Faking Allergies – Don’t do it, but don’t assume others are faking

This article describing the process restaurant kitchens go through to avoid cross-contamination for customers with allergies was fascinating. Labels, separate cutting boards, the whole nine yards.

I have mixed feelings on the article as a whole. I think it points out a real problem but is also too quick to paint people who go gluten-free without celiac or a wheat allergy as bandwagon-hoppers.

11 percent of American households are following a gluten-free diet, even though only a quarter of them said they were doing it because of celiac or gluten intolerance.

The gluten-free spectrum is diverse. About 0.3 percent of Americans have a wheat allergy, meaning that ingesting even a trace amount could send them into anaphylactic shock. Then there is the 1 percent with celiac. Finally, there are people with gluten sensitivity, who suffer symptoms like diarrhea, bloating, or fatigue after eating gluten. Given the absence of diagnostic tools, the size of this last group is particularly fuzzy, though Fasano’s research suggests it’s in the 5 to 6 percent range.

Fasano is troubled that so many people are diagnosing themselves with gluten intolerance, changing their diet without ever going to the doctor. “You don’t say, ‘I’m drinking a lot and peeing a lot, so I must have diabetes,’ and then start injecting yourself with insulin.”

Many who go gluten-free find themselves feeling better and see that as proof that they have gluten intolerance. But a genuine gluten problem is only one of three possible explanations for their improved health, and statistically the least likely. Another reason could be the placebo effect. The most likely explanation is that paying closer attention to diet and avoiding fried and junk food — which tends to be loaded with gluten — is bound to make anyone feel better.

What’s the big deal if gluten-tolerant people go gluten-free, especially since they’ll be eating fewer Pop-Tarts?

The problem is the more these bandwagon-jumpers demand special attention, the more likely that restaurants and wider society will come to see all gluten-free people as phonies.

The assumption, based on a single poll, is that the majority of people doing a gluten-free diet are simply following the fad. But I don’t think the math holds up. If 1 percent of people have celiac disease, .3% have a wheat allergy, and somewhere in the neighborhood of 5-6% have gluten intolerance, and 11% are doing gluten-free, then the majority (6-7 of 11) of those have an allergy or intolerance to gluten. That’s odd considering that it was the main reason given by only a quarter of the gluten-free respondents to the survey quoted. (The summary of the study itself doesn’t list all the potential reasons or indicate whether respondents had to select a single main reason. And only 25% of the respondents believed that a gluten-free diet was generally healthy for everyone. So, a large majority are well aware that gluten isn’t some dietary bogeyman, but something that some people react badly to.

As another confounding factor, gluten-free diets are hawked as a potential weight loss method, and I don’t know whether “weight loss” was a reason given in that survey. And while gluten-free in and of itself isn’t likely to result in weight loss, having severely limited carb options certainly can, at least in the short term. When doctors push weight loss as the solution to any and all problems, it’s not surprising that people would flock to anything that’s promising that as a potential benefit. In their view, they are doing it for a legitimate health reason. The article mentions claiming allergies to dairy as a weight-loss tactic, but doesn’t connect that with a fatphobic culture or pressure to be thin at any cost.

I also think the “you wouldn’t just diagnose yourself as diabetic and start taking insulin” analogy is way off. If eating something makes you feel crappy, and taking it out of your diet makes you feel better, you are under no obligation to prove to anyone else that your issue with that food is legitimate. You get to eat whatever you want, period, end of story, diagnosis or no diagnosis. Sure, if you’re cutting out whole food groups, you should probably work with a doctor and/or dietitian both to verify that it’s necessary and to make sure you’re not missing important nutrients. And if you’re having symptoms that seem allergy-related, then seeing a doctor is an extremely good idea. Both to make sure you have emergency meds if needed and to nail down what precisely you’re allergic to. But if it’s a mild intolerance, and you can cut something out without stressing yourself out or severely limiting your diet, that’s your call and no one else’s. Eliminating a food from your diet isn’t even in the same ballpark as randomly deciding to take prescription medications with no diagnosis.

For example, I don’t eat pad thai. I’ve had it twice, once at a restaurant and once homemade. Both times, it tasted delicious, then sat in my stomach like lead, and I felt lousy. Did I just eat too much of it? Is there something in it or some combination of things that I react badly to? Was it a total coincidence? I have no idea. But when given the opportunity to eat pad thai, I think “ick,” associate it with an upset stomach, and don’t want to repeat the experience. But as long as green curry, chicken satay, and tom kah gai exist in the world, I can live quite happily without ever eating pad thai.

If we decide that I’m not allowed to go “pad thai-free” without a real medical diagnosis, how do I accomplish this? If I go to the doctor and say, “When I eat pad thai, I feel sick to my stomach?” do you think they’re going to run tests or try to figure out if I’m intolerant to fish sauce or tamarind or beansprouts, or do you think they’ll tell me not to eat pad thai? Yes, I know there’s a difference between cutting out one highly specific food and avoiding a staple like wheat, but even people with definite gluten sensitivity often have trouble getting a diagnosis. So they do what they need to do for themselves to feel better. If there are barriers to their getting appropriate medical care (and there are an awful lot of those in the US), we should work on those, but in the mean time, people are still going to take care of themselves as best they know how.

I agree that people shouldn’t lie about allergies. If something upsets your stomach or gives you gas or triggers a gag reflex, it’s not an allergy. That doesn’t mean you should be expected to eat it for politeness’ sake, but lying about allergies does cause people to jump through totally unnecessary hoops to avoid cross-contamination. But I also think that people are too eager to “catch” somebody faking and that they jump on inconsistencies that may or may not be dishonesty. The person who can’t have dairy and then ordered ice cream? Maybe they lied. Maybe they weighed the risks and decided it was worth it. Getting to make your own decisions includes making decisions that aren’t optimal. And sometimes people have multiple competing things going on with food that they don’t feel the need to fully explain, which might look inconsistent or dishonest on the surface. This Captain Awkward post about a part-time vegetarian is a good example. People seem really quick to jump to “Lying!” “Attention-seeking!” instead of “Needed protein!” or “Don’t fit fully into either the carnivore or vegetarian box!”

Personal example time again. I don’t generally tolerate spicy foods well, both in taste and in GI unpleasantness afterwards. But it really depends on the day. There will be times when I think, “Bring on the heat!” and times when lamb korma somehow tastes “hot” to me. And while I’ve had GI unpleasantness from Mexican food, I’ve never had that reaction to hot wings. (Possibly because they go with pizza, so the percentage of “hot foods” to “overall meal” is lower.) So, if I turn something down because it’s too spicy and then next week you see me eating hot wings, it may look like I’m bullshitting you, but that’s not actually the case.

I do think it’s impolite to put other people to trouble you won’t go to yourself. If you’re going to expect a kitchen to slow way down to do the allergy dance for you, then you should be willing to forgo the tasty food with the ingredient you just told them you can’t have. And it would be kind of jerk-like as a semi-vegetarian to insist that your steak-loving friends always go to the vegetarian place rather than having your once-every-so-often chicken come from the place they like.

Food and Consent

I love this post from the Fat Nutritionist about a couple where one is a picky eater and the other is a foodie and keeps pressuring her to try new things.

People have to come around to food in their own time. If they aren’t allowed to, if they are pressured or forced or coerced into trying something that they find intimidating, there is a very good chance they will not suddenly love that food, will not have the Foodie Switch in their brain flipped to the On position.

More likely, they will associate more anxiety with that food, not less, and it will probably taint the memory of the delicious thing you were hoping they’d enjoy.

So what do you do instead? I’m going to sound like a broken record, but: follow a Division of Responsibility.

Not the one for parents and children. The one that exists between adults.

As an adult, you are responsible for your own eating. The other adult is responsible for what, when, where, how much, and whether they eat. You can negotiate certain things — where and when are sometimes necessary to coordinate, and if you’re deciding on a restaurant or a recipe, some negotiation around what will also be useful. But you need to remember that any negotiations around what end at offering. Not ingestion.

What this means is, you can both decide on a place to eat, or a recipe to try, and you can put the food on the table and both sit down.

After that? You must chill.

No one has to put anything in their mouth or their stomach that they don’t want. To insist that they do is a serious boundary violation, and a breach of their bodily agency. There is a spectrum of not-okayness that starts with coaxing, wheedling, and pressuring someone to try something they don’t want, and ends with force-feeding. Don’t be that guy.

One of the many (many, many) ways our culture is screwed up around food is the idea that consent isn’t as important as getting someone to eat the “right” things. This shows up a lot in the idea that it’s healthy and normal to pressure someone to eat :healthy” or try to lose weight, but it’s also depressingly common in the pressure to try new foods, or to eat a wide range of things. There’s the assumption that a diet that includes sushi and Brussels sprouts and kimchee is both healthier and more grown up than one that doesn’t, and that it’s the more enlightened foodie’s job to show their picky partner the light. Oh, and the classism. Let’s not forget the classism. Fancy restaurants, exotic ingredients, even the ability to waste food if you ruin a recipe or end up not liking something—those are all privileges.

Also, I love the idea of applying the Division of Responsibility to adults, with each person having total control over what they eat. I think Michelle is absolutely right that wanting to control what someone is eating, even if it’s by “gentle” pressure, is not treating them as a competent adult. I like the extension of the Division of Responsibility as applied to adults. For kids, it’s pretty easy to make that distinction. The adults choose when, where, and what to offer, while the kid gets to decide if and how much they’ll eat. With adults, as Michele says, there can be negotiation around when and where for a shared meal, and even some negotiation around what, as long as it stops when the food goes on the table.

This got me thinking about how this gets worked out in relationships where one person does most or all of the cooking and one partner is very picky or has food restrictions. (These can be related—a lot of severe childhood pickiness results from choking incidents, and the pickiest person I know also has a long list of foods that will make her sick. When food can and has hurt you, it’s pretty understandable that you’d be wary about it from then on.)

If you’re splitting the cooking 50/50 (or thereabouts), this is pretty easy. When the picky/restricted person makes dinner, they know they’ll get food they like. And the more adventurous person has the option to include foods they like when they cook dinner, as long as they make sure there are also things the other person will eat.

If one person is doing the majority of the cooking, though, it gets more complex. Especially in situations where that division of labor is due to work/school schedules, illness or disability, or other things that make it harder for one person to cook. In general, I think the cook gets final say on what they serve. One of the trade-offs of not doing the work of cooking is giving up a certain amount of control over what gets made. (With the obvious caveat that making someone a meal that doesn’t include things you know they can/will eat is a jerk move.) But at the same time, if you’re preparing most of the meals that your partner eats, and they have food sensitivities or restrictions, I think you owe it to them to provide foods they can/will eat that meet their basic nutritional needs. I’d go beyond including one thing you know they’ll eat and say that at most meals, you should include carbs, proteins, and fats that you know they’ll eat. For example, let’s say the only protein they’ll generally eat is chicken, while you’d much rather have steak, or pork, or wild game. If you do breakfast and lunch on your own and split dinner 50/50, that’s only three meals out of twenty-one where they might miss a protein. Probably not a big deal, especially if some of those meals include other sources of protein like beans or dairy. But if you’re cooking every single meal, and a large portion of those don’t include a protein they’ll eat, that’s really not great. And would probably contribute to a stronger sense of insecurity around food and even less desire to try that awesome quail recipe you found.

The same goes for vegetables, although they tend to be higher on the pyramid of Satter’s Hierarchy of Food Needs, probably hanging out anywhere between “good-tasting,” “novel,” and “instrumental.” So, a meal with a veggie that you can’t eat is less of a big deal than a meal where you don’t get enough of the macronutrients to get you through to the next meal. Still, I think you should meet the person you’re cooking for halfway on veggies. If you don’t do veggies at all, and they need vegetables to feel like a meal is complete, then have a side salad or a simply cooked vegetable at most meals. Likewise, if they will only eat corn, peas, or carrots, you should offer one of those three at most meals if you’re doing the majority of the cooking.

A small taste of institutional ableism

I recently had minor surgery, and my discharge instructions included “Limit climbing stairs to once or twice daily.” I physically *can* do stairs, but my abs get a bit cranky, and I understand the recommendation that I not push it.  Since I work on the second floor in an old building with crappy elevators, it’s been an “interesting” week.

To start out with, I really wish that my doctor, or the hospital, or *somebody* had let me know about the stairs thing at some point in the months leading up to this surgery, rather than only finding out in my discharge instructions. My workplace isn’t exactly conducive to mobility issues.  I work on the second floor, with another little half flight of stairs leading up to my work area. Fortunately, there’s at least a “Porch Lift,” a little elevator designed for a single person to ride up.  The building next door, where I attend meetings occasionally, has a third floor cube farm with *no* elevator access.

So, I came in on Monday, took the elevator up to the second floor and walked up to the disability elevator, only to find that it needs a key to operate.  I, of course, did not have said key.  I walked up the half flight of stairs and looked for the guy who I figured would be in charge of such things.  I didn’t see him, but I did see that the elevator key was in the elevator at the upper entrance.  I grabbed it and shot him an email.  He let me know that there’s another key, which one of the high-level managers has, so I asked said manager for that key.  The elevator requires a key to open the door on both levels, and a third key to actually operate it.  If you hang onto the key when you go down, you can use it again coming back up, but you have to remember to take it each time. Once I got the third key, I could just leave them both in place.

This elevator is a groaning, clunking monstrosity. It takes twice as long to go up half a story than the regular (and also temperamental) one, and it loudly announces your comings and goings to everyone on the floor.  It’s also open at the top, with a half door. A coworker mentioned to me that when a guy who used a wheelchair used to work there, it got stuck, and someone had to jump down to physically get him out. (Facilities has a two-hour turnaround for elevator emergencies.)

Since the surgery was kind of personal, it was also *awesome* to have the noisy elevator announce to everyone that I was using it.  But I definitely mentioned the surgery, without giving details, to anyone who commented on the elevator use, because I didn’t want comments later on me being too fat and/or lazy to take the stairs. (My coworkers are a bunch of smartasses, which I love, but the line between smartass and jackass gets crossed on a regular basis, and there’s a lot of teasing that can get mean-spirited.)

I should mention that, with the exception of a sink and a coffee pot, all the workplace amenities are down on the second floor proper, so I’ve been using this elevator not just to come in in the morning and leave in the evening, but at lunch and every time I visit the restroom and the water fountain. Or the vending machine. Or the kitchen. And since I usually eat breakfast at work, either an oatmeal packet that needs to be microwaved or a Pop-Tart from the vending machine, that’s another trip.

Just when I thought I could not despise this elevator any more, I got in, held down the button, and it descended about three inches and stopped dead. I tried taking the key out and putting it back in, pressing the button again, and bringing it back up then trying again. No joy.  I mentioned it to the appropriate coworker, who emailed the facilities folks. He let me know a couple hours later that they hadn’t responded.

At some point, I just about cried. It was 10ish, and I hadn’t grabbed breakfast, and all I wanted was to go down to the vending machine and get a freaking Pop-Tart. I figured I should wait, though, because the elevator could be down all day and I should save my couple trips up the stairs for lunch and bathroom breaks.  I ended up calling my husband, who works in the building next door, and asked him to bring me a Pop-Tart. He did, because he’s awesome.

Later, I tried the elevator again and discovered that when the half door on the top floor closes automatically, it doesn’t close all the way.  And, strangely enough, the elevator won’t descend unless the door is closed.  Which is a lovely safety feature, except for the fact that the door stops about an inch before it’s actually closed, leaving me to swear a lot and try vainly to get someone to check it.

Before I figured out what was wrong with the elevator, I called my boss and asked if I could move to another location temporarily.  He went off to check who was out on travel or vacation, and he did actually find me another spot. I ended up not needing it, but the actual people I work with have been really helpful. The building design itself, not so much.

For me, this is an annoying inconvenience that will be over Friday afternoon. Even if the elevator dies completely, it probably won’t do damage for me to go up the stairs an extra time or two.  At worst, it’ll hurt some. But for someone with a long-term disability, this would be a nightmare.  That wheelchair-using coworker who used to work in the building?  Yeah, they had to move him somewhere else because of elevator issues.  The elevator would be down, and he’d be stuck in the lobby for two hours instead of being able to come upstairs and do his job.

Nobody intended that certain areas of the building be unusable for people with mobility issues.  Technically, the building is presumably ADA compliant. But in practice, ouch.