Monday, March 22, 2010

Heroes and villains: food intolerance, hypoglycemia, candida and the Failsafe diet – Part 2 of 3

In my last entry I gave a rundown of my food intolerance problem. In this entry I’ll talk about the Failsafe diet, designed primarily for children with food allergies and sensitivities, and the unexpected discovery about hypoglycemia that my search for information about food intolerance on the internet led to. (This entry is way too long anyway so I’ve steered clear of discussing the role of food in causing or worsening psychiatric problems, a highly relevant issue given the usual flavour of my blog.)

It’s very common now for conditions that affect children such as autism, ADD and asthma to be attributed to food intolerance and allergies. That much I expected. What I wasn’t expecting was the extent to which reactions to refined sugar have been discredited as a contributing factor in these conditions. The hypoglycemic and anti-candida diets are out, and the Failsafe diet is in.

The Failsafe diet is based on the finding that many children suffer from intolerances to particular chemicals in food. These chemicals may be artificial or natural and include additives, in particular food colourings, flavourings, and flavour enhancers, as well as chemicals that occur naturally in foods, such as amines and salicylates (these aren’t the only natural chemicals that can cause grief, but they seem to be the most common).

The diet also acknowledges that children and adults may suffer a range of allergies along with their food intolerances, such as allergies to soy, egg, gluten, dairy, and peanuts. (The difference between food allergy and food intolerance is explained here).

The Failsafe diet avoids all harmful food chemicals. To say it’s a welcome development is an understatement. It was actually devised in Australia, at the Royal Prince Alfred Hospital in Sydney, as a more up-to-date version of the US-devised Feingold diet, and has great scientific credibility.

The website of Sue Dengate, an advocate for the Failsafe diet who has researched and authored books on food intolerance and the diet, seems to have by far the most comprehensive information on Failsafe on the web.

The website has a wealth of useful free information about the diet. It is full of testimonies by relieved parents whose previously ill, inattentive, insomniac and appallingly behaved children (often it’s a case of more than one problem) are now themselves again.

However, the website includes an assertion that could be controversial if the problem it refers to were better known. It appears to dispute the existence of ideopathic reactive hypoglycemia as a cause of behavioural problems in children (ideopathic is a fancy word doctors use when they haven’t a clue what causes something).

What is hypoglycemia?

Symptoms of reactive hypoglycemia include irritability, headaches, and mental confusion, and it’s also been linked with panic attacks, depression and anxiety.

It's a condition whose actual process doesn’t seem to be entirely clear, or perhaps it has differing causes. The amount of glucose in the blood becomes low for everybody several hours after eating. Hypoglycemia is related to the hormones adrenaline and cortisol, which the body produces at this time to prevent the blood sugar becoming dangerously low.

Hypoglycemics may produce too little cortisol, which is associated with underactive adrenal glands. Apparently, the symptoms of shakiness, poor memory and so on are a reaction to the adrenaline that is produced as a back up. Poorly functioning adrenals have been associated with food sensitivities. But the central question is: what is the ultimate culprit – the adrenals or the food sensitivities?

Stress has been shown to be a major cause of hypoglycemia. This also suggests that it's relates to adrenal functioning, as long-term stress puts pressure on the adrenals.

Earlier descriptions of hypoglycemia focused on the pancreas and claimed that in hypoglycemics it produced too much insulin as a response to the glucose in the blood, shifting the glucose into the cells and causing a sudden drop in blood sugar. It’s been said that the level of sugar in the blood is not necessarily the problem, but the speed at which the level gets lower.

However, I deliberately haven’t called this condition ‘low blood sugar’ ( a common term) because it wasn’t clear to me after a very basic internet research that the blood sugar of hypoglycemics becomes lower than that of non-hypoglycemics; certainly the blood glucose test has been discredited as a diagnostic tool.

Reactive hypoglycemia should not be confused with hypoglycemic reactions from diabetes, or hypoglycemia caused by serious conditions such as Graves disease and pancreatitis.

Early diets to combat hypoglycemia focused on removing concentrated sugar from the diet and emphasised complex carbohydrates (eg using brown instead of white rice). Following a brief ascension as a fad diagnosis, this condition is all too often routinely ignored by doctors. It seems that research is being done on it, particularly in the case of children, but in my experience that research hasn’t trickled down to GPs.

It’s unfortunate that a condition linked to food intolerance in some way is in fact the province not of allergists but of endocrinologists. The failure to find a cure for another condition that straddles more than one specialty – rosacea – indicates the neglect that can occur when more than one branch of medicine is involved.

What is candida?

More recently, hypoglycemia has been linked with candidiasis, the overgrowth of candida, a fungus, in the digestive system. While yeast overgrowth in areas such as the genitals (thrush) is recognised and treatable, the existence of candida overgrowth in the digestive system as a condition has remained controversial.

Also scientifically unproven are the supposedly associated symptoms of this overgrowth, such as fatigue, and the anti-candida diet to combat these symptoms. Like the hypoglycemia diet, the anti-candida diet removes sugar and emphasises whole foods but it goes much further, also excluding all foods that might contain mould, including fermented foods and drinks (eg conventional bread, beer) as well as aged foods such as cheese and processed meats. The theory is that you literally starve the yeast overgrowth in the gut. Like the Failsafe and hypoglycemic diets, the anti-candida diet acknowledges that some sufferers might also have allergies and intolerances, for example to gluten and dairy.

Candidiasis is linked to so-called leaky gut syndrome, in which damage to the bowel lining is seen as both a cause and effect of hypoglycemia and ever-worsening food intolerance. Wikipedia puts the status of this diagnosis beautifully:

While many practitioners maintain that leaky gut syndrome is a bona fide medical condition, the area of ‘gut problems’ lies between conventional and alternative medicine, and includes other diagnoses such as small bowel bacterial overgrowth syndrome or small intestine bacterial overgrowth (SIBO), and yeast syndrome or systemic candidiasis, and remains controversial and scientifically unsettled.

Disputing the role of sugar

Dengate (and perhaps the developers of the Failsafe diet) disputes both low blood sugar and candida as causes of unexplained symptoms. The website makes the unequivocal assertion that ‘Contrary to popular belief, sugar does not cause children's behaviour problems’.

It goes on to say:
When mothers swear their children are ‘sugar addicts’ whose behaviour is affected by sugar, they are generally surprised on going failsafe to find that their children are actually reacting to salicylates. Sugar craving can be a salicylate-induced reaction.

Similarly, feeling tired, weak and shaky can be a delayed reaction to food chemicals such as salicylates, rather than hypoglycemia.

This is a breathtaking claim. Dengate seems to be saying that food intolerances only mimic hypoglycemic symptoms rather than causing them.

Yet hypoglycemia itself is certainly a distinct phenomenon, even if it is caused or worsened by food intolerance.

Indeed, the website itself admits this elsewhere, seeming to suggest that sugar can play some role in behaviour if ingested on an empty stomach:

It is best to eat sugar as part of a balanced meal (e.g. in a dessert) rather than in drinks or treats on an empty stomach when it can affect blood sugar levels.

Even if we admit that it may not be blood sugar levels that are the problem but the body’s reaction to low blood sugar, why do some people exhibit these symptoms and not others? All this suggests to me the possibility that some children react to their food intolerances with hypoglycemic symptoms and some don’t (ie they have other symptoms). If that’s the case, surely those children with hypoglycemic symptoms should be taken off sugar for a while because it might put extra stress on an already oversensitised system, even if the sugar wasn’t the original culprit?

And does this mean that that if I continue on my low-salicylate, low-amine diet, eventually my system will right itself? (At this point in my diet it’s impossible to say whether I am ‘losing’ what Dengate believes is faux hypoglycemia, but at the moment I would not experiment with cane sugar in, as they say, a ‘pink fit’.)

The claim that sugar is not the villain it has been assumed to be does seem to be borne out by some evidence.

According to the website, a study that successively fed children three different types of sweeteners without their knowledge – sucrose (cane sugar), aspartame (an artifical sweetener) and and saccharin (as a placebo) – found that regardless of the type of sweetener, the children’s behaviour was unchanged.

The study took place over a nine-week period in which the children were fed a diet that changed each week, with the sweetener used in the food being changed every three weeks. Half the children in the study were chosen because they were believed by their parents to have problems with sugar.

However, the emotional language used to describe this study (‘definitive multimillion dollar study’) belies the reality. It used only 48 children, and no children were fed no sweetener at all. The anti-candida diet, unproven as it is, says that all forms of refined sugar exacerbate candida, including sorbitol.

What would have happened if the researchers had withdrawn concentrated sweetness completely from the diets of a control group? Perhaps nothing, but such an addition would have enhanced the efficacy of the study.

One reason why the website supports cane sugar may be that the Failsafe diet warns against artificial sweeteners, which have not been proven safe; in fact some of these sweeteners seem to act like poisons.

And to be fair, the website emphasises that the Failsafe diet should consist of unprocessed foods. Dengate has researched food additives and Australian labelling laws, and it seems that few processed foods are actually safe.

The website also provides information about a form of intolerance affecting some Failsafers: fructose malabsorption. Fructose is a natural sugar derived from fruit, and it’s now added to processed foods instead of cane sugar, for example in the form of corn syrup. Fructose malabsorption can occur alone or in conjunction with other food intolerances.

Too much fructose can affect the most hardy, but it causes all sorts of digestive problems for the intolerant. Fructose occurs in some vegetables as well as fruit, and the solution is to eat only fruits and vegetables with low fructose, and no processed foods containing fructose.

Finally, if Dengate is correct, it’s feasible that some people with food intolerances would show some improvement if they followed the anti-candida diet even if that diet were a crock, because it removes all processed foods. It does allow fresh fruit, however.

My experience

Reactive hypoglycemia is said to have many possible causes. One of these is adrenal exhaustion. My hypoglycemia became worse after I had a ‘breakdown’ (an unfashionable word now) at the age of 21, when my adrenals would have been under an enormous amount of stress. Quite possibly intolerance to amines and salicylates and reactive hypoglycemia exacerbated each other.

When I look back at my food history, giving up most cane sugar at the age of 21 or so had a marked effect, although at the time I was ignorant, like most people, about amines and salicylates. During the period of withdrawing from concentrated sugar I could hardly get out of bed. Sugar acted for me like a drug; but whether everyone giving up sugar would have had a similar reaction, or only people with reactive hypoglycemia, is something I can’t be sure about. However, for reasons unclear at the time I never completely ‘stabilised’, that is, felt normally clear-headed and energetic. And I haven’t since. So Dengate’s assertion is, to say the least, interesting to me.

However, before the diagnosis and before I drastically reduced cane sugar in my diet (I didn’t fully succeed in giving it up for at least three years), I do remember experiencing these occasional, awful feelings of a kind of cognitive emptiness, a sense of vacancy, and I’ve never felt that degree of vagueness and disorientation since giving up cane sugar. My sugar problem still seems a separate issue to me, even if it is at least partially caused by food sensitivities.

To complicate things further, I went to Europe at the age of 23 for five months, developed a full-blown eating disorder and shivered in freezing, mouldy rooms. This period saw a worsening of both my sugar and food sensitivities, and I’ve always associated it with the development or worsening of some kind of candida problem, or at least a sensitivity to mould.

So, despite my interest in Dengate’s assertion, my completely uneducated guess would be that a proportion, perhaps only a tiny proportion, of children with food intolerance might also have hypoglycemia or candidiasis as a separate problem; and if even these were related to food sensitivities, giving up all kinds of concentrated sugar mightn’t be a bad idea for these children, at least for a while until their systems had time to recover from their food intolerances.

There’s a common sense element here: some of the symptoms of ADD, such as vagueness and poor concentration, are also classic hypoglycemic symptoms. If the Failsafe diet doesn’t completely cure the problem, mightn’t it be worth finding out if the child has a separate sugar or candida problem? (You would need a few weeks to check this because the body becomes physically addicted to sugar, and there would be a period of withdrawal.)

But in this case, computer definitely says no. Dengate again: ‘It is counterproductive to try to combine failsafe eating with a candida diet’. Elsewhere on the site, she asserts that a thrush problem ‘does not mean you need to eliminate sugar and yeast. The so-called candida diet is not scientifically proven’.

That puts me between a rock and a hard place. At the moment my diet is extremely strict, and I’m now doing what the website warns against, which is combining Failsafe with anti-candida (this is making finding a suitable calcium supplement, um, interesting). But I’ve done nothing to remove salicylates from non-food products. The website warns:
As perfumed toiletries, cosmetics, airfresheners, scent sprayers and household cleaners mostly used by women have become increasingly pervasive and over-fragranced, they can push you over your salicylate limit.

I can’t help wondering if removing non-dietary sources of salicylates would help my hypoglycemia.

What worries me is that ideopathic hypoglycemia is already ignored by so much of the medical profession – the Failsafe diet will just make this worse.

Whew! In my final entry on this topic I’ll ask whether sugar is good for anybody, take a horrified look at the allergy food industry and present a very shaky, unscientific hypo-hypothesis about the links between reactive hypoglycemia and food intolerance.

See also Heroes and Villains Part 1 and Heroes and Villains Part 3.

1 comment:

  1. I'm suffering from the same things. These words will act as resources for me. Thank you.