Food Allergy, Intolerance, and Sensitivity: Are the foods you eat making you ill?

What is Lactose?

Lactaid Pills: A Solution To Lactose Intolerance?
Parasites are another type of pathogen whose impact has been diminished by improvements in sanitation and water purification. Using an infrared sauna has been wonderful! Under normal circumstances, there is careful regulation of the types and amounts of compounds that enter the brain. Can someone confirm or deny? I have lived with restless leg syndrome for a number of years and only now finding out about the link with restless leg and glutamate sensitivity. It's the place to consult if you want to know when an epidemic of gastroenteritis is afoot, when a mislabeled food has been recalled, or if you want to contact your state public health department.

What is Lactase?

Beyond MSG: Could Hidden Sources of Glutamate Be Harming Your Health?

Symptoms are itchy, red eyes with red circles around them so that I look like a panda bear except my circles are red and not black. I finally realized that I may have this issue after drinking bone broth for almost a year. Every time I had it, especially when I cooked it for a very long time, I would get many unpleasant symptoms, the worse being brain fog and headaches. After doing research online, I discovered this free glutamate intolerance, and then a bunch of things clicked for me.

I get the exact same symptoms when I eat wheat, certain aged cheeses, some cured meats, corn starch, and gelatin. I am going to try to avoid free glutamates as much as I can and see how I feel. I found exactly the same.

I get tachycardia, arrhythmias, numb sensations in my tongue and muscle stiffness. I really appreciate this article as it sheds a lot of light on my reactions. I have a mechanical aortic valve and incision scar tissue that inflames with overabundance of glutamates to block electric pathways, creating atrial fibrillation. I am surprised that a plant growth encouraging compound can also create glutamates in fruits and vegetables.

Hi, I also have real problems with long cooked stews and broths and have learnt that they also create high levels of amines that give me really bad stomach symptoms. I get bloating, intense pain, and depression when I eat them. Meat and cheese and eggs must all be super fresh and never left at room temp. Give them to less sensitive friends or the dog! Also those reacting to bone broths and slow cooked meats — look into histamine intolerance, as that can also cause these reactions.

Thanks for the review; this has some truth, but not all the truth. There, I believe, is still a missing link, perhaps an unveiled metabolic pathway. I think the take home message is to avoid as much as possible, processed food sources. I love all 9 episodes of truth about cancer.

I have just watched a film called the truth about cancer, one doctor says glutamate is a main cause of cancer, even worse than sugar. I thought I was doing well by eliminating msg from our diet, but didnt know it was hidden in ohter forms smh.

Not just those beans of course, but I read somewhere else that sea vegetables are also high in natural glutamates, and this diet is big on the sea vegetables! I did some more checking today and found this, hopefully what they say is accurate? Can someone confirm or deny? It puts my mind a bit more at ease with the macrobiotic diet.. Hi Jude, I watched the same thing. I remember him mentioning black beans and mushrooms. This lady also lists broccoli which another doctor claimed to be good.

Were you able to find a list anywhere of glutamates to avoid? I wanted to ask if I soak my own dry beans if it would still be high glutamate. Sam — yes, mushrooms are another natural source of high Glutamate! That includes supplements made from mushrooms like Reishi.

Hi Chris, thanks for this info. I have been eliminating glutamate and high sulphur foods from my diet for three years and am now finally migraine and fatigue free. My family has a history of Spina bifida and although I d not suffer I did link the folate and nerve health to the glutamate sensitivity and find that if I accidentally ingest glutamate or sulphur I get a reaction in my body within a short time and I take folic acid to counter it. This does work if the dose of sulphur is small.

Otherwise I suffer from glutamate overload and become shaky, laboured breathing, diarrhoea and sometimes vomitting, altered taste and vision and have to sleep for a day. Sports drinks high in magnesium seem to help to flush the toxin out of my system so I can function. Still it takes nearly a week to fully recover. I hope this information helps you. Can I heal my gut from this sensitivity?

It is a genetic problem that does not allow a person to process synthetic folic acid or B There is a special form to take. I and others in my family…also with a history of spina bifida have all been diagnosed, and are on the right folic acid and B This could be the answer to soooo many unexplained health issues! I also found the connection somewhere along the line probably another article online that taking Folic Acid supplements could counteract the effects of eating glutumate. For years, I always had Folic Acid with me and would take it after a restaurant meal particularly fast food.

I seemed to have almost no headaches. I recently found out that people with ulcerative colitis develop a Folic Acid deficiency. I have also had reactions to store-bought icing, although I cannot pin down the ingredients. Not sure where to get this info…. I searched for possibilities of Betaine HCl w pepsin taking grams per day causing high glutamate. I have been using this for about a month consistently and now my glutamate symptoms are through the roof!

Is Betaine HCL considered glycine?? Thanks for any help. After a year of trying to work out what was causing my symptoms rapid heart beat, arythmia and nights unable to sleep at all! I had no idea until recently that these were both linked to free glutamic acid but when I found out it all made sense!!

Does anyone have a remedy for the short-term symptoms relating to this? I naturally now avoid foods with these additives but sometimes they unknowingly make their way into a meal. I have this eat same problem and would love to hear any tips to overcome this condition of overstimulation when exercising. NAC n-acetyl cysteine can help, and magnesium can too. NAC is an anti-oxidant and has many other benefits as well.

Magnesium supplements are not safe for everyone. This misery a I described went on for a couple mo this before I finally figured out the cause. Even too much of a high magnesium food chocolate can do this to me. This is not a common response to magnesium supplementation, but I have met two other people who have the same response. I know of only one other person this happens to.

I have fibromyalgia and everyone wants me to take magnesium. Practitioners all look at me strangely when I tell them about how magnesium causes terrible leg pains and keeps me awake all night. Does anyone know why? Or how to overcome it? Can magnesium really just be bad for a few people? Yep magnesium can cause restless legs, cramps etc I had it when using magnesium chloride transdermally. Anything citric or oxide is a no-no.

Glycinate can cause insomnia, malate and threonate I believe are the two best alternatives. I solved the problem of leg cramps caused by magnesium by eating a couple spoons of molasses each day. It is high in potassium. Well…pushing down potassium may not be the mechanism for me. High potassium foods, potassium supplements do the same thing to me that magnesium does, muscle cramps, low blood pressure, etc. Inadequate vitamin D absorption leads to Calcium deficiency.

Calcium deficiency can lead to magnesium overload. I believe my body preferentially absorbs magnesium over calcium. Both times I had well above the normal range of magnesium in my rbcs. Interesting links between glutamate MSG foods and calcium. I was taking it for several weeks and noticing that my heart rate would be dangerously high at times. It took me a disconcertingly long time for me to figure out it was the NAC! After about a week of not taking it the heart rate improved considerably.

Also, many of tbe same foods also contain tyramines. Is there a way for someone to tell if they rea t to tryamine or glutimate?

Do tryramines damage brain tbe way glutimate does? I have Lamictal to help me with my depression that last for at least 10 years as far as I know. I read articles where the lamitrogine is related to inhabit the glutamate receptor. Does the glutamate diet do the oppoisite by exciting this receptor? I learned recently that glutamates were causing me to have restless leg syndrome. Also had an extreme reaction to whey protein where i was so wired that i did not sleep for 4 days. I stopped eating foods with high free glutamates and the RLS mostly disappeared.

And insomnia continues to be a problem for me even after removing the glutamates. After reading all the comments I will remove gelatin capsules and digestive enzymes to see if maybe they are a problem.

Maybe the glutamate they contribute are not enough to cause RLS but still enough to disrupt my sleep. Does anyone know, if you heal the Leaky gut will the glutamate sensitivity disappear. Although my diet includes many foods that I enjoy, I really miss all of the foods that have a more intense flavor. I have found that my legs become restless when I need more iron. Researchers at Johns Hopkins have noted the even RLS patients with normal blood levels of iron benefit from supplementation with iron.

For this reason, they theorise that some people with RLS can have normal blood levels of iron while they are deficient of iron in their brains. Hi Ann and Valerie. I was interested to read your posts.

I have lived with restless leg syndrome for a number of years and only now finding out about the link with restless leg and glutamate sensitivity. A number of things ive noticed over the years bring on symtoms which I have naturally eliminated from my diet including protein supplements, creatine supplements, maltodextrin supplement, alcohol, coffee and also intense exercise. Is there a way of testing if you have a sensitivity to glutamate that you are aware of?

Hi, did u check your kidney function, endocrine status thyroid , or iron levels? I refer you to NHS choices link, for more detail. May I add, from a personal experience; if u r around menopause age, that could be a notorious reason, and a reason for many more symotoms, especially when camouflaged while hot flashes are yet not fully proclaimed.

I was having migraines continuously and it was recommended to go grain free. I did and the migraines went away. Should I start watching out for Glutamate now too? I had 15 years of chronic migraine that included vomitting and diarrhoea that lasted days to weeks. I could not work and spent 18 months in bed before I started taking betablocker meds.

I discovered hereditary conditions included spina bifida folate deficiency in utero and sulphur intolerance. I have cut out all foods high in sulphur, high free glutamate foods are also on the high sulphur food list. If I accidently eat preservatives or a free glutamate food I begin to get very sleepy and my mood is flattened. I immediately take folic acid to counter this reaction.

I am totally well now, working, and my poor health a distant memory. But I must eat a low sulphur diet, no preservatives or anything with numbers attached. I have the same reactions, high glutamate foods make me tired and sad, just out of interest, how did you find out that folic acid counters this reaction?

Which type of folic acid do you take and how much? I might not tolerate high sulphur foods also, I found this article about the connection between sulphur intolerance and mercury intoxication.

Hi Anne My biological father, when I found him fifty years after my birth, listened to my symptoms and told me the whole family have a sulphur intolerance. He worked in the wine industry and advised me to stop drinking wine with preservative. So I now eat preservative free. Folate is needed in the development of nerve endings, glutamate and sulphur are excitotoxin to the brain, folate helps to counter some of this chemical reaction. The other side of my family suffer from Spina bifida and migraine.

I have a double -whammy intolerance. By connecting the family history and the science it became possible to note that folate lack of folate causes Spina bifida had a role to play in my health. NB Some new anti-epileptic drugs work on the glutamate receptors in the brain also, and may work for migraine. First please studies that free glutamate ingested with food have fast spikes. Because you dont ingest free gluamate alone but with foods and this affecst absorbtion like in glucose.

Second bounded glutamate is very fast unbounded by digestion. Remember no one eat glutamate acid alone however, comes without the natural components of food that help the body regulate glutamic levels. Free glutamate lays physiological and nutritional roles and initiates digestion in the stomach as well as anticipates subsequent processes in the small intestine and the liver. For seasoning I use Himalayan salt, and herbs, nothing else. I cook as healthy a possible, I just recently saw that my daughter is disliking meat now.

She will have very very little almost nothing, wondering why? She is non verbal, but started with few words since on CD and herbal Therapy.

How do we know what is free glutamate and what is bound? And how do walnuts have a high free glutamate index? Nothing is processed in them. You would think that would be the bound glutamate. You will most likely see that they are. Is there any research on the safety of injecting MSG? Is the sensitivity point much lower? My daughter has not received these vaccines yet only partially vaccinated.

I am 43 years old and since I was 13 have been dealing with a seizure disorder. My wife and I were at a Chinese buffet. That night I had terrible seizures. This was about 3 years ago.

Since then, I generally try to avoid those known foods with glutamate. When I do have a seizure approximately 1 every three months and always at night , I can always link it to something I ate the night before.

I came across this article after having had another seizure last night. Not realizing it had so much glutamate, I had quite a bit of blue cheese last night. Also, my son has been struggling with symptoms of ADHD for several years. He has been diagnosed and has been on medication for several years now.

Recently, he has seen by another physician and he has doubts that ADHD is the correct diagnosis. This is a very interesting thought and warrants follow up. Maybe the majority of his problems can be linked to a food sensitivity. My 11 year old with ADHD who has been on meds for a year, saw a functional medicine dietician and has been glutamate free for over a month now. He is so different it is almost a miracle — calm, focusing, fun to be around.

We are yet to reduce the meds…and to re challenge his diet — but am very hopeful. My daughter is getting better, but still missing that raw juicing, vegetable, fruits and nuts, which I learned it now and make sense to me…. Do the seizures happen during tbe night? I get tbe same thing but have been blaming on tyramines rather than glutimates- foiods that have them overlap considerably.

Our first realization was the eczema it caused, but elimination of foods results in less excitability and better cotton and focus.

In the past 3 years we trip on another sensitivity every 6 months or so-including red dye, chlorine and just recently glutamate. We find it based on symptoms then research to find the trigger based on what he most recently ate. I believe many children are being diagnosed with adhd — but really just have food sensitivites.

Praying as a society we stop poisoning ourselves just to use medicines that cause worse issues. As someone who adopted the real food diet this year and bone broth I was excited to be healing a very leaky gut.

However to my dismay, my symptoms worsened and I hit a health low. I finally realized that my joint pain and hives were directly caused by the bone broth and possibly glutamine-containing amino acid supplements prescribed by my functional practitioner. Any suggestions are welcome.

My gut is by far not healed, but got rid of the hives using MSM. The itching was so bad that not even antihistamines only available on prescription several times a day could get rid of it, I then started supplementing with MSM and after 4 months it was gone. I also tried supplementing with glutamic acid also in order to heal the gut, but had to stop taking it, as it worsened my mood.

I also just read a couple of days ago, that zinc helps heal a leaky gut and a leaky brain , so I will try this too now. I am also looking into fecal transplant. I cant restore a healthy microbiome because i cant eat any of tbe aged foods that provide beneficial bacteria.

Between that and not being able to eat any dairy i have no lacobacilli in large intestine. I do not have evidence of leaky gut but do have gratly elevated secretory IgA suggesting my immune system is overactive about something.

Aged foods give me neurological symptoms and have to avoid greatly. Dont know how the dairy intolerance — fresh or aged — factors in. Works wonders also for your mood!

Is glutamate and L-glutamine the same thing? Are you using these words intergangeably perhaps? I hope they are not…. I stumbled upon the msg issue by accident. My grandson, who is non-verbal and autistic, was recently seen by a naturopath and had a full biochemical assessment done which, in part, showed low levels of glutathione. He was given a cream prescription to increase the level, but we were told this is a slow process and could take up to a year.

No satisfied with this answer I went to the internet in search of a quicker way to raise his glutathione levels. I ordered this, and before using my grandson as a guinea pig I tried it myself first. The first day I felt a very small amount of some generalized anxiety, the next day a little more and by the third day I was nearly crawling in my skin. My stomach was in a knot, my limbs, particularly my arms and calves were tingling and felt weak, and I just felt toxic.

I had no idea what exactly was causing this but I knew it was something about the whey, so once again I went to the internet in search of an answer and I saw that on many of the body building forums which is most of the folks who use whey products people were talking about feeling anxiety when using whey. But in my searches I kept seeing glutamate referenced, so I did more searches on glutamate and anxiety and I hit the jackpot!

I could barely believe what I was reading about this substance! Thank god I did not give any of this poison to my grandson. And of course, now, the question is, how is glumatate affecting him on a daily basis and what role might glutamate play in his autism.

What I know of certain, is that I experienced a horrific overload of glutamate and the physical symptoms were real, painful, and disturbing. I cannot understand why the FDA allows this neurotoxin in nearly every single packaged food there is.

Besides avoiding free glutamate, using glutamate blocking supplements, such as magnesium, B6, taurine, etc. This article is fantastic: It is very important to get the modern, hybrid wheat out of your diet. No beer with what malt in it although German beer should be safe as they will not uses Roundup dried wheat to make malt. Is there any wheat but not whole wheat! If i get stuff imported from another country like pastafrom italy would this help?

My daughter is better!! We do Herbs detox, colon detox with Enemas, I can tell you after just one enema, my daughter calms down immediately!! It is a slow process, to get our kids back, Many kids started to talk, my daughter just started to say few words, and that is a positive thing to me, Please don not get any injection of Vitamin B, the worst is B Wish you all the best!

Hi Mira, I just read your comment regarding the article on glutamate and your daughter. At the end of your comment you mentioned vitamin B12 being the worst. Have you thought about testing her genes, as in 23AndMe? Just wanted to pass this on. She has a test that can test for where the methylation is breaking down.

So, could vaccines have toxins that affect methylation further? What about supplements that have their capsule made of gelatin? Should we avoid taking supplements with capsules of gelatin?

I appreciate that you share your experience. I thought there might be another reason for me feeling better without them.

I am new to this so I have so much to learn and understand yet! And then it is so good to hear from others what they do. Do they help with your digestion? Do you see a great improvement in symptoms and do you have any adverse reactions? I used to take this for digestion issues but no longer need it. You need to be specific as well and specify what thewe contaminants a day by-products are. All of the latest and most reputable research indicates both multiple environmental causes MSG could certainly be one and a possible link to the dysbiosis and disruption of the normal bacterial population we all carry that outnumbers our own cells by X.

Finally, you need to edit your work more carefully: All this said, please keep up the good fight because our food truly is our best medicine. Thank you for all the excellent posts and comments. I want to learn more specifically about digestive enzymes possibly being a source of free glutamate?

As was mentioned in one of the earlier posts. Is this really the case? Can someone please confirm with a citation or two with more information? I would be very grateful! Hello, I was using half a cup of bone stock a day — cooked for 12 — 24 hours — when I developed a reaction to glutamate — for me this was an intense burning in my arms and legs. I had to stop all food sources of free glutamate but also had to ditch the fermented foods and digestive enzymes to get the pain to go away.

It did eventually but even after 6 months I am not able to touch any of t he offending foods, this has made life particularly difficult with regards the digestive enzymes, I now have to puree all food. My daughter suggested I check this website to seek help and learn more about glutamates. My husband has Lewy Body Dementia. Mainstream medicine offers some help, with limits and no promises.

Did you ever tried Coffee enemas? Do you take daily probiotic? We have both been vegan for 3 years now and have noticed a significant improvement in our health and mood. I heard Katie interviewed by Holistic Nutrition labs and she was great. Look for her Ted talk as well. My question is, does free glutamate actually cause disorders like autism, ADD and Parkinsons or does it just exacerbate the symptoms because people with these issues are more susceptible?

My thoughts are there may be various factors that result in sensitivity to free glutamate like: For more info see unblindmymind. There is much science missing here and it is complex. Free glutamate need not cross the BBB to induce neuroinflammation in the brain, although crossing the BBB is one way for this response.

Neurotransmission signals and other chemicals like insulin are induced by glutamate binding to glutamate receptors and these signal freely cross to the brain.

The same is true of casein protein or any protein subjected to processes that break the peptide bond. As a follower but not to the nth degree of traditional foods, and as someone trying to heal diagnosed SIBO and reflux, I have turned to bone broth, gelatin, and probiotic foods for help, based on conventional wisdom. How does one know which way to turn? I also have severe food allergies to nuts, peanuts and sesame, implying that there is a gut permeability issue.

Without thousands of dollars of lab tests, any advice for the confused? Also thank you so much for your work, and your dedication to helping those who struggle.

I just watched your TEDx video and found your page. I had a recent experience with a change in diet. I have been avoiding free glutumate for over 30 years due to it causing bad headache and a hangover effect for 24 hours after consuming. Before then, I avoided wheat and never drank milk. My gastroenterologist prescribed the probiotic, VSL 3 and I am back to avoiding wheat and am cutting back on the dairy, but now I think I need to eliminate the milk all together due to the casein connection with glutumate.

As a person who gets migraines and has Fibromyalgia, I definitely have a sensitivity to glutamate. And I have studied this subject tirelessly. MSG is the biggest offender, but most of the products the author listed also bother me except not really broccoli nor homemade broths. I would also add chocolate as one of my main triggers most people with migraines should avoid chocolate too.

I would also add that most IBS is caused by glutamates. As soon as I avoided it as much as possible , my IBS completely went away! Although I do think the condition of the gut and brain barrier play a huge role in individual sensitivity, I think enzymes play a role too. Not just digestive enzymes, but possibly metabolic enzymes.

And so each person will have a varying degree of sensitivity based on their personal profile of genetics and deficiencies and damage to these systems. Here is an article about this study: Because, as an earlier post pointed out, glutamate, like all other amino acids, is balanced in real foods by other inhibitory substances. If you are confused about the difference between the two, the main point of differentiation is that coconut cream lacks the water.

The cream is thick and like a paste and much tastier, in my opinion! While many milk substitutes such as soy are full of cheap additives, the quality of almond milk varies wildly. As can be seen, many substitutes for dairy are available. With this in mind; if you are lactose intolerant and wish to keep eating dairy, Lactaid pills might be worth a try.

Last Updated on August 9th, I especially like the non-dairy alternative. Coconut is abundant in Malaysia and other tropical countries.

Dairy products also have casein that may cause celiac disease. A better choice is organic raw unpasteurized ghee. I think staying away from dairy is probably necessary for many — but not all. Also sometimes fermented dairy is a lot better tolerated than milk.

How does the ghee you made at home taste? I have been struggling with lactose intolerance for 16 years. But I hated being dependent on them.

I started LCHF about a month ago. I was nervous about giving up lactose-free milk and using cream. But to my amazement, no problems! I feel like a normal person. It helped my L. So maybe something about your previous diet could have been causing digestive distress. Another possibility involves gluten.

As gluten sensitivity shares similar symptoms to lactose intolerance, these two often get wrongly mixed up… if you felt better after quitting grains, maybe there could be some relation?

I suppose this one is unlikely after 16 years though. LCHF stands for low carb, high fat. A type of diet that typically contains Michael, you are absolutely right: A lot of people are very happy with using these pills and it makes following a lactose-free diet a bit easier.

Yes, typically their efficiency will depend on the person and the extent of their intolerance. I am self diagnosed with a Lactase problem, found Lactaid many years ago and it worked wonders; been taking it religously with dairy for 30 years or so. Now all of a suden Lactaid is not working? Hello — I am from Turkey and I have had Lactase intolerance for more than 30 years as well.

I have been taking Lactaid during all those years and it worked for me. I also found out that I needed to take more tablets for more concentrated products like ice cream. However, suddenly, I started having problems even though I am taking Lactaid. So, my question is: Can this medicine lose its effectiveness? Thank you for your help. For example, everybody even lactose intolerant people has some level of lactase in their body the enzyme that breaks down lactose.

When you combine the supplement with the natural levels in your body, then usually people have enough enzymes to digest lactose. However, our lactase levels can fall quite a lot and sometimes suddenly in the aging process — this is why some people develop lactose intolerance at an older age.

I could have written this comment, except I have been taking lactase supplements for 40 years! For instance, if you take 3 Regular Strength, take one when you begin consuming your dairy product, one when you finish, one an hour later. To be honest, if I had a dairy intolerance I would probably be the same.

A life of no cheese sounds terrible…. Could taking Lactaid every day have any affect on your potassium? She takes Lactaid three times a day.

Could that be contributing to the potassium not being absorbed? One thing to note though; if you buy actual Lactaid milk, that actually contains quite a bit of potassium — around mg per cup. Another idea I consider a misconception, is the idea of removing milk from the diet for a period and then reintroducing it to see if there is a problem.

That explains why I am more able to take dairy when I have been drinking lactose free milk Anker in New Zealand add lactose. My daughter age 9 just found out the hard way that these types of pills do not work for her: I am East Asian. Bread, once the indispensable "staff of life," is now feared by many as the stuff of distress.

It's not bread per se, but rather gluten — the protein content in wheat, barley, and rye — that has become a food ingredient non grata. Gluten, whose name comes from the Latin root for glue, is an umbrella term for the proteins gliadin in wheat , secalin in rye , and hordein in barley. Bakers know it as the substance that makes dough resilient and stretchy.

If you're making bread, you want gluten in the dough, so that the walls of the little air pockets formed by yeast expand but don't burst open during baking. Gluten has bubbled to the top of the list of food perpetrators partly because doctors are diagnosing more cases of celiac disease, an autoimmune disorder whose symptoms are triggered by gluten.

And a growing number of people who don't have celiac disease but suffer many of its symptoms have been classified as "gluten sensitive" or "gluten intolerant.

Celiac disease is a systemic disorder in which the body can't tolerate gluten. The gluten triggers an immune reaction and causes inflammation of the lining of the small intestine, which can eventually interfere with the absorption of nutrients from food. The problem can be difficult to diagnose because the symptoms are varied and similar to those of many other intestinal conditions, including irritable bowel syndrome IBS and lactose intolerance. Some people have no apparent symptoms or their symptoms are so subtle that they never mention them to their doctor.

As a result, celiac disease may be misdiagnosed or go undiagnosed for years. Moreover, it has long been speculated that those with diagnosed celiac disease represent the tip of a "celiac iceberg" — a much larger number of people with asymptomatic celiac disease who nonetheless are incurring intestinal damage or who have hidden nutritional deficiencies, such as iron deficiency with anemia see Figure 4.

Celiac disease can develop at any time in life. A tendency to develop celiac disease is inherited. Not only are people with a family history of the condition at greater risk of developing it, but so are specific populations.

Celiac disease is common among people of northern European descent but less frequent among African Americans, Asians, and Native Americans. People with celiac disease have an immune reaction that is triggered by gluten. The immune reaction causes inflammation in the lining of the small intestine, where it damages villi and microvilli that are essential for normal digestion see Figure 5. When these tiny structures are damaged, the intestine cannot absorb nutrients properly, leading to malnourishment.

Celiac disease is defined as an autoimmune condition because the body's own immune system damages the intestinal villi, even though the process is started by eating gluten. People with celiac disease also are more likely to develop other autoimmune diseases, such as thyroid disease and type 1 diabetes. A few conditions frequently coexist with celiac disease, including dermatitis herpetiformis an itchy, blistering rash and liver inflammation.

For example, the rate of celiac disease in people with type 1 diabetes is four to 10 times the average. Infertility, recurrent miscarriages, and neurological problems such as ataxia loss of coordination have also been linked to this disease. Historically, it has taken an average of 11 years to be diagnosed with celiac disease after the symptoms first appear.

However, that record is expected to improve as both patients and health professionals become more aware of the disease. Celiac disease has often gone undetected because its classic symptoms resemble those of other common ailments, such as irritable bowel syndrome and lactose intolerance. Moreover, one-half to two-thirds of celiac patients don't have gastrointestinal complaints; instead, they show signs of anemia or fatigue.

In such cases, celiac disease is usually identified only after no other causes, such as internal bleeding, are found for those symptoms. For people with symptoms, a blood test and a biopsy are considered essential for making a definitive diagnosis of celiac disease. Blood tests to look for specific antibodies anti-endomysium and anti-tissue transglutaminase are the first step in diagnosing celiac disease.

If you are being tested, it's essential not to limit the gluten in your diet before the antibody blood test or biopsy, because that can skew the results and affect the diagnosis. One or more of these antibodies are found in almost everyone with celiac disease who is not following a gluten-free diet, but are rarely present in people who do not have this disease. A negative blood test usually can rule out celiac disease. Although a positive blood test for antibodies indicates a strong likelihood of having the disease, it isn't definitive.

People with positive antibody tests should have an intestinal biopsy — the gold standard for diagnosing celiac disease. The biopsy will be conducted during an endoscopy also called an esophagogastroduodenoscopy, or EGD. In that procedure, performed under local anesthesia and sedation, the doctor snakes a narrow tube with a miniature video camera down your esophagus, through your stomach, and into your small intestine. Guided by the image on a monitor, your physician removes a tiny piece of tissue.

A pathologist then examines the tissue sample under a microscope for evidence of damage to the villi which, if injured, will appear flatter than usual and for the inflammatory cells that signal an autoimmune reaction. Celiac disease will cause symptoms as long as you continue to eat gluten.

If a person with celiac disease follows a strict gluten-free diet, the intestines can heal and the disease can be controlled. The good news is that the only treatment for celiac disease — a gluten-free diet — starts to work within days, and the small intestine usually heals completely within three to twelve months. However, any exposure to gluten can trigger a recurrence of symptoms see "Gluten-free eating" and Table 3.

Oatmeal and other oat products can be problematic. Most commercial oat products used to be contaminated with wheat, barley, or rye during harvesting, transportation, storage, milling, and processing.

Some companies now provide pure, uncontaminated oat products that are well tolerated by the vast majority of people with celiac disease. People with celiac disease also need to be scrupulous to avoid cross-contamination. This happens when a gluten-free product comes into contact with something that is not gluten-free.

Here are some tips for avoiding cross-contamination, particularly if you share a kitchen with others:. Buy separate containers of foods such as peanut butter, jam, mayonnaise, and margarine to avoid any contact with a knife or spoon that has been used on bread. Don't buy products from bulk bins because the scoops could have been used in bins of gluten-containing products.

Be careful at buffets where utensils may be used for a variety of dishes, including those with gluten. When eating out, ask how food is prepared and if arrangements can be made to prevent contamination.

A gluten-restricted diet can be challenging, so consider consulting a registered dietitian who is knowledgeable about celiac disease for expert advice and to ensure that your diet contains adequate nutrients, calories, fiber, and variety.

You may also need to eliminate lactose from your diet while the small intestine heals. Because gluten can be found in various multivitamin and mineral supplements, a registered dietitian can help you choose the right supplement.

Foods and beverages aren't the whole story. If you have celiac disease, anything that goes in, on, or near your mouth must be gluten-free. Medications both prescription and over-the-counter as well as vitamins, minerals, and other supplements are often packed in a starch base that may contain gluten.

Make sure yours is derived from corn or tapioca. A pharmacist can tell you which medications contain gluten and advise you on gluten-free alternatives. Gluten is also found in some personal care products, such as lipstick, toothpaste, and mouthwash, and in the glues on envelopes. Most people who follow a strict gluten-free diet can expect symptoms to improve in a few days, and the damage to the intestinal villi typically heals over several months. As long as they follow the diet, people with celiac disease should be able to lead normal lives with no further symptoms.

People with celiac disease are at risk of developing another autoimmune disorder and also have an increased risk of developing small bowel lymphoma, a cancer of the small intestine. Therefore, your physician should consider these possibilities if new problems or symptoms occur. Left untreated, celiac disease can lead to severe malnutrition and can put you at risk of serious consequences, including osteoporosis, anemia, infertility, neuropathy damaged nerves , and seizures.

It's essential to schedule and keep follow-up appointments with your doctor, who can monitor your symptoms and change your treatment as needed. Your doctor can also give you advice that is tailored to your individual needs and concerns. Gluten sensitivity, a separate condition from celiac disease, is associated with many of the same symptoms as lactose intolerance — gas, bloating, and diarrhea — but also with additional and more troubling symptoms, including fatigue and dizziness.

The condition has baffled clinicians and patients alike for years, because it has been difficult to even imagine how gluten could trigger such a host of seemingly unrelated symptoms. One theory is that gluten sensitivity is part of the "undersea" portion of the "celiac iceberg.

In March , a group of researchers in Italy and the United States reported evidence for a potential mechanism to account for gluten sensitivity. Patients with many of the symptoms of celiac disease but no signs of intestinal damage were found to produce an abnormally high number of proteins that play a role in activating inflammation — the immune system's first line of defense — and an abnormally low number of suppressor T cells, which dampen down inflammation once the "threat" is removed.

The inflammatory response, like that brought against the flu virus, can cause fatigue and dizziness. However, because the intestinal villi are not damaged, nutrient absorption isn't affected. The evidence has established gluten sensitivity as a real condition apart from celiac disease, but it hasn't yet yielded a diagnostic test or new treatment for gluten sensitivity.

Thus, gluten sensitivity is still a diagnosis of elimination. Patients in whom celiac disease has been ruled out are asked to eradicate all gluten from their diet. If their symptoms improve, they are deemed gluten sensitive.

Gluten sensitivity can be avoided by excluding all gluten-containing foods and products from your diet. Unlike people with celiac disease, those with gluten sensitivity aren't risking intestinal injury, defective nutrient absorption, and serious complications by eating a little gluten. So if you have gluten sensitivity, you have a little more latitude to experiment than do people with celiac disease. You may want to test whether you can eat foods like soy sauce that have minimal gluten concentrations, or enjoy a bite of cake now and then without repercussions.

Going gluten-free doesn't mean forsaking all of life's starchy pleasures. It just requires enjoying them in slightly different forms. Flour isn't synonymous with wheat — it can also be milled from rice or potatoes as well as amaranth, buckwheat no relation to wheat , millet, quinoa, sorghum, or chickpeas.

Xanthan and guar gums can be substituted for gluten to supply elasticity, so more gluten-free pastries are making their way into bakeries and into packaged cake and cookie mixes. In fact, "gluten-free" is becoming increasingly more common in the labeling of everything from soup to nuts and even beer. Gluten is found in foods such as pasta, bread, wheat cereals, and many baked goods.

But many other less obvious items, such as sauces, soups, salad dressings, toothpaste, medications, and candy may contain gluten. Even corn and rice cereals can have gluten-containing ingredients, such as barley malt extract or flavoring.

You have to be a dedicated food-label reader and pay close attention to all ingredients. Fortunately, an increasing number of companies offer gluten-free products, which keeps the guessing and sleuthing to a minimum. Restaurants are also jumping on the gluten-free bandwagon, and for many ethnic cuisines, it's not a big leap. The more authentic Ethiopian, Indian, Mexican, and Thai cooking is, the less likely you are to find gluten on the menu. Adopting a few good habits when you shop for food, prepare meals and snacks, and dine out can go a long way in ensuring that the foods you eat will be pleasurable and nourishing rather than a source of anxiety and distress.

A food label is actually a legal document in which the manufacturer is obligated to state exactly — down to minute trace ingredients — what is inside the package. If you have a food allergy, celiac disease, or lactose intolerance, the FDA is looking out for you. The Food Allergen Labeling and Consumer Protection Act of requires manufacturers of all foods to name every ingredient that contains, or is derived from, one of the eight major allergens — milk, eggs, wheat, peanuts, tree nuts, fish, shellfish, and soy — in plain English rather than in chemical terminology.

This means that you no longer have to memorize a list of milk proteins or soy products. You can expect to see the name of the allergen in either of two places on food labels: The law doesn't cover everything, however.

It doesn't apply to cross-contamination, in which trace amounts of an allergenic food become incorporated in a nonallergenic food through manufacturing. To cover this contingency, the FDA advises, but doesn't require, manufacturers to include statements like "may contain milk" or "produced in a facility that also processes milk. It's wise to print out a list of ingredients that contain gluten see "Dos and don'ts of gluten-free eating" to match against food labels. As a final check, make sure you aren't picking up a product that is on the FDA recall list www.

Separating foods in the shopping cart, refrigerator, and cooking process is one of the best ways to avoid developing food-borne diseases or triggering allergic attacks and celiac disease. Don't let fish, poultry, or meat come in contact with produce or packaged foods until they reach the plate. Animal products contain bacteria that are destroyed in cooking, but if the microbes are transferred before cooking to produce that is intended to be eaten raw, they can multiply to dangerous levels before the crudités or salad greens reach the table.

When you shop, wrap animal products in plastic bags and place them at the bottom of the grocery cart. If they leak, the juice will drain onto the floor. If you can't fit the fresh produce in the top rack of the cart, separate it from the fish, poultry, and meat with a barrier of packaged goods. Follow the same rule in the refrigerator — produce at the top, meat preferably in a separate drawer or bin below it.

When you're cooking, use separate cutting boards and utensils for animal products and produce. If you don't have two sets of each, wash them carefully in hot, soapy water between uses. It's almost imperative to have two sets of cooking and serving implements if a person in your household has a food allergy or celiac disease, unless the rest of you are following the same nonallergenic or gluten-free diets.

Keeping the food preparation for each group separate is the best way to avoid cross-contamination. You should also take care to store any allergenic or gluten-containing foods well away from the food reserved for the person who is living with food allergy or celiac disease. And if you have a dog or cat, keep your pet's dry food and treats in sealed containers apart from yours. Pet food often contains Salmonella , which may not faze the furry critters but may mean misery for members of your family, especially infants, the elderly, and people with compromised immune systems.

As Ronald Reagan famously advised, "Trust, but verify. There is a fairly narrow window in which foods can be safely chilled but not frozen. In cooking, it's not the oven temperature but the reading at the center of the food that is crucial. Inserting a food thermometer is the only sure way to know that your roast or turkey has passed the danger zone. If you're using a warming oven to keep a dish from getting cold until the guests arrive, you'll want to be sure that you aren't keeping a bacterial colony happy in the process.

And once foods have cooled below the safety zone, speed them to the refrigerator. The commonsense habit you acquired in childhood — washing your hands before eating and after going to the bathroom — is as sound as ever. It's also a good practice after you walk the dog, clean the cat box, weed the garden, blow your nose, take out the garbage, change diapers, care for a sick person, or engage in any other activity that increases your exposure to bacteria.

While there is usually no reason to wash after a friendly handshake, you may want to do so if an outbreak of gastroenteritis, which can be spread by casual contact, is afoot. Several years ago, health authorities realized that for too many people, washing-up meant a cursory pass under a running water tap, so they established standards for a proper cleansing: This exercise, performed correctly, should take at least 20 seconds.

If you're uncertain how long that is, scrub while humming "Happy Birthday" a couple of times. Hand sanitizers have made it into millions of pockets and purses, and while they're a sensible substitute when soap and water are not available, they aren't meant to be used whenever you touch a handrail or greet a stranger. Nor is it necessary to decontaminate your kitchen with antibacterial cleansers or to dip your produce in antimicrobial food washes.

In , an FDA advisory committee ruled that there wasn't enough evidence that antibacterial washes were any better at preventing disease than washing without antimicrobial additives. Moreover, laboratory studies have suggested that the antibiotic agent triclosan, which is added to scores of soaps and washes, may abet the rise of drug-resistant pathogens.

Several observational studies have implicated the increasingly antiseptic environment of industrialized nations in the growing prevalence of allergies. Some researchers theorize that the developing immune system needs to experience enough of the microbes that constitute a genuine threat so it won't attack "innocent" molecules like pollen and food proteins see "The hygiene hypothesis".

It's a good idea to keep a record of your symptoms and the food you have eaten, particularly if you've had gastrointestinal distress for more than a week or two.

Since so many of the symptoms of food allergy, celiac disease, lactose intolerance, and food-borne illness are similar, a detailed account of what and when you eat, and the symptoms you experience, may help your doctors rule out some possibilities and consider others. A detailed food diary can help you to organize the information; see Table 4 for an example, with foods and symptoms entered for Monday. The federal government may have abandoned Orange Alerts for anticipated terrorist attacks, but it's still issuing alerts on oranges gone bad — and all sorts of other food emergencies.

You can keep abreast of such developments — and report any bad food reactions you have had — at www. The site is a gateway to food-related information at all of the above. It's the place to consult if you want to know when an epidemic of gastroenteritis is afoot, when a mislabeled food has been recalled, or if you want to contact your state public health department.

Not that you should pour beer on your breakfast cereal, but it's good to be aware that alcoholic beverages share many of the properties of food, including those that trigger illness. For example, alcoholic beverages contain histamines, and beer and wine have naturally occurring sulfites, which can trigger allergic-like reactions in people who are sensitive to those substances. Rye whiskies contain gluten, and most beers contain both gluten and wheat, so these can produce more than a hangover in people with wheat allergy, celiac disease, or gluten sensitivity.

Moreover, alcohol can act on the CYP system — the mechanism the body uses to metabolize drugs — to either enhance or diminish the effects of prescription drugs. Regular, heavy alcohol drinkers risk serious liver damage if they also take the popular over-the-counter pain reliever acetaminophen Tylenol and other brand names. See "When foods interact with drugs. Alcohol also makes the intestine more permeable, which amplifies the effects of food sensitivity. Diffidence can be charming, but not at the cost of your life.

If you have a food allergy or sensitivity and are dining out, don't hesitate to question restaurant staff about ingredients or even kitchen practices.

If you are having dinner at the home of a friend or acquaintance, let the host know that there are certain foods you can't consume. Most cooks would rather have that information before planning the menu than discover it when they are about to serve a prized dish that a guest can't eat. And don't hesitate to arrive with your own gluten-free crackers or cheese alternative.

Most hosts will be grateful they didn't have to hunt those products down themselves. Finally, if you have an attack in public or away from home, waste no time in tending to it, whether that means extricating yourself from an intense conversation to head for the bathroom or getting out the epinephrine and calling Before you hit the road, hit a couple of Web sites.

Whether you're traveling abroad or taking a "staycation" to visit sites in your neck of the woods, the Travelers' Health link on the CDC home page, www. Just click your destination — foreign or domestic — on the interactive world map. If you're taking a cruise, you might want to click the link to the Vessel Sanitation Program to see how your ship fared on its last inspection.

If you're planning to bring your food with you, the "Keep Food Safe" link at www. And if you have a food allergy, click the "Managing Food Allergies" link under "Education" at www. Unlike food poisoning, which can affect anyone, and food intolerances and allergies, which affect certain otherwise healthy people, food triggers can cause chronic conditions to flare up.

Mounting evidence indicates that particular foods can elicit migraine headaches, heartburn, and even episodes of hyperactivity. For some migraine sufferers, alcohol or a particular food may prompt an attack.

The list of migraine triggers is long, and implicates foods containing a variety of chemicals, including vasoactive amines histamine, tyramine, and phenylethylamine and caffeine as well as common food additives, particularly sulfites, nitrites, and monosodium glutamate MSG ; see "Migraine menu.

A hot flash is a feeling of intense warmth and sweating. They can also occur in either sex as a symptom of certain cancers, infections, alcoholism, or thyroid disease. Researchers do not know exactly what causes hot flashes. Current theories suggest hot flashes result from a menopause-related drop in the body's level of estrogen. Declining estrogen levels affect the hypothalamus, an area of the brain that regulates body temperature.

In a hot flash, the hypothalamus seems to sense that the body is too hot even when it is not, and tells the body to release the excess heat. One way the body does this is to expand, or dilate, blood vessels, particularly those near the skin of the head, face, neck, and chest.

Once the blood vessels return to normal size, you feel cool again. Menopause-related hot flashes can't be prevented except by taking supplemental estrogen. But in some people, hot flashes can be reduced by avoiding certain food triggers, including red wine, chocolate, and aged cheeses, all of which contain a chemical that affects the brain's temperature control center.

Monosodium glutamate MSG can also prompt hot flashes by another mechanism. Caffeine and alcohol can cause hot flashes in some people and make them worse in others. Since the early s, health professionals have speculated about a link between attention deficit hyperactivity disorder ADHD and food additives, particularly artificial colors, synthetic flavors, preservatives, artificial sweeteners, and salicylates.

The Feingold diet propounded by San Francisco physician Ben Feingold in and other diets from which these additives have been eliminated have been tested in more than 30 clinical trials. In March , an FDA panel weighed all the scientific evidence and voted that the available evidence was not strong enough to warrant removing food from the market. However, the FDA acknowledged that, although no biological mechanism has been identified to support the hypothesis that dyes and preservatives are inherently toxic to the nervous system, the additives aren't necessarily off the hook.

The panel allowed the possibility that food dyes may trigger hyperactivity or disrupt concentration in people with ADHD or even in susceptible people who are generally healthy. In short, there may be a segment of the population who are intolerant of certain food additives.

The FDA recommended additional well-designed randomized controlled clinical studies testing the effects of individual food additives on behavior in children. The panel also suggested laboratory investigations of the interaction of specific dyes with dopamine receptors, which play a major role in behavior disorders. If you think that eating foods with artificial colors or other additives is making you restless or disrupting your concentration, you might consider conducting an unofficial study of one.

Start a food diary, noting what you eat and how you feel each day. If, after a month, you discover any associations, you can try eliminating those foods for a few weeks and noting whether you feel calmer and more focused. The following additives have been postulated as triggers for hyperactivity disorders, although the FDA hasn't found enough evidence to remove them from the market:.

Gout is a condition in which uric acid accumulates in joints, causing inflammation. People with gout almost always have high blood levels of uric acid, one of the body's normal waste products.

Most uric acid is removed from the body by the kidneys, so people with kidney disease typically have high levels of it. A unique property of uric acid is that it cannot always dissolve well in the blood and tissues. When the blood levels are even slightly high, uric acid can be deposited as solid crystals in the joints causing arthritis , kidneys causing kidney stones , and other tissues. Sudden sharp pain in a joint, usually the big toe but sometimes the wrist, hand, knee, ankle, or foot, often occurring at night.

Persistent discomfort even after the initial pain subsides, with tenderness lasting days or weeks. Gender, genetics, body weight, and other factors go into establishing a person's level of uric acid. Diet also plays a role. Research suggests that a diet high in meat, seafood, and alcohol increases the risk of a new diagnosis of gout.

In addition, dairy products, fresh vegetables, and coffee may be protective, lowering the risk of gout. However, these studies looked at people who had not had gout before. They did not assess the effect of diet on people who already had gout.

In general, foods high in purines, a building block of protein that is broken down into uric acid, are most likely to bring on gout attacks. Fortunately, most of the foods with the highest purine content are not ones that people eat often. These include sweetbreads thymus and pancreas , liver, kidneys, brains, game meats, and anchovies. Fructose is another matter. Not only is it the one carbohydrate that increases uric acid levels, but it is also ubiquitous in the food supply, both in sweets and in processed "savory" foods like salad dressings and spaghetti sauce.

And observational studies in both men and women have indicated that the risk of gout increases in tandem with the consumption of fructose-sweetened beverages.

It turns out that following a diet devoid of purines probably won't alleviate gout, once it is established. However, if you are beset by gout, you might want to limit your intake of red meat, seafood, and alcohol. There are better ways to help lower uric acid and decrease the risk of further gout attacks, including the drugs allopurinol Aloprim, Zyloprim and febuxostat Uloric.

Every time you swallow, the muscular valve between the esophagus and the stomach relaxes so food can enter your stomach. This valve is known as the lower esophageal sphincter LES. When your stomach is full, a tiny amount of food can sneak back into the esophagus when you swallow — that's normal.

But in people with gastroesophageal reflux disease also known as acid reflux or GERD , substantial amounts of stomach acid and digestive juices get into the esophagus. The stomach has a tough lining that resists acid, but the esophagus doesn't. Its sensitive tissues are injured by acid, and, if the acid makes it all the way to the mouth, other structures can be damaged.

Heartburn, an intense burning sensation in the center of the chest, often occurring after a meal or when bending over. Some substances can make the LES relax when it shouldn't, and others can irritate the esophagus, exacerbating the problem. Some of the chief food culprits in GERD are described below. In addition to expunging those foods from your diet, it also helps to avoid large meals and to try to be up and moving around for at least 30 minutes after eating.

Don't lie down until at least two hours after you eat. Although several other factors — including sleeping position, exercise, posture, and weight — play a role in controlling GERD, staying away from known food triggers is also important.

You've no doubt noticed that the instructions for taking most prescription or over-the-counter drugs tell you whether or not to take them with food in general or with specific foods. When food and drugs are in the digestive system at the same time, food can affect the rate at which a medication is absorbed or eliminated in several ways.

Most of the time it doesn't matter whether you take your pills before, after, or during a meal. But in a number of cases, whether you are eating or fasting can influence the effectiveness of medication and the side effects it produces.

Eating stimulates the release of stomach acid, and the acid bath can affect the way the drug works. The previous meal may also contain nutrients that combine with the drug to hinder or speed its absorption.

For some drugs, particularly penicillin Penicillin VK, Penicillin G , and its kin, ampicillin Principen, Totacillin, Omnipen and dicloxacillin, the acid bath has the expected effect — it eats away the medication before it has a chance to do its job. These medications should be taken more than an hour before eating or at least two hours afterward. Antacids or supplements containing calcium or iron can blunt the effects of the antibiotics tetracycline Sumycin, Achromycin V, Actisite, Robitet and ciprofloxacin Cipro, Proquin.

Neither should be taken within several hours of ingesting such supplements or antacids. Some bisphosphonates, such as alendronate Fosamax , ibandronate Boniva , risedronate Actonel — the osteoporosis drugs — aren't properly absorbed if taken with any food or beverage except plain water.

People who take them have to do so after an overnight fast and must not eat breakfast until at least 30 minutes after taking the drug. For some drugs, gastric acid creates the kind of environment that is conducive to absorption. For example, ketoconazole Feoris, Nizoral , an antifungal medication, is more effective when taken with any food, while the absorption of another antifungal, griseofulvin Fulvicin, Grifulvin , is aided by fat in particular. For some drugs like ibuprofen Advil , stomach acid merely slows the rate at which the drug is absorbed, preserving its effectiveness while reducing its side effects.

Foods can also contain compounds that enhance or weaken drugs. Green leafy vegetables can rob the blood thinner warfarin Coumadin of its anti-clotting power by furnishing vitamin K, which promotes coagulation.

If you are taking warfarin to prevent stroke or pulmonary embolism, you have a good excuse not to eat your spinach. Drinking alcohol doesn't mix with drugs any better than it does with driving. It's well known that washing down a sleeping pill with a nightcap can lead to a much deeper sleep than intended, resulting in coma and even death.

And drinking with certain other drugs — particularly several antimicrobials, including certain cephalosporins, ketoconazole Nizoral , metronidazole Flagyl , and sulfonylureas, a class of diabetes drugs — can lead to a monumental hangover complete with nausea, vomiting, flushing, and palpitations.

Certain foods can affect a drug's activity by influencing enzymes in the cytochrome p CYP system. Drug compounds are normally broken down into smaller molecules by one or more CYP enzymes in the small intestine and liver. However, a few chemicals in foods can inhibit specific CYP enzymes, resulting in certain drugs remaining active much longer than intended. When the wrong food-drug combination comes together, it's like taking a drug overdose.

Grapefruit juice is a notorious inhibitor of CYP3A4. If you were taking lovastatin to reduce your cholesterol, and decided to wash it down with a glass of grapefruit juice, the effects of the drug would last almost twice as long as intended.