These days it seems very common for people to get various symptoms from the foods they eat.  Food is actually quite complex containing similar food components in different foods. It is important to know whether it is a case of food intolerance, food allergy or Coeliac Disease as all differ from each other and have different dietary management.

 

So, let’s get a better understanding of what the three conditions are.

 

 

Coeliac Disease

Coeliac Disease is an autoimmune condition that often presents as gut symptoms such as bloating, diarrhoea or nutrient malabsorption such as iron deficiency with associated symptoms (poor concentration, fatigue, poor sleep).

 

In the case of Coeliac Disease, gluten (a protein found in wheat, rye, barley and oats) causes damage to the small bowel. This is why food labelling laws in Australia state that any food product containing gluten must have it declared on the label.

 

It is essential if Coeliac disease is suspected that tests are done with adequate amounts of gluten in the diet to confirm or rule it out before making any dietary modifications.  Consuming about 1-2 serves of wheat-based foods daily for 6 weeks is required for accurate test results. More information about Coeliac Disease and its diagnosis can be found at http://www.coeliac.org.au/.

 

The management of Coeliac disease is a strict gluten-free diet.

 

Food Allergy

The word ‘allergy’ gets thrown around a lot, usually in substitution for the word ‘reaction.’  However, not all reactions are allergies. A food allergy is usually (but not always) an immediate reaction to a specific protein in the food. It is the IgE antibodies in one’s immune system over-reacting to something that would usually be considered safe. Reactions can range from mild to life-threatening (anaphylaxis requiring adrenalin treatment).

 

Skin prick tests or RAST blood tests can indicate the likelihood of allergy.    An Allergy Doctor (e.g. immunologist) is usually required to interpret the results with knowledge of a detailed history and identify the likely cause of the symptoms or reactions. Information about allergic disease can be found at www.allergy.org.au.   Food labelling laws in Australia require foods common to cause allergic reactions to be declared on the label, such as but not limited to wheat, dairy, soy, egg, tree nuts, peanuts, seafood and fish.

 

The management of food allergies is usually strict avoidance.  But in some cases, such as when children outgrow their allergies, an allergy specialist and Dietitian will advise on how to safely include foods one is allergic to following assessments and tests.

 

Food intolerance

Food Intolerance encompasses several conditions and affects people uniquely in different ways.  Food components a person is intolerant to can be consumed without symptoms depending on their tolerance level, how much is eaten and how often it is eaten.

 

Food Chemical Intolerance

Usually occurs when there is a delayed reaction to one or more natural or artificial food chemicals or components common to many different foods.  People who are sensitive react to more than one chemical, and those really sensitive also react to cow’s milk, soy or wheat.  There is often a strong family history of food intolerance.  There is an extensive range of possible symptoms.  Symptoms can change through different stages of life, and tolerance levels can be affected by stress, hormone changes, infection and inflammation (such as reacting to aeroallergens) in the body. 

 

Food chemical intolerance can affect more than one body system and can look like an allergy.  Some symptoms of food chemical intolerance include but are not limited to:

Skin- eczema, unexplained rashes, hives, itchiness, skin swellings (angioedema).

Gut- mouth ulcers, reflux, IBS, abdominal pain, bloating, excess wind, diarrhoea, constipation.

Respiratory- non-allergic rhinitis or hayfever symptoms.

Central nervous system- fatigue, muscle aches, sleep disturbance, altered mood, poor concentration, hyperactivity, headaches or migraines, anxiety, depression.

 

Unfortunately, there are no reliable medical tests that can identify what food components or chemicals a person is intolerant to.  These food chemicals include wheat, dairy, soy, salicylates, amines, glutamates, and certain additives.  The problem food components can have a build-up effect in the body; symptoms can be delayed for up to 3 days after eating the trigger and can last for up to 3 weeks in people who are very sensitive.  This is why the RPAH Elimination Diet with Challenges is the only best test method to find out what food components are the problem.  After the test diet and challenges are complete, the diet variety is increased, and food chemical tolerance levels can be increased slowly and gradually over time for optimum management of symptoms.

 

Food chemical intolerance is not well known by all health professionals.  It is a very complex area and requires a professional with the specialist knowledge and expertise to make an assessment, rule out other medical conditions and provide the right advice.

 

More information about food Intolerance can be found on the Royal Prince Alfred Hospital Allergy Unit’s Website www.sswahs.nsw.gov.au/RPA/Allergy/default.htm.

 

Lactose Intolerance

Lactose intolerance presents as abdominal pain or discomfort and diarrhoea after consuming dairy products containing lactose.  Limiting lactose in the diet (including the use of lactose-free dairy products) will stop symptoms from occurring.

 

Most people with lactose intolerance can usually manage a serving of lactose-containing milk in food such as cereal, and yoghurt, as the good gut bacteria in the yoghurt often digests the lactose and hard cheese, which is low lactose anyway. 

 

Medical tests for diagnosis can be done but are often not as helpful as dietary testing to assist people in understanding if it is, in fact, lactose that is their trigger and how much and how often they can eat lactose.  Dietary management and monitoring is the best way to avoid unwanted symptoms.

 

It is also important to understand the reason for lactose intolerance, as any damage to the gut will result in lactose intolerance until the gut heals again.

 

FODMAPS Incomplete absorption

FODMAPS stands for Fermentable -Oligo-Di-Mono-saccharides And Polyols. FODMAPS are digested by the microbes in our gut and create gas which is usually reabsorbed by the gut and breathed out.  However, in some individuals, this gas is not reabsorbed from the gut and causes an array of lower gut symptoms such as bloating, distention, pain, diarrhoea and constipation.

 

In everybody’s gut, there is a threshold at which having too many of these FODMAP foods can cause problems.  The FODMAPS diet is promoted as assisting with IBS.  However, it is often the underlying irritation to the nerves of the gut (visceral hypersensitivity) caused by food chemical intolerance that contributes to symptoms, whilst adding gas-producing foods (FODMAPS) tends to further add to the symptoms.  More information about the FODMAPS diet can be found at https://www.monashfodmap.com/about-fodmap-and-ibs/.

 

Other Testing

Many unorthodox tests are available to identify food allergies and intolerances, but the results are often misinterpreted, inaccurate and unreliable. For details, see https://www.allergy.org.au/patients/allergy-testing/allergy-testing.

Whether it is a confirmed case or in the process of diagnosis of Coeliac Disease, food allergy or food intolerance, an experienced Accredited Practising Dietitian (APD) can help in several ways:

• to provide a nutrition assessment by taking a thorough history
• give dietary education on the diet-disease relationship and testing methods for diagnosis
• advise on appropriate dietary modification according to medical advice or evidence-based practice
• to assist with identifying food triggers quickly and accurately
• ensure foods are not avoided unnecessarily, particularly for a long time- ensure nutritional adequacy, preventing deficiencies and chronic disease
• provide ongoing guidance and support with dietary changes.

 

 

Unfortunately, due to so much information at our fingertips these days most people who have decided to change their diet before seeing a Dietitian develop nutritional inadequacies or deficiencies.

 

So, if you or someone you know feel food is a problem, please reach out to get the best help you can from your Dietitian and get back in control of your symptoms and your life.