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Adverse Reactions to Drug and Food Additives: Supplement

| Filed under Allergy

Questions and Answers

1. Is it possible or desirable to have an additive-free diet?

You can avoid food additives in the U.S. by eating at restaurants that say “no food additives” and buying natural, unprocessed foods for the home. Generally, however, people are anaphylactic to only one particular substance. If they can figure out what that is, they can avoid just that substance specifically; they don’t have to strive for an additive-free diet.

2. Are additives in general harmless unless one has a specific allergy to them?

That is correct. The Food and Drug Administration has a list of additives that are considered to be safe. Those have no obvious problems associated with them, unless one looks at a particular group of people who have an unusual sensitivity to a particular chemical.

2. How do asthmatics respond when they eliminate sulfites from their diet?

They do not generally improve, because only five to 10% of asthmatics are in fact sulfite-sensitive, and they are of necessity already avoiding sulfites because otherwise they would be having reactions all the time; the remaining 95% will not notice any difference at all.

3. Are there any potentially dangerous additives that might not be labeled?

In the U.S., I would say no. It’s fairly well covered.

4. Are there any additives that might appear on labels under confusing code names or numbers?

The commonest confusion tends to arise in the case of monosodium glutamate, which often appears on labels as hydrolyzed vegetable protein, or added hydrolyzed something-or-other, but not as MSG. In addition, some colourings appear under the name “natural colours,” though they may provoke hypersensitive reactions in some people. The term “artificial colouring,” or “other approved FD&C dyes,” may also appear in place of the actual name of the dye used. The dye Yellow No. 5 (tartrazine), for example, must be named specifically, but there are other individual dyes for which no such regulation exists.

5. Does the food or drink make any difference in how the additive affects the system? Is there any difference between equal doses of sulfites in a potato salad and in a carbonated drink?

When sulfites are present in a liquid or gas medium, then it’s much more likely that they will be inhaled by an asthmatic and provoke a reaction. If it is actually a constituent part of the food, for example if it is bound to a potato, then it’s much less likely to escape as sulfur dioxide. Of the five percent of asthmatics who are sulfite-sensitive, probably 95% would have no reaction to the potato, whereas they would be much more likely to react to the sulfites in a carbonated drink.

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Adverse Reactions to Drug and Food Additives

| Filed under Allergy

Glossary:

Urticaria: Commonly known as hives, this is a temporary skin condition marked by pale, patchy swelling and itching.

Angioedema: A flushing and swelling of the skin caused by the effusion of fluids into the tissue.

Anaphylaxis: A general, rather than local, allergic reaction characterized by difficulty breathing, wheezing, a shock-like state, or any combination of these symptoms.

There have not been many rigourously controlled studies in the area of additives and allergy, and so much of the evidence for specific links between substance and reaction is anecdotal. Those additives that have most often attracted the attention of investigators can be grouped into about seven substances or families of substances: dyes, parabens and benzoates, BHA and BHT, nitrates, aspartame, MSG (monosodium glutamate) and finally, sulfites.

Sulfites are used heavily in both foods and beverages for their ability to inhibit certain enzyme reactions. It’s the enzyme reaction that causes an apple or an artichoke to turn brown when it is cut, that blackens mushrooms and causes spots to form on fresh shrimp. Sulfite also prevents browning that is caused by non-enzymatic reactions in wine, dried fruits, vinegar and other products and is used in particularly large quantities for this task. Because sulfites are also antioxidants they are used by many pharmaceutical companies in drugs such as Novocaine, Demerol, thorazine and some brands of eyedrops.

Sulfur dioxide is a known irritant for asthmatics, but heat or acid — such as the gastric acid in the stomach — cause sulfites to release sulfur dioxide. For that reason, the U.S. Food and Drug Administration (FDA) requires the declaration of sulfites on food labels if they make up more than a certain proportion of the contents. The FDA also banned the use of sulfites on fresh vegetables, for example, in salad bars where it was once common.

Benzoates such as benzoic acid and sodium benzoate are widely used as preservatives in food and beverages for their antibacterial qualities. Parabens, similar preservatives, are used more in drugs and cosmetics. The worldwide consumption of benzoates, used since the early 1900s in food, is over 10 million pounds. Benzoates have low toxicity, and in fact occur naturally in prunes, cinnamon, cloves, tea, anise and many berries.

Monosodium glutamate is an amino acid commonly used as a flavouring. While it appears naturally in some foods like Camembert cheese, it’s used mainly as an additive, particularly in Chinese and Japanese food. A single bowl of Wonton soup can contain 2.5 grams of MSG. It’s also one of the “secret herbs and spices” in Kentucky Fried Chicken.

Aspartame (NutraSweet) is another additive that enhances flavour. Temporarily banned in the mid-1970s because of fears that it caused mental retardation and endocrine dysfunction, aspartame is now back as a common additive in foods and carbonated drinks. Nitrates and nitrites are preservatives that also add colour and flavour, and are common in preserved meats such as salami. Butylated hydroxanisole (BHA) and butylated hydroxytoluene (BHT) are antioxidants that appear in many grain and cereal products.

Dyes used in foods are either coal-tar derivatives called azo dyes, the best-known of which is tartrazine, or dyes derived from other sources known as non-azo dyes.

Allergic reactions: Urticaria, angioedema and anaphylaxis

Tartrazine and other dyes, benzoates and parabens may aggravate urticaria at times but none of them have been shown to cause it. Parabens have been shown to cause an anaphylactic reaction on a few rare occasions, but never when taken orally. Sulfites also have been known to cause anaphylaxis. MSG is responsible for an allergic reaction known as Chinese restaurant syndrome (CRS), characterized by headache, nausea, chest tightness, sweating and a burning sensation along the back of the neck. The symptoms affect only MSG-sensitive individuals who eat free MSG (usually added in the restaurant as a condiment) on an empty stomach. MSG has also been blamed in a case of angioedema. Aspartame, BHA and BHT are all known culprits in isolated cases of urticaria.

Allergic reactions: Asthma

The exact mechanism by which sulfites cause asthma attacks is controversial, but it has been suggested that inhalation while swallowing sulfite-bearing foods is the cause. This seems borne out by tests in which sulfite-sensitive people with asthma swallowed sulfite solutions with no reaction when they held their breath. Anyone can develop sulfite sensitivity, and many people’s first experience with asthma was a reaction to sulfites, which over the course of a few months became chronic asthma with dependence on corticosteroids. About three to five percent of asthmatics are sulfite-sensitive, and they tend also to be susceptible to other irritants such as exercise, upper respiratory infections, and particularly smog. Any food containing sulfites in sufficient concentration to cause a reaction must now be so labeled under FDA rules in the U.S.

MSG and benzalkonium chloride can cause bronchial constriction in asthmatics, but cases are rare and in the case of the second additive, concentrations are usually too low. Spearmint, peppermint and menthol, which appear in chewing gum and toothpaste, are also capable of triggering an attack. Dyes, parabens and benzoates are not believed to be dangerous for people with asthma.

Olive Oil and Hypertension

| Filed under Cardiovascular Diseases

Researchers may have discovered one of the secrets of the Mediterranean diet: olive oil! The scientific community agrees that olive oil, high in monounsaturated fatty acids (MUFA) and antioxidants, helps reduce levels of total and LDL cholesterol thereby reducing risk of cardiovascular disease. And a new study shows that a diet high in MUFA from olive oil can also help reduce blood pressure levels.

Diet and blood pressure

Researchers have known for some time that the characteristics of a Mediterranean-type diet are important in controlling blood pressure levels. These characteristics include:

- high fiber intake,
- high fruit and vegetable intake,
- high MUFA and low saturated fat intake and,
- low sodium and high potassium, magnesium and calcium intake.

It may be that one or a combination of these factors helps decrease blood pressure levels. And since high blood pressure is a risk factor for stroke, the third leading causes of death in the United States, olive oil may reduce the incidence of stroke.

MUFA vs. PUFA

Ferrara and his colleagues designed a study to look at the effects of a diet high in monounsaturated fatty acids vs. diets high in polyunsaturated fatty acids (PUFA). Twenty-three people with mild to moderate hypertension (10 males and 13 females, ages 25-70 years) were randomly assigned to either a diet high in MUFA using extra-virgin olive oil, or high in polyunsaturated fatty acids using sunflower oil for six months. Both diets contained less total and saturated fat than the subjects’ usual diets. Their usual diets contained 34% total fat and 11% saturated fat, while the study diets contained 26% total fat and 6% saturated fat. After the initial six-month study period, the groups switched to the other type of diet. Both types of diets contained similar amounts of calories, saturated fat, cholesterol, fiber and minerals (sodium, potassium, magnesium and calcium). The only significant difference in the two study diets was the amount of MUFA vs. PUFA.

Ferrara and his colleagues found that while on the extra-virgin olive oil diet, subjects reduced the amount of antihypertensive medication necessary to control blood pressure levels by 48%, vs. only a 4% reduction on the sunflower oil diet. In addition, eight subjects on the extra-virgin olive oil diet required no antihypertensive medications; all subjects on the sunflower oil diet required antihypertensive medication. The authors conclude that a diet lower in total fat and saturated fat that contains higher amounts of MUFA can lower blood pressure levels and reduce or eliminate the need for medications in people with hypertension.

Possible role of olive oil in reducing blood pressure

So why does olive oil lower blood pressure? One possible reason is its polyphenol content. Polyphenols are potent antioxidants which help arteries dilate, thereby reducing blood pressure. Ten grams of extra-virgin olive oil contains five mg of polyphenols; sunflower oil has no polyphenols.

Our recommendations

There are numerous health benefits to replacing saturated and polyunsaturated fatty acids with monounsaturated fatty acids such as olive and canola oil. Switching from polyunsaturated oils such as sunflower, safflower, soybean, and corn to oils high in monounsaturated fatty acids such as olive oil and canola oil leads to decreased risk of stroke by lowering blood pressure levels; and also helps decrease risk of heart attack by lowering total and LDL cholesterol levels. Use olive or canola oil in cooking or salad dressings, and look for margarine-like spreads based on olive or canola oil to use on toast, vegetables, and potatoes to reap the heart-healthy benefits.

Remember that while replacing saturated fats with MUFAs is a step towards improved heart health, moderation remains important. Also, if you follow a very low fat diet and still have high blood pressure, consider adding one to three tablespoons of olive oil to your daily food choices and monitor your blood pressure for any changes.

Diet & Arthritis

| Filed under Arthritis

A balanced diet and careful weight control can help people with arthritis manage the pain, inflammation and loss of movement caused by arthritis. Experts in diet recommend seven basic guidelines for a balanced, healthy diet:

  • Eat a variety of foods;
  • Maintain ideal weight;
  • Use fat and cholesterol in moderation;
  • Use sugar in moderation;
  • Eat plenty of vegetables, fruits and grain products;
  • Use salt and sodium in moderation;
  • If you drink alcohol, do so in moderation.

    What are some diet problems people with arthritis may face?

    Fatigue and pain can lower appetite. Swollen joints and loss of movement may lead people with arthritis to avoid foods, such as vegetables, that need more time or effort to prepare and cook. Some kinds of arthritis, and some medications, can affect the body’s ability to use food.

    What about weight?

    Weight control is an important concern for people with arthritis. Keeping close to your ideal weight helps decrease the pressure on the knees and hips, which bear much of the weight of the body. In a study funded in part by the Arthritis Foundation (published in the April 1, 1992, issue of the Annals of Internal Medicine), researchers found for the first time that overweight, middle-aged and older women can significantly lower their risk for developing osteoarthritis of the knee by losing weight. For people with arthritis, it is important to keep trim by reducing fats, cholesterol and sugar in their diets.

    What has research shown about diet and arthritis?

    In addition to the benefits of a good diet, research has shown several other connections between food and some forms of arthritis or arthritis-related conditions. These include links with gout, osteoporosis (an arthritis-related condition in some situations) and Reiter’s Syndrome. For instance, people with gout have difficulty with the way they use or get rid of chemicals called purines. Researchers now think that diet may serve as a risk factor by increasing the chances for developing certain kinds of arthritis. Diet may change the way the immune system reacts in certain kinds of arthritis that involve inflammation. Researchers also are investigating the effects of food allergies and reactions; fasting, low calorie or low fat diets; and fatty acids such as fish oils on rheumatoid arthritis.

    What about those special diet claims?

    Researchers only accept that there is a connection between diet and arthritis after a number of studies show the same results. However, some people claim that special diets, foods or supplements can cause or cure arthritis. The claims usually appear in magazine articles, books and on talk shows. Most claims for such diets have not been scientifically tested to prove that they work and are safe. In fact, some claims for special diets for arthritis are health frauds. There is no scientific basis for most of these claims. Other diet claims are still under study. When you hear about diet claims in the treatment of arthritis, ask the following questions:

  • Does the diet eliminate any group of foods?
  • Does it stress only a few foods or eliminate others?If the answer is yes to either question, it is probably an unproven diet.

    How do I find out more?

  • Check with a doctor for ways to manage weight and to discuss specific diet options.
  • Request the Arthritis Foundation Diet and Your Arthritis brochure.The information provided by the Arthritis Foundation should not take the place of advice and guidance from your own health-care providers. Be sure to check with your doctor about changes in your treatment plan.
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