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IT MUST be rare for a small paperback book aimed at the popular market to introduce a radical new idea into medical thought. Yet most of the British doctors now studying and treating food intolerance(see last week‘sNew Scientist) trace their interest back to the publication of Not All In The Mindby Richard Mackarness, in 1976. Doctors in the US had first recognised food intolerance more than 50 years earlier, but it was Mackamess, a psychiatrist and physician at Basingstoke District Hospital. who was responsible for intro ucing the concept to Britain.
In Not All In The Mind, Mackamess tells the following tale about one of his former colleagues in the psychiatric department. During a lecture by Mackarness on food intolerance— also known as "masked food allergy"——the psychiatrist began to wonder if his severe and unexplained fatiguemight be due to some such cause. According to Mackarness, fatigue could be a symptom of food intolerance, and the sufferer might-crave the particular food causing the problem. The only food for which the psychiatrist had any craving was bacon, and although sceptical, he decided to try cutting out bacon, and other forms of pork, for a while. The result took him completely by surprise. Initially he felt a great deal worse, but within a week his fatigue had completely disappearedand his former energy returned. When he told his colleagues about his "cure", they reacted, not surprisingly, with total disbelief.
Convinced that the improvement in is health must be due to some other cause. they arranged for the hospital cook to adulterate the steak pie she was preparing for lunch with some finely chopped bacon. The SUbJCCt of the experiment tucked into the pie unsuspectingly, under the watchful eyes of his colleagues. To their collective astonishment, halfway through through the meal he pushed his plate aside, laid his head down on the table and fell soundly asleep. In Mackarness's words:"The doctors who were in on the experiment were impressed and some of them even admitted that there might be something to masked food allergy after all."
A decade later, the idea of food intolerance has much wider acceptance among doctors, but the orthodox medical view is still one of scepticism, despite several impressive double-blind controlled studies. Much of the medical establishment's reluctance to accept food intolerance stems from the lack of any obvious mechanism: how on earth can bacon make a person fall asleep? How, for that matter, can common foods such as wheat, milk or eggs cause migraine, headaches, joint pains, diarrhoea, hyperactivity, fatigue, asthma, eczemaor a constant runny nose? Moreover, why should a 1 erent cluster of s mptoms appear in every patient? Those doctors who study food intolerance, and who are convinced that it is a real phenomenon, realise that they must demonstrate the underlying mechanisms responsible for such complex reactions if they are to convince their colleagues.
The study of food intolerance is historically linked with that of food allergy, and until relatively recently most attempts to find a mechanism centred on the immune system. The cause of classical or true allergies, including those to food, is the production of IgE antibodies to the offending molecule, or antigen (see Box 1). IgE binds to mast cells, and if its molecules then become cross-linked by binding to their particular antigen (a food protein, for example), this causes the mast cell to release various mediators, or chemical messengers. These mediators include histamine, serotonin and prostaglandins, and they have a dramatic effect on the body. In small quantities, they cause intense local inflammation. In larger amounts, they enter the circulation, making the capillaries dilate and become more permeable, so that there is a sudden drop in blood pressure. This reaction, known as anaphylactic shock, can be fatal.
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发表于 2023-9-6 09:33:39
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