Have you ever wondered if your food might be having a less than obvious affect on your health? Have you had a suspicion that your body might be having a negative reaction to something you ate, and you aren't sure how to be certain. In recent years, there have been countless references to food allergies, food reactions, food intolerances, and a big discussion around gluten sensitivities and celiac disease. What does it all mean?! Are they all the same?
Do we have more food allergies all of the sudden? And if there aren't more people with celiac disease like the experts say, then why do my friends that avoid gluten say they feel so much better? I would like to shed some light on this confusing epidemic. And, although I do not expect this to be a comprehensive lesson in immunology and nutrition, I hope it clears up the common terms used surrounding food reactions.
Food Allergies
As a primary care provider, I have frequently had patients request allergy testing or a referral to an allergist "because I want to find out what foods I'm allergic to". It's a very common request. If you have a severe food allergy (an IgE immune mediated response, in scientific terms), you know it. Your throat might swell up, have difficulty breathing, hives, tongue swelling or a similarly awful reaction. Symptoms occur very soon after exposure to the food. Peanuts and shellfish are common food allergies, and these reactions are usually to a protein or fruit. Sufferers carry an EpiPen for accidental exposure. If you have a food allergy, you should not eat the food you are allergic to. This is what distinguishes food allergies from food sensitivities (AKA food reactions). You can eat a food you have an sensitivity to, if you don't mind the consequences. More commonly, my patients have suffered from food sensitivities, but they are often less obvious than true allergies.
Food Sensitivities
Food sensitivities (an IgG response) are more common than you may think. They happen when our body confuses a food with an actual threat, and develops an immune response to it. Food sensitivities are often at play in of a myriad of health conditions from rheumatoid arthritis, psoriasis, and asthma, to anxiety, depression, and ADHD.
Food sensitivities are a dicey subject in the mainstream medical community. In the past four years as a primary care provider, I have seen only one allergist recommend a patient avoid dairy for a dairy sensitivity while treating their seasonal allergies and asthma. I personally have had dozens of patients stop dairy and had chronic conditions clear up, but what do I know?! I asked an allergist recently what he tells patients about food sensitivities when then don't have a true IgE-mediated allergy to any foods, and he rolled his eyes and laughed. But I KNOW that my patients get better when they avoid a food they have a sensitivity to. So you can go on eating eggs if you have an egg sensitivity, but you will continue to have the reaction all the same. I'm certain its more bearable than throat swelling and difficulty breathing with a peanut allergy, but a food sensitivity is not going away on its own.
Food Intolerance
With more rapid onset than a food sensitivity, a food intolerance is a difficulty breaking down the components of a food. In the case of lactose intolerance, the lactose in milk is not digestible as those affected lack the lactase enzyme needed to break down lactose, and the body has a rapid reaction to get it out quickly. This often manifests as bloating, abdominal cramping, and diarrhea. Compared to a food allergy, you could drink milk with every meal and eat ice cream for the rest of your life with lactose intolerance, but I do hope there is a bathroom nearby.
Celiac Disease
Celiac disease is an enhanced immune response to gliadin (the alcohol- soluble portion of gluten. Gluten is a component of grain, especially wheat. This abnormal immune response leads to local inflammation to the gut lining, and the highly absorptive part of our intestines atrophies. This leads to decreased surface area for absorption, and people suffering from celiac disease have a decreased capacity to absorb nutrients and often experience diarrhea, fatigue, bloating, weight loss, and excessive flatulence, yet some people are asymptomatic. People with celiac disease can continue to eat gluten, but they will continue to suffer from these symptoms and decreased absorption of nutrients, which often leads to further complications over time. Celiac disease is most common in women from European decent, and is estimated to occur in 0.3-1% of the US population.
Gluten Sensitivity
In the past decade or so, eliminating gluten from the diet has become a trend in the US. Many people find their symptoms resolve, and assume they have celiac disease. Yet when they are tested for celiac disease with blood work, it is found to not be the case. This is considered a food sensitivity, as we discussed above. The body has identified the gluten to be an invader, and has mounted an immune reaction to it. It does not cause the atrophy of the small intestines that is the hallmark of celiac disease. Gluten sensitivity may cause abdominal bloating, cramping, abnormal bowel movements, but it may also contribute to a host of other conditions as we reviewed above regarding food sensitivities such as a thyroid condition, rheumatoid arthritis, psoriasis, asthma, or a mood disorder.
Interestingly, our food has been found to contain significantly more gluten than it did one hundred years ago, and this is likely the cause of the increase in sensitivities.
Testing Options
Testing is not always indicated to determine which of the above you are suffering from. In the case of lactose intolerance, do you get cramping, abdominal pain, bloating, diarrhea, and excessive gas fairly soon after eating ice cream, drinking milk, a slice of pizza, or other dairy rich meals? Yes? Does it happen when you don't have dairy? No? You have a lactose intolerance.
Food allergies are straightforward as well. If your throat swells up after eating peanuts, you have a peanut allergy. I would skip eating them, and go get an epi-pen or discuss other treatment options with your primary care provider or allergist. You can get formal testing to determine any IgE mediated reactions.
You can order testing online to check for food sensitivities. I do not recommend this. The majority of this testing has not been perfected, and can just as easily show a false positive to foods you eat frequently and have no true reaction to. I did some of these over the counter tests myself, and one said I was reacting to zucchini- one of my favorite foods! I am so glad I investigated further, and found this to not be the case. I would hate for you to eliminate a healthy food you love simply because these tests have not been sensitized enough. I have managed to find a test to offer through my practice that provides quite reliable results, and it did not show any issues with my beloved zucchini. In my own experience, I have cured my personal health problems by identifying food reactions. In my functional medicine practice, I guide my clients through the process of identifying possible food reactions and eliminating them safely and effectively in conjunction with other measures to restore optimal health. This has led to true healing, eliminating unnecessary suffering or the need for chronic medications with a host of their own side effects.