Wanted: waffle maker

In seven years of living Australia I have seen specialized electrical equipment designed for a single purpose, such as cooking pizza, cooking sausages, baking donuts (aren't donuts supposed to be fried), grilling sandwiches, boiling rice, grinding coffee, making coffee, or baking bread.

So why is it that I can't find a waffle maker in this country?

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[Updated 2 April, 2008]

I got the Breville for my birthday.  It arrived this week (a little late for the party, but who cares).  I usually consider waffles a breakfast food, but we couldn't resist making them for dessert the night it arrived.  It cooks well enough, and the non-stick plates are fantastic, but it's awfully small, making it sub-optimal for big groups.

On day two, my son wanted waffles for morning tea - I obliged, and then that night we ate the left overs for dessert with ice cream and chocolate sauce. Yum, yum!

Thanks again AB.  We'll have to have you and the family over for brunch.

Elimination diet: the end

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.

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.

Asynchronous challenges

We're getting to the tail end of the discovery stage of our diet to find the cause of my son's eczema.  Last week my son challenged bread preservative (three crumpets a day, whether he liked it or not; he liked it) and I challenged salicylates again.  We'll do a glutamate challenge later this week, and then we have the option of challenging additives, challenging salicylates again (this would be my son only, as I have just done this), or starting the salicylate reintroduction.

Normally you don't repeat a challenge unless you have reason to believe the results will be different.  I challenged salicylates a second time because we suspected that my mood from the first challenge may have been due to other factors, including the condition of my son's skin during the challenge and anxiety about the results.  In contrast to my first salicylate challenge, which was done at the same time as my son was challenging salicylates and was our first challenge, this last week I experienced no listlessness or irritability, nor did I have any digestive discomfort, so I have concluded that I do not have a sensitivity to salicylates.

The argument for repeating the salicylate challenge with my son is that the results the first time were inconclusive; his skin, though possibly better than it had been prior to the start of the diet, was never clear of eczema, and the dermatologist pointed out that skin irritation that is already present will change intensity without provocation.  We've also discovered recently that even when we clear all signs of eczema by applying cortisone and strictly follow the diet, it takes only three days for some irritation to reappear, so there is some background noise, making it difficult to ascertain the results of any challenge ('his skin got worse, but how much of that was due to the food versus what would have happened anyway').  We observed this pattern during the recent bread preservative challenge, when his skin slowly got worse throughout the challenge until we used cortisone at the end to clear his skin for the next challenge.  The big question is: how much worse?

Perhaps the diet isn't working at all for him.  Have I deluded myself into believing that his skin improved?  Right from the start I struggled to find a way to codify the condition of his skin.  With each new food diary (we're on our third) I have tried to clarify the meaning of the 0-5 scale that I ended up using.  In retrospect, there has been much more value in the notes I've kept describing the locations and extent of the irritation than in the numbered scale the dietitian recommended, but I didn't work that out until I was into the second notebook and starting the challenges.  Realistically, he needs to do the elimination diet for 13 days after clearing his skin with cortisone to find out what happens so we can use the results to filter the results of the longest challenge (salicylates: three days of elimination prior to starting, seven days of salicylates, and three days of elimination following).  But honestly, after three months of this I don't know how much more of it I can stand.

We can skip the second salicylate challenge, assume that my son is moderately sensitive to salicylates based on the results of the first challenge, and start the reintroduction.  To reintroduce salicylates, you eat a very small amount of a food that contains low levels of salicylates once every few days.  After two weeks, if your symptoms have not worsened, then you increase the amount or frequency.  You continue this until your symptoms worsen, then back off to the last level and maintain that (or less).  But since my son's skin will worsen on its own, without the contribution of salicylates, this process would have us conclude that he can withstand no amount of salicylates.

So my conclusion is that we will both challenge glutamates this week, which requires eating soy sauce and parmasean cheese, then my son will challenge salicylates again.  Hopefully we will either see a clearer signal or no sign at all (preferably the latter).  We'll continue to avoid additives, but following the final challenges we will not be remotely as fastidious about what we eat.

Allergy tests reveal error in elimination diet

We finally met with the dermatologist this month, who performed skin prick tests on my son to determine whether he has allergies to a number of common allergens.  As it turns out, he is allergic to egg whites, dust mites, and peanuts.  The good news is that he is not allergic to soy.

It is common for babies to have an allergy to egg whites, and also common for them to grow out of it by the age of two or three.  According to the doctor, my son's reaction was mild, and the allergy is probably already diminishing, so we'll avoid egg whites until a skin prick test indicates that it's okay to challenge them again.

During our elimination diet we've eaten eggs regularly, and, looking back over our food diaries, my son's skin worsened most of these times.  The presence of eggs in his diet has certainly clouded the results, and emphasizes that we should have done the allergy testing before commencing the diet.  My hope is that eliminating eggs from his diet will cause a further improvement in his skin.

I'm annoyed about the dust mite allergy, but not terribly concerned.  We will have to be more diligent about cleaning the house, and we are reconsidering replacing the carpet with wood floors rather than new carpeting.  Fortunately, we were planning on replacing the carpeting anyway, so it's not a waste of good flooring.

I'm definitely more concerned about the allergy to peanuts.  All the information I can find indicates that people rarely grow out of it and that any peanut allergy has the potential to be anaphylactic (translate: life threatening).  This means we will never be able to be carefree about eating with our son again.  Not only that, but we will probably have to give up eating peanut butter, Reece's peanut butter cups (not widely available in Australia anyway), and Thai food, due to the possibility of exposing him to peanut.  I'm very frustrated at the moment, because I was given very little information from the dermatologist and will have to wait two more months before I can get more information from an allergist.  A curious silver lining to this is that the incidence of peanut allergy is  becoming much more common than even just a few years ago, so increased demand for peanut free food may make it easier to get it.

I thought my son's skin looked pretty good when we visited the dermatologist, but when the dermatologist chastised me for not using the cortisone I realized that the eczema irritation really was pretty extensive.  He explained that if there was any irritation then the eczema could flare with no apparent reason and create confusing results during the food challenges, which of course perfectly describes what happened during the food challenges we've already completed.  Therefore we are taking a different approach now, using the cortisone to eliminate all signs of the eczema (if it's even possible), use the elimination diet to keep it clear for a few days, then do the challenge.

We also met with the dietitian this week, who tried to decipher our food logs and concluded that my son is probably not sensitive to amines or soy (she had never heard of someone having problems with soy without testing positive to a soy allergy), so we have reintroduced those into our diet.  He probably is sensitive to salicylates, and so we will slowly introduce salicylates into his diet after he finishes challenges for glutamate and bread preservative.  Now that we know about the egg allergy, I'm tempted to redo the salicylate challenge, but that will depend on whether we can get his skin clear enough to make the signal stand out from the static more clearly than last time.

We've now been on this diet for more than two months and I'm getting tired of it.  I thought we would be done with it one day, that we would be free to eat just about anything we wanted, but now I'm realizing that it was probably good practice for what lies ahead with the peanut allergy.  Food that may contain peanuts is even more common than food that contains soy.  Already I've found three things in our cupboard that may contain traces of peanuts, including the cereal my son has for breakfast every day, and it looks like we will be doing a lot of home cooking in the future.

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I found some more balanced information about peanut allergy (well, technically, my dad found it while I was lamenting about how alarmist all the information I found was).  It says that only 1/3 of the children who test positive to peanut allergy with a skin prick test will have any symptoms, and that the vast majority of people who do have symptoms will get hives, experience abdominal pain, or start vomiting.  The page states that allergies to peanuts that are severe enough to cause anaphalactic shock are extremely rare.  Reading this made me feel much better, and when I consider how often I scraped peanut butter out of the jar with my finger in the first year of my son's life, I now recognize that if my son hasn't had a severe reaction by now, then he's not going to have one.

Defeated by amines

It's been 62 days since we started our elimination diet to identify the causes of my son's eczema and I'm starting to feel defeated.  We've finally completed our amine challenge and now my son's eczema is the worst it's been in nearly two months.  During this period we've also faced two birthday parties, a Christmas party, Christmas dinner, and a week away with friends.  All of these occasions were poignant reminders of how little "normal" food we can eat.

It took three weeks to complete the amine challenge.  First we had to wait for his skin to clear from the previous challenge.  Then we delayed the start of the challenge so it would not interfere with his birthday party.  Next we had a false start when we found him chowing down on salicylate laden watermelon at a neighbor's Christmas party, and then we had to wait several more days for his skin to clear again before starting the challenge in earnest.

Amines result from the breakdown of proteins, and are found in chocolate, cheeses, old meat, fish,  and poultry (including "fresh" meat that has been stored in cryovac packaging, meat that has been frozen for a long time, and ocean fish that is caught a long time before it reaches the market), the skin of poultry (and probably of cows, pigs, and sheep as well, but we don't usually eat these), a number of fruits and vegetables and products derived from them, and most alcohol products.  For the challenge, we were required to consume bananas and chocolate in quantity for a week.  We were also allowed to eat papaya, tuna, and Colby cheese.  My son, who had never tasted chocolate before, was in heaven despite being restricted to very dark chocolate.  The first night of the challenge we had tuna carpaccio and banana splits, and the rest of the week we indulged in toasted cheese sandwiches and chocolate chip cookies.

His skin actually looked quite good during the challenge, which was belied only by the curious red circles that appeared in his armpit on the first day.  We were optimistic that we would soon be able to permanently reintroduce some foods into our diet, but three days after the end of the challenge we were faced with itchy eczema on his tummy, lower back and bum, his upper chest, the back of his neck, on his thighs, and behind his knees, with no alternative explanation to the recent amines.

The literature explains that there's little point in doing the remaining challenges (MSG/glutamate, Propionates, Sorbates, Benzoates, Antioxidants, Colors, Nitrites, and Sulphites) if you respond to both salicylates and amines because you will probably respond to everything else, which means we are now faced with an indefinite period on the elimination diet.

I now realize that I commenced this project expecting it to end after a month or so.  Two months into it we still haven't even finished the first round of challenges (we still need to challenge soy, which would normally be done prior to salicylates and amines) and are likely to have to follow it for many more months before we can enjoy only a few more of the foods we ate before we started the diet without having adverse reactions. 

At times like these it's tempting to say, stuff it, it's too hard.  The food we eat is quite good, but the constraints of the diet are antisocial. We cannot eat out at all, and I've had to provide virtually all our food when we've gone to parties (except at one birthday party, where the host gets a gold star for making sure there was a meat, a vegetable, and an hors d'oeuvre that we could eat).  When trying to plan a recent Christmas dinner with friends it became clear that it was too complicated to ask anyone to cook according to the
constraints of the diet, and it is now obvious that nothing ever satisfies the constraints of the diet just by chance.

So what's keeping me going?  Quite simply, it's the prospect of eliminating my son's eczema, reducing the likelihood of him developing asthma and hay fever, and saving him from the fate of his grandfather, whose childhood was shaped by asthma attacks, endless trips to the allergist for injections, and his mother wrapping his cracked hands each night to soothe them.

Salicylates challenge more than expected

After 31 days of a strict elimination diet, we've finally entered the discovery phase.  Our first challenge, salicylates, was harder than I thought it would be.  For the previous 31 days I had looked forward to indulging in strawberries, mangoes, cherries, pumpkin, and apples, and once again enjoying the flavor provided by curry and cinnamon.  I thought my son would too; he was absolutely fixated on pictures of strawberries.  But the food didn't taste as good as I expected, and I was surprised to discover that I didn't feel very well either.

We embarked on this diet to discover the cause of my son's eczema, which has been present since he was a month old.  It could be anything he has contact with, including the pervasive dust mite, but since food proteins and chemicals can be passed through breast milk, and are one of the few things we have much control over, we decided to do an exhaustive test of foods to determine if any of them were the cause.  Many food allergies can be diagnosed through skin prick tests or blood tests, but foods can also cause irritation without triggering an allergic reaction, and these sensitivities to food can only be determined by altering your diet.  To find a food sensitivity or allergy, you first eliminate all likely causes of irritation from your diet for a period of time.  This is the elimination phase of the diet.  The next stage is to challenge your body with possible irritants.  This is the discovery phase of the diet.  For some irritants, the reaction may be reduced by avoiding exposure to the irritant for a while, so there is a period of developing tolerance following the completion of the discovery phase, and then you should follow a maintenance diet that minimizes consumption of foods that cause a reaction for you.

It is worth noting, since many people I've spoken with about this whole process do not seem to understand this at first, that you are not meant to stay on the highly restricted elimination diet indefinitely.  Nor is it the theory of the diet developers that salicylates are inherently bad for everyone.  Once you have determined which classes of food do not cause a reaction for you through the challenge phase then those foods can be reintroduced into your diet.

The first challenge
Our first challenge was salicylates.  You may be asking yourself "What are salicylates?"  It's a fair question; it's not an everyday word.  Salicylates are a class of chemicals that occur naturally in fruits, vegetables, and nuts and are thought to function as natural pesticides.  According to the research of the Royal Prince Alfred Hospital Allergy Unit, a surprising number of people respond to salicylates, meaning that they will have some sort of reaction if they eat a large quantity.  Responses to salicylates vary dramatically, but can include migraines, rashes, irritability, restlessness, gastrointestinal problems, and asthma.  Salicylates occur in almost all fruits, many vegetables, and virtually anything derived from them, including artificial and natural flavors, most types of alcoholic drinks, and aspirin.

What was the salicylate challenge?
The challenge required eating six serves of salicylate laden foods a day for a week (or until we reacted, which ever happened first).  My own participation in the elimination diet was mandated by the fact that I was still breastfeeding my son, and anything I ate could be passed to him through the breast milk, so I anticipated participating in the challenge as long as my son did.  The foods we were required to eat comprised:

• mangoes
• Granny Smith apples
• cherries
• nectarines
• peaches
• apricots
• watermelon
• cantaloupe
• strawberries
• pumpkin
• sweet potato
• asparagus
• bell pepper
• carrots
• cucumber
• zucchini
• honey
• cinnamon
• curry powder
• tea

There was no shortage of choice, especially since it is stone fruit season.  On the first day, we ate strawberries on our breakfast, watermelon for morning tea, zucchini with lunch, mango and yogurt for afternoon tea, cherries before dinner, and a colorful stir fry for dinner.

Though we continued to stuff ourselves with red and orange fruits, both my son and I lost our appetite for the challenge foods pretty quickly.  On day one, I had a mild stomach ache most of the day, and by the afternoon I didn't feel like doing much of anything.  By day three, I was longing for cabbage, and my son wouldn't eat anything containing salicylates after lunch.  Over six days of the challenge (I didn't last all seven) I had a stomach ache of some sort nearly the entire time.  I was also irritable, emotional, and unmotivated.

Clearly I was responding to the salicylates, however, since my motivation for doing the diet was not to assess the cause of my own moods but to determine the cause of my son's skin problems, it took me five days before I finally clued in to the correlation between my mood and my diet.  Even then, I couldn't stand the thought of missing out on two more days of red and orange fruits and persisted eating them for almost another day before I realized that I was not only torturing myself, but increasing the likelihood of suffering withdrawal symptoms, and stopped the challenge.

It has taken six days for my son's skin to get back to what it was before the challenge and it is now clear that he also reacted to salicylates.

What next?
After the challenge we went back on to the elimination diet.  The first three days following a challenge are considered part of the challenge, as it is possible for reactions to be delayed, and also required to ensure there are no residual effects from the salicylates before the next challenge.  My mood improved almost immediately but both of us continued to show signs of reactions to salicylates over that period.  Since his skin has only just returned to its pre-challenge condition, we will wait a few more days before we go onto the next challenge, which for us will be amines.  Tune in next week for the results.

Elimination Diet: The Dietician's Judgement

A few nights ago I had a dream that I was eating miniature jelly beans.  The following night I dreamt that I was eating steak bathed in ketchup.  In both dreams, my immediate response was Why am I eating this?  It will ruin the diet.

I've never had this response to a diet before, but then this diet is different.  After 30 days, I can identify every item of food that my son and I have consumed.  For the past 23 days I can count on my thumbs every item of food my son or I ate that we weren't allowed.  And on day 30 a dietitian reviewed our progress.

The visit to the dietitian was the source of some trepidation.  The severity of my son's eczema has reduced dramatically, so we've obviously done something right.  We could be ready to start the challenge phase of the diet, which would mean indulging in fruits, vegetables, and spices.  But the eczema is not gone, so maybe we've done something wrong.  We could be about to face two of the hardest weeks yet, with no wheat or cow's milk.  As the appointment with the dietitian approached and the severity of my son's eczema bounced around I got more and more concerned.  It's no wonder I was dreaming about things going awry.

I met with the dietitian yesterday.  She greeted me with a smile and asked how things were going.  Then she examined the food log.  I sat for a few minutes listening to nothing but the occassional sound of a page turning.  She broke the silence by saying You're ready to start the challenges.  Ready to start the challenges?  I was ready to jump out of my seat.  I wanted to do a little victory dance.  Actually, I wanted to do a big victory dance.

Tomorrow I'll be having strawberries on my breakfast, watermelon at my picnic, taziki for my afternoon tea, and carrots and capsicum in my stir fry.  I'll make lentil curry and pumpkin soup.  I'll eat apricots, and cherries, and bake apple pie.  And I'll do it all in the name of science.

I'm so happy about this new food freedom that I need to remind myself of the sour note: if one of us reacts to salicylates then we'll have to stop eating all these wonderful foods, and when the discovery part of the diet ends we still won't be able to eat them.  But I'm not about to let that ruin my fantasizing now.

I still won't be allowed to eat miniature jelly beans or ketchup on my steak, but who'd want to when there are so many wonderful things to eat instead?

Elimination Diet: Weeks 3 and 4

The In-law Challenge

Weeks three and four of our elimination diet were marked by the arrival of my in-laws.  Prior to starting the diet I was so concerned about our ability to eat together harmoniously that I almost delayed the start of the diet until they left.  I was dreading having to listen to snide remarks.  I was afraid that I would have to prepare all of the food, rather than rely on mother-in-law to do some of the cooking, lest she undermine the diet by including forbidden ingredients.  And I was concerned that they would not be supportive of the diet, let alone eat it.  I underestimated my in-laws.

Perhaps it was not entirely fair to pin all these concerns on my in-laws.  After all, being helpful seems to be in their genes.  Many people have been curious about the diet, and very few people have made deprecatory remarks about the diet, but most people I explain the diet to can't shake the thought How could fruits and vegetables possibly cause a malady? and they only start to express an earnest interest in the diet when I reveal that my son's skin has definitively improved since starting the elimination diet.  Of course, I didn't have the luxury of this information when I spoke to my father just before D-day, who was very subtle but obviously doubtful.

In contrast, I was pleasantly surprised by my in-law's support; my mother-in-law baked cookies and scones, was an excellent sous-chef, and even took up the challenge of making two meals.  I did not hear one negative or unsupportive remark from either in-law during their two week visit.  They happily consumed our failsafe food, and even marveled at how many ways you could prepare a leek.  They graciously ate their forbidden foods (they arrived with a fruit cake, lemon butter, and pineapple poppers, and couldn't resist purchasing grapefruits for breakfast) out of site of the rest of the family.  In the two weeks they were here, there was not one diet mistake that could be attributed to their presence, and I am still eating my mother-in-law's cookies.  When they left, I was sad to see them go.

Elimination Diet: Week 2

We have now completed week two of our elimination diet.  You can read about week one in my previous post on the topic.

In the past week our diet has seemed almost normal.  I go to the market, buy lots of good meat, chicken, eggs, and a little fish, plus a lot of pears, leeks, cabbage, green beans, and a few other vegetables.  Now that I know what we need, and have the larder stocked, the market shopping is actually easier than it was before the diet.  I've also found that following recipes is very easy when you already have all the ingredients, so I've been able to try lots of new foods without the hassle I usually associate with it.  And the food, for the most part, has been really good.  I'll be sad to relinquish the cookbooks to the library when they're due.

I must admit that I am starting to get a little tired of cabbage and green beans.  We have one or the other every night.  And my son must miss strawberries; when we read "I Am A Bunny" and "The Very Hungry Catapillar", we can no longer get past the pages with the strawberries on them.  He keeps flipping back to them and calling out "straaaaw-be".  Nevertheless, my husband continues to be amazed by the meals I am coming up with and is now quite content to be on the diet (especially when he gets to eat anything he wants when he's at work).

On a more positive note, I've been losing weight, despite eating absurd quantities of food, especially goodies like carob fudge, cookies, meringues, and homemade granola bars (now that I know what goes into them I'll never again consider them a healthful snack).

We had two major social challenges of the past week, both of which went very well.  The first was a hike followed by a BBQ.  I packed rice crackers and green beans to keep my son happy on the hike, and we brought all of our own food to the BBQ, including marinated chicken breasts, pear and bean salad (very tasty), a noodle and cabbage salad that replicated the one provided by the host, and a potato torte to share with everyone (there were two other beautiful desserts, so it's a wonder anyone found space for this one).  My husband pigged out, eating some of everything we brought and also tasting everything cooked by the hosts!  My son was really good about eating only what we offered him, even skipping the flavored rice crackers that had been left well within his reach before dinner.  Only once did he notice the corn sitting on the table (one of his favorite foods) and beg, but fortunately we were able to distract him.  Unlike our outing last week, there were actually two things I could eat: steak and potatoes, however the chicken and salad were so nice that I declined.

Our second challenge was last night, when we hosted a dinner for overseas friends.  I did a poor job of selecting menu items and found myself juggling four pots at the stove right before dinner.  But nothing was burnt or undercooked and everyone enjoyed the meal (lamb noisettes with pear glaze, steamed green beans, steamed red and green cabbage with a creamy leek sauce, and brown rice) and dessert (poached pears with sabayon).  Next time I'm cooking a roast.

However, the biggest challenge of the week was Melbourne Cup Day, which closed the market Tuesday, when I would usually do the fresh food shopping.  Since the market is only open Tuesday and Thursday through Saturday, I dropped into the local butcher, where I don't normally shop because the selection and convenience aren't as good as the market.  I nearly bought three porterhouse steaks, until I noticed the butcher pulling out a big cryovaced piece of meat.  When I asked how old the meat was, he said about a week and a half, then paused and said maybe two weeks.  It was clear that he wasn't really sure.  Amines continue to form as meat ages, regardless of how the meat is packaged or if it is frozen, so eating fresh meat is critical to sticking to the diet.  We ate vegetarian for three days.

My son's skin no longer seems to be improving and I'm concerned that we will need to eliminate wheat and dairy.  I feel like we should start immediately, but I'm procrastinating until I've had a chance to experiment with the recipes and build up an inventory of wheat and dairy free staples.  Of course, I'm also hoping that the current flare is just the withdrawal symptoms taking their time to subside.  I think I could happily continue this diet for quite some time the way it is, but to eliminate wheat and dairy would require major changes.  Of course, that's how I initially felt about cutting out fruit.

Elimination diet, week 1

I've never successfully stayed on an elimination diet, and I suppose this one is no exception.  Despite all of my preparation, it turns out soy has been leaking into the diet in the form of bread and crackers.  Beware of vegetable oil (it usually contains at least some soybean oil), soy flour, flour improver 472, and lecithin, which sneak into store made food.  In a few weeks we may have to eliminate wheat, and then we won't have to worry about having soy in our bread or wheat crackers, but for the time being I'd like to find alternatives that don't involve making my own bread.

Ignoring the soy problem, which I'll deal with when I do the shopping tomorrow, I've been surprised by how easy this has been.  The two cookbooks mentioned in my previous post on the elimination diet have a huge number of not only tasty, but surprisingly easy, recipes, and I'm sure this experience is making me a better cook.  Here's a sample of some of the dinners we've had over the past week:

• Pan fried fish with butter and garlic
• Lamb noisettes with pear glaze
• Yogurt chicken
• Roast rack of lamb
• Golden chicken (marinated in golden syrup and grilled)

All of our meals have been accompanied by at least two vegetables, usually steamed, but sometimes sauteed.  I've discovered that steamed red cabbage is buttery, and that swedes can be cut lengthwise to make a nice compliment to green beans.

For dessert, or sometimes for afternoon tea, we have natural yogurt with pear, which is a combination we enjoyed before we knew about this diet.  On Saturday, I made poached pears with sabayon, which didn't come out quite the way I expected, but were still extremely tasty.

I'm finding that recipes are unusually easy to follow because the list
of allowed foods is so small that I have all the
ingredients for many of the recipes in the cookbooks, which makes cooking by recipe easier than usual.  I also feel less concerned than usual about how I allocate the vegetables we have, as long as they all get used by the end of the week.

Only once during the past week have I craved something I wasn't allowed to eat, which was chocolate.  I resolved this by making a batch of carob fudge that I've been enjoying ever since (though I must admit it is a little too sweet and the recipe will require some fudging to get right).  My son has been pretty good too.  The first day he was a bit out of character to refuse all of the nice food I gave him, and all he wanted to eat was rice crackers.  But since then he has been quite willing to eat everything and has rarely asked for food he isn't allowed to eat (even though he doesn't actually know that there are foods he's not allowed to eat).

We had our first big social challenge when we attended a birthday party this weekend.  The father of the birthday girl had prepared an all organic spread that could put any caterer to shame: mini quiches, homemade sausage rolls, skewers of fruit, flap jacks (they looked a lot like granola bars), meringues, chocolate coated cream puffs, and a chocalate mousse roll with strawberries for the birthday cake.  I explained that we were doing an elimination diet as soon as they
offered us food, which was pretty much as soon as we arrived, and they were very understanding.  Fortunately, I had anticipated there would be a little food and a cake, so I came prepared with pear slices, crackers, and meringues (since I had eggs left over from my poached pears with sabayon of the night before), but it was a little hard looking at all the beautiful and carefully prepared food and not be able to eat any of it (especially since it was probably the highest quality food we will encounter at a birthday or Christmas party this year).  The merengues had vinegar in them, the flap jacks had coconut in them, the sausage rolls were made with pork, the quiches had vegetables in them, the birthday cake had chocolate in it.   Finally, we worked out that the cream puffs were okay, except for the chocolate on the top, so I ate the bottom and gave the top away, just so I could partake in some way.  My son was even better than me.  He was happy with two slices of pear and one of my home made meringues.

Now we come to the big question: is all this inconvenience worth it?  Is his eczema improving?  The short answer is that it is too early to tell.  According to Sue Dengate's book "The Failsafe Cookbook," as well as our dietitian, we should expect withdrawal symptoms anywhere from four days to a week after starting the diet.  We're still in that range, so we must withhold judgment for the time being.

I don't think either my partner or I would have considered our son, who is nearly two, to be any less agreeable than your average two year old.  However, both my partner and I have noticed he has been less negative and more resilient in the past week than usual.  Whether it is the diet or coincidence, we don't know.  I suppose this may be exposed when we get to the challenge stage.  I'll keep you informed.

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.

Food for thought

"Where would we be without the humble banana?"
      -- father of 11 month old, prior to Tropical Cyclone Larry


About a year ago I had a chat with a mother friend of mine about bananas.  Every mother knows that bananas are an indespensible food with a baby or toddler; it comes in it's own disposable wrapping, requires no preparation, is easy to store, and is universally adored by young children.  In this discussion, my friend proposed that bananas were a single market good; unlike other food, when the price went up, people would not substitute a different fruit.  I denied it.  Surely people would just eat apples, or mandarins, or grapes instead of paying exhorbitant prices for bananas.  Little did I know that within six months I would get to witness the result of a dramatic decrease in the supply of bananas.

Australia has several banana growing regions and does not allow the import of bananas.  The largest and most productive region is on the Queensland coast, centered on Innisvale.  Innisvale happens to be the location where Tropical Cyclone Larry, a category 5 cyclone, hit land in March, 2006.  It decimated the banana crop that was just about to be harvested, and the plants that would be producing bananas through the Australian winter.  Almost immediately, the price of bananas doubled.  The price has since risen to $15 wombats per kilogram, five times its pre-cyclone price.

Being the mother of a toddler, eliminating bananas from the diet complete is not an option, so we ration them.  A single banana currently costs between $2.50 and $3.00 wombats.  We regularly spend $15 on bananas a week.

Since Larry, the price of bananas has been a constant topic of conversation between me and my mother, who lives in Costa Rica. She constantly marvels that anyone would pay so much, and when she visited Melbourne recently (when the price was a mere $10 wombats/KG) she asked the green grocer about it, who replied that you would think that people would cut back, but parents just keep buying them (myself included).

In July the Australian goverment announced that the consumer price index had risen 1.6 percent for the quarter from March through June.  This figure was higher than expected, and economists claimed the rising price of petrol and the cost of bananas were largely to blame.

When my mom bought 6 bananas for 76 colones today in Costa Rica (about 20 Australian cents, or 3.3 cents each) I started to see just how absurd the price is in Melbourne.  In contrast, the typical Costa Rican earns enough money for a full day of work to purchase four bananas at Melbourne prices.

The good news is that the price of bananas in Australia is predicted to start falling this month.

Recycled clothes to ease the travelers conscience

I bought a pair of high tech travel pants today, the kind where the material is partly composed of old plastic bottles.  The tag had a picture of the aforementioned bottles awaiting conversion into these pants.  As I started to examine the picture, I expected to see lots of Coke bottles; Coke is ubiquitous.  But I saw only one or two.  The vast majority of the bottles in the cage were water bottles.

I only rarely drink bottled water.  It is generally reserved for occasions when I need the bottle more so than the water.  I am fortunate enough to have lived my life in places where there is a safe supply of clean water delivered directly to my taps.  Mind you, I did start filtering my drinking water a few years ago when we lived in a house where the water ran brown for the first few seconds whenever you turned on the tap.  However, even when I travel, I usually drink the local water if I've been told by a local that it is safe (the one exception to this is when I visit my mother's house, where I can't stand the taste of the water after brushing my teeth).

A while back I went to Belize.  I spent nearly a week in a small town that would hardly exist if it weren't for the tourists.  On one of our excursions we noted that Coke was still delivered in glass bottles which were sent back to be refilled, but all the local tourists carried a disposable water bottle rather than a reusable bottle that they filled at their hotel.  Each of these disposable plastic bottles came with a little plastic cap to cover the mouth piece, which was further wrapped in plastic to keep it in place during shipping.  These bottles, caps, and little plastic wrappers were all over the roadside.

When I went to Spain a few years later, it was nearly impossible to get water that wasn't bottled; Restaurants didn't serve it and there were no drinking fountains.  The expectation was that everyone would purchase their drinking water in a bottle.  In fact, no matter how nice the restaurant, if you asked for water it was delivered to your table in its original plastic packaging, never decanted, so that it would be obvious that it was not tap water.  I guess this is for the same reason that bottles of wine are always opened in front of the customer.  I can imagine a stuffy old man quaffing his glass of water and puckering his lips as he says, "Hmm, a citrus bouquet, with rich mineral undertones."

About 90 billion liters of bottled water is consumed each year in the world.  The Italians drink the most per capita, but Americans now drink over 4 billion liters of it.  Friends of mine consume bottled water because they perceive it to be cleaner and more healthful than what is available through the tap.  It pays to take care when purchasing bottled water, though, because up to 40% of it comes from a tap.  When in the U.S., where community water supplies are among the cleanest in the world, it hardly seems worth the bother to get your water from a bottle rather than the tap.

Anyway, all this bottled water requires a lot of bottles.  In a place like small town Belize where they barely have garbage collection, the bottles are as good as garbage.  But in Australia and the U.S. they can be turned into pants that are designed to be worn on trips to exotic places with dubious water quality.  It's appropriate that the people creating all that plastic waste are the same ones purchasing the high tech pants.  It's too bad the recycled pants will reduce waste where the tap water is safe and not from the destinations where the pants are intended to be worn.

Send fresh produce for Christmas

I have vague memories of my grandfather sending us a box of pears for Christmas.  I suppose there was a time when this would have been a really big treat, but I think by the time I was a child there was pretty good fruit in the grocery store at Christmas, so I always thought it was a bit of a let down.

I would have thought this tradition had died a long time ago, but it turns out that you can still send a box of fresh produce as a gift.  And in my humble opinion, this one would be even more disappointing then that box of pears.