Intolerance to food can be just as onerous as an allergy
Food intolerances, allergies and celiac disease are topics that come up frequently both in patient visits and in conversations with my friends.
One friend is lactose intolerant, and although she carries a digestive aid with her, she still avoids eating dairy. When I go out to eat with her she often asks servers if there is “hidden” dairy (cheese sprinkled on a salad or butter on a sandwich) in an item.
Frequently, the server says, “Oh, you’re allergic to milk?” The answer is that she is not, but it is difficult for her to explain.
So what is the difference between food intolerance and food allergy?
With food intolerance, your digestive system is irritated by a particular food or cannot digest the food correctly. Lactose intolerance is the most common food intolerance, but people can also have intolerance to soy, alcohol, fructose and disaccharide.
Most food intolerances can cause nausea, stomach pain, cramps, bloating, vomiting, heartburn, diarrhea and headache.
With food allergy, your immune system reacts to a protein or other component of the food, creating antibodies to fight it.
Peanut allergy is probably the one we hear about the most. Other common food allergies include fish, shellfish, tree nuts, milk, eggs, soy and wheat.
Food allergies can cause rash, hives, stomach pain, diarrhea, itchy skin and anaphylaxis, which is a life-threatening allergic reaction resulting in a drop in blood pressure, swelling of the airways and swelling around the face and throat.
Celiac disease is different from food intolerance since it also involves a reaction by the immune system and can lead to malnutrition from lack of nutrient absorption when the dietary restrictions on gluten are ignored.
You should be aware of cross-reactivity for food allergies. Similar foods may trigger an allergic reaction; if you cannot eat shrimp, avoid crab, lobster and crayfish, too. If you are allergic to rubber, then foods related to the rubber plant, such as kiwi, melon and banana, may also cause reactions.
You might have noticed that some of the foods listed and some of the symptoms are the same for intolerance and allergy, and wonder if there really is a difference.
Sometimes with intolerance, you can eat a little bit of the food without it bothering you, especially if you have it with other foods. And usually, the more you eat of the food, the more symptoms you have.
If you have food allergy, you can have a reaction to even a tiny amount of the food and it happens every time.
Depending on the severity of your food intolerance, you may need to limit how much of that food you eat or you may need to avoid it entirely. If you have lactose intolerance you can use a digestive aid and buy specially treated milk to reduce symptoms.
You need to avoid the particular food altogether when you have a food allergy or celiac disease. Your initial reaction may be mild, but there is no way to know if it will be more severe the next time.
For many food allergies it is recommended that you carry a syringe of epinephrine at all times in case of exposure. I also suggest wearing a medical alert bracelet with information about your food allergy.
Diagnosing food intolerance or food allergy can be tricky. Keeping a food diary can help you figure out if your symptoms and foods are related.
Your health care provider may also use your patient history, an elimination diet, and blood or other tests to aid the diagnosis.
It is not easy to become accustomed to limiting your foods, especially if you must avoid something you enjoy.
My lactose intolerant friend has become adept at substituting ingredients in her favorite recipes. Her cookies are just as good without the butter since she found butter-flavored Crisco.
She has learned a few things along the way: instant pudding does not set when you make it with soy milk, but it does with lactose-free milk; soy cheese is much better now than it was 10 years ago; and it is always worth your time to ask the server about ingredients in your meal choice before you order.