The long awaited end to our elimination and challenge diet has arrived. After three and a half months of monitoring everything my son and I ate, we can now go to a party without bringing our own food! During this period we challenged salicylates (twice), amines, and glutamates, and my son also challenged bread preservative. My son finished his second salicylate challenge a few days ago, and he'll be off the diet tomorrow (I finished a little over a week ago). I'm disappointed to report that the only thing I've learned about my son's skin condition from all of this is that my son does not have a severe reaction to any of these things.
That's not to say he didn't react, just that it wasn't obviously caused by the challenge food. The value of this knowledge is not to be dismissed, however his reaction to each challenge was difficult to interpret. As I've mentioned in previous posts on the topic, his skin never completely cleared. Even with periodic use of cortisone ointment, the eczema would inevitably appear after a few days on the elimination diet without drugs. The big question was whether the severity had reduced. At this point I've concluded that he is not unusually sensitive to any of the chemicals we challenged.
Though I'm eager to expand our vegetable intake, we won't go back to our previous eating patterns immediately. I expect to introduce certain foods with caution. For instance, our diet previously relied on high intake of tomato, which is high in salicylates, amines, and natural glutamates, and often associated with eczema. One thing I will introduce immediately is flaxseed oil, as I feel that the elimination diet is distressingly low in essential fatty acids (since everything we ate had to comply with the diet, even supplementation was restricted). He will have flaxseed oil instead of butter on his toast (I've discovered that when drizzled over toast with a little salt it is a totally suitable substitute for butter), and whenever he would have had butter or oil that is not cooked. We will also introduce a number of vegetables and fruits that are only moderately high in salicylates, and cut way back on meat, chicken, and sugar intake, which always felt too high to me.
Lessons learned
We didn't need to spend so long to learn what we did from this experience. We had to repeat challenges to correct early mistakes in execution. Even now, there are things I should do to make up for mistakes made in the beginning, but I've lost the enthusiasm to continue. If I ever have to go through this again, I will do a number of things differently.
What do I consider essential to success while minimizing the pain and duration of the diet? This is written in regards to my experience with eczema, but most of it applies regardless of the condition you are trying to treat.
Do the allergy tests first. You will have more success with the diet if you avoid all foods and other irritants to which you have a positive allergy test. If your doctor suggests it, you can challenge those foods and then reintroduce them into your diet if you do not have a reaction.
Get your hands on one or both of the cookbooks for this diet (Friendly Food and The Failsafe Cookbook). I use them nearly every day. The recipes are fantastic, even if you don't end up doing the diet, and Friendly Food, in particular, is a very good source for people who need to avoid eggs, gluten or wheat, nuts, dairy, or soy.
Stock your larder, experiment with recipes, and make some of the staples (like pear jam) before you start in earnest. Make a few things you can put in the freezer. It will be a lot easier to stick to the diet if you already know how to make a few meals that comply with it and know where to buy the ingredients. You will not have the option to make a last minute dash to get take away on this diet.
Rearrange your kitchen so that the food you will not be allowed to eat is separate from the food you are allowed to eat. For instance, put all forbidden food into a cabinet separate from everything else so you do not get confused or tempted. If you keep snacks in your bag or your car, make sure they comply with the diet as well (we used plain rice cakes and rye cruskits for this). In the refrigerator, designate the least visible shelf for the forbidden food (things that won't go bad during the three or so months you're on the diet, like ketchup and jam, and anything your family members insist on having).
As much as possible get your entire family to follow the diet when eating in the presence of the people on the elimination diet. You may find it handy if you allow the consumption of forbidden foods out of sight of family members who are following the diet, especially right after challenges, when you will probably have left-overs that you can no longer consume but you don't want to waste (for instance, we had cherries and carrots left after our salicylate challenge, so I sent them to work in my husband's lunch). They can also be used to slowly rid the freezer of forbidden foods.
If you have the flexibility, do the diet in the winter. Many of the allowed vegetables are not available or of poor quality in the summer and you won't be taunted by all the beautiful summer fruits.
If you have the flexibility, don't start before the holidays or lots of birthdays. Sticking to the diet is far more pleasant when you don't have to eat out frequently.
Take detailed notes. Keep a description of symptoms in your food diary rather than trying to rate their severity as a number. This will be much less subjective. Even better: get a person who does not know whether you are doing a challenge or in the elimination phase to evaluate the symptoms; it is very easy to let your own wishes interfere with your judgment.
Prior to starting the diet, find out how the skin responds after two weeks without cortisone. While eating your normal diet, treat the skin until it is clear, then take notes on the symptoms for two weeks.
Use the cortisone the way the doctor specifies (i.e. don't try to go
without). Use it as directed for the first week of the diet, when withdrawal symptoms are most likely to occur and to prepare the skin for a two week elimination challenge (see next point).
After starting the elimination diet, but prior to starting challenges, find out how the skin responds to two weeks on the diet without cortisone. A week after you start the elimination diet, do a two week elimination challenge where you do not use cortisone to determine if the elimination diet has resulted in an improvement. If not, consider what else you might need to eliminate or consider stopping the diet altogether.
Label everything you put in the freezer with 1) the contents, 2) whether or not it follows the diet, and 3) the date it was made. If you are avoiding amines, this will help you avoid eating meat that is too old. It will also ensure you don't accidentally eat the zucchini risotto you made for the salicylate challenge during your amine challenge.
Conclusion
Since eczema runs in families (I have it, my dad has it, my son has it), there's a pretty good chance any other kids I have will get eczema, and I may find myself going through this again. If it happens when they are only a month old, I will do the elimination diet immediately to see if it has any positive effect. I will also continue to look for other solutions to the problem. If nothing else, I've learned how to do this better the next time.
Wednesday, February 21, 2007
Tuesday, February 13, 2007
Getting lazy with glutamates
Well, in what feels like a never ending quest to determine what food sensitivities by son has, we challenged glutamates last week. The challenge required eating a whopping 80 ml of soy sauce (4 Australian tablespoons, or 5 1/3 US tablespoons) each day for three days. We were also encouraged to use Parmesan liberally. Technically, those were the only two items in the challenge, but we also indulged in a few other foods that contain glutamates (and amines, which we are no longer avoiding) but no other forbidden chemicals. We also continued to indulge in small amounts of glutamates during the three day elimination period that follows each challenge.
The most famous glutamate is Mono Sodium Glutamate, also known as MSG. It is widely associated with Chinese restaurants, but it, and a few other glutamates are often used as flavoring in packaged food. As it turns out, glutamate also occurs naturally in a range of foods, including aged cheese, soy sauce, tomatoes, peas, mushrooms, broccoli, and grapes and their products.
After about 50ml of soy sauce on the first day I couldn't take it anymore; I do not believe that one person could consume enough food in a day to disguise that much soy sauce. And after a night of anxious sleeplessness and a headache, I was content to finish the challenge right then. Was it the glutamate? I don't know - I also had a lot to do and a son who was no keener than I to eat that much of the challenge food, but it sounds like classic Chinese restaurant syndrome. Regardless, given that most of the foods where glutamates are found in high concentration are also high in fat I'll probably try to limit my intake anyway.
On day two of the glutamate challenge I phoned the dietitian because my two year old son had decided not to complete the challenge (he wouldn't eat anything that tasted like soy, and I can't blame him). The dietitian recommended substituting Parmesan, so we had pizza for dinner. That worked. I also cheated by indulging in a little Cambazola cheese, and we both cheated by having peas, both foods that contain glutamates and no other forbidden substances that are not part of the challenge. In the end, after eating lots of Parmesan, my son did not appear to react to the glutamates.
The day after the official end to the challenge, we went backpacking. I do not recommend camping while on this elimination diet, nor do I recommend backpacking with a two year old child, but that's another story. It was very difficult to find suitable foods. All pre-packaged camping foods were out of the question. Dried fruit was out (except for bananas, but we couldn't find those because of the recent banana shortage anyway). Most of the vegetables that we usually take were out. GORP was definitely out. No pepperoni or smoked fish either (we camp in style). We ended up taking lots of bread, chocolate and Colby cheese (which has amines, but we are eating those now), homemade cookies, oatmeal and powdered milk for breakfasts, and couscous, lentils, rice, and chickpeas for dinner. We cheated by bringing Parmesan and freeze dried peas and adding those to the meals (technically we should have been avoiding glutamates by then). To get vegetables we took fresh vegetables! Leek, potato, swede (which never got eaten), and green beans. Fortunately, we were hiking with someone who agreed to carry the food.
In theory, our three day elimination period that follows the glutamate challenge fell during our camping trip, but we cheated by eating peas and Parmesan. The reason for the elimination period is two fold - to distinguish a delayed reaction to the glutamate challenge from a reaction to the next food challenge, and because a reaction to one food can inhibit a reaction to another food if the second food is eaten too soon after the first, thereby masking the reaction to the second food. However, since my son requires cortisone after 10 days without, which must be followed by a further three day elimination period, it didn't seem necessary to remain strict about avoiding the challenge substance (glutamate) in this case.
On the way home from the camping trip we stopped at a pub. It was our first restaurant meal in over three months. I was surprised at how well they were able to cater for my son's curious eating restrictions. He had grilled chicken, boiled potato, and steamed peas and cabbage. As for me, I had my first non-diet meal. Now, a pub is probably not the first place you think of to break a fast, but that is where I found myself. So I had peppercorn steak with chips and salad. All three were disappointing and surprisingly bland. Fortunately, the Pavlova was better.
I'm eager to put this diet behind me because, despite my efforts to eat healthfully and provide healthful food to my family, I am uncomfortable with how limited our choice of vegetables has been and how much we've relied on meat and refined sugar. In an attempt to counteract the limitations of our diet over the past three months, I've started eating flaxseed oil on my salads, and I am keen to replace the canola oil we've been using in our cooking with olive oil. In less than a week my son will be finished with the last challenge he will do, then we will try to return to our previous, more healthful diet. However, after three and a half months on the this diet, I still feel compelled to write down everything I eat and I can't shake the feeling that I'm cheating every time I put a piece of fruit in my mouth.
The most famous glutamate is Mono Sodium Glutamate, also known as MSG. It is widely associated with Chinese restaurants, but it, and a few other glutamates are often used as flavoring in packaged food. As it turns out, glutamate also occurs naturally in a range of foods, including aged cheese, soy sauce, tomatoes, peas, mushrooms, broccoli, and grapes and their products.
After about 50ml of soy sauce on the first day I couldn't take it anymore; I do not believe that one person could consume enough food in a day to disguise that much soy sauce. And after a night of anxious sleeplessness and a headache, I was content to finish the challenge right then. Was it the glutamate? I don't know - I also had a lot to do and a son who was no keener than I to eat that much of the challenge food, but it sounds like classic Chinese restaurant syndrome. Regardless, given that most of the foods where glutamates are found in high concentration are also high in fat I'll probably try to limit my intake anyway.
On day two of the glutamate challenge I phoned the dietitian because my two year old son had decided not to complete the challenge (he wouldn't eat anything that tasted like soy, and I can't blame him). The dietitian recommended substituting Parmesan, so we had pizza for dinner. That worked. I also cheated by indulging in a little Cambazola cheese, and we both cheated by having peas, both foods that contain glutamates and no other forbidden substances that are not part of the challenge. In the end, after eating lots of Parmesan, my son did not appear to react to the glutamates.
The day after the official end to the challenge, we went backpacking. I do not recommend camping while on this elimination diet, nor do I recommend backpacking with a two year old child, but that's another story. It was very difficult to find suitable foods. All pre-packaged camping foods were out of the question. Dried fruit was out (except for bananas, but we couldn't find those because of the recent banana shortage anyway). Most of the vegetables that we usually take were out. GORP was definitely out. No pepperoni or smoked fish either (we camp in style). We ended up taking lots of bread, chocolate and Colby cheese (which has amines, but we are eating those now), homemade cookies, oatmeal and powdered milk for breakfasts, and couscous, lentils, rice, and chickpeas for dinner. We cheated by bringing Parmesan and freeze dried peas and adding those to the meals (technically we should have been avoiding glutamates by then). To get vegetables we took fresh vegetables! Leek, potato, swede (which never got eaten), and green beans. Fortunately, we were hiking with someone who agreed to carry the food.
In theory, our three day elimination period that follows the glutamate challenge fell during our camping trip, but we cheated by eating peas and Parmesan. The reason for the elimination period is two fold - to distinguish a delayed reaction to the glutamate challenge from a reaction to the next food challenge, and because a reaction to one food can inhibit a reaction to another food if the second food is eaten too soon after the first, thereby masking the reaction to the second food. However, since my son requires cortisone after 10 days without, which must be followed by a further three day elimination period, it didn't seem necessary to remain strict about avoiding the challenge substance (glutamate) in this case.
On the way home from the camping trip we stopped at a pub. It was our first restaurant meal in over three months. I was surprised at how well they were able to cater for my son's curious eating restrictions. He had grilled chicken, boiled potato, and steamed peas and cabbage. As for me, I had my first non-diet meal. Now, a pub is probably not the first place you think of to break a fast, but that is where I found myself. So I had peppercorn steak with chips and salad. All three were disappointing and surprisingly bland. Fortunately, the Pavlova was better.
I'm eager to put this diet behind me because, despite my efforts to eat healthfully and provide healthful food to my family, I am uncomfortable with how limited our choice of vegetables has been and how much we've relied on meat and refined sugar. In an attempt to counteract the limitations of our diet over the past three months, I've started eating flaxseed oil on my salads, and I am keen to replace the canola oil we've been using in our cooking with olive oil. In less than a week my son will be finished with the last challenge he will do, then we will try to return to our previous, more healthful diet. However, after three and a half months on the this diet, I still feel compelled to write down everything I eat and I can't shake the feeling that I'm cheating every time I put a piece of fruit in my mouth.
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