Food Allergies and Food Intolerances
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Does the word “food allergy” trigger images of hives, stomach cramps, and vomiting? How about food intolerance? Again, most people immediately think of skin and digestive issues. While it’s true both can occur upon exposure to offending foods, some symptoms of food allergies and intolerances can be more subtle—especially when it comes to a food intolerance.
In a food allergy, the body mistakes an ingredient in food—usually a protein—as harmful. In response, the immune system produces a protein called Immunoglobulin E (IgE)—an antibody—to fight it. These antibodies attach to cells in the skin, lungs and gastrointestinal tract, causing any number of the following symptoms:
- Hives, rash, or itching
- Wheezing or shortness of breath
- Chest pain
- Nausea or vomiting
- Cramping/stomach pain
You’ve probably also heard of more severe reactions to food (i.e. peanuts) where the allergen causes a potentially life-threatening reaction called anaphylaxis.
The most common food allergies include: fish, shellfish, tree nuts, eggs, peanuts, wheat, soy, and cow’s milk.
Those with diagnosed food allergies are advised to avoid the offending food completely, as symptoms can be triggered by even a small amount of the food and will occur every time it is eaten.
More common than food allergies, food intolerances are a digestive response to a food rather than an immune response. They are thought to be caused by enzyme deficiencies, impaired food absorption, and other gastrointestinal issues.
Potential symptoms of a food intolerance include: nausea, vomiting, respiratory problems, brain fog, and skin conditions (i.e. eczema).
Unlike food allergies, those with food intolerances may not have symptoms unless they eat a large portion of the food or if they eat it frequently. Because of this, some people may choose to continue eating the problem food, rationalizing it with statements like:
“It’s just a little digestive upset—I’m willing to pay the price.”
The problem here is this: if left unmanaged, food intolerances can increase the risk of developing neurological disorders and autoimmune disease—a condition where the body essentially attacks itself. Two examples of autoimmune disease are inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and psoriasis.
So you see, just like food allergies, intolerances can be equally (if not more) detrimental to long-term health.
4 Common food intolerances
The four most common food intolerances are:
- Celiac disease
- Non-Celiac Gluten Sensitivity
- FODMAP intolerance
- Lactose intolerance
Celiac disease is an inherited autoimmune disorder affecting the digestive process of the small intestine. When a gluten-containing food is eaten, the immune system launches an attack against the gluten, mistakenly damaging healthy cells lining the small intestine in the process. Gluten is a protein found in wheat, rye and barley.
Contrary to popular belief, Celiac disease is not the same as a wheat allergy. Remember, a food allergy triggers the immune system to overreact to a particular food, causing potentially serious side effects shortly after ingestion. A food allergy is an immune reaction…not an autoimmune reaction.
Managing celiac disease:
A lifelong gluten-free diet is the only known treatment for this condition because as long as gluten is consumed, damage to the digestive system will continue to occur. Serious side effects can include:
- Nutrient malabsorption
- Unexplained iron-deficiency anemia
- Diarrhea, gas, or abdominal pain
- Chronic fatigue
- Brain fog
- Migraines or seizures
- Bone/joint pain
- Osteoporosis or osteopenia (bone loss)
- Tingling in the hands or feet
- Depression or anxiety
It’s important to note that many patients with celiac disease have no GI symptoms and may not even know they have it. This “silent” form of the disease is far from harmless and is associated with higher rates of iron-deficiency anemia, osteoporosis, and neurological symptoms.
Non-Celiac Gluten Sensitivity (NCGS)
Non-celiac gluten sensitivity—also known as gluten sensitivity—is neither an allergic nor autoimmune response. Symptoms often overlap with those of celiac disease and improve when gluten is eliminated from the diet. The difference is, the individual doesn’t test positive for the disease.
Just like celiac disease, the only treatment for NCGS is the complete removal of gluten from the diet.
For more information on celiac disease and NCGS, please visit the Celiac Disease Foundation at: www.celiac.org
Gluten sensitivity can be confused with an intolerance to FODMAPs, which stands for: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are all carbohydrates found in common foods besides wheat, barley and rye.
- High-fructose fruits such as: apples, dried fruit, watermelon, peaches, pears
- Vegetables such as: garlic, onions, asparagus, Brussels sprouts, cauliflower
- Beans such as: black, kidney, lima, soy
- Dairy products such as: cow, sheep, and goat’s milk, yogurt, ice cream, cream cheese
- Sweeteners such as: agave, high fructose corn syrup, honey, sugar alcohols (i.e. sorbitol and xylitol)
In FODMAP intolerance, the GI tract isn’t fully digesting and absorbing these carbohydrates. In some cases, the carbs become fermented by pathogenic bacteria in the small intestine. Excessive gas, abdominal pain, inconsistent or excessive bowel movements occur as a result, allowing for an increase of uncontrolled gut bacteria. This is often referred to as small intestinal bacterial overgrowth, or SIBO.
In other cases, individuals may lack adequate enzymes to break down and absorb the fermentable sugars.
Managing FODMAP intolerance:
Along with a low FODMAP diet, addressing intestinal bacterial overgrowth and imbalance is key. A popular dietary treatment to help heal the gut is the GAPS diet. This plan eliminates difficult-to-digest foods that may damage the gut flora, and replaces them with nutrient-rich, gut-healthy foods.
For more information on FODMAPs, please visit: www.monashfodmap.com
Also known as “milk sugar”, lactose is the carbohydrate-portion of animal-based dairy products such as milk, yogurt, ice cream and cheese. Individuals who are lactose intolerant, have trouble digesting lactose due to a decrease in production and/or functionality of the enzyme lactase. Side-effects can include:
- Stomach pain
Lactose intolerance tends to run in families, but can also be the result of intestinal damage caused by certain health conditions or treatments, such as celiac disease, certain cancer treatments, and gastrointestinal surgery.
Managing lactose intolerance:
Most people with lactose intolerance can handle small amounts of lactose, and may even be able to enjoy yogurt, kefir, butter, and hard cheeses, such as cheddar or Swiss in moderation, without experiencing any symptoms. However, it is probably best to minimize dairy products and consider replacing them with plant-based options like almond milk, coconut yogurt, cashew-based cheese, and coconut butter.
Start by improving gut health
In many cases, your food intolerance may be due to compromised gut health, a condition caused by improper digestion and/or food molecules making their way past the gut lining—something they should not be able to do.
Here are some suggestions you may wish to consider to help support the health of your gut:
- Get tested and treated for intestinal pathogens or SIBO (small intestinal bacterial overgrowth). The goal here is to reestablish a healthy gut flora.
- Eat fermented foods like raw sauerkraut and kombucha—they are wonderful sources of gut-friendly bacteria, called “probiotics”.
- Consider taking a probiotic supplement.
- Enjoy foods rich in fermentable fiber—known as “prebiotics”. These foods act like fertilizer for healthy bacteria and can be even more effective than probiotics at improving gut health. Prebiotic foods include: asparagus, Jerusalem artichokes, onions, garlic, leeks, jicama, seeds, unripe/green bananas, plantains, cooked and cooled parboiled rice, cooked and cooled potatoes, and soaked or sprouted legumes that have been cooked and cooled.
- Drink bone broth! The gelatin, glycine, and glutamine in bone broth all have beneficial effects for the gut.
Detecting food allergies and intolerances
Keeping a food diary
If you suspect a food allergy or intolerance, keeping a food diary can be an extremely helpful way to map your symptoms and pinpoint any potential culprits. To keep a food diary, open up a fresh notebook and record the following information for one full week:
- All foods and liquids consumed (include type of food and brand name)
- Amount of food or liquid consumed
- Time food or liquid is eaten
- Time symptoms begin (if applicable)
- Symptoms and remarks (including symptom description, how long it lasted, and any medications)
Possible symptoms to look out for:
Hives, itching, rash, trouble swallowing, nausea, vomiting, diarrhea, stomach pain/cramping, stuffy nose, runny nose, itchy throat, coughing, wheezing, trouble breathing, shortness of breath, chest pain/tightness, irritability, fatigue, faintness, dizziness, headache, anxiety, brain fog, lethargy, seizures
Although food allergy testing can be beneficial, an allergist or immunologist will likely request that you keep a food diary first (assuming the allergy isn’t life-threatening of course!). If a problem food is suspected, you may be sent for a formal allergy test to confirm and identify any other allergies. This could be a combination of blood tests and “skin scratch” tests.
It’s important to note that food intolerances will not show up on standard allergy tests, but that doesn’t mean your symptoms aren’t real.
Potential food intolerances can be measured using antibody-based tests called IgA and IgG. There is some controversy surrounding these tests, however, food exclusion diets based on these results have been shown to offer relief from conditions like ulcerative colitis, migraines, and skin disorders.
With detailed food diary in hand, the next step is an elimination diet—the gold standard for identifying a potential food allergy or intolerance. It involves removing foods from your diet that you suspect your body can’t tolerate.
Next comes the “oral challenge”. This is where you eat the eliminated food(s) one by one after a period of avoidance to determine your reaction.
Temporary withdrawal symptoms may occur when you stop eating a problem food. If this is the case, you may have to follow an elimination diet for two weeks or so before the symptoms clear up and you’re ready to start testing foods in an oral challenge.
To reduce the guesswork as to which foods are problematic—and to help guide your elimination diet—some practitioners will test for food intolerances first.
Following an elimination diet requires commitment, careful record-keeping, and paying attention to your body. This is why I recommend enlisting the help of a qualified practitioner. They can also help you navigate confusing food labels and offer reasonable substitutions.
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