Happy Sulfite Intolerance
February 21, 2013
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I started to develop chest tightness and wheezing out of the blue in the middle of running with one of my neighbors last spring. I figured that I was out of shape from my pregnancy and the strange sensation slowly resolved as I walked. But then it came back again and again, each time a little bit worse, and sometimes with chest pain. I had a chest CT to evaluate for a pulmonary embolism, since I was at risk due to being postpartum, and it was normal. My chest x-ray was normal too. My heart tests, including an EKG and Echocardiogram, were unremarkable.
One night at work I had to go to the ED because I was having so much difficulty with breathing. I was diagnosed with possible asthma, given albuterol, and sent home with a prescription for a course of oral steroids. Despite the treatment, over the course of the next few weeks my breathing declined. I went from being able to run a 10K to getting winded and short of breath walking across a Target store. I wracked my brain trying to figure out why asthma would just “pop up” suddenly when I was in my mid-thirties....
I had pulmonary function tests and a methacholine challenge, to look for exercise-induced asthma, about 6 weeks after my symptoms first started, and everything was normal (I did not have asthma).
I began to notice that my chest tightness/wheezing would occur shortly after eating. Around this time I was back to work and eating a lot of Apple Cinnamon Chex and KIND bars for both snacks and meal replacements. I began to keep a food journal and discovered that all the the following foods were triggers for my symptoms: Apple Cinnamon Chex, raisins, wine, Juices, KIND bars, eggs, certain bottled waters, balsamic vinegar, shrimp, and anything that contained molasses as an ingredient. I looked at a box of Apple Cinnamon Chex over and over until I saw the words “contains sodium sulfite.” I did a web search for foods that contain sulfites, and I found that ALL of my trigger foods were on the list. I discovered that I had a sulfite intolerance, which is also called a "sulfite allergy."
FAQ about about sulfites:
What are sulfites?
Sulfites are sulphur-based compounds which are added to foods and supplements as a preservative and/or flavor enhancer. They may also occur naturally. Sulfite sensitive individuals need to avoid all of the following:
- sulfur dioxide
- sulfurous acid
- sodium sulfite, sodium bisulfate and sodium metabisulfate
- potassium sulfite, potassium bisulfite and postassium metabisulfite
What foods contain sulfites?
- Baked goods
- Beverages (including beer, wine, hard cider, fruit juice, vegetable juice, and tea)
- Bottled lemon and lime juice (concentrates)
- Condiments
- Cornstarch
- Dried fruits
- Dried and/or processed potatoes
- Fruit toppings/jams/jellies
- Gravies
- Maraschino cherries
- Molasses
- Sauerkraut
- Shrimp
- Soy
- Vinegar
- Wine
The most comprehensive list and forum to check out regarding sulfites is the website:
www.holdthesulfites.com.
Sulfites can be present in medications. A lot of generic acetaminophen tablets and other OTC meds contain sodium metabisulfite. Cornstarch, which is sulfited during processing, is a filler in a lot of pills, and depending on the degree of one's sulfite sensitivity, may trigger a reaction.
Why do people develop a sulfite intolerance?We do not know. Most of the scientific papers about sulfite allergies are case reports which were published back in the 1980s (most are in French). Some theories I have come across on the internet regarding why a sulfite intolerance develops include that sufferers may have a partial sulfite oxidase deficiency (a full deficiency is fatal, so perhaps we are "carriers" of the gene and express some symptoms), or that symptoms are due to a deficiency of molybdenum, which is a mineral cofactor in the breakdown of sulfites. Other lines of thought are that the intolerance is related to an environmental exposure of some sort and/or is immune-related (a non-IgE mediated food allergy). In my interactions with others with this problem it seems like a lot of us have either Celiac Disease or gluten sensitivity. But, this is all anecdotal, as there is no research out there (and as far as I know, no one doing any research into the problem of sulfite issues).
How is a sulfite intolerance treated?The most important thing is the obvious:
avoid sulfites! However, this is easier said than done! The only mandatory labeling is for foods and drinks with a lot of sulfites added in, such as wine, beer, and hard cider. Other foods which contain sulfites, such as dried fruits and KIND bars, do not have mandatory labeling. I have been unable to find any GF, sulfite free beers or hard ciders. The main sulfite free wine makers are Frey and Orleans Hill. I am partial to the Orleans Hill's Zinfandel, Syrah, and Cabernet, and am slowly getting used to bringing my own bottle with me when I socialize. Many people report a lessening of symptoms while taking Molybdenum. I tried Molybdenum, and, unfortunately, and it did not help me. Other supplements which I have seen recommended include Vitamin B12, Magnesium, and Probiotics. It also never hurts to have an Epipen (or 2) around, just in case of a severe reaction. Ironically, though, Epipens do contain sulfites as preservatives!
How are sulfites metabolized?Sulfite Metabolic Pathway (from http://pathman.smpdb.ca/pathways/SMP00041/pathway):
Update January 2014: Since writing this post last spring I discovered that my sulfite intolerance is the result of an immune system disorder called mast cell activation syndrome (MCAS) and I have since started on a treatment regimen. Please see my recent post on MCAS for more details. Thank you.References/Links:1.
www.holdthesulfites.com: This is hands-down the most comprehensive resource out there for those who are suffering with sulfite issues.
2. "
Allergies and Sulfite Sensitivity." www.webmd.com. 2012.
3.
American Academy of Nutrition and Dietetics Nutrition Care Manual (accessed 8/10/12)
*Also, a quick reminder that this is a blog. I am summarizing medical literature, but also adding in my own thoughts and opinions on what I have read. I am not trying to tell anyone what they should do for their own health, nor am I giving medical advice through this page. Thank you!