Department of Planning, Information and Management, The University of Tokyo Hospital, Tokyo, Japan. imamura-t@umin.ac.jp
Abstract
Food allergies have increased in recent years in Japan. Details of causative foods, places where anaphylaxis developed, and other allergic factors remain unknown, and we investigated them. A'questionnaire survey for the prevention of food allergies' was conducted using a nationwide group of patients with food allergies. A total of 1383 patients from 878 families (including 319 patients who experienced anaphylaxis) provided valid answers to the questionnaire. The average age of the first anaphylactic attack was 3.20 +/- 6.327 yr.
The most common allergens causing anaphylaxis were in order milk, eggs, wheat, peanuts, and soybeans, followed by sesame and buckwheat.
The most common place where anaphylaxis developed was the patient's own home, followed by fast food restaurants, places visited, restaurants, and schools. In patients' own homes, fast food restaurants (buffet), places visited and schools, the most common allergens were milk, eggs, and wheat.
In restaurants and accommodation facilities, eggs were the most common allergen followed by milk. As possible food allergies can cause anaphylaxis, it is necessary to provide precise information for consumers regarding packaged and processed foods.
Where is the hippo? Trying to repair a complex community of a couple of hundred different species of bacteria by just changing diet, is like a zoo trying to add hippos by building a new enclosure and supplying it with fodder.
You can wait and wait, but you can't add new species without adding new species. Hippos don't appear by spontaneous generation and neither does E. coli or other gut bacteria. You have to ship in hippos from other zoos and after antibiotic-induced extinction of gut bacteria, you have to introduce or eat missing species of bacteria. Also just adding probiotics will not provide a lasting fix for damaged gut flora any better than adding more elephants or giraffes will improve the diversity of a zoo lacking hippos.
I am amazed that Dr. Oz and the medical industry can encounter symptoms of dysfunctional gut flora, e.g. constipation, food intolerance, autoimmunity, allergy, that are preceded by antibiotic treatment and not address the compromised species diversity of the gut. The involvement of gut bacteria in immune system function is documented in the biomedical literature. The lasting impact of antibiotics on gut bacteria is known. Then why do Dr. Oz and the rest of the medical industry just recommend probiotics, a half dozen different species of bacteria found in fermenting dairy products (think elephants and giraffes), to repair a decimated gut bacterial community? They seem to be perplexed and ask, "Where is the hippo?"
Generalizations about Gut Bacteria
Each healthy human maintains a subset of a couple of hundred of the couple of thousand different species of bacteria found in humans around the globe. The diverse community in each individual may differ in species, but has approximately the same complement of genes in people sharing the same diet.
1-200 different species of bacteria per person
1-2000 different species of human gut bacteria
1 million different genes among the different bacteria
Most genes are involved in digesting plant carbohydrates, i.e. soluble fiber, inulin, pectin, fructans, algal sulfated polysaccharides, etc.
Diet diversity, e.g. the Modern American Diet, reduces the diversity of the gut bacterial community, presumably because the rapid change in foods permits survival of only generalist bacteria that can digest many different foods.
Simple diets produce gut flora diversity, but only if there is access to diverse bacteria.
Health may result from diverse gut flora developed from a simplified diet and ample bacterial resources.
Obesity and other diseases may result from simplified gut flora developed from a changing, complex diet and a sterile environment/isolation.
Vegan and paleo extremes can lead to healthy gut flora diversity, if the gut bacterial community is permitted to adjust to the diet composition by avoiding rapid changes and providing diverse bacterial sources.
Meat contains complex polysaccharides, e.g. glycosaminoglycans, such as chondroitin sulfate and heparan sulfate proteoglycans, which are bacterial fodder equivalent to soluble fiber.
Probiotics are unique bacterial species that do not persist in the gut of adults, but dominate the gut of milk eating babies and stimulate development of the gut and immune system.
Probiotic bacteria can temporarily provide developmental signals for immune system development that are normally provided by a healthy gut flora.
Damage to Gut Flora is Not Repaired by Diet Alone There is little or no effort being made by the medical industry to develop approaches to repair gut flora damaged by disease, unhealthy diets or medical procedures. This is similar to a surgeon stepping away from removal of a diseased organ without closing the wound. Antibiotics leave a gut flora that will remain permanently damaged without systematic, monitored repair. It might also be suspected that disruption of gut flora by antibiotics and the introduction of large amounts of new foods, such as high fructose corn syrup and vegetable oils may contribute to or cause the modern prominence of obesity. After all, gain or loss of weight changes gut flora, obese individuals have damaged gut flora, and trading gut flora between fat and lean animals, trades weight gain/loss behaviors.
Sources of Bacteria to Repair Damaged Gut Flora
We must eat new bacteria in order to replace bacterial species lost by antibiotics or unhealthy diets.
Probiotics -- specialized bacteria that grow in milk products
Spices and herbs -- plant products abundantly contaminated with bacteria that digest plants
Fresh vegetables -- bacteria are on the surfaces of plants unless the vegetables are cleaned or cooked
Fermented foods -- Bacterial growth leading to acid or alcohol production has beed used in the preparation and storage of many foods and provides a rich bacterial resource.
Environment -- Bacteria are transferred to our hands and face from other people, pets and surfaces, unless hands and the body are continually washed. Sanitizers and frequent washing of hands and surfaces eliminate acquisition of environmental bacteria to repair damaged gut flora. Social isolation and hygiene block repair of gut flora.
Replacement -- experimental replacement of damaged with healthy gut flora (fecal transplant) has been very effective in curing many diseases without significant risks, but is restricted by the medical industry.
For many GAPS patients, the diet should be followed for two years at least. The book Gut & Psychology Syndrome will provide recipes and more explanation about the diet.
The best foods are eggs (if tolerated), fresh meats (not preserved), fish, shellfish, fresh vegetables and fruit, nuts and seeds, garlic and olive oil. Apart from eating vegetables cooked, it is important to have some raw vegetables with meals, as they contain vital enzymes to assist digestion of the meats. Fruit should be eaten on their own, not with meals, as they have a very different digestion pattern and can make the work harder for the stomach. Fruit should be given as a snack between meals.
It is very important to have plenty of natural fats in every meal from meats, butter, ghee, coconut (if tolerated) and cold pressed olive oil. Animal fats on meats are particularly valuable. Fermented foods (sauerkraut, yogurt, and kefir) are also a very important part of this diet in addition to homemade meat or fish stock. It is recommended to take a cup of warm meat or fish stock with every meal as a drink as well as soups and stews made with the meat or fish stock. The stock, kefir and fermented vegetables will over time restore the stomach acid production, which will improve digestion.
It is best to avoid processed foods (any packet or tinned foods). They are stripped from most nutrients that were present in the fresh ingredients used for making these foods. They are a hard work for the digestive system and they damage the healthy gut flora balance. On top of that they usually contain a lot of artificial chemicals, detrimental to health, like preservatives, colorants, etc. Try to buy foods in the form that nature made them, as fresh as possible.
Poor absorption of most FODMAP carbohydrates is common to everyone. Any FODMAPs that are not absorbed in the small intestine pass into the large intestine, where the bacteria present ferment them. The resultant production of gas potentially results in bloating and flatulence. Most individuals do not suffer significant symptoms but some may suffer the symptoms of IBS. Restriction of FODMAP intake in the latter group has been found to result in improvement of symptoms.[2]
Fructose malabsorption and lactose intolerance may produce IBS symptoms through the same mechanism but, unlike with other FODMAPs, poor absorption is found only in a minority of people. Many who benefit from a low FODMAP diet need not restrict fructose or lactose. It is possible to identify these conditions with hydrogen and methanebreath testing and thus eliminate the necessity for dietary compliance if possible.[2][3]
FODMAP sources in the diet
The significance of sources of FODMAPs varies through differences in dietary groups such as geography, ethnicity and other factors.[3]
Breathtaking diet offers hope for those who can’t stomach fructose
Date
Natalie Craig
JACKIE Love can eat bananas but not apples. Beans but not snow peas. Gluten but not wheat.
‘‘I really have to look at every single thing I put in my mouth,’’ says the 44-year-old French teacher. Love has a food intolerance that is as complicated as it is common.
Usually described as ‘‘fructose intolerance’’, but often extending to malabsorption of other sugars, scientists believe the condition could affect almost half of the 15 per cent of Australians with irritable bowel syndrome (IBS), and be the prime trigger of symptoms such as diarrhoea, constipation, bloating and pain.
Diagnosis is confirmed by a breath-test, and the number of specialist diagnostic centres in Melbourne has risen since 1999 from one to an estimated 18.
Sufferers are treated with a low FODMAP diet, which stands for six sugars. It restricts most fruits, many vegetables, wheat, some dairy and other everyday foods such as honey.
‘‘Some people just give up on asking you out for dinner — it’s that difficult to work out,’’ says Ms Love. But she says her painful and socially awkward IBS symptoms have disappeared, and as a FODMAP-follower she’s not alone.
The diet, which was developed in Melbourne by dietitian Dr Sue Shepherd in 1999 and later proved effective by Dr Shepherd and Monash University, has spawned a thriving local industry.
‘‘There are lots of diets being promoted ... but this is one where we know why it works,’’ says Dr Shepherd.
Her annual patient list has soared from 100 to 4000 in 13 years (about 80per cent of whom are being treated with the FODMAP diet) and she also publishes cookbooks, consults overseas and conducts supermarket tours and information sessions for chefs.
Natalie Nott, 35, is among her acolytes. ‘‘FODMAPs has really changed everything.’’ Relieved of her irritable bowel syndrome symptoms, last year she self-published the Low Fodmap Cookbook, which has sold about 600 copies, and has 1000 subscribers to her blog.
She says dining out is still difficult, but restaurants such as Fox in the Box, in Hampton, and The Firehouse, in Ringwood, now cater specifically for FODMAPs.
Food companies Naturally Good and Simply Wise include a ‘‘fructose-friendly’’ label on relevant products.
Meanwhile, breath-testing clinics are booked out weeks in advance. Paul Rose, manager at Stream Diagnostics, says the company’s Box Hill and Brighton centres conduct about 300 breath-tests a week, and that about 60 per cent of clients test positive for fructose malabsorption.
Patients drink a solution of fructose and then breathe into a device similar to a police breathalyser several times over three hours. Malabsorption is indicated by increased hydrogen in the breath. The tests costs between $85 and $100 each and there is no Medicare or private health insurance rebate.
Karen McHarg, 42, an administrator, asked for a referral from a GP after hearing about fructose malabsorption at work. ‘‘Of a workplace of about 200 people, I know of 10 who have been diagnosed or who are following the FODMAP diet.’’
She hopes they will provide an answer to her IBS issues. Dr Shepherd says better diagnosis of fructose malabsorption has made the condition seem more prevalent, although some speculate that increased fructose in our diets, particularly from high-fructose corn syrup in many processed foods, is also to blame.
But Australian Medical Association president Steve Hambleton said the incorrect perception of food allergies and intolerances was also on the rise, and warned that the FODMAP diet should only be used under professional guidance.
‘‘You need to go to a GP first to make sure you don’t have a serious, treatable medical condition — especially one of the inflammatory bowel diseases,’’ he said.
‘‘There is an objective increase in recognised food intolerances, But there’s probably an equal number of people who think they’re intolerant or allergic without robust reason.’’
Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPs) are found in the foods we eat. FODMAPs are sugars that are poorly absorbed in the small intestine and reach the large intestine where they produce gas and attract water.
FODMAPs are a large group of dietary sugars found in many common foods such as specific dairy products, wheat and other grains, and fruits and vegetables. While FODMAPs are poorly absorbed in all people, those with specific gut disorders such as IBS are thought to experience the uncomfortable symptoms due to the gut being unusually sensitive.
A Low FODMAP Diet is usually recommended for 6-8 weeks at a time. Progress should be assessed by anaccredited dietitian. They will help advise which foods can be gradually re-introduced into your specific diet.
It is essential to develop a strategy and plan ahead. Work with your dietitian to develop easy and tasty meal plans. Ask for a low FODMAP shopping guide. Maintaining a low FODMAP pantry is key to sustaining a Low FODMAP Diet.
FREE Information Sheet
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FODMAPs are a large group of dietary sugars found in many common foods such as specific dairy products, wheat and other grains, and fruits and vegetables. While FODMAPs are poorly absorbed in all people, those with specific gut disorders such as IBS are thought to experience the uncomfortable symptoms due to the gut being