From the Desk of Carolyn Dean MD ND
We are well into this season of preparing, indulging in, and sharing foods, and I know that while you were planning your Thanksgiving feast with invited guests, you had to take into account what people “can” eat. So instead of putting whatever you wanted on the table, you had to consider that the cousin you invited can’t eat wheat anymore, or somebody’s new partner has food allergies. It’s difficult to navigate that menu and it may be a little frustrating to do so when you’ve not been given a lot of information about these new food rules. I’m going to sort through some of this for you, starting with what you might find if you go online which really won’t illuminate things for you.
What Dr. Google might say about food allergies and intolerances
Food Allergy
Dr. Google does take food allergies seriously as it’s considered a medical condition involving an immune response to something your system considers to be harmful, but it focuses on acute reactions. Such an allergy can invoke one or more of number of reactions within two hours of ingesting even tiny amounts:
Skin – hives, rash, eczema, itching
Breathing – shortness of breath, wheezing coughing
Digestive – pain, vomiting, diarrhea
Nasal – sneezing, itchy nose, runny nose
In severe cases, anaphylaxis
Most common food allergies
Nuts and seeds, especially peanuts and sesame
Fish, including shellfish
Gluten grains – Wheat, rye, and barley
Milk
Eggs
Soy
Dr. Google might suggest medical testing
You might be referred to an allergy specialist who can conduct allergy skin tests where a small amount of the allergen is scratched into your skin to see if there is a reaction. Blood tests might show that you have antibodies for certain allergens. A supervised food challenge test will monitor reactions to ingested foods.
Depending on the severity of your reaction, you may be prescribed an Epi Pen (containing epinepherine) to halt an anaphylactic reaction, but you will simply be told to avoid the offending allergen.
Food Intolerance
What Dr. Google might say about food intolerance
Dr. Google, and the medical field are typically intolerant of food intolerance and liken it to food sensitivity in a tone that minimizes their impact on a person’s wellbeing. It’s not acute and hard to diagnose and medicine would rather just ignore it but they do have to accept lactose intolerance and gluten intolerance. The symptoms are said to be mostly gastric because the stomach has difficulty digesting certain foods, but the symptoms can actually be body-wide.
If lactose intolerance is suspected, you may have a hydrogen breath test but there are no tests for gluten intolerance. You have to graduate into celiac disease, gluten enteropathy to be properly tested for that condition.
What I say about food allergies and intolerances
First, I’m going to clear up confusion about the terms used to describe how we respond to food. These terms are often used interchangeably and are particularly confusing when someone with a particular food reaction is trying to explain why they won’t indulge in the cheesy pizza. Somebody might use the term allergy so that people will take their food intolerance more seriously. But the misuse of terms has led to misunderstanding and dismissal around many a Thanksgiving table.
Allergy, intolerance or sensitivity
In short, the medical community defines food allergy as a reaction to foods involving a specific immune system response that can often be measured with blood tests or skin tests. Food intolerance is generally used to describe a physical reaction to lactose (milk sugar) or to gluten (a protein in wheat), which can be measured by breath tests after the food is eaten. Food sensitivity is not a medical term and is difficult to define scientifically, but most doctors agree that it usually involves an inability to break down and digest a food, which results in gas and bloating and can be mistaken for a food allergy or intolerance. The gas and bloating may not be entirely due to the food but may come from organisms that feed on the undigested food particles. More widespread symptoms may come from the incompletely digested food being absorbed through a leaky gut causing those body-wide symptoms I mentioned.
Food allergy
Many people use the word allergy whenever they notice that their bodies react badly to certain foods. But the medical community is much pickier about how it uses the term. It relies on seeing an immediate, and specific type of reaction, such as hives, asthma, shortness of breath, or swelling, and on finding a certain level of immune cells or antibodies on blood tests.
Medically, the term allergy is usually limited to those conditions in which there is an immune reaction on a skin test or blood immunoglobulin E (IgE) antibody test. Your body thinks a particular food is harmful and sets up a massive outpouring of histamines and other chemicals to try to wash it out of your system. IgE food allergy reactions tend to occur within a few hours of ingesting an offending food.
With some food reactions, diarrhea serves to flush out the offending substance. The clue to identifying a food allergy as the culprit for diarrhea is the presence of other histamine collateral damage like hives, asthma, eczema, and nasal discharge. If you have a double or triple whammy of symptoms after eating certain foods, the simple solution is to give them a pass at the dinner table.
The most common forms of IgE-mediated food allergens, which doctors believe are true food allergies, are shellfish, nuts, and strawberries. IgE-mediated food allergies, however, are fairly rare. Fewer than 5 percent of all children and 1 percent of adults have these actual food allergies. My dad had an allergy to strawberries, and we would watch as hives popped up all over him. But his allergy wasn’t life threatening, and it certainly didn’t stop him from eating strawberries! There was calamine lotion everywhere!
Integrative medicine practitioners define food allergies slightly differently from your typical MD practitioners. That’s because we recognize that it’s possible to have a delayed food allergy – one that’s mediated by a cousin of IgE, the IgG antibodies. Such a reaction could take up to 48 hours to appear making it very hard to allocate blame.
Because it is next to impossible to remember what you ate two days ago, integrative medicine practitioners either ask you to keep a food diary or order blood allergy tests and have patients remove the foods that seem to cause reactions or have high IgG levels. There is mounting clinical evidence that high levels of IgG antibodies in particular foods are associated with IBS, and removing those offending foods decreases IgG antibodies and IBS symptoms.
Common foods with high IgG levels are dairy products, wheat, soy, and corn. These foods turn up so often on allergy tests that many practitioners simply recommend that you avoid these foods for 3 weeks and then do a challenge of each individual food and wait 48 hours to see if you react. Hey, guess what? You’re doing your own clinical trial! N is the number of people in a trial – so you have a trial of N=1.
Food intolerance
The medical definition of food intolerance typically references lactose and gluten. These two conditions, lactose intolerance and gluten intolerance, are usually inherited but can be acquired, and they involve a deficiency of the enzymes needed to break down these foods. These two conditions are quite often mistaken for IBS. Although not as well-defined, fructose intolerance also affects some individuals. (Fructose is the sugar found in fruit.)
Note: Fructose intolerance may follow a gastrointestinal infection with diarrhea where the inflammation and irritation of the gut lining removes enzymes that break down fruit sugar. Eating fruit keeps the diarrhea going because the undigested fruit becomes food for the intestinal bacteria and yeast.
So how do you develop a food intolerance? In the case of gluten, the intolerance is genetic and often reveals itself during childhood. But all three types of food intolerances may actually be brought on by a bowel infection like the one I described above.
Some people who suffer bowel infections can end up having symptoms of IBS. That’s because acute episodes of infectious diarrhea, like dysentery, can scrape off layers of cells from the delicate mucus lining of the gut. That lining contains enzymes that digest wheat, dairy, and fruit. The short-term lack of these enzymes causes an “acquired: lactose or gluten intolerance.
In some people, a bowel infection can be severe enough to throw them into genuine lactose intolerance, and/or fructose intolerance. And, if you have the genetic predisposition for gluten intolerance (celiac disease), a gastrointestinal infection may be enough to bring it out of the closet.
To try to prevent future symptoms or food intolerance when you have a gastrointestinal infection due to bacteria or parasites, proactively stop eating wheat, dairy, and fruit because the enzymes to digest these foods have likely been stripped away. Usually, you can go back to eating these foods after your symptoms subside. But you may need some help with probiotics, fermented foods like sauerkraut or yeast overgrowth treatment.
Food sensitivity
Some people who have neither an IgE food allergy nor a diagnosable food intolerance can still find themselves suffering with food reactions. These reactions are usually jumbled up under the heading of food sensitivity.
My husband, Bob used to get a scratchy throat when he ate commercial oranges. But that never occurred when he ate organic ones.
Some foods are just hard to digest and can cause gas and bloating. Cruciferous vegetables are high in sulfur making them a healthy food because sulfur helps the liver sulfation detoxification pathways. However, a big plateful of broccoli, Brussels sprouts, cauliflower, onions, and cabbage can release a lot of sulfur leading to gas and bloating and trigger an episode of IBS. Sulfur foods also produce a very smelly end product.
As noted above, some people react very negatively to pesticides and herbicides found on some foods, or to artificial dyes, colors, sweeteners, and other additives. Some of the worst offenders are aspartame and MSG. Your best defense against food additives is to read labels and not eat anything that you can’t pronounce!
Healthy options for food responses
Avoid the foods that you suspect give you unwanted reactions. If you’re attending festivities, let the host know you have some food challenges and offer to bring “safe” alternatives to the bread-based turkey stuffing on offer.
Please forward this blog to people in your life who are dealing with uncomfortable food responses. Now you’re armed with more information as you plan your next feast and the bottom line is that you can help your guests minimize their discomfort, and avoid spending the holidays in your bathroom!
Carolyn Dean MD ND
The Doctor of the Future.
