COPING WITH FOOD ALLERGIES: RULES OF THE ROTARY DIVERSIFIED DIET
In devising a rotary diet for patients, I follow certain basic rules. Patients are instructed in these rules and given advice on how to follow them when they return home.
Rule 1: Eat whole, unadulterated foods. Our ancestors generally ate their food in a simple form, without complicated mixtures, sauces, condiments, and the like. A diet such as this is cheaper, more readily available, easier to prepare, and more digestible than fancier fare.
Today, most of us have the ability to eat both simply and with variety. Culinary refinement, while pleasing to the palate, can sometimes be harmful to health, if it is pursued on a regular basis by susceptible individuals. The overrefinement of foods and their packaging for convenience or longer shelf life have led to abuses. Many people do not know what a diet of plain, simple foods taste like or how good it can be. If a person tolerates beef, he can and should enjoy a steak, a hamburger, or a piece of boiled beef instead of, say, a meatball sandwich. If he eats steak, he has consumed one food—beef. He can then have another food, or several other foods, for his next meal. But the meatballs may contain beef, soy, pork, onion, oil, butter, milk, egg, black pepper, and wheat flour used as a “meat-stretcher.” The bread will contain more wheat, rye, corn oil, yeast, sugar of some sort, caramel, lactic-acid cultures, and assorted chemicals. If the sandwich is topped with catsup, it will contain tomatoes, vinegar (grain, cider, or wine), corn sweetener, onion powder, spices, and flavorings. Mayonnaise will add more eggs and vinegar, as well as soybean oil and sugar (beet or cane).
Thus, what most people think of as a fairly simple meal—a meatball sandwich such as is available in many restaurants or “take-out” places—actually may contain more than two dozen different foods, including some of the most common allergy-causing substances—wheat, corn, beef, beet, milk, cane, yeast, soy, or eggs. Most likely it will also contain an assortment of chemicals as well.
If you are allergic to any one of these common items (and almost all food allergy patients are), you will not be able to discover this fact by sticking to the average American diet. The reason is that you will eat these common foods over and over again, every day, almost without letup. The symptoms caused by one or more of these foods may fluctuate, but they will never really be absent for long, because their cause is not absent for long. If you find that an average meal gives you reaction, it will be virtually impossible to track down the cause of that reaction when you are eating two dozen different foods at a sitting.
Rule 2: Diversify your diet. In addition to eating whole, simple foods, the patient must learn to diversify his diet. The modem marketplace offers us a wide variety of different foods from various climates and cultures. We should make use of this diversity. Yet most people eat the same few foods over and over again, sometimes quite literally ad nauseam. Wheat, milk, beef, corn, beet or cane sugars, and eggs, in their many varieties and disguises, represent the monotonous basis of the American diet. Some people even brag of being “meat and potato men,” who must have these two foods in order to feel satisfied (an almost certain sign of food addiction).
Patients can learn to diversify their food choices. The world is filled with an enticing variety of foods which they can exploit for both enjoyment and good health. For example, few people enjoy (or have even tasted) all of the foods in a well-stocked fruit and vegetable market. They become stuck on certain often-repeated favorites, such as carrots, celery, and lettuce, and bypass what is unfamiliar. Turnips and parsnips are rarely eaten as vegetables in their own right, although they make a delicious dish. Some people have never tasted artichokes, avocados, mangos, or papayas. Each of these can form the basis of a satisfying meal.
Some foods are only eaten on special occasions or in special combinations. Cranberries are highly popular at Thanksgiving, but are rarely eaten at any other time of the year; yet they can usually be incorporated into the diet with little trouble, and in many markets they can be purchased fresh throughout the fall season.
The foods of other countries offer interesting possibilities. Many markets now carry bean sprouts and (soy) bean curd. Bean sprouts can be readily grown in a jar in the kitchen if they are not available in the store. Health food stores usually stock a wide variety of Japanese foods. The larger cities have stores, listed in the Yellow Pages, which sell specialty foods of other nationalities. There is much to be gained by learning to enjoy the cuisine of cultures other than one’s own.
In fact, the Rotary Diversified Diet is in some ways less limited, and more enjoyable, than the supposedly unrestricted but monotonous American diet. It calls on you to eat in a controlled, rational way, but within that plan it offers great latitude for innovation and experimentation with food.
Rule 3: Rotate your diet. Patients are told that they can develop an allergy to any food if they eat it day in and day out and are susceptible to it. This is as true of the more exotic foods as it is of beef, potatoes, or eggs. A colleague of mine once attempted to practice clinical ecology in Taiwan. He soon discovered that the Chinese people of that island had widespread allergies to the foods eaten there, especially soy and rice, but also including others, some of which are rare by American standards.
The whole point of this diet is to let the body recover from the effects of a food before eating it again. In general, it takes up to three days for a meal to pass through the human digestive system. To be safe, we allow four days between ingestions of a particular food.
In general, patients are instructed to have only three meals per day. They can eat as much as they wish, although they are encouraged to eat portions of normal size. If he follows a four-day rotation, the patient can eat a particular food on Monday and then eat it again on Friday. Thus, if he has wheat on Monday, he will have to count four days following Monday before he can have wheat again. Bear in mind that this means wheat in any form: bread, spaghetti, lasagna, cream of wheat, even the breading on a pork chop. It is important to add that, for the purposes of this diet, wheat is identical to rye, barley, malt, and millet. Of course, if the patient continues to eat the average American diet, he could not manage that, since there is wheat (or a related grain) in almost every typical meal. But on the Rotary Diversified Diet, it is not difficult to avoid unknown or unsuspected ingredients in foods.
While four days is what we might call the “legal limit” on food repetition, many patients go on a seven-day cycle. This allows them to eat the same basic diet each week. The diet can be posted on the refrigerator and is easy to follow. All the patient needs to begin a seven-day food cycle are twenty-one foods to which he is not allergic.
Rule 4: Rotate food families. Foods, whether animal or vegetable, come in families. Some of these are fairly obvious: cabbage, kale, broccoli, and cauliflower, for example, all taste somewhat similar and are clearly related. You probably would not guess, however, that they are in the mustard family, which also includes horseradish and watercress. Similarly, you would not automatically know that cashews, pistachios, and mangoes are in the same group or that beef and lamb are in the same family but that deer and elk are in a separate group.
Food families are important in devising a Rotary Diversified Diet. A listing of common foods, grouped by their families, is given in Appendix A, to convey some idea of the relations between various foods.
The reason food families are important is that patients can cross-react to the “relatives” of food to which they are allergic. Thus, if you are allergic to beef you must suspect goat (not to mention veal and milk, both of which are seen as similar to beef by the body—veal being young beef, and milk a product of the female of the species). People who are allergic to potato must suspect other members of its family, including tomato, green pepper, red pepper, chili, eggplant, and tobacco.
Another reason why it is important to be aware of food families is to prevent the formation of allergies by a steady consumption of foods which are members of the same family. If you eat tomato on Monday, eggplant on Tuesday, potato on Wednesday, green pepper on Thursday, and tomato again on Friday, you are not really rotating foods—you are eating from the same food family every day, and this could develop into an addiction to one or all of these items.
Thus, the ingestion of foods which are members of the same family must be spaced, but not quite as strictly as foods themselves. The rule is that the patient must rotate food-family members every two days. Using the above example, it might be perfectly all right to have tomato on Monday, eggplant on Wednesday, and tomato again on Friday, provided that no other members of this family were eaten in between.
If a patient has a known allergy to a particular food, he must also avoid the other members of that food family, at least for a while. Thus, sensitivity to beef brings with it a ban on beef, beef by-products such as gelatin, margarine, and suet, milk products, veal, buffalo, goat, lamb, or mutton.
Rule 5: Eat only foods to which you are not allergic, at first. Patients who are emerging from the Ecology Unit are given a summary of their food-test reactions. They therefore know which of the most common foods cause reactions and which do not.
Upon going home, one of their goals is to test other foods which were not evaluated in their weeks in the hospital. If a new food causes no reactions, then it can be added to the Rotary Diversified Diet to give greater variety to the meal plan.
On the other hand, the diet serves as a perpetual diagnostic screen, helping patients to avoid unsuspected sources of mental and physical complaints. It can readily detect the first signs of an adverse reaction to any food, since that food is not in one’s system at the time it is eaten.
Basically, there are two kinds of food allergies—fixed and nonfixed, or temporary. A fixed allergy is one with which you are probably born, which does not go away with time. These are relatively less common. More frequently, patients can regain tolerance to troublesome foods after a period of some months of avoidance. The greater the reaction to a food, the longer it takes, in general, to reestablish tolerance. The process usually takes from two to eight months, after which the food can usually be eaten again, if used in rotation. Since the incriminated food is often a favorite and is craved in an addictive manner, the hope of regaining tolerance to it offers some consolation to the patient suffering its temporary loss. Until and unless such tolerance is regained, however, the patient cannot safely use an allergenic food. Moreover, it must not be abused by cumulative intake when it is returned. Re-sensitization occurs very readily and very subtly.
One exception to this rule is the so-called universal reactor. As mentioned earlier, such a person is allergic to all or most foods, and will get sick no matter what he eats, although he feels tolerably well on a fast. Naturally, he cannot avoid all foods to which he is allergic or he will starve. In this case, we do the next best thing. He is instructed to eat only those foods to which he has lesser reactions.
In addition, other procedures can be employed to benefit such patients. Some clinical ecologists employ “neutralizing doses” in the treatment of this condition. As was previously explained, a “neutralizing dose” is an infinitesimally small amount of the offending substance. If this dose, placed under the tongue, is at just the right dilution, it will have the effect of turning off a reaction. The same substance in a larger dose will, of course, cause a renewal of symptoms. This seems contradictory, but the effectiveness of the neutralizing dose is attested to by many clinical ecologists.
With the exception of universal reactors, all patients are instructed to keep away from the foods which cause their reactions until these can safely be reworked into the diet.
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