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.
Tuesday, February 13, 2007
Saturday, January 27, 2007
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.
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.
Saturday, January 13, 2007
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.
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.
-----------------------------------------
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.
Monday, January 1, 2007
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.
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.
Wednesday, December 13, 2006
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:
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.
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
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.
Friday, December 1, 2006
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?
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.
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.
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