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November 15, 2004

Head vs. Stomach

There's a new craze among the "allergic" to everything crowd, and it's the elimination diet. The concept is pretty simple: you remove all possible irritants from your diet and slowly add them back in so you can tell which one is causing the trouble. The problem is, from what I can tell from a discussion with one of these people over the weekend, they're going about it all wrong.

...

First let's talk a bit about allergies. Most people don't really understand how allergies work, and what an allergy is. There are real allergies, and there are intolerances, and there are irritants. Irritants are things like dust and smoke that irritate your body. Everybody is affected by them. You're not "allergic" to smoke. Smoke is just irritating. I'm allergic to tobacco -- my throat swells up and begins to close when I am around it, whether it's burning or not.

Intolerances are when your body just doesn't react properly to something, usually something you eat. Lots of people are lactose-intolerant, which means they can't properly digest lactose and end up in gastric distress from consuming it. Cruciferous vegetables and beans can provoke similar reactions. A very small number of people are actually allergic to milk, which means their throats swell up and they get out of breath if they consume it.

See where I'm going, here?

If you have an allergy, or your doctor suspects you have an allergy, the way to test for it is with prick tests or blood tests, not by potentially exposing you to a lethal dose of the allergen with a dietary test. Noel is allergic to milk. They found this through a blood test. If you're really allergic to a substance, they can test for it without putting you through a complicated diet routine. If you have an intolerance, it's fairly easy to eliminate the most obvious suspects in one go and figure it out, based on the symptoms and when they show up. The only reason for an elimination diet is to figure out an intolerance that is not obvious. So if you're doing an elimination diet, the first thing to know is what symptom you're trying to treat. If you have hives on your hands, an elimination diet is not likely to tell you where they are coming from.

So let's get back to our dieter. She (why is it almost always a she? For the same reason that "hysteria" got its name, originally) started out by basically going on Atkins, eliminating carbohydrate sources like vegetables and breads. But not nuts, which are the cause of plenty of allergies, or fats, which cause excess bile production and acid reflux. She did eliminate milk and soy. So basically no sources of calcium.

In contrast, when an actual doctor had me on an elimination diet, the first four days I drank a glucose/water syrup and was more hungry than I've ever been in my life. I could have eaten a whole cow, live, maybe even unwashed. Glucose is a completely digestible sugar. it's what your body breaks food down into. The idea was to have enough calories to get through the day, and enough fluid, but nothing that could cause problems. If you're allergic to glucose, you're allergic to life.

Then we added slightly more complex sugars, working our way up to complex carbohydrates like whole wheat. Some people have sugar intolerances, so the idea was that we'd find them right away. You keep the diet totally simple so there's nothing else to worry about but the intolerance. In contrast, my friend added vegetables in after a week, then soy (which is, um, a vegetable, but OK).

After a week of adding carbs, we began with possible irritants like fruits and vegetables known to cause intolerances or allergies, like strawberries, cruciferous vegetables, beans, and so on. One a meal from my ordinary diet. Still almost no fats (we now had vegetable oils) and no meat or dairy. By this time my doctor was almost convinced it was milk that was causing the problem, so we added a glass of milk. That was before I took the antibiotic that made me lactose intolerant, so nothing happened, so we added in an egg, and still nothing. Oh, the frustration. On the other hand, I was no longer spending two hours a day in the bathroom. Small mercies.

Let's contrast to my friend, the allergy sufferer. She's got a fairly complex diet already going, with no reactions. Meat and nuts, vegetables, now soy, and what does she add in? Citrus. Seriously, citrus. Which is not a type of fruit that tends to cause allergic reactions. It can cause acid reflux, because it's high in acids, but heck, if you have a tendancy to acid reflux anything can cause it.

Next she adds in yeast. A lot of people think they are allergic to yeast, or have some sort of sensitivity to it. I think they're just squeamish about eating live animals whole.

The next thing I added into my diet was chicken, which sent me running to the toilet ten minutes after lunch. We have a culprit, ladies and gentlemen. Odd that I can eat eggs and not poultry but there you have it. Chicken is usually considered a mild food, so our best guess is that I'm having a reaction to some drug the chicken is dosed with. I do have some antibiotic allergies, so it might be that.

In the meantime, my friend has added wheat to her arsenal. Some people are gluten intolerant. Remarkably fewer than you would think given the number of people who claim to be gluten intolerant when I start talking about how much I love bread. I can sit and listen and be appreciative while somebody talks about how good a burger was and what the qualities of a good burger are. I expect the same level of politeness from meat eaters who abstain from the goodness of wheat. Never going to get it, though.

The last things she adds in are all the Major Sins of the anti-food world: white sugar, chocolate, and alcohol. Some people are allergic to chocolate, but if you are you know it already. Some people have control issues with alcohol, but that's not going to be picked up by an elimination diet unless you go through the DTs. And some people have blood sugar issues, but that's best tested for with blood tests, not diet tests. But a stunning number of people tell me that they have a physical adverse reaction to white sugar. It gives them blinding headaches, makes them unable to concentrate, causes their muscles to ache, in the tiniest of doses. Sugars from other sources don't have this effect: one of the people who made such a claim to me was drinking a mango smoothie as she told me how she had to avoid sugar at all costs.

The real problem here is that a person with very little scientific or medical background is trying to do a scientific study of her own body with no controls and little or no understanding of what she's looking for. The person in question was trying to find out why she was so tired. The first place you look for reasons for low energy is not diet. It's mood. Since she's a chronic depressive, that might be the reason, and she should spend more energy on treating the depression first before messing with her diet. She didn't know what she was looking for, didn't know how to deal with the results she got, and yet had this vague, insistent belief that somehow chocolate could be the cause of her low energy level, rather than a chemical makeup that inclines to low seratonin levels.

And she was not the only one. When we were talking about this, two other people nearby mentioned that they'd either gone on or been considering going on an elimination diet recently. "It tells you so much about yourself." I had to hold myself back from explaining in great, boring detail just how little the sort of diet they were doing could tell them. I wonder if there's some sort of fake-medicine newspaper that these people are getting that includes all these bizarre ideas about holistic medicine and how food can be poison. It's a convenient way to avoid taking responsibility for your own health and body, because obviously you thought wheat was fine for you until you discovered that it can be a poison! For a small number of people, allergies and intolerances make some ordinary foods more dangerous. For most people, the source of your problems is elsewhere.

Posted by ayse on 11/15/04 at 8:21 AM