You often pay a premium for a gluten-free product, so at the very least you want it to taste good. For Coeliac Awareness Week we take a look at the gluten-free highlights from our blind taste tests.

Hot cross buns

This year we included gluten-free hot cross buns from Coles and Woolworths in our taste test – the traditional fruit and chocolate offerings from each brand.

While, overall, gluten-free buns scored poorly compared with regular versions, the following – both with a ÌÇÐÄVlog Score of 56% – are the best tasting, according to our expert judges:

Traditional fruit: 

• Coles Gluten Free Fruit Hot Cross Buns $3.50 per 3-pack ($1.17 per bun)

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• Woolworths Free From Gluten Choc Hot Cross Buns $4.50 per 4-pack ($1.13 per bun)

White bread

There’s a decent range of gluten-free alternatives to this grocery list staple in supermarkets. So which is best? 

Our expert judges tasted and scored 30 sliced white breads, six of which were gluten-free. Of these, the following came top, both with a ÌÇÐÄVlog Score of 77%:

• Aldi Has No Gluten Free Sliced White Bread $3.99 per pack ($0.80 per 100g)
• Coles Gluten Free White Bread $4.50 per pack ($0.90 per 100g)

They both have their selling points – the Aldi bread is a little cheaper, but the Coles bread contains a higher proportion of Australian ingredients (63% compared with 58%).

Yeast extract spreads (‘mites’)

In our blind taste test of nine vegetable or yeast extract spreads, 31 ÌÇÐÄVlog staff voted for their favourite. 

Five of the products on test were gluten-free, and of these the following were voted as best tasting, both with a ÌÇÐÄVlog Score of 55%:

• AussieMite Yeast Spread ($2.20 per 100g)
• Vegemite Gluten Free ($2.09 per 100g)

They might both taste equally good but, if it’s the Aussie factor you’re after, the Vegemite product contains more Australian ingredients (97% compared with 37%).

Premium ice cream

Taste-testing 11 premium vanilla ice creams was a tough job for our expert judges, but they dedicated themselves to the task. 

Six of the products either made a ‘gluten-free’ claim on the label, or didn’t include gluten/wheat in their ingredients list or in their on-pack allergen declarations (including ‘may contain’ precautionary statements). Of these, the best tasting, with a ÌÇÐÄVlog Expert Score of 79%, was:

• Sara Lee French Vanilla $9 per litre ($0.90 per 100mL)

The post Which gluten-free hot cross buns, bread and ice cream taste best? appeared first on ÌÇÐÄVlog.

The misery of hay fever is nothing to sneeze at – but help is at hand. We take you though the options when it comes to allergy relief and help you choose the right medication for your symptoms. 

What is hay fever?

Hay fever is an inflammation or swelling of the nasal lining, which may cause congestion, a runny nose, itchy throat, watery or itchy eyes and/or sneezing. Hay fever has two forms:

• Seasonal allergic rhinitis tends to occur in spring and summer due to an allergy to pollen from grass, weeds and trees.
• Perennial allergic rhinitis has similar symptoms and may be triggered by dust mites, animal dander (particularly that of cats) or mould spores, and can occur throughout the year.

Affecting almost 20% of Australians, hay fever can have a significant impact on sufferers, causing lack of sleep and reduced productivity at work or school. Although it can’t be cured, the symptoms can be managed to some extent. An allergy test can determine the source of the problem, which in turn can help with prevention and treatment strategies – avoiding or limiting exposure, for example.

Hay fever treatment options

Antihistamines and corticosteroids are the mainstays, but there are several other treatments which may suit some sufferers.

Top tips for taking hayfever medication

• If you’ve never taken hayfever medication before, or are trying a new drug, it’s a good idea to consult your doctor or pharmacist to make sure it’s safe for you.
• People respond differently to different drugs, so if you’ve tried one type of antihistamine or corticosteroid and found it didn’t help, try another.
• All hayfever medications have side effects, can interact with other drugs, and shouldn’t be used by people with certain conditions or with allergies to ingredients.
• If you’re pregnant or breastfeeding, ask your doctor whether the potential benefits of medication outweigh the risks.
• Before giving hayfever medication to a child under 12, consult your doctor for advice – some medications aren’t suitable for young children, and some come in a child-friendly form such as drops or syrup. Read more about treating kids for hay fever.

The post What’s the best hayfever treatment? appeared first on ÌÇÐÄVlog.

On this page:

• Mandatory vs voluntary labelling
• How real is the risk?
• To eat or not to eat…

But labels warning that a food “may” contain an allergen, rather than definitively stating that it does, can be frustrating, confusing and – when they’re commonplace – dangerously tempting to ignore.

Voluntary advisory labels on packaged foods, such as “May contain traces of…” or “Manufactured in a facility which also processes…” have increased recently, with one study finding these now appear on more than half of all packaged foods in Australian supermarkets. Not surprisingly this is causing some confusion.

Mandatory vs voluntary labelling

Food allergy affects around one in 20 children and two in 100 adults, and even a trace amount of the food they’re allergic to can cause a reaction.

So it’s mandatory for peanuts, tree nuts, milk, eggs, sesame seeds, fish, shellfish, soy, gluten, wheat, lupins and sulphites in concentrations of 10mg/kg or more to be listed as allergens on food packaging if they’re included as an ingredient.

However, voluntary advisory labels (known as precautionary allergen labels or PALs) can also be placed on packaging by manufacturers to warn that there may be accidental cross-contamination with allergens during the processing of food. 

For example, a chocolate bar may not contain nuts, but if it’s made in a factory that makes other foods with nuts, there’s a risk that tiny traces or even a fragment of nut may contaminate the bar.

As there’s no standard wording, font or style specified, manufacturers can use whatever wording they like – making the huge variety of so-called precautionary warnings confusing for consumers.

“Labelling is a big issue,” says says Dr Rob Loblay, allergy unit director at the Department of Clinical Immunology, RPA Hospital, Sydney. “It’s easy for people to miss allergen information, and they often only find it after a reaction when they go back and look at the packet. The print is too small and hard for older people to read, and packaging can sometimes fold over, obscuring the warning.

“I’d like to see a recognisable standard health information panel on all packaging that is separate to the ingredients list and contains allergen warnings, additives and health claims. That way, everyone knows where to look.”

How real is the risk?

It’s impossible to know, but Murdoch Children’s Research Institute (MCRI) in Melbourne found 90% of the top five foods at risk of contamination – chocolates, breakfast cereals, muesli bars and savoury and sweet biscuits – now carry a PAL, and more than 50% of packaged processed foods in Australian supermarkets show these precautionary warnings.

A study by the MCRI found that 80% of parents of children with a history of anaphylaxis did not know if a food with a precautionary warning is safe, irrespective of the wording.

Only five percent felt they could “completely trust” food labels, and tended to ignore warnings because they perceived them simply as a way for food manufacturers to cover themselves legally.

When tested, only seven percent of the high-risk products with warning statements about peanuts actually had detectable levels of the nut. Other samples that had precautionary labelling for hazelnut, milk, egg, soy or lupin had no detectable level of those allergens present at all.

On the other hand, some packaged food that carried no cautionary labelling has been shown to cause anaphylaxis. Results from a 2018 survey of Australian allergy sufferers published in The Journal of Allergy and Clinical Immunology: In Practice,  found that 6.7% with known allergies had self-reported an anaphylactic reaction to packaged foods where the allergen was not listed as an ingredient. Of those reactions, 53.5% were reportedly from foods that didn’t contain a voluntary warning statement for the suspected trigger food and 8.6% didn’t have any PAL at all .

As a result it’s up to the consumer to decide, with no real information, whether to take the risk of eating a food, and people with serious allergies are left with a diminished choice of products they can consume with confidence.

To eat or not to eat…

It all comes down to a personal assessment of risk, with the help of your doctor, says Loblay. “Some people will find a food with a warning hasn’t affected them in the past and doesn’t affect them now and they continue to eat the food. Others won’t feel confident to take the risk.

“Despite the concerns of many people with coeliac disease, most can tolerate 20 parts per million of gluten, so occasional trace amounts aren’t such a huge issue,” he says. “But for those allergic to nuts, a fragment – a quarter of a peanut in a food – can be life-threatening.”

Some brands of chocolate that don’t list nuts can have nut traces, so Loblay advises anyone with a nut allergy to be wary of eating chocolates labelled ‘may contain nuts’ and only buy those labelled ‘nut free’.

People with certain severe allergies need to take ‘may contain’ messages very seriously, and call the manufacturer for advice if unsure. And it’s not always as simple as trusting a brand that you know to have been allergen-free in the past, as labelling and packaging is often confusing – and can change without warning.

In March 2018, nine-year-old Melbourne girl Isabel Marrero died after eating a Cadbury chocolate chip cookie that contained traces of egg. The packaging was near identical to another Cadbury chocolate chip cookie that she regularly ate because it didn’t contain egg. Cadbury has since updated the packaging.

In April this year Melbourne woman, Kaley Drummond, who is allergic to both nuts and lactose, ended up in intensive care after eating an Aldi chocolate Easter bunny labelled “Milk Fine” which she misread as “Milk Free”.

In response to Kaley’s reaction, Allergy and Anaphylaxis Australia has publicly called on the manufacturers of the chocolate to “improve labelling to make it clearer for consumers with food allergies”.

The VITAL solution

If many foods with warnings don’t actually have allergen contamination, then why are manufacturers using unnecessary warnings?

“Allergens were not on the radar of manufacturers last century, but after mandatory allergen labelling began in 2002, most big manufacturers cleaned up their act,” says Loblay. “However, avoiding all cross-contamination in a factory that makes different products requires a lot of time and investment – and in some cases, building separate facilities. In the small Australian market, this may not be cost-effective.”

The good news is that there is a solution to this label confusion. The bad news is that it’s not being widely used.

 (Voluntary Incidental Trace Allergen Labelling) is a process to assess cross-contamination risk. Developed by food manufacturers, the industry group Allergen Bureau,  and allergy support groups, it estimates the risk of cross-contamination in a factory and can tell if a product will be safe for 90% of people.

Under VITAL, a ‘may be present’ warning should only be placed on packaging by a manufacturer if the risk of contamination is assessed to be above a certain level.

It’s a great idea but…

While VITAL can provide consumers with clarity around risk levels, there’s currently no way for people to know whether a product has been through the VITAL risk assessment or whether the manufacturer is adding the warning just in case.

Research from MCRI in 2012 also found that only 12.7% of foods with precautionary labels surveyed had been through the VITAL process, which means the other 87.3% of warnings are likely to be placed on products as an insurance policy for the manufacturer.

Would a VITAL logo work?

One option could be that manufacturers whose products have been put through the VITAL process would carry a VITAL logo so consumers could be confident that the risk had been assessed. Some allergen labelling advocacy groups would also like the VITAL process to be made mandatory for all food manufacturers, in order to reduce the number of unnecessary precautionary warnings.

“The idea is that VITAL can define the level below which 90% of people will not have an allergic reaction,” says Loblay. “VITAL may be useful to prevent acute anaphylaxis, but traces can still be a problem for the most sensitive people who must avoid all contact.”

He prefers a harder line: “Food companies should be forced to use ‘may be contaminated with’ rather than the less confronting ‘may contain’. This would spur the food industry to put more effort into developing allergen-free foods, which would make it easier for consumers to trust the labels.”

Sharing the responsibility

Maria Said from  applauds the efforts of the Allergen Bureau and the food industry to improve labelling, but explains VITAL is still a work in progress to make warnings more believable for consumers.

“Food labelling in Australia has made great strides and is leading the world,” says Said. “But we still have a way to go when it comes to food safety for those with a food allergy. Although most anaphylaxis occurs outside the home and in food service outlets, packaged foods continue to be recalled at alarming rates. In recent years, due to deaths from cow’s milk allergy and sesame allergy, regulators, enforcement officers, food industry and food service staff are sharply more aware of food allergens and not just peanuts or tree nuts.”  

The big players in the food industry are making an effort, she says, but it’s the resource-poor smaller businesses that need more information and support from  about how to label their products correctly.

“While a ‘may contain’ label may be less than perfect, a product with no precautionary label can be more dangerous if the manufacturer isn’t educated about the risks of cross-contamination.”

And when it comes to the food service industry, many businesses may not understand that when a customer says they have an allergy, it’s illegal to serve them food containing allergens they need to avoid.

Said is calling for the food service industry to acknowledge food allergy as a serious safety issue, as well as for a national allergy management education plan. She urges staff in food businesses to complete the free online training for food service at foodallergytraining.com.au.

“We applaud food service staff who do their best to accommodate the needs of people with food allergy,” she says. “The risk of reaction cannot be eliminated but there is lots staff can do to reduce their risk. And importantly, individuals with food allergy need to be reasonable in their requests and always have their emergency medication with them.”

Said also says that while consumers have a primary responsibility to care for themselves if they have a food allergy, the entire community has a role to play. “Gyms, Sunday school morning teas, a volunteer parent on a Scout camp – you too have responsibilities,” she says.

The post Food allergen warnings appeared first on ÌÇÐÄVlog.

On this page:

• What's a 'FODMAP'?
•  Who should try a low-FODMAP diet?
• Can it cure people of IBS?
• What is a low-FODMAP diet?
• Can I DIY the FODMAP diet?

Recently you might have heard of the low-FODMAP diet (sometimes referred to as LoFo). So what is it, who is it for and what are its benefits? It’s often recommended for people with irritable bowel syndrome (IBS). But does it work?

What’s a ‘FODMAP’?

FODMAP is an acronym for a group of short-chain carbohydrates (sugars):

• F±ð°ù³¾±ð²Ô³Ù²¹²ú±ô±ðÌýOligosaccharides (e.g. fructans and galacto-oligosaccharides)
• Disaccharides (e.g. lactose)
• Monosaccharides (e.g. excess fructose) and
• Polyols (e.g. sorbitol, mannitol, maltitol, xylitol and isomalt)

These sugars are fermented by the bacteria that live inside our intestines and are present in many of the foods we eat. Common high-FODMAP foods include garlic, onions, apples, milk, mushrooms, bread and chickpeas, among many others.

For 85% of the population, the fermentation of these sugars isn’t an issue, but for one in seven people, some high-FODMAP foods can trigger the uncomfortable and potentially debilitating symptoms of irritable bowel syndrome (IBS). For these people, the low-FODMAP diet can be life-changing.

 Who should try a low-FODMAP diet?

The low-FODMAP diet isn’t for everybody; you won’t lose weight on it, burn tummy fat or improve your general health. 

In fact, without an IBS diagnosis from a doctor or dietitian, embarking on this highly restrictive diet has the real potential to cause unnecessary damage to the health of your gut microbiome.

But, if you do have IBS, the short-term Monash University Low-FODMAP diet is a diagnostic tool that can help you identify your trigger foods, and reduce and manage your IBS symptoms in the long term.

Can it cure people of IBS?

No, but it can help you manage symptoms.

There’s no known cure for IBS. It’s a chronic condition that needs to be managed long term, which is where the low-FODMAP diet comes in. 

Recent studies have revealed the low-FODMAP diet reduces IBS symptoms for around 86% of people. In addition, symptoms can continue to improve with the reduction of triggering high-FODMAP foods for a long time, provided these foods are avoided or significantly limited.

“The idea is to settle the symptoms right down,” says Nicole Dynan, accredited practising dietitian and spokesperson for the Dietitians Association of Australia (DAA).

“So, it might just be that you’ve been overloading yourself with that particular sugar group, and if we find your personal tolerance level then there’s no reason you can’t go on tolerating an amount of that particular group.”

What is a low-FODMAP diet?

Monash University’s Department of Gastroenterology launched a major study in 2005 to see if IBS could be managed through diet, and found four classes of short-chain carbohydrates (sugars) that were poorly absorbed in the small intestine. 

These sugars attract water into the bowel, and when they reach the large intestine they’re fermented by the resident gut bacteria and, in combination with a sensitive gut, can result in IBS symptoms such as bloating, distension, pain, constipation and diarrhoea.

Over the years the Monash University research team has shown in numerous studies that a diet low in high-FODMAP foods can help ease the symptoms of IBS. 

Subsequently, the team developed the Monash University Low-FODMAP diet, now considered frontline therapy for IBS around the world.  

How does it work?

The first thing you should know about the low-FODMAP diet, says Associate Professor Jane Muir, Head of Translational Nutrition Science in the Department of Gastroenterology at Monash University, is that it isn’t just another fad diet.

“It is important to emphasise here that the low-FODMAP diet is a diet therapy for a medically diagnosed condition – IBS,” she says.

Muir describes the FODMAP diet as three-phased.

Step one: “Patients swap high-FODMAP foods for low-FODMAP alternatives, thus lowering their overall FODMAP intake, which they follow for around two to six weeks,” she explains.

“If they notice an improvement in their IBS symptoms in step one, they progress to step two.”

Step two: This should take between eight and 12 weeks and involves introducing high-FODMAP foods back into the diet, one at a time, and increasing the amount each day to determine which foods trigger IBS symptoms, and how much can be tolerated.

Step three: A ‘personalised’ low-FODMAP plan for the future is devised, which is minimally restrictive and intended to maintain an adequate level of symptom control.

“Well-tolerated foods and FODMAPs are included in the personalised FODMAP diet, while poorly tolerated FODMAPs are restricted, but only to a level that is necessary to maintain adequate symptom control,”  says Muir.

For short-term use only

The low-FODMAP diet is a diagnostic tool and isn’t recommended for long-term use.

“The effect of FODMAP restriction on the gut microbiota occurs because some FODMAPs (e.g. fructans and galacto-oligosaccharides) are a fuel source for good bacteria in our gut; that is, they’re ‘prebiotics’,” says Dr Jane Varney, research dietitian with the Department of Gastroenterology at Monash University.

“If poorly implemented, the diet can also restrict intake of some nutrients, such as calcium and fibre. This is one reason why we strongly recommend people only implement the diet short term – and under the guidance of a FODMAP-trained dietitian.”

How to start a low-FODMAP diet

The first thing you should do, if you haven’t already been diagnosed with IBS, is to go to your local GP and have tests done to rule out other medical conditions that present a range of similar symptoms, such as coeliac disease, gluten sensitivity, anxiety, depression and stomach or colon cancer.

Then, get a referral from your GP to a DAA-qualified dietitian who has expertise in food intolerances and the low-FODMAP diet.

“Go to the DAA website and search for an Accredited Practising Dietitian in your area,” Dynan says.

Under the supervision of your dietitian, you’ll embark on stage one of the low-FODMAP diet and remove all high-FODMAP foods from your diet for a specified length of time. 

Some of the more common high-FODMAP foods, along with their low-FODMAP alternatives, are as follows:

Dynan says she provides any IBS patients embarking on the low-FODMAP diet with resources from the (GESA).

“We look through lists of common foods they might be eating that are in the high-FODMAP lists and we highlight them,” she says.

“Then I show them a sample diet and what they’re able to actually eat in that first phase, swapping high-FODMAP foods for low-FODMAP foods.”

To ensure her patients maintain good nutritional balance throughout the process, she also recommends they download the (iOS, $12.99/Android, $9.50).

“It’s a traffic-light system for high- and low-FODMAP foods and it guides them so they’re able to implement the diet really effectively. The app also has recipes on there and things like that… it’s a great resource,” says Dynan

People may experience almost immediate relief from IBS symptoms during the initial phase of the diet, however, it’s important for gut health not to remain in this phase for an extended period of time. 

Once high-FODMAP foods are recognised as the culprits, moving into the reintroduction phase works to determine which high-FODMAP foods trigger IBS symptoms, and how much of these foods the body can tolerate.

Medicare subsidies

Medicare provides for people with long-term chronic health conditions, which subsidises appointments with allied healthcare professionals – in this instance, a dietitian.

“It’s up to your GP to determine if your condition qualifies,” says Dynan. “If it does, for each of the subsidised consultations via Medicare you get a $52.95 rebate off the cost.”

Can I DIY the FODMAP diet?

It’s not advised. IBS symptoms mimic those of many other gastrointestinal disorders, such as coeliac disease, inflammatory bowel disease and bowel cancer, so it’s important that these are ruled out and an IBS diagnosis is made by a medical doctor before embarking on the FODMAP diet, explains Muir.

“Individuals who are experiencing gastrointestinal symptoms should consult their doctor, and once the diagnosis of IBS is made, the doctor can refer them to a qualified dietitian to explore the use of diet therapy to control the symptoms,” she says.

The low-FODMAP diet is a highly restrictive diet that, without the supervision of a dietitian,  may result in inadequate fibre, calcium and other essential nutrients. A dietitian ensures the diet is implemented properly to achieve the best diagnostic results, and that nutrient requirements are met.

The role of the dietitian

Dynan says a dietitian plays an essential role in the low-FODMAP diet.

“I had one chap come in, in his 40s. He’d been to every doctor, every specialist, had every scan, every test, every scope possible because he’d had chronic diarrhoea for two years and he couldn’t get resolution on it,” she says.

“[After doing the low-FODMAP diet] it came down to onion for him and he came back two weeks later and said to me, ‘I can’t believe I went to professors, all the gurus, and it’s the little dietitian who solved my problem’.”

The food industry is taking note

As more people learn about the impressive success for IBS sufferers on the low-FODMAP diet, canny food manufacturers are producing food products to cater to the growing number of FODMAP adherents. But are they worth the added cost?

“When I first started seeing FODMAP products on the supermarket shelves twelve or so months ago, I was actually quite shocked,” says Dynan.

“It’s a medical diet, not something that the public should really be embarking on on their own.

“Also, these products aren’t necessarily healthier. As with anything processed … you should look carefully at the nutrition label for things like salt, saturated fat and sugar content.”

Increased convenience

That said, these readily accessible products do offer increased convenience for consumers on a low-FODMAP diet.

“We’re all very time poor so it does give people who are on the diet easy choice, and there’s obviously a demand for them,” says Dynan.

Monash University’s food certification program stamps a wide range of foods in Australian supermarkets suitable for those following step one and step two of the low-FODMAP diet. 

“All products included in the Monash University Low-FODMAP Certified^TM program have been laboratory tested by the independent team at Monash University, using validated scientific methods to ensure they meet the low-FODMAP criteria,” Varney says.

FODMAP Friendly is another low-FODMAP certification stamp, which claims to be the “only registered certification trademark worldwide certifying FODMAP levels in food products that have been laboratory tested to be low in FODMAPs” and designed to enable people with IBS to “shop and eat with confidence”.

Increased cost

But these low-FODMAP certified products do come at a significantly increased cost compared with foods that are naturally low FODMAP. Varney says there are a number of reasons why this may be the case.

“Specialty products often include ingredients that are more expensive, production volumes may be lower (meaning there are more overheads to cover per unit of production) or there may have been significant investment in the development process to ensure that flavours and textures are optimal,” she says.

“There are also costs associated with certifying low-FODMAP products, and food labelling laws in Australia prohibit manufacturers from making claims about FODMAP content without inclusion in a certification program.”

The post What is a low-FODMAP diet? appeared first on ÌÇÐÄVlog.

On this page:

• Common food allergies
• Common food intolerances
• Testing
• Other medical tests
• Unproven tests
• Why getting the right test matters

While perplexing to those with genuine allergies, some people are willing to go to great lengths to be “diagnosed” with allergies or food intolerances – and plenty of people are willing to take their money and tell them what they want to hear. Offered by naturopaths and other natural health practitioners, or over the internet, unfortunately many of these popular tests lack credibility.

In this article we look at some of the most popular alternative tests on offer and find out which ones actually work.

Allergy vs intolerance vs sensitivity

An allergy is when the body’s immune system reacts to proteins in food or other substances like pollen, nickel, pet dander, bee stings and medication. This can result in itching, coughing, wheezing, vomiting, rashes or runny nose, and at its most severe, anaphylaxis.

Coeliac disease is not an allergy but an autoimmune disease affecting about one percent of the population (with possibly more who are undiagnosed), where the immune system reacts abnormally to the protein gluten and attacks and damages the lining of the bowel.

A food intolerance, on the other hand, is not based on an immune response and doesn’t show up on allergy tests. Symptoms can include headaches or migraines, hives, nausea and other gut symptoms. ‘Food sensitivity’ or ‘hypersensitivity’ are terms sometimes used instead of intolerance or allergy respectively.

Common food allergies

According to the Australasian Society of Clinical Immunology and Allergy (ASCIA), there are nine foods that cause 90% of food allergic reactions: 

• cow’s milk
• egg
• peanut
• tree nuts
• sesame
• soy
• fish
• shellfish and 
• ·É³ó±ð²¹³Ù.Ìý

More than one in ten one-year-olds have food allergies, though many outgrow them – about two percent of adults have food allergies.

Common food intolerances

It’s harder to measure the prevalence of food intolerance in the population, as many people claim food intolerances but don’t have them formally tested and diagnosed. Common food intolerances include:

• Lactose – A sugar found in milk for which some people lack the enzyme needed to break it down, causing gut symptoms (bloating, pain, diarrhoea).
• Amines – Chemicals that cause blood vessels to expand, resulting in flushing, congestion and migraines. Sources include some fruits and vegetables, wine, chocolate and cheeses.
• Sulfites – Preservatives used in drinks and dried fruit, can cause wheezing and other respiratory symptoms.
• Salicylates – Aspirin-like compounds found in certain herbs, spices, fruits and vegetables. Can cause a range of symptoms including asthma-like symptoms, congestion and headache.
• Glutamates – Found in camembert, parmesan cheese, tomatoes, soy sauce and mushrooms.  Symptoms may include headache, hives and nasal congestion or runny nose.
• FODMAPs – Among people diagnosed with irritable bowel syndrome (IBS), there seems to be an intolerance to certain sugars referred to as FODMAPs – fermentable oligo-, di-, and mono-saccharides and polyols. A diet low in FODMAPs has been found successful in resolving symptoms in 50-86% of patients. A low-FODMAP diet usually significantly reduces the amount of grains, fruits and vegetables, dairy and legumes that you eat. It should be done under the supervision of a dietitian trained to administer the diet to avoid nutritional deficiencies. 
• Gluten – One of the most controversial food intolerances is gluten. Also known as non-coeliac gluten sensitivity, gluten intolerance is associated with gut symptoms such as bloating, diarrhoea and nausea, as well as fatigue and psychological symptoms such as depression and brain fog.

Gluten intolerance

With gluten increasingly demonised over the last decade in alternative health and food faddism circles, many Australians who are not coeliac or allergic to wheat buy gluten-free versions of foods at least sometimes, and up to nine percent of Australians claim to be gluten intolerant. But this number is likely to be an overestimate of the true prevalence of gluten intolerance.

It’s not uncommon to experience fewer gut symptoms when giving up gluten-containing foods, as people eat less in general, but it may not be due to the gluten.

Because the symptoms attributed to gluten intolerance overlap those of IBS, it may well be that people who get symptoms from eating bread and pasta and other gluten-containing foods are actually reacting to FODMAPs in wheat rather than the gluten protein.

Studies have found that some self-declared gluten-intolerant people have their symptoms resolve when following a low-FODMAP diet, and when challenged with gluten protein suffer no symptoms. While to most intents and purposes eating ‘gluten’ means eating FODMAPs as well, some gluten-free products may contain FODMAPs that should be avoided. And if FODMAPs are the problem, it would be better to deal with all relevant foods, not just grains.

Testing

The key to managing food allergies and intolerances is an accurate diagnosis of the foods causing the problem. The type of test you have depends on whether you have a suspected allergy or an intolerance.

Recommended tests

Allergy tests

The gold standard test for allergies is a skin prick test. This involves placing a drop of suspected allergens on the skin, which is then pricked with a lancet allowing the allergen extract to enter the skin. A reaction at the site, such as an itchy lump, likely means an allergy to the substance – whether food, pollen, cat dander, dust mites, bee sting and so on.

If the skin prick test can’t be carried out – for example if the patient has eczema, has taken anti-histamines in the last week, or if a severe reaction may be expected – another test is a specific immunoglobulin E (IgE) test, formerly known as the RadioAllergoSorbent Test (RAST). This test measures antibodies against specific allergens, with a separate test required for each suspected allergen.

Skin prick and specific IgE tests are covered by Medicare.

Coeliac test

Family history and blood tests can indicate the possibility of coeliac disease, but diagnosis can only be confirmed by taking a biopsy of the small bowel and checking for damage.

Food intolerance testing

The gold standard for food intolerance testing is a temporary elimination diet followed by a controlled food challenge to identify dietary triggers. Under the supervision of an accredited dietitian and a medical practitioner, foods suspected of causing symptoms are removed from the diet, and when symptoms are gone the food is reintroduced to see if symptoms return.

Other medical tests

Some tests, while scientifically plausible and useful in some situations, aren’t as reliable or informative as the recommended tests, and are not recommended by ASCIA under general circumstances.

Breath hydrogen tests

Malabsorption of fructose and lactose, often associated with gut symptoms such as bloating, gas, pain and diarrhoea in people with IBS, can be detected using breath hydrogen tests. It’s based on the notion that hydrogen on the breath comes from fermentation of poorly absorbed carbohydrates. After following a special diet low in fermentable sugars, the patient is given a dose of sugar (fructose or lactose) and the hydrogen arising from malabsorption can be measured. While these tests are widely used, there have been issues with reliability of the method and interpretation of results.

Total IgE antibodies

While genuine allergy tests measure IgE antibodies directed at specific allergens, total IgE tests measure the total number of antibodies in a blood sample. Any increase in IgE antibodies could be due to allergies, but also parasitic infections and other medical conditions. On the other hand, people with allergies may have normal total IgE levels.

Eosinophil testing

Eosinophils are a type of white blood cell that may be higher in people with allergies. However, as with total IgE, raised levels could be due to another cause, and they may appear at normal levels in people with allergies. So, a test result that shows a high eosinophil count isn’t necessarily helpful for an allergy diagnosis.

Unproven tests

“I did the IgG test one-and-a-half years ago. I was strong for brazil nuts, kidney beans, cow milk and almonds. Also issues with egg white and tomatoes. Ironically it didn’t show up wheat/gluten which I know 100% that I am intolerant too. I have also done an IgE test which did not show up gluten. I followed up by going to a naturopath who uses a Vega machine – finally, a test that showed I was intolerant to gluten.” – Rebecca

There are many other tests on offer over the internet or from alternative health practitioners such as naturopaths and chiropractors that haven’t been proven to work. ASCIA estimates that around half of all people with allergies consult alternative therapists each year.

The tests below have been criticised for various reasons, including lacking any scientific plausibility, lacking correlation with medically accepted tests and giving inconsistent findings when repeated in the same person.

IgG tests

One of the most common alternative allergy and food intolerance tests is an IgG test (not to be confused with IgE tests), with brands like ImuPro and Hemocode. They’re widely offered by naturopaths and other alternative practitioners, or can be done yourself by mail order. These claim to test for almost three hundred different foods using a drop of your blood, at a cost of hundreds of dollars.

The claim is that if you’re allergic or intolerant to a particular food, you’ll have certain antibodies which can be detected in the test, and it also tells you the degree to which you’re sensitive.

Experts say that while IgG does play a role in allergic response, the tests don’t tell you anything useful. The antibodies detected simply reflect what you’ve eaten – so exposure rather than intolerance. They also find that for people who are growing out of allergies – which happens in kids especially – the level of IgG antibodies goes up.

Tests have found that people with known genuine intolerances, proved by elimination diet and oral challenge, don’t show raised IgG antibodies. 

According to ASCIA, “there is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms”.

Cytotoxic and ALCAT tests

Cytotoxic tests (“Bryan’s test”) are based on observing changes to white blood cells after exposing them to potential allergens, while the antigen leucocyte cellular antibody test (ALCAT) measures changes in the white blood cell diameter after being challenged with specific food substances to detect intolerances.

Hair analysis

Hair analysis claims to test for allergies or intolerances to up to 600 different food and non-food substances using technology that is “based on quantum physics and incorporates the principals of [Electro-acupuncture According to Voll] EAV, radionics and homeopathy”. It claims to measure the electromagnetic energy of the hair sample when it’s in contact with the substance. Some test for heavy metals and mineral deficiency, and claim these are somehow linked to allergies. There’s no scientifically plausible means of being able to detect allergies or intolerances in hair, and no evidence it can do so.

Vega tests

Vega machines or BioEnergetics testing claim to detect allergies and food intolerances by measuring changes in galvanic skin response. Other names include Electrodermal, Voll, Quantum and Dermatron testing – sometimes the machine names are used. An electrode is placed on your finger, and a sealed container of food is introduced into the circuit. Reduced or ‘disordered’ electrical current means an allergy or intolerance.

Bicom testing

The Bicom is a bio-resonance machine said to pick up “specific frequency patterns” from a patient (or from substances that harm or stress the organism) via electrodes. It claims to be able to test and treat allergies including food allergy, hay fever and skin rashes.

The device has been the subject of a number of complaints in Australia and the UK, and despite the company being unable to provide any evidence it can detect or treat allergies and food intolerances, it continues to be advertised and used by natural practitioners and is listed as a medical device with the TGA.

Applied kinesiology

Practised by some chiropractors and other natural therapists, allergies and food intolerances can be diagnosed using principles of applied kinesiology by having the patient hold a sealed container of a test substance in one hand, while the practitioner tests the muscular strength of the opposite arm.

Why getting the right test matters

“We got live blood analysis done years ago on myself and kids. We also went down the hair analysis road. I tried every different alternative therapy and it cost us a fortune – and no results. As a mum of a child who has life-threatening multiple food allergies, I would say go the experts at an allergy clinic. Get a skin prick test and a RAST test. This will tell you what the allergies are and the level. At the allergy clinic we were bulk billed. It cost us less to fly to Sydney as a family and get tested than it did for the previous alternative tests which showed nothing.” – AllergySave

Apart from the fact that special foods or diets free of allergens may also be more expensive than regular foods, there are numerous repercussions if someone decides they have a food intolerance or allergy that isn’t real – whether self-diagnosed or diagnosed with the help of unproven or unorthodox tests.

Firstly, missing a real allergy could be life threatening. This is most likely to be an issue for children, who are more likely than adults to have allergies. Furthermore, symptoms attributed to food intolerance may be due to a more serious illness. If you’re concerned about symptoms, see a (real) doctor.

People who avoid certain foods may be at risk of nutritional deficiencies. It’s recommended that people with genuine food intolerances consult an accredited dietitian to ensure this doesn’t happen. Meanwhile, avoiding a food due to unwarranted concerns about allergy could result in a genuine allergy developing – there are many examples of this occurring in children.

Finally, allergy fakers and people with self-declared intolerances can also make it difficult for people with genuine allergies who may not have their allergies taken seriously. This is especially the case in restaurants and cafes, where it’s not uncommon for people to declare an allergy or intolerance to dairy or gluten, say, only to eat cake and ice-cream for dessert – “I’m only a little bit allergic.” As with the boy who cried wolf, the resulting complacency among restaurant staff may end badly.

ÌÇÐÄVlog verdict

The consequences of bogus testing go beyond just your wallet. If you come across an allergy or intolerance test on the internet, or are offered one by your natural health practitioner, it’s worth doing some research to find out whether it’s evidence-based or not. As a first port of call, ask your GP about it, or check the – it has many fact sheets on allergy and food intolerance testing.

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