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Spring 1996

Food Sensitivities & Fatigue
Diet could be a factor
By William G. Crook, MD

Many clinicians who work with chronic fatigue and immune dysfunction syndrome (CFIDS) patients have noted that sensitivities to common foods contribute to their patients' symptoms. I first learned of the relationship of food sensitivities to fatigue (and other symptoms) from the mother of a 12-year-old boy almost 40 years ago. She convinced me (against my will) that her son's fatigue, headache, muscle aches and depression vanished when she eliminated milk from his diet.

A short time later, I read several articles about the subject published in peer-reviewed medical journals.^1-3Each described persons with fatigue and other symptoms who improved (often dramatically) when they eliminated milk, wheat, corn and other common foods from their diets.

After reading these articles, I began putting some of my fatigued patients on elimination/ challenge diets. Although it did not help all of them, I was astounded and delighted when many of their chronic and often disabling symptoms disappeared when they stopped eating some of their favorite foods.

I first reported my observations on 50 children with food-related fatigue and other symptoms in a major pediatric journal over 30 years ago.⁴ I published other reports in the 1970s.

In the 1970s and 80s, other physicians described the relationship of food sensitivities to a diverse group of health problems in children and adults.^7,8 In spite of these reports, most allergists and other physicians continued to ignore this type of food sensitivity.

Why is this so? Here's one of the reasons: these sensitivities are not IgE-mediated and cannot be confirmed in the laboratory, yet they can be easily identified using an elimination/ challenge diet. On such a diet, a person avoids a number of his/her favorite foods. When convincing improvement is noted after one week, the eliminated foods are eaten again, one food per day, and reactions are noted. (See "The Elimination Diet" below.)

During the past decade, a number of observers have commented on health problems, including food sensitivities which develop when the gut flora is changed. In a comprehensive review of antigen handling by the gut, W. Allan Walker of Harvard Medical School commented, "There's increasing experimental and clinical evidence that suggests that large antigenically active molecules can penetrate the intestinal surface not in sufficient quantities to be of nutritional importance, but in quantities that may be of immunological importance."⁹

In another report, John Hunter, a British investigator, commented on adverse food reactions which occur in people with migraine, irritable bowel syndrome, rheumatoid arthritis and other disorders. In this discussion, Hunter said that patients with food intolerance have abnormal gut flora even though pathogens are not present. And he said, "If food allergy is not an immunologic disorder, but a disorder of bacterial fermentation in the colon, it might be more appropriately named an 'enterometabolic disorder.' This is of more than mere terminological importance: modern microbiology has opened the way to the manipulation of bacterial flora to allow the correction of food intolerances and thus the control of disease."

Based on my experiences in practice during the last 15 years, repeated use of antibiotics and resulting yeast overgrowth play a major role in contributing to food allergies and sensitivities. And many health professionals have found that a sugarfree special diet and nystatin, Diflucan and other antifungal medications play an important role in helping people with fatigue, depression, headache, muscle ache and other symptoms.

How is a yeast-related disorder identified? Although stool and blood tests may provide some useful information, the diagnosis remains a clinical one. George E Kroeker, MD, a board-certified internist said, "Unfortunately candida remains a disease in search of a laboratory test for diagnosis. The best test remains the history and one-month trial of antifungal medication and a sugar-free diet. I've tried to utilize antibody assays, cultures, etc., and they all fall short of diagnostic certainty."¹¹

References

1. Rowe AH: Allergic toxemia and fatigue due to food allergy West Med 1930;33:785.
2. Randolph TG: Allergy as a causative factor of fatigue, irritability and behavior problems of children. J Pediat 1947;31:560.
3. Speer F: The allergic/ tension/ fatigue syndrome. Pediat Clin N Amer 1954;1:1029.
4. Crook WG, et al.: Systemic manifestations due to allergy Pediat 1961;27:790.
5. Crook WG: The allergic/ tension/ fatigue syndrome. Pediat Ann April 1974.
6. Crook WG: Food allergy - the great masquerader. Pediat Clin N Amer 1975;22:227.
7. Deamer WC: Pediatric allergy: some impressions gained over a 37-year period. Pediat 1971;48:930.
8. Gerrard JW: Understanding Allergies. Springfield IL: Charles C. Thomas, 1973.
9. Brostoff and Challcombe: Food Allergy and Intolerance. Philadelphia: WB Saunders, 1987:209-222.
10. Hunter JO: Food intolerance. Lancet 1991;338:495.
11. Crook WG: The Yeast Connection and the Woman. Jackson TN: Professional Books, 1995:653-654.
    

Dr. Crook is author of Chronic Fatigue Syndrome and the Yeast Connection and The Yeast Connection and the Woman (items 3080 and 3200 on pages 63-64). He is a Fellow of the American Academy of Pediatrics, The American College of Allergy, Asthma and Immunology and The American Academy of Environmental Medicine. He is president of the International Health Foundation.

The Elimination Diet
Carrying out an elimination diet isn't easy Here are some of the things you'll need to do to succeed:

1. Before beginning your trial diet, discuss it with your family.
2. Carry out the diet at an appropriate time. Don't try it during a holiday
3. Before beginning a diet, keep a diary or symptom inventory for at least three days.
4. Continue the symptom diary while you're following the diet.
5. On the initial elimination diet, you can eat the following foods:
   ---any vegetable but corn, peas or beans
   ---any meat but bacon, sausage, hot dogs or luncheon meat
   ---rice, oats, barley and the grain alternatives amaranth, quinoa and buckwheat (available at health food stores)
   ---any fruit but citrus (also avoid any fruit you currently eat more than once a week)
   ---bottled, spring or distilled water and herb teas
6. On the initial elimination diet, avoid: milk, tea, coffee, Kool-aid, soft drinks, eggs, bacon, sausage, hot dogs, lunch meat, peanuts, peas, beans, corn, citrus fruit, any fruit you eat more than once a week, processed foods, sugar, wheat, chocolate, food colors, and dyes.
7. Continue the diet for 5-10 days, until there is convincing improvement in your symptoms lasting 48 hours.
8. To identify specific food sensitivities, eat one of the eliminated foods per day and note any reactions. Symptoms may occur within a few minutes, a few hours or the next day.

Note:If you have been bothered by asthma, severe hives, swelling or other serious allergic reactions, consult your physician before beginning an elimination diet.

From: "Detecting Food Allergies" by the International Health Foundation. Available from the non-profit International Health Foundation, Box 3494, Jackson TN 38303. A long, self-addressed, stamped envelope and a donation of $1.00 is requested. Dr. Crook provides a detailed discussion of the elimination diet in CFS and the Yeast Connection (item 3080 on pages 63-64.)

Signs and Symptoms of Food Sensitivity

• fatigue
• nasal congestion
• dark circles under the eyes
• headache
• muscle aches
• irritability
• abdominal pain
• hyperactivity
• attention deficits
• memory loss