Roller Coaster

Sometimes trying to identify problem foods feels like a roller coaster. Is a reaction from something you ate two minutes or three hours ago? Does your stomach hurt from today’s yogurt or yesterday’s chocolate cake? Just as you think you’ve crested the hill and figured it out, here comes a curve.

It goes without saying that keeping a meticulous food journal can be instructive over time, but no one wants to feel bad in the ensuing interval. So what can you do to minimize adverse symptoms while you’re riding the roller coaster?

The fewer possible irritants your system is exposed to at a giventime, the easier it will be to identify trigger foods. (If you have been prescribed an elimination diet or other specific regimen, you’ll need to follow that and only implement suggestions that are not contrary to the plan you’re following.)

  • Avoid foods you know are problematic. When your system is going haywire, a little cheat here or there can cause a huge wave of problems.
  • Avoid soaps, cosmetics, perfumes, creams, and lotions that are new or that you have questioned in the past.
  • Use cleaning products that are unscented or that you know don’t upset your system.
  • Wear a mask when cleaning so that dust or spores won’t trigger a reaction. Gloves are a good idea as well.
  • Postpone yard work and avoid any related chemicals if you can. If not, wear a mask, gloves and keep your skin covered. The same applies to gardening and field work.
  • Eat only foods that have typically left you feeling well. If after a few meals, symptoms have lessened, slowly increase the range of fresh foods you consume. It may be helpful to minimize processed food.
  • Keep adding observations to your food journal as you go.

As a practical matter, you may only be able to eliminate some irritants. That can still be helpful both in reducing symptoms and identifying triggers. It may also help you feel as though you can keep trying to find and eliminate problematic foods.

When you’re suffering from inflammation, fatigue, cramps, itchy rashes, migraines, or diarrhea, it can sometimes be difficult to stay on course. Even minor relief can help you retain a positive outlook amidst understandable frustration.

If you’re comfortable, you can share your experience with certain foods to that of friends or family. They may say something that sparks a memory or association you will want to run by your physician.

No matter how diligent you are when keeping track, it can still feel like a relentless roller coaster at times finding trigger foods. That doesn’t mean you won’t be successful. It just means the ride may not be smooth.

Not Exactly an Allergy

Even though your nose is running, your stomach churning, and your skin itching, you may be experiencing something that’s not exactly an allergy. It could be histamine intolerance.

Histamine Intolerance

Histamine intolerance, also known as enteral histaminosis, is a disorder that arises because of a body’s inability to degrade histamine due to diminished diamine oxidase (DAO) enzyme activity which leads to histamine accumulation in plasma and the appearance of adverse effects. That means when a person with histamine intolerance eats foods high in histamines (or that trigger their production) they’ll have an excess of histamine in their system just like they would if an allergic reaction triggered their body to release histamines. Unsurprisingly, the resulting symptoms are similar.

Symptoms

Symptoms of histamine intolerance include headache, dizziness, nasal congestion, sneezing, bloating, diarrhea, abdominal pain, nausea, itching, swelling, eczema, tachycardia, and hypotonia. The most common are gastrointestinal followed by dizziness, headaches, and palpitations, then respiratory and finally, dermatological. An Austrian study found an average of 11 symptoms per patient. That’s a lot of discomfort.

And while histamine intolerance may be causing a lot of unpleasantness, the lack of consensus for a diagnostic algorithm makes diagnosis a dicey proposition. Patients often end up seeing multiple physicians in an effort to get a diagnosis and treatment that will reduce symptoms.

Treatment

The primary strategy for treating histamine intolerance is to follow a low-histamine diet. Foods to avoid include spinach, eggplant, tomatoes, fermented foods, and meat or fish that is not fresh. It is also possible for papayas, kiwis, strawberries, pineapples, and plums to trigger the release of histamine so they should be consumed with caution.

DAO supplements have been proposed as an additional treatment. In Europe, regulations authorize a DAO supplement of enteric-coated porcine kidney protein extract to be marketed as food for special medical purposes.

More to Come

Multiple symptoms in multiple systems, a condition that’s difficult to diagnose, dietary treatment – these probably sound familiar to anyone with celiac disease. And it’s possible there is a connection. DAO activity increases progressively from the duodenum to the ileum and is located mainly in the intestinal villi. What is the effect when the villi become damaged from celiac disease?

Studies showing lessened DAO enzyme concentrations in untreated celiac patients vs those on a gluten-free diet could be an indicator that there is a relationship to be explored. Other connections to IBS and non-celiac gluten/wheat sensitivity (NCGWS) have been established. But studies of histamine intolerance are relatively new. We have much to learn and many connections to make.

In the meantime, if you suspect that histamine intolerance good be causing your allergy-like symptoms, keep a food/symptom diary. This will give you a written history to share with your physician. Don’t be afraid to ask whether they have considered histamine intolerance. You are a valuable part of your medical team.

Together with your doctor, you may develop a diagnostic plan that includes some of the following: skin-prick test; histamine elimination diet; analysis of blood, urine, and stool samples. Once a diagnosis is established, dietary change can eliminate most or all of the symptoms.

While a dietary change may not be your preference, fewer symptoms will bring you relief. And relief is what most of us are looking for even if what we have is not exactly an allergy.

Read the Label!

Whether you’re allergic or have food intolerance, it’s always important to read the label! My kids loved to watch GI Joe when they were little. I remember hearing …”and knowing is half the battle” over and over and over again during the PSAs at the end of the show. When it comes to keeping yourself from ingesting foods or medicines that will harm you, knowing really is half the battle. Reading the ingredients on product labels is a first line of defense to keep you from harm.

NutriLabelOf course it’s tempting to skip over reading labels. It’s time consuming and sometimes difficult when the text is in 2 point type. I’m most likely to neglect this task on products that I buy frequently. If I read the label a week ago, I think, why should I do it again? That’s just silly. But it isn’t silly because products change and I won’t know that unless I’m checking.

I also know that sometimes reading labels will lead to the recognition that everything that seems to trigger my dermatitis has the ingredient povidone or things that give me indigestion all contain corn in some form. Such an insight can quickly lead to an elimination of discomfort and an acceleration of healing. That makes me feel better and how can that be bad?

Still, you may think there’s no reason to read labels on items that logic dictates will not contain anything of concern. It may be time to think again. Not sure?

Take this quiz and see how you do:

Listed below are items that could be of concern to the allergic or food intolerant. Match the ingredient that is an item of concern with the product in which we found it lurking, then take a look at the answers and see how you did.

Item of concern – POVIDONE

A)Farm Raised Atlantic Salmon
B)Morton Iodized Salt
C)Tylenol
D)Dried Cranberries
E)All of the above

Item of concern – MAGNESIUM SULPHATE (Epsom Salt)

A)Hormel® Black Label® Bacon
B)Target Market Pantry Purified Drinking Water
C)HIllshire Farm Lit’l Smokies
D)Fiber One Chewy Bars
E)None of the above

Item of concern – AUTOLYZED YEAST EXTRACT (Contains glutamates)

A)Swanson Natural Goodness Chicken Broth
B)Wonder Classic White Bread
C)Kashi® GOLEAN Crunch® Cereal
D)Van’s Gluten Free Totally Original Waffles
E)All of the above

Item of concern – CORN

A)Yoplait Light Thick & Creamy Yogurt
B)Tylenol
C)Honey Nut Cheerios
D)Tums
E)All of the above

Item of concern – NATURAL FLAVORS (May contain corn, gluten, or dairy)

A)Rice Krispies Cereal
B)Sara Lee All Butter Pound Cake
C)Keebler Club Crackers Original
D)Pepperidge Farm Gluten Free Goldfish Mega Cheese Puffs
E)Cap’n Crunch Cereal

Item of concern – SOY

A)Hidden Valley Ranch Salad Dressing
B)Campbell’s Cream of Potato Condensed Soup
C)Nacho Cheese Doritos
D)Manischewitz Egg Noodles
E)Schar Table Crackers

Item of concern – WHEAT

A)Kikkoman Soy Sauce
B)Campbell’s Cream of Mushroom Soup
C)Mission Garden Spinach Wraps
D)Thai Kitchen Curry Stir Fry Rice Noodle Meal Kit
E)All of the Above

Item of concern – PEANUTS

A)Philadelphia Cream Cheese
B)Honey Nut Cheerios Cereal
C)Special K Protein Bars
D)Honey Nut Chex Cereal
E)Wonder Classic White Bread

Item of concern – DAIRY

A)Coffee-Mate® Liquid Non Dairy Creamer
B)Phillips Coastal Crab Cakes
C)Kinnikinnick Gluten Free Cinnamon Sugar Donuts
D)Land O’Lakes Margarine
E)A & D, or B & C

Item of concern – Malt

A)Equate Ibuprofen Tablets
B)Werther’s Original Caramel Coffee Candy
C)Kellogg’s Corn Flakes
D)Chick-fil-A Vanilla Milkshake
E)Nancy’s Lorraine & Florentine Petite Quiche

Now, take a moment to review the answers below. Were your instincts correct? Were there any surprises? Did you discover a possible reason you are having symptoms?

Perhaps it’s time to consistently read the label. What do you think?

Answers:
Povidone – C)Found in Tylenol
Magnesium Sulphate – B)Found in Target Market Pantry Purified Drinking Water
Autolyzed Yeast Extract – A)Found in Swanson Natural Goodness Chicken Broth
Corn Starch – E)Found in All of the Above – Yoplait Yogurt, Tylenol, Cheerios and Tums
Natural Flavors – D)Found in Pepperidge Farm Gluten Free Goldfish Mega Cheese Puffs
Soy – B)Found in Campbell’s Cream of Potato Condensed Soup
Wheat – E)Found in All of the Above – Soy Sauce, Cream of Mushroom Soup, Spinach Wraps, and Curry Stir Fry Meal Kit
Peanuts – C)Found in Special K Protein Bars*
Dairy – A&D)Found in Coffee-Mate® Liquid Non Dairy Creamer and Land O’Lakes Margarine
Malt – C)Found in Kellogg’s® Corn Flakes

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

*Honey Nut Chex Cereal does not list peanuts in the ingredient list or a peanut warning, but is considered controversial by some. Consume at your own risk if you have severe allergies. http://www.foodfacts.com/ci/nutritionfacts/Breakfast-Foods/General-Mills-Honey-Nut-Chex-Cereal–oz/1647

Should My Whole Household be Gluten-Free, Wheat-Free, Egg-Free, Dairy-Free, Nut-Free, Shellfish-Free, Soy-Free? Ten Important Considerations

pantry mixI’ve been visiting my son in LA and the question keeps coming up, “Should my whole household be gluten-free?” I think it first arose with the smell of chocolate chip cookies coming from the kitchen. They were for a client and contained the traditional wheat prevalent ingredients.

Of course the aroma piqued our desire for gluten-free chocolate chip cookies as well. It seemed like a good idea to bake both while the oven was hot, but the kitchen hadn’t been fully cleaned from prepping the traditional dough. Was it a good idea to mix up the gluten-free cookies yet?

This question led to a discussion of the labels on the pimento cheese containers and the two containers of yogurt (one used for traditional baking) in the fridge and the stash of teeny tiny jellies in the cupboard which then led to a debate on the possible merits of eliminating all gluten from the household.
contaminated
My family has members who are celiac, gluten-intolerant, allergic to shrimp, and able to eat absolutely anything. If your family is like mine, you’re familiar with the balancing act required to keep the affected parties away from harm while keeping the rest of the family satisfied.

Of course there’s no one size fits all solution for determining what works best, but here are a few things to keep in mind when discussing the options:

1)How severe is the allergy or intolerance?

The last time I ate shrimp, my throat swelled shut and I sounded like I had whooping cough when I tried to breathe. Households with peanut allergies may have experienced the horrible helpless feeling that comes along with severe anaphylaxis. Reactions of this level or that are obviously progressively worse with each exposure mean a food allergen will be eliminated from my house.

With gluten, the response to a tiny amount can vary widely. While I would not cook a gluten-free grilled cheese in the same skillet you just used for your regular sandwich without washing it in between, I have no hesitation about using the same skillet once it’s washed. I’ve never had a problem from a burger cooked on a grill where they heat regular buns. There have been times I’ve inadvertently eaten fries that were fried in the same oil as onion rings without suffering any ill effects. But that’s me and those were unique events. Your experience may be very different.

The severity of response to a particular allergen may require some patient observation. Once my gut had healed on the Specific Carbohydrate Diet, I returned to a gluten-free regimen only to discover that I can’t tolerate very much corn. It seems that some of my previously assumed gluten reactions were actually corn related.

2)How is an allergen or irritant stored and who has access to it?

My household has a different rule for medications. Since I have no allergic children or mentally impaired relatives living with me, I don’t mind placing a bottle of aspirin or cough syrup with codeine in the medicine cabinet even though ingesting a single aspirin will have me covered in hives in less than 30 minutes. I simply avoid opening the bottles and consuming the meds.

3)How many people in the household are detrimentally affected by the substance in question?

In the beginning of my gluten-free days, I was one-third of the household and the only one who had to follow the regimen. In other words, I was outnumbered. While I was careful to clean pots, pans, utensils, and surfaces in between, I continued to cook regular pasta, pizza, and dinner rolls for the rest of the family. (A gluten molecule is too large to pass through the skin, so any risk from cleaning up surfaces was easily avoided.) Another option would have been to designate certain pots and pans gluten-free. And, of course there were many more prohibitive options, but it seemed extreme to me to restrict 2/3 of the household as long as I was not suffering any detrimental effects.
GFMix
4)What are the ages and temperaments of the parties at risk?

Young children cannot be expected to read labels on packages or to consistently make good choices. Having a system in place that minimizes their risk and helps them learn at the same time is ideal. Children who tend to follow the rules may respond well to having only gluten-free options in the refrigerator door and a “special” shelf in the pantry from which they are allowed to make their own choices.

Children who are more prone to challenge or mischief may mean a need to eliminate all gluten from the household to minimize your risk as well as theirs. There was some rethinking of my system when my kids decided celiac was a “mental disorder”, meaning it was all in my head, and set out to develop secret tests to see if I would get sick. Funny how all that changed when one of them had to go gluten-free. Ahhhhh, irony…and paybacks! If you have enough patience, these things often work themselves out.

5)What is the cooking environment like?
Is a ceiling fan always running in the kitchen? Is there often a breeze blowing through the open windows or door when you bake? Strong air currents in the kitchen will carry flour particles a long way potentially causing a gluten cross contact problem. You may be careful to clean up the countertop where you’re working, but flour can ride the airwaves across the room to land on gluten-free muffins cooling on another counter.

I always have a cutting board sitting on the peninsula – usually the same one. Are you in the habit of using a single cutting board for everything? Is that cutting board made of a permeable material? How often does it get a thorough cleaning and will you remember to clean it each time it comes in contact with an allergen? All of these things must be considered when determining whether your kitchen environment is conducive to safely using allergens.

6)How many different people in the household cook?

If cooking is a shared duty, it will be necessary to assess the knowledge level and commitment to cooperation of each cook before making a plan.

7)What is your style of cooking or serving food?

Ben and I cook using primarily fresh fruit, vegetables, meat, poultry, and individual baking ingredients. James and my sister use more premixed seasoning packets, boxed meal extenders, and batter mixes. You may purchase mostly precooked, frozen or packaged foods. Some folks put the food in serving bowls, others fill plates in the kitchen, and still others put pots on the table and use a single spoon to dish out the food. You may remove jelly from the jar to your plate with a spoon that never touches your biscuit. We’re in the habit of sticking a knife in the jelly jar to drive my mom crazy. If you do that and smear a piece of regular toast with jelly then stick the knife back in the jelly jar, you’re trailing pieces of toast into the container and contaminating it with gluten.

Your family’s style of cooking and eating will present a unique set of considerations: Are you able to vary the pancake recipe if your child is allergic to eggs and milk? Do you stick your measuring cup in the wheat flour container and then in the sugar when you’re baking? If so, are you willing to break that habit or do you prefer to keep two different containers of sugar so that your gluten-free cupcakes don’t contain contaminated sugar? Are you in the habit of reading labels when pulling something out of the pantry or refrigerator to make sure it doesn’t contain any problem ingredient or do you prefer to be able to use anything in the house without having to think about it?

8)How much space do you have and how organized is your family?

Some families have elaborate storage systems and ample pantry space in which to easily categorize. In my kitchen with its narrow, deep pantry, reused plastic containers are stacked on plastic pull-out organizer drawers from The Container Store. It’s not unusual to see trail of white rice flour on the top of the sorghum flour container. Adding a container of wheat flour to this collection would be ill advised even if it were clearly labeled. In a different environment, a labeling system would be sufficient for preventing cross contact.
cans
9)How much waste will be created by having a dual system?

The discussions that prompted this post have often centered on how much food is getting thrown away. If everything were gluten-free in my son’s house, there would be less waste. Of course this means that to get a consensus for such an arrangement, there must be a high standard for the taste and texture of the gluten-free food so that it is pleasing to everyone. Households like this are one of the reasons Cooking2Thrive is committed to developing gluten-free recipes that go beyond providing an acceptable substitute in order to please the discerning gluten-eating palate.

10)Is it more costly to remove all allergens and irritants from the household or to purchase some of both?

Even with the finances, there’s no specific formula for deciding which will cost more. The answer will vary depending on how many packaged foods you buy, how many different allergies or sensitivities you must accommodate, and whether or not you end up regularly throwing away food. The more data you collect and the more accurate your observations, the greater your ability to determine this outcome.

There’s rarely an easy answer to the question, “Should my whole household be gluten-free, wheat-free, egg-free, dairy-free, nut-free, shellfish-free, soy-free?”, but exploring the options will make you more aware of your habits and the concerns of other family members. That is valuable information upon which to build. My family has found that developing an acceptable plan can reduce stress in the household and make it easier to support each other’s health.

And that would be a good thing for most families…problem is, we LIKE to argue the relative merits of pretty much anything. Of course, you can help us out. Start a whole new discussion by telling us how things work in your household.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”