The term brain-fag is unfamiliar to most readers. Brain-fag refers to a particular aspect of the environmental disease problem and in fact characterizes the very serious minus-three level. Brain-fag is marked by confused thinking, moodiness, unexplained sadness, and apathy. Frequently, the individual with this phase of the problem cannot concentrate and may find it difficult to express himself. The term itself was first used in this context by an astute patient, and I have adopted it to refer to what may be the most characteristic part of food and chemical susceptibility.

We all know, of course, what fatigue is. Normal people experience it when they have exerted a great deal of energy. Others, however, experience fatigue on an allergic basis. In other words, their tiredness is not related to any particular exertion on their part, is unrelieved by rest or sleep, and is frequently worse in the morning.

Fatigue may also be caused by other disease states, such as chronic infection, metabolic disorders, heart ailments, anemia, dietary deficiencies, or even cancer. If none of these conditions exist, food or chemical allergy should definitely be suspected.

Physical fatigue is a minus-two symptom. It can occur at any age, but not uncommonly afflicts a younger patient than does brain-fag. It can be ruinous for any person who must perform difficult or complicated jobs.

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For the chemically susceptible, the worst kind of engine exhaust is that of diesels. Diesel exhaust is particularly aggravating to many susceptible individuals and if encountered in the course of driving can represent a real traffic hazard.

Busses using diesel fuel can be troublesome for passengers or those riding in other vehicles. Moving vehicles generally tend to suck in their own exhaust fumes if the windows are open. Therefore if a passenger rides in the rear of the bus, he is more likely to be exposed to these fumes than if he stays in the front of the passenger compartment. One patient with a relatively mild form of the chemical-susceptibility problem reported that he enjoyed riding in the back of the bus with the window open. He found this a stimulating experience, although he had no idea why. Afterwards, however, he noticed a feeling of depression. This appears to have been an addictionlike response to chemical fumes.

Sometimes busses follow each other in a caravan. In these cases, the exhaust of one bus is swept up into the passenger compartment of the next, especially if the wind is traveling in the same direction as the fumes.

Passengers often develop headaches and other reactions, such as nausea, during or following bus trips, without ever suspecting exhaust fumes as the cause. These effects can be cumulative, occurring after the passengers have been riding in the vehicle for a certain number of miles or minutes. In less susceptible people, the symptoms may only come on if the bus is in poor repair or if the rear windows are left open.

Often the effects of diesel fumes are subtle and go unnoticed. For instance, the fatigue associated with riding the bus downtown to go shopping is frequently out of proportion to the actual amount of activity involved. Much of this exhaustion often stems from the fumes of busses and from general traffic pollution.

In railroad stations, the diesel fumes are greatest at the entrances and exits. This is especially true of underground or covered stations in which passengers are forced to walk past a line of “purring” locomotives to reach their coach or the station exit. Some patients have become acutely ill whenever they have attempted to run such a gauntlet. Other than this, however, diesel trains actually provide less troublesome exposure than busses or automobiles, especially during rush-hour traffic. The reason for this is the rapid speed of the trains, the avoidance of traffic jams, and the relative isolation of the passenger compartment from the source of pollution.

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Home care

If your infant vomits or has cramps or diarrhea after you have introduced a new food into the child’s diet, withdraw the food promptly. This does not necessarily indicate a food allergy, but you should wait (two to four weeks) before reintroducing the food. Add new foods to the child’s diet one at a time, and allow several days between each introduction so that you can be sure that no problems are occurring.

Precautions

• Persistent diarrhea is a clue to malabsorption or an allergic problem.

• If diarrhea persists, temporarily cut milk and milk products out of the child’s diet and substitute clear liquids.

• Certain antibiotic drugs and digestive tract viruses may cause a temporary loss of digestive enzymes, particularly lactase (the enzyme that aids digestion of milk sugar). This enzyme deficiency can last up to six weeks after viral gastroenteritis.

• Symptoms of malabsorption call for a sweat test to rule out cystic fibrosis.

Medical treatment

The doctor diagnoses a food allergy or malabsorption syndrome on the basis of the following: changes in the child’s diet; culture and examination of stools for blood, fat, and starch; analysis of digestive enzymes; biopsy of the intestinal lining; sugar tolerance tests; sweat test; chest X rays; and other factors. Treatment involves a controlled diet and, sometimes, a prescription of digestive enzyme supplements.

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