are present as added fructose in cool drinks, fruit juices, flavoured waters and energy drinks) and sugar alcohols such as sorbitol, mannitol, maltitol, xylitol, polydextrose and isomalt in sugar-free products such as chewing gum and sweets.
•Vegetables such as artichokes, beetroot, Brussels sprouts, cabbage, fresh chicory, fennel, garlic, leeks, onions, peas and green beans, and fruits such as peaches, prunes and watermelon. This is a limited list. When you investigate this topic more deeply, only a few vegetables and fruits will remain “safe”.
•Grains such as wheat, rye and barley.
•Legumes such as cooked dried beans, chickpeas, lentils and soya products, as well as nuts such as pistachio nuts.
•Dried chicory in drinks such as coffee.
The determining of a food allergy or intolerance
Allergic reactions can be determined by skin-prick tests, electrodermic skin tests, blood tests and intestinal biopsies, or record-keeping of all food intake and the resulting reactions. Refer to the three examples of record-keeping.
With an elimination diet, all suspected foods are excluded from the diet with the intention of reducing or eliminating the cause of the symptoms.
The so-called food-challenge test can be done to confirm a food allergy or intolerance and usually takes place when a person is evaluated and is symptom-free after doing an elimination diet. The suspected food items are reintroduced to the diet one by one in a certain ratio and in a certain order. It is important to do this food challenge in collaboration with your doctor and dietitian, especially if you have a history of anaphylactic reactions. (Read the last remark under “Symptoms”.) All reactions should be monitored and carefully noted.
A proper medical evaluation and diagnosis regarding a food allergy or intolerance is of the utmost importance. Eliminating foods unnecessarily could result in nutrient deficiencies in the body, which may hamper the immune system of the body even more. Consult a registered dietitian who will help you to plan a balanced diet and formulate a meal plan to meet your personal nutritional requirements, taking your specific health problems into account.
Example 1: Food and symptom record
| Date | Time | Food/drink consumed | Symptoms | Severity of symptoms* |
* Symptoms according to scale: 1 = mild 2 = mild to moderate 3 = moderate 4 = severe
Example 2: Food and symptom record
| Food, liquids and medicine takenDay and date | Negative symptomsTime of the day |
| Breakfast | |
| In between | |
| Lunch | |
| In between | |
| Supper | |
| Late evening | |
| Environmental factors such as wind, dust, pollen and so on, which aggravate symptoms |
Example 3: Weekly food and symptom record
| Day/date | |||||||
| Symptoms after a night’s sleep | |||||||
| Breakfast | |||||||
| Symptoms | |||||||
| In between | |||||||
| Symptoms | |||||||
| Lunch | |||||||
| Symptoms | |||||||
| In between | |||||||
| Symptoms | |||||||
| Supper | |||||||
| Symptoms | |||||||
| Late evening | |||||||
| Symptoms | |||||||
| Medication taken | |||||||
| Environmental factors (dust, smoke, and so on) |
Healthy nutrition
A healthy, balanced diet consists of a variety of food items to provide for the body’s energy needs, to regulate ongoing processes in the body and to provide building material to repair and maintain a healthy body. It is also important to maintain a healthy body weight.
When avoiding certain food items due to a food allergy or intolerance, the elimination diet should still comply with the guidelines for optimal nutrition regarding gender, age and stage of life.
The South African Food-Based Dietary Guidelines are easy to follow and include the following:
•Eat a variety of foods every day and distribute the food evenly in your meals over the entire day.
When foods must be excluded due to a food allergy or intolerance, the diet and meal plan should be adjusted with the remaining permissible foods to comply with the needs of the body for sufficient nutrients to repair and maintain the body, as well as the need for energy production.
•Make starchy food part of most of your meals. Eat more low-glycaemic-index (low GI) starchy foods.
When, for example, excluding gluten-containing grains, the choice of starchy food is more complicated and in some instances good planning is needed to balance the glycaemic index of a meal. Other sources of fibre should be considered when grains are excluded from the diet. Grains are also an important source of B vitamins. Unrefined grains include whole-wheat products, rye, barley, oats, sorghum, unpolished or brown rice, and buckwheat.
•Eat at least five portions of fruit and vegetables every day.
Vegetables and fruit contain a variety of vitamins and minerals which can strengthen the immune system. They also provide good fibre and energy. Unpeeled vegetables and fruit, fruit juice with pulp, and purée made from whole fruit provide good fibre.
•Eat cooked dry beans, split peas, lentils and soya regularly.
Provided you are not allergic or intolerant to one or more of these foods, they can be a good source of fibre in the diet. These foods may improve the increased intake of plant protein, plant sterols and water-soluble fibre. Cooked legumes may replace starchy food in a meal plan and help to lower the GI of a meal.
•According to your food budget, lean red meat, chicken, fish, eggs, milk, yoghurt or cheese can be eaten daily.
The choice of these foods depends on your food allergy or intolerance. Protein needs are calculated according to individual circumstances. Especially in the case of growing children, a calcium supplement should be taken when excluding milk products from the diet. Also, especially in children, the absorption of iron is hampered when the protein intake is insufficient.
•Use fats sparingly and choose monounsaturated and polyunsaturated fats more often.
A fat intake of between 25% and 35% of the total daily energy intake is considered ideal, with a balance between saturated fats and fats which are high in monounsaturated and polyunsaturated fatty acids. Fatty acids help to improve immunity and strengthen the cell membranes. Fat is also an important carrier of the fat-soluble vitamins A, D, E and K.
•Get into the habit of drinking sufficient clean, safe water every day.
•Use salt and salt-containing foods sparingly.
•Use sugar and sugar-containing foods sparingly and in consultation with your doctor and dietitian.
•Be more active and keep your body weight under control.
Food supplements
The addition of mineral and vitamin supplements should only be done according to your doctor’s evaluation and a nutrient analysis by your dietitian. Injudicious mineral and vitamin supplementation is not only very expensive, but could, in the long run, damage your body or result in the unwanted accumulation of certain substances.
Explanation of less-familiar ingredients
Read the chapter “Easy bakes, bread and rusks” about the different gluten-free flour mixtures.
Barley
In South Africa barley in often used in soup, but it can also be cooked in