Navigating Allergies And Intolerances With Dr Janet Aylott

Hello and welcome to the early years parenting podcast brought to you by Number 9 The Nursery Inc. I'm Jesse Cox and I'm your host today as well as the head of business development at Number 9. I'm also a mum of two who have both been at our nursery and today we are joined by Dr Janet A lot. Janet is a registered nutritionist with over 25 years experience across many different areas including infant and child nutrition. She works with nurseries and preschools to improve the food and nutrition that we give to our young children. She's also a mum of two have now grown up boys so you are in very good hands today. Janet thank you so much for being with us today. On our previous podcast we've discussed Fussy Eaters and Winning Babies and we've also done one recently on how to build healthy food habits and today we're going to be discussing intolerances and food allergies. Now Janet please forgive my ignorance but what is the difference between an allergy and an intolerance? So thanks for having me today. The difference between allergies and intolerances is all very scientific so an allergy a true food allergy is actually an immune reaction to protein in food so it's a type of the way that the immune system reacts to that food it almost treats it like an invader of foreign object. So it's a true food allergy is an immune reaction and intolerance is different and intolerance is where the body is unable to either digest the food properly so for example a milk intolerance won't be anything to do with the protein in the milk it's to do with the sugar in the milk so the lactose in the milk. Wow so they are completely different in terms of the scientific process that goes on within the body. Yeah true food allergy is something that would need to be diagnosed yeah whereas food intolerance is a little bit more tricky because it's not often immediate yeah it can be something that can happen over the course of hours or days after the food's ingested whereas true food allergy tends to be very immediate and you know having had two children myself I think it'd be quite difficult to spot in intolerance. It's very difficult and food isn't the only thing that causes its reactions in children and I think we sometimes think that if a child gets eczema for example or a rash that it's down to the food they've eaten but it might be something completely different it might be a different type of washing powder or exposure to environmental toxins so it's not always food that's the problem so diagnosing a food intolerance is very very difficult. Gosh and you know it seems to me that there's a there's a lot more kind of awareness now about allergies and intolerance is that something that we've always had these issues and now we're just noticing it or is it you know we're seeing our children being more sensitive to these things so there's definitely been an increase in allergies and intolerances over the probably the past 30 40 years. Some of that will be because we're better at diagnosing and recognising those things yeah and some of it will be down to the changes in medical care yeah the environment that we live in the types of foods we have in our diet the way that we raise our children can all have an impact on development of these things so there's definitely been changes and there's been increases but probably not as huge a rise that as much as we think yeah exactly that's so interesting and our children born with these allergies you know and is it the same with intolerance or does it happen over time so that's a really big question to answer in a way so allergies can be are developed sometimes before birth wow so there is an influence of maternal nutrition maternal health and nutrition the way a baby is born so if a baby is born by cesarean or for through a normal birth if a baby is breastfed or forming a fed can have an influence what mom ate during pregnancy yeah whether mom or dad has allergies themselves can have an influence gosh the environment that you're brought up in can have an influence so yes it's something that you can be born with there's definitely a tendency to be more at risk of developing an allergy if you come from a genetic background which has a lot of allergy in it yeah but there are other influencing factors as well gosh that's so interesting because I think as parents we almost want to put it down to like that one thing don't we just want to find the answer and move on but it sounds really nice quite complex it's much more complicated than that and there are instances where you may have parents with very severe allergies and they have children who have no allergies so there's sometimes no rhyme or reason as to when a child will develop an allergy or won't and we see often often in families siblings where one sibling will have allergies and the other sibling will be absolutely fine so it's very hard to say whether or not a child will develop allergies and are there like some common symptoms with like intolerances particularly that you know you can go or well that looks like an intolerance yes certainly and allergies and intolerances do have similar symptoms in lots of ways so it's it's quite difficult to determine which it is but intolerance is tend to be more digestive issues so for example tummy pains abdominal pains just don't know absolutely but things like diarrhea, vomiting, constipation it's sometimes a sign of an intolerance and sometimes it develops into skin problems like eczema or hives or rashes on the body but as I said earlier it could be something completely different to food so it's so difficult to actually pinpoint exactly what is happening and is there any like merit for like getting your child tested before that you start weaning the simple answer is no because having a test before you start weaning isn't going to tell you anything so what we understand from a scientific point of view is that allergies develop after exposure to the said allergy right so if you're if you're doing a test before they even started it's not going to get anything anyway right interesting that level of exposure could happen in utero right it could happen through breastfeeding it could be through another mechanism so until you actually give that child that food you're not going to know what that reaction or no reaction would be and even in a child who's being exposed through breast milk or in utero that could lead to what we call tolerance for that allergen so there's lots of scientific evidence now to show that the more exposure we have to allergens that less likely a child is to develop those food allergies well that's changed doesn't it because I'm sure like at the beginning there's all these lesser things you shouldn't be eating when you were you know pregnant absolutely don't have peanuts when you're pregnant that's all changed that's completely changed so back in the day when I had my kids there was definitely a thinking that if you had peanuts for example during pregnancy that would potentially lead to an increased risk of developing peanut allergy but the scientific understanding now is that actually exposure to those allergens during pregnancy helps a child to tolerate those allergens as they become older so there's loads and loads of research looking at what we call all tolerance for allergens wow so actually building up an ability to deal with those allergens because the immune system isn't designed to actually be allergic gosh that's so interesting and I think when you have that little baby you know when they arrive they seem so new you just want to keep everything away from them you want to live in like a really sterile environment you know you want everyone to wash their hands before they come in this should anyway but you know are we doing more damage by keeping our kids in a very sterile environment yes so there's the thinking around the principal what used to be called the hygiene hypothesis which is that the more clean you are the more likely you are to develop allergies oh my goodness so the reason being is that the immune system that we have in our bodies our innate immune system is designed to fight off pathogens so we're trying to protect the body yeah and what happens in this very sterile clean environment is the immune system doesn't have very much to do so it almost is trying to search and find a way to react and that can happen to things like food allergens because the immune system hasn't had the ability to deal with anything else gosh that makes it sound like it's almost like a muscle that you need to exercise to develop that in your body yeah it's almost like that and there's thinking now that it's all down to our gut bacteria so there's a lot of research going into what we call the gut microbiome yeah um so the bacteria that live in our in our bodies which are there we we cohabit with those bacteria yeah but it appears that the gut bacteria have a role to play in developing our immune system gosh so it's almost like we need to find a way to work without our gut bacteria to make it have a positive effect in our immune system rather than negative effect effect wow that's so interesting and it's it seems to be that there's there's a couple of foods that is recognised a lot for like intolerance or allergies like eggs like milk is there a reason behind that the main reason is that's often the first foods that range is exposed to so if you imagine um you know we don't see allergy allergies to foods that you don't get exposed to yeah exactly so it tends to be foods that are main major parts of the diet that you are exposed to quite early on. So milk being a like a big one, it acts being a big one. - Yeah. And we see often with those forms of allergies or intolerances that children tend to grow out of those. - Yeah, is that because they're given the opportunity to grow out of them? Because you know, I was talking to him on the other day, her child has got like a milk intolerance. I was pretty certain that my son had the same thing, but we kept on doing the milk ladder. I think I must have started that milk ladder about eight times before we got to the point where he could, you know, have it and be all right. And she was saying, "Oh, no, I'm just not gonna, "I'm just not gonna bother. "I'm just gonna cut it out of their diet." Is that, should we be putting our children on these milk ladders and pushing them to try and get through it? Or do they just go through it naturally and I was probably just pushing my son a bit hard? - Yeah, so the important thing to say is, if you have a suspicion that your child has an allergy or an intolerance, it's important to speak to a healthcare professional. - Yeah. - What we don't want to do is to start diagnosing, asserting ourselves purely because what you don't want to do is restrict your child's diet unnecessarily. - Yeah. - So you're quite right in saying that if we continue to give that food, whatever it might be, we can start to build up a tolerance. But that's only safe if you know that that child isn't gonna have a severe reaction. - Yeah. - So it's really important to talk to a healthcare professional. But with milk intolerance, particularly, if you don't in keep including milk in the diet, then your body reduces the ability to actually digest that milk. - Wow. - So there's something in milk called lactose, which is the sugar that we have in milk. And our body's produced an enzyme, which is what breaks down that sugar called lactase. - Right. - And if you stop giving milk, then we stop producing lactase. So therefore it's the self perpetuating. - Just goes on and on and on. - They never devote the ability to have it. - And that's the same in children and adults as well. - So it's really important. - If there is not gonna be a negative implication in terms of that baby's health to keep giving that milk in the diet. - That's so interesting. And will children naturally grow out of that? Or is it putting it back in the diet that helps them do that? - Again, if you know it's gonna be different. But what we do know from the statistics is that milk and egg allergy particularly tend to be ones that children will grow out of. What we do see though is that a child who has had a milk or an egg allergy particularly not necessarily intolerance but an allergy will tend to go on to develop other allergies later in life. That could be another food allergy like peanuts or tree nuts or it could be things like hay fever, allergic rhinitis. And so if a child has that almost allergic tendency we call it the atopic environment. - Yeah. - If they are going to be in that environment, that way of developing they are more likely to go on to develop other allergies later in life. - Goof. - So is there anything as parents that we can do to kind of reduce allergies or intolerances or is it just luck of the draw? - It's a bit of both really. If you are as a parent you are someone who has allergies or your partner has allergies then there is a chance that your child will develop those allergies. What you can do, I mean one of the key things is to try and breastfeed. So there's quite a lot of evidence to show that breastfeeding helps to reduce risk of derollipping allergies. However, saying that is not a given. So there is still a chance that a child will develop allergies when they've been breastfed or not breastfed. If you are a parent who is worried about specific allergens like for example if you have a peanut allergy and you worried that your child will have a peanut allergy you may want to talk to a health profession about how you might start to wean your baby to make sure that they're in a safe environment. But a lot of the advice around allergies to try and eat as normal a diet as possible during pregnancy. So trying to have that raft of different foods - Not just eating pasta like I did. (laughing) - But it's all about exposure. The baby is being exposed to those different foods. And as I said in previous podcasts it's about if you're exposing your baby to all the foods that you like they're more like to have that like and dislike. It's the same with allergies. If you're exposing them to peanut proteins and milk proteins and egg proteins during pregnancy they are more likely to build up those tolerances. - So like for cutting stuff out when you're pregnant it probably isn't going to be the solution that you hope it is. - Absolutely not. - Gosh. - But it's important to take that on an individual basis. So if you yourself have an allergy - If you've got an allergy you can do exactly. So it's really important to listen to your health professional. - Is there any merit for like organic food? Does that stop allergies or intolerance? - No scientific evidence at all to say that organic food would have any impact whatsoever. If you think about what organic means it's about reducing levels of things like pesticides. - Yeah. - And there's no scientific evidence to link pesticides to developing allergies. - Gosh, because I've had a lot of people going it's got to be organic because I don't want the baby to have an intolerance that's so interesting. In the UK the food regulations are very very strict. So any food that is sold in the supermarket whether it be organic or non-organic has very strict guidelines in terms of the levels of pesticides that can be used for example. So any food that you buy in the UK in a supermarket will not have very very high levels anyway. Organic is a preference or choice that you might make for your family but it won't necessarily have an impact in terms of allergy risk. I wondered if some of the advice that we're getting is because of other countries and not for others. - It's possibly because of other countries and I think everybody wants to do the best by their child. - We love them so much. - Absolutely, keep them safe. - Absolutely. So that's a choice that you make as a parent and it's something that it's not gonna do any harm to the child to give them organic food. It's just more expensive. - It's just got a lot more expensive on me. Does food affect skin conditions like X-Mart? Does it can it make it worse and better? - It can do, is the answer. And as I said previously, it can be food. So we do see situations where you'll see a reaction for milk or egg for example, where a baby's skin will be affected. But what we need to be careful of is that we don't start taking treats out of the diet without that. - Without talking more. Because it might be something completely different. It might be the environment. It might be the fabric condition you're using. It might be what you wash your bed sheets in. So it's really important to take the advice from the health professional. And when you're playing around with a baby or a child's diet, you've got to do that with a bit of support. Because it's very easy to think, well, okay, it's milk. I'm gonna remove milk from baby's diet. That has huge implications in terms of their nutrition. So there's always a replacement and alternative that needs to be substituted. - And sometimes those alternatives can make it worse, with my son trying different formulas, we actually ended up in a worse position than we were before. - Yeah, absolutely. So it's really important to take that medical advice from a health visitor, offering a GP, just to make sure that you're trying everything. But you're also making sure there's nothing else going on. There's no other medical reasons for exema. Exema, unfortunately, is a very, very common condition in very young children. Often they grow out of it as they get older. And often it's nothing to do with food. It's something completely different. - Of course, it's so interesting. - And is there like an age for children where they're kind of home free, where you think, oh, we haven't got any allergies? Or is it just one of those things that can happen at any point? - Unfortunately, it's something that can happen at any point. And you might have had a child who's had absolutely no problems whatsoever. They might then go on to develop asthma or hay fever, which is not necessarily a film allergy, but it's all linked to the end topic situation. I mean, I've got a relative who developed a fish allergy in her 70s. - Oh, forget her, so. So there's no time in your life where you're home and dry. Things like celiac disease, which is a gluten intolerance. Often it develops in people's 30s and 40s. So it very much depends on your genetics and the environment you live in. - And is it, you know, if you've got an analogy like in your 70s, can you get over it? Is it just, is it one of those things that can come and it can go? - Not really, once you tend to get food allergy, or severe food allergies later in life, they tend to be, that's it, yeah. But something like a fish allergy is potentially easier to manage than a meal allergy or an air allergy, 'cause it's not in every food that you have. - It's such a big topic. And there's been, you know, 30, 40 years of research looking at, you know, what causes allergies and we still don't know the answer. And we don't understand exactly what the causes are. We understand a bit more about what contributing factors might be. And certainly, the whole research around the gut microbiome, the gut bacteria is gathering pace. - Developing and then I think over the next 20 years, potentially, we will find a solution. But right now, there isn't one. There's also a lot more research now into this, building this all tolerance. So there's trials going on where children with severe peanut allergies are being cured if their allergies through building or tolerance through clinical trials, which is amazing. - That's so interesting, isn't it? 'Cause you always think that the peanut allergy is the one that's like the most dangerous and there's no cure. So that's really interesting. - So I mean, clinical trial stages, there's been some really positive results. So we see children who have been unable to tolerate any peanuts and how able to eat peanuts every day. Gosh. But the key thing with that is that they have to keep eating the peanuts. So even if they don't enjoy the taste, they have to keep eating them every day because it continues that keeps up that oral tolerance. Because the body is just amazing as you know that it can even do that. Absolutely. But the key thing with that is you should never do it on your own. So you don't think, or my child's got a peanut as you, I'll just give them peanuts because that obviously don't do that, please don't do that at home. Always take medical advice. It's, I think it's interesting now because we live in such an age of information that it's so easy for you to kind of self-diagnose now and I think as a parent, you often don't think you need to go and get help when it comes to food. What's the best place to start if you think your child has got, you know, an intolerance? So the best place to start is either your health visit or your GP. The problem we have is that things take a long time. So there's not enough allergy specialists here in the UK to deal with the level of patients that are looking for appointment. So GP health is definitely the best place to start. There's also some really good charities. So there's a charity called the Anaphylaxis campaign, which deals with severe food allergy. But also allergy UK is another charity and they have loads of information on their websites to go and have a look. If you think you have a problem with your child, look for the information, they'll sign post you to where to find more detailed. Because you can see those things online and I think it's more aimed at adults where you can do like the allergy test. What's your thoughts on that? Yeah, you can see the face. I don't know. They can't see. I can see your face. So yes, there are tests that you can pay for. There is not a whole lot of scientific basis for those types of tests. Often they are looking for markers in the immune system, which indicate that within your body you're having some form of reaction to that food stuff. The problem with those types of tests is they tend to diagnose rafts of different allergens. So for example, you might be told that you're intolerant to maybe 10 or 20 different foods. The issue is then what do you do with that information? Do you just remove all those things from your diet? If you remove all those things from your diet, you might end up with nutritional deficiencies. So the advice from a nutritionist's point of view would always be speak to a health professional first. If you think as an adult a certain food is causing you problems and you can remove that food from your diet without it having any implications to nutritional intake, that's fine. If it's going to cause you problems, then you should always speak to professional. So Janet, is a food aversion the same as an allergy in an intolerance? So no, a food aversion is quite different. So if you imagine you're trying to give your child a food and they point blanks, say no, they don't want it, that's an aversion. Aversion is having a reason of preference over what they might see. It's very different to an allergy in intolerance and it's really important as parents and also in the nursery setting that we are giving a really good range of different foods to improve nutritional status of that child. If we were to allow every child to say their likes and dislikes and what they're going to eat and what they're not going to eat, then we're going to limit their diet. Having a true food allergy or an intolerance is a very different situation and we have to be very clear that giving a child that food when they have an allergy in intolerance could cause harm whereas the food aversion, it's not going to cause them harm. So we have to be very clear that we are expanding the diet as much as we possibly can when children are very small for all of the reasons that we talked about in the last podcast about building those healthy habits and also providing a wide range of nutrients that the child needs to grow and develop. Yeah, and I think it's so interesting, you know, it was saying last podcast about, you know, children's growth that we can stop them reaching their potential if we're limiting their food. And I think, you know, as a parent, you know, you want your children to be strong and healthy and have good bone structure and all of that. I never really thought that if you're having preferences of what they can or what they can't eat, that you might be damaging that. Yeah, absolutely. If you imagine a child who doesn't want to eat different foods and there's a whole different array of different foods they don't want to eat or they're being refused to have them in their diet by parents or by nursery, then they're missing out on the nutrients those foods give them. And it's fine. If it's a rare fruit or vegetable that they don't like and it doesn't impact their nutritional intake, that's fine. But if it's the whole food group like milk, dairy, then it can have a real impact in terms of growth and development. Wow, that's so interesting. And you know, when we're thinking about, you know, like allergies and intolerance, you know, I kind of have that picture of wanting to keep the kids like super clean and, you know, not wanting them to get dirty, you know, and know we touched a bit on this before. But is there a part of that where if we keep them super clean and we don't let them get messy, then that won't, that might not affect them having allergies or intolerances? Yeah. And there's a lot of thought that if we keep our kids too clean, it's almost like fueling the fire for those allergies and intolerances. Wow. So actually the opposite of what you're hoping. Absolutely. Because the immune system is there to protect us from invasion, from infection, from viruses, from bacteria. So if we don't, if we don't use the immune system the way it's designed, so by fighting off of those things, then it turns itself around on its head and starts fighting off things that we do need like allergens in food. So messy play is really important, you know, playing in the dirt is really important. Being outside, having animals in the house, they can all help to reduce our risk of developing allergies. Because our immune system is dealing with the pathogens or the things in the atmosphere that it's meant to deal with, not with allergens in food. I think that's so interesting. So I think, you know, it was a while ago now, but, you know, the whole process of COVID has really changed the way that we saw, you know, infection and the environment that we're raising our children in, you know, before, I don't think there was, many of us gave much thought about it. Now, there's this kind of feeling as a parent that you want to wipe everything clean with antibacterial, and you, you know, you walk around with the antibacterial wipes in your handbag for the children's hands, it's hard to think that that actually could be doing damage. Yeah. And it's not going to do damage in the situations like that, you know, if you're out for the day in, in a city and your kids got dirty hands, obviously you're going to wipe them. It's more about, you know, in safe environments like the home or, you know, at nursery or playing in the garden, it's fine for kids to get messy. Yeah. We don't have to, they don't have to be clean all of the time. That, you know, that freedom to express themselves through messy play is really, really important. Not just for reducing risks of things like allergies and intolerances, but also for social behavior. So, you know, all of those things are really important for children's development. Yeah. And I think, you know, as parents, we can almost pass our fear onto our kids, can't we? You know, we want them to live in this pristine, wrapped in bubble wrap home life. And it's not always helpful, isn't it? Yeah. Absolutely. And, you know, the world isn't like that. You know, we do need to experience exposure to all of those different environmental things that are going to potentially help us in terms of reducing risk of allergies and intolerances too. Wow. Every time I talk to you, I just learn so much. And I love what you've said about, you know, the immune system almost been like a muscle where we needed to let it exercise and, you know, develop and grow and not keep us in a position where we're fighting it for them, allowing those children to have their own immune system. Yeah. Absolutely. And this even research showing that things antibiotics can increase the risk of developing allergies. So, we're almost at wiping out or not supporting our immune system to develop by changing our gut bacteria. So, our gut microbiome and that can have an implication for allergy risk too. And so there's all sorts of things going on in the body's very clever at trying to use this like it's immune system in different ways. Gosh. That's so interesting. I love that about my GP, because he's always so careful about giving antibiotics. And I think that's really interesting what you've just said there. I think a lot of us feel like we just want the quick fix, we just want to get over the thing quickly. But, you know, our bodies are incredible and good at fighting stuff. Oh, thank you so much. I just love talking to you, I can talk to you all day. And thank you at home for listening, and if you have any questions for us, then please do get in touch. We'd love to hear from you. You can do that on our website, which is number 9, the nursery dot code at UK, or you can email us at manager at number 9, the nursery dot code at UK. Please do get in touch. Thank you so much for listening, and we will talk to you again soon, no doubt. (upbeat music)