FAQ & Fact Sheets

Tocopherol is vitamin E.  It is sometimes included in a product as an antioxidant to reduce rancidity of any oils in the preparation.  It is  a “natural” preservative and should be fine for you.
 
Dried fruits are fine as long as they are not sulphited.  The ones in supermarkets generally are sulphited and should be avoided.  You can buy non-sulphited ones in health food stores.  They will be labelled "sulphite-free" or similar words.

You can easily tell if a dried fruit is sulphited or not - the sulphite preserves the colour.  Therefore, if the fruit in the packet is the correct colour, for example if the apricots are a nice orange colour, they are sulphited.  If all the fruit is a neutral beige "non-colour" it is not sulphited.

Being allergic to a specific food is very much an individual reaction.  Yes, there are certain foods, such as peanuts, tree nuts and shellfish, that more often cause allergies in adults than other foods.  And in babies and children, cow’s milk, egg, and soy, as well as peanuts, chicken, and wheat seem to be the most frequent causes of allergy.  However, it is possible for a potentially allergic person to develop an allergy (become sensitized) to any food; it is just that some foods are more likely to cause allergy than others.

Then we have the complication that some foods cause symptoms that resemble allergy, but in fact are not true allergies because the immune system is not involved:  these reactions are more accurately called intolerances.  An intolerance is usually a reaction to a food additive, such as an artificial food colour, a preservative (such as sulphite), an artificial flavour (such as MSG), a naturally-occurring chemical (such as a benzoate), or food component (such as lactose) that the body is unable to metabolize efficiently.  Some foods are high in histamine (e.g. strawberries, tomatoes, shellfish and many fermented foods) that if eaten in large quantities cause symptoms indistinguishable from allergy.  So your question unfortunately does not have a simple answer!

Nevertheless, we can make some generalizations about the degree of allergic potential (usually referred to as the allergenicity) of foods.  I have developed an allergen scale (often referred to as the Joneja Food Allergen Scale), that has proved to be useful as a sort of comparative measure of the allergenicity of foods, based on the frequency of reactions in people eating a typical Western Diet.

The short answer is that there is no laboratory test that on its own will determine exactly which food is causing a person’s symptoms.  All of the tests need to be followed by elimination and challenge of the suspect foods before we have a reliable picture of a person’s food allergies.  Elimination and challenge involves avoiding all of the foods that produce a positive test for a month, and then reintroducing each one separately in a dose-controlled fashion, to determine exactly which symptoms are triggered by the food when it is consumed.

My Factsheet “Diagnosis of Food Allergy” will explain exactly how each test is carried out, and what the results mean. 

Diagnosis of Food Allergy

My book “Dealing with Food Allergies: A Practical Guide to Detecting Culprit Foods and Eating a Healthy, Enjoyable Diet”, Published by Bull Publishing, Boulder, Colorado in 2003 will give you full instructions for the Elimination and Challenge procedure.

Dealing with Food Allergies

I am advising parents who wish to find out if their child might benefit from avoiding casein and gluten to try the diet for a month. If they see improvement, then continue. However, it is essential that the child obtain complete balanced nutrition whenever foods, especially those considered staples, are eliminated from the diet. It is particularly important for children to obtain all the nutrients they require during critical stages of their development, but especially so for autistic children, who tend to be very selective in their choice of foods. The assistance of a registered dietitian should be obtained whenever a child’s diet needs to be drastically altered.

I am advising dietitians to support the parents by supervising the diet, and ensuring that any foods that are excluded are replaced by ones of the same nutritional value. I do have an outline of the diet with a few recipes that I give to parents who request it, but dietitians might wish to develop their own. In addition, many autistic children have specific likes and dislikes and are quite choosey about their food, so the dietitian must also take this into account.

For people who would like more information on the topic of diet and autism, Dr.J’s presentation Current Theories on the Role of Food in Behavioural Problems and Autism: Review of Adverse Reactions to Foods: Mechanisms and Management of Specific Medical Conditions can be viewed in PowerPoint by clicking here

The key to the apparent mystery is that it is most likely neither salicylate nor glutamate sensitivity (confirmed by the patient’s non-responsiveness to challenges) but intolerance of benzoate that the patient is experiencing.  It is significant that the question comes form Australia, where there is a strong belief in salicylate intolerance, while practitioners in North America and Europe are not so strongly convinced about its prevalence.  It is important to realize that most of the foods thought to be culprits in triggering the patient`s symptoms as a result of salicylate intolerance are actually high in natural sources of benzoates. Spices such as cinnamon, nutmeg, clove and anise are very high in benzoates, which would explain the patient`s sensitivity to spices.

Derivatives of benzoic acid (benzoates) are commonly used as preservatives in a variety of manufactured foods, and usually will be listed as ingr4edients on food labels.  In addition, benzoates occur widely in nature as simple salts (sodium, potassium), esters, and amides.  Mostly, benzoates of all types are converted to benzoic acid.  Benzoic acid is rapidly absorbed through the intestine and transported to the liver. There the benzoate is converted to a thioester with co-enzyme A (CoA) to form benzoyl-CoA in the mitochondria and other sites:

Benzoic acid + CoA  = benzoyl-CoA + water

 Benzoyl-CoA then reacts with glycine to form hippuric acid, which is excreted in the urine

        Benzoyl-CoA + glycine = hippuric acid + CoA

It is possible that vitamin D may aid this process.  If this is the case, a deficiency in vitamin D would lead to inefficient excretion of benzoate, benzoate would remain in excess, and thus elicit the symptoms of benzoate intolerance. The form of the vitamin D might also be important in facilitating benzoate removal from the body.

I compiled a list of all of the published sources of levels of natural benzoates in foods for my 1998 book Dietary Management of Food Allergies and Intolerances: A Comprehensive Guide, second edition, published by Hall Publications, Vancouver, pages 208-211 .  Almost all of the published papers are in German, so I had them translated. 
 
In my work as Head of the Allergy Nutrition Research Program at Vancouver Hospital and Health Sciences Centre I saw a number of patients who presented with problems similar to the one you described, with a variety of additional deficiencies (sometimes the B vitamins), who all did extremely well on the benzoate-restricted diet (detailed in the book).  In comparison to avoidance of salicylates, the benzoate-restricted diet is fairly easy, especially as any additive sources of benzoates are usually clearly marked on food labels.
 
You will find a number of papers on benzoate sensitivity in the research literature.

As a corn-allergic person myself, I can completely sympathise with your dilemma. It is fairly easy to avoid obvious sources of corn as a vegetable such as corn-on the cob, or corn kernels, and corn grain products such as corn bread and chips. Happily, a corn-free diet does not pose any nutritional risks since the nutrients in corn are all readily available from other grains.  However, if a large part of your diet is processed, packaged, and pre-prepared foods and quick restaurant meals, I agree that it is extremely difficult to avoid corn because it is a common additional ingredient in many manufactured products.  That is why I never use packaged, processed, or pre-prepared products in my home. You cannot do better than to follow my example and make sure that everything you consume is cooked "from scratch".  All of my meals are made from fresh, frozen or canned foods without any additives, and for the most part I can remain symptom-free.

The answer from Health Canada is correct.  The amount of protein in the corn oil carrier of the fat-soluble vitamins added to commercial milk is so small that in most cases it is insufficient to cause an allergic reaction.
However, if you think that additives in the milk are the cause of your skin eruptions, you should be able to obtain raw milk before the vitamins are added. Some farms will supply you with raw milk before it is sent for processing and artificially fortified. You must boil the milk and cool it before consumption to ensure that any harmful micro-organisms are destroyed.  This does not destroy any important nutrients such as calcium, and it would allow you to enjoy milk and its nutritional benefits once again.
However, the raw milk will not supply your requirements for vitamins A and D, so be sure to obtain your daily requirement of these vitamins from alternate sources (see below). 

 Sources of Vitamin A:
Vitamin A from plant sources (carotenoids) can be found in dark green, leafy vegetables (broccoli, swiss chard, kale, spinach, romaine lettuce, endive, Brussels sprouts) and orange or yellow vegetables (carrot, sweet potato, pumpkin, winter squash) and fruits (apricots, peaches, cantaloupe, papaya).
Animal sources of vitamin A (retinol) include liver, fish liver oils, milk, milk products, butter, eggs.

Sources of Vitamin D:
The main source of vitamin D is the action of sunlight on the skin.  Half an hour in direct sunshine will supply the daily requirement for vitamin D for the average adult. Food sources include egg yolk, liver, oily fish and fish liver oils.

You have actually given me some important information about your son, and have asked what seems to be a simple question, but which has a complex answer.  I will try to be brief:

First of all, it is important to understand that food does not cause eczema, nor does food cause allergy.  It is the person’s immune system reacting to the food as if it were a threat to the body’s health that results in the symptoms of allergy.  Eczema (or in medical terms, atopic dermatitis) is one of the important symptoms that can result from an allergic reaction to food.  Eczema can also occur as a response to an allergic reaction to environmental allergens such as dust mites, mold spores, animal dander, and plant pollens, among others.

 Eczema as a symptom of food allergy seems to be much more frequent in early childhood than later in life.  The first symptoms that alert health care providers and parents that a baby is allergic (or atopic) are in the digestive tract (often exhibited as symptoms such as prolonged colic, vomiting, and diarrhea) and in the skin (eczema and hives).  In babies under the age of six months, eliminating the foods that are triggering symptoms often leads to a significant improvement in the eczema, and in some cases, total remission.  These foods may be in the diet of the breast-feeding mother, or in the baby’s diet if he/she is formula-fed, or has started to consume solid foods.

In our experience in the Allergy Nutrition Clinic at Vancouver Hospital, the foods that most frequently trigger the onset of eczema in babies and children tend to be:
Eggs
Milk and milk products
Peanut/soy/green pea (but not other legumes)

 When a breast-fed baby has eczema we first eliminate these foods from the mother`s diet (while replacing them with nutritionally equivalent foods) and find that a very high percentage of babies under 6 months of age experience a significant improvement in their eczema. Of course every baby is an individual, and may have been sensitized to foods other than those on the above list.  If elimination of these three foods does not result in complete resolution of the baby’s eczema we proceed to eliminate others, based on careful analysis of a food and symptoms record of the baby’s diet and symptoms, and the diet of the mother if the baby is breast-fed. After careful elimination of the suspect foods, reintroducing each separate food and monitoring of the baby’s response will usually provide all the information we require to formulate a diet that is free from the baby’s eczema triggers, and provides complete balanced nutrition from alternate sources, both for the baby and for the breast-feeding mother.

Unfortunately, we do not see the same degree of improvement in older children because after a year, environmental allergens (dust mites, mold spores, pollens, animal dander) begin to be as, or more, important than foods as a cause for the eczema.  It is likely that the baby’s immune cells come into contact with these environmental allergens through the skin in places where early eczema has caused a breach in the usually intact tissue barrier.  Thereafter, whenever the baby encounters these allergens, the immune system is primed to respond with symptoms of allergy.  Sometimes this allergy is eczema, but it can also be expressed as rhinitis (nasal stuffiness) and wheezing (which can be a symptom of asthma) when the allergens have sensitized tissues of the respiratory tract.

So, your 2 year-old is exhibiting signs of allergy, possibly to both foods and environmental allergens.  This would explain the obvious increase in the severity of his eczema, and his rhinitis and wheezing, when he has been in an environment where the level of the allergens (in his case dust and cat dander), are unusually high.

I would advise you to take your son to a pediatrician or pediatric allergist for allergy evaluation and RAST, which is a blood test that will demonstrate whether he has been sensitized to specific allergens, both in foods and in the environment.  Skin testing is not advisable for children who have eczema, because their skin is already highly reactive and will frequently produce false positive results, as well as creating a possible route for sensitization to allergens in the test reagents.
 Since your son is fairly young he might still be reacting adversely to some foods in his diet.  A short time trial (from two weeks to a month) on a diet that excludes the most frequent food allergens (eggs, milk and milk products, peanuts, tree nuts, soy, and green peas) should show improvement in his symptoms if foods are playing a significant role in the eczema.  Reintroducing these foods separately and monitoring your son’s response by looking for reddening of his skin, itching, and an obvious increase in his eczema, will confirm that the specific food that triggered this response should be avoided. I strongly urge you to enlist the help of a registered dietitian in this process of food elimination because it is extremely important that each food that is excluded from your son’s diet be replaced by one of equal nutritional value.  We do not want to put him at any nutritional risk as a result of removing important food groups (such as milk and milk products) from his diet at this critical stage of his development.

You might find my article, “Babies, Children and Food Allergies” in the Journal of the Institute for Optimum Nutrition, Volume 13, Number 2.  Spring/Summer 2000  to be helpful in providing you with further information about food allergy.

By the age of 14 months it is likely that your son is out-growing his early reactivity to egg, and it would be wise for him to undertake a direct challenge test to determine whether he still develops symptoms when he eats egg, since this is an ingredient in many nutritious foods which can be introduced now.  However, there is a risk of a severe reaction when egg is consumed because egg is one of the foods that has the potential to cause anaphylaxis in young children. Clearly, you do not want to risk this reaction at home.  Talk to your child`s doctor and make arrangements for a challenge test to take place in a clinic or hospital.

 You could carry out a safe non-provocation preliminary test for egg allergy at home: Apply a small amount of egg yolk to your son`s cheek and wait 20 minutes. If there is no sign of reddening or irritation at the site of application, apply a little to the outer border of his bottom lip (not inside); again wait for 20 minutes.  If there is no reddening, blistering, or irritation, it should be safe to proceed to a direct challenge

Usually, a small amount of egg is placed on the child`s tongue.  If there is no reaction the child is given a very small amount of egg yolk (e.g. ¼ teaspoonful) to eat and monitored for up to four hours for a reaction.  If no symptoms develop, give him ? teaspoon yolk, and again, if there is no reaction after a further four hours, one teaspoon of yolk.

If the child does not react to egg yolk, egg white can be challenged in exactly the same way.

Egg in vaccines: Although a small quantity of egg from the viral culture medium might contaminate vaccines such as the MMR and flu, there is very little reported evidence of anaphylactic reactions to the egg component of the vaccine, so most physicians seem to feel safe in administering these vaccines to egg-allergic children who have not had a severe reaction.  In the cases where anaphylactic reactions to egg ingestion have occurred, the physician may give the vaccine in small doses rather than all at once.  Talk to your child`s doctor or health clinic for their recommendations and policy on administering viral vaccines to egg-allergic children.

Because your son did not start to develop loose stool and diarrhea until he started to eat a wider range of foods, it is unlikely that he is allergic to milk, and lactose intolerance would be very unusual at his age unless he has had a recent digestive tract infection. A clue to his problem is that when you removed milk from his diet and substituted apple and pear juice, the diarrhea became worse.  This suggests that he may be exhibiting signs of fructose intolerance, or more accurately, fructose malabsorption, a condition that is not uncommon in early childhood.

Apples and pears, unlike other fruits and their juices, contain more of a sugar called fructose than glucose (most other fruits contain about the same quantity of fructose as glucose, which combine to make the disaccharide sugar, sucrose).  It is thought that immaturity in the system that transports the sugars across the digestive membrane into blood causes the large amount of fructose in apples and pears to be left behind in the small intestine.  The fructose is thus undigested and causes problems when it moves into the large bowel.  Here it provides nourishment for the micro-organisms that live in the bowel, which ferment the sugar and cause the stool to be loose.  Diarrhea results.

Removing apples and pears and their juices from your son’s diet will solve the problem if fructose intolerance is the cause of his diarrhea.  Try avoiding all fruit juices for a while.  Give him plenty of plain water, and milk should be OK, and continue to breast-feed.  After about four weeks, if the diarrhea has cleared up, try juices other than apple or pear. Although, as you correctly say, orange juice is considered to be more allergenic than apples and pears, it does contain less fructose, so try diluted orange juice as a test when your son’s stool has returned to normal.

If the diarrhea does not resolve after about a week without fruits and juices, consult your son’s doctor, who will probably order tests to investigate other causes for the diarrhea.

My Fact Sheet, Fructose Intolerance, will give you more information on this condition.

Fructose intolerance usually presents as loose stool and diarrhea after the patient eats fruits, especially apples and pears, that have a higher fructose:glucose ratio than most other fruits.  As you probably know, fructose is one of the monosaccharide sugars that contribute to the structure of sucrose; glucose is the other.  When there is an impairment in digestion and /or absorption of fructose, the undigested sugar passes into the large bowel, where it causes increased osmotic pressure, resulting in a net fluid increase, and hence loose stool. In addition, the extra sugar in the bowel acts as a substrate for microbial fermentation.  Organic acids and gases, especially hydrogen, are produced.  The hydrogen passes into circulation, and is transported in blood to the lungs where it is excreted in the breath.  Hence, an increase in breath hydrogen after a fructose challenge is a strong indicator of fructose malabsorption or maldigestion.

 There are several conditions that result in fructose intolerance, including enzyme deficiencies (more correctly designated inborn errors of metabolism) and inefficient absorption.  Enzyme deficiencies are quite rare, and include:

• Fructose-1,6-bisphosphatase deficiency
• A deficiency in the liver enzyme aldolase B, usually called Hereditary Fructose Intolerance
• A deficiency in fructokinase, usually called Essential Fructosuria

More common in early childhood is an inefficient transport of fructose across the epithelium of the small intestine.  Fructose moves into circulation via a glucose-dependent energy-requiring transport system.  When there is an impairment in this system, which might be due to immaturity in the young child, glucose is preferentially transferred, leaving excess fructose in the gut lumen, which passes into the large bowel.

In each condition, except Essential Fructosuria, hydrogen is excreted in the breath as a result of microbial fermentation of fructose in the large bowel.  Therefore, although the hydrogen breath test indicates fructose intolerance, it will not differentiate between fructose malabsorption and an impairment in fructose metabolism.  Biopsy and measurement of liver enzymes is usually required to determine a specific enzyme deficiency.

Management of the two conditions differs.  Fructose intolerance due to inefficient absorption requires only avoidance of the fruits and their juices (principally apple and pear) in which there is a greater concentration of fructose than glucose.  Fructose intolerance due to an enzyme deficiency requires avoidance of all sources of fructose, which means avoiding all sources of fructose and sucrose
More information on fructose intolerance can be found in my Fact Sheet Fructose Intolerance.

The symptoms you describe, and the type of pattern of onset, seems to suggest that you are dealing with a situation of histamine excess.  Excessive histamine, from a variety of different sources, will result in symptoms often indistinguishable from allergy.  This is not surprising since the early symptoms of an allergic reaction are mediated by the histamine released during the progress of the allergic response.  The question, of course, is why are you experiencing symptoms of histamine excess now?

The key to your problem is possibly the “bad infection” you had about three years ago.  I assume you had at least one course of antibiotics, although you do not give details of the infective micro-organism and the treatment you received. It is possible that the infective organism, and/or any antibiotics you may have taken at the time, caused a change in the bacteria that inhabit your large bowel. The bacteria now in your intestines may be the types that make histamine from incompletely digested food materials that pass into the bowel.  This can result in more histamine entering your body than previously, and augmenting both your natural histamine (that we require for a various functions in the brain and digestive tract as well as processes in the  immune system), and histamine in your diet.

The problem with "histamine excess" is that we are dealing with a very complex process.  It is not like an allergy where we can identify exactly which foods contain the allergen and avoid them - it is much more complicated.  I`ll try to explain.....
 
Histamine comes from many different sources - your body makes it, and the micro-organisms that live in your bowel also make it from food materials that are incompletely digested.  In addition, some foods themselves contain histamine naturally, and some ingredients in foods (especially food additives like some food dyes and preservatives such as benzoates and sulphites) cause the body to release more.  It is the accumulated amount of histamine from all these sources that causes symptoms.  And furthermore, it often takes time for the level of histamine to build up to a “reactive level”.  So you see - it is not an easy job finding out which of these possible sources of histamine is the culprit in any given situation.  It is rarely a single food that is the cause, and avoiding one or two foods will rarely solve the problem. It is important that all histamine-rich foods be avoided in order to reduce the total amount of histamine entering the body in the diet.  And even then, the reduction in histamine from external sources (extrinsic histamine) may not be sufficient to achieve complete remission of a person’s symptoms, especially in cases where histamine is being released continuously from a chronic inflammatory process.  A histamine-restricted diet in cases of chronic inflammation may reduce the intensity of a person’s symptoms, but because the cause lies elsewhere, total symptom remission may not be achieved.

  The reason that some people get symptoms of histamine excess and others do not is because there is a difference in the amount of specific enzymes to keep histamine levels in check that each person naturally produces.  This can be an inherited trait, or may be affected by factors that are as yet completely understood.  We do know that certain medications can affect the process of histamine breakdown in some cases. However, we do not know of any process that will increase the amount of these enzymes that the body produces.  All we can do is to intercept histamine before it causes symptoms, using antihistamines, and reduce the amount of histamine coming from our food by following a histamine-reduced diet.

In my clinical practice of managing food sensitivities I have encountered a large number of patients with exactly the kind of the symptoms that you describe, who have responded extremely well to a histamine-restricted diet.  The basis of the diet is avoidance of foods that are rich in natural histamine; in particular, fermented foods in which bacterial activity during their manufacture produces histamine; foods that contain histamine, possibly as a result of the ripening process (e.g.strawberries, raspberries and tomatoes); and foods and food additives that release histamine by a process that is incompletely understood at present.  Details of the diet can be found in my book: Dealing with Food Allergies, Pages 234-244

You will find further information on Histamine Intolerance in my Fact Sheet, and one of my published articles on the subject.  In addition, I have provided one of my PowerPoint presentations on the topic for those of you who would like even more information.  Please click on the links below to access these resources:

Joneja JMV and Carmona Silva C. Outcome of a histamine-restricted diet based on chart audit. Journal of Nutritional and Environmental Medicine 2001;11(4):249-262

The Pivotal Role of Histamine in the Symptoms of Food Intolerance

Unless Michael has other signs of allergy, such as skin rashes (eczema or hives), tummy problems, perhaps with diarrhea, or respiratory symptoms such as a stuffy runny nose, itchy eyes and ears, his hyperactivity is not a sign of food allergy.  Hyperactivity alone is never caused by food allergy.
However, recent research has indicated that some food additives, such as artificial colours and certain preservatives, may have an almost drug-like effect on young children, causing a noticeable change for the worse in their behaviour.
Because the manufactured foods that contain the additives frequently also contain a lot of sugar, it has become a common misconception that sugar is the culprit.  So often I hear parents state that their child is “on a sugar high”, or words to that effect. In fact, foods with a high sugar content tend to make a person feel lethargic and sleepy.  That is because sugar, especially in the absence of protein, promotes the production of the “sleep chemical”, called serotonin, in the brain.
It is most likely that Michael’s worst behaviour results from an overload of manufactured foods, which inevitably contain artificial colours and preservatives.  You would probably see a significant improvement in his behaviour if you restrict his intake of manufactured prepared and processed foods, especially candies, packaged and “convenience” foods, and pop. Provide meals based on natural foods, with a good range of fresh vegetables, fruits, poultry, meat, fish, eggs, whole grains, and fruit juices.

My Fact Sheet Diet and Hyperactivity In Children will give you more information on this topic.
For a detailed discussion on the subject of diet and behaviour, please read my article Diet and Behaviour – Myth or Science? and view my PowerPoint presentation Diet and Behaviour – Myth or Science?

This is just the right age to start your baby on solid foods, and I am so pleased that you have asked the question before exposing her to a lot of foods to which she might react.  At this stage there is a lot that we can do to reduce Alisha’s chance of developing food allergies.  She is already at a distinct advantage because you have been breast-feeding her since birth.  In addition you have removed her most likely allergens from your own diet, and therefore decreased Alisha’s exposure to them through your breast milk. Now we need to take equal care in exposing her to the potential allergens in solid foods.

The longer we can protect Alisha from becoming sensitized to the most highly allergenic foods, the greater chance we have that she will not become allergic to them at all.  As Alisha gets older, her immune system and her digestive tract become more mature, and the chance of the immune system “fighting” her food (which is a simplistic way of describing what happens in a foods allergy) is reduced.  However, we cannot delay introducing solids much beyond 6 months of age for most babies, because this is the age when they need to experience different tastes and textures, and lean how to chew and move the food round the mouth and swallow it.  If we delay too long, this part of the baby’s development can sometimes be disrupted.

While introducing foods to an allergic baby we have to take into account an important immunological process that we call tolerance.  Tolerance is achieved when the immune system learns to distinguish between materials that are foreign and a threat to the body (viruses, bacteria, cancer cells, etc.), and those that are foreign but no threat (e.g. food).  In the non-allergic individual this is a process that goes undetected: infections are warded off, and food is consumed without any difficulty.  However, the immune system of the allergic person acts differently, and tries to protect the body from the “foreign” molecules in food, developing symptoms of allergy in the process. Therefore, we need to take steps to “educate” the allergic baby’s immune system so that it does not try to fight the food that is essential to the baby’s survival.

We “educate” the baby’s immune system by taking advantage of the fact that tolerance develops when food is introduced in a “non-threatening” manner.  We start with a small amount of a single food and increasing the quantity gradually.  The first foods to be introduced need to be those that are least likely to cause allergy.  We introduce the more highly allergenic foods later as the baby’s immune and digestive systems mature.

  My Factsheet: Feeding the Allergic Infant:  Adding Solid Foods After Six Months of Age provides you with a schedule that will help you choose the most appropriate foods for your baby.

Thank you for sending the detailed food and symptom record.  Analysis of that data gives me a good idea of the dietary factors that are contributing to your distress.

Even though you are choosing more or less the "right foods" for the IBS diet, the cause of your persistent symptoms (abdominal pain, rumblings, frequent and loose bowel movements) is the quantity of complex carbohydrates that you are consuming.  More of this food material than your digestive system can cope with finds its way into the lower bowel, where it is being merrily fermented by micro-organisms.  The result is production of gas (the rumblings and pain) and unbalanced osmotic pressure (loose stool, frequent BMs and possibly occasional diarrhea).  You will definitely need to eat a diet that is higher in protein and lower in fermentable carbohydrate than you are eating now.

Just as an example, your first day lists: apple juice; porridge; dates; honey; boiled apples; yam; aubergine; courgette; carrot; onion; red pepper; broccoli; mushroom; tomato; rice cakes; stewed figs; orange juice; rice cakes again; potato chips; and stir-fried vegetables.  All this is potentially fermentable food for the micro-organisms in your bowel.  The protein eaten on that day is small in comparison - soy milk (which may be sweetened?), tofu, cashew and peanut butters, and shrimp.

Unfortunately, your total diet follows this pattern, and results in far too much fermentable carbohydrate, and too little protein overall. I`m afraid that your symptoms are indicating that a predominantly vegetarian diet (which I can perfectly understand to be your preference) is not going to serve you well as far as your present digestive tract function is concerned.

This is actually well illustrated when you consumed the banana; you had "heaps of gas" which would likely be the result of 90% of the starch in a raw banana being indigestible, moving down into the large bowel where it would be avidly fermented by the bacteria living there.  Sorry - this sounds like a definite "can`t eat".  Please cook all banana well before consuming it.

Rather than vegetable-predominant stir-fries, the old meat and two vegetables of the traditional English diet would serve you much better: e.g. roast chicken; cooked broccoli and potatoes; fish and chips and green beans; steak, rice and cauliflower; I’m sure you get the picture!  Breakfast might be a mushroom omelette and hash brown potatoes. Try to limit your vegetables and fruits to only one, or at the most two, per meal for the time being. Lunch could be a nice stew with meat (lamb perhaps?) carrots or parsnips, and celery or perhaps ground beef, onions, potatoes and leeks.  There are lots of good recipes in my book Digestion, Diet and Disease: Irritable Bowel Syndrome and Gastrointestinal Function published by Rutgers University Press in August 2004 Please do not reduce your total intake of food - we do not want you to lose weight or suffer some miserable nutritional deficiency!

Oh dear, you do seem to be having a hard time!

The real story is that it is not the individual foods that are causing your reaction, but the type of food.  In other words, at this stage it would appear that you are not going to tolerate any fruits or vegetables in the RAW state.  The early symptoms are possibly caused by the structural components of the food reacting with the irritated lining of your digestive tract. And the undigested parts of the food are passing into your large bowel where they provide a fermentable substrate for the millions of micro-organisms that are multiplying and living there – hence the gas, bloating and pain!  The unavoidable conclusion is that you must cook everything that you eat at this stage, otherwise you will have symptoms.  Sorry.

The stuffy nose could be due to a mild cow`s milk protein allergy. The quantity of casein (in the form of a total of 6 ounces of Mozzarella) that you consumed would be sufficient to demonstrate that.  If it isn`t a cold (which it sounds as if it could very well be!), consider this as a possibility.  Avoid the Mozzarella until your nasal symptoms have cleared up entirely, then do the challenge again.  If you get the same symptoms you can consider that as an indication of possible milk allergy.

It depends on the grain from which the bran was extracted.  Bran is the name we give to the outer coating of a grain or seed that is removed by milling to release the starchy kernel inside, which is usually white or a creamy colour.  Thus, removing the outer coating of wheat gives us a whitish kernel, which is ground to make white flour.  Removing the outer coating of rice (which is naturally brown) gives us white rice, and so on.  The outer coating of the grain is then marketed as “bran”. Usually bran is the outer husk of wheat, but bran from a variety of grains is available.  Bran from wheat, rye, barley and corn is not allowed on the IBS diet since they tend to be too harsh for the irritated digestive tract.  Rice and oat bran are usually tolerated, but since the IBS diet excludes oats, only rice bran is allowed until oats are challenged after the initial 4-week elimination period.

 So the simple answer:  rice bran is allowed, but bran from all other sources is not.

Smoked bacon seems to cause problems for some very sensitive IBS sufferers.  “Green” bacon (marketed in the UK ), which is more or less cured bacon without the smoke is fine.  If you can find unsmoked bacon, you can include it in the IBS diet.

Yes.  The gluten-free variety of soy sauce is usually marketed as tamari sauce.

Fruit in a can is allowed, as is the juice of that fruit, because both the fruit and the juice have been heated sufficiently in the canning process to change the structure of the components of the food inside to a form that will be non-irritating. You do not need to boil the juice separately.

Probably the closest food to cheese would be tofu.  It is derived from soy, which is allowed on the IBS diet.

Tofu can be fried in cubes and added to a stir-fry; it can be crumbled into a salad, and can be stirred into scrambled eggs and other savoury dishes where you might have previously used cheese.

Although spices derived from roots are not allowed on the IBS diet, ginger tends to be an exception.  Some people do have a problem with ginger, but others have reported that they find it soothing.  So – here you will need to do a bit of experimenting.  Put the ginger root in water in a saucepan, bring it to the boil and heat for about 5 minutes.  Take it off the stove and allow to infuse for about 10 more minutes.  Remove the ginger and add the lemon juice that has been previously boiled.  Alternatively, you could boil the ginger root in the lemon juice to which you have added water.  Try this lemon-ginger tea, and if it causes no problems, include it in your diet.

Lactose is the sugar in milk.

Lactose intolerance results from the lack of the enzyme that is necessary to digest lactose. Lactose intolerance is not an allergy. An allergic reaction to milk involves a response of the immune system to the proteins  in milk. A lactose intolerant person can consume milk and milk products if the lactose is removed before consumption

There are a number of laboratory tests that are often used to identify lactose intolerance:

The Fecal Reducing Substances Test is considered by many clinicians as the most reliable. After a drink containing lactose, the feces are collected and Fehling’s solution added.  The presence of undigested lactose in the stool will be indicated by a change in colour, indicating that lactose has not been digested, and thus suggesting a deficiency in lactase production.

The  Hydrogen Breath Test is a more common test for lactose intolerance. In this test the patient ingests a quantity of lactose and after a prescribed interval, a breath sample is analysed for the presence of hydrogen.  If hydrogen is detected, it indicates that bacteria in the digestive tract have acted on undigested lactose and produced hydrogen as one of their metabolic by-products.  Unfortunately, this test is not specific for lactase deficiency, because any sugar remaining in the digestive tract will be metabolized by bacteria with the production of hydrogen.  Undigested sucrose, maltose, or a starch will give a similar result.

The Blood Glucose Test involves measurement of the level of glucose in the blood after taking a drink containing 50 g of lactose.  An increase in blood glucose indicates that lactose has been broken down to glucose and galactose, the levels of which rise in the blood when the body is producing an adequate amount of lactase.  Measuring the level of galactose would be equally informative.

If there is no increase in the level of glucose in the blood, lactose intolerance is confirmed.
If the feces collected after the above lactose drink are acidic, with a pH of 6 or lower (the Fecal pH Test), it is an indication that microorganisms in the large bowel have fermented the undigested lactose.  The microbial activity results in the production of acids, which lower the pH of the stool. Thus the diagnosis of lactose intolerance is further reinforced.

Lactase deficiency is easier to manage than cow’s milk protein allergy, because any milk or milk product free from lactose can be consumed with ?impunity.  Lactose-free milk is available as products such as ?Lactaid or ?Lacteeze milk.  Alternatively, a commercial form of lactase (sold as?or ?Lactaid   liquid) can be added to the milk before consumption.  After?Lactaid 24 hours in the fridge, the lactose is split into its two component sugars, glucose and galactose, which the body can absorb and use without harm.  Alternatively, a lactose-intolerant person can take ?Lactaid pills before consuming milk products containing lactose.  The lactase in the pills will break down much of the lactose in the food or beverage while it is passing through the digestive tract.  All of the nutrients and proteins in milk are thus available to the body, and the risk of nutritional deficiency as a result of long-term avoidance of milk can be avoided.

It is more difficult to avoid lactose in prepared foods; anything containing milk or milk solids is likely to contain lactose also.  Some people find that they can consume lactose-containing foods with impunity by taking Lactaid tablets  before eating.

Lactose intolerance is dose-related.  Usually the cells are producing a limited amount of the enzyme lactase, and small doses of foods containing lactose can be processed.  Problems occur when the amount of lactose in the food exceeds the capacity of the enzyme to digest it.  The important thing is to determine individual tolerance levels.  By remaining within personal limits, symptoms should not occur. Most people who are lactose intolerant can drink a 6 ounce glass of milk without symptoms, but experience abdominal discomfort if they exceed this amount.

There is no reason to stop breast-feeding your baby – and do not stop drinking milk yourself.  The lactose composition of your milk will remain constant, regardless of whether or not you consume milk and milk products yourself.  Even though a  breast-fed baby will ingest significant quantities of lactose in mother`s milk.. there are several ways we can manage the condition without any need to discontinue the breast-feeding.

• If the baby`s lactose intolerance is secondary to a gastrointestinal tract infection or other condition that is expected to be transient, you can  continue breast-feeding and expect the diarrhea to gradually diminish as the underlying inflammation disappears.

• Some practitioners recommend placing a few drops of Lactaid liquid directly into the baby`s mouth before a feeding.  This may provide enough of the enzyme to break down some of the lactose in mother`s milk, and thus reduce the baby`s digestive tract symptoms.

• Alternatively, you  can pump your  breast milk and treat the milk  with Lactaid drops (4 drops per 250 ml milk), and allow the enzyme to act for 24 hours in the fridge.  Then feed baby the lactose-free milk the next day.  Continue in this way  until the diarrhea abates, when the baby can be gradually put back to the breast.

You do not need to stop drinking all milk – you can buy milk without lactose.  And most hard cheeses do not contain lactose.  Having lactose intolerance does not mean that you have to avoid all milk and milk products – you only have to limit those that contain lactose.

My Lactose Intolerance Factsheet will provide you with all the information you need to adjust your diet so that you can avoid lactose, but continue consuming milk and milk products, and benefiting from the nutrients that milk provides.

• Lactose-intolerant babies will usually tolerate lactose-free infant formulas.

• If the baby is not allergic to milk,  milk-based formulas such as ^TM Enfalac LactoFree (Mead Johnson) or ^TM Similac LF (Ross) which are free from lactose are suitable.

• If the infant is also allergic to cow`s milk proteins, a  casein hydrolysate formula such as ^TMEnfamil Nutramigen (Mead Johnson) or ^TMAlimentum (Ross) (Mead Johnson)  should be be tolerated.  All are free from lactose.

Thank you for contacting me. You have managed your son`s milk allergy well, and I congratulate you on his present symptom-free status.

I would suggest that it is time for your son to be reassessed for his milk allergy. It is likely that he has outgrown the early allergy, but you cannot be sure, and need to take precautions because of his early acute reaction to milk. The fact that he felt that application of the goat`s cheese to his skin made him feel itchy suggests that he has not yet outgrown his allergy to milk proteins (some of which are the same in cow`s and goat`s milk).

 If there is any risk of a serious allergic reaction, the food should only be reintroduced ("challenged") in a hospital or a suitably equipped clinic. Contact your family doctor, or your child`s paediatrician if he has one. Ask for the challenge, and the doctor will make all the arrangements to have it carried out in safety.

You describe a very typical picture of oral allergy syndrome (OAS).  This is a reaction in the mouth and surrounding tissues, such as the throat, that can develop after years of hay fever symptoms.  The initial reaction is in the upper respiratory tract, and is an allergy to inhaled pollens from trees such as birch and alder, grasses and weeds.  The respiratory tissues are close to those of the mouth and it seems that over a prolonged period of time, the adjacent oral tissues also become sensitized.  Then fruits, vegetables and sometimes nuts that contain proteins (allergens) that have the same structures as the pollens, interact with the sensitized oral tissues.  When you eat the plant foods the symptoms develop in your mouth and throat.  There is very little evidence to suggest that this reaction progresses to become systemic, that is, causes an anaphylactic reaction.  Although you may experience throat tightening, it seems to be as an extension of the oral symptoms, and not a result of anaphylaxis.

You will most likely be able to control your symptoms by cooking all the fruits and vegetables that have the same allergens as the pollens to which you are allergic.  It is the raw form that will cause you a problem.  So in future, only eat apples, watermelon and carrots when they are well-cooked.

However, if he is not yet eating a complete range of foods, he will need a formula until he is. I would strongly recommend that you switch to a casein hydrolysate formula such as Alimentum (Ross) or Enfamil Nutramigen (Mead Johnson). He will find the taste unusual at first, but all children seem to get used to it over time. Alimentum is sweeter (it contains sucrose), so tends to be more palatable when changing from a milk- or soy-based formula.

The connection between milk and soy allergy has nothing to do with cross-reactivity of allergens - there is none. The reason for not using soy-based formulas as a substitute for milk-based ones is that there is a very high potential for the child who is allergic to milk to become allergic to another highly allergenic food, such as soy. Furthermore, soy allergy is much more difficult to manage than a milk allergy because children start to out-grow their early allergy to milk starting at about 18 months of age; by age five, 90% of children have outgrown their milk allergy. However, in contrast, soy, like its close relative, peanut, tends to be an allergy that persists for life. With the increasing numbers of manufactured foods "enriched" with soy protein, it is becoming a very difficult task to avoid all sources of soy in the modern diet. I most certainly agree that a soy-based formula is not a suitable food for milk-allergic infants.

And yes - there is a link between soy and peanut allergy - not only are the two foods closely-related legumes (though with structurally different antigens), the same argument as the relationship between milk and soy formulae applies: the highly allergic child will develop allergies to the highly allergenic foods, especially when they are introduced to them in the first 12 months of life when the potential for allergic sensitization is highest. Peanut is one of the foods that are most frequently cited as potential triggers of anaphylaxis, and any measure that will reduce the possibility of such a reaction should be taken seriously. Therefore, we recommend that an allergic child not be exposed to peanuts until after three years of age when sensitization to foods is becoming less likely.

Calcium pidolate is manufactured in Germany, and the absorption studies indicate that it is absorbed as well as calcium gluconate, which is good.  So yes - this should be fine.

As a 22 year old female you require a total of 1,000 mg of calcium per day.  The richest source of calcium is milk and milk products, and since you are following a completely milk-free diet, it would be wise for you to take the total recommended dose as a supplement.
Calcium supplements vary in their absorbability.  The acidic forms of calcium such as calcium citrate, calcium gluconate, and the Kreb’s cycle derivatives of calcium carbonate (citrate, fumarate, succinate, malate, glutamate) are absorbed best.
 In addition, the acidic forms of the mineral do not neutralize gastric acid (which is required for the first stages of protein digestion) in the stomach, so do not interfere with the digestion and absorption of other nutrients.  The alkaline forms of calcium, such as calcium carbonate or bicarbonate, tend to neutralize gastric secretions, so are not as beneficial as the acidic forms.

You do not tell me how much elemental calcium each capsule contains.  It is the elemental; calcium that tells us exactly how much calcium will be available for absorption.  The calcium in the capsule is attached to the pidolate molecule, which accounts for what seems to be an excessively large dosage (8 X 350 = 2,800 mg), but only a small proportion of that is actually calcium; the rest is pidolate. The recommended 6 to 8 capsules of calcium pidolate per day sounds about right.