nce a suspect food is excluded from your diet, you should notice an improvement of symptoms within 1-2 weeks. Retry the food again after 6 weeks and if there's no reaction you can happily eat it in moderation.
In the meantime replace the excluded food with an alternative to avoid malnutrition. There are plenty of wheat and dairy-free products in supermarkets and healthfood shops, or substitute different fruit and veg like cassava, yam or plantain available from Asian groceries. There are several types of drinks available that can be used either to supplement the diet or to completely replace foods.
If you have no foods left to eat, see your GP immediately to discuss food alternatives. If they cannot help they should refer you to a dietician, allergy specialist or gastroenterologist. Under the Patient's Charter you have the right to ask for a referral to an allergy specialist, for a second opinion from another consultant, or for a referral to a teaching hospital that specialises in intestinal malfunction and management.
There are several types of drinks available that can be used either to supplement the diet or to completely replace foods. In a few circumstances (such as bowel disease), the drinks are available on prescription, but most people with food sensitivity end up having to buy them. Costs vary according to the type of drink. The most common (and cheapest) forms of nutrition support are ready-mixed cartons such as Ensure Plus, Entera and Enlive. Each drink contains varying amounts of preservatives, colourings and sweeteners, so check ingredients carefully to avoid triggering known sensitivities. Some hypoallergenic baby milk powders could also be considered. A dietician can help you find something suitable and make sure your diet is not lacking in essential nutrients.
Another group of drinks are formulas such as Vivonex, Pepdite and Elemental 028. These types of nutrition support consist mainly of amino acids and essential fats. They contain fewer food ingredients than the ready-mixed cartons so may be more easily tolerated. The formulas come as powders to mix with water, with or without flavourings. They can be taken alongside food or as a complete substitute although are more expensive than the cartons. A GP should be able to advise you.
Both types of drinks are very useful as a temporary measure, especially while reintroducing foods on a rotation diet, or to restore weight. However, even the powdered formulas do contain small amounts of food substances so it is possible to become intolerant of them, especially if you are consuming the same one at every meal. As there are so many to choose from, this should not be a problem, but if it is, you could consider getting a specific homeopathic remedy made up to antidote the drinks and neutralize intolerance reactions.
If you have difficulty drinking nutritional supplements, some types (such as the Elemental 028), can also be delivered directly into the stomach or small intestine through a thin tube inserted either via the nose (a naso-gastric tube) or through the skin, (a Percutaneous Endoscopic Gastrostomy or PEG). Once the tube is in place, feeding can be carried out at home. See your GP for details.
Individuals who become intolerant of all oral nutrition formulas may wish to consider Parenteral Nutrition. This involves intravenous feeding directly into a vein through a catheter. This type of nutritional support consists of very basic nutritional elements that can be absorbed directly into the bloodstream. Because there are no recognisable food substances, these formulas are highly unlikely to provoke sensitivity reactions. Many people have their nutrition 'fed' to them at home during the night so it doesn't interfere with daytime activities. Parenteral Nutrition (PN) is also referred to as 'Total Parenteral Nutrition' (TPN) and 'Home Parenteral Nutrition' (HPN).