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Friday 8 February 2019

Paranoia at the dinner table

What? 19 per cent of people report suffering a food allergy; 11 per cent actually suffer from one.

Why? Adult-onset allergies are really on the rise. Fear of food is both the psyche and science at work.

By Bee Wilson

Why are so many people in the modern world scared of food? A koala does not run in terror from its eucalyptus leaves. A dog does not see a meaty bone and tremble. Alone among animals, modern humans look at a perfectly edible and delicious plate of food and ask, is it #wheatfree?

Last month, a new large-scale study from the US caused a stir when it found that nearly half of those who think they have food allergies don’t actually have one. Here was confirmation of how deep and how wide our collective fear of food has gone. The study – which was published in Jama, the Journal of the American Medical Association – found that out of a sample of more than 40,000 adults, 19 per cent reported suffering from at least one food allergy, whereas only around 11 per cent were actually allergic to any foods. If this study is correct – and it’s worth noting that Jama is a very well established and respected peer-reviewed journal – then nearly one in ten Americans is suffering from a phantom food allergy. The researchers suggested that allergy testing should be offered to those who suspect themselves of being allergic, “to ensure food is not unnecessarily avoided and quality of life is not unduly impaired”.

This story will have given satisfaction to those who believe that “special diets” are just a form of fussiness. I’ve heard dinner party hosts – especially those of an older generation – saying how annoying they find it to be asked to cater for special food requirements from guests. They say it in a tone of voice that indicates they believe food allergies are all in the mind, dreamed up to inconvenience the cook. These dinner party hosts tend to ignore the other side of the picture on allergies, exposed by the Jama study, which is that food allergies are all too real, and modern medicine can neither tell us why nor offer a cure.

A couple of years ago, I heard a talk given at a nutrition conference by a food allergy doctor. He remarked that when it comes to allergies, we are currently living through two distinct epidemics. The first is the rising threat of life-threatening food allergies in the developed world. This epidemic is real and it is terrifying. Food allergies are serious conditions involving the immune system, in which the body responds to even tiny quantities of certain proteins as invaders. A whole host of common ingredients are now implicated in allergies, from peanuts to celery, from eggs to the sesame seeds that killed 15-year-old Natasha Ednan-Laperouse after she bought a Pret A Manger baguette at Heathrow airport in 2016.

But the allergy doctor remarked that there is also a second, much bigger, epidemic, which afflicts the millions of people who wrongly believe that they – or their child – have an allergy when they don’t. Stephen Till, a professor of allergy at King’s College London, has commented in The Guardian that he sees patients so convinced that they have a severe allergy when they don’t that they have put themselves on a very restricted diet to avoid the slightest suspicion of ingesting the “suspected culprit”.

In theory, dinner should be a delight, as well as a source of nourishment, so something strange is happening in our collective relationship with eating when we start to be quite so needlessly nervous of food. Some of this fear has been stoked by the gurus of clean eating, such as Gwyneth Paltrow, who suggest in their books that certain foods – from gluten to cheese to “night-shade” vegetables such as aubergines, tomatoes and peppers – are a cause of concern for much of the population rather than just for an unlucky minority. This kind of message can easily make a person look askance at everyday foods. Paranoia is not a healthy emotion to bring to the dinner table.

Then again, fear of food of one kind or another has been around for a long time. Just because we are omnivores does not mean that it is natural for us to eat everything. It has always been the case that ingesting the wrong substance in the wrong quantities could bring serious consequences. As omnivores, humans need to be both adventurous and cautious about new foods. That caution is called food neophobia and it is a survival mechanism. Back in our hunter-gatherer days, being slightly risk-averse in food selection could keep a person alive.

Harvey Levenstein is a professor of history and the author of Fear of Food: A History of Why We Worry about What We Eat (2012). He argues that “fear of what unseen hands might be doing to our food is natural to omnivores”. But, in Levenstein’s view, fear of food in America became a kind of national pastime from the 19th century onwards. Various medical experts encouraged Americans to look on food not with pleasure but with fear. First, Americans were terrified of invisible germs; then of lack of vitamins; then of excess chemical additives; then of fat. Levenstein argues that there is something puritanical in American culture that makes people susceptible to the view that all food is potentially toxic. Unlike in France, where food is still regarded above all as a pleasure, Americans have felt almost happy to be told by medical “experts” that they must avoid fat or cholesterol or salt, as the case may be, in the name of health.

When it appeared in 2012, Levenstein’s book did not cover food allergies, and I emailed to ask him what he made of the current fear of food generated by allergies and intolerances. He told me that when he wrote his book, he “deliberately avoided the ever-changing panoply of quacks and faddists, who start off with a grain of acceptable science and then ride it to ridiculous extremes … Were I to add a chapter on current trends to Fear of Food, I wouldn’t include the gluten-free and allergy/intolerance people, as they fall into this category, with virtually no support from mainstream science for their alarmism.”

I can’t help feeling, however, that the current fear of food allergies cannot be dismissed quite so easily. Is it still alarmism when the alarm is justified? In all the newspaper coverage of the Jama Network Open study, there was remarkably little discussion of the main finding of the paper, which was that prevalence of true food allergies in the US does seem to have gone up markedly, for reasons that are still being debated by scientists. It is staggering to think that nearly 11 per cent of American adults are now suffering from a true and potentially fatal food allergy. Previous studies had put that number at ten per cent, so it seems the numbers are creeping up.

There are indications that food allergies are on the rise everywhere, in Asia as well as the West. There is no agreement on what is causing this rise in allergies, though it is closely linked, in many cases, to eczema. The new thinking on how to prevent allergies is that exposing young children to tiny amounts of potential allergens, such as peanut butter, very young is actually better than delaying giving it to them, as parents were advised to do for decades.

In the UK, the number of people admitted to hospital with anaphylaxis doubled from 1998 to 2012 (from 1.2 per 100,000 to 2.4 per 100,000). Australia has the highest rate of food allergies in the world, a record attributed to various theories, ranging from the fact that Australian milk is not fortified with vitamin D to the zealous attitudes of Australian parents towards hygiene. Its emergency admissions for anaphylaxis have quadrupled since 1998.

Food allergy used to be regarded as mostly a problem of childhood – and indeed many children do eventually outgrow their allergies, particularly towards milk. But in recent years there has been an acceleration in cases of allergy among older children and teenagers, suggesting that ever more people will be forced to manage an allergy for their whole lives.

It is quite natural to be at least a little bit scared of food if you suffer from one or more of these allergies. Over Christmas, I got talking to a man at a party whose young daughter suffered from a range of allergies. He said since her condition started, he finds it alarming to be on a plane and to see row upon row of people eating tiny packets of peanuts in a confined space. Before he became a parent, he thought nothing of it. But now these peanuts look like miniature weapons, out to attack his child.

Symptoms of food allergy – which develop within minutes or hours – can include anything from swelling and hives to difficulty swallowing and trouble breathing. Fatalities from food allergies remain thankfully rare – around 200 cases a year in the US, for example – but every allergy sufferer knows that they do happen. The Jama study found that around half of sufferers had experienced at least one severe reaction and around half had an allergy to more than one food (the most common were shellfish, milk, peanut, tree nut and fish).

And then there are a whole host of food intolerances, from dairy to fructose, which can also be very unpleasant to live with, even if they don’t carry the same acute risks of an allergy. Most of the people in the study who misreported themselves as suffering from allergies were actually suffering from food intolerances. Unlike an allergy, a food intolerance will not put the sufferer in a state of anaphylaxis.  Intolerances do not generally involve the immune system, and you need to eat more than a small amount of the food in question to develop symptoms. But the result is still no fun. Symptoms – which vary from person to person and from food to food – include bloating, headaches, diarrhoea, nausea and tiredness.

The anxiety of living with food intolerances can be compounded by the fact that mainstream medicine is so poor – for poor, read completely useless – at diagnosing them or offering help. I have a friend who suffers from coeliac disease. For ten years, she periodically went to her GP and told him that foods with gluten made her feel awful, and asked whether she could be coeliac. “Oh no, you’d know if you had that,” the doctor kept telling my friend.

“When I was a child, the terminology was different,” says Michelle Berriedale-Johnson, who has been working in the area of food allergies and intolerances in the UK for more than 30 years. People used to say, she recalls, that “eggs/milk/pork/sweets/aubergines, etc, did not agree with you”. It wasn’t “medicalised as an intolerance”, she notes, and that probably made it less scary.

I remember people of my granny’s generation endlessly talking about whether something was digestible or indigestible. Nuts were indigestible and might make you “bilious”. Berriedale-Johnson feels that some of our fear of food in the modern age is really a form of nervousness “which may be based on a bad experience with some specific foods, but which is usually merely an expression of some deeper anxieties”.

On the other hand, living with a genuine food allergy or a severe intolerance is enough to make anyone a bit nervous. Those of us lucky enough to be unaffected should be kinder to allergy sufferers. Berriedale-Johnson observes that the “genuine and significant rise in allergy” means that there really is something there to be “quite reasonably afraid of”. She notes that peanut allergy in children in the UK has gone up from one in 500 to one in 50 in just 30 years. Her website, Foods Matter, publishes expert advice and guidance on how parents of children with allergies can manage to be vigilant while also reassuring their children that food is a good and life-enhancing thing. The key thing, she says, is not to “scare the life out of them so they become nervous wrecks”.

This sounds like advice that anyone living and eating in the modern world could use. We are not necessarily wrong to be scared of our current food supply. But the question each of us has to figure out for ourselves is how we get beyond that fear and back to pleasure.

Further reading:

https://www.foodsmatter.com

A great source of well researched information for allergy sufferers, ranging from scientific reports to blogs to recommendations for the best ‘free-from’ food products. Created and edited by Michelle Berriedale-Johnson

Ruchi Gupta et al ‘Prevalence and Severity of Food Allergies Among US Adults’ JAMA New Open January 4 2019

The Allergy-Free Family Cookbook by Fiona Heggie and Ellie Lux. “But what can I feed them?” is the question every parent of a child with allergies has to navigate. Here is a collection of simple family recipes tailored to allergies, from nut-free chicken korma to shepherd’s pie without the celery.