Posts Tagged ‘chemical intolerance’

Elimination diet
An elimination diet is a method of diagnosing idiopathic food intolerance (see p. 74) and certain other

forms of food sensitivity where indirect tests, such as skin tests, are unhelpful. The principle of the

elimination diet is very simple. It begins by removing from the body every food that could possibly

cause a reaction, and seeing if this produces a symptom-free state. If it does, the elimination diet

then presents the body with different foods, each in its pure form, to see which ones cause symptoms.
While the principle is simple, the practicalities of the elimination diet can be much more complex, and

it is vital to understand the details fully before you start. There is absolutely no room for

‘cheating’ with this diet – one mouthful of cake is enough to ruin the whole thing. You need forward

planning and a lot of self-discipline, backed up by a good stock of the permitted foods for moments

when hunger overcomes you. Some cooked foods, stored in the freezer in individual portions for quick

defrosting, are a great help.
Doing an elimination diet incorrectly is not just a waste of time. Some people acquire new

sensitivities during the diet, which may make it very much more difficult to do a second elimination

diet. So plan ahead and get it right first time.
The planning stage
First of all, start an accurate symptom diary. This will give you a precise picture of how bad things

are now, before you try any dietary measures. A detailed daily symptom record, covering a period of

about two weeks, can be very useful, whether or not you actually do an elimination diet. It can serve
as a baseline against which to judge the effects of any future treatment.
Before you begin an elimination diet, you must see your doctor and ask if it is safe for you to do the

diet. Read through the next four pages first – the more you know about elimination diets, before

talking to your doctor, the better.
There are some conditions where, although an elimination diet can be very helpful, it should not be

attempted without full medical supervision. Two main causes for concern exist:
•    For people who are undernourished to start with, the elimination diet may be too demanding – it

is difficult to eat enough calories during the first few weeks of the diet, unless an elemental diet is

used as a supplement (see box on p. 196). If you are underweight, or have rheumatoid arthritis or

Crohn’s disease, the possible use of elemental diets is something you should discuss with your doctor.
•    With certain diseases (see list that follows), the testing stage may induce severe symptoms.

Sometimes these can be life-threatening and need immediate medical attention.
Medical supervision during food testing is recommended for anyone with these conditions:
•    Crohn’s disease – testing can bring on a prolonged relapse. Very small amounts of food should

be tested initially, and the quantity slowly increased.
•    Brittle asthma – after a period of avoidance, a culprit food can bring on a severe and possibly

life-threatening asthma attack.
•    Atopic eczema – the risk of reactions is higher if skin tests are positive (see p. 198).
•    Chronic urticaria – occasionally there is an immediate reaction to an offending food. It is

advisable to test foods in very small portions oust a mouthful) at first. If there is no reaction

whatever after four hours, a normal portion can be tested.
Note that an elimination diet is not suitable for anyone with true food allergy (see p. 62). If you

have ever had an immediate reaction to any food, or any symptoms in the lips or mouth, testing foods

can be dangerous. Caution is also necessary if you have ever reacted to a food with violent vomiting

and/or diarrhoea some hours after eating. This could be due to an infection, of course, but such

symptoms can also, very rarely, result from true food allergy (see p. 64). Finally, if you have ever

suffered anaphylaxis from any cause – not just food –the testing phase of an elimination diet might be

risky. Ask your doctor’s advice.
Once you have your doctor’s permission to try the diet, work out how the stages of the diet will fit in

with your life over the weeks or months ahead. Until it is over, eating food made by other people is

virtually out of the question. When eating away from home, you must either take prepared food with you,

or just eat very simple foods – such as permitted fruits or nuts. Think about the practicalities of

carrying food for meals away from home.
Finally, devise the diet you will follow during the exclusion phase (see right), locate shops that sell

the more unusual foods, and stock up on everything required.
You will continue to eat a lot of these foods for the first few weeks of the testing stage, so you may

want to buy extra stocks and refrigerate them for
longer storage, especially if the sources of supply are some distance from your home.
Note that food ingredients in medication could interfere with the results of the elimination diet. For

example, if you are very sensitive to maize (corn), the cornflour that is added to many antihistamines

and other drugs could create much confusion. Food-free medicines are available – talk to your

pharmacist about this initially, then to your doctor if you need a different prescription.
The exclusion phase
During the first part of an elimination diet, you exclude all the foods that you normally eat, plus any

closely related foods. For example, if you normally eat oranges, you should avoid all other citrus

fruits, including lemon, limes and grapefruit, even though you do not normally eat these. If you

normally eat plenty of broccoli, you should omit all its relatives, such as cabbage, kale, spring

greens and cress.
The best way to conduct the exclusion phase is not to follow a set menu, such as the well-known

‘Iamb-and-pears’ diet, but to draw up your own list of permitted foods. This can include foods that you

have never eaten before, and those you eat rarely.
The list should run to at least ten items. One problem with an exclusion phase that consists of only

two foods (as in the ‘Iamb-and-pears’ diet) is that you are bound to eat a huge amount of these foods.

This is asking for trouble if you have a tendency to food intolerance, because you can quite quickly

become sensitive to new foods if eating them in large amounts.
Your list of permitted foods should include:
Some starchy items. These are essential for keeping hunger at bay: try some of the more exotic root

crops, such as sweet potatoes, yams, dasheen and cassava. These are available in large supermarkets and

in small shops catering to Indian, African, Chinese and Caribbean communities. (Cook them as you would

potatoes. In the case of cassava, it must be boiled, not baked.) You can also eat parsnips, turnips,

chestnuts and pumpkin. Tapioca, sago, buckwheat, millet, quinoa and sorghum are other possibilities: a

health-food shop is a good source of some of these. Use rice if it is not normally part of your diet.

Do not include sweetcorn or maize meal, even though you do not normally eat these –corn products are

very widely used in packaged food, and sensitivity to corn is not uncommon.
Several fruits and vegetables that you don’t normally eat. Exotic produce such as mangoes and okra can

help a lot in keeping the diet tasty. Avocados, which are very rich and nutritious, can be included if

you don’t eat them often.
Some protein items. For carnivores, this is the easy part – any meat that you don’t normally eat is

suitable. Consider turkey, rabbit, pigeon or game, for example. (Soak rabbit meat in salt water

overnight to get rid of the strong taste, if you dislike this.) Strict vegetarians have more problems

here, since goat’s milk, sheep’s milk and all birds’ eggs are disallowed – their proteins are much too

similar to those of normal milk and eggs. Soya products such as tofu should definitely be avoided, as

should other pulses initially, because sensitivity to these is a possibility among vegetarians. Quorn,

or mycoprotein, could affect anyone sensitised to yeast, and should not be included. Fortunately the

exclusion phase is fairly brief, so a low intake of protein will not be disastrous. Including some nuts

on your list of permitted foods will help, as these contain protein. If nuts are part of your normal

diet, you may have to resort to rarely eaten kinds such as macadamias, cashews or pistachios.
Elemental diets
An elemental diet is a powder that contains all the nutrients the human body needs but is free from the

substances in food that provoke allergic and intolerance reactions. It is mixed with water to create a

complete substitute for food. Originally designed for space travel, this totally synthetic form of

sustenance is also known as ‘the astronaut’s diet’.
Used alone during the exclusion phase, elemental diets are the basis for the ultimate – and

theoretically foolproof – elimination diet. They sustain you through the exclusion phase, and continue

to provide your basic diet during the testing phase.
For anyone with multiple food sensitivity, using an elemental diet circumvents the problem of finding

ten or more safe foods with which the elimination diet can begin.
Those who are underweight can also benefit from using an elemental diet, simply as a calorie-boosting

supplement during the exclusion phase and testing phase.
Unfortunately, elemental diets taste fairly unpleasant and are quite expensive. You
may need a prescription, so talk to your doctor. Ideally you should get an elemental diet that does not

contain sucrose (sugar).
Some items that make good snacks. Nuts, pumpkin seeds, sunflower seeds, fresh fruit and dried fruit are

all useful for times when you are away from home, or feel hungry between meals. At the outset of the

diet, use only unsulphured dried fruit –available from health-food shops. At a later stage, you can

test ordinary dried fruit (all of which is treated with sulphur preservatives – see box on p. 207).
A cooking oil, preferably one that you have not used much in the past. Use this fairly liberally, to

keep the calorie content of your diet at a reasonable level
Note that this is a very plain diet – you eat the permitted foods and absolutely nothing else. You

cannot use spices, herbs or other flavourings. Salt is allowed, but sugar is out, as are tea, coffee,

alcohol and all soft drinks. You must drink only mineral water and pure juices from permitted fruits.
Don’t use canned or packaged versions of the permitted foods. Buy raw food and cook it yourself. The

idea is to avoid food additives and other contaminants, such as those from the linings of cans.
Throughout this phase, and the next, you must be very careful not to eat too much of any one food.

Never eat any food every day, and stay away from any food that you begin to develop a real passion for

– this is always a bad sign in people with food intolerance. It is better to go a little hungry

(assuming you are not underweight to start with) rather than binge on any of the permitted foods.

Acquiring new sensitivities is all too easy.
Assuming you do have food intolerance, and you have excluded all the foods that affect you, there

should be a complete clearance of symptoms within 7-10 days. The response is usually unmistakable. A

partial or slight response is probably just a coincidence, and should be discounted, except for those

with rheumatoid arthritis (see below).
Be warned that you may feel a great deal worse before you get better. For those who do have idiopathic

food intolerance, the first 5-6 days of the diet can be very unpleasant – usually they suffer the same

symptoms as before the diet, but far more severe.
Some conditions, such as Crohn’s disease and rheumatoid arthritis, may require a longer exclusion

phase, but there is no point in continuing beyond three weeks. Bear in mind that long-term structural

damage to arthritic joints may prevent a complete recovery. A partial but sustained improvement in the

joints, accompanied by a distinct improvement in general health, suggests that food could well be

playing a part in causing the disease, and that it is worth going on to the testing phase.
Symptoms that are only intermittent, such as chronic urticaria or migraine, pose a special problem. You

need to decide, before starting the diet, how long the exclusion phase should continue in order to give

you a clear sign that your state of health is improved. A symptom diary is vital here. If, for example,

your symptom diary shows that you sometimes have a week that is symptom-free but you never get through

two weeks without an attack, then your exclusion phase should continue for two weeks.
You should only go on to the testing phase if you improve during the exclusion phase. If you do not

improve, you have excluded the possibility of food intolerance, and can give up the diet.
The testing phase
This part of the diet, which is sometimes called the reintroduction phase, takes about eight weeks. It

requires careful observation of your symptoms, and constant self-discipline about everything you eat.

You should not stop or delay the testing unless you are ill – it is vitally important to complete it as

quickly as possible.
Foods have to be reintroduced one at a time, with a space between in which symptoms can be observed. It

sounds simple, but this is where errors can easily occur.
During this phase, as well as noting your symptoms daily, you should also record absolutely everything

you eat.
For the first 2-3 weeks you should test foods that are unlikely to cause symptoms. Start by testing

fruits, vegetables and meats that you do not eat very often normally, but which you do like. If they

pass the test, you can use them to vary your diet. This will make life much easier and reduce the risk

of developing new sensitivities.
Next test foods that you do eat reasonably often, but not every day. Leave the most likely culprits –

the foods you eat very regularly, such as wheat and milk products – until you have established a safe

diet that contains at least 25 different foods. This safe and relatively varied diet should be the

backdrop against which you test staple foods.
The testing procedure changes over time, because your sensitivity may decline as the diet progresses.

During the first eight weeks, you should test one food each day, eating a normal-sized portion for

lunch or supper. A reaction to the food might occur quite soon after the meal, or some hours later. Any

symptoms that occur within the following 24 hours should be provisionally attributed to that food.
Unfortunately, bowel symptoms can sometimes take longer to develop – up to 48 hours. This can confuse

things when a new food is being tested every day.
There may also be uncertainty about intermittent conditions such as chronic urticaria. You may not be

absolutely sure that the problem really responded to the exclusion phase. If so, when the symptoms

recur during the testing phase, this may be due to a food, or it may just be coincidence.
Should there be any doubt about which food caused a particular set of symptoms, cut out all the suspect

foods for now, and retest them after a couple of weeks, using a three-day testing procedure (see

below).
When a reaction does occur to a food, stop all testing and go back to the safe diet until you feel

completely better. But don’t wait too long before resuming testing. You need to get through most of the

testing within eight weeks because, for some people, intolerance to the foods begins to fade after

that.
This does not mean that the intolerance has been ‘cured’, unfortunately. A period of eating the food

regularly will soon bring the problem back.
If you are still testing foods after eight weeks, you must change to three-day testing – eat a normal

portion of the food every day for three days, stopping only if you get symptoms. Should you have no

reaction to the food by the end of the fourth day, you can consider it safe. (But leave it out of your

diet for at least another four days.)
There are some special procedures for testing certain foods:
•    When you test wheat, even if it is quite early on, use the three-day test procedure (see

above). Reactions to wheat can be very slow. (If you have rheumatoid arthritis, you should spend a full

five days testing wheat, and eat it at least twice a day.) Don’t use bread to test wheat because this

also contains yeast and other ingredients. Use a pure wheat cereal such as Shredded Wheat – moisten it

with fruit juice if you cannot have milk. Note that some people who react to whole-wheat are sensitive

to the wheat germ, and can tolerate refined wheat, as in white bread and flour. For others only white

flour is a problem – they are usually reacting to additives in the white flour. Careful testing will

sort out these issues.
•    Test milk before cheese and butter. You may react to one but not the others. If you react to

fresh milk, wait a few weeks, then test evaporated milk. Later, you can test goat’s milk and then

sheep’s milk. Some people can tolerate these, but must be very careful not to consume too much of them.
•    You can test yeast using Marmite or yeast-based B-vitamin tablets. Do this before you test

mushrooms, •    At some point, test a canned food. This is to check for reactions to the lining

material used on cans. Choose something that contains no other ingredients or additives, such as

carrots. Test it first in a frozen or fresh form, so that you are sure you don’t have a reaction to the

food itself.
•    Throughout the testing period, continue with cooking all your own food from scratch. At a

fairly late stage in the testing, when you have tested most foods, spend three days eating packaged

food. The idea is to eat a wide range of different food additives all at once. Read the labels

carefully (see p. 172) to check that all the food ingredients are ones which you have already tested

and found safe. You are unlikely to react to these packaged foods, but if you do, you should then

conduct tests with all the individual food additives. You may need some help from a dietitian for this

(see p. 201).
Testing becomes more and more uncertain after 12 weeks. If you
have not completed it by then, reintroduce all the untested foods.
Should your symptoms come back, cut out all those foods again,
then test them individually.
What next?
For anyone who recovers during an elimination diet, and successfully identifies their problem foods, a

period of complete abstinence from those foods follows. After about a year, it is worth testing the

foods again, as the sensitivity may have subsided. (Don’t do this if you have rheumatoid arthritis –

see p. 23.)
If, after a year or two, you find that a food no longer makes you ill, don’t go back to your old ways –

remember that you must only eat the food occasionally. Once every three or four bays is a good rule of

thumb for a food to which you were previously intolerant. You might get away with having it slightly

more often than this, but never go back to eating it daily. If it starts to become your ‘favourite

food’ again – the thing you fancy more often than anything else – watch out.
Good nutrition is an important issue for anyone avoiding certain key foods. If you have cut out all

milk products, for example, you should probably be taking a calcium supplement, unless you eat a lot of

other calcium-rich foods. Ask your doctor to refer you to a dietician or nutritionist if you feel you

need help.
An elimination diet for children with eczema
Before putting your child on any kind of restrictive diet, it is vital that you talk to your doctor.

The risks of malnutrition are far higher for children, and there can be serious long-term consequences,

such as stunted growth or impaired intelligence. You must therefore have medical consent and

supervision for an elimination diet.
For young children with atopic eczema, there is rarely any need for a stringent elimination diet, such

as that described on pp. 194-7. Children are usually sensitised to only one or two commonly eaten

foods.
In the case of recently weaned infants, it is enough to simply cut out individual foods, one at a time.

Avoid each food for two weeks, while observing symptoms carefully.
For older children a simple elimination diet, with an exclusion phase which avoids just the most likely

culprits, works well. The foods that you should exclude at the outset are:
•    any food which has given a positive skin-prick test (see p. 69)
•    any food which you think may have caused digestive symptoms, such as diarrhoea, either now or

in the past
•    eggs, milk and all milk products
•    beef and chicken
•    citrus fruits (oranges, lemons etc.)
•    food additives.
If the child’s skin is no better after a week of this diet, cut out the following foods as well:
•    peanuts and other nuts
•    soya
•    fish
•    wheat and maize (corn)
•    tomatoes
•    lamb.
If there is no response after another week, food is unlikely to be contributing to the eczema.
For the testing phase, use three-day testing, as described on p. 197, if you have fewer than ten foods

to test. Use one-day testing if you have more than ten foods to test.
You should begin by testing a very small amount of the food. Wait ten minutes for any symptoms (not

just skin symptoms – the mouth or stomach may also be affected) then give a little more if nothing has

happened. Build up gradually to testing a normal portion of the food.
A more cautious approach is required for children who give positive skin-prick tests to foods, or have

a history of symptoms in the mouth or digestive tract. They are more likely to suffer severe symptoms

in the lips, mouth and throat – the type of reaction associated with food allergy. Emergency medical

treatment may be needed. You can see if there is any likelihood of a severe immediate reaction to foods

by starting with a test on the face, and then the outer lip (see box on p. 23). If nothing happens, it

is probably safe to go on to the next stage – giving the child a very small amount of the food to eat.

However, you should have medical supervision for Rare reactions
Very occasionally, atopic eczema sufferers on milk-avoidance diets develop a sensitivity reaction to

calcium supplements. There is no scientific explanation for this, but it has been very well documented

in two children. Should you encounter this problem, the answer may be some alternative natural source

of calcium: sardines or other small fish, eaten whole, are one possibility, assuming your child will

eat fish. A dietician can advise on how much is needed per day.
There has also been one well-documented report of a child reacting to mineral water. When the water she

usually drank was changed to another brand, her eczema cleared up. This is very unlikely to be a common

problem.
this procedure in the case of foods that gave positive skin tests. If your child has both severe eczema

and additional symptoms (such as nettle rash, or symptoms in the mouth or digestive tract) it may be

advisable to have medical supervision when testing all foods.
Bear in mind that atopic eczema naturally fluctuates a great deal. To observe the effects of trying out

a food, you need the child’s skin to be in a steady state. That means being absolutely consistent about

applying steroids and moisturisers, avoiding (for the period of testing) any stressful situations that

could provoke a flare-up, not exposing the skin to sudden doses of irritants or airborne allergens, and

keeping scratching under control. Be aware of other factors that could muddy the waters by provoking a

flare-up of eczema – such as teething, or a cold (see p. 44).
If certain foods are identified as provoking eczema symptoms, and you decide to cut the food from your

child’s diet, a nutritional supplement may well be needed. Ask your doctor to refer you to a

nutritionist or dietician.
Other diagnostic diets
These diets are not used by (or even known to) the majority of doctors. While some, such as the

low-nickel diet, have been subjected to rigorous scientific testing and have shown their worth, others

have not been tested scientifically. The evidence in favour of them is purely anecdotal – in other

words, doctors have used these treatments repeatedly and observed good results with some of their

patients. That is not hard science, but it is how innovations in medicine often begin.
There are few risks with any of these diets – the number of foods to be avoided is small, and you are

most unlikely to become malnourished. Your doctor should not object to you trying any of these diets,

however sceptical he or she may be about its possible benefits.
Low-nickel diet
This diet is sometimes of benefit to adults with eczema. There are various pointers which indicate that

the diet may help, as described on pp. 55-6.
Make sure that you have absolutely no contact with any nickel (e.g. in jewellery, jeans studs, watches

or hair clips) throughout this diet, and for at least two weeks before starting it.
Ideally you should also stop treatment with steroids or antihistamines a week or so before starting the

diet. This allows any improvement to be easily observed. Obviously you should get your doctor’s

permission to do this.
The diet could take anything from six weeks to six months to take full effect. Some people have a

complete clearance of their eczema, while for others there is a partial but distinct improvement.
The foods with a high nickel content, which should be avoided as far as possible, are:
•    shellfish
•    green beans and peas
•    beansprouts and lucerne sprouts
•    dry beans and lentils (pulses) of all kinds; soya protein and products containing it (e.g.

vegetarian sausages and burgers)
•    spinach and kale
•    lettuce, leeks
•    wheat bran (avoid bran cereals and other products; replace wholemeal bread with white bread, or

eat it in moderation only – you can get plenty of fibre from fruits and vegetables; do not eat

multi-grain breads at all)
•    oatmeal, millet and buckwheat
•    raspberries, prunes, pineapple, figs
•    chocolate and cocoa
•    tea from drinks dispensers (restrict intake of other tea and coffee, and don’t make them too

strong)
•    peanuts, hazelnuts, almonds and marzipan
•    liquorice
•    sunflower seeds, linseed
•    baking powder, in large amounts
•    vitamin or mineral preparations that contain nickel (check the label carefully), Nickel is also

found in drinking water, and absorbed from certain cooking utensils, so:
•    Do not use items plated with nickel (e.g. tea balls, some tea strainers, egg beaters). The

extremely shiny appearance of nickel makes these easy to recognise.
•    Do not cook acid fruits in stainless steel pans, since the acid leaches some nickel out of the

stainless steel. An enamel cooking pot is safe.
•    Minimise the amount of tinned food that you eat.
•    In the morning, run off the first litre of water from the tap, as this may contain nickel

released from the tap itself.
Several other foods and drinks seem to aggravate the skin of nickel-sensitive people, even though the

foods are not rich in nickel. These foods and drinks should also be avoided:
•    beer, wine
•    herring, mackerel, tuna
•tomatoes, carrots, onions, apples; oranges and other citrus fruits, including their juices.
Low-chromium and low-cobalt diets
Skin sensitivity to chromium or cobalt can, very occasionally, result in a tendency to react to these

same metals when consumed in food or drink (see pp. 56).
Unfortunately, both chromium and cobalt are essential for good nutrition, so avoiding them is fraught

with problems. You would need the help of a really good dietician, or a doctor with a particular

interest in nutritional problems, to guide you through a diet of this kind.
The only measure you can safely take at home is to cut down on excessive consumption of these metals,

for three weeks only, to see if this produces any improvement in your symptoms. If it does, that should

encourage you to seek expert help for a more thorough avoidance diet.
In the case of cobalt sensitivity avoid:
•    all canned and bottled beer.
In the case of chromium sensitivity avoid:
•    beer, wine and cider
•    yeast extract and yeast tablets
•    black pepper
•    calf’s liver
•    wheatgerm and wholemeal bread
•    cheese.
If you also have nickel sensitivity, avoid nickel-rich foods (see p. 199) at the same time.
Low-histamine diet
Histamine in food is mostly produced by bacterial action. The majority of people can break down any

histamine they eat, as long as the amount is not excessive (see box on p. 67).
Temporary susceptibility to histamine may accompany viral hepatitis or other liver conditions.
A permanently impaired ability to detoxify histamine is relatively unusual. When it does occur it can

result in symptoms such as chronic urticaria, migraine or recurrent headaches. A low-histamine diet may

help in these cases. All of the following should be avoided:
Very high histamine content:
•    red wine, champagne
•    tuna, sardines
•    Emmenthal and Camembert cheeses.
High histamine content:
•    beer, white wine
•    anchovies
•    Gouda, Roquefort, Stilton and all other well-matured cheeses
•    salami and other well-matured sausages, Westphalian ham
•    sauerkraut
•    spinach
•    tomato ketchup.
If you improve only partially on this diet, this may indicate that you are on the right track

(histamine is indeed the problem) but that the bacteria in your gut are undermining your efforts with

the additional histamine which they generate. You can investigate this possibility by trying a

low-carbohydrate diet, as described on p. 53.
Low-amine diet
Naturally occurring substances called amines, found in many different foods, can have a drug-like

effect on the blood vessels, making them open up a little and so increasing the blood flow. The effect

is usually small, but some people are more susceptible than others. A low-amine diet is worth trying if

you have chronic urticaria or migraines, and have not improved with other treatments. A low-amine diet

can also be useful in atopic eczema: amines in food are not a basic cause of eczema, but they can

aggravate the rash by increasing blood flow to the skin. To begin with, cut out all foods listed below:
Very high amine content:
•    all cheeses except cottage cheese
•    dark or plain chocolate
•    yeast extract (Marmite etc.), miso, tempeh, tomato paste, tandoori spice mix, stock cubes,

ready-made sauces •    cola drinks, orange juice, tomato juice
•    any dried, pickled or smoked fish
•    sausages, pies and smoked meats, beef liver, chicken skin
•    broad beans, spinach
•    sauerkraut
•    almonds.
High or moderate amine content:
•    milk chocolate
•    soy sauce
•    beer, wine and cider
•    pork, including bacon and ham, salami, chicken liver, offal
•    all fresh or tinned fish, except white fish
•    all nuts except chestnuts and cashews
•    sesame seeds, sunflower seeds
•    avocados, aubergines, mushrooms, tomatoes, broccoli, cauliflower
•    olives and olive oil
•    oranges, lemons and other citrus fruits
•    pineapples, bananas, raspberries, strawberries, pineapples, plums, grapes, dates, figs, kiwi

fruit, passion fruit.
Continue for at least three weeks, and longer if your symptoms are normally intermittent. if you

improve, you can then experiment with reintroducing small portions of foods from the second list, three

or four times a week. Gradually build up to a higher intake, but cut back if your symptoms return.
Organic diet
The objective here is to avoid pesticides, i.e. chemical sprays applied to kill fungi and insect pests.

This may be helpful for people with chemical intolerance (see p. 84).
`Chemical-free’ or ‘unsprayed’ food (crops grown without pesticides) will do just as well as 100%

organic food (which is grown without either pesticides or artificial fertilisers).
The highest intake of pesticides is from fresh fruit and vegetables, so if your budget is tight,

concentrate on buying organic or chemical-free versions of these. If you have a garden, growing some of

your own food will reduce the cost.
You can also reduce the pesticide content of ordinary fruits and vegetables by:
•    Storing them for as long as possible before using them, because the pesticides break down quite

quickly
•    Always peeling them. With difficult-to-peel items such as peaches and tomatoes, pour boiling

water over them and leave them to stand for a few minutes first, as this loosens the skin. Rinse in

cold water, then peel.
•    If peeling is not possible, washing them very well with soap or detergent, then rinsing them

thoroughly
•    Cooking them, as this drives off some of the pesticides; avoid inhaling the steam and ventilate

the kitchen well while doing this.
You should drink mineral water from a reputable source, or use a very high-quality water filter (not a

jug filter).
Additive-free diet
Food additives are occasionally the culprit in chronic urticaria (see p. 53). At the same time as

avoiding additives, people with chronic urticaria should cut out other potential culprits – alcohol,

spices and all aspirin-like drugs (see box on p. 151).
An additive-free diet may also be of value for some people with chemical intolerance (see p. 84).
In the case of children with Attention Deficit Disorder (ADD), also called Hyperkinetic Syndrome, the

role of additive-free diets is a contentious issue (see p. 81).
An additive-free diet is very healthy but quite hard work. It means making all your own food from 100%

fresh, unmodified produce (you cannot have bacon or ham, and even things like cooked chicken and

ready-to-eat salad can contain some additives; so does most restaurant food). Note that wines, beers

and other alcoholic drinks can contain many additives without declaring them on the label. (German

bottled beer is an exception here.) Baked goods sold unwrapped can also contain many additives without

declaring them.
Stop using toothpaste unless it is an additive-free brand. You can buy such toothpaste from a

health-food shop – or use sodium bicarbonate powder instead. Drink mineral water or filtered water (you

need a good-quality filter for this, not a jug filter).
Medicinal drugs can contain colourings and other additives, so you should try to get additive-free

versions. Talk to your pharmacist about this initially.
Assuming the symptoms clear up, testing can begin, but you will probably need medical help to work out

exactly which additives are at fault. It is difficult to organise these tests at home, because most

foods contain such a mixture of additives.
With chronic urticaria, there is the possibility of quite severe reactions on testing, so medical

supervision is desirable. You can undertake cautious testing with small amounts of tap water, spices

and alcohol at home, but make sure you are in a position to get emergency medical help if you need it.

Aspirin or aspirin-like drugs should not be tested at home. Life-threatening reactions are common in

sensitive individuals, and temporary avoidance can heighten your reaction.

When Leonard Noon reported his first tentative experiments with immunotherapy for hayfever, in 1911 (see p. 164), he believed that pollen contained a toxin. Most people were

‘immune’ to this toxin, he said, in the same way that people might be immune to measles or diphtheria, but hayfever sufferers lacked this immunity. Noon thought that his

steadily increasing doses of pollen, injected just under the skin, were inducing immunity to the pollen toxin, in the same way that a smallpox vaccine could induce immunity to

smallpox.
Noon’s theory was all wrong, as we now know, but the important thing was that the treatment seemed to work. In fact it transformed the lives of some patients, especially those

who were very severely affected by hayfever. One spoke of a ‘marvellous cure’, another of going for walks to kick my old enemy the hay’.
So doctors kept using Noon’s treatment, and in time — when it became clear that Noon’s theory was flawed — medical researchers began trying to figure out how the injections

really worked.
Surprisingly, they have still not succeeded, even though a great deal is now known about the changes that can occur in people undergoing immunotherapy. Despite a wealth of

detailed knowledge (see p. 166), it remains impossible to say exactly how conventional immunotherapy reduces allergic reactions. Surprising discoveries about the effects of

conventional immunotherapy are being made all the time.
New methods of immunotherapy are still being devised today, and there are three different approaches being taken.
Firstly, there are doctors experimenting with modifications of the technique devised by Noon. For example, instead of injecting the allergen extract, some doctors are giving it

to their patients in capsule form. to be swallowed. Others are giving it as a liquid, to be placed under the tongue and held there for a few minutes, then swallowed (see p.

169). Sound scientific trials show that both these methods work well, at least with some allergens.
There are also experiments with speeded-up immunotherapy
(see p. 166), called ultrarush techniques — at the outset, injections are given at hourly intervals, or even more frequently (in hospital, of course, where severe reactions can

be dealt with immediately). Doctors have found that they can induce a remarkably rapid tolerance of the allergen in this way.
The second approach is to apply modern medical knowledge about allergic reactions and so develop entirely new methods of immunotherapy (see p. 168-9). Such research involves

working out, from first principles, novel ways of modifying the immune response in general, or the reaction to one allergen in particular.
This theory-led approach is certainly successful for classical allergies such as hayfever and perennial allergic rhinitis, where there is a good understanding of the basic

mechanism (i.e. the malfunctions of the immune system that produce the disease). But for those diseases where the underlying mechanism is only partially understood, such as

atopic eczema, this approach is not necessarily the best one. And for diseases such as food intolerance, where the cause of the illness remains largely unknown, it is a complete

non-starter.
The third type of approach is to devise a technique by trial and error, and then puzzle out the ‘how’ question later. This is the same sort of path as Noon originally took, and

some believe that this kind of pragmatic experimental approach — practising a method which seems to be effective, even though it’s a mystery how it works — is as valid now as it

was in 1911. Others disagree.
210 complementary therapies The two most widely used methods that have been developed in this way are Provocation-Neutralisation and Enzyme- Potentiated Desensitisation.

Although these techniques are practised by doctors with a conventional medical training, they remain ‘outside the pale’ as far as orthodox medicine is concerned. The

controversies that surround them are discussed below.
Enzyme- Potentiated Desensitisation (EPD)
This technique has been developed by a British doctor, Dr Len McEwen, who began work on it in the 1960s. It is now practised in many parts of the world, as well as Britain,

including the United States, Germany and Italy.
EPD is used for a far wider range of problems than conventional immunotherapy, being given to people with food intolerance and chemical intolerance, as well as to those with

true allergies. This — along with the fact that it is unclear how it works —contributes to the controversies that surround it, because these conditions do not have the same

basic causes.
Dr McEwen began with the observation that, when immune cells are aroused during inflammation — whether caused by allergy or some other stimulus — they release large amounts of

an enzyme called beta-glucuronidase. This enzyme increases the immune response to the allergen or antigen that provoked the inflammation.
Dr McEwen experimented with injecting beta-glucuronidase into the skin, along with very small amounts of allergen, believing that in such circumstances the enzyme might have the

opposite effect, and reduce the immune reaction to the allergen. Eventually he discovered a combination of enzyme and allergen which seemed to have the desired effect.
EPD has been tested, in a rigorous scientific manner, and the results suggest that it can work for hayfever and asthma, as well as for childhood migraine and hyperactivity in

children when these are triggered by foods.
In one trial with hayfever patients, researchers measured the levels of anti-pollen IgE following EPD treatment, and it did not rise during the pollen season as it normally does

in those with hayfever. This kind of finding is impressive because it is unlikely to be due to placebo effect. Not all studies have produced positive results, however.
In addition, doctors using EPD claim that it is very effective for patients with allergies who have not done well on the standard course of immunotherapy injections (see p.

164). This fits in with other studies suggesting that the immune changes brought about by EPD are fundamentally different from those induced by traditional immunotherapy.
Patients with true food allergy have been given EPD, and while it does not enable them to eat their culprit food, it does
seem to reduce their reaction to accidental exposures.
Doctors in the Netherlands are using EPD as a treatment for people with Chronic Fatigue Syndrome (CFS), and report that it helps about 50% of patients.
One point in favour of EPD is that it uses very small amounts of allergen, and is therefore very safe — anaphylaxis has never occurred with this technique.
Provocation-Neutralisation
‘After following conventional methods [of immunotherapy] for thirteen years, I heard Carleton H. Lee deliver a paper on provocative testing in 1965, at a meeting of the American

College of Allergists in Chicago. I was naturally sceptical, but tried his suggestions when I returned to my office. The results can only be described as astounding. Many

patients with unresolved allergic problems responded markedly and rapidly. Many with resistant asthma or perennial allergic rhinitis improved greatly or cleared completely when

food injection therapy was added to their inhalant injection therapy.’ So wrote Dr Joseph B. Miller — a distinguished allergist and paediatrician, and a Professor of Medicine at

the University of Alabama, in 1972.
The technique which he learned from Carleton H. Lee was controversial then and, although Miller developed it with great care and precision during the years that followed, it

remains controversial now.
There are two elements in provocation - neutralisation: testing and treatment. Both are used for a wide range of problems — not just classical allergic diseases, but also food

intolerance and chemical intolerance. As with EPD (see left), this is one of the controversial aspects of the technique.
Although provocation-neutralisation involves an injection technique that looks, superficially, very much like conventional immunotherapy (see p. 164), there are several

important differences. Firstly, the allergen extract used (in the case of true allergies) is a very dilute extract, so that far less of the allergen is injected than in

conventional immunotherapy. Likewise, in the case of food intolerance and chemical intolerance, the extracts of the offending substance are used in highly dilute form.
Secondly, the idea of the neutralising dose — which is the central plank of provocation-neutralisation — is quite different from anything in conventional immunotherapy. Broadly

speaking, the conventional technique (see pp. 165-6) works by slowly reeducating the immune system with a gradually increasing dose of the allergen. Only after a succession of

injections does the immune system start to behave differently on encountering the allergen. By contrast, in provocation-neutralisation treatment, the neutralising dose is

claimed to have an instantaneous and direct effect on the body, ‘turning off’ symptoms that have already begun. This is the neutralisation aspect of the technique. The doctors

who practise this technique do not claim to know how the neutralising dose might work.
According to the theory of provocation-neutralisation, the strength of the extract that acts as a neutralising dose is specific for a particular allergen and a particular

person. It can only be worked out by a rather slow procedure involving a series of injections. These are intradermal injections – they place the allergen extract in the skin, at

a slightly deeper level than a skin-prick test. (For treatment, rather than testing, subcutaneous injections are used – these go deeper than intradermal injections, placing the

allergen extract just underneath the skin. Neither hurts very much.)
Ideally, the neutralising dose should be decided on by measuring the size of the wheal (a raised area of skin around the injection site), and whether it grows, stays the same

size, or disappears. The doctor or nurse carrying out the procedure can, in theory, work out the neutralising dose just by careful examination of the skin wheals.
However, it is part of the tradition of provocation-neutralisation techniques that verbal feedback from the patient is also taken into account – so if the patient says that an

injection has turned off the symptoms, that reinforces the belief that the neutralising dose has been found.
The problem with this aspect of provocation-neutralisation is that expectations, and the power of suggestion, can become involved. So if the doctor or nurse says ‘you may find

that this next injection makes the symptoms go away’, that is often exactly what happens – because the forces of placebo effect (see p. 233) come into play. Unfortunately,

verbal interactions such as this are a key aspect of the provocation-neutralisation procedure in many clinics.
Just the same hazard besets provocation - neutralisation if it is used to test for the existence of allergy or intolerance, because it is quite common for practitioners to tell

patients which allergen (or other offending substance) is being injected and to ask if any symptoms are provoked by the injection. This is not good practice – if someone expects

to react to a particular substance, they are quite likely to produce symptoms through purely psychological mechanisms (see pp. 232-3).
Quite apart from this, the question of allergy testing with provocation-neutralisation techniques is contentious, because the pioneers of the technique, such as Professor

Miller, never advocated using provocation - neutralisation in this way. Using it as a routine test for sensitivity reactions was a later development, and there are many doctors

today who, while they practise provocation-neutralisation as a treatment, say that it does not work well as a test for sensitivity reactions. While they agree that injecting a

dose
which is either stronger or weaker than the neutralising dose may provoke actual symptoms (this is the provocation aspect of the technique) they don’t think the reaction is

reliable enough to form the basis of a test for allergies. Nor do they think that using skin-wheal measurements alone (i.e. silent testing) turns the technique into an accurate

test for allergies. That is not what the provocation-neutralisation technique was designed for – it is about treatment, not testing.
The evidence from research
Recent research from the Nova Scotia Environmental Health Centre in Canada confirms that testing by provocation injections is not reliable. The subjects in this study were all

suffering fr= multiple chemical intolerance, a condition which – for one reasor or another – makes patients liable to develop symptoms at an,, time. No less than 70% of these

patients experienced symptoms in response to a dummy injection which contained none of the offending substance. Indeed, 15% of patients also produced a skin wheal in response to

some of the dummy injections, confirming that even this reaction may be subject to the power of suggestion (see pp. 232-3).
Looking just at the patients who did not react to the placebo injection (i.e. those least susceptible to suggestion) the test still did not yield any reliable result – a person

might react to one injection with a particular substance, but fail to react to a subsequent injection with the same substance. The authors concluded that their patients were ‘in

a state of heightened sensitivity as the result of the chronic irritation by various environmental components and other external and internal stressors’. In this state of

sensitivity. patients are so close to the brink all the time that the smallest thing can trigger symptoms. So the apparent reactions to the test injections were actually

determined by other factors – some psychological factors (including a psychological response to the prick of the needle) and some external ones, such as exposure to smells or

very small amounts of airborne chemicals.
Another recent research study, carried out by scientists at the University of California, confirmed the finding of the Nova Scotia team as regards testing. Although this study

did not set out to look at the use of the neutralising dose for treatment, some of the patients were given neutralising doses during the testing process and the researchers

observed that ‘in most cases a single neutralising injection relieved the symptoms’. This casual observation clearly needs to be confirmed by more rigorous testing. Oddly

enough, despite this positive observation about the neutralising doses, the overall conclusion of the researchers was to completely dismiss all aspects of

provocation-neutralisation as ‘the result of suggestion and chance’. This conclusion has been widely publicised in the United States as part of a general campaign against

provocation-neutralisation and doctors who practise it.
Other researchers have looked at treatment with neutralising doses, using stringent scientific methods (a double-blind placebo-controlled trial — see p. 90), and found that they

do work. In one such trial, patients with asthma. and allergies to dogs or cats, were treated with injections of the neutralising dose. They showed a reduction in the

sensitivity of their airways, as measured by objective tests. In another experiment, patients with perennial allergic rhinitis and an allergy to house-dust mite were studied,

and the neutralising dose was given as drops of allergen extract placed under the tongue (sublingual drops) – an alternative to injections. The blockage of the nose, as measured

by scientific tests, was reduced by the neutralising dose.
A great many more trials of this kind would be required to convince most doctors that provocation-neutralisation works.
Furthermore, the recent study from California – which observed a number of practitioners of provocation-neutralisation at work with their patients — showed that these

practitioners need to be a lot more rigorous and objective in their approach. However, the fact that provocation-neutralisation is often practised badly does not necessarily

mean that the basic technique is without any value. There are a great many level-headed doctors and patients who, while initially very sceptical about

provocation-neutralisation, have found it surprisingly effective – just as Professor Miller did back in 1965.
Deciding for yourself
So is provocation-neutralisation an option that is worth trying for your condition?
As regards testing, the answer is probably ‘no’. The most reliable tests are skin-prick tests or FAST blood tests for true allergies (see pp. 91-2), an elimination diet for food

intolerance (see p. 194), and avoidance followed by re-exposure (a challenge test) for chemical intolerance.
As regards treatment for true allergies, conventional immunotherapy has been far more thoroughly tested and, if you can get it (not easy in Britain — see p. 164), is probably a

better bet. It is definitely the best treatment for allergy to insect stings.
The major advantage that provocation-neutralisation has over conventional immunotherapy, in the case of true allergies, is that it is far safer. Because such small amounts of

allergen are used, anaphylactic reactions (see p. 58) don’t occur.
When it comes to treatment for food intolerance, complete avoidance of the problem food(s), for a period of a year or two, is usually a very effective treatment (see p. 77).

Other forms of treatment are only needed for people who find that they have
intolerance to a great many different foods (on the basis of an elimination diet, not kinesiology, blood tests and the like — see p. 93) and cannot devise an adequate diet from

the foods they are able to eat. For such people, provocation-neutralisation may be worth a try. Many patients feel that they have gained considerable help from this treatment.

They report suffering fewer symptoms and being able to return to a more nutritionally balanced diet.
In the case of chemical intolerance, the first line of treatment should be to avoid the substances concerned as far as possible, eat a good balanced diet, and take a vitamin and

mineral supplement if nutritional deficiencies are suspected. Treating any underlying hyperventilation (see pp. 226-9) can also help considerably. Only if there are persistent

symptoms, and you are sure these are not due to psychological causes, might provocation-neutralisation be worth a try. Some people with chemical intolerance do find it is

helpful, but whether this is a real effect, or simply placebo, remains uncertain.
If you decide to give provocation-neutralisation a try, find a practitioner who has good medical qualifications, who seems objective and sensible in their approach, and who

doesn’t make implausible claims for the technique. Take note of what other treatments the practitioner offers, and whether these seem rational or not – this is often a good

guide to the care and objectivity with which provocation - neutralisation is carried out.
Ask the doctor how he or she assesses the neutralising dose. and avoid anyone who does not use the traditional method of a series of injections combined with wheal measurement.

When the neutralising dose is being assessed, say that you would like it to be done ’single-blind’ – that is, you don’t want to be told anything about what is being injected.

Reporting how you feel to the doctor or nurse during the assessment is fine, but only mention really significant symptoms, or a very definite clearance of the symptoms, if this

occurs. These precautions will help you to be sure that you are getting something which is of genuine benefit, rather than just a very expensive form of placebo treatment.
I always wanted to be a doctor, and I enjoyed
medical school immensely, but once I became a
ell GP, I no longer felt quite so sure about what I was doing. It seemed clear to me that there were a lot of people coming to my surgery who I couldn’t do much for. And there

were others who, while I could treat their obvious medical problems with some success, remained distressed and were not coping well with life. Once I became a senior partner in

this practice, I experimented with having a counsellor come in for one session a week, and then an osteopath for the bad backs. It was popular with the patients, and I saw some

people improve enormously. Now we have stress-management classes too, and one of my colleagues has trained in acupuncture, which he uses for selected patients. We also use

elimination diets for patients with a lot of long-term problems like migraine. Overall, I think of it in terms of having more tools at our disposal - being able to tackle things

from a different angle when standard medicine isn’t hitting the spot.’
Geoffrey, a GP in the north of England, is typical of the reconciliation that is now beginning to occur between conventional medicine and alternative medicine. But he also has

plenty of criticisms to make of the alternative scene. ‘The idea that alternative medicine is “holistic” while conventional medicine isn’t, really raises my hackles. Most GPs

could be magnificently holistic if they had an hour with each patient as alternative therapists usually do. We have just 15 minutes, on average, and we have to pack a lot into

that - including our basic duty to eliminate the possibility of serious organic disease such as cancer. Time pressure is everything now, and it has squeezed the humanity out of

medicine, to a very large extent. But the potential for a holistic approach is there - most doctors have a tremendous store of wisdom and life
experience at their disposal, which could form the basis of a holistic approach to treatment if only there were more time to spend with each patient.’
It is in search of a more unhurried and all-embracing approach to treatment that many people turn to alternative medicine. Frequently, what they get out of the therapy has less

to do with the actual methods used, and still less with the theories behind those methods, but everything to do with spending a quiet hour with someone supportive and caring who

listens to all the complex concerns that surround any illness, gives reassurance or advice, or just offers a `safe space’ in which to talk about life’s difficulties.
Other people turn to alternative therapies due to a more serious disillusionment with orthodox medicine. When patients with inscrutable medical problems -such as persistent

unexplained diarrhoea, joint pain or chronic urticaria - are given a succession of different diagnoses by different doctors, they often lose faith entirely in modern medicine

and reject orthodox treatment in favour of alternatives. This is a great mistake. Modern medicine isn’t perfect, but that is only to be expected, because it is not a fixed body

of knowledge but a process - a continuing journey of questioning, investigation, discovery and improvement. Scientific medicine has come a tremendously long way from the state

of ignorance that prevailed two centuries ago, and it will undoubtedly go farther.
Conventional medicine has a great deal going for it - ask anyone over 50, with severe life-long asthma, what they think of treatment now compared to treatment in the 1950s or

early 1960s. You will hear a hymn of praise to the improvements in both drugs and drug delivery systems. Asthma is just one example -conventional medicine has a lot to offer for

all the classical allergic diseases. Alternative medicine should always be regarded as an adjunct to conventional treatment, not a replacement. That is why many doctors prefer

the term complementary medicine.
A third reason for using alternative medicine is a more philosophical one, a need to understand illness in some larger sense, often part of a general search for meaning in life.

Some types of alternative treatment attempt to offer metaphysical reasons for allergy -rather than the mundane explanations of antibodies and immune cells that are given in this

book - and this can be attractive to some people. There is no harm in this approach, which can prompt you to make a critical review of your life, look at unresolved emotional

issues, or reassess choices that are making you unhappy.
But not all illness, or worsening symptoms, can be explained by emotional causes, and the rigid belief that every illness must have a meaning can be damaging. It easily

degenerates into the wholesale psychologisation of illness, the kind of blame-the-victim mentality which can attribute hayfever to ‘Emotional congestion; fear of the calendar; a

belief in persecution; guilt’ and asthma in babies to ‘Fear of life; not wanting to be here’. Both these diagnoses are taken from the best-selling You
can Heal your Life by Louise Hay, which is very influential among some alternative therapists. This compulsive psychologisation of illness can be profoundly damaging, and if

your complementary therapist is preoccupied by ideas of this kind, you could find yourself on a very long guilt trip indeed.
Apart from the psychological aspects of alternative medicine, there is the question of whether it actually works in a practical sense - whether it provides more than just

emotional support and placebo effect (the benefit that comes from any treatment which you believe in). This is always the central question for scientific medicine in relation to

its own treatments,
and conventional doctors naturally apply the same criteria to alternative medicine. Most of this chapter is concerned with trying to answer that question.
Unfortunately, there are so many different kinds of alternative therapy available today that it is impossible to cover all of them in this book. To complicate matters further,

many complementary therapists now practise two or more different techniques, mixing them to
produce their own unique cocktail of diagnosis and treatment. This eclectic approach can span a remarkable range - you may find a therapist doing distinctly whacky stuff such as

iridology (looking at the eye to diagnose all illness - it has been tested and definitely doesn’t work), combined with something perfectly rational such as an elimination diet.

(The elimination diet might be presented as a ‘detox diet’, but it is actually being used to detect food intolerances.)
With new forms of therapy springing up all over the place, a healthy scepticism is a distinct asset for the consumer. Be sceptical about any diagnostic test or treatment that is

only being practised by one person in the country, or in the world - when doctors hit on something that works, they want other doctors to try it out. World exclusives in

medicine are usually suspect.
Avoid any practitioner who tells you to stop using your drugs without your doctor’s consent. Likewise, avoid those with a messianic gleam in their eye, an evident disregard for

logic or reasonable discussion, or an amazing cure that fixes everything from acne to AIDS. Very few of those who sell bogus cures and phoney diagnostic tests are complete

rogues. Most are nice people who are quite genuinely convinced that they have indeed found the answer to people’s problems. The powers of placebo effect (see p. 233) can sustain

such a conviction for a very long time.

‘I get ill if I do a long coach journey - six or seven hours say. I usually feel sick by the end of the journey, and have a headache. The funny thing is, if I’m walking along

the street and I happen to see a coach of the kind that I do long trips on, I feel a bit sick then too, just for a short while. It seems crazy, but I get ill just from seeing

the coach.’
What Jake is observing is the powerful effect of the mind on the body, in the reaction known as conditioning. Some people are more susceptible to it than others, but no one is

completely immune.
The Russian scientist Ivan Petrovich Pavlov first demonstrated conditioning in 1889, with his famous dog-and-dinner-bell experiment. Pavlov rang a bell every time he fed the

dog, and eventually the dog would salivate each time it heard the bell, whether dinner was being served or not. Its stomach would also begin to secrete acid, in anticipation of

the meal, simply on hearing the bell.
Modern-day experiments have shown that conditioning works with immune reactions too. For example, rats can be conditioned by repeatedly giving them an immunosuppressive drug and

always adding saccharin to their drinking water on the day the drug is given. Subsequently, just the taste of saccharin in the water is enough to- suppress their immune

responses.
This surprising discovery is partially explained by the finding that there are nerves running to the lymph nodes – key areas where the immune responses are coordinated. In other

words, the immune system and the nervous system, once thought of as completely separate domains, are in conversation with each other. In fact this is a three-way discussion,

because the hormones are also involved. The study of these complex interactions,
which we are only just beginning to understand, is known as psychoneuroimmunology.
Even before Pavlov carried out his classic experiment, Dr John MacKenzie of Baltimore had discovered that an artificial rose, in the vase on his desk, would bring on an attack

of rhinitis and asthma in one of his patients who believed that she was allergic to roses. (In fact such an allergy is unlikely –see box on p. 127. It is usually the strong

scent that triggers symptoms, the allergy being to something else, often grass pollen, which is in the air when roses flower.)
Much more recently, something similar happened – this time unintentionally – when a boy with severe hayfever and pollen asthma was undergoing hypnosis aimed at helping him

relax. Part of the hypnotist’s standard technique was to describe an idyllic scene in an alpine meadow, and ask the subject to imagine being there. For this boy, it worked all

too well – the thought of the grass pollen in the meadow brought on a severe asthma attack. The hypnotist, with great presence of mind, asked him to imagine a helicopter

suddenly appearing in the sky and rescuing him from the meadow – and the asthma attack subsided. How allergies affect the mind
In studying the psychological aspects of allergy, researchers have discovered that some patients frequently have thoughts that catastrophise the situation. In the case of atopic

eczema, these thoughts might go along the lines of ‘this terrible itching will never end’ or ‘none of the treatment really makes much difference’.
Such thoughts may be just below the surface of the conscious mind most of the time, and it is only by developing the ability to notice what is going on internally that the

allergy sufferer can become aware of them.
Researchers have also found that, when negative thoughts such as these arise, eczema sufferers are far more likely to scratch their skin and so make the eczema worse. Thus the

thought becomes a reality – a self-fulfilling prophecy.
The tendency to catastrophise difficult situations is something that most people develop (or acquire from others) at a very young age, and it may take some effort to even become

aware of this mental habit, let alone change it. Yet it is possible to start thinking about illness, and about life in general, in a different way – for example, as a difficult

challenge but one that can usually be overcome.
Allergies are in no sense unique. Any long-term disease that causes intense discomfort, makes life unpredictable or limits your activities, is bound to have profound effects on

the personality. However strong a person you are, it affects your life, and influences you in a very deep way – shaping you as a thinking and feeling individual. This is

especially true if illness begins at an early age, becoming part of your formative interactions with your parents (see box on p. 233) or marking you out as different from other

children.
This shaping can have both positive and negative aspects, and it is important to recognise that there is a choice about which aspect you emphasise. It is never too late to try

to change the emphasis. Counselling or psychotherapy (see p. 225) may help with this, especially if the counter-productive attitudes to the illness are deeply rooted in family

experiences.
The role of the mind in asthma
The diagnosis of intrinsic asthma has long since been abandoned. This diagnosis, which was commonplace in the 1950s and 1960s, technically meant ‘asthma with no external cause’.

But the widespread assumption was that the cause was psychological. As older asthmatics will tell you, this made their lives particularly miserable, because they were held

responsible for their disease. Families were often ashamed of having an asthmatic child.
The injustice of this sweeping assumption is clear today. Modern research shows that an external stimulus which initiated the asthma, such as an allergen, can usually be found.

Among asthmatic children, an allergic cause exists in 80-90% of cases. Even where no specific stimulus can be found, there is still a clear-cut state of inflammation in the

airways. No one with any knowledge of asthma would now claim that it is an entirely psychosomatic disease, nor even that it is predominantly psychosomatic.
Nevertheless, once asthma has begun, the mind may play an important role in bringing on attacks, or making them worse, as many asthmatics know from their own experience. This is

entirely understandable when you think how closely breathing is tied up with our emotional lives – fear, sadness, excitement and anger all alter the usual breathing pattern in

different ways, and any of these reactions may trigger an asthma attack.
The interactions between the mind and the airways are complex in the extreme, and vary from one person to another. Anxiety and tension can make asthma a great deal worse for

some people, while others only suffer an asthma attack when the stress is over. A few people actually have less trouble with their asthma when under stress and, oddly enough,

this is the reaction that is easiest to explain. Stress activates the sympathetic nervous system (see box on p.235), which produces adrenaline, and the adrenaline opens up the

airways.
For stress to make asthma worse, as it frequently does, there must be some other reaction going on which overrides the effect of the adrenaline. Doctors don’t know exactly what

this is, but asthmatics who get worse when stressed could be hyperventilating (see p. 226) just a little – not enough for it to be obvious, but enough to make their airway

muscles contract.
Breathing through the mouth, rather than the nose, can also occur under intense stress, and this is bad for the airways because the air they receive tends to be drier, dustier

and possibly colder, for not having passed through the nose first. This raw air may irritate the sensitive airway linings of an asthmatic, and so make the airway muscles

tighten. Small local nerves, that run directly from the airway linings to the airway muscles, could cause this reaction.
Scientific tests, carried out in a laboratory, back up these casual observations. For example, many people who are allergic to grass pollen will suffer an asthma attack if the

experimenter says they are inhaling grass pollen through a mouthpiece – even though they are actually inhaling fresh air.
It can work the other way as well. Telling the same asthmatics that they are now inhaling a reliever drug will stop the attack, even though they are still breathing the same air

as before. This is the basis of placebo effect, the benefit that tends to occur with any treatment, even a dummy pill, as long as patients believe that the treatment will work.
Note that it is not necessarily the immune system producing all these reactions. There are also direct effects of the mind on the skin, in atopic eczema, on the airway muscles,

in the case of asthma, and on the nose, in rhinitis. Some of these are due to the autonomic nervous system (see box on p. 235) while others are much less well understood.
The findings described above should be reassuring for anyone who has noticed that their allergy or asthma symptoms are sometimes affected by their thoughts and feelings. There

is no need to feel bad about this, and it certainly doesn’t mean that your allergies are ‘all in the mind’. Conditioning, and other psychological responses, are an entirely

natural reaction to a very real illness.
However, if you suspect that psychological reactions are making a big contribution to your symptoms, you could try to address the problem directly. Hypnotherapy (see p. 223) can

be particularly useful in this regard, because those who are most susceptible to conditioning are also very responsive to hypnotic suggestion – which can counteract the

conditioning messages. Hypnotherapy can also help those asthmatics who
become psychologically dependent on their inhalers – something that happens quite often, especially in people with severe asthma. In the words of one asthmatic ‘If I found that

I’d left my Ventolin at home, that would sometimes start me off wheezing straight away. I was so afraid of being without it.’ Of course, it is important to carry your reliever

inhaler with you at all times, but this kind of excessive psychological dependence is distinctly unhealthy. At worst, it can lead you to over-use your reliever inhaler, which

can increase your risk of a life-threatening asthma attack (see pp. 153-4).
Sometimes the psychological effects involved in allergies and asthma are far more complex and deep-rooted than this, not just a matter of simple conditioning. It is not uncommon

for asthma attacks, in particular, to be provoked by family tensions and anxieties, or by suppressed memories from childhood. This can occur even though the asthma also has a

clear-cut physical cause, such as an allergy to house-dust mite. Some people find that their asthma always gets worse when they are in a certain place, with a certain person, or

in a particular situation. These problems are usually helped by psychotherapy (see p. 225).
While hypnotherapy and psychological treatments can sometimes be valuable, it is vital to remember that the mental factors in allergic reactions are always operating in

combination with purely physical responses – such as the triggering of mast cells by allergens (see box on p.12). Using psychological treatments alone is as much of a mistake as

ignoring the mental and emotional dimension of ill-health completely. The two aspects of treatment – physical and psychological – should always go hand in hand. Be very wary of

alternative therapists who overemphasise the psychological aspects (see p. 209).
Under the skin
To see a baby with severe eczema is heart-breaking for any parent – tormented by something it cannot understand, the child often experiences touch, not as a comforting and

pleasurable contact, but as a further irritation. According to some psychologists who have studied eczema in depth, suffering from severely itchy skin in the early years of life

may create long-lasting psychological problems. They believe that the discomfort associated with the skin, and especially with being touched, interferes with normal processes of

relating to the world and developing loving relationships with others. That is why it is so important to get the skin symptoms under control, with the proper use of steroid

creams, skin care, dietary changes if appropriate, and an anti-scratching programme (see p. 47).
Psychological symptoms from sensitivity reactions
‘People thought that because the hospital couldn’t find anything wrong with me, and because I wasn’t terminally ill, there was nothing wrong with me at all. No one could

understand how I was feeling, or even believed me. My friends and family lost patience with me. I overheard one member of my family saying they thought I was just

attention-seeking. This hurt me so much. I hated being ill all the time. I wanted to go out and enjoy myself and do the things I’d always done, but I couldn’t because I felt so

bad.’
Josey, who is now 27, was ill in this way for seven years, and her symptoms were so incapacitating that she had to give up work and abandon any sort of social life. Now, as she

puts it, ‘I have my life back again.’
The cause of her symptoms – dizziness, confusion, panic attacks, depression, shortness of breath, and a conviction that she was dying – turned out to be a sensitivity to

caffeine which was inducing hyperventilation (see p. 226). Giving up tea, coffee
and cola drinks restored her to normality very promptly, and she has not relapsed since, except on one occasion, when she unwittingly took a headache remedy that contained

caffeine.
What is clear from Josey’s story is how much the disbelief of those around her added to her problems. She felt trapped by her symptoms, which she could not overcome, while

everyone around her assumed that the whole problem was in her head, and that she could ’snap out of it’ if she chose to.
The suffering of patients like Josey could easily be avoided if more GPs knew how to recognise hyperventilation. This is one of those conditions that is well described in the

medical literature, but does not always get onto the curriculum in medical schools. As a result, many hyperventilating patients go through a lot of expensive and time-wasting

investigations, and may not get a proper diagnosis even then. This is especially sad when hyperventilation is so easy to diagnose and treat (see p. 228).
While the symptoms of hyperventilation are easy to spot, once you know what to look for, this is certainly not true of all
The autonomic nervous system
The autonomic nervous system is a kind of ‘auto-pilot’ – a set of controls that generally keeps you well adjusted to your external circumstances without you having to think

consciously about the situation at all.
The autonomic nervous system controls all the involuntary muscles – those in the heart, around the digestive system, and around the airways. It also controls the state of the

blood vessels, including those in the skin. The autonomic nervous system does its work by issuing two different sets of signals – one set that gears the body up for action and

one set that calms the body down.
Two completely separate nerve networks, the sympathetic nervous system and the parasympathetic nervous system, issue these different signals. The target organs – the airways,

heart, skin, and so on – all receive input from both networks.
The ‘get active’ signals are issued by the sympathetic nervous system, which comes into play at times of stress, excitement, fear or anger. When you can hear your heart pounding

or feel your pulse race, that is your sympathetic nervous system at work. It also makes your nasal passages and airways open up, because extra oxygen is needed for intense

physical activity, and it tightens the muscles around the blood vessels, which raises your blood pressure.
‘Chill out’ messages are delivered by the parasympathetic nervous system. This network comes on-stream when you know you can afford to relax. It slows down the heart, lowers the

blood pressure, encourages the digestive system to do its work, and makes the airways grow narrower because less air is needed when you are less active.
Adrenaline (epinephrine) is the messenger substance released by the sympathetic nervous system. Its action in tightening the muscles around the blood vessels allows adrenaline

to be employed as a drug, which saves the lives of people affected by anaphylaxis (see p. 150). During anaphylaxis, there is a massive fall in blood pressure produced by

histamine (see box on p. 12), but an injection of adrenaline can reverse this.
Both adrenaline and its derivatives, the beta-2 relievers such as Ventolin (see p. 152), also help in asthma attacks. They do this by making the muscles around the airways

relax.
The messenger substance of the parasympathetic nervous system is acetylcholine. Drugs which oppose its action – the
anti-cholinergics – can also help relieve an asthma attack (see p. 156) by blocking the airway-narrowing action of the parasympathetic.
One of the ways in which acupuncture appears to work is by adjusting the activity of the autonomic nervous system. When
acupuncture is used to deal with the immediate symptoms of an asthma attack, this is probably how it makes the airways open up.
sensitivity reactions. Food sensitivity can occasionally cause some unexpected psychological symptoms, such as bouts of hysterical crying (see p. 80) that no conventional doctor

would ever associate with food.
Inevitably, patients with sensitivity problems such as these will initially be diagnosed as having a psychological illness rather than a physical one. It may be a very long time

before the correct diagnosis is established.
Even if the patient works out the link between eating the food and experiencing the psychological response, the doctor may well remain unconvinced. What complicates matters for

doctors is that quite a few people with genuine psychological problems would prefer to think that these have a non-psychological cause, such as a sensitivity to food. (In the

opinion of most doctors, patients of this kind are far more common than patients with psychological problems that are genuinely caused by food or chemical intolerance.) For such

patients, accepting that their problems have a psychological cause means thinking about what that cause might be – and it is often something deeply distressing which the person

would rather forget.
Unfortunately, for people who get into this situation, the phoney explanation doesn’t actually help at all, though it can provide a temporary distraction. Ignoring unpleasant

hidden memories is not the answer – the problem does not go away, it just festers. Facing up to the real underlying problem is the only way to get rid of the distress (see p.

225).
If you have psychological symptoms of any kind, bear in mind that psychological causes are by far the most likely. Such causes can include difficult life circumstances, damaging

experiences during childhood, loss of close relationships, or extremely traumatic incidents in the more recent past. Where there are longstanding problems, neurological factors

(damage to the nerves or brain) or metabolic factors (something affecting the balance of chemicals in the brain), might also play a part, or sometimes be the sole cause.
For a busy doctor, without much time to spare, it is immensely difficult to distinguish patients who really do have psychological symptoms due to food or chemical intolerance,

from patients with psychological problems that they have mistakenly attributed to an intolerance reaction.
What adds to the difficulty is that, with time, psychological causes can sometimes be grafted onto a straightforward intolerance problem. This occurs because illness of any kind

can produce some psychological problems of its own, especially if the person affected cannot lead a normal life. The psychological effects of the illness invariably get worse if

the person concerned has been treated with disbelief by doctors, family or friends – as
is frequently the case when a person has indefinite long-term symptoms that are due to food or chemical intolerance. Separating the secondary psychological reactions to the

illness (or to the scepticism of others) from the primary psychological symptoms that are genuinely produced by the intolerance reactions is far from easy.
Hyperventilation and chemical intolerance
Hyperventilation (see pp. 226-9) and chemical intolerance (see p. 84) often go hand in hand. A person who is sensitive to airborne items which they cannot avoid inhaling, such

as perfume or petrol fumes, may well feel apprehensive when they catch a whiff of these, and unconsciously alter their breathing in response. They may hyperventilate.
If they do, this can both aggravate the sensitivity symptoms, and increase their anxious feelings – because one key symptom of hyperventilation is anxiety (see p. 227). In this

way the problem begins to feed upon itself, and can spiral out of control.
Hyperventilation, pure and simple, may also masquerade as chemical intolerance. In these cases, a deep underlying anxiety probably exists in the person concerned, and one way in

which this expresses itself is as a fear of synthetic chemicals. The person’s fear triggers hyperventilation, which is the initial cause of symptoms. That is not how the person

interprets those symptoms however – because the person was anticipating a reaction to synthetic chemicals, the symptoms seem to confirm that a reaction has occurred. Again, a

vicious circle has been started which is hard to break.
Another possible scenario is that someone with a few sensitivity reactions – for example, a reaction to perfume and cigarette smoke – starts to feel concerned about other

chemical sub-
‘ and to suspect that these might also cause problems. If an anxious reaction to the presence of these substances develops into hyperventilation, symptoms will ensue from the

hyperventilation. These symptoms will appear to confirm the person’s fears about yet more sensitivity reactions. In this way, people with relatively mild chemical intolerance

can begin to believe that their chemical intolerance reactions are far more extensive and disabling than they actually are.
Where the symptoms of hyperventilation are all tangled up with symptoms due to genuine chemical intolerance, opinions tend to split. Some doctors will interpret all the symptoms

as psychological, while other doctors will attribute them all to the intolerance. Both are over-simplifying the problem, and missing a crucial ingredient – hyperventilation.

Recognising and treating hyperventilation (see p. 228) can help a great deal to alleviate the illness.
The psychologisation of illness
‘From the moment Joanna was born, she was never hungry’ Sandra recalls. ‘It took all day to force an ounce of milk down, and she seemed to have terrible stomach pains. At six

months old, after countless trips to the doctor, she was admitted to hospital. The hospital doctors couldn’t work out what was wrong, and in the end they said that she was just

very independent and that she wouldn’t eat until she could feed herself. I couldn’t believe my ears – what a thing to say about a six-month-old baby!’ But as far as the doctors

were concerned, that was that.
As Joanna got older, the symptoms got worse. She developed severe constipation, opening her bowels only once every four weeks. Because her over-full bowel put so much pressure

on her bladder, she wet herself several times a day.
‘She hated school, because the other children teased her, saying she smelled. And she had such awful stomach pains that she couldn’t bend down to tie her shoelaces. When she was

six she was admitted to hospital for a second time.
‘Again they said there was nothing physically wrong with her and it was all in her head, and this time they decided that it must be because something traumatic had happened at

home. They wanted her to see a psychiatrist. It was terrible. I knew nothing like that had happened to her at home, but it was impossible to convince them.’ There was talk of

Joanna being taken away from her parents, because of suspicions about child abuse.
Two weeks before seeing the psychiatrist, something happened to change Joanna’s life. Sandra saw an item on television about a book on food allergies. She bought the book and,

remembering how fiercely Joanna had rejected milk as a baby, she hazarded a guess that milk was the problem. She immediately took all dairy products out of Joanna’s diet.
The effect was astonishing. ‘Within 12 hours her tummy ache had gone, and after six weeks she began opening her bowels almost every day. She stopped wetting herself, and was so

much happier and healthier.’ In fact, all of Joanna’s symptoms went away. and she has remained well on a milk-free diet.
Psychologisation is most frequently encountered by patients %vith medical problems that are unrecognised by conventional medicine – Joanna is a typical example of such a

patient. Occasionally, however, those with true allergies find themselves in the same situation. Take, for example, someone who has collapsed after being stung by a wasp but

gives a negative skin-test result to wasp venom. In the case of insect-sting allergy, skin-tests are supposed to give very few false negatives – so the doctor may be sceptical

about the patient’s observation of what happened. A PAST test (see p. 92) may be ordered, but sometimes this too gives a false negative.
Doctors are – not unreasonably – more inclined to believe that the patient is an unreliable witness (there was never any insect involved), or that the patient has a

psychological problem that has led to this consultation, than that both these tests gave a false-negative result. A patient in this position may need to be quite persistent to

get proper treatment. The same goes for anyone else with unusual allergic reactions that are initially labelled ‘psychological’ by their doctor. In such cases, good

communication is everything.
Good communication with your doctor
Given the intense pressure under which they work, doctors often react badly to symptoms that don’t fit into a neat diagnostic pigeonhole, or don’t respond to standard treatment.

They simply do not have the time for unravelling complex problems and there is a common tendency to ‘psychologise’ such symptoms automatically. This often does great damage to

the patients concerned, boxing them into a corner from which it is impossible to escape – the more they try to convince the doctor their symptoms are genuine, and request

further tests or treatment, the more the doctor views them as difficult, demanding patients with psychological problems. Unfortunately, it is part of the dogma about

psychosomatic illness that patients affected by it will object vehemently to such a diagnosis. So the more you insist that the symptoms are not psychological, the more this

confirms the diagnosis as far as many doctors are concerned.
The psychologisation of illness becomes a real nightmare where the patient is a child, and parents are accused of actually causing the symptoms in some way (see Joanna’s story,

left). This has happened more than once to children with unusual sensitivity reactions.
Good communication skills may stop you from sliding into this situation with your doctor. Firstly, whatever else you do, stay very very calm. Getting emotional, agitated or

angry always causes doctors to suspect a psychological cause for your symptoms.
Secondly, be very open with the doctor, and don’t conceal anything. Be clear about describing symptoms, and accurate about times, the intensity of the reaction and any other

details. Never, ever exaggerate. If you are given to describing things quite colourfully in everyday life, tone it down as much as possible for your doctor’s benefit.
Thirdly, don’t make your own diagnosis – doctors are taught to believe that patients who diagnose themselves may well be suffering from hypochondria. Present any medical

knowledge you have acquired from books or the Internet as tactfully as possible. Finally, it will probably help a lot to use the appropriate words to describe your illness when

talking with the doctor.

Air Pollution and Allergy

Air pollution plays a variety of roles in allergic reactions. Some pollutants irritate the nose and airways (and sometimes the skin) making them more sensitive to allergens. These pollutants can worsen existing allergic symptoms and may promote the development of allergies in children, by making the airway membranes more permeable. Other chemical pollutants may affect the immune system directly, increasing any existing tendency to allergic reactions.
Indoor pollution
For many of us, the air in our houses is much more polluted than any outdoor air. Several of the indoor pollutants irritate the nose and airways, and some can trigger asthma attacks. A few of the pollutants found indoors can also make allergies and asthma more likely to develop in young children.
Background pollution
One of the worst irritants in indoor air is tobacco smoke. Other people’s cigarette or pipe smoke can trigger asthma attacks in the short term, and makes asthmatics generally worse in the long run. Passive smoking might also affect the immune system making allergies more likely to develop, though this is not proven. Do whatever you can to eliminate tobacco smoke from your home.
Everyone is different
This article considers air pollution from the point of view of someone with classical allergies (e.g. hayfever or asthma). Those with chemical intolerance (see p. 84) may well be more severely affected by air pollution.
If you smoke yourself, there are many good reasons for giving up:
• If individuals from atopic families (see p. smoke, they have a far greater chance of developing allergies and/or asthma when exposed to an allergen in the air.
• For those who had asthma as children and have since grown out of it, cigarette smoking doubles the chance of it coming back.
• Parents of asthmatic children who smoke indoors make their children’s asthma worse. Teenagers can be just as badly affected by passive smoking as young children.
• Smoking during pregnancy significantly increases the risk of a woman’s baby developing allergies and asthma. (Smoking also leads to more prematurity, still-births and cot deaths.)
If possible, have an electric cooking stove rather than a gas one –or fit a powerful extractor fan. Cooking with a gas stove generates a lot of nitrogen dioxide, a gas that you can’t smell or see but which affects the airways. This same gas also comes from motor traffic, but peak levels of nitrogen dioxide in kitchens with gas cookers are often ten times the average level on city streets, and frequently exceed standards for outdoor air set by the world Health Organisation. Other sources of nitrogen dioxide include cigarettes, gas fires and kerosene-burning stoves.
For some people with allergies, nitrogen dioxide enhances their response to the allergen. So if you inhale dust-mite allergen together with nitrogen dioxide, it may have more effect than the Smoke screen
Smoke particles from coal or wood do not seem to make allergies more likely to develop - in fact, quite the reverse. In rural areas of Germany, researchers have found that children with coal or wood stoves in their homes were less likely to have allergies or asthma. An Australian study made a similar finding. Bronchitis and pneumonia are more common in those children with wood and coal stoves and these infections may stimulate the immune system in such a way that allergies are less likely to develop later. However, wood smoke may be a cause when asthma begins in an adult.
allergen alone. Breathing sulphur dioxide (see below) and nitrogen dioxide together boosts the reaction to allergen more powerfully than either gas alone.
Nitrogen dioxide might also make asthma attacks more likely, but the evidence on this is conflicting.
For young children, a high level of nitrogen dioxide at home may make the development of allergic reactions more likely. A recent Canadian study showed that children exposed to high levels of nitrogen dioxide in the home - usually from gas cookers - were ten times as likely to develop asthma as those breathing low levels of nitrogen dioxide. If a dog, cat or other furry pet was kept, and there were high nitrogen dioxide levels, the risk of developing asthma shot up even higher, to 25 times that of children with low nitrogen dioxide and no pets. (Other studies have not produced the same spectacular results, but their methods of measuring nitrogen dioxide exposure were less precise.)
Try to eliminate materials that produce formaldehyde fumes, or seal the items with a good coat of paint. Formaldehyde is given off by chipboard and to a lesser extent by MDF (medium-density fibreboard). Injected cavity wall insulation can also produce persistent formaldehyde fumes, and is very difficult to get rid of -moving out is often the only option. A recent study from Australia showed that children exposed to formaldehyde, especially in the bedroom, were more likely to develop allergic reactions: the higher the level of formaldehyde exposure, the more severe the child’s allergic sensitisation.
Those with asthma have more frequent symptoms if exposed to high formaldehyde levels. A recent study from Finland shows that easy-to-clean plastic wall-covering and flooring increases the risk of asthma in children.
A Canadian study found that children whose first home was less than 20-30 years old were 50% more likely to develop asthma than children living in older houses. One possible explanation for this lies with the materials used in the construction and fitting of new houses, especially the plastics, wood preservatives and insulation materials. Solvents, and chemicals such as formaldehyde, are still being given off by these materials some years later.
Air fresheners provoke asthma attacks in some people. For a few individuals they can cause general symptoms of ill-health that are similar to those described for mild chemical intolerance (see p. 84). Those affected generally don’t realise that the air freshener is the source of the trouble. This malign effect is not entirely surprising, since air fresheners work by giving off a chemical that targets part of the brain - the part involved in processing sensory input from your nose. The chemical ‘freshens the air’ by partially disabling your sense of smell. Better to open a window.
Cleaning products, furniture polish and deodorant were never intended to go into the nose and airways, but that’s what happens when they are sprayed from an aerosol, and they can trigger asthma attacks. Steer clear of aerosols as much as possible - there are usually alternatives.
Pollution peaks
Read the instructions and ingredients lists on all products carefully. It is not just a question of what’s in them, but also what gases they might give off when used. One asthmatic died within minutes when the de-rusting agent she was using on her dishwasher produced a large amount of sulphur dioxide gas: her airways tightened up so much that she couldn’t even use an inhaler to save herself. ‘Sulphuric’, ’sulphate’ or ’sulphite’ in the list of ingredients should ring warning bells if you have asthma: sulphur dioxide gas could be given off by this product.
Bleach, and other chlorine-based cleaning products, such as toilet cleaner and scouring powder, should be used sparingly, and with plenty of ventilation. These products release chlorine gas which, in large amounts, can irritate the airways of asthmatics. Never allow bleach or toilet cleaner to become mixed with any other product. Take care with any product containing hypechlorte, chloramine, ammonia, acids or morpholine and with the chemicals used for swimming pool water. All these can trigger asthma attacks.
If doing repairs or DIY work about the house, take special care. Always ventilate the work area well, and wear a dust mask if sawing or drilling.
The smell of paint is due to solvents, and these can act as irritants to the nose and airways. When decorating, ventilate well, and use low-odour water-based paint. Some of the best low-odour paints, tested and shown to be safe for paint-sensitive asthmatics, are only available by mall order: see p. 255.
‘Instant foam’ kits sold for DIY insulation can provoke asthma in those who were not asthmatic previously. Two different substances are mixed to create the polyurethane foam, and during the mixing process, isocyanate is released – this is one of the most powerful asthmagens known (see box on p. 132). The level of isocyanate can breach the safety limit set for factories.
Avoid using fly spray or other insecticides: look for other methods of pest control. A study from Ethiopia showed that people using an insecticide in their houses were twice as likely to develop allergies. A study of Canadian farmers suggested that asthma might be linked to the use of carbamate insecticides (e.g. carbofuran). The sprays used for cockroaches can act as irritants for those with allergic rhinitis or chronic sinusitis.
If advised that your house needs spraying with insecticide, for woodworm or other wood-boring pests, ask for more information before you go ahead. Is the spraying really necessary? What will happen if the house isn’t sprayed? How quickly will it happen? Is there any other method of eradicating the pest? Spraying is often done when it is not really essential – houses remain standing even with woodworm holes all over them. Unless you have a heavy infestation that is threatening the structure of the house, you are probably better off not having the house sprayed. The heavy and ongoing exposure to insecticide that spraying of a house involves is something you and your family should avoid if at all possible. All the sprays used are toxic to some extent – don’t believe those who tell you otherwise. A heavy exposure to pesticides can sometimes make allergic symptoms worse or precipitate chemical intolerance (see p. 85).
The garage, workshop or garden shed can also be very polluted. Petrol, kerosene and paraffin can affect some people with rhinitis or asthma, and can bring on their symptoms. These fuels should always be kept in airtight containers. Paints sold for cars often contain isocyanates, among the most common causes
of work-related asthma (see box on p. 132). If using such paint, wear a mask with an activated carbon filter and make sure the area is well ventilated. Avoid prolonged or repeated exposure.
Outdoor pollution
Some of the pollutants in outdoor air can make allergic reactions worse and can trigger asthma attacks in people who are already asthmatic. A study of hospital admissions in London, Paris. Barcelona and Helsinki found that high levels of pollution increased hospital admissions for asthma by about 3%.
The pollutants that matter to those with allergies are:
• ozone, which soars to high levels on sunny days, mainly in country areas that are near large cities. The reason for this is a chemical reaction which occurs when car exhaust fumes are exposed to sunlight, producing ozone, a highly reactive form of oxygen. Further chemical reactions, involving another ingredient of exhaust fumes, then break the ozone down again. Thanks to this second reaction, there is usually little ozone in city air. But in a relatively rural area 20 miles or so upwind of the city, the pollutants are too dispersed for the second reaction to occur, and the ozone from the urban traffic can accumulate.
Ozone levels in the air tend to peak in the late afternoon and early evening – but it takes 4-24 hours for ozone to produce its effects on the airways. Indoors, ozone breaks down very quickly because of contact with other gases inside the house.
Ozone can increase the effects of allergens, such as pollen, on the nose and airways.
In addition, ozone makes the airway muscles contract, even for people without asthma. Healthy people tend not to notice these effects, whereas some asthmatics may have more symptoms, and may need more drugs, on days when ozone levels are unusually high.
• diesel particulates, which can become a problem in town centres, and close to main roads used by vans and lorries. Unlike ordinary petrol, diesel fuel contains oil, so when it burns it produces tiny black particles. These consist of flakes of carbon (soot), coated with complex chemicals that are produced by the
But what about the ozone layer…?
Is ozone good for us or bad for us? People often get confused about this, because of all the discussion about
‘the destruction of the ozone layer’. But that ozone layer (which screens us from harmful ultraviolet light) is a natural phenomenon and it is thousands of feet up, well away from our lungs. At ground level, in the air we breathe, ozone is unnatural and potentially damaging .
The size of the particles
Diesel particles are 1-10 microns in size, with most smaller than 2.5 microns. Tobacco smoke, coal smoke, fumes from oil-burning boilers, and the smoke from frying food all contain very much smaller particles, down to a hundredth of a micron (.01 microns) in size. (A micron is a thousandth of a millimetre.)
In pollution reports, counts for particles in the air (mostly diesel particles these days, except in heavily industrialised areas) will often appear as ‘PM1 0′, meaning ‘Particulate Matter less than 10 microns in diameter’. This particle size is chosen because larger particles tend to settle in the nose and throat, and not reach the airways of the lungs. The term ‘Small Particles’ is sometimes used to mean PM10.
To deal with air pollution, you need a really good mask with two filters: a dust filter that can take out very small particles and an activated carbon filter that absorbs irritant fumes and gases. Note that while activated carbon filters remove most pollutants, they do not take out nitrogen dioxide unless they have been specially treated.
partial combustion of the oil. It is probably these surface chemicals, rather than the soot particles themselves, that have such bad effects on the nose and airways.
Some research suggests that diesel particulates might increase the risk of allergies developing – to pollen for example. Additionally, when levels of diesel particulates are high, asthmatics tend to have more symptoms. If levels rise above 50 micrograms per cubic metre there is a sharp increase in asthma attacks – and a recent study in Birmingham showed that such levels are regularly reached at roadsides.
• sulphur dioxide, which often reaches high levels in areas of heavy industry, particularly near coal-fired power stations and coking plants. It acts as an irritant to the airways and can trigger attacks in asthmatics, who are far more sensitive to sulphur dioxide than healthy people (see box on p. 207). However, at the sort of concentrations normally encountered, even in quite polluted air, sulphur dioxide does not have any effect on most asthmatics.
• nitrogen dioxide, which is produced by all types of vehicles, and by power stations and some factories. In towns and cities with heavy traffic, nitrogen dioxide can build up to high levels. This gas is also found indoors (see p, 128) – often at far higher levels.
Oil refineries and cement works
In addition to these widespread pollutants, there are localised areas of air pollution, around industrial sites, that are frequently accused of causing health problems, including high rates of asthma. The kinds of industrial sites regularly mentioned include:
• oil refineries and oil-burning power stations
• cement works that use waste solvents for fuel
• dock areas where oil is loaded into tankers.
None of these accusations has been investigated in any detail, so it is impossible to say if there is a real link with asthma.
Avoiding outdoor air pollution
If you live in the kind of area that experiences high levels of ozone (see p. 130), plan your outdoor activities, especially jogging or playing sport, to avoid summer afternoons and early evenings.
Those who live very close to a main road, with a lot of lorries going past, would probably improve their own health, and reduce the chance of their children developing allergies and asthma, by fitting air conditioning or high-quality HEPA air filters – or by moving house. However, the benefits, in terms of decreased risk, are not enormous, and it is important to take other preventive measures as well (see Chapter 8).
When driving, if you stop behind a lorry or bus, keep your distance, close the window and turn off the fan. Diesel vehicles often emit a thick cloud of particles as they set off, and this can come straight into your car, setting off severe attacks for some asthmatics.
A car with air conditioning will reduce your exposure to diesel particulates while driving. When buying a new car, you can make a contribution to air quality by choosing a non-diesel vehicle, preferably one with a catalytic converter fitted. Alternatively, buy a diesel vehicle with a particle filter on the exhaust (now fitted as standard in Germany).
In Britain, the Vehicles Inspectorate of the Department of Transport encourages the public to report lorries and buses seen pumping out black smoke (look in the phone book for the number).
If you are asthmatic, breathing through your nose may help as this can filter out some damaging pollutants before they reach the airways in your lungs. (If your nose is usually blocked, try the exercises on pp. 230-31).
When levels of ozone or sulphur dioxide are high, taking a supplement of Vitamin C and eating plenty of foods that contain Vitamin E and beta-carotene (see p. 207) can protect your airways.

Breathing Exercises
Breathing is a delicate art, and it is possible to get it wrong, in a variety of ways and for a variety of reasons. A poor breathing pattern can gradually become habitual,

without the person concerned being aware that his or her breathing is at all abnormal.
Allergy and sensitivity reactions sometimes play a part in causing abnormal breathing, and the symptoms produced by a poor breathing pattern may then augment the symptoms of

sensitivity, creating a vicious circle. Correcting an abnormal breathing pattern, by means of breathing exercises and re-training, can produce remarkable improvements in health

for some people.
Breathing too much
Taking in too much air, often called over-breathing or hyperventilation, is the most common breathing disorder. It can produce a variety of rather strange symptoms (see p. 227)

that are sometimes diagnosed correctly, and treated appropriately, but often get overlooked or misdiagnosed.
The primary purpose of breathing is to obtain oxygen from the air and absorb it into the blood. The lungs are a crucial interface here, a trading post for gases that are

exchanged between the bloodstream and the external air. The delicate, moist membranes that cover the inner surface of the lungs are accessed by millions of tiny thread-like

blood vessels known as capillaries. Oxygen from the air seeps into the blood through the thin walls of these capillaries. At the same time, the lungs clean the blood of carbon

dioxide, a waste gas produced by the body’s metabolism. As oxygen seeps into the blood, carbon dioxide seeps out.
That is the school-textbook view of breathing, and it is correct up to a point. But it is over-simplified and misleading if it simply portrays oxygen as totally
good and carbon dioxide as totally bad. In fact, there is a correct level in the blood for both gases, and too little or too much of either can cause problems.
Carbon dioxide plays an important role in the equilibrium of the blood because, when dissolved in any liquid, carbon dioxide makes a weak acid. So the amount of carbon dioxide

present is crucial in deciding the acidity of the blood. Given that the blood reaches every part of the body, it is not surprising that any changes from its normal composition

have far-reaching effects.
Normally, blood is very slightly acidic, and that is what the body is accustomed to. While some body parts can cope with small changes in the acidity of the blood, other parts

respond very badly. The nerve cells are particularly vulnerable to changes in acidity.
Hyperventilation, or over-breathing, has relatively little effect on the level of oxygen in the blood, which is carefully controlled, but it can lower the level of carbon

dioxide in the blood, thus making it less acid. More commonly, hyperventilation just makes the level of carbon dioxide vary a great deal.

When the carbon dioxide levels in the blood yo-yo about all the time, this has some unpleasant effects. In particular, it disrupts the smooth running of the nerve cells, which

is why many of the symptoms of hyperventilation involve the senses, feelings or behaviour.
The symptoms of hyperventilation can include:
•    numbness or pins-and-needles in the hands and feet, occasionally affecting the lips and tongue as well
•    difficulty in swallowing
•    aching muscles, cramps, tremors and twitches
•    sudden loss of strength in the muscles
•    dizziness, confusion, unreal or spaced-outfeelings
•    blurred vision, ringing in the ears
•    headache, migraine
•    breathlessness
•    aching in the chest
•    abnormal heart rhythm
•    sensitivity to bright lights and loud noises.
There may also be some severe psychological symptoms:
•    panic – a brief but intense state of anxiety
•    prolonged anxiety or depression
•    hallucinations, although this is rare
•    mood swings and phobias, most frequently a fear of dying. The irrational conviction that death is imminent can be overwhelming, even in someone who is young and

apparently in good health.
Each of these symptoms can, of course, be caused in several other ways, but when this whole cluster of symptoms – or a large number of them –occurs together in an individual,

that person is very likely to be a hyperventilator.
When there are short self-contained bursts of hyperventilation, the effects are often described as a panic attack. Doctors usually have no trouble recognising this problem, but

– not surprisingly – are often misled by the sustained psychological symptoms of chronic (long-term) hyperventilation. Many people with chronic hyperventilation are diagnosed as

having some kind of mental illness, and they may go for years without getting the right diagnosis.
Hyperventilation and sensitivity reactions The link between sensitivity reactions and hyperventilation seems to be a complex one. Unfortunately, very little research has been

done in this area, so what follows is based on the case-histories of patients, and the collective experience of doctors, not on hard scientific data.
In some cases, a sensitivity reaction may
directly provoke a change in breathing pattern. This
is what appears to happen for some people with
caffeine sensitivity. Cutting out all caffeine-con-
taining drinks (coffee, tea and colas) seems to put a
stop to the hyperventilation symptoms, because the
multiple symptoms promptly disappear (see p. 235).
In other cases, a severe sensitivity problem such
as multiple chemical intolerance results in an anxious
state of mind, and the anxiety leads to hyperventi-
lation. Hyperventilation, pure and simple, may also
masquerade as chemical intolerance (see p. 236).
Wheezy as a mountain breeze
Ionisers — devices that supposedly turn indoor urban air into a fresh mountain breeze — are often promoted as alternative devices that can clear allergens from the air. They do

remove some allergens, but in the case of asthma, research shows that some ionisers can actually make symptoms worse, by generating ozone which irritates the airways. It is

usually the cheaper ionisers that do this. More expensive models are less likely to produce ozone, but they are unlikely to help either. Several scientific trials show that

ionisers have no significant benefits when used by asthmatics.
Hyperventilation and asthma
While hyperventilation can develop in anyone, asthmatics are particularly vulnerable. During an asthma attack, especially a severe one, developing an abnormal breathing pattern

is an entirely understandable reaction. In an attempt to get more air, you may start breathing more rapidly and taking air into the upper chest, using the accessory muscles of

breathing (see p. 230). These muscles should not normally be used when you are at rest — they exist to give you extra breathing capacity when running fast.
As long as the asthma attack lasts, this forced breathing does no harm, because its effects are cancelled out by the narrowing of the airways. But if this over-breathing

persists after the attack has ended, then too much air is going in and out of the lungs, so carbon dioxide levels in the blood begin to fall.
Simply feeling anxious can also trigger off rapid upper-chest breathing. If you get very worried when an asthma attack starts, you may begin hyperventilating just out of

anxiety.
For asthmatics, in addition to the usual symptoms of hyperventilation (see p. 227) there are some subtle effects of hyperventilation that can make asthma worse:
•    The airway muscles (and all other muscles that are not under voluntary control) contract slightly when carbon dioxide levels in the blood fall.
•    Mast cells are quicker to degranulate (see box on p.12) when
there is less carbon dioxide, and this triggers allergic symptoms. Just to complicate matters, one of the symptoms of hyperventilation is breathlessness. Sometimes this is the

most prominent symptom in non-asthmatic hyperventilators, and the doctor overlooks the other symptoms and gives a diagnosis of asthma. In such cases, people are told they have

asthma when they are actually suffering from hyperventilation alone.
Testing for hyperventilation
You can do two simple tests for hyperventilation at home, if you think that it could be playing a part in your symptoms. (If you are asthmatic, only do these tests when you have

no asthma symptoms and your peak-flow reading is good. Make sure your reliever inhaler is nearby, in case of a bad reaction to the test.)
The first test should be done when you have some symptoms that might indicate hyperventilation (see p. 227).
Find a clean paper bag and hold it over your nose and mouth while breathing normally. Any symptoms that are due to hyperventilation should clear up, because, by re-Inhaling the

air that you have just breathed out, you will increase the level of carbon dioxide in your blood.
The second test is done when you don’t have any of the symptoms listed for hyperventilation.
Speed up your breathing, and inflate your upper chest with each breath. Do this for a few minutes. Do any of your usual symptoms appear? If they do, this suggests that they may

be caused by hyperventilation.
If either of these tests indicates hyperventilation, make an appointment to see your doctor. It is important that you should have a proper medical diagnosis, so that you get the

right professional treatment.
Treating hyperventilation
If you hyperventilate, you could be taught a more healthy breathing pattern by a physiotherapist — ask your doctor for a referral. Certain complementary therapists, such as

osteopaths and Feldenkrais practitioners, can also teach good breathing patterns, and so can experienced yoga teachers (see p. 224). A teacher or therapist who works at a

relaxed pace, is not too dogmatic, and helps you to find your own way to healthy breathing, is preferable to one who tries to impose a regimented breathing pattern on you.
On the assumption that most hyperventilators don’t just over-breathe, but also breathe with their upper chest and under-use the diaphragm (see pp. 229-230), all these different

practitioners will take a combined approach — tackling both sides of the problem at once. This represents an important difference from the Buteykc, method (see below).
The Buteyko method
The stated aim of the Buteyko method (also called the Buteyko treatment) is to stop people from hyperventilating. However, Buteykc, practitioners do not work with people who

have the symptoms of hyperventilation, as recognised by conventional medicine (see p. 227). Instead they work with asthmatics — any asthmatics, not just those whose symptoms

suggest that they might be hyperventilators.
The rationale for this is the claim, by the originator of the exercises, Professor Konstantin Buteyko, that asthma is actually caused by hyperventilation. (What is more,

Professor Buteyko cites hyperventilation as the cause of no fewer than 150 different diseases, including allergies, eczema, migraines, insomnia, bronchitis, high blood pressure

and haemorrhoids. However, his treatment is only marketed for asthma.)
The claims made for the success of the Buteyko method in treating asthma are startling. According to one training centre, it can get 97% of asthmatics off most of their drugs

and able to control attacks within a week of starting.
Not surprisingly, this is a bit of an exaggeration. But the real achievements of the Buteykc, method are still quite impressive: an Australian research study showed that during

the course of Buteyko lessons, the overall use of reliever inhalers (e. g. Ventolin) fell substantially and remained relatively low three months later. However, the patients’

average peak flow stayed the same, and 15% of those studied were admitted to hospital with a severe asthma attack during the trial. In the eight months that followed, 30% needed

a course of steroid tablets – indicating a substantial worsening in their condition. In other words, the Buteyko method can give some help to many asthmatics, but the claim that

it can get almost everyone off asthma drugs and free of asthma is just hype.
Professor Buteyko’s claim to have discovered the fundamental cause of asthma is clearly untrue. What he seems to have discovered is that there are many more hyperventilators

among asthmatics than was widely realised, and that they generally show no obvious symptoms of hyperventilation. His other important contribution is to suggest that

mouth-breathing may create a lot more problems for asthmatics than previously recognised.
The Buteyko method has three aspects:
•    unblocking the nose
•    training to breathe through the nose, not the mouth
•    training to take fewer breaths and pause between breaths. Unlike other treatments for hyperventilation (both conventional and alternative), the original Buteyko method

pays no attention to teaching asthmatics to breathe with the diaphragm. However, a few Buteyko practitioners are now beginning to incorporate this aspect of treatment.
If you decide you would like to try the Buteyko method, there are several different options. Classes are the most expensive route, with very high fees being charged. There are

video cassettes you can buy, which are less expensive. Alternatively, there are various books, which are much less costly, and which explain how to do the exercises (see p.

255).
Whichever option you choose, it is vital that you get your doctor’s permission before starting. Ensure that your reliever inhaler is in your pocket while doing the exercises,

because they could provoke an asthma attack. Keep taking your preventer drugs regularly throughout the treatment. If you start to feel much better and want to reduce your dose

of preventer, you must talk to your doctor first.
Don’t follow the Buteyko method blindly, because some of the advice given is dangerous. For example, some Buteyko publications advise you to refuse oxygen if you are taken to

hospital with a severe asthma attack. They claim that oxygen levels in the blood are not reduced during a severe asthma attack, but this is just not true. Measurements clearly

show that the level of oxygen
gets very low, and this is frequently the cause of death.
Another very peculiar Buteyko idea is that you should not try to shift mucus from your airways because mucus ‘protects you’ against losing too much carbon dioxide. This too is

dangerous advice. Accumulated mucus narrows the airways, adding to your asthma symptoms, and it can even block a small airway completely. The part of the lung served by that

airway then collapses – a serious complication that no asthmatic would want.
Using the right muscles
Hyperventilation is often linked with an abnormal way of breathing, in which the wrong muscles are used. This is one common pattern that conventional doctors recognise for

hyperventilators:
•    The main muscle of breathing – the diaphragm (see below) is not used fully
•    The muscles of the upper chest become involved in breathing, even at rest, when they should not be needed
•    There are lots of rapid, shallow breaths
•    The breathing is quite irregular, with deep, sighing breaths from time to time, or frequent yawning.
Even in those who do not hyperventilate, breathing with the upper chest, and/or neglecting the diaphragm, can become a problem. This pattern of breathing is sometimes linked to

anxiety and emotional problems (see p. 230).
To understand what goes wrong, you need first to know about the healthy way to breathe.
The rib-cage and the diaphragm are the work-horses of breathing. You can feel your rib-cage through your skin, and feel its movements, but the diaphragm is far more

inaccessible. It lies below the lungs, but above the stomach and intestines.
In its contracted state, the diaphragm becomes a thick slab of muscle, with a slight curve, like an inverted saucer. When it relaxes, it becomes far more curvaceous, changing to

a shape like an inverted bell. In this shape, there is less space for the lungs above the diaphragm.
If you are breathing correctly, the diaphragm contracts when you breathe in and relaxes when you breathe out. The contraction lowers the dome of the diaphragm, pulling the base

of the lungs downwards and so making them expand.
Breathing out requires no muscular force whatever, as long
as you are just sitting or walking about (and therefore not breath-
ing hard). The lungs are naturally elastic, like balloons, so they
automatically contract and force out the air, once the diaphragm
relaxes into its bell-like shape and stops pulling them downwards.
While you cannot feel the diaphragm itself, you can feel the
effect of its in-breath contraction. As it contracts, the diaphragm
pushes down on the stomach and intestines, so that your abdomen bulges out a little with each breath. Western women, conditioned to admire an unnatural flat-bellied body shape

(unnatural for a woman, that is), often breathe badly because they are trying to ‘hold the tummy in’. This steely tightening of the muscles across the front of the abdomen

opposes the contraction of the diaphragm, and prevents a natural and relaxed in-breath.
The diaphragm should do virtually all the work of breathing in, when you are not exerting yourself much. The upper part of the rib-cage should hardly expand at all and the

muscles that run between the ribs, the intercostal muscles, should not be working.
When you become more active, and therefore need more oxygen, the upper chest automatically starts to expand with each in-breath. At this point the intercostal muscles become

involved, along with a whole team of other muscles in the chest region —these are known as the accessory muscles of breathing.
The effects of an asthma attack
In the grip of a severe asthma attack, you may well start using the accessory muscles of breathing to try to take in more air. If you have frequent attacks, or if this way of

breathing gets to be a habit and goes on between attacks, then the chest may be distorted by the constant use of the accessory muscles, plus the over-inflation of the lungs.

Severe asthmatics often have high shoulders and a `barrel-chested’ look as a result of this. Hyperventilation may also start in this way.
Observing how you breathe
To discover whether you are breathing with your diaphragm or your upper chest, lie on your back with your left hand on your belly, and your right hand on your upper chest. Just

lie still for a few minutes, let your arms relax, then start to pay attention to your hands. When you breathe in, which hand rises? It should be the left hand, with little or no

movement in the right.
Alternatively, bend over and hold the back of a chair with your hands. Your back, head and arms should form a straight horizontal line, at right angles to your legs. Just stay

quietly in this position for a while. It is very difficult to breathe with the upper chest in this pose, whereas breathing with the diaphragm is easy. If you feel fine in this

position, then you are probably breathing well normally.
Correcting upper-chest breathing
Learning to breathe with the diaphragm is often an important part of correcting hyperventilation (see p. 228). It should also be taught to anyone who has the kind of chest

deformities that develop in severe asthma (see above).
Diaphragmatic breathing, or abdominal breathing as it is sometimes called, should help make you feel more relaxed
because the in-breath can disperse tensions in your abdomen. This is where many people ‘hold on to’ their fears, with chronically tense abdominal muscles. When you start

breathing into this area of tension, it is important to take things gently and not force the breath downwards. Be aware of any resistance to the in-breath in the abdomen, and of

any emotional reactions that occur when you challenge this resistance.
Sometimes breathing in this way for the first time can bring up emotional difficulties that may need careful handling. That is why it may be better to learn abdominal breathing

from someone who has time to deal with such issues, and with whom you feel very comfortable and relaxed — for example, a yoga teacher or an alternative therapist who you like

and trust. Physiotherapists tend to take a very brisk and practical approach to breathing, which may not be entirely appropriate or helpful when habitual ways of breathing are

tied up with emotional problems.
When learning to breathe with the diaphragm, be careful not to get carried away and become a ‘belly breather’, whose every in-breath sends the abdomen bulging out like a

mainsail. The abdominal muscles should oppose the downward movement of the diaphragm to some extent, without being too tense.
Clearing the nose
Breathing through the nose, rather than the mouth, is beneficial for asthmatics, because it cleans and warms the air. It can also help those with chronic sinusitis because it

oxygenates the air in the sinuses, which discourages some of the more troublesome microbes responsible for sinus infections.
This technique for clearing a blocked nose, part of a set of breathing exercises for opera singers, is based on a time-honoured yoga exercise called alternate nostril breathing:
•    Sit with your mouth closed.
•    Press your right nostril against your nose to close it, using the thumb of your right hand.
•    Breathe out through your left nostril.
•    Press your left nostril against your nose with the index finger of your right hand, to close it. (The hand makes only a very small movement from side to side.)
•    Breathe in through your right nostril.
•    Repeat the sequence.
Once you have got the hang of this, do ten fairly rapid breaths, with no pause between out-breath and in-breath. Pause and rest.
Repeat using your left hand, and reversing the flow of the breath: out through the right nostril and in through the left. Again, do ten breaths and then rest.
Alternatively, try the following exercise, which is recommend by Buteyko practitioners for unblocking the nose. This technique has not been tested scientifically, but the

reports of asthmatics who have used it suggest that it often works wonders, even with children who could never breathe through their noses previously:
•    Have your reliever inhaler to hand, just in case the exercise brings on an asthma attack.
•    Breathe as you do normally, and at the end of a normal out-breath, close your mouth and hold your nose
•    Stay like this, without inhaling, for as long as you can without discomfort. Walk around the room while you are doing this or, if you are young and fit, do something

more strenuous – either walk upstairs or squat-then-stand several times.
•    When you need to breathe in, keep your mouth shut but release your nose
•    Breathe in slowly through the nose
•    Repeat the exercise if your nose becomes blocked again.
Special exercises for asthma
In addition to tackling the problem of hyperventilation, if one exists, asthmatics can use other breathing exercises to tackle specific aspects of their asthma.
Clearing mucus from the lungs A physiotherapist can teach methods of clearing mucus from the airways which are suitable for asthmatics. Ask your doctor for a referral. You could

also try the following exercises:
Huffing Take an in-breath, then tighten your abdominal muscles very sharply, to push the air out. Imagine there is a candle in front of you, and you are trying to extinguish it,

but using your belly muscles only. Your out-breath should make a short soft ‘huff’ sound – if it is more of a loud ‘w000sh’, you are contracting the muscles in your chest as

well as those in the belly. Try again, and focus your attention on your belly as you make the out-breath.
The in-breath should be effortless with this exercise – it just bounces back in. Do as many huffs as you can without feeling breathless. Rest and repeat. The aim is to build up

stamina until you can do 30 or more huffs in succession.
Pursed-lips breathing Take a fairly deep in-breath, then purse your lips together. As with huffing, your belly muscles have to do all the work of the out-breath, but in this

exercise they are working against the muscles of the lips. The aim is to divide the out-breath into as many fragments as possible – to push the air out through the lips in a

succession of tiny, forceful blasts.
One objective of these exercises is to encourage mucus to start moving up to the top of the airways. From there, it can be cleared with a little throat-clearing cough. Note that

the mucus will probably take a while to reach the throat – this may happen some time after you do the exercise. For maximum effect, repeat these exercises several times each

day.
Coping with asthma attacks
The crucial thing during an asthma attack is to focus on your out-breath, not your in-breath. Of course this goes against the grain, because you feel so desperate for air, but

remember that the central problem is stale air from your last in-breath, now trapped in your lungs by the narrow airways. If you can focus on exhaling this used air, you will

have more space for fresh air to come in with the next in-breath.
At times when you are not suffering from an asthma attack, it is worth doing some exercises that improve the strength of your out-breath. The key problem during an asthma attack

is that the natural elasticity of the lungs, which should power the out-breath, is not equal to the challenge of pushing out all that air through narrowed airways in a short

space of time. In this situation, contracting your abdominal muscles so that they push upwards and assist in emptying the lungs is helpful.
The two exercises described above for clearing mucus –huffing and pursed-lips breathing – also strengthen those abdominal muscles which can assist you with your out-breath

during asthma attacks.
Strengthening exercises
Several different exercises or pursuits that strengthen the breathing muscles seem to produce an improvement in asthma. The reasons for this are not understood.
Asthmatics who take up a wind instrument, such as the flute, often report that their asthma improves considerably. The same effect has regularly occurred with asthmatics who

undertake classical training in singing. One set of exercises, taught to aspiring opera singers and designed specifically to strengthen the diaphragm, has been scientifically

tested and shown to improve asthma and reduce the need for drugs. These exercises can be learned at home (see p. 255). There are also some mechanical devices which can

strengthen the breathing muscles (see p. 255).

Chemical Intolerance
`To start with, I just used to get this irritation in my throat when I was reading a magazine. Over the years it got much worse, and there was a dreadful burning feeling, not

just in my throat now, but also in my eyes and nose. Sometimes I could scarcely breathe. My doctor said it couldn’t be magazines and diagnosed asthma. Twenty years on, I can’t

look at a magazine, even for a few minutes, and other things affect me now too. If I go in a room with a photocopier running I start to choke and can’t breathe. Whenever I

describe this problem to anyone — apart from the doctor, that is — they almost always say they know someone else who has a similar problem. But the doctors still say that what

happens to me can’t happen.’
Mary has chemical intolerance, which is also known as chemical sensitivity, environmental Illness or idiopathic environmental intolerances. It is a condition that arouses more

passionate controversy than any other described in this book. Many believe that it simply does not exist, or rather that people who claim to have chemical intolerance are

actually victims of psychological problems, which express themselves as physical symptoms. Careful studies show that, while some people with supposed chemical intolerance do

fall into this category, others do not – they have no psychiatric problems, but they do appear to have valid symptoms when exposed to certain synthetic chemicals.
`People with MCS are desperate. They will go to great lengths and do almost anything to find a doctor, anyone, who believes them.’ So speaks one sufferer from MCS (Multiple

Chemical Sensitivity), the most extreme form of chemical intolerance. It is often severely disabling, with symptoms such as exceptional fatigue, nausea, headaches, poor memory

and concentration, dizziness. muscle aches, joint pain, chest pain and digestive problems. Those with MCS react to a very wide range of chemicals, and very often to foods and

food additives as well.
These severely affected patients are a small minority, however, and many more people are like Mary, with sensitivity to just one or two types of chemical exposure. Surveys in

the United States suggest that about 30% of the population are affected in this way. The authors of one such survey note that ‘the widespread idea that chemical sensitivity is a

condition of educated, urban housewives was not supported by our study. The region surveyed was rural… and individuals who reported chemical sensitivity were found in all age,

gender, income, race and employment groups.’
The chemical exposures that are identified as triggering symptoms include:
• perfumes
• pesticides
• cigarette smoke
• paint fumes
• petrol
• exhaust fumes
• cleaning products
• newspaper ink
• plastics, especially those with a strong smell
• glossy paper (e.g. In magazines).
Typical symptoms, in those with sensitivity to just one or two chemical products, are:
• a blocked or runny nose
• sore throat
• irritation of the eyes
• sinus pain and congestion
• headache
• breathlessness and wheezing
• nausea
• skin rashes
• extreme fatigue
• dizziness.
How does chemical intolerance begin?
For some of those with MCS, the problems began with a sudden over-exposure to a toxic chemical, such as a chemical spill, or pesticides from a crop-spraying plane. Others are

first affected by regular doses of pesticide at lower levels, such as spray drift from nearby fields or from a neighbour’s garden. It seems as if, for these people, their inborn

ability to detoxify both natural and manmade toxins is overwhelmed by an unusually heavy exposure, and never fully recovers. Although there have been no systematic studies of

this – it is difficult to imagine how they could be done –the wealth of well-documented cases is convincing. And studies of those exposed to high levels of pesticides in

accidents at work support the idea that this can cause lifelong sensitivity to very small doses of some synthetic chemicals. Sensitivity to alcohol and caffeine usually

increases enormously too.
In some cases, classical allergies also feature in the range of symptoms for those with MCS. If they had an allergic tendency before the accidental exposure to pesticides, this

is especially likely: after the accident, along with chemical intolerance, they have far more pronounced allergic reactions to common allergens.
The loss of tolerance to everyday chemicals may be related to some kind of damage to the enzymes in the liver that carry out the important task of detoxifying toxins that enter

the bloodstream. This detoxification system evolved to deal with natural toxins, such as those in plant foods, and those produced by bacteria living naturally in the gut. These

enzymes can also detoxify the widely used synthetic chemicals, when these are encountered in relatively small amounts, but the enzymes are overwhelmed by large doses.
Chronic Fatigue Syndrome (CFS)
This is a disease that probably has multiple causes rather than a single cause. The main symptom is fatigue that is not relieved by rest. Many people with CFS also have a

slightly raised temperature, problems with concentration and memory, headaches, sore throat and swollen lymph nodes (’swollen glands’). The lymph nodes are part of the immune

system, so this symptom suggests some disturbance of immune function. Other findings, related to immune cells in the blood, also support this idea. However, there are often

minor abnormalities in the brain as well, with some loss of the insulating material around the nerves (myelin).
For many patients, the disease develops in the wake of a viral infection, but for others the origin may be unclear. Whatever the origin of the disease, avoiding synthetic

chemicals is very helpful in many cases. Some sufferers also find an elimination diet helpful (see pp. 194-7). Doctors working in this area say that there is no sharp

demarcation between patients with Chronic
Fatigue Syndrome (CFS) and those with MCS.
Autism
In the search for a cause of autism, many possibilities are being investigated. The consensus now is that there is a genetic predisposition which, when combined with certain

trigger factors, leads to autism.
What are those trigger factors? Some researchers suggest that autistic children have poorly performing detoxification enzymes and are therefore sensitive to synthetic chemicals,

both in food and the environment. The suspicion is that these chemicals affect the developing nervous system.
Other researchers pinpoint food as the culprit. They believe that children who develop autism are affected by exorphins (see p. 76) produced from the proteins in wheat and/or

milk, and that these damage the child’s developing nervous system. There are claims that a dairy-free and gluten-free diet can help, but that it must be ultra-strict to work,

and may need to continue for at least six months before any improvement occurs. You must have your doctor’s approval for this.
Before starting them on such a diet, some doctors also give a course of anti-fungal drugs to those autistic children who have been treated repeatedly with antibiotics. This

combined treatment is reported to have very good effects for some children.
Treatment
Assuming that you really do have chemical intolerance rather than some deep-rooted psychological problem – and you have to be honest with yourself here, because otherwise you

will never get better – then careful avoidance of the offending synthetic chemicals is the only effective treatment. If you have eliminated everything that obviously affects you

and are not much improved, then try tackling common indoor pollutants (see pp. 128-30) as well.
Such measures are of value to some with chemical intolerance but may not be adequate for those most severely affected. If you need to take more radical steps, you may benefit

from the bedding, paints and other household items manufactured for those with chemical sensitivity. Once you reduce the level of synthetic chemicals in your everyday

environment, you may find that you can tolerate occasional exposures much more.
Some doctors recommend taking supplements of vitamins and minerals to speed your recovery. These (especially antioxidants – see p. 206) may be helpful for some people, but be

sure to get nutritional advice from someone with good medical qualifications, rather than a self-styled ‘nutrition therapist’.
Neutralisation therapy (see p. 211) seems to be effective for some people with chemical intolerance, but you will still need to avoid the offending substances. Hyperventilation

(see p. 236) can make chemical intolerance much worse.