One of the fun things about being a Type 2 diabetic with a nut allergy is the weighing up of risk when shopping for food and drink, cooking and eating. Every decision to purchase has to be based on a number of factors: are the sugars contained in the product listed as 10g per 100g or below? (Given there can be up to a 20% variance allowable there.) Are the saturated fats also below a certain level? What are the overall carbs, and are they complex and/or low GI? (that's Glycaemic Index for those unfamiliar with the abbreviation.) I then have to add in whether nuts are listed somewhere in the ingredients. If they are, I don't buy it. If they are not, but the mysterious phrase "flavourings" is listed, then I have to consider the risk.
When you start shopping around this matrix, then several aisles of the supermarket or store become off-limits. One retrains one's eating habits and the satisfactions from them away from much of what constitutes a "normal" diet to folks raised around the U.K. The majority of cereals are off limits, so other than porridge or specialist brands of flakes of various sorts, one starts to breakfast on other things. Meat and vegetables become important in the first meal of the day. Not all sweeteners are good for you, or even work as they are described to on one's blood sugars, so "diet" and "light" items are not an instant alternative. (The title of this post comes from something I learnt in my initial diabetes awareness sessions that Surrey NHS ran back in 2006 when I was diagnosed: each and every diabetic reacts differently to their intake as compared with other diabetics. In other words, what is good for one person is not always good for another; hence, Your Mileage May Vary or YMMV for short.) Juice and fruit can be dangerous, and smoothies can be lethal, given the sheer volume of sugars delivered quickly to the system by these methods, so one has to work harder to keep up the recommended "five a day". (When I allow myself juice I drink at least half and half with water; in some bars and pubs I've had to ask for a third juice and two-thirds water given the amount of added sugar in the brands they stock.)
Lately, however, the nut allergy side of things has become more complicated, just when it should be becoming simpler. As companies look to keep their profits, pricing down the various elements in their supply chain, a number of companies from whom I bought products in the past have moved from having no nuts or warnings for nuts on their labels to still having no nuts listed in the ingredients, but carrying a warning about the place of manufacture used. These latter clearly are locations where cross-contamination is possible, for whatever reason. Until a few months ago, this was something I would have to weigh up and consider the relative risk of, as unlike friends of mine with severe allergies, my own seemed to react to direct ingestion and not mild or trace cross-contamination. All that has now changed, and called into question the fact that I have lived by for many years now, which is that when all the research is said and done, in the end you have only your own body as a lab for testing products; after all, YMMV.
I have had a bad allergic reaction to something unknown - presumably nut-based - once a month now for four months, breaking a five year streak of no serious reactions. In two of those cases my partner and I could narrow down the possible culprits, and have had to stop using products from companies that only a week or a day before I was eating without problems. The other two involved home-cooked food I made myself from ingredients that should not in any way have contained nuts, and certainly carried no listings to that effect. The most recent incident - this past Friday night - was bad enough that I had to use an epi-pen for the first time, which was not enough by the time I used it, and the paramedic, ambulance staff and A&E staff all did what was necessary to help me get the swelling under control (many thanks to Buckinghamshire South Central Ambulance Service and Stoke Mandeville A & E yet again!). In the end, it took another two days for the swelling to go down and the side-effects, diabetic and otherwise, of having been administered 100mg of hydrocortisone to go away. I resolved to do that thing which friends with more severe dietary issues than I had been egging me on to do, and decided to bake for the first time since junior school. (That was the seventies, in case you were wondering.) The results have proven to be so effective on both allergic and diabetic fronts that I intend to do more of the latter. (See the main image above for the flapjacks made from a Sweet Freedom recipe.)
There is just one problem with doing more baking at home. In the past, I inquired with a number of flour manufacturers about nut-free status and possible contamination, back when I first considered baking things at home. NOT ONE OF THEM WOULD GUARANTEE THAT THEIR FLOUR PRODUCTS WERE NUT-FREE. Not plain, not wholemeal, not spelt, none of them, all due to manufacturing methods. This is in keeping with the guarantee, or rather legal shield covering their asses, on the product I ate Friday night - you can read it for yourself below.
Note that there are no nuts used in the recipe, and none in manufacturing. In theory, this should guarantee a nut-free product. However, the company in question state that they cannot guarantee their ingredients to be nut-free. This begs a number of questions: where are they sourcing these from? Why are the source companies not offering guarantees of their own? (See the flour issue above, perhaps.) If any of the ingredients might be suspect, why is no specific warning listed on the label (an additional asterisk or cross next to each ingredient that might be contaminated, with the nomenclature listing that symbol for "Cannot guarantee nut-free)?
While the answer for myself is clear - despite eating the companies products in the days before the allergic reaction with no problem, I am will not now buy anything from them again - what worries me here, as always, is the bigger picture. If ingredients themselves cannot be offered with guarantees of being free from nuts, then two thoughts occur to me:
- Making my own food at home from scratch is no longer a method guaranteed to keep me safe from harm, unless I start making vegetable substitutes for items, e.g. cauliflower "flour" for baking alternatives;
- Clearly the process of ensuring one or more processing/manufacturing lines in any factory/plant handling/packing ingredients remain nut-free is considered too time-consuming and expensive to do, whether in-house or out-sourced. This might be why companies are opting to print warnings instead of actually do the more expensive work to offer a safer product for those of us who suffer from such allergies. (Peanut allergy affects 1 in 50 young infants in the U.K., and four out of five of those will continue to suffer from them as adults; tree nut allergy sufferers are on the rise as well.) After all, profit is more important than customer safety, as all consumers well know; the mathematics of the free market have ever dictated thus.
The NHS will be retesting me to see if my allergy is the same or has changed over time at the end of March. However, the suddenness with which this has all come on, the fact these reactions have occurred on days when I have taken antihistamines in the morning (120mg of Fexofenadine is my usual dosage), and that they are occurring with products that were previously safe for me to eat, has me convinced that the wider issue of the supply chain is where I need to look for the culprit. The question now is: can I make yet another set of fairly major changes to my diet without incurring additional expenses of time and money? I'm not sure I have a choice in the matter now.