by Dr Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology

ALLERGY AND FOOD INTOLERANCE :

It is well known that deficient intake of protein, calories, vitamins, or minerals leads to a variety of nutritional disorders.  It is known that food contaminated with toxic materials or bacteria may cause illness if consumed.  It is also known that certain foods contain non-nutrient poisonous substances that may cause illness and in some cases death. Nevertheless, it is not generally realised that the nutrient components of foods, in themselves may be toxic for certain people, causing illness or aggravating pre-existing illness.

THEORETICAL CONSIDERATIONS :

Food Intolerance may be defined as any illness or biochemical or metabolic abnormality that is causally connected to the ingestion of any food or dietary component. An illness that is causally connected to non-nutritive dietary component may be referred to as food poisoning or food toxicity. The term food intolerance is usually applied to illness resulting from the ingestion of substances that have nutritive value such as carbohydrate, fat, proteins and amino acids, and accessory factors such as purines (purines are responsible for gout in some sensitive individuals).

There may be an obvious connection between food ingestion and the production of acute illness or a less obvious connection so that a patient may fail to recognise

the relationship between his disease and the offending dietary component.

Under special circumstances certain combinations or amounts of food substances may cause illness in otherwise healthy individuals. For example, fasting followed by refeeding may result in stomach and intestinal distress or fluid retention. Another example is in illnesses that cause anorexia where feeding may be associated with nausea and vomiting. This type of Food Intolerance may be considered to be secondary type since the food is non toxic but illness or fasting has so altered the normal physiology that the patient becomes intolerant to many types of food.

REVIEWING SOME COMMON NUTRIENT FOOD INTOLERANCES :

Carbohydrate Induced Food Intolerances

• Lactose Intolerance is the most common. Most people around the world are deficient in the intestinal enzyme lactase and thus have an inability to digest lactose-containing foods (eg.milk). Symptoms associated with lactase deficiency are bloatedness, wind and diarrhea. Lactose Intolerance may occur of various ages, it may occur at birth or at a latter age to different people. Treatment requires the avoidance of lactose by restricting dietary milk and milk-containing products. Lactose Intolerance should not be confused with milk allergy which is related to milk proteins.
• High refined carbohydrate diet, in general, may be related to a number of medical problems. For example-low blood sugar (hypoglycaemia) which associated with variety of symptoms including fatigue, weakness, irritability, headaches and sugar craving may classified as diabetic.
• For the sake of complete example of carbohydrate induced food intolerance are as listed : Glucose-galactose intolerance, sucrose-starch intolerance, sucrose-fruit intolerance, fructose-glycerol intolerance, lactose intolerance, pyruvate dehydrogenase deficiency.
• All intolerances are due to lack of specific enzymes required for the metabolism of the particular sugar.

Protein Induced Food Intolerance

• Coeliac disease results from a sensitivity to the protein, gluten, contained in wheat, rye, oats and barley. The disease manifests in most individuals as gastro-intestinal discomfort, wind and diarrhoea. However gastrointestinal symptoms need not be present and the disease may manifest as eczema, or arthritis. Strict avoidance of gluten is necessary in the treatment of this disease.
• Cow’s milk (casein) allergy or more particular allergy or intolerance to a protein component of milk. It is associated with vomiting, chronic diarrhoea, eczema and failure to thrive. 
• Other common food sensitivities are to egg protein, soy protein and shell fish. Symptoms may vary from hives to gastrointestinal symptoms, asthma to neurological disturbances (poor concentration, irritability, behaviour disturbances). Avoidance of these food results in remission of symptoms.
• Individuals suffering from liver failure, cirrhosis of liver, kidney failure or pancreatic insufficiency all show intolerance to most proteins. The intolerance is due to the ailing body’s inability to either digest, metabolise or excrete proteins, amino acids or their waste products. So limiting the intake of protein until the body recovers its health or reduce symptoms.

Lipid Or Fat Induced Food Intolerance

• Symptoms of diarrhoea (Steatorrhoea) wind, fatty motions occurs whenever fat is malabsorbed.  Steatorrhoe represents an intolerance to dietary fat or lipid. Fat malabsorption occurs in pancreatic insufficiency, various disease of the small bowel (cystic fibrosis, coeliac disease, liver disease, gall bladder disease and diabetes. Obviously a restriction of dietary fats or supplementation with digestive enzymes must be incorporated in the treatment of the above diseases.
• Very high blood fat concentration due to a deficiency in lipoprotein lipase is associated with severe fasting, pronounced elevation in plasma triglyceride, eruptive xanthomas (fatty nodules in the skin) and recurrent episodes of abdominal pain due to pancreatitis. A low fat diet can control the disease process.
• High blood cholesterol and altered lipoprotein profile can be viewed as a fat intolerant disease. Treatment in most cases requires the introduction of a low fat diet or supplementation with chromium and essential fatty acids.

Dr. Tan Boon Cheong

MBBS (MU), MS Ortho (MU)

One of the most common causes of knee pain, especially when oneself is approaching middle age, is usually links to degenerative joint disease (age as risk factor), but it is more complex as some young people have it too and for some it may be hereditary.

By definition knee osteoarthritis is defined as chronic joint disorder in which there is progressive softening and disintegration of joint cartilage, accompanied by new growth of cartilage and bone at the joint margins and capsular fibrosis. The prevalence of knee osteoarthritis increase with age (>45 years) and females have a higher incidence compare to male.

Knee pain is one of the most common chief complaints for knee osteoarthritis. The knee pain usually takes place with prolonged walking or standing. Resting the joint will relieve the pain. Stiffness is another common complaint. The stiffness happens after prolonged immobilization especially when getting up from a sitting position or early morning when oneself tries to get out from the bed to walk. The patient will need to stand for a brief second before he/she can start to walk. After a few steps, the patient will feel easier to walk.  Frequently, the patient may have episodic attack of knee swelling due to inflammatory process that takes place. When the knee osteoarthritis become more advance, the patient will have deformity, which most of the time the leg appear to curve inward, and if the patient’s both knees are involved, then the deformity would appear like an ‘O’ shape (in most of the patients). Knee osteoarthritis has no immediate threat to one’s life, but it reduces the quality of life due to persistent pain and immobility.

The management of knee osteoarthritis starts with the establishment of its diagnosis. Beside a good history given above, an examination by a doctor will help to come to this diagnosis and exclude other causes of knee pain. A plain X-ray of the knee with the patient standing will be good enough to tell the grading of the knee osteoarthritis. Kellgren and Lawrence classification system (Grade 0 to 4) are usually in use.

The treatment of knee osteoarthritis will depends on the severity of it and how much the symptoms affect the patient’s on daily basis. Joint supplements such as glucosamine sulphate and chondroitin have been used widely for knee osteoarthritis. Analgesia (pain killer) can be used but will give grieve side effects if abused. Intra-articular injection of hyaluronic acid (gel), PRP (blood) and stem cells have been widely introduced but their effectiveness and cost should always  be taken into consideration. Surgical intervention such as total knee replacement surgery will be the last resort when everything fails and the pain is tremendously affecting the quality of life. Beside all the above medical treatment, the lifestyle of the patient should also be modified such as exercising and weight management.