Food Intolerance/Allergy and the Allium Family

  Food intolerance is an adverse reaction to a particular food that does not involve the immune system (unlike food allergy), often develops over a few hours, and is not life threatening; it is also much more common than food allergy affecting up to 20% of the population (compared to 2-5% for food allergy). Recognized causes of food intolerance include fructose and lactose and sensitivity to food additives such as monosodium glutamate, sulphites, caffeine and tyramine. The issue of non-celiac gluten sensitivity (NCGS), non-allergic gluten sensitivity in those who do not have celiac disease, is a more controversial potential cause of food intolerance; persons with this disorder are not allergic to gluten, the main cereal protein allergen in celiac disease, but may be sensitive to another component of gluten-containing grains, FODMAPS (fermentable oligosaccharides, disaccharides, monosaccharides and pyrols), which can cause abdominal discomfort and bloating.  

  The symptoms of food intolerance, irrespective of cause, are often similar to those associated with food allergy including respiratory symptoms, runny nose, itchiness, facial swelling, abdominal discomfort, fatigue, headaches and muscle aches. What differentiates food intolerance from the allergy symptoms is the relatively slow onset over hours and prolonged duration, the reduced severity and the absence of any detectable antibody levels to food in the blood; the symptoms of food intolerance are also dose-dependent, the more you consume the worse you feel, whereas consumption of minute quantities of a food allergen may have very serious consequences.

  A less well-know food intolerance is to members of the allium family (garlic, onions, scallions, chives, leeks, shallots) which I am aware of and interested in primarily because I suffer from it. I did not have any obvious sensitivity to this food family in my teens or early adulthood, but when I was in my mid thirties I noticed that eating  food with a lot of garlic for dinner was associated with hangover symptoms the following morning including difficulty getting out of bed, lethargy, headache and vague abdominal discomfort. If I consume a dish with garlic during the day after about an hour I become somnolent, and feel vaguely unwell; a lunch loaded with garlic may ruin the rest of my day. Although, I am most sensitive to garlic (closely followed by leeks), other members of this food family cause similar symptoms in a dose dependent manner; for example, a single onion as an ingredient in a beef stew is not a problem but I will be miserable after a good helping of caramelized onions or a bowel of French onion soup.  There appears to be a genetic component to allium intolerance as my daughter and one of my sisters are also intolerant.

  It is likely that there is an overlap between food intolerance and food allergy. Immunological reactions in humans, including specific antibodies in the blood, have been documented for more than a 100 common foods but for many of these foods the prevalence of an immunological reaction is very low. The European Union has identified 14 common food allergens and mandated that they be specifically listed when included in manufactured food products or in restaurant menus. These allergens include: cereals containing gluten, crustaceans, eggs, fish, peanuts, soybeans, milk, nuts, celery, mustard, sesame seeds, sulphur dioxide/sulphites, lupin, molluscs.

  Sensitivity to members of the allium family including allergic hypersensitivity to garlic and onions has been found in approximately 3% of food hypersensitivity patients in a cross-sectional observation study conducted at an allergy clinic in Spain (1). In a retrospective study on a smaller number of suspected food allergy patients in Saudi Arabia specific antibodies to garlic and onions were detected in 13.8% (2). 

In summary, sensitivity to members of the allium family is relatively common and largely underappreciated among food producers and restauranteurs as well as in the general population. 

(1)  Armentia A, Martín-Armentia S, Pineda F, Martín-Armentia B, Castro M, Fernández S, Moro A, Castillo M. Allergol Immunopathol (Madr). 2020 May-Jun;48(3):232-236. 

(2) Almogren A, Shakoor Z, Adam MH. Afr Health Sci. 2013;13(septiembre de (3)):689-93.

Restaurant Review: Mara

Mara is the new fine-dining restaurant at the Four Seasons in Minneapolis run by the ubiquitous Gavin Kaysen that opened in the summer of 2022. The food at Mara is excellent and offers an interesting contrast to the usual fare at the better restaurants in the Twin Cities. The cuisine is described as Mediterranean but apart from a few dishes that make a nod toward Italy, I think that North African or Middle Eastern would be a better description. The first section on the menu Spreads and Vegetables offers dishes that are ideal for sharing. The choices in the Raw and Cured section were uniformly excellent.  Among the more substantial main courses, stand out dishes were the lamb shanks and the bucatini with lobster; the salt-baked branzino was also excellent but at $68 for a modest sized fish was something of an extravagance. The desserts were superb even for someone like me who normally skips this course. The wines by the glass list was interesting but unreasonably expensive; the bottle list was good and competitively priced but odd, presented in one long column with no attempt to categorize based on region, country or grape.  Despite the overall excellence of the food and wine and the visually attractive space, the general ambience was not pleasant; I had the sense of eating in a large, impersonal, and noisy dining hall which significantly detracted from the experience. If I return, I will eat in the bar which is cosier and more intimate.  

Cooking During Pandemic 2: Couscous with Vegetables

Couscous with Vegetables (serves 4)

I usually find plain couscous to be dry and uninteresting. This version which is a little closer to the North African original is more substantial and quite tasty.

Couscous 3 cups
Chick peas 1 cup
Cherry tomatoes 1/2 lb.
Onion chopped, one half
Zucchini (green) 1; sliced to a 1/4 inch
Raisins 1/2 cup
Spices: nutmeg, clove, cinnamon, black pepper 1/4 tps each
Butter/Olive Oil: 4 tbps

Set oven to 400 F.  Peel, finely chop and fry onion in oil for 2-3 minutes until transleucent. Cut the cherry tomatoes in half. In a large-diameter saucepan bring 3.5 cups of water to the boil. Stir in the 3 cups of couscous until water absorbed. Add the chick peas, cherry tomatoes, zucchini, cooked onions and raisins.  Stir the mixture, season generously with salt, and add additional 1/2 water. Cover saucepan and place in 400 degree oven for 15 minutes. Finally add the ground spices and butter/olive oil and stir into couscous. If dish too dry add another 1/2 cup of water.

Variations: Other vegetables can be added, instead of, or in addition to, those listed above, such as chopped cabbage, artichoke hearts, carrots.

Cooking During Pandemic 1: Tomato Sauce

Best Tomato Sauce (4-6 servings)

This recipe is a modification of one originally published by Marcella Hazan and produces one of the best tomato sauces I have tasted. It is simple, economical and can be made quickly if you are in a hurry*. There are also many possible variations that can transform the dish into something completely different such as adding any of the following ingredients alone or in combination: (i) chopped fresh basil, (ii) tinned tuna, (iii) anchovies, (iv) olive paste.
Recipe sufficient to dress 1 lb. of pasta.  Serve with grated Parmesan cheese.

Tomatoes chopped 3 cups (fresh if in season otherwise, Pomi or other quality brand)
Olive oil 2 tbsp.
Butter 2 tbsp.
Large onion, one half peeled

Melt butter in a medium saucepan and add olive oil. Add the chopped tomatoes and onion, bring to boil and stir. Simmer at very low heat in uncovered saucepan for about 1 hour.
*If you are in a rush, you can cook sauce in about 30 minutes. After mixture has come to boil, cover saucepan and allow to bubble at low to moderate heat (make sure it does not burn) for 15 minutes, then uncover and continue at low heat for another 15 minutes.

Wrongly Convicted: High-Fructose Corn Syrup

The use of high-fructose corn syrup (HFCS) has become the punching bag of those who are legitimately concerned about the ubiquitous practice of adding large quantities of refined sugar to processed foods, cereals, and to manufactured beverages of all kinds.  However, focusing on the perils associated with the use of HFCS while tacitly or explicitly approving the addition of more ‘natural’ sugars to food and beverages is a misrepresentation of the link between the addition of refined sugars to our diet and the current epidemic of obesity and diabetes.  The fact is that HFCS and table sugar (sucrose) are identical in their chemical composition and there is no evidence that they have differential effects on the rate of obesity or diabetes. It is the total amount of refined sugar in the diet that is important not whether it comes from sugar cane or beets (sucrose), or from corn (HFCS).

Sucrose, or ordinary table sugar, is chemically classed as a disaccharide in which each molecule is formed by the combination of two simple sugar molecules, one glucose and one fructose.  Corn syrup is derived from corn starch and the sugar it contains is 100% glucose which is not as sweet as fructose.  To produce a realistic substitute for table sugar, corn syrup is modified to a high-fructose corn syrup that has the same percentage of fructose and level of sweetness as table sugar.

The most ardent critics of the practices of the food industry agree that there are no fundamental chemical differences between sucrose and HFCS.  However, it is certain that the introduction of HFCS as an additive to food and beverages has facilitated a large increase in the total amount of refined sugars we consume with its concomitant negative effects on health.  The damage being wrought by HFCS is because its often low cost relative to cane sugar has made it possible for food producers to increase the amount of added sugar in their products without having to implement the cost increases that might impact consumer demand.  Although food producers, with the help of HFCS, have been able to give consumers the sweetness they seem to crave without requiring them to pay the price, the ultimate cost to the consumers in terms of poor health is likely to be much higher than they bargained for.

No Free Lunch: the Story of Non-Caloric Artificial Sweetners

Non-caloric artificial sweeteners (NAS) are sugar substitutes used to give sweetness to food and drinks without the inconvenient calories; to those among us with a sweet tooth their unique properties may seem too good to be true. NAS are widely used in processed foods, soft drinks, and diet products.  In the United States, the most commonly used NAS compounds are saccharin (e.g. Sweet N’Low), aspartame (e.g. Nutrasweet), and sucralose (e.g. Splenda), all of which have been approved by the Federal Drug Administration (FDA) which regulates the use of NAS as food additives.  The FDA has also approved three other NAS food additives (neotame, advantame, and acesulfram potassium) and had ‘no objection’ to the use of Stevia, a plant-based sweetener, in foods because it is generally regarded as safe.  Despite the long history of NAS consumption (Stevia has been used as a sweetener for centuries in South America and saccharin was first synthetized in 1879) and the FDA evaluation and approval of specific NAS, there has been a lingering suspicion that their unique properties may indeed be too good to be true.  A scientific paper (1) published in the journal Nature in late 2014 provides indirect evidence that the widespread use of NAS is not good for human health and supports those who are skeptical of the concept of a free lunch.

The authors examined the effect of adding formulations of each of three common NAS (saccharin, sucralose, aspartame) to the diet of mice. The main findings were that the NAS led to abnormal glucose tolerance* in the mice and this was associated with specific changes in the gut flora (microbiota) of these mice. Transfer of the gut flora from the treated to a group of untreated mice (by fecal transplant) led to the development of glucose intolerance in the recipients indicating that the change in the composition of the micobiota led to the abnormal glucose metabolism.  The authors also studied the association between NAS consumption and physical and metabolic measurements in 381 human subjects and found that there was a positive correlation between the amount of NAS they consumed and increases in body weight and blood glucose and in the prevalence of abnormal glucose tolerance.  Finally, they supplemented the diet of seven healthy human volunteers with the maximum acceptable daily dose of NAS recommended by the FDA for a period of seven days and found that four out of seven developed abnormal glucose metabolism in this short period of time.  Although none of the findings in the study provide definitive proof that the regular consumption of NAS in food is an important contributor to the explosion in the prevalence of diabetes and obesity in the economically advantaged parts of the world, the data should give those who regularly reach for a diet soda a moment of pause.

(1) Suez J et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota.  Nature. 2014 Oct 9;514(7521):181-6. doi: 10.1038/nature13793.

*The glucose tolerance test is a method used to assess how the body metabolizes a standard infusion of glucose over a two-hour period. First, the baseline fasting blood glucose is measured then another blood glucose level if measured two hours after the ingestion of a specific amount of glucose (in humans for example, the standard dose of glucose used for the test is 75 gm).  The principle on which the test is based is that normal metabolism tightly regulates the increase in blood glucose through the release of insulin which shifts the glucose from the blood stream into the tissues.  Therefore, one can predict the blood glucose two hours after being given a specific amount of glucose and departures from that prediction indicate abnormal glucose tolerance.  For example, in human subjects the blood glucose two hours after ingestion of 75 gm glucose should be less than 140 mg/dL; levels between 140 and 199 mg/dL indicate abnormal glucose tolerance, and levels greater than 199 mg/dL are diagnostic of diabetes.    

Emulsifiers in processed food and your health

A recently published paper in the journal Nature (1) suggests that the emulsifiers added to many processed foods can lead to inflammation of the large bowel and to obesity and related diseases such as diabetes. The paper is an account of a research study in which groups of mice were fed one of two common synthetic emulsifiers (carboxymethylcullulose and polysorbate-80) in their drinking water for 12 weeks and then compared with genetically similar mice who over the same time period had been given an identical diet but without the added emulsifiers. The mice who ingested emulsifiers had a profound change in the composition and in the distribution of intestinal bacteria (gut microbiota): (i) there were fewer bacterial species overall and a reduction in the numbers of bacterial species commonly associated with good health, and (ii) the distance between the bacteria and the cells lining the bowel, normally covered by a layer of protective mucus, was reduced by 50%. Associated with these changes in the gut microbiota, the emulsifier-treated mice had a higher prevalence of inflammation of the large bowel and of obesity, an increased fasting blood glucose, and an abnormal response to large doses of glucose similar to that found in diabetes. Transfer of the gut microbiota (through fecal transplant) from the emulsifier-treated mice to a group of non-treated mice led to the development of bowel inflammation and obesity in the transplanted group indicating that changes in the microbiome were necessary and sufficient for all the other effects that were observed. The authors of the study suggest that the harmful effect of the emulsifiers was through disrupting the thick layer of mucus that lines the intestine and protects it from intestinal bacteria; damage to the mucus layer would reduce its protective effect making chronic inflammation and associated abnormalities (obesity, diabetes) more likely.

Emulsifiers are used to bind different liquids together (e.g. oil and water) that under normal circumstances would remain separate. Creating an emulsion is a crucial step in the production of many processed foods, and as a consequence, emulsifiers are ubiquitous in the processed food industry that uses 400,000 metric tonnes of synthetic emulsifiers each year in products ranging from ice cream, baked goods, and processed meats to chewing gum. The results of this study discussed above are not comforting to those for whom processed food is a major component of their diet. It is not known how the findings in this study relate to human obesity, dietary choices, and the practices of the food processing industry. However, the results are consistent with the growing conviction that the gut microbiota has an important role in human matabolism, nutrition, and immunity. It is possible that change in gut microbiota that result from changes in diet, particularly the additives in processed food, is a significant contributor to the epidemic of obesity in the United States and in other economically advanced countries.

(1) Chassaing B, Koren O, Goodrich JK, Poole AC, Srinivasan S, Ley RE, Gewirtz AT.Dietary emulsifiers impact the mouse gut microbiota promoting colitis and metabolic syndrome. Nature. 2015 Mar 5;519(7541):92-6

Review of Citronelle, Washington DC

I have dined Citronelle on several occasions over the past ten years and have enjoyed both the food and the quiet ambience. I visited the restaurant again last week when I was less impressed by the cuisine; whether my impressions were influenced by the swelting Washington weather, the lateness of the evening, or the disappointing book I had brought with me as a companion remains unclear.

The restaurant has a prix fix menu with several price levels based on the number of courses one wants. Fish courses are strongly represented among the starters and the main courses and many of the dishes contain crab which is a regional specialty. The space is modern and quiet and the tables well-spaced. The wine list is excellent with a focus on French wines, Burgundy in particular, and there is usually a knowledgable sommelier on hand to provide guidance and suggestions (as there was on this occasion) The guests, if in need of distraction, can see directly into the kitchen though a large picture window.

I had the three course menu costing 110 dollars. My first course was soft-shell crab tempura served with a cream-based sauce that also had tomato and mustard. The crab itself was excellent and the tempura batter was light. The creamy sauce, however, was overpowering and smothered the delicate taste of the crab. For the second course I chose 'timbale of skate'. Skate is particular favorite of mine and when fresh and properly prepared is sweet and buttery. Unfortunately, rearranging skate into a timbale proved to be a poorly conceived idea, which when combined with the indifferent execution, left me unable to finish the dish. This timbale, which was not unlike a crabcake in appearance, was topped with several small hillocks of a red jammy substance that reminded me of cranberry jelly. A generous quantity of lump crab was placed in geometrically strategic positions about the plate. I cannot remember the details of the sauce but its essence was sweetness; this combined with the contents of the hillocks made for a very unpalatable accompaniment to a naturally sweet fish. For dessert, I had a cherry pie which was quite good.

In summary, Citronelle continues to have a pleasant dining room with an attentive staff, good service, and a wonderful wine list. However my experience on this occaions suggests that all is not well at a conceptual level in the kitchen. M. Ricard should consider providing more direct instuction and guidance to the current chef de cuisine.