept that such a wide and often bewildering range of symptoms may have a single cause.
 
Most importantly, they do not know that there is a reliable way to scientifically diagnose food intolerances.

The article below was prepared for the journal that most GPs see, but they chose not to publish it. You are welcome to pass it to your GP directly and engage them in the issue.

Download and print (4 pages) to give to your GP please.  Here is the content of the printout:

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Food intolerance rarely diagnosed by GPs        FINletterhead

Members of the 14,000 member Food Intolerance Network frequently report that their food issues were not diagnosed or taken seriously by general practitioners. Comments such as the following are all too common.

“In 23 years, not a single doctor ever once asked if my condition might be caused by the food that I eat “– Mark from story [524]

Such attitudes drive people to alternative medicine, which might work although not for the reasons given, but in the process the practice of medicine might be brought into disrepute.

The main reason seems to be that doctors are not familiar with food intolerance. It is not part of their training and they do not know that there is a reliable way to scientifically diagnose food intolerances. This article attempts to briefly address these issues.

KEY POINTS

There are no scientifically proven laboratory tests for food intolerance

The scientifically proven way to diagnose food intolerances is through the use of an elimination diet with challenges

Patients who would like to investigate diet can be referred to dietitians who regularly undertake the RPAH elimination and challenge process. https://www.fedup.com.au/information/support/failsafe-friendly-dietitians-and-other-health-professionals

What is food intolerance?

Food intolerance can be clearly distinguished from food allergy. Food allergy is an uncommon, quick immune system reaction, usually to proteins in food. Food intolerance is more common, and is usually a slow pharmacological reaction, like the side effects of a drug, to a specific chemical or range of chemicals in food. Both children and adults can be affected but the prevalence is unknown.

Food intolerance symptoms are protean, as seen in Box 1, with a range of mixed and variable expression.

·         irritability, restlessness, difficulty falling asleep

·         mood swings, anxiety, depression, panic attacks

·         inattention, difficulty concentrating or debilitating fatigue

·         speech delay, learning difficulties

·         eczema, urticaria and other itchy skin rashes; angioedema or swelling of the lips etc often associated with rashes

·         reflux, colic, stomach aches, bloating, and other irritable bowel symptoms including constipation and/or diarrhoea, sneaky poos, sticky poos, bedwetting

·         headaches or migraines

·         frequent colds, flu, bronchitis, tonsillitis, sinusitis; stuffy or runny nose, constant throat clearing, cough or asthma·   

Box 1 Some symptoms of food intolerance

Conceptually, Figure 1 shows how a range of food sources of amines, which have known pharmacological effects, build up over time until a symptom threshold is reached. Unfortunately, it is usually the last food eaten that gets the blame, but that is not how food intolerance works. In this case, it would take elimination or reduction of all food and medication sources of amines over a period before symptoms would abate.

RPAH01
Figure 1 The cumulative and delayed nature of food intolerance (from Friendly Food, Murdoch Books 2004 ISBN 174045376X with acknowledgement to the Royal Prince Alfred Hospital Allergy Unit)

How can food intolerance be diagnosed?

It takes specialised knowledge to understand that all of the foods shown in Figure 1 contain, among other chemicals, natural biogenic amines. Fortunately, this clinical knowledge has been developed in the Royal Prince Alfred Hospital Allergy Unit Elimination Diet over 30 years.

The RPAH Elimination Diet works by avoiding a limited range of artificial and natural food chemicals over a three to six week period until, if food is in fact responsible, a stable baseline of symptom remission is obtained. This process is frequently accompanied by withdrawal symptoms, often a worsening of presenting symptoms, which itself provides evidence that food chemicals that were causing the symptoms. Systematic challenges over succeeding weeks then establish which food chemicals are responsible for the symptoms and dietary management within tolerance guidelines is implemented.

Australia is fortunate in that there are now trained dietitians who regularly undertake the elimination and challenge process described. Because it can be complicated for families, an experienced and supportive dietitian is necessary for success.

The Food Intolerance Network also provides free information and support for individuals and families through this process.

What are typical causes of food intolerance?

Most people with food intolerance react to between 3 and 6 food chemicals and effects are related to dose. Overall, the main culprits are a limited range of food additives and the natural food chemicals called salicylates, found in most fruit and some vegetables, as shown in Box 2. However everyone is different which is why the elimination diet and challenge protocol is required for scientific diagnosis. Surprisingly, other symptoms show a similar pattern.

Symptoms may emerge or change with age, stage of life, stress and illness. Food intolerance can be triggered or even caused by some medications.

75% react to natural food chemicals in most fruit and some vegetables called salicylates

65% react to preservatives such as sorbates, benzoates, sulphites, nitrates and propionates

55% react to some artificial colours and a natural colour

40% react to MSG and other flavour enhancers, natural glutamates

40% react to synthetic antioxidants such as BHA 320

40% react to natural food chemicals called amines

20% react to dairy foods

<1% react to gluten (figures are higher for other symptoms, up to 20% for irritable bowel)

Box 2 Approximate percentage of overactive children likely to react to each challenge following the RPAH Elimination Diet (adapted from Loblay RH, Swain AR. Food Intolerance. In: Recent Advances in Clinical Nutrition' Vol 2, 1986. Libbey, London. Eds: Wahlqvist ML and Truswell AS, pp169-177)

Conclusion

An increasing number of general practitioners are recognising food intolerance:

“For the last 15 years I have known of intolerances … I have the book "Friendly Food” and  have tried half half-heartedly to follow the diet but never with help … A recent doctor’s visit introduced me to your website. It is wonderful. I finally feel that I am not the only one”- Ann from story [1482]

Some of these are affected themselves:

“I'm a 40 year old physician who has a severe reaction to consuming annatto (natural colour 160b). If I eat any significant amount, I have the onset of severe vomiting and diarrhea roughly 12 hours later, which then persists for 12-24 hours. I don't have any classic "type I hypersensitivity" symptoms such as hives, just a severe delayed gastrointestinal symptoms ….” – from story [984]

And some have observed problems themselves:

“… symptoms in a boy aged 4 years old onwards … 160b annatto, high salicylates, glutamates and MSG - observed behaviour: defiance, prolonged tantrums, aggressive (out of character), poor concentration, irritable, difficulty settling at night for up to one week.” – Helen GP from story [1334] 

Patients who would like to investigate diet can be referred to dietitians who regularly undertake the RPAH elimination and challenge process. https://www.fedup.com.au/information/support/failsafe-friendly-dietitians-and-other-health-professionals

Prepared by Dr Howard Dengate for the Food Intolerance Network, March 2018

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References and more information

The development of the RPAH Allergy Unit elimination diet and challenges

http://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/development.html

Distinguishing food allergy and intolerance

http://www.slhd.nsw.gov.au/rpa/allergy/resources/foodintol/ffintro.html

http://www.fedup.com.au/factsheets/support-factsheets/allergy-or-intolerance

Support and information for food intolerance

www.fedup.com.au

Recommended dietitians

http://www.fedup.com.au/information/support/failsafe-friendly-dietitians-and-other-health-professionals

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Please download above article and print (4 pages) to give to your GP

 

 

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Food intolerance

Some of the many symptoms of food intolerance that can be helped by diet:

Airways: Asthma, Stuffy blocked or runny nose/ nasal polyps, Frequent nose bleeds, Catarrh, chronic throat-clearing, Sinusitis, Frequent ear infections, Frequent tonsillitis, Frequent colds and flu, symptoms of Samter's Triad, hayfever, allergic rhinitis Skin: Eczema, Urticaria (hives), Cradlecap, Other skin rashes, Angioedema (swollen lips, eyes, tongue), Geographic tongue, Pruritis (itching), Rosaceae, Allergic shiners (dark circles under eyes), Pallor (pale skin), Flushing, Excessive sweating, Body odour, Sore vagina in children, Alopecia (patchy baldness) Digestive system: Irritable bowel symptoms (IBS), Recurrent mouth ulcers, Indigestion, Nausea, Bad breath, Vomiting, Diarrhea, Stomach ache, Bloating, Reflux in babies, adults, Constipation, Colic in babies, adults, Sluggish bowel syndrome (feeling of "more to come"), Encopresis, Soiling (sneaky poos), Dairy intolerance, Gluten and wheat intolerance, Eating disorders (ed), anorexia nervosa, bulimia nervosa, binge eating disorder (BED)  Bladder: Bedwetting, Daytime incontinence, Urinary urgency, Recurrent inflammation (cystitis) Skeletal: Growing pains, Gout, Arthritis, joint pain, arthralgia Eyes: Nystagmus (involuntary movement), Blurred vision Muscles: Low muscle tone, Myalgia (muscle pain), Tics (involuntary movement), Tremor, Leg 'jiggling', Heart: Rapid heart beat, Heart palpitations, Cardiac arrhythmias, Pseudo heart attack (feeling of impending doom, chest pressure, pain down arm), Tachycardia (fast heart beat), Angina-type pain, HHT Central nervous system: Headaches or migraines, unexplained tiredness, Chronic fatigue, Feeling 'hung-over', Confusion, Dizziness, Agitation, Tinnitus (noises in ear), HyperacusisAuditory sensory processing disorder (ASPD), Paraesthesia (pins and needles), Dysaesthesia (numbness), Hypoglycemia, Salicylate-induced hypoglycemia, Epileptic seizures, Fits, Sensory symptoms of multiple sclerosis, Scents and perfume sensitivity, Symptoms of lupus Anxiety: Panic attacks, Depression, Obsessive ruminations (repetitively focusing on bad feelings and experiences from the past), Self harm, Suicidal thoughts, actions, teeth grinding (bruxism) Impaired memory: Vague or forgetful, Unable to concentrate, Won't persevere, Unmotivated, Disorganised, Easily distracted, Difficulty reading and writing Speech: Loud voice (no volume control), Speech hard to understand, Speech delay, Selective mutism, Stuttering, Repetitive noises, Talks too much (empty chatter) Coordination: Poor handwriting, Poor coordination, Frequent accidents, Vertigo Sleep: Difficulty falling asleep, Restless legs syndrome (RLS), Persistent night waking, Insomnia, Nightmares/night terrors/sleepwalking, Sleepless babies, Sleep apnoea Mood: Brain snaps, Mood swings, Premenstrual tension, Grizzly or unhappy, Cries easily or often, Irritable, Uncooperative Oppositional defiance: ODD, Loses temper, Argumentative, Refuses requests, Defies rules, Deliberately annoys others, Blames others for own mistakes, Touchy, easily annoyed, Angry, resentful Other behaviour: ADHD, ADD, Autism, Aspergers, Inattentive, easily bored, unmotivated, 'Unable to entertain himself', Restless, fidgety or overactive, Head banging, Hyperactivity, Fights with siblings, Difficulty making friends, Destructive, aggressive, Unreasonable, Tantrums, Demanding, never satisfied, Disruptive, Discipline is ineffective, Pervasive Development Disorder

Some causes of food intolerance:

Food additives: Artificial colours: (food dyes, artificial colors) tartrazine 102 (E102, FD&C Yellow No.5), quinoline yellow 104 (E104), sunset yellow 110 (E110, FD&C Yellow No.6), azorubine, carmoisine 122 (E122), amaranth 123 (E123), ponceau, brilliant scarlet 124 (E124), erythrosine 127 (E127, FD&C Red No.3), allura red 129 (E129, FD&C Red No.40), indigotine, indigo carmine 132 (E132, FD&C Blue No.2), brilliant blue 133 (E133, FD&C Blue No.1), green S, food green, acid brilliant green 142 (E142), fast green FCF 143 (E143, FD&C Green No.3), brilliant black 151 (E151), brown, chocolate brown 155 (E155)  Natural colours: (colors) Annatto (annatto extracts, bixin, norbixin, 160b, E160b) Preservatives: Sorbates: (sorbic acid 200, E200, sodium sorbate 201, E201, potassium sorbate 202, E202, calcium sorbate 203, E203) Benzoates, hydroxybenzoates, parabens: (including benzoic acid 210, E210, sodium benzoate 211, E211, potassium benzoate 212, E212, calcium benzoate 213, E213, ethyl para-hydroxybenzoate 214, E214, sodium ethyl para-hydroxybenzoate 215, E215, propylparaben 216, E216, propyl 4 hydroxybenzoate 217, E217, methylparaben 218, E218) Sulfites, bisulfites, metabisulfites: (200-228, sulphites, sulphur dioxide, sulfur dioxide 220, E220, sodium sulphite 221, E221, sodium bisulphite 222, E222, sodium metabisulphite 223, E223, potassium metabisulphite 224, E224, potassium sulphite 225, E225, calcium sulphite 226, E226, calcium bisulfite 227, E227, potassium bisulphite 228, E228) Nitrates & nitrites: (249-252, potassium nitrite 249, E249, sodium nitrite 250, E250, sodium nitrate 251, E251, potassium nitrate 252, E252 Propionates: (bread preservative, mould inhibitor 280-283: propionic acid 280, E280, sodium propionate 281, E281, calcium propionate 282, E282, potassium propionate 283, E283, 'natural' preservatives in bread, cultured wheat, cultured dextrose, cultured whey) Synthetic antioxidants: Gallates 310, 311, 312 (E310, E311, E312), tBHQ 319, E319, BHA 320, E320, BHT 321, E321 Flavour enhancers: (flavor enhancers) glutamic acid and all glutamates, MSG monosodium glutamate 620-625, yeast extract, hydrolysed vegetable protein HVP, disodium guanylate 627 (E627, DSG, GMP), disodium inosinate 631 (E631, DSI, IMP), ribonucleotides 635 (E635, I&G, nucleotides)  Flavours: (flavors)  Natural food chemicals: Salicylates: salicylic acid, sodium salicylate, acetylsalicylic acid Biogenic amines: vasoactive amines (tyramine, phenylethylamine, histamine and others) Glutamates:  Natural foods: Dairy: milk, yoghurt, cheese, butter, lactose-free milks Wheat or Gluten: (wheat, rye, barley, oats) Soy: Sugar free sweeteners:Sugar free sweeteners: polyols, sorbitol, mannitol

On this website, failsafe refers to foods that are Free of Additives and Low in Salicylates, Amines and Flavour Enhancers. Note that copyright applies to the commercial use of the term "failsafe" in the food and health context so as to control inappropriate use by the food and health industries.