SA cookbook for allergies and food intolerance

South African

COOKBOOK FOR ALLERGIES AND FOOD INTOLERANCE

Hilda Lategan RD (SA)

Tafelberg

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Foreword

It’s natural to want to enjoy food and, for many of us, meals form an important part of our daily routine. When food and food additives are the cause of allergies and food sensitivities and the negative effects from these result in ill health, it is easy to feel confused and despondent about how to choose and prepare suitable foods.

At the request of Tafelberg Publishers, I have selected the best recipes from South African Cookbook for Allergies and Food Intolerance (2004), my previous book on this topic, and have added new information as well as more tried-and-trusted recipes to help people with food-related conditions.

Regardless of the limitations in your diet due to food allergies and sensitivities, in this book you will find recipes for tasty and affordable dishes which are prepared from widely available ingredients. Each recipe, together with its suggested variations, is suitable for a variety of conditions.

The repair and maintenance of a healthy body contributes to a healthier immune system. A balanced diet and meal plan are essential to meet your unique nutritional needs, as well as to manage your specific allergies and sensitivities.

Remember that this book should not take the place of a visit to a registered dietitian. A dietitian who is familiar with your specific condition will provide you with useful advice and will assist you in creating a suitable meal plan.

I trust that this cookbook will contribute to your good health and will help you to create a positive attitude towards formulating a meal plan that takes into account certain food limitations.

Bon appétit!

Hilda Lategan RD (SA)

Introduction

When you or your child has been diagnosed with an allergy or sensitivity (intolerance) to a certain nutrient or additive, this could signal the end of long-standing illness and lengthy medical and other tests. The fact that the cause of the illness has been determined starts a new phase, which includes the positive treatment of the condition. At this stage a new problem often arises, that of how to handle the lists of permitted foods and foods to avoid with which you are confronted. These lists may discourage you, and you may be left wondering how on earth you will be able to prepare a plate of edible food. However, it remains important to maintain and repair the body and immune system. To do this, a healthy and balanced diet that excludes the forbidden food items and additives is key. A calm approach is also important as continuing stress will hamper the immune system further and may worsen inflammation in the body.

The difference between a food allergy and a food intolerance

FOOD ALLERGY

A true food allergy is a reaction of the immune system that results from eating a specific food item and can be tested clinically because there are changes present in the immune system. Antibodies (also known as immunoglobulins) develop in the blood when the food item or the allergen is consumed. Antibodies are, therefore, the immune system’s response to an allergen. Large numbers of antibodies will be present in the blood when a food allergen is consumed and, in association with the physical symptoms, the diagnosis of a food allergy can be confirmed. Usually blood tests confirm a diagnosis.

FOOD INTOLERANCE

A food intolerance is a reaction that takes place following the intake of specific food or additives, but which does not cause a response in the immune system. This could mean that the blood tests which are normally done to determine an allergic condition do not show positive results, even though the person experiences symptoms very similar to an allergic reaction. Lactose intolerance is an example of an intolerance. It is caused by the deficiency of a specific digestive enzyme, called lactase, in the gastrointestinal tract.

Symptoms

The appearance of the symptoms of a food allergy or food intolerance may vary from a few seconds after contact or intake to even two days thereafter. Sometimes the intake of a small quantity of the offensive substance has little or no effect but could, over time, cause a reaction due to the so-called cumulative effect. It seems that food eaten more often or consumed as a staple food in a person’s diet is more likely to contribute to an allergic reaction or food intolerance.

Nowadays people consume many processed foods, snacks and drinks that contain preservatives and colourants. This means that larger quantities of additives are being consumed, to which some people may be sensitive.

Symptoms associated with food allergy and food sensitivity include:

•Severe headaches and migraines, as well as some epileptic attacks.

•Depression and unpredictable mood swings.

•Teary eyes, dark circles under the eyes, swollen eyelids, and blurred vision.

•Cherry-red cheeks (rouge patches).

•Ear, nose and throat symptoms, such as:

–A constantly blocked nose or a runny nose.

–Long-lasting colds that won’t clear with conservative treatment.

–Itchiness and scratchiness of the nose, ears, mouth or throat.

–Recurring middle-ear infections, which may require grommets to be placed in the ears.

–Loss of hearing.

–Asthma, bronchitis and pneumonia.

•Symptoms of the gastrointestinal tract: dyspepsia, heartburn, flatulence, stomach pains, diarrhoea and constipation.

•Muscle and joint pain, fibromyalgia, arthritis and gout.

•Food cravings.

•Cutaneous reactions: eczema, hives, acne and dermatitis herpetiformis (a chronic rash).

•Fluid retention.

•Severe menstrual symptoms and premenstrual stress (PMS).

•Anaemia.

•Bed-wetting.

•Poor concentration, attention deficit disorder (ADD), poor short-term memory or hyperactivity.

•Weight gain, weight loss or wasting away.

•Anaphylactic reaction, including nausea, diarrhoea, chest pain, heart palpitations, asthma, hives, low blood pressure, shock and even death in the absence of timeous medical attention.

Diseases that may be linked to food allergies or intolerances

DISEASES OF THE GASTROINTESTINAL TRACT

Coeliac disease

Coeliac disease is a condition in which the lining (villi) of the small intestine is damaged by gluten, a protein which is present in wheat, rye, barley and, to some extent, in oats. This damage restricts the absorption of nutrients from the gastrointestinal tract, with resulting symptoms such as a bloated abdomen, nausea, vomiting, loose stools, poor appetite and eventually malnutrition and undesirable weight loss. In my practice I have also seen patients with coeliac disease battle with weight gain, but this is often the result of medication taken to treat the symptoms of the disease. In exceptional cases, patients may also experience sensitivity to lactose (milk sugar) and sucrose. It is important to consult a dietitian when planning a diet and meal plan to combat coeliac disease.

Dermatitis herpetiformis

This is a chronic skin condition characterised by a severe, itchy skin rash. It results from poor absorption of nutrients due to atrophy of the villi in the mucosal layer of the small intestine. This condition is associated with coeliac disease. The dietary treatment is the same as for coeliac disease and often it may also be necessary to eliminate milk and milk products.

Inflammatory gastrointestinal diseases (ulcerative colitis and Crohn’s disease)

Several theories exist regarding the causes of these diseases, including genetic as well as infective and immunological factors. In some people the distinction between the two conditions is slight.

When one or more segments of the small or large intestine are inflamed, then the condition is called Crohn’s disease. The symptoms include fatigue, poor appetite, joint pains, pain in the lower-right quadrant of the body, cramps, diarrhoea and fever.

When the inflammation starts in the rectum and extends to the colon, without affecting the ascending or right side of the colon or the connection with the small intestine, the condition is called ulcerative colitis. The symptoms include discomfort in the lower bowel, cramps, chronic diarrhoea, depression, irritability and emotional instability.

Initially, the same dietary principles are applied to both conditions. As lactase-enzyme activity is reduced in people with these conditions, milk and milk sugar (lactose) are restricted in the diet. Some people do well on a milk- and gluten-restricted diet. It is very important to consult a dietitian with the planning of this diet to improve the health of the gastrointestinal tract and to provide the necessary nutrients to the body in the long term.

Increased intestinal permeability and intestinal dysbiosis

A healthy gastrointestinal tract provides an effective barrier or filter to prevent the invasion of harmful substances into the bloodstream via the intestines. This barrier may become less effective due to diseases, resulting in substances such as bacteria, allergens and large protein molecules passing into the bloodstream.

Increased intestinal permeability may contribute to an increased incidence of food allergy and food intolerance. The excessive intake of antibiotics is also thought to have an effect on the incidence of the condition.

Intestinal dysbiosis can briefly be described as the inability of the gastrointestinal tract to absorb nutrients effectively, thereby impairing the immunity of the body.

In the medical and academic world there is no consensus on dysbiosis or increased intestinal permeability. Despite differences of opinion, many people suffering from these conditions experience relief when following a balanced elimination diet, which could include the avoidance of milk, milk products, wheat, gluten-containing grains, yeast, moulds and sugar.

Note that it is important to carefully consider the avoidance of any nutrients and to ensure that an elimination diet complies with the basic nutritional needs of a person. A dietitian will be able to provide sound advice in this regard.

Lactose intolerance

Lactose is milk sugar and is present in all forms of animal milk. Hard types of cheese contain little or no lactose. Soya milk, rice milk, coconut milk and nut milk, such as almond milk, contain no lactose. A lactose intolerance may be the result of a lactase-enzyme deficiency, which is responsible for the digestion of lactose. This enzyme deficiency may be the result of damage to the membranes of the gastrointestinal tract due to long-standing use of antibiotics, diarrhoea, malnutrition, or inflammation in the gastrointestinal tract due to Crohn’s disease or ulcerative colitis.

Sucrose intolerance

Sucrose is present in many products, of which cane sugar and sugar from beet are the most familiar. A sucrose-enzyme deficiency hampers the digestion of sucrose to glucose and fructose, the forms in which sugar is absorbed and consumed by the body. Sucrose intolerance may contribute to diarrhoea and a bloated abdomen due to fermentation and gas production in the gastrointestinal tract. Note, however, that sucrose intolerance is not the same as diabetes mellitus.

Lactose intolerance and sucrose intolerance may be present in the same person, possibly because the respective enzymes are produced and excreted in the same region of the gastrointestinal tract.

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is one of the diseases that keep dietitians and doctors very busy because it is a common problem in our rushed daily lives. Ongoing stress and poor eating habits weaken the immune system and may aggravate the symptoms of IBS.

The typical symptoms of irritable bowel syndrome include abdominal pain, a bloated abdomen, winds, and altered stool habits, which may include diarrhoea and constipation.

Several studies have been done regarding the causes of IBS symptoms. In summary, the following:

1.Studies suggest the possibility that some people with IBS could be suffering from a clinical condition known as non-coeliac gluten sensitivity (NCGS), resulting in a sensitivity to gluten and more specific products prepared from wheat flour such as bread, pasta and pizzas, which also contain stabilisers such as fructans to improve the texture and stability of the products. Despite the presence of gluten in rye, it seems as if pure rye products are tolerated relatively well.

2.In recent studies the influence of FODMAP (an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols) in people with irritable bowel syndrome has been documented. We will discuss FODMAP more in the next topic.

3.When comparing people without IBS to people suffering from IBS, the latter have less of the good bacteria, lactobacillus and bifidobacterium, in their intestinal flora. These good bacteria cling to the epithelial cells of the gastrointestinal tract and this reinforces the buffer or filter function of the intestinal wall and prevents pathogenic bacteria from clinging to the epithelial cells or passing into the bloodstream. These bacteria do not produce gas when carbohydrates are digested and will also suppress the overgrowth of the clostridium species (people who are troubled with an overgrowth of this bacteria will detect the smell of methane gas when passing wind). The tolerance for FODMAP, as well as fibre in general, will improve when supplementing a person’s existing intestinal flora with the lactobacillus and bifidobacterium species.

4.Inulin and FOS (fructo-oligosaccharides) are important foods for maintaining good bacteria. Keep this in mind if you decide to follow the FODMAP guidelines, especially when you consider eliminating water-soluble fibre (including oats, barley, cooked legumes, vegetables and fruit) from your diet.

The low FODMAP diet

As mentioned earlier, FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols.

Although the principles of the low FODMAP diet are commonly recommended by medical practitioners in some countries, in Australia especially, the low FODMAP diet is still a relatively new concept in South Africa. Read the following information together with the information above regarding irritable bowel syndrome. Keep an accurate record of your food intake and determine if it is necessary to eliminate all the food items below. Remember that unnecessary exclusion may lead to an unbalanced diet with a poor intake of nutrients. It is also valuable to note your state of mind every day as food is often blamed for symptoms, when in fact stress is to blame. Consult a dietitian to assist you in creating a balanced meal plan.

Food items and ingredients which are eliminated in the low FODMAP diet:

•Oligofructose, inulin and FOS (fructo-oligosaccharides). These serve as prebiotics (food) for the good bacteria (lactobacillus and bifidobacterium) in the gastrointestinal tract and are often added as functional ingredients (fructans) in products such as meal-replacement formulas. However, inulin and FOS may worsen the symptoms of IBS in some people. Although IBS symptoms can be relieved by avoiding inulin and FOS, keep in mind that in the long term this elimination may hamper the growth and survival of good bacteria.

•Processed and convenience foods such as breads, pizzas, pastas, instant breakfast cereals, cakes, biscuits and crackers to which fructans have been added to improve the quality and shelf life of the products. On the food label fructans will be indicated as flour enhancer or stabiliser.

•Polyols such as lactose (milk sugar), fructose (when more than 12% of the total carbohydrates are present as added fructose in cool drinks, fruit juices, flavoured waters and energy drinks) and sugar alcohols such as sorbitol, mannitol, maltitol, xylitol, polydextrose and isomalt in sugar-free products such as chewing gum and sweets.

•Vegetables such as artichokes, beetroot, Brussels sprouts, cabbage, fresh chicory, fennel, garlic, leeks, onions, peas and green beans, and fruits such as peaches, prunes and watermelon. This is a limited list. When you investigate this topic more deeply, only a few vegetables and fruits will remain safe.

•Grains such as wheat, rye and barley.

•Legumes such as cooked dried beans, chickpeas, lentils and soya products, as well as nuts such as pistachio nuts.

•Dried chicory in drinks such as coffee.

The determining of a food allergy or intolerance

Allergic reactions can be determined by skin-prick tests, electrodermic skin tests, blood tests and intestinal biopsies, or record-keeping of all food intake and the resulting reactions. Refer to the three examples of record-keeping.

With an elimination diet, all suspected foods are excluded from the diet with the intention of reducing or eliminating the cause of the symptoms.

The so-called food-challenge test can be done to confirm a food allergy or intolerance and usually takes place when a person is evaluated and is symptom-free after doing an elimination diet. The suspected food items are reintroduced to the diet one by one in a certain ratio and in a certain order. It is important to do this food challenge in collaboration with your doctor and dietitian, especially if you have a history of anaphylactic reactions. (Read the last remark under Symptoms.) All reactions should be monitored and carefully noted.

A proper medical evaluation and diagnosis regarding a food allergy or intolerance is of the utmost importance. Eliminating foods unnecessarily could result in nutrient deficiencies in the body, which may hamper the immune system of the body even more. Consult a registered dietitian who will help you to plan a balanced diet and formulate a meal plan to meet your personal nutritional requirements, taking your specific health problems into account.

Example 1: Food and symptom record

* Symptoms according to scale: 1 = mild 2 = mild to moderate 3 = moderate 4 = severe

Example 2: Food and symptom record