***image1***When I started writing this column, it was with an aim of providing recipes that were easy to prepare and tasty specifically for those of us who suffer from a gluten intolerance. I have discovered over the past few years that eating anything that has gluten in it makes me feel bloated, uncomfortable and at times, depressed.

This month, after hunting around for an ingredient that would begin with the letter ‘I’ that I could use in gluten free cooking, I decided that it would be interesting to write about intolerances and the different types of intolerances that exist. Hence, ‘I’ is for Intolerances.

’I’ is for Intolerances

What is food intolerance and how does it differ from an allergy? The website www.foodintol.com defines the terms ‘food allergy’ and ‘food intolerance’ as follows:

‘ Food Allergy is a rather fast response by the body’s immune system to a perceived invader. Signs or symptoms are typically immediate, dramatic and visible: coughing, sneezing, vomiting, migraines, watering eyes, rashes, swelling tissue, hives — or in severe cases anaphylactic shock which requires emergency intervention. However other symptoms like the gastro-intestinal responses nausea, vomiting and diarrhoea can be delayed for hours or even days.’

‘ Food Intolerance on the other hand is an inability to process a particular food. It is also thought to be an immune system response. The gastro-intestinal tract in some people is simply unable to produce appropriate enzymes for normal chemical breakdown. The food passes through unprocessed, or lingers in the gut fermenting producing excess ‘gas’.’

In a nutshell, food allergy has more immediate and dramatic effects on one’s life where as, food intolerance has a delayed effect and is on one’s lifestyle. However, if untreated, the latter could cause problems which could culminate in life threatening illnesses

The Different Types of Intolerances

There are various intolerances in existence but the four main types identified are: gluten, lactose, yeast and fructose. The table below identifies the likelihood of occurrences of the different intolerances:

Type

Occurrences

Gluten intolerance

15%

1 in 7 people

Yeast intolerance/sensitivity

33%

1 in 3 people

Fructose intolerance

35%

1 in 3 people

Lactose intolerance

75%

3 in 4 people

Food Allergy

1 in 100 people

Table taken from www.foodintol.com

Significantly more people suffer from some form of intolerance as opposed to an allergy but very few people are aware that they are intolerant to specific foods and carry on as normal.

Lactose Intolerance

Out of the four intolerances mentioned above, lactose intolerance is the most common. It is caused by a metabolic deficiency of the enzyme, lactase which is normally released from the lining of the small intestine. Lactase is required in order break down lactose into the two sugars, glucose and galactose so that they can be absorbed into the blood stream. When a person suffers from lactase deficiency, they can suffer from the following symptoms:

· Bloating and wind

· Audible bowel sounds

· Abdominal pain

· Diarrhoea

The best form of treatment for a lactose intolerant person is to eliminate lactose from one’s diet and substitute cow’s milk products with soya or low lactose milk products. The table below indicates the lactose content in a glass of different types of milk.

Full fat cow’s milk

9.3g

Skimmed cow’s milk

9.8g

Low lactose, cow’s milk

0.5g

Goat’s milk

8.6g

Sheep’s milk

9.8g

Soya milk

0.0g

Yoghurt made from cow’s milk has low lactose content as the process of fermentation breaks down lactose.( see www.ivillage.co.uk)

Fructose Intolerance and Malabsorption

Like lactose intolerance, fructose intolerance is also caused by the body’s inability to produce the enzyme, fructose, for digestion. This is a rare condition and is usually genetic. What is more common, however, is lactose malabsorption where special cells known as epithelial cells which exist on the surface of the intestine can not assist in the digestive process. The digestive process continues and existing bacteria in the colon break the matter down into fatty acids and carbon dioxide and hydrogen gases. It is the gas that is produced which cause bloating, diarrhoea and wind.

When this kind of malabsorption takes place, it can cause other nutrients which are in the body to be lost and lead to other serious diseases like anaemia and osteoporosis. Adults suffer more from this type of intolerance than children. Symptoms of both fructose malabsorption and intolerance are as follows:

· Bloating and wind

· Diarrhoea

· Fatigue

· Low Iron/nutrient deficiency

The symptoms of both fructose intolerance/malabsorption and lactose intolerance are very similar, however, treatment is different. In the case of fructose intolerance/malabsorption the treatment is to stick to a low sugar or fructose free diet. This can be difficult as most food has some fructose in it, especially processed food.

Yeast Intolerance

Unlike lactose and fructose intolerances, where there is an inability to produce an enzyme, yeast intolerance occurs from overproduction of candida. Candida or yeast is something that we all have within our bodies in its natural state. What creates intolerance to it is when there is an abnormal growth of candida within the body to a level which is in excess of what is required. There are many possible causes for this; hormone imbalance, stress and poor nutrition. A diet which is lacking in the right nutrients weakens the immune system so that it has difficulty coping with the toxins that the excess yeast produces.

Some of the symptoms of yeast intolerance are as follows:

· Bloating and wind

· Diarrhoea

· Headaches

· Thrush

· Mouth ulcers

· Furry or coated tongue

· Itching

· Hypoglycaemia

· Sugar and sweet cravings

· Mood swings

The only way to eliminate the symptoms of yeast intolerance is to follow a yeast free diet at least until the symptoms have subsided. This means taking out food like cheese, yoghurt, caffeine etc. from the diet and that is just to name a few. The list is endless in the case of yeast intolerance and is quite difficult to follow but the good thing is that the foods causing the problems can sometimes be re-introduced into the diet once the correct balance of yeast has been produced in the stomach. Generally a period of 3 months is recommended before any re-introduction of food groups. (see http://www.discoveryfoods.co.uk/eat_health.asp )

Gluten Intolerance

Gluten intolerance or coeliac intolerance is caused by sensitivity to the protein ‘gluten’ which exists in many cereals, predominantly wheat although rye and barley are also in the same family. It is fairly common and said to affect more females than males. The symptoms of gluten intolerance are numerous and not everybody has all of them and many are unaware that they suffer from the condition until they are tested for it or are advised by professionals to follow a wheat free or gluten free diet. Examples of the symptoms are as follows:

· Fatigue

· Breathlessness

· A general feeling of malaise

· Bloating and wind

· Abdominal pain

· Diarrhoea

· Vomiting

· Weight loss

· Changes in skin condition

Gluten contains a small protein ‘gliadin’ which triggers an abnormal change to the lower part of the small intestine. It can instigate this change because of the pure and simple reason that the intestine just doesn’t like it and hence, has a toxic effect on it, or because the immune system is in over drive possibly because of a virus that might be present. The only way to prevent this change from happening is to follow a gluten free diet.

It is important to understand that there is a difference between gluten intolerance and wheat intolerance. Those who are gluten intolerant can not eat anything that has gluten in it. Hence they can not eat wheat, rye or barley and any other cereals that contain gluten. However, someone who is wheat intolerant can eat rye and barley as the main culprit in their intolerance is wheat (see www.foodintol.com)

It is obvious from the brief synopsis that I have provided on the four intolerances that they are all connected to the digestive system and many of the symptoms are similar. One of the biggest problems with intolerances is that they can not be identified quickly because the effect or reaction to the food may take up to 48 hours after it has been eaten and hence the connection may not be made. Many people decide to go and buy over the counter medication to get rid of the symptoms rather than going to the doctor. This is added to the fact that some of the symptoms maybe considered as mere interferences in their lifestyle and not serious.

Intolerances get worse with age and are likely to increase the conditions that may already be in existence like, heart disease, liver, kidney and lung problems. It is also a fact that like allergies following a pattern and running in families, the same applies with food intolerances. If one member of the family is intolerant to a particular food, it is highly likely that other members will also suffer from the same intolerance.

In my own case, I decided to have an intolerance test and went to a health store in London where the test took a total of 1 hour to decipher which foods I had a problem with. I discovered that I had an intolerance to gluten and yeast. The latter is much more difficult to control but the nutritionist did emphasise that if I eliminated gluten and yeast and all products that contained both of them from my diet for a period of 2-3 months I should see some benefit. Taking yeast out of the diet is much harder because most products have yeast in them or ingredients that create bacteria. I love yoghurt which is lethal for those who are yeast intolerant. Cheese is another favourite of mine and that is also not allowed on a yeast free diet.

Finally all I can say is that the rewards are good if the intolerance can be identified and dealt with through diet. However, it requires a tremendous amount of discipline and a change in lifestyle to be able to cope with those changes. For this months recipe I wanted to provide something that people who suffer with all four intolerances could cook, so it’s a simple Spinach Stir Fry.

Recipe of the Month: Spinach Stir Fry

Ingredients

500g Fresh Spinach

2 cloves of garlic chopped finely

1 onion chopped finely

Handful of pine nuts (check label for gluten)

Olive oil

Salt and pepper to taste

Method

Pour a teaspoon of olive oil in a pan and allow to heat up. When oil is hot, add the onions and garlic and salt and fry till brown. Add spinach and toss. Put lid on the pan and allow the spinach to cook in its own steam. While the spinach is cooking, toast a handful of pine nuts under the grill until brown and then leave to cool. When spinach has wilted some what, add a pinch of nutmeg and serve immediately. Sprinkle the pine nuts over the spinach and serve as an accompaniment to fish, meat or poultry or anything else you might desire to have with it.

Back next month with more from the A-Z of Nosh, by Naz! If you have any suggestions, please do not hesitate to contact me on noshbynaz@yahoo.co.uk . Feedback is always encouraged.

Bye for now.

Nazia .

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