Pearl barley is sold in most large supermarkets, and in healthfood stores. Add it to stews, casseroles and soups to make them more filling. The barley needs about 1 – ? hours cooking time.

Plantains are obtainable from West Indian groceries and look like very large green bananas. They are starchy and less banana-like in flavour than one might expect. Peel them (quite difficult – needs a sharp knife) and then fry in oil, or boil and mash. They can also be baked in their skins.

Gram-flour pappadams are obtainable in some Indian groceries and can be eaten as an accompaniment to a meal. Check that they do not contain wheat flour. This is a traditional Indian recipe for gram-flour bread: mix two cups of gram flour with a small finely chopped onion, ? teaspoon cumin seeds, ? teaspoon salt and a pinch of chilli powder. Rub in 1 tablespoon of clarified butter. Add a little water – enough to make a stiff doughy mixture. Take small balls of this and press down lightly with your hand on a floured surface. Fry on a griddle or hot plate, turning once.

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You should be avoiding packaged and processed foods anyway, but if you do eat any, be aware that milk may be called by various synonyms on the ingredients label – see p292.

Most margarines contain some milk solids, and should be avoided anyway as they are highly processed.

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Crohn’s disease is a serious and debilitating illness – most of those with food intolerance have much milder symptoms. Indeed, many people in the early stages of food intolerance may scarcely be aware of being ill: headaches, indigestion, persistent tiredness and occasional diarrhoea are all reported as the early, symptoms, by those who later become more seriously ill and then discover they are sensitive to food. Symptoms of this sort are everyday problems that most people tend to accept as part of life.

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To ensure that the brand of yoghurt you are buying really is live, add a spoonful to some warm milk that has been heated to boiling point and then allowed to cool. Keep the mixture in a vacuum flask for 6-8 hours. If it has not turned to yoghurt, then the original yoghurt was not live. The best way of ensuring your yoghurt is live is to make your own – starter cultures are available from some health-food stores, or by post.

If you cannot eat yoghurt, because of a sensitivity to milk, then commercial preparations of bacteria might be worth considering, but ask to see a bacteriological analysis showing how many live bacteria there are per gram (there should be several million) before buying.

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These definitions are ones that the majority of mainstream doctors practising in this field would feel reasonably happy with. But bear in mind, if comparing this book with other books or articles, that the same words may be used in an entirely different way. It is also important to remember that they are theoretical definitions, and there is a sizeable gap between theory and practice when it comes to diagnosing individual patients. In practice the designation of an illness as ‘food allergy’ or ‘food intolerance’ would not depend so much on skin-prick tests or other tests as on the type of symptoms that the patient shows. If the symptoms are among those traditionally associated with allergy, such as asthma or urticaria, and if foods are shown to be responsible, then the condition will probably be labelled as food allergy, even if skin-prick tests are negative, as they sometimes are in such cases. If, on the other hand, the symptoms are not of the allergic kind – as in Susan’s case – then the label ‘food intolerance’ will be used. Skin-prick tests will not normally be carried out because they are most unlikely to give a positive result, so they will not contribute much to the diagnosis.

In theory, then, the distinction between allergy and intolerance is based on causes. In the doctor’s surgery, however, the distinction is likely to be based on symptoms, because it is known that asthma or urticaria are probably true allergic reactions, while migraine or depression are not. With a symptom such as diarrhoea, the cause might be an allergic reaction, an intolerant one, or something else entirely. In such cases, special tests would be needed to make a diagnosis of ‘food allergy’.

Where patients show a collection of symptoms that include, say, asthma and migraine, the diagnosis is more difficult. If all these symptoms clear up at once when certain foods are avoided, is it allergy or is it intolerance? This is not a question that can be easily answered at present, and for the purposes of this book we will use the umbrella term ‘food sensitivity’ to cover such situations.

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• Exercise 10-15 minutes per day.

• Also engage in passive exercise, like walking.

• Enjoy some massages.

• Halve intake of all negative substances – like alcohol.

• Double intake of all positive substances – like fruit and vegies.

• Lose weight in the first week.

Remember to make all goals achievable. Encourage yourself to perform in short bursts, making sure that you do tire yourself out – just a little bit for starters. Don’t have a complete body revolution – your body might still need its coffee, and those who get headaches will soon know if they are being too radical with their restraint. Prefer to restrain yourself gradually, being comfortable that you can – and will – achieve what you intend.

Medium Term

• Exceed 15 minutes of exercise per day.

• Start having fun – compete with your previous times and efforts.

• Put more effort into walking.

• Avoid intake of all negative substances.

• Increase intake of all healthy foods.

• Lose more weight. /

Medium term performance is most satisfying, because you really start to see spectacular results. Once you get over the muscular aches associated with starting to get fit, the body begins to perform at levels which only four weeks ago seemed impossible! Also after three – four weeks of solid effort, you start to see results. Your friends and your family might not start to notice yet, but you will certainly find yourself feeling and looking better, and beginning to wonder what you will do for clothes one size smaller.

Longer Term

• Exercise 60 minutes per day – 30 minutes weight and muscle training and 30 minutes heart and lung training.

• Continue to engage in passive exercise and don’t let your partner break the habit of giving you massage.

• Imbibe negative substances only very occasionally.

• Continue intake of healthy foods.

• And continue to lose weight.

The unfit have no idea how great it feels to be fit. This longer term program is the one you must settle into in order to retain what you have gained. It will become your lifestyle, and you should try to find ways to enjoy it. Eliminate all those things you ‘tried’ and hated in the first few weeks – maybe the paw-paw wasn’t so good, but you learned to love mangoes! And maybe the rowing machine wasn’t for you, whereas you can read or watch television on the treadmill!

By now you may have picked up a few friends along the way. Your social circle might have widened as you interact with like-minded people, and you will alter your plans in order to meet at various locations where you can encourage each other.

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