If you’re wandering down any typical grocery store in Ottawa, you will usually come across one isle or two promising “freedom” from some of the typical things most people eat: gluten-free, dairy-free, egg-free, soy-free, and the list goes on. You may have wondered if those foods are healthier, and if you should also be filling your grocery cart in that isle.
Food sensitivities and allergies are on the rise in North America. It’s hard to plan a kids’ party without someone having some dietary restrictions. So, what’s the difference between food sensitivities, intolerances, and allergies?
Most people with food allergies found out the hard way. They ate some peanuts and had difficulty breathing, or ate some strawberries and broke out in hives. These reactions are usually severe, and are mediated by a type of antibody called IgE (antibodies are produced in the body and attach to specific protein sequences that they recognize). If you went to an allergist and got pricks in your forearms, you were most likely tested for IgE reactions.
Symptoms of food allergies usually show up fast, usually starting within 15min of consuming the food, and can be quite severe. They are the type of food reaction that is usually immediate, and are associated with anaphylaxis. If you have a food allergy, you have to be very careful about avoiding even trace amounts of the food in question.
Food sensitivities are typically harder to pinpoint than food allergies, so many people go undiagnosed for years. They are delayed reactions to food mediated by a different type of antibody, IgG. Symptoms occur most commonly within the first day of eating a food, but can occur up to 3 days after. The symptoms of a food sensitivity tend to be more subtle than a food allergy. They can include:
-digestive issues (bloating, gas, diarrhea, constipation, etc.)
-feeling like food “just sits there” and doesn’t digest well
-difficulty losing weight
-skin issues (acne, eczema, psoriasis)
-behavioural issues in children
Food sensitivities can be identified either through an elimination diet, or through IgG food sensitivity testing. Many patients opt for IgG food sensitivity testing to get a more objective starting point of which foods to start eliminating. This involves a simple blood test that will look at the level of IgG produced with respect to 120-200 foods. However, food sensitivity testing is still controversial. It is not 100% accurate, must be interpreted in the light of what is going on with the patient, and possible cross-reactions (i.e. shellfish IgG can show up high in someone with a dust allergy because the body recognizes a similarity between them). False positives can occur if the patient has a condition referred to as leaky gut syndrome (where the bowels are hyper-permeable and allow too many undigested foods through). False negatives can occur if you have not been eating a certain food, so it is better to do the testing before you start eliminating foods from your diet.
In research studies, IgG-based elimination diets have been found to help with:
-both migraines and irritable bowel (Aydinlar et al., 2013)
-IBS (Drisko et al., 2006; Atkinson et al., 2004)
-Crohn’s disease (Bentz et al., 2010)
Despite the lack of conclusive research, I have found the test to be very clinically relevant in practice: most of my patients with the relevant symptoms improve quite dramatically when we remove their food sensitivities from their diet.
Reading through articles can be confusing, since the term “food sensitivities” and “food intolerances” is often used interchangeably. However, food intolerances are non immune-mediated reactions to food (no antibodies are involved). Typically, the body will lack something which will make it intolerant to a food. A common food intolerance is lactose intolerance, where one cannot tolerate lactose-containing dairy products because he/she lacks the lactase enzyme in the digestive tract necessary to break down lactose. With lactose intolerance, symptoms usually occur within 30min of consuming lactose, leading to stomach cramps, abdominal pain, and diarrhea.
An elimination diet can help identify both food sensitivities and food intolerances. It may take some further testing after that to identify if, for example, your reaction to dairy is due to a sensitivity or an intolerance.
What To Do About Them
Once you identify which foods are a problem for you, there are healthy and not-so-healthy ways to eliminate them from your diet. Many of the specialty foods free of common allergens/sensitivities are highly processed, and contain fillers, emulsifiers, and sugars to make the texture or flavour more similar to their regular counterparts. Your best bet is to stick with whole foods that are minimally processed most of the time, and only have the processed ones as an exceptional treat. You may also need additional supplements to help heal your gut barrier so that you can potentially tolerate your sensitivities more in the future.
Do you think you may have a reaction to a food you are consuming? If you have any questions or would like to get started on an elimination diet or IgG food sensitivity testing, please contact me at either of my Ottawa offices, in Nepean or Orleans.
Atkinson W1, Sheldon TA, Shaath N, Whorwell PJ.Gut. Food elimination based on IgG antibodies in irritable bowel syndrome: a randomised controlled trial. Gut. 2004 Oct;53(10):1459-64.
Aydinlar EI1, Dikmen PY, Tiftikci A, Saruc M, Aksu M, Gunsoy HG, Tozun N. IgG-based elimination diet in migraine plus irritable bowel syndrome. Headache. 2013 Mar;53(3):514-25.
Bentz S1, Hausmann M, Piberger H, Kellermeier S, Paul S, Held L, Falk W, Obermeier F, Fried M, Schölmerich J, Rogler G Clinical relevance of IgG antibodies against food antigens in Crohn's disease: a double-blind cross-over diet intervention study. Digestion. 2010;81(4):252-64.
Drisko J1, Bischoff B, Hall M, McCallum R. Treating irritable bowel syndrome with a food elimination diet followed by food challenge and probiotics. J Am Coll Nutr. 2006 Dec;25(6):514-22.
Images from 123RF.com
Published in To Your Good Health, a natural health journal, Winter 2014, Issue #1
Does our gut really have the capacity to “feel”? If you have ever had food cravings when you are feeling down, or digestive upset in anticipation of a stressful event, then the connection certainly appears to be as real as anything else you experience. In fact, research in the growing field of psychoneuroimmunology (which looks at how the fields of psychology, neurology, and immunology blend together) shows that the nervous system of the gut, called the enteric nervous system (ENS), responds to more than 30 neurotransmitters. In fact, the ENS contains approximately 95% of the body’s serotonin, also known as the “feel good hormone” (Hadhazy, 2010). Because of its complex nervous system, the gut is now often referred to as the second brain. It is closely linked to the central nervous system of the brain (CNS) through the peripheral nervous system (PNS), which leaves the spinal cord and connects to different organs, including the gut. Being aware of this strong connection between the brain and the gut, naturopathic doctors typically target both the gut and the brain when managing mental health conditions such as depression, anxiety, autism, and ADHD.
The connection between the brain and the gut is no longer thought of as unidirectional, top-down control (Stasi et al., 2012). Research actually points to a predominance in the other direction: 90% of the nerve fibers in the vagus nerve (the primary nerve connecting the CNS and the ENS) carry information from the gut to the brain (Nibber et al., 2013)! In addition, the 100 trillion microbes residing in the gut are also involved in neurotransmitter production and therefore influence our mental well-being (Nibber et al., 2013). As a naturopathic doctor, optimizing digestive health is an integral part of almost every treatment plan, with the added bonus of its downstream effects on improving mental health. As well, because of the close link between the gut and input from the nervous and endocrine systems, stress management is an important component in helping to address digestive issues.
Food sensitivities can sensitize nerves in the gut, which in turn can trigger changes in the brain (Nibber et al., 2013). These changes can occur so insidiously that it may be difficult for the patient to pinpoint the culprit. This happened in the case of a 43 year old female who presented to my office with chief concerns of weight gain, fatigue, and generalized aches and pains. She was not on any medication at the time, but had a history of depression. Although she had daily bowel movements, her stools were sometimes loose, and she experienced bloating, which she attributed to excessive hunger and overeating. A careful look through her diet diary and questioning revealed that her diet was high in wheat and glutinous grains, and that her chief concerns had become more pronounced after eating more gluten on a regular basis. Within 5 days of removing gluten from her diet, she found that her stools were more solid, she had more energy, and had increased mental clarity. We continued on a gluten-free diet for 3 weeks, along with botanical medicine to support liver detoxification, and nutraceutical adrenal support due to the long-term stress she was under (confirmed by a Koenisburg adrenal urine stress test). At her next follow-up, food cravings had much improved, and she had lost 12 pounds over the previous 5 weeks. The mental clarity which she had originally experienced persisted while she avoided gluten. Physical injuries which had previously lingered on were now healing faster. If occasionally she ingested gluten, she would experience loose stools, nausea, and headaches. This case exemplifies how certain foods can trigger mood and behavioural changes. While gluten is a common culprit, food sensitivities are highly individual and must be properly evaluated, either through careful elimination and re-introduction, or through blood testing where appropriate.
As well, it is important not to forget about the role of commensal bacteria in the gut in helping achieve better mental health. Studies in mice showed that supplementation with specific probiotic strains, Lactobacillus rhamnosus and Bifidobacterium longus, decreased symptoms of anxiety and depression in these mice, through a vagus nerve-dependent mechanism (Grenham et al., 2011). Studies in mice also show that some probiotics increase resistance to stress by decreasing the release of stress-induced corticosterone (Grenham et al., 2011). Although to date we lack large randomized controlled trials in humans, Messaoudi et al. did find that a specific probiotic combination alleviated psychological distress in otherwise healthy volunteers in a small double blind, placebo-controlled, randomized clinical trial (2011). This may explain in part why strain-specific probiotics can be used to alleviate symptoms of conditions with a strong psychogenic link, such as irritable bowel syndrome.
The link between the gut and the brain is complex and multifactorial. For patients with mood and psychological distress, it is often a relief to find out that what they ingest can impact their mental health, and that it’s not all “in their heads”. Obversely, those presenting with digestive disturbances are often surprised by the alertness and mental clarity they experience once the health of their digestive system is improved.
Our first and second brains are in constant communication, and symptoms such as anxiety, depression, mental fog, and digestive upset are red flags to alert us that something is out of balance. Will you listen?
Grenham, S., Clarke, G., Cryan, J.F., and Dinan, T.G. (2011). Brain-gut-microbiome communication in health and disease, Frontiers in Physiology, December 07; 2(94): 1-15.
Hadhazy, A. (2010). Think Twice: How the Gut’s “Second Brain” Influences Mood and Well-Being, Retrieved August 23, 2013, from the Scientific American website:http://www.scientificamerican.com/article.cfm?id=gut-second-brain.
Messaoudi, M., Lalonde, R., Violle, N., Javelot, H., Desor, D., Nejdi, A. et al. (2011). Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects, Br J Nutr, Mar; 105(5): 755-64.
Nibber, T., O’Brien, C., McIntyre, C., Dumas, C.A., Chou, M, Al-Kawally, M. (2013). The Gut-Brain Connection, Advances in Orthomolecular Research, 4(3): 4-7.
Stasi, C., Rosselli, M., Bellini, M., Laffi, G., and Milani, S. (2012). Altered neuro-endocrine-immune pathways in the irritable bowel syndrome: the top-down and the bottom-up model,J Gastroenterol, Nov; 47(11): 1177-85.
Dr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions.