Food Intolerance: Just fussy eating?? Fad, friend or foe?

We are what we eat and it will affect how we feel. I recently attended a dinner party where each of the 12 guests had at least 1 dietary requirement. This is a relatively new normal, but food intolerance, to some degree, is thought to affect more than half of us.

There can be a lot of confusion surrounding this topic, with labels such as food hypersensitivity, food allergy and food intolerance often being freely interchanged. It is important to make the distinction between a food allergy and a food intolerance because the management can be quite different.

A true food allergy is relatively rare. It affects approximately 1% of the adult population and common allergies include nuts and shellfish. Here, the body sees the proteins found in the culprit food as a threat, and tries to attack it – this is called an immune response.

Symptoms of an allergic reaction usually start immediately (although sometimes a delay of a few hours can occur) and can include tingling in the back of the throat and lips, a rash and vomiting and/or diarrhoea. In more severe cases, it can lead to swelling of the face and breathing difficulties. This is called anaphylaxis and is a medical emergency. The treatment is adrenaline injected in to a muscle as soon as possible, and so once diagnosed, you may be asked to carry an EpiPen with you at all times. You need to avoid this food for the rest of your life.

This attack (or immune response) usually releases an immunoglobulin called IgE and this is what we check for when performing an allergy test. The 2 most common allergy tests are a skin prick test or a blood test known as a radioallergosorbent (RAST) test. Non IgE mediated allergies do exist, but these are more common in children. Speak to your doctor for more information.

An intolerance is different. Your body finds it difficult to break down and digest certain substances in foods but no allergic reaction place. Common intolerances include:

  • Dairy
  • Gluten
  • Wheat
  • Yeast 
  • Alcohol

 

Gluten free

 

It can take quite a long time to diagnose an intolerance or identify a trigger food, and there are many reasons behind this. Sometimes your body can tolerate a small amount of the food, but when eaten in larger quantities it can be troublesome. Often, you might just notice that you don’t feel quite right but you can’t quite explain why. You can feel tired and sluggish or notice problems with your skin. You may become constipated or have diarrhoea or a mixture of the two. Commonly, you can feel very bloated and you may find yourself passing more wind, which can be embarrassing.

It is not uncommon for your symptoms to change from day to day, or get worse over time. They can start to have a negative impact on day to day life and overall make you feel quite miserable!

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If you are having any of these symptoms, book an appointment with your GP. They will take a full history, and ask questions such as: Have you had any change in your bowel habit? Have you noticed any blood in your stool? Have you had any weight loss? Your GP may also carry out basic investigations such as blood tests and possibly a stool sample to rule out things like coeliac disease, inflammatory bowel disease and even bowel cancer.

If you are given the ‘all clear’ for any specific cause by your doctor, it can take a while to accept there is no magic solution to the very real symptoms that you are having. They will probably advise you to make changes to your diet, and although it may feel like a bit of a cop out, this really is the management.

Your GP may mention the FODMAP diet to you, it stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. Foods containing these short chain carbohydrates are difficult to digest because they attract water and feed gas-generating bacteria inside the intestine, which leads to bloating, flatulence and loose stools. This reaction affects some people more than others. The list of foods to avoid on the FODMAP diet can appear endless, but when done properly, it can make you feel a lot better.

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Your doctor may make other suggestions about what to avoid in your exclusion diet and most often they will recommend a referral to a dietician or nutritionist for support and guidance. It is essential that we ensure you are still getting all the nutrients you need, despite making quite significant changes to your diet. The aim is to exclude a food for a period of time and then re-introduce it slowly and monitor for return of any symptoms.

Can’t I have blood test to check what I am intolerant to?

To be honest, there is no scientific date supporting the accuracy of this test. The most common commercially available tests look at the level of Immunoglobulin G in response to hundreds of different foods and report whether you have a reaction to them. I would advise caution when thinking about getting one, and don’t get one done without consulting a doctor.

That being said, I sympathise fully with sufferers, and being one myself, as a desperate last resort, I paid to have one done. I found my results very interesting (and a little depressing – I couldn’t eat anything I loved!!) Here are my results:

FIResult

R = Reactive and I should eliminate B = Borderline reaction (may or may not be helpful to eliminate)

There are also lots of other commercially available tests claiming to diagnose food intolerances. Novak Djokovic has famously used kinesiology which uses muscle testing to detect imbalances in the body and he has since cut out gluten amongst other things from his diet. Please speak to your doctor before paying lots of money to get any of these tests done, as the scientific evidence backing these methods is limited.

Food intolerance is real, and it can have a significant effect on people’s lives. If you are having symptoms then the first port of call should be your doctor to rule out any serious illness. Food intolerance tests are expensive, and not entirely backed by science, but some do find the results helpful as a guide. Usually, I find this is because it gives them focus and motivation to control their diet, which really is the key. Make use of a dietician or nutritionist to ensure you stay healthy.

Good luck with anything you are advised to try – its not easy but it will be worth it!

Staying Well: Stress… How it affects my body and how can I best manage it?

PriLakhani1Stress is a part of everyday life. A little bit of pressure can be a good thing to keep us motivated to get things done; too much however, and it can be a different story entirely. Stress is the feeling you get from being under too much mental or emotional pressure. Common causes include work, family, relationships, financial difficulties, unemployment and illness.

The stress response causes physical changes within our body as it releases hormones such as adrenaline and cortisol, triggering the ‘fight or flight’ response. This makes your heart beat faster, raises your blood pressure, makes you breathe faster and deeper so that you have an increase supply of oxygen, makes your muscles tighten up and causes a release of sugar into the bloodstream to give you a boost of energy.

All of this is excellent in the short term to help you up your game, but problems can arise when you are constantly stressed due to the continuous release of hormones. You can end up feeling tired all the time, not sleeping well, develop muscle aches and pains (usually back and neck) and suffer with headaches. You might also find that you have symptoms of acid reflux (heartburn) or get an upset stomach. Longer term, it can increase your risk of developing high blood pressure and heart disease.

You might notice that you keep getting ill, this is because cortisol and other hormones released over a continuous period of time can weaken your immune system. You also probably haven’t had enough time to rest. If you are feeling like this, listen to your body as it is trying to tell you something.

Being stressed can affect your mental health too. Emotionally you might find yourself withdrawing or feeling like you are walking around in a bit of a daze. Feeling like you are unable to cope is common, and you might even feel very anxious or depressed. It is important that you speak to your doctor if you are feeling like this, as they will be able to help.

The best way to deal with stress is to identify it early and make long term changes to the way you do things. Lets face it, you probably won’t be able to take away most of the things that make you stressed but you can ALWAYS deal with things in a better way.

First and foremost, try and avoid picking up (or returning to) bad habits like smoking, drinking excessive amounts of alcohol or using other recreational drugs. It might be tempting but it’s just not worth it, and in the long run you will end up feeling worse.

Exercise  – This might be difficult to fit in to your busy schedule, but try to get moving wherever and however you can. Exercise itself is known to relieve stress and it releases natural endorphins to make you feel more positive. It can help you to feel more focused, self confident and motivated and help improve your quality of sleep.

Eat well –  you are what you eat and it will affect how you feel. Try and avoid refined sugars, which are found in processed foods, as these can cause energy crashes that might leave you feeling unnecessarily tired and irritable. Opt instead for a handful of nuts, some dark chocolate or a banana. Avoid comfort eating – easier said than done I know! Try also cutting down your caffeine intake (although you might feel you need more of it) because it is a stimulant and can make your feeling of stress worse.

Take a step back and take control – When you can’t see the wood from the trees, stop for a moment and reassess. Make a list of what needs to be done and prioritise it in order of importance. Delegate where possible and set realistic goals. There’s no point in making yourself feel worse – so be true to yourself with what you can realistically achieve with the time that you have.

Work smarter not harder – keep this as your mantra – look at ways you can improve the way you do things to make you more efficient. Learn how to say ‘no’ tactfully – this may be difficult at first, but it will help to minimise situations where you agree to take on new roles or responsibilities when you already have too much to do and too little time to do it in.

Relax and / or Meditate – ok, it’s not for everyone, but whatever you want to call it, try and spend a few minutes a day reflecting inwards. This might be practicing a few breathing exercises or trying to focus your mind on clearing away any negative energy. Mindfulness really can help you a great deal in your day to day life.

Make time for your hobbies and friends – I really can’t stress this enough! Doing things that you enjoy will naturally make you feel better and offer a welcome distraction from everything else that might be going on. Just remember what I said about those bad habits – everything in moderation!

TALK ABOUT IT – a problem shared is definitely a problem halved. Talking to friends or family might be all you need to regroup and get going again. Sometimes though, you might feel totally overwhelmed or have found that talking to your support network hasn’t quite done the trick. Speak to your GP – they can help. They can offer support, and if needed, refer you for talking therapy such as cognitive behavioural therapy. This can help in identifying your stress triggers and give you techniques to deal with them in a better way. If needed, they can prescribe medication to help your symptoms.

Finally, remember life is short! Try and look on the bright side – stop worrying about the things you can’t control and focus on the positives, once you start looking, you will find them!

Surviving Hay Fever Season!!

The Great British Summer is upon us! For most, this means picnics in the park, evening strolls and enjoying the great outdoors. But for some, it is a time of great misery.

Hay fever affects approximately 20% of the population at one time or another. It is caused by an allergic reaction to pollen. The body’s natural defence system reacts to the pollen as if it were harmful (even though it isn’t) and tries to fight it off, by releasing a substance called histamine.

Symptoms Include:

  1. Sneezing
  2. Runny nose
  3. Itchy, watery eyes
  4. Itchy throat
  5. Cough
  6. Lethargy

The pollen count is the number of grains of pollen in one cubic metre of air. Symptoms will usually be worse when the pollen count is high. I have compiled a few top tips to get you through those days!

Medication

  • Use a daily non-drowsy antihistamine – the most common ones you can buy over the counter are loratadine and cetirizine. If one stops working then switch to the other.
  • If these antihistamines don’t help then see your GP, they can prescribe a stronger antihistamine such as desloratadine or fexofenadine.
  • If your symptoms aren’t controlled with tablets, your GP might prescribe a nasal spray that has a steroid in it – this reduces the inflammation in the nose and helps with sneezing, itching and congestion.
  • Use sodium cromoglicate eye drops – four times a day

Reducing pollen exposure

  1. Use Vaseline around the nose to act as a barrier to the pollen entering your nose
  1. Wear sunglasses (ideally wrap arounds) to keep the pollen out of your eyes
  1. Change your clothes when you get in from being outside, and wash your hair if you can – this will reduce the transfer of pollen to furniture and your pillow
  1. Keep your windows closed – especially early in the morning and late evening when the pollen count is thought to be highest
  1. Avoid hanging your clothes outside to dry – they can collect pollen
  1. Keep your car windows closed when driving and use the ‘re-circulate’ button if there is one
  1. Don’t let your pets get too close to your face – they carry pollen in their fur. You can wipe them down after a walk.

Add on treatments

  • Sodium cromoglicate nasal spray – may help with a runny / itchy nose symptoms
  • Ipratropium bromide nasal spray – may help with a runny nose but not sneezing or congestion
  • Decongestant nasal sprays – can give immediate relief for a blocked nose, but shouldn’t be used for more than a few days
  • Nasal saline washouts – to help wash out any pollen in the nostrils

In severe cases

A short course of steroid tablets can be prescribed to help settle the inflammation in special circumstances – for example if you have an exam coming up. Immunotherapy treatment which aims to desensitise the body to pollen over a period of time may also be offered in rare cases.

Don’t Despair!

Usually, once you find the right combination that works for you – your symptoms can be controlled! Speak to your GP if you have any questions.