Health and medical information

Have you ever noticed a peculiar, acrid odor in fruit and vegetable markets? This smell may very well be coming from the crates used to pack citrus fruits, which are impregnated with fungicide. This is a good way to stop the growth of molds on cartons but can cause serious health problems for those inhaling the vapors. One patient, Doris Meredith, carelessly took a peck of citrus fruit in a fungicide-impregnated case into her home. Every time she entered the part of her house where the cartons were stored, she couldn’t seem to catch her breath and began to wheeze uncontrollably.

Her husband eventually suspected that spray residue on the oranges was the cause and therefore washed each orange in hot, soapy water, drying each fruit separately. The odor still lingered, however, and continued to cause Mrs. Meredith to have acute respiratory symptoms.

Somewhat later, when she and her husband were moving to a new home, she became acutely ill and was confined to her bed, complaining of asthma and headaches. Her husband then recalled that her asthma had started shortly after the packing cases (citrus boxes) were brought into the home. Her symptoms subsided after the boxes were removed but recurred when the same boxes were brought back into the house (this time without her knowledge).

This woman also became depressed for days whenever she ate commercially available oranges. Her depression was so severe that she had contemplated going to a psychiatrist. However, treatment by the methods of clinical ecology was more effective in locating the cause of her problem, namely, fungicide residues, and in eliminating future such instances. She found, for example, that she could eat organic oranges with impunity—that is, oranges which had not been sprayed, dyed, or packed in fungicide-treated cartons.

We are just now beginning to understand the full power of these chemicals. For example, we now know that packing cases and express cars which have been contaminated with insecticides retain this contamination for long periods of time and may subsequently contaminate other loads.

This type of “second-hand” contamination may explain why some people are made ill by wheat which is shipped in paper or cardboard containers for long distances but not from the same organic wheat when it is shipped in metal containers. Some of the pesticides in the railroad car or truck manages to seep into the grain which is packed in porous paper.

Although cases such as Mrs. Meredith’s are extreme instances, the fact that they occur underlines the need for chemically susceptible patients to have local sources of supply, so that food can be transferred from producer to consumer without becoming contaminated.

A more common source of container problems is the ubiquitous “tin” can, now usually made of aluminum or steel. Certain patients react to canned foods, while tolerating the same foods raw or uncanned with no trouble. I had made this observation often enough but could not figure out a way to separate the contribution of the can and its golden-brown phenol lining from that of the various sprays and chemicals found in processed foods. Phenol-containing compounds are used on the inside of tin cans to prevent the metal from bleaching the color of the food. I was finally able to make this distinction when a relative who lived in the state of Washington sent me some salmon which she and her husband had caught and “put up” in glass jars, as well as some tomatoes which had also been home-grown and packed.

When these foods were given to selected patients, they had no reaction. But when these same patients were later given salmon and tomatoes from commercial cans, lined with the golden-brown coating, they all became sick.

These patients have been able to eat fresh or home-packaged salmon or tomatoes since then with no difficulty. It is only when they try to eat such food in cans with phenol lining that they run into trouble.

Admittedly, only a minute amount of the resins and other chemicals used to line cans gets into the food. Is this really enough to cause a reaction? Yes, it is! Think of the difference in taste between canned and uncanned salmon, peaches, or other foods. Some of the characteristic “canned” taste of these foods comes from the substances in the lining, which seep into the food itself. If you can taste it, it can certainly have an effect on your health as well.

Patients who have suffered from depression, asthma, headache, and other symptoms have found relief of their long-term problems by avoiding chemicals and also by eliminating canned foods from their diets.

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These drugs are used where NSAIDs have been.tried, and have failed to control the symptoms. Most have some effect on the immune response within the joint. They have the advantage of checking the progress of joint destruction caused by rheumatoid arthritis, whereas NSAIDs simply suppress the immediate effects. On the other hand, they are powerful drugs which are more likely to cause side-effects. Once they are started, they will probably have to be taken for many years. For this reason, doctors delay using them until they are sure they are necessary. If taking such drugs, it is very important to have regular medical supervision and report any side-effects to the doctor.

The drugs commonly used are: penicillamine (Distamine, Pendramine) gold salts (Myocrisin, Ridaura) sulphasalazine (Salazopyrin) hydroxychloroquine (Plaquenil)

In severe cases of rheumatoid arthritis, that do not respond to other treatments, drugs which have a general suppressive effect on the immune system may sometimes be used. The main one is azathioprine (Azamune, Imuran). These drugs make the body less able to fight infections, and at high doses they could make patients more susceptible to cancer. Corticosteroids (see Section 5) are sometimes used where none of the above treatments are effective.

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The relevance of food relationships to food sensitivity is explained on p255. Briefly, a person who is sensitive to one plant food (eg oranges) may react badly to other foods from related plants (eg lemons and grapefruit). The same also goes for foods from animal sources?

In the past, a great deal of emphasis has been placed on ‘food families’ – by those treating food intolerance. These doctors have automatically looked at the taxonomic family of plants and animals to predict when cross-reactions are likely to occur.

But the family is just one sort of group in taxonomy – the science of biological classification. A closer look at the cross-reactions shown by patients suggests that the family is not always the most relevant group to consider. Sometimes we need to consider higher or lower levels of classification. The over-emphasis on food families can create problems. For example, it can lead food-sensitive people to eat too much of some potentially troublesome foods (eg fish) while avoiding many plant foods unecessarily.

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One of the strand of the argument is more contentious and very difficult to test scientifically. It suggests that we need more nutrients than we once did, simply because our bodies have to deal with so many more toxins – pesticide residues in food and water, air pollutants and so on. Although this might seem rather far-fetched, it is not implausible. We protect our bodies against toxins by breaking them down with enzymes. Many vitamins act as coenzymes – substances that are needed by specific enzymes to help them do their work. Minerals such as zinc and magnesium are also important for enzyme function. Faced with an extra burden of toxins to destroy, perhaps we do need more vitamins and minerals than our traditional diet provides.

A related issue here is the Pill, which is said to alter the nutritional balance of some women – perhaps the majority of women who take it on a long-term basis. Zinc, magnesium, manganese and iron may be deficient in Pill-takers, while copper is often very high. Vitamin A seems to be stored in excess, while many of the B vitamins are in short supply. Some of the adverse side-effects of the Pill have been linked to these changes in vitamin and mineral status. Simply stopping the Pill does not seem to put these nutritional disorders right – they may persist for three months or more and cause continuing problems.

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One line of research into food intolerance has investigated what normally happens to food in the healthy person. There is no reason why the immune system should not attack food molecules just as enthusiastically as it attacks invading germs – after all, food is chemically different from our own bodies, and that is exactly how the immune system recognizes unwelcome aliens.

At one time it was thought that the gut wall rigidly excluded all food molecules, but this is not the case (see p21). In fact the body ‘learns’ not to mount a major immune attack on food. This is done by small areas of the gut wall, known as Peyer’s patches. These patches, which are part of the immune system, take up small droplets of fluid from the gut, in a process known as antigen sampling.

What the Peyer’s patch does is to ‘examine’ the foreign substances it finds in the gut, ‘make a decision’ about how the body should respond to each of them, and ‘communicate’ that decision to the rest of the body. They are rather like immigration officials, alerting the body’s police force (the rest of the immune system) to the arrival of a suspected criminal (a bacterium or virus). But how does the Peyer’s patch distinguish the ‘suspected criminals’ from the ‘innocent holidaymakers’ – in other words, harmless food molecules? No-one knows at present, but the smaller size of food molecules and their lack of ‘stickiness’ is probably important – microbes have a habit of clinging to cell membranes, which is a potential give-away.

Once the Peyer’s patch has recognized a given molecule as food, rather than foe, it tells the body to respond to that molecule in a particular way. It produces a type of cell known as a T-suppressor cell, which is speqific for that molecule and tones down the immune response to it. T-suppressor cells can also influence the type of antibody produced in response to a particular molecule. Some isotypes of antibody produce inflammation when they bind to their antigen (in this case, the food molecule). One isotype does not -it is called immunoglobulin A or IgA and it plays an important part in the body’s response to food.

When microbes get into the blood from the gut, they are met by IgG and IgM antibodies. These bind to their antigen (a molecule on the surface of the microbe) and thus form immune complexes. Once bound, both IgG and IgM summon the body’s defensive forces for an all-out attack, which may cause local damage to the body’s own tissues, seen as inflammation. IgA is different – it has a ‘softly softly’ approach. Although it binds to its target to form immune complexes, it does not provoke inflammation. Circulating immune complexes containing IgA are mopped up by phagocytes or ‘eating cells’ – the body’s garbage-disposal team – without any fuss.

It will be clear that IgA is the ideal antibody for disposing of food molecules which accidentally make it through to the bloodstream. One effect of the Peyer’s patches is to tell the body to form more IgA to food molecules, and less IgG, so that the immune complexes produced are less inflammatory. This process is called the induction of oral tolerance.

The idea that this process breaks down in food intolerance is an attractive one. At present, there is some evidence to support it, but not a great deal. It does seem, however, that patients with food intolerance make more IgG to food molecules,in the blood, and less IgA. They may also produce some IgE, so that the immune complexes could trigger off mast cells.

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If defective genes lead to allergy then one would expect most allergies to begin early in life, as indeed they do. Symptoms cannot be produced the first time a person is exposed to an allergen, however. Although the body already has the capacity to produce antibody to the allergen concerned (in the form of as-yet-unactivated B cells) the antibody itself is not there. An initial exposure is required to enable the body to ‘find’ the right B cell from its extensive stock and multiply it up to useful levels. Once this has happened, a second exposure to the allergen can stimulate antibody (IgE) production. The allergen can then trigger off IgE-coated mast cells with devastating results.

Despite this, a baby may react to a food allergen the first time he eats it because molecules of the food may have reached him by other means. One such route is breast milk, which contains molecules from the foods the mother herself is eating – only a few, of course, but enough to sensitize a highly atopic baby. Some babies may even be sensitized before birth, by food molecules in the mother’s blood that pass into the foetus’s blood. So it is important for atopic mothers-to-be to think about their diet. Chapter Thirteen suggests practical steps that can be taken by parents to reduce the risk of sensitizing their children.

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As pure cotton, and in blends with synthetics, cotton is very widely used. Allergy to cotton is very rare, despite its wide exposure. It is a cellulose fibre, not a protein fibre like wool, and is hence less likely to provoke an allergic reaction. However, if a reaction does occur, it is the cotton flock – the small particles given off from the fibre – which causes reactions when inhaled. Some people allergic to cotton find they can tolerate it if they avoid very fibrous cotton, such as towelling, knitted cotton or cotton wadding.

When people react to cotton fabrics, it is often found that they are sensitive to resins applied to the fabric to give easy-care properties, rather than to the cotton itself. If you follow the guidelines for testing cotton in the Pillow Test, resins should not interfere with the test. They are not applied to cotton towels or blankets; and they are rarely or lightly applied to T-shirts and pillowcases. They are also usually washed out after several washes, so using a well-washed cloth for testing should prevent problems for even those highly sensitive to resins.

Always wash clothes or fabrics well before using. It may prevent any problem with chemical treatments unless you are highly sensitive.

Fabric resins are applied to furnishing fabrics as well as to clothing fabrics. In addition, pure cotton furnishing fabrics are often treated with fire-retardant chemicals to meet with fire regulations, and some have stain-protection chemicals applied as well. These chemicals may be responsible for apparent reactions to cotton.

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Certain allergens or substances are more likely to cause cross-reaction than others. Moulds, for instance, have a high degree of cross-reactivity and if you react to one particular mould, you are more likely to react to other moulds or yeasts. Grass pollens cross-react with other grass pollens. Foods are also prone to cause cross-reaction, especially between closely related foods within the same biological cl; Certain chemicals, natural and synthetic, are known to with other chemicals, drugs or foods – the active chemical in aspim, a specific example.

Some pollens cause cross-reaction to nuts and fruits that are related to them, but, by and large, if you react to one species of pollen, there is no reason why you should cross-react to other pollens. Being allergic to grass pollen, for instance, does not pre-dispose you to react to tree pollens, say, or any other species of pollen. Similarly, being allergic to one species of animal should not make you cross-react to another species of animal, though you can react to related animals; people known to be allergic to horses have cross-reacted to donkeys, mules and zebras, which are of the same species.

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Try and make a special diet as flexible and normal as you can. Have the confidence to ignore any pressure from family or friends to conform or not to give unusual foods – if the child is well on his or her special diet, that is your justification.

One of the most difficult areas is to establish rules on things that a child can or cannot do – especially things to eat and drink. If you operate a total ban on some things (e.g. playing with friends’ pets, buying sweets, eating ice creams, going swimming or eating biscuits) then you have to trust the child to observe them when out of your sight.

If you are fairly sure that the child is breaking the ban but lying about it, it may be better not to have an absolute prohibition. One option is to allow treats or outings at regular intervals, so that there is less emotional friction around the issue. Although the child may be doing things that

upset him or her, at least you know the extent of the damage and the child is sharing in the responsibility for his or her actions.

Food fads can also be tricky to handle. Food sensitive children often have strong food cravings or obsessions, and aversions to other foods. Craving, addiction or aversion to a food is often an indicator of allergy or intolerance. However, food faddiness is also common to many children – most children have periods of strong preference and aversion, and go through phases in which they will only eat certain things, or phases in which they use refusal of food you offer as an emotional tool. Managing food fads can be exhausting at the best of times, without adding to it the need to stop a child eating a food that clearly does him or her harm.

Again, there is no easy solution, except that if you decide that your child must stop eating a particular food in the interests of health, then you will have to carry it through firmly and take the storms that will follow. If you are concerned that your child does not eat enough or has the wrong balance of nutrients, be reassured that studies have shown that children left to themselves to choose what they eat select foods which give them a proper balance of nutrients – even if they only eat one food for a day or more.

A child who is hungry will eventually eat, and although you may have to endure two or three (or more) terrible days when you first take out a loved food out of a child’s diet, a child will eventually co-operate if you are firm and do not weaken.

It helps a great deal if other family members do not eat the deprived food in front of the child (and do not tease him or her about it). But often this cannot be managed and you will have to sit things out.

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If reducing the level of any food has little effect, you should go further and leave the chosen food totally out of your diet totally. If you do this for common foods, such as cow’s milk, wheat, eggs, yeast, com and soya, it can mean drastic changes to your diet and usually entails leaving out most processed and manufactured foods.

There is also advice on what substitutes to use, on nutritional balance and precautions to take against new sensitivities developing in the baby.

Babies with a tendency to food sensitivity can become sensitive to foods that are introduced into a breastfeeding mother’s diet as substitutes (e.g. to goat’s milk or soya milk used as an alternative to cow’s milk) and you need to take care not to binge on or overuse any foods you use as substitutes in case this happens. So, even if a mother is not food-sensitive herself, she needs to observe the preventative guidelines.

If leaving out these foods seems hard at first, an easier route, and one that women sometimes try before they turn to total exclusion of cow’s milk, etc., is to leave out some common culprits which are less fundamental parts of the diet, and see if baby improves. You could choose one of these food groups at a time and leave it out for two to four days to see what happens. Move on to another if you get no response. Try leaving out one of the following groups at a time:

• Tea, coffee, cocoa and chocolate

• Alcohol

• All sweet and fizzy drinks, sugar, sweets, biscuits and bakery

• Orange, grapefruit, lemon and other citrus fruits and juice

• Onions, garlic, leeks, spring onions

• Spices (NB curry)

• Cabbage, broccoli, sprouts, cauliflower, kale, spring greens

Some babies are sensitive to chlorine and other chemicals from tapwa-ter passing in breastmilk. The mother could try as an alternative using filtered or bottled water (Evian, Buxton or Malvern for preference). Use the chosen water for drinking, making hot drinks and soups, and for all cooking purposes. For more information on water.

A breastfeeding mother needs to take care of her own diet. Consult your doctor about any intentions you have to leave out common foods, and about the need for any vitamin and mineral supplements.

It can sometimes take several days for the benefits of exclusion to be seen on a breastfeeding baby. So give each food (or group of foods) time to show results.

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