FOOD SAFETY SERIES. General Series Editors ]. Edelman London, UK S. Miller Texas, USA. Series Editor - Microbiology T. Roberts Reading, UK

Transcription

1 Food Intolerance

2 FOOD SAFETY SERIES General Series Editors ]. Edelman London, UK S. Miller Texas, USA Series Editor - Microbiology T. Roberts Reading, UK Editorial Board D. Conning London, UK D. Georgala Reading, UK ]. Houtvast Wageningen, The Netherlands C. Mercier Paris, France E. Widdowson Cambridge, UK Forthcoming Tides Immunoassays for Food-poisoning Bacteria and Bacterial Toxins G. Wyatt The Staphylococci and their Toxins M. Bergdoll The Aeromonas Group as a Foodborne Pathogen S. Palumbo and F. Busta Food Preservation G. Gould Fibre and Complex Carbohydrates I. ] ohnson and D. Southgate

3 Food Intolerance Maurice H. Lessof Emeritus Professor of Medicine United Medical and Dental Schools Guy's and St Thomas's Hospitals JAMES X JAMES SPRINGER-SCIENCE+ BUSINESS MEDIA, B.V.

4 First edition 1992 M. H. Lessof 1992 Originally published by Chapman & Hall in 1992 Softcover reprint of the hardcover 1st edition 1992 Typeset in 12/13pt Garamond 3 by Columns of Reading Ltd ISBN ISBN (ebook) DOI / Apan from any fair dealing for the purposes of research or private srudy, or cr1tic1sm or review, as permitted under the UK Copyr1ght Des1gns and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission m writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of licences issued by the Copyright L1censing Agency in the UK, or m accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on th1s page. The publisher makes no represenration, express or implied, with regard to the accuracy of the information contained m this book and cannot accept any legal responsibility or hability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication dara available For Leila

5 Contents Series introduction lx 1 Nutrition in the modern world Escape from malnutrition and contaminated food Food problems of the affluent society Lifestyle, diet and disease What is a healthy diet? Food as a focus of anxieties 'Fast foods' and 'E' numbers Food ingredients: fibre The 'saccharine' diseases Food and coronary artery disease Salt and high blood pressure Back to nature? Conclusion 17 2 Food intolerance and attitudes to food Definitions Epidemiology Eating habits The eating disorders Food faddism Anorexia, bulimia and obesity 25 v

6 CONTENTS Psychiatric illness and food Childhood hyperactivity: food-related or yet another 'attitude'? Conclusion 34 3 Food and alternative medicine Ecology and the protest movement The problems of pollution Food and the counterrevolution The total allergy syndrome Unorthodox diagnosis and treatment Alternative medical practice and the patient Diagnoses which can be missed Conclusion 51 4 Physiology of digestion Basic functions of the gut Role of the digestive enzymes Role of bile Mucosal immunity Amplifying mechanisms Immune responses to ingested substances Antigenic foods Biogenic Amines Disorders of intestinal motility Conclusion 71 5 Mechanisms of food intolerance Immune responses provoked by food Type 1 reactions Type 2 reactions Type 3 reactions Type 4 reactions How much is immunological? Pseudoallergic mechanisms Toxic effects Pharmacological effects Enzyme defects 81 vi

7 CONTENTS Complex mechanisms Conclusion 85 6 Clinical manifestations Establishing the diagnosis Validity of tests Food intolerance in childhood Incidence Infantile eczema Childhood asthma Other childhood symptoms Reactions in older children and adults Food antigens and cross-reactions Clinical features Diagnosis of food-induced asthma Headache, migraine and neurological symptoms The joints The kidney The blood Occupational reactions to food Management of adverse reactions Conclusion Food additives What are they? How did the use of additives develop? Regulations on food additives Examples of additives in current use Do additives cause unpleasant reactions Sulphites Benzoates and parabens Coal-tar dyes Monosodium glutamate Aspartame Other additives Regulating additive usage Confirming clinical suspicions Estimates of prevalence Do we need them? Conclusion 140 vii

8 CONTENTS 8 Cow's milk and some alternatives Allergens of cow's milk Alternatives to cow's milk Cow's milk protein intolerance: prevention, treatment and research The case for hydrolysates Alternative approaches to milk processing Milk homogenization Effects ofheat-processing Milk fermentation and cheese-ripening Hyposensitizing milk formulas Conclusion Gluten sensitivity and coeliac disease Coeliac disease and prolamin toxicity Nature of gluten sensitivity Racial and geographical prevalence Clinical features Unusual presentations Mucosal damage and its effect on symptoms Dietary management Conclusion The patient's dilemma Initiating a diet 10.2 Patient self-help groups Maternal problems 10.4 Dietary errors 10.5 The doctor-patient relationship 10.6 Diagnostic tests The need for better information 10.8 Conclusion Glossary References Index viii

9 Series Introduction Consumer safety has become a central issue of the food supply system in most countries. It encompasses a large number of interacting scientific and technological matters, such as agricultural practice, microbiology, chemistry, food technology, processing, handling and packaging. The techniques used in understanding and controlling contaminants and toxicity range from the most sophisticated scientific laboratory methods, through industrial engineering science to simple logical rules implemented in the kitchen. The problems of food safety, however, spread far beyond those directly occupied in food production. Public interest and concern has become acute in recent years, alerting a wide spectrum of specialists in research, education and public affairs. This series aims to present timely volumes covering all aspects of the subject. They will be up-to-date, specialist reviews written by acknowledged experts in their fields of research to express each author's own viewpoint. The readership is intended to be wide and international, and the style to be comprehensible to non-specialists, albeit professionals. The series will be of interest to food scientists and technologists working in industry, universities, polytechnics and government institutes; legislators and regulators concerned with the food supply; and specialists in agriculture, engineering, health care and consumer affairs. Perhaps no aspect of food safety has attracted more attention than ix

10 SERIES INTRODUCTION people's reaction to food itself. Intolerance by some individuals to specific foods or their components is well documented. This can range from true allergies to psychologically based aversions, and is often difficult to diagnose. Real knowledge and advice in the subject is not easy to come by. Professor Lessof, himself a distinguished medical specialist, has made an intensive study of the subject, so his book will appeal to medical practitioners and other health care workers. But the problem impinges on the food supply system as a whole; Professor Lessofs book has been written with a view to informing not only the medical world, but agriculturalists, retailers, legislators, consumer groups and others concerned with the well-being of the public at large. ]. Edelman X