Chef card?

Here's an interesting project from Britain's Food Standards Agency launched this week. It's a guide to buying food when you have a food allergy and some advice on how to handle restaurants.

The on-line version here is probably more accessible than the pdf of the booklet accessible from here.  Most of the advice is basic common sense and what you would do any way. I'm interested in the idea of using a chef card. It would certainly be a discreet way of passing a message to a waiter and a chef to check ingredients or, at the very least, to pay attention to what I say.

As I've reported over the years, service varies. If you're ordering on the spot, you need waiters and chefs to pay attention to what you say, for instance: "I'll have the pasta but no sauce, herbs or pepper." If they're a budget establishment using cook-chill or frozen dishes, they are not going to be able to oblige - so the best answer is usually fish and chips and peas, or maybe steak and chips.

So far so good. But then I followed through some links to the FSA's directory of food allergies, studied the list and what did I find? Nothing at all on salicylate allergy! No wonder it's impossible to explain to caterers.

I wonder how this can be redressed. Perhaps an e-petition somewhere?

RAS

Frying fish?

I'm not sure what to make of this report, which says that frying fish reduces its omega-3 content. As it appears to have been conducted in Hawaii, it may depend on what fish is fried in. What do they use in Hawaii? Palm oil?

Tonight, in fact, I had baked trout. It turned out to be the only fish we had left in the freezer. The report says baked or boiled fish is the best - although to my mind boiled fish is awful and a sure way to kill any taste that is there.

Usually I sort of stir fry fish. Perhaps my fish sauces are only partially fried and partially boiled as I stir fry first and then add juices. So maybe that is also boiling it. In addition I'm using rapeseed oil, which is rich in omega-3, although maybe not the best kind.

This may put a dampener on my tuna con chips concoction - possibly. Again I'm not really frying the tuna in much more than its own oils.

As for good old English fish and chips. It's nice to buy occasionally, although increasingly expensive. And nobody ever said it was an especially healthy meal.

RAS

Genetically engineered soy

I'm no fan of the idea of genetically engineered food but this release from the American Heart Association about soya is interesting.

http://americanheart.mediaroom.com/index.php?s=43&item=857

I use a lot of soy sauce for cooking as it's not meant to contain salicylate. Although it contains omega-3, I've noted in the past it also contains omega-6 oil, which aggravates the reaction to salicylate. There's no indication whether this genetic engineering would reduce omega-6 levels in soy sauce. Apparently, the aim is to make the omega-3 content even "healthier" and a substitute for fish.

In truth it's probably not much of a solution if fish stocks run out. I need to eat fish as a substitute for meat. Is soy an acceptable vegetarian alternative to meat? Maybe it's time to find out.

RAS

Revised caterer guidelines

This is the revised version of the guidelines I sent through to last week's caterers.

"It's salicylate hypersensitivity, which you may not be familiar with.

In general:

no pepper, spices or herbs. Most fruit is out and quite a few vegetables.

Banana and golden delicious apple are okay as are chips, baked potato, cabbage, peas, sprouts, lettuce, leek and celery.

All meat, dairy, plain cheese and fish is fine, although fish is especially good. Not sausages.

Small amounts of chocolate as in cake or pudding are fine. No nuts, except cashew nuts if necessary.

Only drinks are water or decaffeinated coffee. Nothing else.

The general principle I work to is that sauces and pies are dodgy. Plain meats, battered fish etc are okay."

Looking at this I suppose I could add:

"the only herb or spice that is okay is parsley and the only sauce is soy sauce, provided it has no additives."

And also:

"For cooking rapeseed oil is the best choice."

RAS

Caterer does well

They really made an effort at the event I was at last week.

At lunch there was a single plate of cheese and lettuce sandwich. It was not marked but I assumed it was for me. Unfortunately others also took a shine to them so I also had to try a plain cheese and onion sandwich. I removed the onion but the bread and cheese was stained with juice and I suffered for the rest of the day. My lip got quite thick - odd really, as onion is not suppose to be that packed with salicylate.

This was unfortunate as they had marked a plate for vegetarian and a plate for gluten free. This had celery and carrot sticks on it and as nobody seemed to be eating them I pinched some.

The evening meal was terrific. Not very tasty but they had tried ever so hard. The starter was cabbage, lettuce and cheese cubes. Main course was white fish and baked potato and the pudding was a plate with a golden delicious apple and a banana. It wasn't a great meal but was the first time someone had actually prepared a full meal according to the guidelines.

I'll post the revised guidelines that I sent shortly. The main thing is that they worked - far better than sending a list of dos and don'ts or simply assuming they can get their hands on salicylate avoidance guidance independently.

RAS

UK petition

Sometimes I speak to friends and realise I'm incredibly lucky. My original symptoms were clear enough to get me referred to a specialist. I had a miserable nine months, doped up with anti-histamines and forever hungry. But I got a diagnosis and a prescription that work most of the time.

I've spoken to people who live with asthma and allergy together - taking multiple anti-histamines and montelukast with little effect because they cannot identify the allergy. In these circumstances you may be managed by, say, a chest physician and a dermatologist, if you're lucky. Or else just a GP. It's not just the disease - living with the pills is dreadful too.

On the specialist web-sites, salicylate hypersensitivy - my problem - is usually mentioned as a possibility. But GPs, caterers, the wider world knows little about it.

So I'm happy to urge support for this petition that's been posted on the website of 10 Downing Street, the British prime minister. So far fewer than 200 people have signed - it needs more!

It reads: "We the undersigned petition the Prime Minister to take action to improve NHS allergy services and the inadequate care received by millions of patients living with allergic disease; and call for action to implement the recommendations of independent national reviews including the House of Commons Health Select Committee, that more allergy consultant and trainee posts be created, priority be given to commissioning of allergy services and for improved knowledge of allergy in primary care. "

Mandy East of National Allergy Strategy Group writes: "Around a third of the population have a condition where allergy may be involved and about 7 million have allergy severe enough to require specialist care. This creates a large burden for the patient and the NHS. There is a lack of expertise in allergy right across the NHS.Most doctors just don’t know, or know little, about allergy; there is a lack of expertise in hospitals and a lack of knowledge or understanding of allergy in primary care. This means that very large numbers of patients are being seen by a doctor who has little understanding of their disease; and things are made worst by there being a small number of full specialists in allergy."

RAS

Caterers and cheese

I sent through my guidelines for caterers for an event I'm attending next week. Today the caterer rings me up.

"I've made inquiries," she says, "and I can't find out anything about this allergy. What can you eat?"

I stress the answer is plain food, maybe cheese sandwiches. We're doing a finger buffet and there will be cheese and onion somethings, she says. No, finger buffet is disastrous, I say. Plain cheese sandwich will be fine. After all, all I need is something to keep me going.

In fact I amended the instructions a little before sending them through. The trouble is I don't know what to say about cheese. Plain cheese is okay - but I've been eating plain, salicylate free food for a few days now and The Ring is back. As I write, it's even itching - so I need to take a pill.

I'll take another look at the revised instructions and post them again.

RAS

The little things

A couple of weeks' silence here means a couple of weeks struggling with the little things. For instance I put some cashew nuts and a couple of bars of cheap Tesco chocolate into the pantry.

Although cashew nuts are meant to be near zero salicylate they are of course rich in omega-6 - which means they should only be eaten as part of a salicylate free diet. I don't believe chocolate is zero salicylate as it can be quite rich in caffeine - however my lists say cocoa is low salicylate. But a bar of chocolate is far too nice, especially when working. So a couple of squares soon becomes the whole bar - and that is too much chocolate and too much caffeine. I need to revert to not buying chocolate, even if the supermarket brands are incredibly cheap.

It all means flurries of disturbance and the occasional rush for a montelukast to calm down some itching or irritation.

Then there are the snacks that people provide. I dipped into a bowl of cashew nuts the other day - the trouble is they were coated in spice. So that was salicylate in the spice and omega 6 in the nuts. I took a montelukast when I got home. Then there was the beef sandwich. It looked plain but tasted far too nice. Was that mustard?

After one of these episodes I sat down in the evening and got up. My left knee was weak, the finger and thumb of my left hand ached and the old left eye felt sore. I took a montelukast and the problem faded away.

What about Jack Daniels? My illusions that it might be any better than Scotch whisky have been shaken. Somebody told me it's matured in hickory wood. I looked into this a little further and discovered that whisky's golden colour is acquired from the wood in which it matures. All I can say is that Jack Daniels never causes too much harm - but maybe I should keep it to the occasional tipple.

It's all little things that can suddenly build up into a big problem if they are not taken care of.

RAS

Fish and rheumatism

I'm intrigued and encouraged by this recent analysis of allergy prevention, suggesting that eating fish is one of the best ways of dealing with problems.

There doesn't seem to be an explanation for this. In the case of salicylate hypersensitivity, there appears to be a very clear explanation as I discovered a couple of years ago. This is that the condition is caused by a reaction between omega -6, found in meat, and salicylate. So substituting fish, which has omega-3 fats, for meats can help prevent these reactions.

This is not necessarily what happens in classical IGe allergy (in truth, I don't know.) So are the benefits of fish thrown up because studies of diets include a number of people with salicylate problems? Or does it provide other benefits for allergy sufferers, eg in reducing inflammation?

Today I went for another Chinese buffet. I forgot to take a montelukast before going. A few days ago I wrenched my arm. I had picked up one of those cheap plastic containers full of papers and one end broke. The container slumped down, twisting my arm. It seemed to recover with some minor aching, but tonight my left hand aches like Hades, just about on the index finger. I thought I had a pretty safe meal at the Chinese - but if you eat anything remotely processed you cannot be sure what's in it. My feast today included cauliflower cheese, plain chicken in batter and biscuit pudding - plenty of opportunity for odd chemicals and components to creep in.

I really do not want to get rheumatism in my hand so I have now taken a montelukast.

RAS

Celery and beer

 I threw some red cabbage, leek and celery into the steamer tonight. Nothing new about that. I was surprised when the delicious aroma of curry came from it.

It can't have been the pans - you don't cook curry in a steamer and I don't think anyone in the household has eaten anything that spicy for ages.

I savoured the smell, which continued to fill the air after I served up. It seemed to come from the celery. There was no taste of curry in the food - but the smell gave some added spice to the meal.Memo to me: I must do something about making that home-made curry.

In contrast, I was listening to a report on beer on the radio the other day. I was never a great beer drinker but there have been moments in life when beer has been delicious, mainly on the European continent. I enjoyed chilled lager in the Italian heat and exotic strawberry-flavoured beers they serve in Belgium. There seems no possibility of enjoying those tastes and those moments again.

RAS