In recent years there has been a raft of new products aimed at the growing number of consumers with apparent food allergies or intolerances. Besides making life easier for those with real allergies and intolerances, do such products also pander to consumer fads and encourage self-medication? Bernice Hurst finds out.

Question One: do more people suffer from food intolerances and allergies because of the way our food is produced or are doctors simply better at diagnosing problems that have long existed?

Question Two: is there more the food industry can or should do to respond to consumer needs or are they just feeding fads and encouraging people to delete certain foods unnecessarily, thereby dissuading them from taking professional advice and possibly doing themselves harm?

Question Three: is meeting needs and pandering to fads acceptable because customers want it?

Question Four: chicken or egg?

According to Ian Marber, nutritionist and head of the London, UK-based Food Doctor Nutrition Clinic, it's a bit of both. More people are suffering intolerances for reasons that include changes to our environment and the way in which food is grown or produced. In addition, he told Johnnie Walker on BBC Radio 2, some people blame intolerance just to avoid foods they don't like or want to eat. Claiming that bread makes them bloated could be down to what is on the bread and how much was eaten rather than the basic ingredient itself.

While the symptoms of indigestion, irritable bowel syndrome and other discomforts are real enough, the underlying causes may be more of an excuse for faddy eating than any medically attributable problem.

Bloating can, in some cases, be attributed directly to the amount eaten. It can also, in other cases, be caused by food combinations. While bread containing wheat may be blamed, it could actually be the butter or jam or whatever is on the bread that causes discomfort.

According to a review published on studentBMJ , the international medical student journal, true food intolerance (allergy and intolerance combined) is estimated to affect 5-8% of children, most of whom outgrow the condition, and less than 1-2% of adults. But the review also found that around 20% of the population think they have a food allergy/intolerance, so many people may be restricting their diet unnecessarily.

A balanced diet

Isolating specific foods that cause discomfort is a complicated process, not one to be undertaken at random and without care for conflict. Removing specific foods from the diet may also lead to further problems or complications as the body is deprived of essential vitamins or minerals.

Lyndel Costain, consultant dietician and nutritionist, worked as a healthcare professional in Australia before moving to the UK. Among her clinical and media credits is an active role as spokesperson for the British Dietetic Association (BDA). She believes that "if people do cut whole food groups such as dairy foods, or staple foods such as wheat from their diet, without advice about how to keep their diet balanced, they can be at risk of dietary deficiencies.

"Looking at the overall balance of people's diets is important too. By cutting out wheat, for example, they may improve the quality of their diet by replacing biscuits, cakes, white bread and pasta loaded with butter or creamy sauces with more oats, brown rice, fruit, vegetables, fish, lean meat etc. This in itself may make them feel better, reduce sluggishness and weight gain without necessarily being subject to a 'wheat intolerance'," she adds.

More harm than good

Marketing must also be considered carefully. Despite millions being spent by manufacturers of probiotic yoghurts, drinks and supplements, there are still doubts as to their efficacy. And even if the so-called good bacteria they contain may benefit the digestion of some consumers, others may find little or no difference in the way they feel. Although at worst, they may be harmless, at best their value doesn't address the underlying causes of gastric problems.

The process of identifying and treating food intolerances is one of trial and error. Many approach it as they would self-medication: they eliminate a food and see whether it makes a difference to the way they feel. They don't necessarily consult any kind of professional so have no real idea what eliminating a specific food can do and whether it can be as (or more) harmful than actually eating it.

Only when full-blown, undeniable allergy rears its ugly head can problems be indisputably diagnosed. But fear of anaphylactic reaction can be enough in itself. Studies of the ways in which children's behaviour, especially, may be controlled by nutritional adjustment have been helpful but, because of their inconclusiveness, potentially harmful. What works for one doesn't necessarily work for all. At the least, arbitrarily deleting food from the diet can be harmless; at the most, it can deprive the body (especially that of a child) of essential nutrients.

Making life easier

just-food reported in April 2003 that the UK's biggest supermarket chains were launching own brand ranges designed to be more tempting than those previously available through health food shops. Gluten-, wheat- and dairy-free products were meant to be interesting and tasty, as well as less expensive. But journalist Hugh Westbrook also pointed out that clear labelling of allergens and availability through merchandising in the category were equally important.

Costain contends that, for the small percentage of adults genuinely suffering from a food allergy, "having food products that help vary their diet and make their life easier is great". 

"However," she adds, "the 20% or so of the population who think they have a food allergy or intolerance are prime targets for food manufacturers to promote their 'specialist' foods to. In a way you can't blame the food industry for the latter as, generally speaking, they aren't encouraging self-diagnosis but providing a product that people already think they need. And these products also are genuinely helpful for people with diagnosed intolerances, for example people with coeliac disease who must follow a strict gluten-free diet for life, people with diagnosed cow's milk protein allergy or lactose intolerance, or people with peanut, soya, egg, other nut or seed allergy."

Responsible marketing

As American Anne Munoz-Furlong, founder and CEO of the Food Allergy and Anaphylaxis Network, told Westbrook, labelling and developing awareness are important goals. Both Costain and Munoz-Furlong agree that specialist products are useful for some but adequate labelling is useful for all.

"The way the food industry can be more responsible is to ensure that on-pack messages and promotional literature convey the known science behind food allergy/intolerance prevalence, that is to say by not suggesting it is widespread, and advising  people who think they may have a food intolerance to see their doctor," says Costain. "This is firstly to ensure that their symptoms aren't due to some underlying medical problem, secondly to ensure they get a responsible diagnosis if food intolerance is the problem and thirdly they get safe and reliable dietary advice and review, usually from a registered dietician.
 
"There is a need for specialist products for those with true food intolerance/allergies. They add variety and help people to ensure they have a nutritionally balanced diet. But manufacturers should develop and market them responsibly," she adds.