Eating friendly food to challenge eczema

When my son was about a month old, in the middle of a typically hot Melbourne summer, he developed a heat rash on his face.  Rather than fading after a few hours, the rash spread to his chest the next day.  When it hadn't cleared after a few days I took him to the doctor, who diagnosed eczema and told us to put cream on it.  It slowly cleared up off his face, but there continued to be some part of his body covered in rash.

When he was a few months old he got a wicked nappy rash that would not respond to the traditional nappy creams.  Once again it was diagnosed as eczema.  This time the diagnosis came with a prescription for a low concentration hydro-cortisone ointment.  The redness would reduce while he was using the ointment, but flare back up as soon as he stopped.  Another trip to the doctor yielded a more powerful cortisone ointment, which would eliminate the redness while it was in use but did nothing for the long term.  Finally, a trip to the tropics caused a marked improvement in his skin.

Sadly, within a few months his eczema returned.  We continued to "manage" it using greasy ointments after every bath, avoiding the common irritants, and treating it with the cortisone when it got really bad.  We've finally come to the conclusion that we need to put in an honest effort to figure out what is causing the eczema, which is easier said than done.  The problems could be environmental (like dust mites) or food intolerance or allergy.  Or it could be genetic.

So What Are We Going To Do About It?

Only a very low proportion of excema is caused by allergies, so it isn't as easy as doing skin prick tests (which are apparently unreliable anyway).  We have decided to try the Royal Prince Alfred Hospital (RPAH) Allergy Unit's simplified elimination diet for natural and artificial food chemicals.  The aim of the diet is to remove all possible dietary causes of irritation until a marked improvement in symptoms occurs, then "challenge" the body with individual chemicals to determine which ones cause irritation.  Challenges must be done with only one chemical at a time to avoid confusing signals, and must be spaced so that the signs of a reaction are clear.  Since reactions to food can happen any time in the 48 hours after the food is consumed, and some challenges require large doses (to reflect the cumulative nature of eating those chemicals in everyday life), challenges must be spaced by several days.  The PhD thesis of Anne Swain, head dietician of the RPAH Allergy Unit, explains the development of the diet, and details what chemicals, artificial or natural, are likely to cause problems.

The problem foods can be classified as follows:

1. Salicilates, found in most fruits and vegetables, nuts, and many oils;
2. Amines, found in a few fruits, and aged food including cheese, wine,
   suction packed meat, frozen meat or fish (the Failsafe Cookbook
   recommends buying meat fresh and eating it within two days or freezing
   it immediately and eating within four weeks);
3. Glutamates,including natural, found in a number of really tasty vegetables (like
   tomatoes), mushrooms, and a huge variety of foods;
4. Sulfates, which are found in dried fruit;
5. Nitrates and nitrites, which are found in smoked food;
6. Artifical flavours;
7. A few classes of preservatives, antioxidants, and colours (artificial and annatto 160b); and
8. Anything that contains "natural flavours".

To further complicate matters, apparently there is a labelling loophole in Australia that allows food manufacturers to omit ingredients from the label if they are a small proportion of an ingredient, so antioxidents are often used in the vegetable oils that are used to make many processed foods without being put on the label.  This means that any item that contains "vegetable oil" must be avoided unless you have checked with the manufacturer.

This diet appeals to me for several reasons.  The first is that I've never been a fan of food additives (this has been especially true since I read Fast Food Nation). The second is that the RPAH has provided a convincing argument through their research that naturally occurring salicylates, amines, and glutamates, and a series of artificial food additives can cause a host of problems, including eczema.  The third, and final one I can think of right now, is that typically doctors recommend eliminating two or three likely triggers, which means you are likely to 1) not see significant improvement during the elimination portion, and 2) get false reactions during the challenges due to other triggers that haven't been eliminated.  This diet minimizes both of these.

I decided to be sensible about this, so we visited a dietitian, just to make sure we will have proper nutrition, and also because I'm going to need all the encouragement I can get to stay on this diet, especially since I've never been very good at staying on diets.  The good news is that we can eat as much as we like, as long as it's well balanced.

So What Can We Eat?

The food we can eat can best be summarized as follows:

• Fruits, vegetables, herbs and spices: Peeled pears, or canned pears in syrup, leeks, chokos, cabbage, brussel sprouts, mung bean sprouts, bamboo shoots, shallots, celery, green beans, garlic, swedes (also known as rutabagas), potatoes, dried beans (except broad beans), iceberg lettuce, parsley (in small quantities), saffron, salt.
• Fresh meat, chicken, and white fish (nothing that is pre-made)
• Wholemeal or white bread with no preservative (no multigrain bread)
• Plain crackers and cookies with no additives
• Cereals without additives or corn
• Milk, rice milk, oat milk, natural yogurt, vanilla yogurt, vanilla ice cream, eggs
• Butter, select margarines, sunflower, safflower, and canola oils
• White sugar, brown sugar, maple syrup, golden syrup, glucose syrup, rice syrup, carob powder
• Decaf coffee (no tea of any type), whisky, gin, vodka
• A variety of baking ingredients including flour, baking powder, etc.

The dietitian gave me a food list so exhaustive that it even dictates what vitamins I can take and what toothpaste we can use (mint is a huge source of salicylates, so most toothpaste isn't allowed).

Where Can I Get More Information?

Sue Dengate, who runs the extensive, but not very well organized Food Intolerance Network website, wrote a cookbook for the diet, "The Failsafe Cookbook" (she calls the elimination diet "Failsafe", which stands for: Free of Additives, Low in Salicilates, Amines, and Flavour Enhancers).  Her cookbook provides a food list and a reasonably good explanation for why many foods aren't allowed.  This is a good resource full of pedestrian recipes and substitutes for foods you're not allowed to eat.  It includes a shopping list.  Unfortunately, this book is hard to come by right now since it is between printings.

You can find a complete list of the additives to avoid on the Food Intolerance Network's website.  One thing I noted when I first read about these, is that red dye #2, which has been de-listed in the U.S. since I was a kid (remember when the red M&Ms were taken off the market?), is still allowed in Australia.

The RPAH has also put out a cookbook, called "Friendly Food" (now in its second edition).  This book also explains the diet, though it virtually ignores the role of food additives despite being clearly implicated by Anne Swain's PhD thesis.  It is filled with pretty fancy looking meals.  It also contains a shopping list and has the advantage of being readily available in Australian bookstores.

The Diet Begins

Today is day one.  The preparation has taken several weeks.  In addition to the visit to the dietitian, I have spent the past two weeks testing out recipes and tracking down ingredients.  Yesterday I prepared an eating plan for my son's childcare, and tomorrow I will be meeting with them to make sure they know exactly what food they can give him and what to do if he eats something he isn't meant to.

I've been to four grocery stores, and three green grocers, a candy store, a health/vitamin store, and three pharmacies to find suitable foods.  One thing that has struck me is how small the "health food" section is in the supermarkets.  This should tell you something about the healthfulness of what's general available in supermarkets.  Another thing I've noticed is how limited the health food sections are, as if the grocery store defines health food as food that no one would choose to eat unless they were avoiding a more mainstream food (i.e. rice pasta instead of wheat pasta, or carob instead of chocolate, except that I happen to really like carob, and it's so uncommon here that the big supermarkets don't have it even in the health food section).  The other thing I've noticed is that all health nuts must be soy addicts, judging by the ubiquity of soy in that aisle (technically, I'm supposed to be avoiding soy in addition to everything else listed above).

In the spirit of my friend Ron, who went on a 10 day juice diet and documented everything he ate on-line, I will periodically post our progress (though not in such exhaustive detail).  Incidentally, virtually everything Ron ate during those 10 days would not be allowed on this diet.

Wish us luck, and please, keep your cynical thoughts to yourselves, or at least save them until we're done.  As I've already mentioned, I'm going to need a lot of positive encouragement to stick to this.

One Final Note

I have yet to find carob chips without palm oil, nor have I found a recipe for making them from carob powder.  If you have one, please post it as a comment.