Food Intolerance
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
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.
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 978-0-412-44850-8 ISBN 978-1-4899-4503-7 (ebook) DOI 10.1007/978-1-4899-4503-7 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
Contents Series introduction lx 1 Nutrition in the modern world 1 1.1 Escape from malnutrition and contaminated food 1 1.2 Food problems of the affluent society 2 1.2.1 Lifestyle, diet and disease 3 1.3 What is a healthy diet? 6 1.4 Food as a focus of anxieties 8 1.4.1 'Fast foods' and 'E' numbers 9 1.4.2 Food ingredients: fibre 11 1.4.3 The 'saccharine' diseases 13 1.5 Food and coronary artery disease 14 1.5.1 Salt and high blood pressure 15 1.6 Back to nature? 16 1.7 Conclusion 17 2 Food intolerance and attitudes to food 18 2.1 Definitions 18 2.2 Epidemiology 20 2.3 Eating habits 22 2.4 The eating disorders 24 2.4.1 Food faddism 24 2.4.2 Anorexia, bulimia and obesity 25 v
CONTENTS 2.4.3 Psychiatric illness and food 28 2.4.4 Childhood hyperactivity: food-related or yet another 'attitude'? 29 2.5 Conclusion 34 3 Food and alternative medicine 35 3.1 Ecology and the protest movement 35 3.1.1 The problems of pollution 36 3.2 Food and the counterrevolution 39 3.2.1 The total allergy syndrome 41 3.2.2 Unorthodox diagnosis and treatment 42 3.3 Alternative medical practice and the patient 47 3.3.1 Diagnoses which can be missed 49 3.4 Conclusion 51 4 Physiology of digestion 52 4.1 Basic functions of the gut 52 4.1.1 Role of the digestive enzymes 56 4.1.2 Role of bile 56 4.2 Mucosal immunity 58 4.2.1 Amplifying mechanisms 65 4.2.2 Immune responses to ingested substances 65 4.2.3 Antigenic foods 66 4.2.4 Biogenic Amines 67 4.3 Disorders of intestinal motility 70 4.4 Conclusion 71 5 Mechanisms of food intolerance 73 5.1 Immune responses provoked by food 74 5.1.1 Type 1 reactions 74 5.1.2 Type 2 reactions 76 5.1.3 Type 3 reactions 77 5.1.4 Type 4 reactions 78 5.2 How much is immunological? 78 5.3 Pseudoallergic mechanisms 81 5.3.1 Toxic effects 81 5.3.2 Pharmacological effects 81 5.3.3 Enzyme defects 81 vi
CONTENTS 5.3.4 Complex mechanisms 85 5.4 Conclusion 85 6 Clinical manifestations 87 6.1 Establishing the diagnosis 87 6.1.1 Validity of tests 87 6.2 Food intolerance in childhood 90 6.2.1 Incidence 91 6.2.2 Infantile eczema 95 6.2.3 Childhood asthma 96 6.2.4 Other childhood symptoms 98 6.3 Reactions in older children and adults 98 6.3.1 Food antigens and cross-reactions 6.3.2 Clinical features 99 101 6.3.3 Diagnosis of food-induced asthma 108 6.3.4 Headache, migraine and neurological symptoms 109 6.3.5 The joints 112 6.3.6 The kidney 114 6.3.7 The blood 114 6.4 Occupational reactions to food 115 6.4.1 Management of adverse reactions 117 6.5 Conclusion 122 7 Food additives 123 7.1 What are they? 123 7.2 How did the use of additives develop? 127 7.3 Regulations on food additives 128 7.4 Examples of additives in current use 129 7.5 Do additives cause unpleasant reactions 131 7.5.1 Sulphites 131 7.5.2 Benzoates and parabens 133 7.5.3 Coal-tar dyes 134 7.5.4 Monosodium glutamate 134 7.5.5 Aspartame 135 7.5.6 Other additives 135 7.5.7 Regulating additive usage 136 7.6 Confirming clinical suspicions 137 7.6.1 Estimates of prevalence 138 7.7 Do we need them? 139 7.8 Conclusion 140 vii
CONTENTS 8 Cow's milk and some alternatives 142 8.1 Allergens of cow's milk 143 8.2 Alternatives to cow's milk 144 8.3 Cow's milk protein intolerance: prevention, treatment and research 146 8.3.1 The case for hydrolysates 147 8.4 Alternative approaches to milk processing 148 8. 4. 1 Milk homogenization 148 8.4.2 Effects ofheat-processing 149 8.4. 3 Milk fermentation and cheese-ripening 150 8.4.4 Hyposensitizing milk formulas 151 8.5 Conclusion 153 9 Gluten sensitivity and coeliac disease 154 9. 1 Coeliac disease and prolamin toxicity 155 9.2 Nature of gluten sensitivity 157 9.2.1 Racial and geographical prevalence 159 9. 2. 2 Clinical features 160 9.2.3 Unusual presentations 162 9.2.4 Mucosal damage and its effect on symptoms 164 9. 3 Dietary management 166 9.4 Conclusion 166 10 The patient's dilemma 10. 1 Initiating a diet 10.2 Patient self-help groups 10. 3 Maternal problems 10.4 Dietary errors 10.5 The doctor-patient relationship 10.6 Diagnostic tests 10. 7 The need for better information 10.8 Conclusion Glossary References Index 168 169 170 172 173 174 175 177 179 180 187 204 viii
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
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