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Dr H Morrow Brown MD
General Medical Council Registered Specialist
for Allergy and Respiratory Medicine


Dietary Manipulation

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It will be obvious from the many references to the “Few Foods” diet that many readers will expect some guidance on this aspect of allergy and intolerance. This is difficult because there is a definite risk that someone will continue indefinitely on a diet which is designed only to be endured for a few weeks in order to find out if the problem, whatever it may be, will improve. Unfortunately it is quite impossible to foretell what some misguided person might do, and it would be dreadful if, for example, a mother inflicted a restricted diet on her child, and even though there was no improvement after two weeks persisted indefinitely until the child suffered from malnutrition, starvation, or worse. Further, I would probably be accused of being responsible and be blamed instead of the misguided patient or mother.

ChickenFor the above reasons a specific diet is not being detailed, and only the principles of this test diet outlined. It must also be emphasised that the family doctor should be involved in trying out restricted diets, especially when for children, and a dietitian should also be involved if available. It is unfortunate that there are so very few dietitians with knowledge of the importance of food allergy and intolerance, and the use of trial diets in diagnosis of food intolerance. The British Dietetic Society do not accept that beef and beef extracts should also be rigidly excluded from milk free diets, but in my extensive experience about a quarter of the milk intolerant patients cannot tolerate beef either. It is difficult to understand why this simple fact is not recognised, because milk comes from beef and contains very similar proteins. It was gratifying recently to have confirmation of my experience from the top American experts in food allergy and intolerance that beef also causes problems. The occasional role of milk in causing constipation is also seldom recognised, but recently one enlightened authority stated that milk as a cause should be excluded before prescribing laxatives for children.

PotatoesThe "Few Foods Diet” is a test diet to exist on for two or three weeks, and is the only practical way to find out if avoiding all other foods will bring about improvement. It is of such short duration that there is no question of vitamin or mineral deficiencies resulting from it. Restricted diets require a great deal of motivation, cooperation, and perseverance, and should be accompanied by a diet diary recording everything that passes their lips, including all supplements as well as medicines, and even toothpaste etc. It is not uncommon for symptoms to get worse in the first few days, and cravings can be a problem. I find it is very helpful; to arrange that the patient reports weekly by phone to doctor or dietitian to discuss progress and problems, as otherwise they can lose their initial enthusiasm.

WheatThe “Few Foods Diet” is a very simple diet limited to the few foods which very seldom cause intolerance or allergy, and is intended to be endured for only two or three weeks. Rice is the backbone of the diet because rice very seldom causes problems in the West, where wheat, other cereals, and potato are the main source of carbohydrates. The fewer the foods included in the diet the less chance there is that a food which is causing trouble will be included, therefore the ideal “elimination” diet could be to exist on nothing but rice and water for a fortnight !! No improvement after sticking rigidly to this diet means that intolerance to foods is not the cause of the problem, whatever it may be. The unlikely alternative, especially if symptoms actually got worse on the diet, is that the cause of the problem is one of the few foods. In this situation it might be worth while, before discarding the idea of food intolerance altogether, to try reversing the diet and avoiding the few foods instead, but this is a very uncommon situation.

MilkImprovement means that a food or foods which is not being eaten may be the cause of the problem, so the next step is to introduce foods one by one to find out which foods will repeatedly cause the symptoms to recur. Instructions regarding dietary challenges in the diagnosis of food intolerance have already been mentioned in the section on tests, together with severe warnings about the dangers of anyone with known food allergy experimenting with diets.

The shorter the interval between eating the food on test and the reaction to it the more likely this is an important intolerance, but the possibility that the reaction having taken place by chance is so high that, unless the reaction was very quick and severe, it is essential to repeat the test later to find out if the same amount of the same food will cause the same reaction after the same delay time. In fact the diagnosis is usually only definite after three test feeds because reactions are often delayed to the next day.

The whole process can be tedious and frustrating, and needs perseverance. Sometimes accidental exposure, or intentional challenges organised by a partner, will provide conclusive evidence, but finding out what was in a dish in a restaurant is often very difficult.

Breaded fishLamb is the most suitable meat as sheep still eat mainly grass and sometimes turnips and other vegetables,. Welsh, Scottish or New Zealand lamb is very suitable, but battery lambs are to be avoided. Similarly, battery chickens and other poultry are taboo, but free range poultry and eggs and any sort of game should be acceptable. Fish or eggs are allowable unless allergic, as shown by skin testing or bitter experience. Most vegetables and fruits are allowable, with the exception of all cereals, potato, tomato, peppers, peas, beans, and citrus fruits, unless already aware that some items are not tolerated.

Problems with this temporary test diet are often about what to have for breakfast, packed lunch, and so on. Rice Crispies (caution is advised as there are several ingredients other than rice in this product), rice cakes, and rice milk are very suitable but boring. Many gluten free or wheat free products contain potato flour, which can create more difficulties. Gluten free does not mean wheat free unless so stated. Leading supermarkets, especially Tesco, have a section entirely devoted to dietary products which is getting bigger, and will supply “free from” lists on request.

Advice from other websites is variable in quality. The Coeliac Society website is very comprehensive and full of good advice, but directed specifically to gluten avoidance. For food intolerance and allergy the website resource at is full of useful information for management of all food problems.


"It is a paradox that while Britain has the highest incidence of allergic disease in the world, it also has the most inadequate allergy service"

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