It would be ideal if every person could eat organic food all the time. This is impossible to advocate today, since the supply of truly organic food of high quality is severely limited. Unsprayed, uncontaminated food should be made available first of all to those people who simply cannot function without it—the patients in advanced stages of chemical susceptibility.

An increasing demand for organic, uncontaminated food, however, should eventually lead to an increased supply of products. Consumers should be aware, however, that what passes for “organic” and “natural” nowadays is often not very pure, and susceptible patients often have reactions to what are at best semi-organic products.

*112\110\2*

After two weeks, the patients were split into two groups, one of which began an elimination diet. For the first week, this diet consisted of twelve rarely eaten foods. All milk products, eggs, cereals, beverages and additives were excluded, along with most meats and all commonly eaten fruits and vegetables.

After the first week, these excluded foods were reintroduced, one at a time. Any foods that caused a flare-up of symptoms were not eaten again. The assessment of the patients continued for six weeks – long enough for them to have tested most foods and established a workable diet that excluded all ‘incriminated’ foods.

While the first group of patients was undergoing the elimination diet, the other group kept on taking their dummy tablets. After six weeks they were told that a different form of treatment would be tried – and they were then put on to the elimination diet. The objective here was to use the second group to assess the placebo effect – the improvement that is produced by any new form of treatment. Their response during the first six weeks on the dummy tablets was a measure of the placebo response that might be expected in the other group during the elimination diet.

The joint symptoms of all the patients were assessed using various standard measurements of pain and stiffness, plus routine blood tests that help evaluate the severity of rheumatoid arthritis. Dr Ramsey, who was unaware of which patients belonged to which group, and was therefore unbiased, made the assessments. The patients who received the dummy tablets first did show some improvement – so there was a placebo effect – but the group that undertook the elimination diet did far better. When the placebo group later went on to the diet, they too showed a much more striking improvement.

Notice that these measurements are a rather crude assessment of improvement in the group as a whole: when considered individually, some showed little change while others seemed to respond dramatically to the treatment. (The reasons for assessing patients as a ‘job lot’, rather than individually, will become clear when we look at the next trial.) At the end of the diet, three-quarters of the patients claimed to feel ‘better’ or ‘much better’ than at the outset.

*107\180\8*

Some doctors, however, still work with a much broader definition of what allergic disease encompasses. They prefer the term ‘allergy and environmental medicine’ to describe the field. (In the United States, this is commonly called ‘clinical ecology’.) This definition covers a wide range of illnesses and symptoms, including true allergy in the strict immunological sense, but also encompassing food intolerance, chemical sensitivity, and other disorders that respond to avoidance or elimination of specific substances from the individual’s environment.

If you know that you react to something in your environment, you may feel that these distinctions do not really matter if the end result for you is the same, i.e. that you react to a given substance and you have to avoid it to stay well. In simple terms, you are right. It doesn’t matter, for instance, whether you are ‘allergic to chemicals’ or ‘chemically sensitive’ if the outcome is the same in practical terms, that you have to avoid certain chemicals. However, there are differences in the types of therapy and treatment you might find helpful, and in the guidelines on avoidance, so making a distinction does help you to have a greater understanding of what you are asked to do.

It also matters in another important respect. Doctors disagree (sometimes passionately) about what allergy actually is, what its symptoms are and how to treat it. You may get one diagnosis and suggested course of treatment from one doctor, and a totally different approach from another. Many practitioners (on both sides of the argument) make assertions about the nature of allergy when the facts are not fully known, and when the reality is manifestly complex. You need to understand the background to the controversy – and the facts, as far as they are known – in order to be able to make sense of what doctors say to you.

*1\117\8*