Food/Symptom Diary

What is food intolerance?

Food intolerance (also known as food sensitivity) used to be called food allergies, but this is a misnomer. True allergies directly involve the immune system – even just by touching whatever it is you’re allergic to, whereas food intolerance is caused by the inability of the body to process a particular food correctly. Instead, either it’s not digested at all, or it only reaches a certain stage in the digestive process, leaving behind substances which can cause reactions ranging from slight to severe.

The severity of the symptoms may change over time. In celiac disease, a type of gluten intolerance, there is damage to the villi in the gut, and in the early stages this may cause symptoms like diarrhea, constipation or an alternation between the two. But if someone who has celiac disease (whether they know it or not) continues to eat gluten, at some point they will probably also start to experience abdominal pain. In the long term, without diagnosis and a change in diet, bowel cancer can develop.

True allergies cause almost instant reactions which escalate every time you’re exposed to them, and can lead to potentially fatal anaphylactic shock. Testing for this type of allergy should only be done under the direct supervision of trained medical staff.

Food “allergies” (intolerance/sensitivity) do not have instant effects, and can be safely tested for by means of a food/symptom diary. Many nutritionists recommend using this method as a means of diagnosis, which may avoid the need to turn to the much more difficult regimen of an elimination diet.

Symptoms associated with food intolerance sometimes change over time, especially if the food which triggers the problem is removed from your diet for a period and then you start eating it again. This, together with the fact that symptoms may occur up to 48 hours after the offending food is eaten, can make identifying the food causing the problem more difficult, which is why a food diary is used. A food/symptom diary helps to pinpoint the reactions and link them with the cause.

Diagnosing food intolerance

Food intolerance used to be called ‘food allergies’. However, there is a world of difference between an allergy, such as the infamous peanut allergy – which can kill almost instantly, and an intolerance to, for example, gluten – leading to general poor health and obesity.

Although food intolerance is not the same as food allergy, many medical authorities, who really ought to know better, insist on classifying them as the same, pointing out what is already known, that these types of problem do not show up in blood tests. The reason for this is that there is not usually any involvement with the immune system. Instead, there may be an inability to digest the food in question, perhaps because an enzyme is lacking, or some other difficulty.

Even though certain conditions are most often caused by an intolerance to one or two particular foods, the same symptoms may be brought on by different triggers in some patients. Different people are intolerant of different foods, and the same set of symptoms may be caused by a completely different food from one person to the next.

In case you’re wondering why people eat foods they are sensitive to, I should point out that it’s perfectly possible to have an intolerance to something as common as wheat for years without realizing it. In a 3-year study at Addenbrooke’s Hospital, Cambridge, UK, 60% of patients were found to be intolerant of wheat! In fact, you yourself may be intolerant to wheat, dairy products or some other major part of your diet.

The only reliable way to test for such a food sensitivity is by means of an exclusion diet.

How to find out if you are food intolerant

Because food intolerance is not the same as a food allergy (as mentioned already), classic allergy tests don’t work – they are testing for the wrong thing.

You may find the following types of test being offered to test for food intolerance:

- Skin test -

This is the classic test for immune response. Good for discovering if you have an allergy, but useless for pinpointing intolerance.

- Tongue test -

A modification of the skin test, again only suitable for discovering allergies, rather than food intolerance.

- RAST test (radioallergosorbent test) -

A blood test. Another test suitable for testing for allergies, but not for intolerance.

- Cytotoxic test -

Attractive in theory, but disappointing in practice. Do not take this test as the results are unreliable, with many false positives.

- Hair test -

A test for mineral deficiencies is offered as a way of diagnosing possible food intolerance. However, there does not seem to be any link between mineral deficiency and food intolerance.

- Blood mineral analysis -

Again, mineral levels are tested, but the link between mineral deficiencies and any food intolerance has not been demonstrated.

- Blood antibody test -

Any food antibodies found in the blood will demonstrate an allergy. However, the lack of an antibody does not indicate that a food is tolerated.

 
Save your money. None of these tests are of any value in finding out if you are food intolerant or not. Only one reliable method exists: an exclusion diet. Another option, where the food is not already known, is use of a food/symptom diary.

Keeping a food/symptom diary

A food/symptom diary (commonly called just “food diary”) is a way of discovering hidden causes of your health problems. After you have kept it for a while, you will be able to detect patterns that you were never able to see before. In fact, the whole process of finding out what is going on becomes, as Sherlock Holmes might say, “elementary, my dear Watson”.

If you or your medical adviser suspect that your health problems are caused by an intolerance to food, one of the best ways to find out for sure is to keep a food diary. That’s unless you are happy to go for total exclusion of all possible candidates followed by careful, individual re-introduction after at least two weeks’ total abstinence.

Most of us aren’t really up for the deprivation routine, so here’s a basic explanation of what’s involved in keeping a food diary. Doing this should help you work out what you’re reacting to (if anything) – bearing in mind that more than one food group may be involved.

The first thing to do is to get yourself a suitable notebook. Probably the best type would be an A5 one – around 20cm (8″) tall by 15cm (6″) wide, spiral-bound so that it lies flat when you open it. Get one bound on the side, not at the top.

Use one page a day. Divide the page into 2 columns (a simple fold will do). At the top of each page, write that day’s date.

The left hand column is for the food you eat. You need to keep a note of everything you eat or drink every day. This sounds like a bit of a pain, and truthfully it can be, but it’s better than cutting everything out on the off-chance.

Write down the time, the type of food, (if it’s a branded product, the brand), and how much you ate of it (by volume or weight). Also write down the mood you were in when you ate it.

Be specific. For example, don’t just write down “potatoes”. If you eat french fries (UK: chips), write down that you ate potatoes cooked in oil. If you ate mashed potatoes, write down that you ate mash and the brand if it came out of a packet, or potato, butter and milk if it’s the real stuff.

Don’t forget snacks, such as chips (UK: crisps) or cookies (UK: biscuits), or sauces, such as gravy, salad dressing or custard – possibly made from eggs and milk or cornstarch (UK:cornflour) with vanilla – (and include the brand of gravy or whatever if it’s not home made from scratch). Remember to include drinks, from water (bottled or tap water? There may be differences in the mineral content), through tea and coffee, to soft drinks and alcohol.

On the right hand side, you write down symptoms you experience, and the time they occurred. This includes things like changes of mood, headaches, stomach problems, dizziness, insomnia, in fact anything at all that might be considered not part of a normal healthy life. Even if you have got so used to the symptom that “for you” it’s normal, write it down. Also write down the time it occurred, how long it lasted and how severe it was.

As you need to include a lot of information, it’s important, if you can possibly do it, that you take your food diary with you whenever you go out. Explain to anybody who asks that you are engaged in detective work – they are likely to be intrigued.

After two or three weeks, look through the entries in your diary to see if you can see anything obvious. You might notice that every time you eat some particular type of food, 4 or 5 hours later you get a particular symptom. The less the time between eating something and getting a result from it, the easier it is to spot. But some foods can trigger a reaction up to 48 hours later, so you might have eaten many other different foods in the meantime. This is why an elimination diet is often recommended for tracing food intolerance.

Your medical practitioner or nutritionist may also have software that make analysis of your paper diary easier, though this is quite high-tech, so don’t be surprised if he/she hasn’t.

I hope this article has been helpful. Don’t forget, many niggling symptoms that you’ve put up with for years may be caused by your body’s inability to cope with certain foods. Cut them out of your diet and you will cut out the symptoms as well.

I stopped eating gluten some time ago, and I’ve never felt better. Problems I’ve put up with since childhood (which is a fair few years ago) just disappeared. And I started to lose weight, as well – even though I was eating more!

Keeping a food/symptom diary is not that difficult, though it does have to be thorough – treat it as a puzzle or mystery that you want to solve. After a few weeks, you will have all the clues, and you may be able to pin the blame for your health problems on one particular culprit.

The Food/Symptom Diary app which I produced for the iPhone is designed to make this process as easy as possible, and you won’t have to remember your notebook and pen. I almost always have my phone with me, and I guess you’re the same, so having an app on your phone just seemed like the logical way to go. Happy detecting!

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Coping with a celiac disease diagnosis

There are several ways to cope with celiac disease, but unfortunately only one of them will give you a happy, healthy life – and hopefully a long one, too. It’s no good ignoring your diagnosis or pretending you don’t have to avoid gluten. Though in the future there may be an actual cure, for now the only viable option is to stick to the diet as well as you can – basically you have to suck it up, just like diabetics and people with allergies.

One advantage you have is that, unlike people who are allergic to, for example peanuts, you’re not going to keel over instantly and be taken out on a stretcher if you accidentally eat some gluten. That’s not to say you can be offhand about avoiding it. Gluten takes up to 3 weeks to leave your system, so even if you don’t notice any obvious symptoms, damage is still being done in your gut until every particle is gone.

So, if you’ve just discovered you have celiac disease what are your next steps? It’s not the easiest diet in the world to follow, but there are lots of other people who share the same problem, so it’s good to know you’re not alone.

The first thing to do is to go through your kitchen stores like a sleuth, reading every ingredients label carefully and either throwing contaminated products out entirely or putting them into a quarantine area (if there are other people living with you who don’t need to be gluten free, and maybe it’s some favorite product for them).

Check everything, even if it’s “obviously” ok. You might not realize that most soy sauce is made with wheat, or that fake seafood is made out of refined gluten. Many bottled sauces also contain some wheat derivative. All these are unsafe.

Don’t forget frozen food. Many potato products contain flour as a coating or bulking agent. Be religious about reading the ingredients on every single pack of food you have in stock.

As you find products that you can’t use any more, start making a list of things you need to replace. Many items can be substituted by alternatives, but not all of these are perfect substitutes, so if you share your home, you may have to educate anyone else who uses the kitchen about the new rules, as they may want to stick to their familiar items.

And there will have to be rules, if you are to stay healthy. For example, if you like gluten free toast, you will need to put the bread in a toaster bag before using a shared toaster – or even one you used to use for regular bread. This is cheaper than buying a new toaster just for you, but your family need to know that they can’t use your toaster bags for their gluten-rich snacks.

Once you’ve been through the kitchen store, take a look at worktops and chopping boards. Are they made of something porous like wood, or easily scratched like some types of plastic? Do they have a groove that might have picked up invisible specks of gluten? You may need to replace them. Glass and granite are good materials that will not pick up too much contamination, but must still be cleaned more thoroughly than you might have done before, scraping the surface after every use for anything that contains gluten – or have two, one for you and one for everybody else, if you can lock it away or you trust the rest of the household to stick to the right one.

But the kitchen stores aren’t the end of it. You also need to check bathroom products and if you wear makeup, your cosmetics as well. Check anything that will come into contact with your skin including shampoos (some have added wheatgerm, purely to make it sound good, but it will harm you if it goes in your eyes, and you always get miniscule quantities in there whether you realize it or not), foundation, lipstick, mascara… Check your toothpaste. Also check household cleaners, though these are less likely to contain gluten.

Once you’ve dumped or quarantined any contaminated products, it’s time to head to the store. Choose a specialist health food store for your first trip, as they will have a larger range of gluten free products. You may prefer to shop online for the biggest range long term. GlutenFree.com is a great site if you live in the US or Canada, and Amazon also has a gluten free range of food, not just books!

Start off by buying replacement staples like bread and pasta. Genius makes good gluten free bread (only available from GlutenFree.com) and Orgran makes the best gluten free pasta I’ve found. If you use flour, buy a bag of all purpose gluten free flour – Dove’s Farm is a good make (UK only, I’m afraid), and I’ve heard good reports of Bob’s Red Mill brand.

I’ve written elsewhere about quick and easy gluten free meals, and I think I’ve given you enough to be doing for the time being anyway! Good luck.