It’s all so confusing! Is it an allergy, intolerance, or sensitivity?

allergies

Our bodies don’t always like the foods we eat and beverages we drink. I’m sure this is no surprise. What can be confusing, though, are the different types of reactions to food and beverages that our body can produce. Understanding the differences can help figure out what is going on. However, even understanding the differences and labels for those responses can be confusing. There isn’t a standard definition of allergy, intolerance, or sensitivity that is agreed upon in the medical community. The definitions I use below are the ones I use with my clients.

The first type of reaction is a true allergy. With a true food allergy, there is an anaphylactic response. This means the person gets an itchy mouth, closing of the esophagus, swelling of the tongue, etc. These require an immediate response, usually with an EpiPen and a trip to the hospital.

Next, are food intolerances. These are when someone is intolerant to a food it is less serious and typically involves digestive issues. For example, lactose intolerance is a food intolerance. You are missing the enzyme lactase that is needed to break down lactose. Irritable bowel syndrome may be a cause of food intolerances. Stress and psychological can come into play – the thought of food can make you sick.

Food sensitivities are when your immune system releases mediators. There are about 100 different mediators that your immune cells can release in response to a food. Mediators can cause inflammation, edema (water retention), mucus secretion, and pain receptor activation among other symptoms. When you eat a food and your immune system responds by releasing mediators you feel a symptom from that food that may not necessarily seem to be related to the food. Some mediators are linked to migraines. Others to IBS. Others seem to be associated with arthritis and other inflammatory conditions.

There is no “gold standard” for food sensitivity testing. That’s another reason that is confusing. However, that doesn’t mean that food sensitivity testing shouldn’t be a tool you can use to figure out what is causing your problems.

Have you been tested for food sensitivities? If so, post your experience below. I’d be interested in hearing about it. If you’re interested in food sensitivity testing or seeing if it is right for you, you can contact me here.

I’m so confused! Where do I start?

When you’re dealing with digestive issues, figuring out where to start to get your symptoms under control can be overwhelming. There are so many choices and approaches. So much information on the web. A lot of it conflicting. What works for one person may not work for you. All you want is to get well. To get your symptoms under control so you can get your life back.

I’ve been there. As a Registered Dietitian with a PhD in Kinesiology I was so frustrated! Understanding how the body works and how food works in the body is my job! My area of expertise. And, I couldn’t figure out my own symptoms. Once I’d finally had enough, I became obsessed with getting my symptoms under control and my life back.

In my research and training specific to digestive issues I learned about the “5 Rs of Gut Restoration”. The 5 Rs are:

  • Remove
  • Replace
  • Repair
  • Reinoculate
  • Rebalance

The 5Rs have become an integral part of my practice when working with clients who have digestive issues. (If you want more details about the 5Rs, I’ve done a series of blog posts. You can start here with an overview of them). I also created a graphic you can download to get more information about each “R” and how they fit together.

When I use the 5 Rs in my practice I start with the first one – Remove. Why? There is usually one or more foods that are causing problems. And, I want my clients to start getting better NOW! I know when I was dealing with digestive issues, I wanted to feel better NOW.

In the Remove step, there are three basic ways to figure out what needs to be removed:

  1. Food sensitivity testing
  2. Basic elimination diet
  3. Structured elimination diet

All are great places to start. And, they can be used in combination.

Food Sensitivity Testing

Food sensitivity starts when decide which testing to use and send in a blood sample. Let lab analyzes your sample and sends the results to your practitioner. Then, you meet, develop a plan and start on your elimination diet. The main downsides:

  • There’s no gold standard for food sensitivity testing. I use both ALCAT and LEAP in my practice. Food sensitivity testing, regardless of the test used, is not fool-proof. It is a starting place though.
  • It takes time – usually 2 to 4 weeks – before you can start on the plan.
  • It can be expensive. Depending on the type and amount of testing and amount of counseling needed food sensitivity testing can run from a few hundred to a few thousand dollars.

Basic Elimination Diet

When using a basic elimination diet, you choose what food and drinks to eliminate and how long to eliminate them. You could eliminate diary, gluten, eggs, soy, nuts, peanuts alcohol, and other foods you believe may be causing problems for anywhere from a week to a month. Then, you introduce the foods one-by-one to determine which is causing the problems.

  • A basic elimination diet can also be a good place to start. Some of the downsides are:
  • It can be very restrictive and hard to stick to. Depending on what you choose to eliminate it can be difficult, if not impossible, to eat out or at other people’s homes.
  • You may or may not get the foods that are causing the issues eliminated. I’ve known people who did an elimination diet down to, basically, chicken and rice only to find out later that rice is a food that triggers their symptoms.
  • The reintroduction period can be hard. If you’ve been on a strict elimination diet for a couple of weeks to a month, when you get into the challenge/reintroduction phase it’s really easy to go wild and eat everything you’ve been denying yourself.

FODMAPs

Finally, you can use a structured elimination diet like FODMAPs. I’m going to talk specifically about FODMAPs because it was developed by a university (Monash University in Australia) and has been the subject of at least 100 research studies. FODMAPs has been shown to help reduce the symptoms of people with Irritable Bowel Syndrome. In my practice, I’ve found that it helps those who have a broad range of digestive issues.

FODMAPs removes certain sugars from your diet. Specifically, FODMAPs stands for Fermentable Oligo-, Di-, Mono-saccharides And Polyols. These are types of sugars that some people have problems digesting. When doing the FODMAPs diet, you go through an elimination period (one week to a month) of following a diet with little to no FODMAPs. Then, you go through a Challenge Phase where you test out each type of FODMAP in various amounts. This is critical because you may be able to digest one FODMAP but not another, or you may be able to digest a small amount but not a lot. This program allows you to figure out how much of each type of FODMAP you can tolerate without causing symptoms. The Challenge Phase can take 5 to 8 weeks or more, depending on how you choose to do it.

As with any of these approaches, the FODMAP elimination diet has some downsides. These are:

  • Figuring out which protocol to follow. There are a lot of FODMAP resources out on the web. This is good and bad. It’s great to have a lot of information. And, it can also be overwhelming.
  • Finding information that is up-to-date can be a challenge. Given the plethora of information on the web about what is and isn’t FODMAP-safe, a lot of it is out-of-date and requires you double check it with the latest information put out by Monsh University.
  • As with the basic elimination diet, the challenge period can be hard. You need to continue following the FODMAP elimination diet during the challenge phase.
  • It’s common to eat everything you’ve been restricting when you finish the elimination phase and not finish the program. Then, you’re right back where you started.

Where To Start?

With any of these approaches, you should assess how you feel before you start and then several times through the process. If you’d like the form I use with my clients, you can get it here.

In my practice, I usually use a combination of approaches. Typically, I’ll use the FODMAP plan to get people started. Then, we’ll decide whether to do food sensitivity testing. I use this approach because most people with digestive issues who follow the FODMAP plan start feeling better within a few days. And, I’ll use food sensitivity testing to refine the foods they can and can’t have. We can always do food sensitivity testing after we see how they respond to the FODMAP diet.

The difference between food sensitivity testing and FODMAPs is that food sensitivity testing identifies foods that are causing an immune reaction. Food sensitivities cause an immune reaction that isn’t as severe as an anaphylactic reaction, but is still causing your immune system to react. It can be important to get these foods out of your diet in order to reduce inflammation as well as other symptoms including digestive issues, migraines, arthritis, joint aches, muscle aches, etc.

FODMAPs on the other hand are sugars that your body has a hard time digesting. They don’t cause an immune reaction. They can cause digestive issues including gas, bloating, constipation and diarrhea. This is because when they pass into the small intestine they aren’t broken down, usually due to a lack of the enzymes that are needed to break them down. This causes additional fluid to be pulled into the small intestine to dilute these sugars. Then, when the sugars pass into the large intestine (or colon) some of the microbes in your microbiome love to eat them, and eat them quickly. Then, the microbes release gas into your intestines which causes further discomfort. It could be one or more FODMAPs that don’t get along with you. A well designed FODMAP program will help you figure out if it’s one or more FODMAPs that don’t get along well with you and the amounts of the ones you do get along with that you can eat without causing symptoms.

If you’re having digestive issues and are ready to take control of your symptoms, the best place to start is by figuring out what you need to remove. Then, you can move into the other Rs from there.

If you’d like to get started with a FODMAP protocol, here are the FODMAP Resources I use with my clients.