Natural Foods Merchandiser

Is it a food allergy, intolerance or sensitivity?

Some experts argue that an allergy is an immune symptom response and that an intolerance is a digestive system response. Others think the difference is a matter of the degree and type of symptom. But Stephen Wangen, MD, author of Healthier Without Wheat (Innate Health Publishing, 2009), thinks that understanding what you react to is more important than how you react. “Allergy and intolerance and sensitivity aren’t useful words,” he says. “Everybody uses them differently.” Here, Wangen reveals how to expose food culprits.

Q. What’s a food intolerance?

A. There are standards for the way we use the word intolerance, but they are different for different foods.

You can have, for example, a lactose intolerance. That is an enzyme deficiency where you don’t digest lactose well, and the symptoms are going to be digestive—gas, bloating and diarrhea. You can take an enzyme to solve those symptoms. You can drink lactose-free milk.

The next example is gluten intolerance. That mechanism in the body is completely different from a lactose intolerance. It’s an immune reaction against gluten. You can get a host of secondary effects from that reaction because of inflammation and malabsorption of nutrients. You can get hundreds of problems that are connected to gluten intolerance that don’t have to be digestive problems. They can be headaches, migraines, arthritis, osteoporosis or dementia.

Q. What’s a food allergy?

A. A certain antibody is involved. The immune system produces different types of antibodies to different foods.

In a gluten reaction, it’s usually an IgG antibody reaction or an IgA antibody reaction. You also can have a classic IgE reaction to gluten or wheat. For example, baker’s asthma is a well-known classic IgE allergic reaction to gluten.

You have to do blood testing to tell you whether it’s IgE, IgG or IgA. The symptoms aren’t necessarily indicative of the mechanism underlying it.

Q. What’s celiac disease?

Celiac disease is a form of gluten intolerance. It starts as an immune reaction against gluten, which turns into an autoimmune reaction in the gut that causes a very specific kind of damage called villous atrophy. [Villi are tiny fingerlike projections in the small intestines.] You don’t have to have this damage to be gluten intolerant, but you do have to have it to be celiac.

Q. How do you test for a food allergy or intolerance?

A. Blood work is helpful. I test for reactions to about 100 foods and then narrow it down. I’m looking for antibodies in the blood. Once I find that, I know there’s an immune reaction to the food, and I can focus patients on avoiding that food. I can’t look at the test results and say, "Well, you have a reaction to these five foods, so therefore you’ll have this or that symptom." The symptoms vary tremendously.

Q. Do elimination diets help determine culprit foods?

A. They certainly have their place. I’m all for people taking charge of their health and trying to sort things out by cutting out foods to see if they’re reactive.

The other side of things is that a lot of people—for example, a lot of celiacs—are essentially asymptomatic, and they don’t notice a difference until they get [blood] testing. They won’t know that they’re reacting to the food. That’s been clearly shown in a lot of big studies. A lot of celiacs don’t have classic digestive symptoms until enough damage has been done over decades or until they discover they have osteoporosis. It’s not something they feel. But then maybe a doctor digs in to find out why they have osteoporosis, and it turns out they’re celiac and they just didn’t know it all those years. So elimination diets are valuable and they have their place, but they don’t necessarily prevent things that you can’t experience in a real obvious way.

Q. What’s the fix for a food allergy or intolerance?

A. Essentially, avoidance is the only clear answer that works long term. Then antibody levels go down. That happens in all kinds of food allergies and intolerances as long as they're immune-mediated. But as soon as people start eating the food again, the antibodies can come back up.

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