First – what’s the difference between an allergy and an intolerance?
There’s a big difference, says Dr Natalie Direkze, consultant gastroenterologist of OneWelbeck. “A food allergy occurs when the body develops an immune response to a particular food, and this can occur with even tiny amounts of that specific food. An example of this is a nut allergy, when even tiny amounts of nuts can cause a severe, often immediate, immune reaction which can in some cases prove fatal.” A food intolerance, on the other hand, happens when the body struggles to digest a particular food, Natalie explains. “You may get symptoms, but an intolerance is not as severe as an allergy. A person with an intolerance may tolerate small amounts of the food in question with no problem, but larger amounts are more likely to cause symptoms.” The other main difference, says Dr. Shabir Daya, pharmacist and co-founder of Victoria Health, is that the reaction to an allergy is immediate, while food intolerances take longer to manifest. “In some instances, there may be a delayed reaction as long as 48 hours,” he says.
Have food intolerances really increased in recent years?
You’d be forgiven for thinking we’re a nation riddled with food intolerances, with sales of free-from foods having trebled in the last three years. But are intolerances really on the rise? The evidence isn’t so clear-cut, and the experts remain divided. “Levels of food intolerances have increased over the last two decades and this is not simply because we are more aware or better at diagnosing them,” says Shabir. “It’s thought that the reasons behind a rise in intolerances is linked to our lifestyles, diet and environment.” Natalie, however, believes the rise is down to increased awareness around food and increased testing, notably tests to assess the causes of common gut symptoms. “Several reports suggest food intolerances affect less than 2% of British adults, although 20-30% believe they have some form of intolerance,” she says. Nonetheless, it’s not to say intolerances to substances such as gluten don’t exist – studies show around 13% of British adults experience symptoms when they eat gluten-containing foods, yet only 0.8% of the population has been formally diagnosed with coeliac disease.
What are the most common food intolerances?
“Dairy, wheat and foods containing fermentable sugars, such as onions, garlic and beans, are among the most common foods people claim to be intolerant to,” Natalie explains. However, the experts also say there are other less obvious foods, which may trigger a sensitivity in some people. Take nightshades, for example, a plant group that consists of tomatoes, peppers, aubergine and potatoes, which can be inflammatory for some people. Egg whites also contain a protein, which can cause problems if you have leaky gut syndrome, while the roughage of nuts can irritate some people. Yeast – found in bread, baked products and alcohol – is also a common intolerance. Shabir also says tea, coffee and citrus fruits can be inflammatory, too.
What are the signs you may have an intolerance?
Given an intolerance arises when a food isn’t properly digested, it makes sense that symptoms are often related to the gut. As the food in question begins to ferment in the gut, it’s common to experience abdominal discomfort. “The commonest symptoms of a food intolerance include bloating and diarrhoea that start a few hours after eating a specific food and tend to be worse the more of the food you eat. On the other hand, if you have an allergy, symptoms can include tingling around the mouth with swelling, wheezing and difficulty breathing. These symptoms always need emergency medical attention,” Natalie says. Skin rashes and itching are also common signs of an intolerance.
Is it possible to suddenly develop an intolerance?
Yes, says Natalie, especially if you’ve been unwell. “Some people develop a food intolerance after an episode of gastroenteritis, with dairy being something that people struggle with after a bout of illness.” Shabir agrees, saying it’s not uncommon to develop an intolerance as you get older. “They can be triggered by a stressful event such as starting a new job, childbirth, stress and perhaps overuse of antibiotics."
How can you get tested for a food intolerance?
First – don’t be lured by Instagram ads of at-home intolerance tests. At present, there is no regulation of food intolerance testing in the UK, so many of the products out there have zero science behind them. “Having dealt with patients with severe malnutrition after undertaking diets based on some of these tests, I am very wary of them and am not clear on the evidence underlying their use,” Natalie warns. “If you have severe or concerning symptoms related to food, especially if they are new or progressive, you need to ensure you seek medical advice,” she advises. While a dietitian is your best port of call, not everyone has the budget for one-on-one expert advice, so it could be worth trying an elimination diet, especially if your symptoms are mild, Natalie says.
Any advice for getting started with an elimination diet?
“The first thing is to ensure you are meeting your nutritional requirements – if you are cutting something out you need to be clear how you are going to replace its nutritional value,” Natalie stresses. “Plus, if you are changing your diet, only change one thing at a time. If you change lots of elements of your diet at the same time you will find it hard to know what part of the change has made the difference. If you can, get the support of a dietician; The British Dietetic Association website can help you find a dietician near you.” Shabir also recommends keeping a food diary: “Write down exactly what you eat for each meal including contents and portions and then list any symptoms and use a scale of 1 to 10 for any reactions. Maintain this for three to four weeks and you should be able to find some connection between the foods that you eat, the portions and any symptoms.” An elimination diet may seem tedious, especially if you’re after quick results, but the experts say, given its affordability and reliability, it remains the gold standard for identifying food sensitivities.
How else can you support your body if you suspect an intolerance?
Shabir believes healing the gut will help you tackle food intolerances as well as enhance immunity, improve digestion and boost mood and bowel movements. He recommends a four-pronged approach:
REMOVE: “This is the step of removing foods we know can damage or cause inflammation within the gut. This includes alcohol, caffeine, gluten, dairy products, processed and sugar-laden foods. Whist it may not be possible for everyone to remove offending foods such as caffeine and alcohol, one could at least try and reduce the weekly intake.”
REPAIR: “Repairing the gut is crucial to heal the damaged lining of the gut walls. The amino acid l-glutamine constitutes more than 20% of amino acid levels in the body. The gastrointestinal tract is by far the greatest user of glutamine in the body and the cells lining the gut use glutamine as their principal source of energy. Using glutamine as a source of energy, the gut cells can promote cellular regeneration and therefore repair within the gut. Studies also indicate glutamine improves the gut barrier function and hence minimised the chances of a leaky gut. Glutamine is available in powder and capsule forms; aim for a dose of 1000mg daily preferably on an empty stomach.”
REPLENISH: “This step involves the use of a good probiotic supplement such as Mega Probiotic ND, a non-dairy probiotic supplement that contains eight strains of beneficial bacteria. Scientists estimate that a good gut should contain 85% of these beneficial bacteria but that most of us simply do not have sufficient numbers of these. This supplement can help maintain a healthy intestinal tract, fight infection and break down food more efficiently.
REPLACE: “Ageing is another factor that results in lower production of digestive enzymes, which are important as they break down carbohydrates, protein and fats efficiently. A good digestive enzyme supplement such as Enhanced Super Digestive Enzymes also contains enzymes that naturally have an anti-inflammatory effect in the gut, thus protecting gut cells and the lining of the gut from damage that we could inflict due to diet and environmental factors.”
Are there any other products that can help?
If you suspect dairy is a problem, Natalie recommends switching up your regular dairy milk for lactose-free milk, also known as A2 milk – keep an eye out for Arla LactoFree in the supermarket. “A2 milk lacks a specific protein not related to milk sugars, and so will not influence your symptoms if lactose intolerance is the issue,” she says. It’s also worth noting that even if you are lactose intolerant, studies suggest you may be able to drink up to around 250ml of milk in one sitting without symptoms, and possibly twice this amount spread through the day if consumed with food.
If, after following an elimination diet, you’ve worked out you’re intolerant to a certain food, don’t panic, as the experts say it is possible to outgrow a sensitivity. This is because the antibodies that trigger an intolerance only live for a couple of months – if you avoid the problematic food for three to four months, it’s likely these antibodies will have left the bloodstream, meaning your body will be better able to tolerate that food.
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*Features published by SheerLuxe are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.