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If single-food dieting has been inconclusive or confusing, or if you appear to have multiple food sensitivity, the next step recommended by doctors is often a special exclusion diet. It is a halfway stage between single food testing and a total exclusion diet.

There are two basic kinds of special diet. The first type is a so-called low-allergen diet in which all the major foods that commonly cause allergy or intolerance are omitted. The second type is a much more specific type of diet, in which a specific range of foods is suspected of causing allergy or intolerance. These only are omitted, often leaving some common allergens in the diet. Specific diets of this kind include gluten-free, anti-candida, mould-free and low-salicylate diets.

Before a doctor chooses which diet to put you on, you will usually be asked to keep a Foods Diary, noting down absolutely everything you eat, swallow or ingest, and monitoring the timing and nature of symptoms. The doctor will then choose the specific range of foods according to your particular pattern of symptoms and food habits.

The principles of low-allergen diets are to leave out all foods commonly causing allergy and intolerance, to leave out processed and manufactured foods, and to eat foods which are as free of additives and chemicals as possible. The best known of the so-called low-allergen diets is the Stone-Age Diet pioneered by Dr Richard Mackarness.

It is usually recommended that you follow this type of diet for five days to a week, giving time for your symptoms to clear. You may, as with the single-food diet above, find you feel worse at first and have withdrawal symptoms. However, if you have excluded the foods that upset you, you should begin to feel much better after five days.

The benefits of a special exclusion diet of this kind are primarily for people who have had confused results from leaving out single foods, or who can identify no obvious candidates for single-food exclusion, or who have other multiple allergies or sensitivity with competing symptoms. It is a less rigorous approach than a total exclusion diet, and more balanced nutritionally, but more rapid and effective than single-food dieting.

Two major drawbacks of a special exclusion diet are that it is expensive and inconvenient. You have to rely on being able to eat mainly at home, or carry packed foods with you. It is also eccentric and makes you conspicuous. You often feel ravenous and empty, although these can be withdrawal symptoms. A final drawback is that, if you really have very severe problems with multiple sensitivity, it will not be adequate to sort them out straightaway. Only a total exclusion diet on a rotation basis will do that.

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Symptoms are only partly helpful as an indicator of the cause of reactions. It used to be thought that the site where your symptoms occurred was the route or the place where the substance causing the reactions had entered the body. On this basis, only things you inhaled could cause nasal and breathing symptoms; only things you swallowed could cause gut symptoms; only things you touched could cause skin symptoms, and so on. Many doctors no longer accept this, since there is evidence that molecules travel in the bloodstream and can trigger allergic and other reactions at sites in the body other than those where the substance entered. Some doctors, however, still hold firmly to the original belief that symptom = site of reaction = cause of reaction.

Nonetheless, it is true to say that certain symptoms do have prime suspects as causes, and they are a good place to start. Nasal and breathing symptoms are most likely to be caused by things you breathe in, especially house dust mites, pollens, moulds, fibres, feathers, animal hair and chemicals. Start with these, perhaps, but remember that other things, such as foods, do cause such symptoms. Gut and digestive symptoms are most commonly caused by things you eat or swallow, such as foods, drinks and drugs, but they are also very often caused by chemicals you inhale. Mental symptoms are most likely to be caused by inhaling chemicals, but are often caused by intolerance of foods, drinks or drugs.

Skin symptoms are commonly caused by things you touch, such as chemicals, but they are equally likely to be caused by things you eat or swallow, such as foods, drinks and drugs; or by things you inhale, such as house dust mites, pollens, moulds, fibres, feathers, animal hair or chemicals. Itchy eyes, headaches, joint pain, nettle rash and water retention have no real prime suspects as cause.

So use the nature of your symptoms as a partial guide only. The Pattern of your symptoms – when and where they occur – is a much better guide.

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If you would like full information on fibres and how to detect allergy or sensitivity to them. For a short guide to detection, read on.

There is a relatively cheap and easy way to test at home whether you are allergic or sensitive to specific fibres – the Pillow Test. Washing the cloth with sodium bicarbonate and drying thoroughly before use will minimise the possibility of sensitivity to laundry agents, chemicals or moulds interfering with the test.

You will get clearer results from the test if you are able to avoid totally the fibre you are planning to test for at least a day, preferably several days, before you do the test. You can then confirm the results of the Pillow Test by avoiding totally (or as far as is practicable) the fibre or fibres you suspect for a period of a week and then reintroducing it – by wearing or using it again. Monitor any symptoms for the period of avoidance and on reintroduction.

If you have multiple allergies or sensitivities and have to avoid many fibres, you may simply have to choose your safest options and stick to them. Some people with sensitive skin find that they can tolerate a fibre to which they usually react, provided they do not wear it next to the skin. So try wearing a vest or shirt of a different fibre next to your skin under other garments. If this works, you may not have to replace large parts of your wardrobe.

You can also try rotating fibres (wearing one specific fibre per day or one per week), to give your system a rest. Don’t shun anything – you may react, say, to nylon or wool, but they could be better than any other choice you have. Stay flexible and keep varying your options until you find the one that suits you best.

Take precautions if you borrow clothes to test them out. Check out what soap powder or conditioner has been used. Sniff for any perfumes that might cling to them.

Take great care if you buy clothes secondhand or from charity shops. Ask about soap powders and conditioners. Look out for dust, cigarette smoke or animal hairs which might cling.

Avoiding your worst culprits may make you able to tolerate them again after a while. You could be able to wear them occasionally or even regularly. Never throw anything away.

Do not have a massive clearout and replace everything at once. You can sometimes tolerate something well for a while, then find it comes to upset you. Take one step at a time.

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If buying new, buy whatever you can of natural fabrics, materials and metal – cotton, wood and metal have many advantages. Avoid foam padding on chairs, mats and mattresses if you are able, or air well and wash before using. Avoid new chipboard veneered furniture if you can.

If you have to buy things of synthetic materials, (such as a buggy or pram), buy well in advance and let them air before use. If buying secondhand or using equipment passed on to you.

For waterproofing a cot, bed or pram, waterproofing sheets of plastic are well tolerated if washed several times before use, which disperses the fumes. Wash just in water or in a solution of sodium bicarbonate or Borax – one tablespoonful per bowl or machine.

Most baby goods suppliers sell wood and metal cots and chairs. It is also possible to find pure cotton baby carriers, and bouncing chairs. Kiddycare sell a pure cotton babies’ sleeping bag with a pure cotton lining.

Do not put a newborn baby into a newly decorated room. Decorate and air the room well in advance of the birth, using relatively trouble-free materials if possible.

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Animal allergens can disperse throughout the whole environment around them. It is not necessary to touch or handle animals or birds to be allergic to them. Pet allergens can waft through the home and, even if the animal or bird is confined to a limited area, traces of allergens can be found in other parts. If you are not very sensitive to them, this will be no problem; but if you are highly allergic, then it can be a cause of difficulty.

If a cat or dog sleeps in your bedroom at night, it could be the cause of reactions. If you allow them to sleep on a bed during the day, they can leave traces of allergens which can upset you later when you go to bed.

Pet allergens are also found in house dust and if you react to this, animal allergens may be the cause. They can also cling to clothing or surfaces where an animal has been, such as car seats, furniture, the animal’s bedding, carpets and rugs, so visiting other people’s homes or travelling in their cars may cause trouble. Even if you do not have a pet, people who come into your home can bring animal allergens in with them on their clothes. Again, if you are exceptionally sensitive, this can be a problem.

Animal allergens can also be an occupational hazard, depending on your type of work. Laboratory workers using animals or birds in experiments are known to develop allergy, as are zoo or circus employees, kennel workers and dog handlers. Blind people can develop an allergy to their guide dogs.

Hobbies and leisure pursuits, such as horse-riding, which bring you into contact with animals can also be troublesome. Birdkeeping is a known hazardous hobby. If you are exceptionally sensitive, even inhaling animal allergens at a distance can trigger reactions. Going to the races, visiting a circus, or watching a gymkhana, have been known to cause reactions in people allergic to horses, for instance.

If your problems started on moving house, or soon after, animal allergens from previous owners may be a cause. These can be very persistent.

If you sit next to someone wearing clothes with cat or dog allergens clinging to them, even invisibly, this can upset you. This may be the cause of problems at work, at school, at leisure activities, or even on public transport.

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Here is some advice that can help you and your partner through this difficult time:

• Remember, no one is to blame. Assigning blame is always unproductive and often unjustified. Look to the future, not the past. Use your time and energy to get appropriate help solving the problem.

• Think in terms of we—not just he, or me. People who successfully overcome their difficulties work together as a team. They grow stronger as a couple as they confront and solve the problem.

Just examine Marianne’s story to find out how important these guidelines are.

Marianne, a 35-year-old personnel manager, has been happily married to Jack for almost a decade. If you asked her, she’d make no bones about describing herself as aggressive, smart and capable. She and Jack have had their ups and downs, but generally their marriage has been strong. Their friends call them a happy couple.

But their friends haven’t seen their private side. When Jack lost his ability to get an erection, Marianne felt threatened and blamed herself. Although she usually communicated well with her husband, she knew this subject upset him. Rather than make him more worried, she kept her feelings a secret for a long, painful time. The results were far-reaching. “I thought it was my fault—initially,” says Marianne. She had always been might mean the end of something important that she enjoyed, that also brought them close emotionally.

But in many ways, Marianne was fortunate. Jack, although hurting and depressed himself, was able to reach out to her and reassure her that she was not to blame for his difficulty, and that he still found her attractive and wanted her sexually. And Marianne had other responsibilities, like her job, that demanded much of her energy and prevented her from becoming obsessed with the sexual problem. And even though she was emotionally hurt, Marianne was determined not to let the erection difficulty create a barrier between her husband and herself. She made special efforts to let Jack know she cared about him and wanted to be physically close to him—intercourse or not.

Although Marianne was careful not to spend all of her time concentrating on the lack of potency, neither did she withdraw from her husband. She gave him plenty of affection and didn’t shy away from being physical with him.

And perhaps as important, she took an active role in getting help. She urged him to check whether there was a physical cause. As it turned out, tests showed that Jack did not have a physical cause for his lack of erection. What he did have was an overload of stress, anxiety and tension—feelings he had been keeping bottled up inside. Sex therapy turned out to be the right treatment.

Marianne’s openness and willingness to help were important to the sex therapy. She didn’t regard the erection problem as Jack’s alone, and she did not withdraw sexually. She examined her own expectations and beliefs. She worked to keep her tendency to blame herself from overwhelming her by encouraging her husband to seek a solution.

Marianne and Jack had a number of important things in their favor:

• They were very committed to each other.

• They had a history of a mutually satisfying and pleasurable sexual relationship,

• They made efforts to communicate with each other, although both felt bad.

• They sought help early on in the situation.

In short, they took an active stance instead of a passive approach.

Encouraging Jack to get an evaluation was a smart move on Marianne’s part. Sometimes knowing the cause makes it easier to cope with the problem, because it removes the stress of being in a state of limbo.

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Sometimes potency responds best to treatments only a doctor can give. Often these treatments are administered by your doctor in his office, with additional instructions that you follow at home. Other times surgery is necessary. Either way, medical treatments have restored potency to a lot of men— permanently. And there are a lot of treatments to choose from. Here’s the latest.

Penile Shots

It seems frightening, but it works wonders: the penile shot. Sticking a needle in your penis to get an erection might not be as romantic as a candlelit dinner and a snapping fire, but some men with potency problems are finding that the shots boost their sex lives. Once they learn the technique, they can use the injections at home when they want to make love.

Your reaction to even the thought of an injection in your penis is probably to shrink back. But really, there’s notvery much to worry about. Men report that the injection doesn’t hurt any more than any other type of shot—and the pain doesn’t last.

The needle is so small—about three quarters of an inch long and quite skinny—that the initial jab itself isn’t very painful. The needle is inserted into the side of the penis, about midway along the length of the organ. There is a slight burning sensation when the medicine is injected, but it quickly disappears.

The drug injected will usually be papaverine, or a combination of papaverine and phentolamine. These medications dilate the arteries in the penis, thereby increasing the blood flow to the organ. In addition, it appears that papaverine dilates the sinuses within the penis where the blood is trapped during an erection. Dilation of the sinuses compresses the veins so there’s less blood leaving the penis.

And a man with a papaverine erection won’t lose it when he ejaculates, because the drug will keep working. The man will still feel pleasure and may be able to ejaculate again, although the ejaculation might seem less intense. The erection will subside only as the medicine gradually leaves the penis and disperses throughout the body.

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Sometimes a man who’s desperate will insert some long, hard object into his penis, in the hopes that the organ will become erect around it. But there’s no such luck. Instead, in short order, the man is in great pain, in danger of developing an infection, and possessed of a great and immediate interest in getting the object out. However, he usually finds it’s impossible to remove the object on his own. Emergency room doctors can recount tales about the variety of objects they have removed from men’s penises: pens, pencils, eyedroppers, swizzle sticks and even animal penises are some of the items doctors have extracted from this sensitive area.

Inserting a foreign object into your penis will not produce an erection, but we can almost guarantee it will produce pain and soreness. Sometimes the object prevents a man from urinating, which can be a very dangerous situation. And for some unfortunate individuals, permanent injury to the penis results from infection or damage caused when the object is finally removed.

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Joe and Mary have been married for more than ten years, and each contributes to the family income. In their budget, each partner is allocated a certain amount of personal spending money. The rest of the money goes for joint expenses, like food, house payments and savings.

Suddenly, Joe is demoted at work, and his hours are cut. His paycheck suffers a huge reduction. Although the change at work isn’t Joe’s fault, and lots of other employees are similarly affected, Joe’s sense of self-worth is shot full of holes. He feels like less of a man.

Joe doesn’t tell his wife about the change in his situation and how bad it makes him feel. Without a word, he just cuts back on the amount he contributes to the family budget. He feels embarrassed, ashamed and guilty about his reduced participation, and he withdraws as much as possible. He doesn’t talk much to Mary. He refuses social invitations. He becomes quite depressed.

Naturally Mary reacts by worrying about the reduced household budget. Although she is filled with questions—Is Joe spending his money on someone else? Did he lose his job, or get reduced hours at work? Does he feel less love for her, and thus want to contribute less?—she is afraid to ask them.

Joe deals with Mary’s silence with his own set of unspoken questions. How is she coping with less money? Doesn’t she mind? Is she making up the difference by getting more money from someone else?

If this tension and anxiety increase and the situation is allowed to continue, it will develop a life of its own, with each partner attributing negative motives and feelings to the other. The once-positive relationship Joe and Mary enjoyed will be poisoned by their imaginations. But this does not have to happen. Simple questions and answers spoken early on, coupled with warmth and support, can break this communications deadlock. Joe and Mary can decide what they want to do about the change in their finances—together. The same applies to potency problems.

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TAKING A PILL to regain lost erectile function is an incredible development in the history of drug intervention. But the pill itself cannot obliterate the other problems a couple experiencing ED may have. In fact, in certain circumstances, it may even add to the existing issues with which the pair has had to cope.

One of my greatest concerns as a physician is that the new treatment for ED gives people an unrealistic expectation about their ability to immediately cure their emotional relationships along with their physical ones.

Nothing could be further from the truth.

It is no secret that men and women react differently to sex— before, during, and after it takes place. The availability of a new quick, painless treatment for ED can have one impact on men and quite another on women. Consider the comments I’ve heard in my office:

From a thirty-three-year-old man under tremendous work-related stress: “The pill is the best thing lhal could have happened to me.”

The comments of his partner, a twenty-nine-year-old lawyer who was equally busy: “Right now we can have the sex we want when time allows for it—which isn’t very often.”

From a fifty-two-year-old man whose extra poundage and drinking made ED a constant companion: “In one way I feel great because I can have sex again. But in another I feel awful, because I can’t hide behind my weight anymore.”

His fifty-four-year-old wife had a different view of the situation: “For the last five years his primary relationship has been with food. Now everything has changed and, frankly, I’m not happy about it. It sort of puts the focus on me now.”

A forty-six-year-old man, on the verge of a divorce after eight years of marriage, told me: “Ever since I found out that a drug could help me, I’ve wondered how to use it. Our marriage was based, to a large degree, on sex. For two years we’ve been trying to find other ways to communicate. We never did. Having the means to have sex again is wonderful—but I have to ask myself, what kind of relationship did we have in the first place?”

His forty-three-year-old wife concurred: “He’s right. It was a big reality check to see how little we had in common. Yes—I’d like to have sex with him again. But where do we go from there?”

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