Are foods the cause of your digestive issues? Explaining food reactivity
Digestive issues? Reactive foods may or may not be the cause.
There is a spectrum of reactivity to different foods; intolerance, allergy and sensitivity are terms often used interchangeably but actually refer to different reactions and processes happening within the body, some of which can be changeable depending on the cause.
This is one of the most serious food reactions in terms of chronic effects. The immune system becomes activated by the presence of food molecules, most commonly Celiac’s disease where gluten and gliadin found in various grains and processed food products are responsible for the reaction. As the immune system is activated, it attacks intestinal cells and can often affect other parts of the body including joints and the thyroid. As an autoimmune disease, meaning the immune system mistakenly attacks ourselves, we may see other types of autoimmune diseases present including Type 1 diabetes, Rheumatoid arthritis and Hashimoto’s (autoimmune) thyroiditis. This is a genetic and permanent reaction to these types foods/molecules and strict avoidance is necessary. Having Celiac’s disease, it is important to not only avoid foods containing gluten & gliadin, but watch for cross-contamination (cooking tools & kitchen surfaces) as well as non-nutritional exposure including cosmetics and body care products (yes, even your shampoo could be worsening your condition). Any exposure can have a lasting impact on the body for months at a time.
The gold standard of testing is an intestinal biopsy, where a sample of cells are removed and tested for the disease. There are blood tests that can test for immune system activation (auto-antibodies) as well as genetic testing, but can be less reliable or non-specific to Celiac’s disease.
Celiac’s disease can present differently— as many as 50% of people won’t experience digestive symptoms. Clinically, we may discover presence of the disease because of nutrient absorption issues (including iron deficiency), difficulties conceiving, or losing patches of hair.
The most common example of an intolerance is lactose-intolerance. In these cases, the cause is genetic and the body lacks the enzyme necessary to break down lactose, a type of sugar in milk and other dairy products. When this sugar isn’t properly broken down, it will ferment in the gut creating unwanted, smelly and embarrassing gas, bloating, stomach or intestinal discomfort/pain, often immediate diarrhea, and can wreak havoc on your gut flora (bacteria naturally present in your gut). This type of food reaction is usually quite obvious and immediate, making it easier to identify than other types. There are tests for lactose intolerance including genetic testing, or rather unpleasant lactose intolerance tests that require you to drink a lactose solution and test either your breath or blood for reaction.
Individuals with lactose intolerance do best avoiding lactose, including lactose-free dairy products or dairy alternatives. One can use digestive enzymes/medications that include lactase, the enzyme responsible for breaking down lactose that their body doesn’t make. Sometimes these enzymes aren’t effective if there are other digestive issues occurring, or the lactose-intolerance has been misdiagnosed.
ALLERGIES & Sensitivities
There are different types of food allergies based on the part of the immune system the foods activate.
With allergies and sensitivities, the immune system creates an antibody, an immune protein that will react when the food is present. We can test for different antibodies to understand how the immune system is reacting.
When most people think of food allergies, we think of severe peanut or shellfish allergies. This is called a type 1 allergy (IgE), where there is an immediate, and potentially life-threatening, reaction. Lesser reactions can come out in hives, puffy face and eyes, and itchy mouth (often called oral allergy syndrome) and can be kept under control by anti-histamine medication such as benadryl. More severe reactions called anaphylaxis can exhibit the above symptoms, but include throat swelling and airway interference that will prevent breathing. These are serious allergies where the food must be avoided and it’s advised that an Epipen is on-person in the event of exposure.
Another type of food allergy, often called a food sensitivity, is a delayed onset immune reaction (IgG). The food culprits are often harder to identify because of this time delay, and you may think a food you ingested for lunch is an issue when you’re actually reacting to the eggs you had for breakfast.
You can do IgE and IgG testing for these different types of food allergies. It is important to know that different factors can affect these results, so it’s pertinent to discuss if testing would be beneficial for you with a qualified healthcare practitioner.
You may get a false negative if you’ve avoided eating these foods for some time; it’s good to be prepared for that possibility and assess if consuming the dairy (that you know gives you horrible stomach aches and joint pain) before you do the test if worth having that positive result or not.
If you’ve taken pain medication, acid blockers, or immune suppressants before the test (PPI, anti-histamines, steroids) this will lower the activity of immune cells and affect your results, again with potential false negatives.
We can also get false negatives if you aren’t making enough immune proteins.
When we do food sensitivity testing, sometimes results will come back where EVERY food flags, especially the foods you eat most commonly. This could be for a couple reasons: “leaky gut” is present, or you have an issue with your stress hormone, cortisol, that makes more immune proteins.
Just like some doctors say that you “grow out” of an allergy, these can be, to a degree, changeable. After identifying reactive foods, it’s optimal to avoid these foods while addressing the root cause of the reactivity.
Food allergies come from a number of different causes including:
Culture & genetics including your mother’s exposure during her pregnancy
Food introduction & establishment of the digestive system
Immune system development/activation including latent or active infections/”dysbiosis”
Decreased food quality including modification and poor farming practices
Improper cooking/processing of foods
Digestive inflammation and/or “leaky gut”
This is why identifying food allergies/sensitivities is only ONE part of the puzzle. It’s not just the what, it’s the WHY you react to these foods.
Even if there isn’t an immune reaction to foods, if there are other underlying causes to your digestive woes some foods could make you feel worse.
Issues any time you eat something fatty? Pain any time you eat red meat? Gassy any time you have onions or Brussels sprouts? Avocados don’t sit well? Fruit makes you feel bloated?
Each of these food triggers suggest certain conditions and causes to a skilled practitioner. That’s why a comprehensive history taking is important.
Additionally, while they may not be an allergy or sensitivity, there are foods that are known to cause inflammation including sugar, alcohol, dairy, gluten, red meat, corn, legumes, and nightshade foods.
And then there's the foods that just don't agree with us.
Sometimes this can be foods that that don’t serve your constitution from a traditional food systems approach such as Ayurveda or Traditional Chinese Medicine. This is another nuance of personalized medicine and identifying the best nutrition for YOU.
My approach to nutrition is not about “demonizing” certain foods, or inflicting shame or guilt on food choices. I address digestive issues and create resilience within your digestive system while emphasizing foods that serve you, bringing fun, flirtation and flavour to your eating habits.
Food is medicine. Our relationship with food, with how we feed our soul, is just as important as what we feed our body.
♥ Dr. B.