Friday, November 1, 2013
Symptom Assessment, Food Diary and Elimination Diet in Food Intolerance and Allergy - A Primer
Celiac disease, gluten sensitivity, cow's milk protein sensitivity and other food intolerance may be associated with numerous digestive and non-digestive symptoms. Some of the most common non-digestive symptoms include fatigue or sense of being overly tired, headaches, bone, joint and/or muscle pain, mental fogginess or impaired attention, nerve pain (neuropathy), and painful or severely itchy skin rashes. The most common digestive symptoms include feeling of excess fullness with meals or afterwards, bloating or distended abdomen, diarrhea, excess or foul gas, constipation, heartburn, nausea, vomiting and abdominal pain.Rating the severity and frequency of common symptoms, in particularly creating and tracking your own individual "Top Ten Symptoms" will be very helpful to you and your doctor, especially when combined with a detailed food-symptom diary. In addition to medical tests like blood work, stool samples, and endoscopic exams, assessing symptoms for severity and frequency before, during and after an elimination diet trial is critical. This helps determine if certain foods are causing or aggravating your symptoms.The foundation of treating food intolerance usually includes an elimination diet. Prior to an elimination diet, a food diary is usually kept and reviewed for trends by a doctor. In the context of your medical history, symptoms, family history and medical evaluation a medical evaluation is usually recommended that may include blood and stool tests, skin testing for food allergens, and scope examinations of the upper and/or lower digestive tract. Your medical evaluation however could vary widely based your doctor's experience, specialty, biases about food allergies or intolerance and your history, symptoms and age.Before seeing a doctor for an evaluation for possible food intolerance or allergy you should establish an initial symptom's list that includes your baseline rating of the frequency and severity of your symptoms. This should be done before making any change in your diet or eating pattern. A scale of 1-5 or 1-10 is commonly used to rate symptom severity and frequency. Within 2-3 weeks I will be publishing a very inexpensive symptom-food diary. You may try using a spiral notebook to record what you eat and track at least weekly your personal "Top Ten" list of the most common or troubling symptoms by severity and frequency. With a written record, you and your doctor can more easily track your progress and identify any trends.For 28 days, I recommend you eliminate all grains, legumes, and dairy as well as processed foods. Foods in those categories are the most common foods that cause people problems. In those categories you find the foods that have commonly identified food proteins, lectins, gluten or casein that are known or suspected to cause symptoms. The foundation for the elimination diet is commonly referred to as the paleolithic, neanderthal, hunter-gatherer, caveman or simply Paleo diet as popularized by the health scientist Loren Cordain, Ph.D. in his numerous scientific publications and book The Paleo Diet.The basis for the initial diet consists of lean meats and fish (unless fish allergic), fresh fruits and vegetables with additional foods eliminated based on your personal history. For example, you eliminate any foods that are specific to you based on any known food allergies, intolerance or suspected food intolerance because of your genetics, family history, presence of nasal, pollen or skin allergies, or prior medical tests. In particular, certain foods are known to cause reactions in some people who have documented allergies to grass, weeds, and/or tree pollens, house dust mite and latex. The latter food sensitivity association is well recognized clinically as the oral allergy syndrome (OAS). The modification of the Paleo diet based on individual assessment I have termed the Neo-Paleo Specific Diet.4 weeks or 28 days of following your Neo-Paleo Specific Diet is recommended before attempting to re-introduce foods one at a time, every week to two weeks, while continuing to track your symptoms. This allows your gut time to heal and establish a long enough time to establish a pattern of adequate diet elimination and symptom pattern assessment. Theoretically, this should allow those with dietary induced gut injury or irritation associated with any "leaky gut" predisposition to heal adequately to reduce abnormal immune reactions or absorption of foods and/or food derived proteins and gut bacteria. It also may take some time for you to identify hidden sources of possible problem foods and adjust to your new eating pattern.You should also be aware that some people experience classic withdrawal like symptoms in the first 3-7 days of eliminating certain foods, in particular grains and dairy products. Gluten, in products made from wheat, and casein, in products containing cow's milk, contain morphine like substances. These can be addictive.The key to determining if certain foods are contributing to how you feel and the kinds of symptoms you are experiencing, is an adequate trial of elimination combined with accurate recording of what you eat and how you feel. A commitment of 4 weeks strictly eliminating the foods recommended according to your specific assessment while recording accurately what you are eating and how you feel will help you identify patterns and stay motivated to eliminate, restrict or rotate regularly any problem foods.