Food Sensitivities, Intolerances and Allergies: How They’re Different & How to Address Them
The terms food allergy, food sensitivity and food intolerance are commonly used interchangeably and can be easily confused. Food intolerances and sensitivities are much more common than allergies. It is estimated that food sensitivities and food intolerances impact 15-20% of the global population. Actual food allergies impact only 3.6% of the U.S. population and must be taken seriously when preparing, storing, selecting, and serving foods.
Food Allergies:
A food allergy is an immune reaction as result of an IgE-mediated response (“think ‘E’ for Emergency”). Individuals with food allergies have severe reactions (usually within minutes of ingesting the food) such as anaphylaxis, allergic asthma, urticaria, rhinoconjunctivitis and even complete closure of eyes and throat within minutes to hours of ingestion or of being exposed to a food/foods they are allergic to. This reaction is a result of mast cells (types of immune cells) releasing histamine into your body.
The most common food allergens in the U.S. are:
Dairy
Eggs
Peanuts
Tree nuts: (almonds, brazil nuts, cashews, hazelnuts, macadamia, pecans, pine nuts ,pistachios, walnuts)
Wheat
Soy
Shellfish
Fish
Sesame
Food Sensitivities:
Food sensitivities are harder to determine as they generally lead to delayed reactions (hours up to days). Food sensitivities also involve the immune system. When a food is ingested one or multiple food proteins in that specific food will bind to antibodies/immunoglobulins which leads to an immune response. The specific immunoglobulins we look at when testing for food sensitivities are: IgA, IgG, IgM, and Ig4 antibodies. It is common that impaired GI function such as intestinal permeability can lead to and or exacerbate food sensitivities. Some of the most common symptoms associated with food sensitivities are fatigue, bloating/gas, irregular stools, nausea, brain fog, skin issues, joint pain, and migraines.
The most common food sensitivities in the U.S. are:
Dairy
Eggs
Gluten
Soy
Corn
Shellfish
Tree nuts
Coffee/caffeine
Hot spices
Food Intolerances:
A food intolerance does not involve the immune system and occurs when a person has difficulty digesting a particular food. They may be caused by impaired absorption ability, specific enzyme or nutrient deficiencies, low stomach acid, inflammation, and other GI issues or conditions. For example when someone is lactose intolerant, they lack the enzyme lactase which helps to break down the lactose in dairy products. Food intolerances most commonly present as GI issues such as gas, bloating, irregular stools, and stomach pain. Common food intolerances include: dairy products, wheat, sulfites, histamines, FODMAPs, food preservatives, artificial flavors/dyes, chocolate, citrus fruit, and acidic foods.
Different Types of Immunoglobulins
These are mast cells which lead to impaired airways or anaphylaxis, hives or rashes, and swelling,
The most abundant immunoglobulin, presents in a more global way such as issues with fatigue, joint pain, inflammation, and GI disturbances.
Found in our mucosal tissues (throat, lungs, saliva, intestines, tears, nasal passages). Generally leads to congestion, mucus, phlegm, GI and skin issues.
This is one of the first lines of defense when the body senses threat or infection. IgMs are produced in response to foreign antigens.
A special non reactive protective immunoglobulin. Elevations may be an indicator of chronic exposure to a certain food/foods and is also associated with certain autoimmune and GI conditions.
Food Sensitivity Testing and Interventions
Food intolerances can often be identified through a period of elimination (an elimination diet) while food allergies and sensitivities are generally discovered through blood work testing. We use the Vibrant America Food Sensitivity Test which tests for the most common foods and food additives by looking at IgG & IgA antibodies. With both food intolerances and sensitivities a period of removal of the problematic food/s is recommended which we refer to as an elimination diet.
Elimination Diet
A temporary dietary intervention used to either identify potential triggers for the symptoms you are experiencing or to remove foods known to cause symptoms and see if they improve.
Generally lasts anywhere from 1-6 months (we recommend no shorter than 3 months)
Reintroducing Foods After an Elimination Diet:
The reintroduction of foods or food groups is done slowly and methodically. Foods that are removed need to be introduced one at a time, in small amounts that increase slowly (we generally suggest starting off with 1 T. of the food), and as single ingredient foods (if you are introducing eggs you would want to introduce it as a hardboiled egg or scrambled egg not as a quiche as that involves multiple ingredients). As you reintroduce foods it is important to observe any symptoms/reactions and pay close attention to how you feel on the days you are introducing the foods as well as the days after. Only introduce the next food if you have no adverse reaction and have had a complete bowel movement.
Healing the Gut
Once the problematic foods have been removed for a period of time and reintroduced (if possible) then comes the important process of restoring balance and overall health and promoting a robust gut microbiome.
It’s important to REPLACE anything that has been depleted. This phase often consists of adding in digestive enzymes, bitters, bile acids, and hydrochloric acid- all key parts of healthy digestion.
REPOPULATE the good gut bacteria by adding in both prebiotic and probiotic-rich foods, sometimes a probiotic supplement may be added in as well. Variety in the foods you eat is key during this phase!
REPAIR the lining of the GI tract by supplying it with key nutrients and herbs. Here are some of our go to nutrients and herbs we turn to help heal the GI tract: vitamin A, C, E, fish oil, L-glutamine, zinc carnosine, aloe vera, slippery elm, mucin, chamomile, marshmallow root, quercetin, and deglycyrrhizinated licorice extract.
Find BALANCE. This is a good time to make sure you are feeling a sense of calm in your work and personal life, make sure you have stress management techniques in place, and that you are sleeping well. Celebrate all you’ve done to get your body feeling better and honor all it’s doing for you!
Citations
Acker WW, Plasek JM, Blumenthal KG, et al. Prevalence of food allergies and intolerances documented in electronic health records. J Allergy Clin Immunol. 2017;140(6):1587-1591.e1. doi:1016/j.jaci.2017.04.006
Food Allergen Test. (n.d.). https://www.vibrant-america.com/food-allergen/
Lomer MC. Review article: the etiology, diagnosis, mechanisms and clinical evidence for food intolerance. Aliment Pharmacol Ther. 2015;41(3):262-275. doi:1111/apt.13041
NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-S58. doi:1016/j.jaci.2010.10.007
Tuck, C. J., Biesiekierski, J. R., Schmid-Grendelmeier, P., & Pohl, D. (2019). Food Intolerances. Nutrients, 11(7), 1684. https://doi.org/10.3390/nu11071684