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Sulphite intolerance? A Dietitian’s Story.

Feature | July 27, 2015

A smiling woman sitting down to eat a healthy green salad.
Sulphite intolerance? A Dietitian’s Story. Featured Image

As I’m sure you’ve noticed – in quite a few of my posts I have hinted to my avoidance on sulphites. Well, cats outta the bag – I’m sulphite intolerance. (well if you want to get technical – sulphite sensitive – but let’s use the language everyone uses, for simplicity sake). What the WHAT?!

If someone told me they didn’t eat sulphites 5 years ago, I would have been like “oh you’re allergic to sulpha drugs? Common allergy. No biggie. Don’t take the antibiotics that contain them and you’re GOLDEN!”.

Well. I did NOT know what I was talking about. sulphites ≠ sulpha.

My story of a sulphite sensitivity

It all started two years ago. Probably longer, if I had started putting two and two together. I LOVE wine. I was part of a wine club. I had a wine subscription. Wine came to my door, and I’d normally enjoy a glass during the week, and a glass or two on weekends. I loved making beef bourguignon for guests. Whipping up a fantastic white wine risotto with lemon and green peas. I loved eating fancy cheeses with different wines. BUT, I began to notice, more and more, that each glass of wine I drank had me feeling worse and worse as time went on. Maybe I was always intolerant to sulphites. Or maybe I grew into it. But over time, I found wine made me feel like crap!

When my work schedule changed to starting at 6:45 am every Wednesday, I would pre-pack dried fruit – my favourites being apricots and dates, as well as nuts for a quick and easy breakfast. I thought I was brilliant, pre-packing 4-5 baggies at once for a grab-and-go breakfast or snack. I felt like garbage on these days. I thought early mornings just weren’t my thing.

One day after a bag of dried fruit and nuts, I was rounding with my team. I was dizzy. My lungs were constricted. I felt a fogginess in my brain. I thought my blood vessels were going to burst out of my eyes. I was SO vasodilated – the veins in my arms and hands were like Arnold Schwarzenegger in his prime. I told the team I felt like crap. Concerned as they were- they took my blood pressure. 142/90-something. Hypertensive. What was going on?!

Days and weeks went on – I felt like crap. I was constantly dizzy, foggy after eating, burdened with uncontrollable heart burn. It felt like my childhood athsma had taken a resurgence.

I went to the doctors. Wanting to replicate the effects of what was going on, I went about my usual day. Dried fruit? check. I mentioned my symptoms – Dizziness. Fogginess. Difficulties breathing. Upper right quadrant pain in my gut. I mentioned I worked in an oncology hospital. At the time, I thought I was histamine intolerant. My friend worked in neuroendocrine tumors. Did I have a neuroendocrine tumor? Is THAT why I was so sensitive, all of a sudden? My mind asked these questions, in this frenzy. The doc took my blood pressure. 160/low 100’s. Compared to my usual 120 over 80 – this was extremely high. He sent me on my way with two large jugs to collect my urine. Of course, it was negative for a neuroendocrine tumor -but they didn’t really have an answer for why I felt so unwell.

It was then that a dietitian friend introduced me to the concept of a low histamine diet. Dr. Janice Joneja, who is ALSO a dietitian has done a LOT of fantastic research in this area. I consumed it all. Why had I not learned about this before? Yes, I had learned about allergies. Intolerances? Not so much. I did my research. I went on a low histamine diet. I felt good. But it was hard- oh so hard. Especially given that I already follow a low-ish FODMAP diet. I started gradually re-introducing foods. Each time I would expose myself to sulphites, or sulphite-containing foods, I would feel unwell. All symptoms described above.

I requested a referral to an allergist – maybe they had fantastic insight on how to manage a sulphite intolerance.

The allergist, verbatim, told me that I would “know more about avoiding sulphites than (he) did” and sent me on my way.

The allergist, verbatim, told me that I would “know more about avoiding sulphites than (he) did” and sent me on my way.

I don’t think I had ever been so frustrated. If I struggled as a dietitian and health professional to understand what was going on, how was the rest of the public coping?

What are Sulphites?

Sulphites are commonly found in salt-form and are used in the preservation of food, cosmetics, and pharmaceuticals. They prevent oxidation and browning. All fine and dandy, everyone likes well-kept food, food that isn’t infested with bugs and germs, unless of course, you have a horrible reaction to that preserving agent. As a general rule, sulphites are safe for the majority of the population. Unfortunately, there are some individuals whose body can’t hack sulphite exposure. Mechanism – unknown – although there ARE several theories – which I will discuss in future posts.

Symptoms of a Sulphite Sensitivity (Intolerance)

  • chest congestion
  • wheezing (especially if you’re athsmatic)
  • dizziness
  • headache
  • nausea, vomiting, abdominal pain
  • Flushing, icteria, hives
  • A drop in BP (oddly – mine goes up)
  • anaphylaxis (people have died of sulphite exposure – usually secondary to athsma)

Risk Factors of a Sulphite Sensitivity

The jury is out on this one. If you have athsma, you appear to be more likely to suffer from a sulphite intolerance.

Sulphite-Containing Foods

Unfortunately, the labelling of sulphites can be confusing – and the risk of accidental sulphite exposure leaves us on edge! LUCKILY Canada has made sulphites one of its priority allergens. Legally, added sulphites above 10 ppm must be labelled, even if it’s a secondary (or further down the list!) ingredient. So trust that in Canada, the US, Europe, and Australia – sulphites are properly labelled. (your dietitian may provide you specific advice around this due to labelling issues that currently exist – but for the most part – our labelling laws are great.)

Some common sulphite-containing foods include:

  • beer, wine, champagne
  • Condiments like squeezable lime and lemon juice, vinegar, pickles/pickled foods
  • dried fruit & coconut (if its brightly coloured its likely sulphite containing)
  • Shellfish
  • Potato flakes, pre-made pastries, buns, bread, biscuits, pizza dough
  • some canned tomato products
  • Pre-sliced fruit, potatoes, etc. (Think: those little packs of sliced apples that don’t brown)

Read Ingredient Labels – common forms of sulphites listed on ingredient labels include:

  • Sodium Sulphite
  • Sodium Sulphate
  • Potassium Sulphite
  • Sodium Thiosulphate
  • Sulphurous Acid
  • Sulphur dioxide
  • Sodium Metabisulphite
  • Potassium Metabisulphite
  • Sodium Bisulphite
  • Potassium Bisulphite
  • Sodium Dithionate

So. This is my low-down in sulphites. I’ve done lit-reviews. I’ve studied the evidence. I’ve learnt a lot of things. Trial and error through personal experience. I’ve come to the conclusion that there is not enough awareness and resources out there to support people with a sulphite intolerance.

Which is why I created a WORKSHOP for dietitians on how to counsel patients with a sulphite sensitivity. In the course we review everything YOU need to know to help your patients, including the resources I use in practice!

Sulphite Sensitivity Training for Dietitians and Health Professionals

This blog post is most frequently visited by my RD colleagues and doctors – I get a TON of emails from my colleagues asking for help in this area. You can access the course content on sulphite sensitivity here – keep in mind this is for medical professionals and is HIGHLY technical.Counselling patients with a sulphite sensitivity, sulphite intolerance, sulphite allergy - including sulphite resources and a workshop as well as case studies!

 

If you have a sulphite intolerance, and don’t know what to do, I recommend working with one of our Ignite dietitians trained in immune-mediated food sensitivities!

References

  1. CFIA Canada. (2017, September 5). Government of Canada. Retrieved from https://www.canada.ca/en/health-canada/services/food-nutrition/reports-publications/food-safety/sulphites-priority-allergens.html