Choosing a restaurant for dinner out with family and friends has become increasingly more challenging, considering how many of us have acquired growing lists of foods we can no longer stomach. So, it’s not surprising that the prevalence of food allergy and intolerance is on the rise in urbanized countries, now affecting one in five people.
Health care practitioners often misuse the terms food allergy, intolerance, and sensitivity in conversation, which commonly leads to confusion among patients. Knowing what type of food reaction you’re experiencing is key for making appropriate dietary choices that address the underlying problem and foster overall health long term.
What’s in a name?
Food allergy is a pathological immune reaction against normally harmless proteins in foods, which can be life-threatening. This immune reaction can trigger acute symptoms in the gut, skin, respiratory tract, cardiovascular system, and neurological system.
Common food allergens include dairy, egg, fish, shellfish, tree nuts, peanuts, soy, and wheat.
Food intolerance is a non-immune mediated reaction arising from an insufficiency of enzymes required to break down a specific component of food. This reaction commonly causes gastrointestinal symptoms such as diarrhea.
Common causes of food intolerance include lactose, gluten, FODMAPs (a group of short-chain carbohydrates), additives, and biogenic amines such as histamine. Carbohydrate intolerance is fairly common among children.
A food sensitivity is an adverse reaction to food that is not related to food allergy, food intolerance, or celiac disease. Research suggests these reactions may be immune mediated and commonly recruit IgG immunoglobulins.
Food sensitivities can cause digestive issues in addition to widespread symptoms such as chronic joint pain, fatigue, rash, and brain fog. If you’re dealing with chronic health concerns, it may be beneficial to investigate unidentified food sensitivities.
In contrast to fast-acting food allergy, food sensitivity reactions may be delayed hours to days after eating the problematic food. To complicate matters further, reactions may not occur every time you eat the food.
Diagnosis and management
Begin by asking your family doctor for a referral to an allergist, which will allow you to pursue allergy testing. Skin prick tests and blood tests are commonly used to identify IgE immunoglobulin mediated food allergy. Food allergy is best managed with complete avoidance and emergency medication.
If your allergy testing comes back normal, then you might want to consider intolerance or sensitivity as the cause of your symptoms. While testing options may include hydrogen breath testing for lactose intolerance and blood testing for IgG food sensitivities, Harvard Health considers the elimination diet to be the gold standard for identifying problematic foods.
Speak with a naturopathic doctor or nutritionist for support during an elimination diet and how to implement new dietary habits to accommodate food intolerance and sensitivity. Ask about natural supports for gut healing using minerals, amino acids, and herbs.
Take heart in the knowledge that with proper management, food sensitivities commonly fade over time.
Elimination diet how-to
This diagnostic tool involves a brief elimination of common food culprits, followed by a food reintroduction phase. With careful experimentation and observation, it is possible to identify which foods are causing your symptoms.
Foods that are commonly removed during the elimination phase include dairy, eggs, wheat, sugar, soy, potato, tomato, corn, strawberries, and nuts. You should also eliminate any food that you suspect may be causing your symptoms.
Before starting your elimination diet, speak with your natural health practitioner for ideas on how to make meals and snacks without your staples. Ultimately, we want to encourage compliance while maintaining satiety and avoiding nutrient deficiency. Ask your practitioner about hidden sources of common food sensitivities, which can sneakily reduce the effectiveness of the elimination phase.
The general guideline is to maintain a symptom-free state for two to four weeks before the reintroduction phase. This promotes a clear baseline for symptom observation.
Reintroduce a single food at a time, and have a couple of servings per day for a few days in a row. To test dairy, for instance, you could have cheese, unsweetened yogurt, and milk on back-to-back days.
Observe whether this food reintroduction triggers your symptoms. If it does, then it’s a problematic food that is best kept out of your regular diet. Stop eating it, and wait until your symptoms clear before reintroducing the next food on your list.
If the food doesn’t cause any symptoms, then you can keep eating that food and proceed to testing the next. Continue until you’ve reintroduced all the foods you’d eliminated.
Dos for dining out
- Learn hidden sources of your food allergen (sauces, oils) and common sources of cross-contamination (deep-fried foods).
- Choose a restaurant that uses whole, rather than processed, foods.
- Call the restaurant ahead and ask if they have an allergy-friendly menu.
- Tell your server about your concerns and ask for recommendations.
- Order a simple meal with a small list of ingredients.
- Bring reinforcements in case of allergen exposure, whether that’s an epinephrine autoinjector (EpiPen), digestive enzymes, or peppermint tea.
Embracing new food habits
- Google common alternatives to your favorite foods.
- Borrow allergen-free cookbooks from the library.
- Prep meals on Sundays for a smooth work week.
- Involve the family in cooking dinner.
- Challenge your friends to try new cuisines and restaurants that cater to your needs.
This article was originally published in the January 2024 issue of delicious living magazine.