How is it that over 50% of people in this country claim to suffer from food allergy or intolerance yet medical tests establish a diagnosis in less than a tenth of them?   How can elimination of specific foods such as milk or wheat from the diet seem to cure illnesses when there is no objective evidence of allergy or intolerance?   Have doctors just become so immured in their scientific evidence that they are not seeing the broad picture?   Have patients become so fearful of food toxicity and contamination that just the thought of it makes them ill? 

 

Food intolerance exposes a real clash of cultures.   According to medical criteria, allergy is an immunological hypersensitivity to specific food, like, for example, peanut allergy, while food intolerance requires objective biochemical criteria, such as deficiency of lastase enzyme in milk intolerance.  But many patients and the organizations that represent them tend to define allergy in much the same way as my Chamber’s dictionary, ‘an unnatural reaction to a natural substance’.   So to the doctor, food allergy is relatively rare, but the millions who suffer from reactions to food, it is very common.  Problems arise when people adopt the broad definition of allergy and expect it to be confirmed by immunological evidence or when doctors fail to acknowledge that there are many reactions to food that cannot be validated by immunological tests.  This creates a gap in which private entrepreneurs develop their own allergy tests – leading to exploitation of a vulnerable population.  This was the topic of yesterday’s blog. 

 

Dr Harry Morrow Brown, emeritus consultant physician and specialist in allergy, has stated that ‘specialization has created barriers to the holistic approach which is essential for the recognition of the diverse illnesses caused by reactions to food and the environment’.  He is correct, because with medical specialization comes the requirement for hard evidence.  Yet food intolerance is more than just a stereotyped bodily reaction to a specific food.  It is the response of the whole person; mind, body and meaning, to his or her environment. 

 

Surveys have shown that most people with food intolerance have reactions to a variety of foods.  Questionnaires reveal that people with Irritable Bowel Syndrome (IBS) and food intolerance report that between 5 and 22 different foods can provoke their symptoms.  This suggests that it is not the food that is the problem, but their sensitive guts.  It is rather like when you try to put on your shirt after you have been out in the sun for too long.  Your skin feels sore, not because you are allergic to your shirt, but because your skin has became sensitive by being burnt by the sun.  Foods that have rough edges, foods that distend the gut with fluid and foods that are fermented releasing large volumes of gas are particularly likely to cause symptoms.  These include cereal fibre, fruits, vegetables, especially pulses, beer, some fruit juices and onions.  Also implicated are foods that are associated with emotional tension.

 

We all know how emotion can wrench the gut out of kilter.  If we are tense or we try to eat to quickly or we are worried about what we are eating, then we can get pain and feel sick.  Physiologically, emotional tension increases the activity in the sympathetic nervous system which impairs digestion by drying up secretions,  inhibiting peristalsis, causing spasm and making the gut very sensitive.  As a result, we may end up feeling ‘gutted’.   

 

Ask me how I feel today.

I feel as unfit as an unfiddle.

And that’s because of a certain turbulence in my mind

And a certain burbulence in my middle.

                                                            Ogden Nash

 

 

Sensory signals from the organs of the body are normally damped down in the spinal cord by inhibition from the brain, but if you are anxious, the increased vigilance inhibits that suppression, so that more of the signals reach consciousness as pain and induce gut reactions.  So excessive or unnatural reactions to food can be caused by emotional upset .       

 

Amanda had ignored how late Rick was coming home and the increasing number of nights he had to spend out of town.  Times were tough for both of them and she knew that Rick was taking on extra jobs so that they could get married and start a family.  So when Rick suggested that they go out for a meal because there was something he had to say to her, she felt thrilled and excited.  The venue was perfect; a little fish restaurant in a village a few miles away.  Rick was attentive as usual but seemed somehow tense and sad.  They chose the ‘salmon with prawns and that delicious buttery sauce’  She had just finished hers when he blurted out that he had been having an affair with Margaret, who worked in the office.  It had been going on for some time.  He still loved her but he loved Margaret too, and well – somehow she had got pregnant.  Amanda listened with mounting horror and dread.   How could this be happening?  Suddenly she couldn’t stay there any more.  She insisted that Rick drive her home, where she was seized with the most violent diarrhoea and vomiting, which continued for three days.  Every time she even thought of food she would be sick.  That was three years ago.  Rick left and married Margaret, but she lost the baby.  Amanda moved to Doncaster, but she continued to be unwell.   Subsequent to the attack of gastroenteritis on that fateful evening, she developed an ‘allergy’ to fish so that  even the smell of fish made her violently ill.  This spread to other foods and even an invitation out made her feel ill. 

 

Amanda’s gut reaction to Rick’s catastrophic news had been so dramatic that anything that reminded her of that fateful evening made her feel sick.  Her gut has become  conditioned to the associations – going out on dates, nice meals, and particularly fish.   Her doctor has sent her to a gastroenterologist – all the tests were negative.   She has been to an allergist, who carried out tests and advised a very restricted diet.  She was still no better, so in desperation, Amanda went to see a psychotherapist and was able for the first time to talk about what had happened.  Slowly, she gained in self confidence and her symptoms improved.

 

We all know how the memory of a traumatic events can cause our heart to race,  make us feel faint, cause us to get a lump in our throat or make us feel sick.  What I am suggesting is that if the trauma occurs in association with some particular illness or bodily reaction, then those symptoms persist as a kind of bodily memory triggered by whatever was associated with the event. 

 

Research on patients with gastroenteritis confirm this conclusion.  Usually,  gastroenteritis or food poisoning only lasts a few days, but in a small percentage of people, the symptoms become chronic and go on for years, even though all traces of the infection are long gone.  Questionnaires administered at the time of the original illness showed that patients who were depressed or anxious about something were more likely to develop persistent symptoms.  It seemed therefore that the gut symptoms had been recruited to express what was going on in the patients’ lives. 

 

So food allergies may not necessarily be specific immunological or biochemical reactions to particular food components,  but may more usually represent to thoughts and memories associated with a particular food.  In the 1950’s,  patients with severe milk intolerance were fed by gastric tube so they didn’t know what was given to them. The researchers observed that they could tolerate milk quite well when it was given down the tube, but they rapidly developed symptoms if they were told that milk was injected into the stomach irrespective of whether that was true or not.  In other words, it was the idea of the milk that caused the symptoms not the milk itself.      

 

In other patients the connection between emotion, food and gut symptoms may have been primed early in childhood.  Meals can so easily become a battle ground as foods come to represent a resistance to parental control.  If mum and dad try to make their  little monster eat up his greens, he may get so upset that he is sick and never eats greens again.  The emotion, the food and symptom can establish an aversive loop, which can be very difficult to break it.  I remember that my brother would never eat baked apples.  He complained they gave him stomach ache. This caused mother to become quite exasperated, but then she hit on the idea of calling them ‘Simon’ apples. Immediately he began to view them as a good thing and from that time on would eat his pudding up without getting tummy ache.  Often a specific intolerance bears a closer association with what that food represents for the patient.     

 

Tracey, a bubbly, pleasantly plump  29 year old,  would only eat chocolate.  Everything else made her sick.  But she was frustrated by her limited horizons of family, her work in the local mill, and a husband who had no ambition apart from supporting the local football team.  She needed more out of life,  more love, more excitement.   The vomiting of the meals she had cooked for the family represented her rejection of the domestic role, while her chocolate consumption represented her desire to have a good time for herself. She never vomited when she went on a girl’s night out.          

 

 Food is the currency of relationships.  It brings people together and induces feelings of relaxation and companionship.   The primary relationship between mother and infant does not only provide food but also provides warmth, comfort, safety, protection and love.  So from the earliest times of our lives nourishment and nurturing are intimately associated.   Lovers often feed each other like infants.    Going out to dinner is often the precursor of greater intimacy. The family meal is of critical importance in consolidating family ties. Couples invite other couples around for meals to establish a sense of shared experience and empathy. 

 

The way a person is with food can represent how s/he feels and how s/he is with other people.   People who are wary about what they eat often find it difficult to trust.     Those who suffer from eating food can find relationships and other aspects of life difficult. 

 

The conviction that food is the cause of the symptoms is more likely to become consolidated when the emotional connection is too shameful or distressing to talk  about.  Psychotherapy can help to make this more accessible, but for Sheila, this was a mixed blessing.   

 

‘For years, I was so careful about what I ate because I was convinced that my disease was caused by an allergy to food.   At Christmas when I went home, I ate everything and didn’t get any problems with my tummy at all.  Now I’ve come back to the stress and problems of my life here, all the symptoms are back again and I’m watching what I eat.  I guess it must be due to stress.‘

     

‘But you’re disappointed.’      

     

‘Yes, because I have no control over the stress.’  

 

 

Sounds like more therapy!

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