KEEPING A DIET DIARY
by Del Stigler, M.D.
Pediatrics and Clinical Allergy
Fall 1990 AEHA Quarterly
Food allergies are the most common sensitivities in children, and most children who are allergic at all have some problem with foods. Tracking down food allergies must begin with careful record keeping in order to discover which foods are the most likely to be causing problems. This is accomplished by keeping a diet diary. It should list everything your child eats or drinks, his/her activities, environmental conditions, all symptoms which occur, and times associated with each entry.
Step one, the baseline diet diary, is kept while feeding your child as you usually do, changing nothing in the diet, and should be kept for at least five to seven days. The baseline diet diary will help your allergist to determine which changes in your child’s diet might be helpful. The diet diary should be kept throughout all changes in the diet, and as long as the child has any unresolved allergy problems. Take the diary each time you visit your allergist, even if you have not been specifically asked to do so. A diet diary will look something like this:
TIME FOOD/DRINK/MEDS ACTIVITIES SYMPTOMS (1-4+)Use a notebook to keep all your records together. Adjust the form so it is suitable to your own needs, as long as you continue to include all the information needed. DO NOT PUT OFF FILLING IN THE DIARY UNTIL THE END OF THE DAY. It is helpful to get in the habit of keeping the diary notebook and a pencil handy at all times so that you won’t be tempted to delay the recording. Memory is no substitute for careful record keeping.
RECORDING FOODS, DRINKS AND MEDICATIONS
When reading labels, watch for derivatives of potentially allergenic foods. Following are some of the common derivatives:
MILK butter, whey, casein, caseinate, calcium caseinate, sodium caseinate, dried milk powder or solids, evaporated milk, condensed milk, lactose, cream, buttermilk, margarine, yogurt, lactate, lactalbumin, cheese, curds, whey.For foods or medicines used regularly, you may find it easier to make a separate list of ingredients in the back of your notebook, so that the daily listing of foods will not take so much time. For example:
Flinstones Chewable Vitamins with IronAs you will quickly see, feeding simple meals without a lot of processed pre-packaged foods will simplify note keeping and will make it much easier to pinpoint your child’s food sensitivities. By removing artificial flavorings, colorings and other chemicals, you can determine your child’s reactions to specific foods.
RECORDING ACTIVITIES AND ENVIRONMENTAL
FOOD ELIMINATION AND CHALLENGE TESTING
When the food is first eliminated, the child may manifest worse symptoms and beg repeatedly for that food. These cravings and “withdrawal” symptoms are common when eliminating a potent allergen, and should not alarm you. This phase usually passes in a day or two, and the child’s symptoms will appear to improve as the allergen is cleared from the body. The craving will also diminish. If the child is still in withdrawal after four days, hold off challenging the suspected food until the symptoms are stabilized. Bear in mind that most children have more than one food allergy, so not all the symptoms will vanish with the elimination of a single food.
After a food has been eliminated for at least four days (but not more than a week), it is time to challenge your child with that food:
1. Feed a normal breakfast which does
not contain the food to be challenged.
NOTE: IF YOU HAVE REASON TO BELIEVE YOUR CHILD MAY REACT SEVERELY TO A CERTAIN FOOD, CHALLENGE ONLY AFTER CONSULTING WITH YOUR PEDIATRICIAN/ALLERGIST. THE ELIMINATION AND CHALLENGE SHOULD BE USED AT HOME ONLY FOR SUSPECTED FOODS THAT ARE REGULARLY IN THE CHILD’S DIET.
If your child reacts severely to the challenge, you may give two to four Alka Seltzer Gold tablets within the first hour to neutralize the reaction.
Once you have pinpointed certain allergies, the food may have to be eliminated entirely for several months, and may then be gradually reintroduced in limited quantity once or twice a week. There are no hard and fast rules about how much of a given allergen will be tolerated, or how often your child may be fed the offending food. Please plan to discuss the results of any food elimination and challenge with your pediatrician/allergist before deciding on a treatment plan.
SUGGESTIONS FOR COPING WITH FOOD ALLERGIES
(2) Continue to keep your family routine as normal as possible. Discipline your child as usual. Giving undue attention to relatively minor reactions may result in you child learning to use allergies for his or her own gratification and will make it more difficult to separate actual sensitivities from normal misbehaviour. Older children can be taught to report symptoms with good reliability without developing hypochondria. In most instances, allergies are a health problem like many others - we help the child learn to live as normally as possible, while doing what is necessary in order to stay healthy.
(3) Do not make the mistake of thinking that all behaviour problems or health problems are due to allergies.
(4) Give all of your children positive attention as often as possible. This will help to eliminate the need for your child to use allergic reactions as attention getters, and will also minimize the jealousy which may occur among siblings when one is “sick” and perceived as getting more attention due to the condition.
(5) Consider making an appointment with a registered dietician who provides nutrition counselling. S/he can help to analyze the adequacy of the diet if there are a number of eliminated foods, and can suggest substitutes for familiar foods and provide menu and recipe ideas.
(6) As your child grows and changes, the food sensitivities may change. Be prepared to begin keeping a diet diary again as soon as you notice a potential allergic problem, and keep the diary current until all symptoms have satisfactorily resolved. Many parents find it helpful to keep a diet diary even when the child is doing well. THE DIET DIARY IS THE MOST VALUABLE TOOL AVAILABLE IN TRACKING DOWN YOUR CHILD’S FOOD ALLERGIES, AND YOUR COMMITMENT TO GOOD RECORD KEEPING WILL SAVE YOU TIME AND MONEY IN THE MONTHS TO COME.
The preceding advise applies equally well to adults. Keeping a food
diary is one of the most important rules you can abide by, especially in
the early stages of diagnosis. It enables you to find “patterns”
in your symptoms. The Quarterly is most grateful to Del Stigler,
M.D., and Kathleen Dolce, C.H.A., for sending several information sheets
currently used in his Pediatrics and Clinical Allergy office in Denver,
Colorado. Our pleasure is increased by the note reading: Please
feel free to publish them in the Quarterly.”