Title: Modified Exclusion Diets for food allergy and intolerance.

Key words: coeliac disease,elimination diet, exclusion diets, food allergy, food intolerance, helicobacter, irritable bowel syndrome, migraine, tyramine, salicylates.

Date: April 2001

Category: Special diets

Type: Article

Author: Dr M Draper

 

Modified Exclusion Diets for food allergy and intolerance

Food Allergy and Intolerance - a practical guide.

Introduction

In various studies (1) (2) it has been found that many people who are fit and apparently well cannot tolerate certain foods, because they cause indigestion, heartburn, bloating, distension and/or flatulence. These individuals may get migraine and find foods containing tyramine are more likely to aggravate an attack. The usual response is to exclude the offending food(s) and self-limit intake, often without consultation to a Doctor or Nutritionist.

I would suggest that the persistence of such symptoms, especially those linked to abdominal pain and/or change of bowel habit, should prompt a consultation with a G.P. The G.P. may then, as a precautionary measure, arrange investigations such as routine blood tests, Helicobacter tests, coeliac tests, stool microscopy and culture, faecal occult bloods etc. or refer the individual to a gastroenterologist for his opinion about performing endoscopy and/or Xrays or scans (Barium meal, Barium enema, Ultrasound or CTscan).

Whilst waiting for an appointment, or after serious bowel pathology has been excluded, and particularly if a 'diagnosis' of Irritable Bowel Syndrome (IBS ) has been made, it may be appropriate to try an Exclusion Diet. These diets were produced by systematic enquiry and collation. To a certain extent they are therefore empirical. When more than 20% of people noted some reaction to the food, it was then excluded. I will not go into the various types because they are usually similiar. I have recently learnt, in addition, that some exclusion diets exclude all raw foods as these are more likely to provoke a reaction (3). Alcohol and/or physical activity can also lead to a 'leaky' bowel and make food reactions more likely (3). The interval of exclusion varies from 6 days (elimination diet of Lamb, Pears and Rice) to 14-28 days. Three weeks seems a reasonable compromise if instigating it yourself (4).

 

 

Table 1 Basis for Modified Exclusion diets

Food Type

Excluded

Included

Meat

Beef,pork,preserved meats,sausages,bacon.

Lamb,turkey,rabbit,game always lean cuts,cooked plainly.

Fish

All smoked fish,shellfish.

White fish (except for

patients with eczema).

Vegetables

Potatoes,onions, sweetcorn, soya. Patients with bowel symptoms are not allowed any beans,lentils, brussels sprouts or cabbage

Spinach,swede,celery, lettuce,leeks,peas, lentils,all beans except broad and green beans,brussels sprouts and cabbage.

Fruit

All fruits except 5.Tomatoes are excluded.

Bananas,peeled pears,mangoes , pomegranates ,paw-paws .

Cereals

Wheat,oats,barley,rye,corn.

Rice,ground rice,rice flakes,rice flour,sago, Rice Krispies,tapioca, millet, buckwheat , rice cakes.

Cooking Oils

Corn oil,soya oil, vegetable oil,nut especially peanut.

Sunflower oil, Safflower oil, olive oil, linseed oil.

Dairy products

Cow's milk, butter, most margarines, cow's milk yogurt and cheese.All goats',sheep's and soya milk products, eggs and chicken.

Tomor or Vitasieg

(Some magarines contain colourings, wheatgerm and cows' milk derivatives etc and should be avoided.)

Beverages

Tea,coffee(beans,instant and decaffeinated),fruit squashes, orange juice, grapefruit juice, alcohol, tap-water.

Herbal teas eg camomile, Mineral,distilled, deionised or filter water. Use a water filter

 

Miscellaneous

Chocolate , yeastpreservatives.All food additives.Herbs, spices, sugar,honey.

Sea salt.

 

 

 

 

Management after exclusion diet has shown benefit:

The question of how quickly to challenge with the excluded foods is partly a measure of the severity of and type of symptoms previously experienced. In an ideal world a Nutritionist, Dietician or other healthcare professional trained in this expertise should guide the individual who is keeping a food diary and noting symptoms. The reintroduction can start either with those foods that are least likely to be the cause ( from collated data) or those the patient would most like to include for taste, texture and convenience. Cumlative single or group foods are reintroduced at 2-7 day intervals respectively and if a reaction occurs to a group items can be looked at singularily eg grains/ wheat.

For a more complete guide, I would suggest practitioners obtain either reference (3) or (4).

References

(1) Bender AE, Matthews DR. 'Adverse reactions to foods.' Brit J Nutr 1981;46:403-7.

(2) Burr ML. Food intolerance in a community survey. Brit J Nutr 1983;49:217-9.

(3) Joneja JM. Dietary Management of Food Allergies and Intolerances

2001 2nd Edition ISBN 0-9682098-2-3.

(4) Chapter 8 Food Allergy and Intolerance - Investigation and Management ( pp 106-140) in Environmental Medicine in Clinical Practice By Anthony H, Birtwistle S, Eaton K, and MaberlyJ.

BSAENM Publications 1997. Available from PO Box 28, Totton, Southampton SO40 2ZA Tel 01703-813912.

Associated topics

see Nutrition Matters article "Low salicylate diet - Clinical indications to implement a trial"