Whilst laboratory scientists, doctors and complementary practitioners of every hue search for the elusive comprehensive allergy tests, the rest of us have to muddle along as best we can. I am frequently impressed by the power of simple observation and the clarity of vision the patient shows in interpreting adverse reactions to food.

Could simple observation be a substitute for a wallet thinning experience where the patient’s trust in the therapist/laboratory is stretch to the point of disbelief ? Yes, if the patients symptoms are believed and understood, and if commonsense is brought to bear. I will leave the observation to the reader (or the relevant therapist), but I will provide a commonsense guide to food allergy, intolerance and irritable bowel syndrome.

I see many intelligent patients who, once provided with the right information, are able to unravel the dietary component of their problems themselves.

Irritable bowel syndrome is defined as a collection of symptom including:

• PAIN, which is associated with a change in the frequency or consistency of the stools or is relieved by defaecation Together with one or more of the following:

• More than 3 stools per day or less than 3 per week

• Altered stool form (lumpy/hard or loose/watery)

• Altered stool passage (straining. urgency, feeling of incomplete evacuation)

• Passage of mucus/slime but not blood

• Abdominal bloating

The type of treatment and dietary advice that is appropriate depends very much on the main symptoms and their pattern. There is no one diet for IBS because there is too much variation from patient to patient. The key step in unravelling food intolerances is a period of dietary exclusion when a number of potential trigger foods are avoided, followed by their careful reintroduction one at a time, usually at weekly intervals.

Occasionally the avoidance of single foods on a piecemeal basis can lead to identification of intolerances and significant improvement.

There are some useful pointers for individual foods which are listed below. However, it should be remembered that:

• there is enormous variation from person to person as to symptoms and intolerances

• any food can produce intolerance reactions though most fall into the categories below

• reactions to most meats, fish and vegetables apart from those listed are very rare

• cooking vegetables and fruits aids digestion and reduces or stops intolerance

• judging intolerance reactions is much more difficult if there is underlying constipation (which should be treated with appropriate bulking and laxative agents)

References:No More Irritable Bowel Syndrome. Maryon & Alan Stewart. Vermilion 1997

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