Food intolerances require trial and error

Q: I read the Dec. 4, 2014, article about phenylketonuria (PKU) with great interest. I have been struggling with a likely metabolic disorder for years without a definitive diagnosis. The best guess so far has been the catch-all term of food intolerance. I get bad dreams and feel like I have a terrible hangover.

It has been extremely difficult to pin down which foods are the problem. I’ve identified a few things that are clearly culprits — chocolate, alcohol, nuts — and I also suspect the nightshade family.

During the bad periods, I stay on a strict rice, pulses and vegetable diet. When I feel better, I add in a greater variety of food, and if nothing happens for a week, I add more (including desserts, which I love) and then, bingo, I’m sick again.

When this happens, I’m quite sure it’s not the last thing alone that I have added that is the problem. I suspect that it’s a case of low level intolerance to many foods but once a certain level is reached I hit the tipping point.

As you can tell, it’s been difficult to pin down what to eat and what to avoid.

Is there a simple test for PKU? It’s not likely that I have this exact problem. Are there other metabolic disorders that I could consider? Any advice would be appreciated.

A: I think it is extremely unlikely that you have PKU because you would most likely have severe brain damage and seizures by now if it was left untreated. There is a simple blood or urine test for PKU, which is routinely done on newborn babies in this country.

Each inherited metabolic disorder is rare in the general population. Even all of them added together only affect about one in 1,000 to 2,500 newborns. Certain ethnic populations, such as Ashkenazi Jews, have a slightly higher incidence.

My guess is you are mostly suffering from gastrointestinal symptoms like bloating, indigestion and diarrhea. Some doctors believe that chocolate, cheese and alcohol can be trigger factors in migraine headaches.

Shellfish or strawberries may cause rashes, and nut allergies can be severe and life threatening due to anaphylaxis.

Egg allergies are also fairly common, which may be a problem for getting certain vaccines because eggs may be used in their manufacture.

Other well known forms of food challenges include gluten sensitivity and lactose intolerance.

Nightmares and bad dreams may be related to eating a late night snack, certain medications or withdrawal from drugs or alcohol.

Re-living previous traumatic events can produce nightmares, as in patients with post traumatic stress disorder.

The only way to find out for sure about food intolerances is to cut back to just white rice and water. After a day or two, you could add some plain meat like chicken or beef. Then gradually add in more foods one by one, allowing at least a week in between before making another change.

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