The intolerant classes

Not everyone enjoyed my recent post about PoMas — post-materialist consumers who live modestly but spend up big. Some readers were particularly irritated by the comment about food intolerances. For example, Galaca says:

I can’t help feeling this is yet another article sneering at inner-city lefties. The sentence "In a PoMa household there’s almost always someone with a food allergy or intolerance" does seem a bit of a giveaway.

I’m sure you don’t care what I think, but for me to take you seriously, I’d like some evidence please, otherwise I’ll have to conclude that you’re just recycling right wing prejudices.

Not surprisingly, I haven’t been jetting around the country conducting focus groups or commissioning market research surveys to test out my ideas. But as far as evidence goes, there is some reason to think that perceived food intolerance in children is associated with mother’s level of education. For example a study published in the British Medical Journal reported that:

The association between the mother’s level of education and her perception of food intolerance was very strong. The proportion of food intolerant children was about three times higher in mothers with university or polytechnic education than in those who reached only secondary education level (table III). Food intolerance was also associated with the father’s social class and the number of siblings but not with the mother’s hours of working outside the home (table IV). Food intolerance was more prevalent in the upper social classes and slightly more common in large families. After adjustment for the other factors only the mother’s level of education was associated with food intolerance, and this remained strong (p<O-Ol).

Other studies have reported similar findings.

A thesis by Nina Gunnarsson looked at child allergy from the parent perspective. Gunnarsson interviewed a sample of parents of school age children with exclusion diets. She reported that "The proactive strategies parents use might be interpreted as a way for them to attain moral recognition from others."

Doctors can sometimes be dismissive when parents raise the issue of allergies or intolerances. But Gunnarsson argues that health professionals need to work with parents and respect their choices and decisions. The parents in her study typically sought help only after they had tried to manage the problem themselves. She writes:

… seeking professional medical help is, especially for mothers, not merely about receiving a diagnosis and effective treatment or about receiving advice for children’s problems. It is also about their identities and moral character as individuals and parents. The fact that mothers experience that they are being recognized as competent and responsible parents by health professionals is likely to shape the doctor-parent meeting in a positive and mutual direction that will take into consideration both the doctors’ medical expertise and the particular expertise of the mothers …

Even if food allergies and intolerances aren’t as common as parents might think, this doesn’t mean they’re rare or unimportant. And Gunnarsson is right to argue that medical professionals need to work with parents rather than dismiss their concerns.

Note: Allergic responses involve the immune system and in extreme cases can be fatal (for example peanut allergy). Food intolerances do not involve the immune system (for example, lactose intolerance). Allergies and intolerances can share similar symptoms.

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Patrick
12 years ago

Seriously, speaking as someone who drinks soy lattes and is happy to cook gluten-free (and is who certainly not ‘rich’ in an Australian sense), does anyone really think that food intolerances are much more than a rich (in a global sense) affectation?

I avoid milk, and I find it disgusting, but I know I’m being precious and only because I can afford to be so. How many people out there are deluding themselves that they really wouldn’t be healthy if they gobbled gluten and lactose?

Also, what kind of evolutionary impact are we having? Are we becoming the first species to mass auto-select?

Don Arthur
Don Arthur
12 years ago

I’ve heard that people who avoid meat often come to see it as disgusting.

I know a few people who really do have coeliac disease. It makes sense for them to avoid gluten.

Andrew Norton
Andrew Norton
12 years ago

It’s likely that educated parents are simply more aware of possible causes of food issues, and take more steps to have them diagnosed. I have one (fructose malabsorption) which few people know about, including GPs. I only worked it out because my sister, who also has coeliac, was diagnosed with it, and was told that any siblings should also be tested. Changing my diet significantly reduced symptoms.

Don Arthur
Don Arthur
12 years ago

Its likely that educated parents are simply more aware of possible causes of food issues, and take more steps to have them diagnosed.

You’d expect educated parents to be more aware of adverse reactions to food. You’d also expect them to be more able to communicate their suspicions to a health professional and, as a result, get treatment.

A common claim in the medical literature is that far more people think they suffer from food allergies than actually do. But a response to this is that when people say ‘allergy’ they actually mean something more general — an adverse reaction to food (ie non-immune reactions as well as immune system reactions).

Given that food intolerances do occur, it’s difficult to talk about overdiagnosis without offending people. But there are some reasons for thinking that food problems are overdiagnosed (and not just those that are self-diagnosed).

One theory about why these problems are overdiagnosed is that people feel less anxious if they feel they are in control — when they are actively doing something about the problem.

So instead of rituals of prayer or sacrifice, you get rituals about food avoidance or (in the case of the environment) recycling.

These rituals can take on a moral dimension when they are done for the benefit of others. People get very angry and upset if you challenge the ritual and suggest that it’s ineffective. A typical response is: “Well I don’t see you doing anything about the problem!”

barry
barry
12 years ago

A common claim in the medical literature is that far more people think they suffer from food allergies than actually do.

Self diagnosis is a problem, but it’s also worth noting that coeliac disease – which i have, and was only diagnosed with at 25 – is massively underdiagnosed. From my experience working class families are more likely to write off debilitating exhaustion from such conditions as laziness or being unfit.

Andrew Norton
Andrew Norton
12 years ago

I’m willing to believe that there is a lot of incorrect self-diagnosis, but this is not because people don’t have symptoms, but because the symptoms are consistent with so many potential causes. People who think they might be coeliac, for example, may actually have other problems that cause adverse reactions to wheat. That was the case with me.

galaca
galaca
12 years ago

Don said “Not surprisingly, I havent been jetting around the country conducting focus groups or commissioning market research surveys to test out my ideas.”

Well actually Don, I am surprised. In that case where did you get your ideas from? How do you know that this group even exists, much less what its members think, do, or spend their money on? If it’s just something you dreamt up without any market research or focus groups, then why on Earth should you or it be taken seriously? And you don’t need to jet anywhere. A survey of whatever the trendy suburb or suburbs are in Perth would be enough.

Incidentally you are wrong in saying that I didn’t enjoy the article. I found it very amusing. I quite liked the idea of the inner-city being populated by a shabbily-dressed, fair-trade-coffee-drinking class who live in poverty because they spent too much buying a run-down terrace and waste whatever money’s left on quackery and free-range eggs. But until it’s grounded in some kind of fact, I would have to dismiss it as a not particularly enlightening caricature.

Don Arthur
Don Arthur
12 years ago

galaca – I’m glad you found the article amusing. It would be a mistake to take it too seriously.

I’m curious though — why did you single out the bit about food allergies and intolerances?

galaca
galaca
12 years ago

Don Arthur said “Im curious though why did you single out the bit about food allergies and intolerances?”

Perhaps you misunderstood the point I was making. Commentator Dilletante put it better than I can:

“The anti-environmentalists see (your piece) as satire, as one of our boys sending up those stupid hypocritical greenies, yeah!. It seems to me the post is really quite neutral as to the moral value of the proposed PoMA outlook, except for the theres almost always someone with a food allergy or intolerance comment which seems a bit of a cheap shot.”

I’m not in the least bit interested in food allergies. Like Dilletante I thought your piece had a veneer of neutrality, but the comment on food allergies betrayed your real point of view.

Regardless, I am pleased that you acknowledge that it is not something that is meant to be taken seriously. I hope I haven’t appeared to do so.

Don Arthur
Don Arthur
12 years ago

galaca – I think I understand the point you and Dilletante were making. The remark about food allergies/intolerances indicates that I harbour right wing prejudices.

It may be that I do have right wing prejudices (the irritating thing about prejudices is that everyone’s prejudices are obvious except your own). But what I don’t understand is why this particular remark is such a give away.

I’m happy for anyone to reply to this.

Patrick
12 years ago

Easy, Don, as you pointed out all lefties are intolerant or know someone who is, so only right-wingers could be skeptical of the genuine suffering involved :)

Tel_
Tel_
12 years ago

Im not in the least bit interested in food allergies. Like Dilletante I thought your piece had a veneer of
neutrality, but the comment on food allergies betrayed your real point of view.

Given that Don could quickly and easily produce supporting stats for the statement, it probably betrays more about the readers’ point of view than anything else.

I felt the comment about anxiety and SSRI was a bit more cruel and cutting, my gut feeling is that you will see more prescription “happy drug” uptake amongst the working class, but I don’t have any handy stats. How’s your quickdraw Don? Got a breakdown-by-class on prescription psychoactive’s?

Tel_
Tel_
12 years ago

… all lefties are intolerant …

The false dichotomy of left v right long ago ceased to be meaningful amongst the very broad consensus that those bastards over there are intolerant whilst we over here are quite rationally selective given we have such high standards and all.

Don Arthur
Don Arthur
12 years ago

Tel – How about this:

Total antidepressant utilisation increased with age. Among those aged 15 years, female utilisation was about double that of males. About half of antidepressant utilisation was accounted for by sertraline, venlafaxine, citalopram, and paroxetine. SES differentials in antidepressant utilisation changed across age groups for males and females: among those aged 19 years, total antidepressant utilisation was significantly less in lower SES groups (P < 0.001); there was no relationship to SES among 2029-year-olds; and among those aged 30 years, antidepressant utilisation was significantly higher in lower SES groups (P < 0.001). SES differences were attenuated after adjusting for urban or rural residence, but remained statistically significant. Antidepressant utilisation rates were highest in regional centres.

Don Arthur
Don Arthur
12 years ago

Jacques – Yes. My guess is that antidepressant use in children and teens is influenced by parents’ awareness of a problem and efforts to seek treatment.

I think Tel is on the right track. Depression and anxiety disorders are more common among people who are at the bottom of the socioeconomic heap. There’s a clear socioeconomic gradient in health generally.

There’s some evidence that economic circumstances adversely affect mental health (eg this US study).

In Australia, Peter Butterworth has looked at the prevalence mental disorders among income support recipients. He found high levels of depression and anxiety disorders among unpartnered women with children.