Today’s article is compliments of Functional Medicine Physician, Christine Maren D.O. IFMCP. We have an epidemic of food allergies and sensitivities in this country. When I was in second grade, my teachers doled out salted peanuts as a reward. Can you imagine? It’s now the norm that classrooms are strictly nut-free because there’s at least one child who has a dangerous, even life-threatening reaction. That’s a food allergy. But food sensitivities like gluten intolerance are also a growing concern. They are a cause of chronic disease, a sign that something in our environment has gone awry, and a problem that should be taken seriously.
Food Allergies + Sensitivities are More Common
The incidence of food allergies in the United States is becoming more common. According to the CDC, food allergy among children increased by 18% from 1997 to 2007. This is a conservative estimate, based on other reports I have read. More dramatic is the rise in hospitalizations for food allergy related issues. From 2004 to 2006, the CDC reported that food allergy accounted for an average of 9,537 hospital discharges per year. This is an increase of 365% from 1998 to 2000.
Food allergies illicit an abnormal immune response that triggers an immediate or delayed hypersensitivity reaction. Immediate (Type I) hypersensitivity reactions, mediated by IgE, are obvious. Histamine is released, causing varying degrees of symptoms like hives, itching, swelling, trouble breathing, wheezing and anaphylaxis. They are easier to study because of this and most research is centered around these types of reactions.
There are also non-IgE mediated reactions to food that are not as obvious or immediate. They are less well understood at this point, although increasing in frequency. They include atopic dermatitis, dermatitis herpetiformis, celiac disease and eosinophilic esophagitis.
Food intolerance or sensitivity, on the other hand, does not involve an abnormal immune response. It is a negative reaction to a certain food, often with a delayed onset. Other than lactose intolerance, food sensitivities are not well understood. Nonetheless, they are also becoming more prevalent, perhaps the most well known being Non-Celiac Gluten Sensitivity (NCGS). A proposed mechanism to explain NCGS is an imbalance in the gut microflora characterized by decreased Firmicutes and/or Bifidobacteria, leading to low levels of intestinal butyrate. This is progress, but more research is needed to understate the exact mechanisms at play.
Hidden Food Sensitivities at the Root of Chronic Issues
Because they are sometimes less obvious and can take 72 hours to develop, food sensitivities may remain unrecognized in many people. This Dutch study concluded that many parents are not aware that chronic ailments in their child may be caused by food intolerance. In my experience, most physicians in the United States don’t consider food triggers as a cause of chronic symptoms.
Hidden food sensitivities are a real problem. Recurrent exposures to unknown food triggers can inflame the gut, activate an immune response, and cause chronic underlying inflammation. This can manifest as anything from skin issues to behavioral problems, to chronic gastrointestinal complaints. Some of the more common issues include:
- Chronic constipation
- Chronic diarrhea
- Excessive mucous production and phlegm
- Failure to thrive
- Irritable Bowel Syndrome
- Joint pain
- Poor immune function
- Recurrent ear infections
- Seasonal Allergies
Why are We Suddenly Allergic to Food?
Our food supply has changed dramatically in the past 15-20 years. Our genes have not. So what gives? I think that the former food industry analyst, Robyn O’Brien, puts it best: “Are we suddenly allergic to food? Or what’s been done to it?”
There is not one distinct cause for the rise in food allergies and sensitivities. It’s the perfect storm that has disrupted our intestinal barriers and immune function. Contributing factors likely include:
- Environmental toxins and chemicals
- Food additives
- Food-borne illnesses and infections
- Genetically modified foods (GMOs)
- Hand sanitizers and other contributors to the hygiene hypothesis
- Increased intestinal permeability (aka leaky gut), especially during pregnancy and childhood
- Processed foods
It’s hard to pinpoint, but it’s clear that there have been multiple environmental changes that contribute to this problem.
A Vicious Cycle
Intestinal permeability (aka leaky gut) and food sensitivities go hand-in-hand. There are many contributors of leaky gut, namely dysbiosis (an imbalance of intestinal microbes). Certain bacteria can create lipopolysaccharides (LPS) which cause an increase in intestinal permeability. Larger, undigested food molecules can then cross the intestinal lumen where they elicit an immune response. This creates a vicious cycle, whereby food and gut bacteria “leak” into the bloodstream causing systemic inflammation and worsening food sensitivities.
How to Tell if You Have Hidden Food Sensitivities
Traditional allergy testing is helpful for people who have IgE-mediated allergic reactions. For the less obvious reactions, there are blood tests for IgA and IgG antibodies that are more controversial. IgA and IgG tests are not recommended at this point by the American Academy of Allergy Asthma and Immunology, so most conventional doctors do not use them. However, many practitioners (including me) and patients (also including me!) find them to be a useful guide. And more recently, a study published in the British Medical Journal supports the use of individualized elimination diets based on food sensitivity testing to reduce the symptoms of Irritable Bowel Syndrome (IBS).
To test directly for NCGS, I use a comprehensive test from CYREX Array 3 to measure antibody production not only to alpha gliadin and transglutaminase-2, but the many of the other components of wheat protein including glutenin, gluteomorphin, and transglutaminase-3 and -6. To test more broadly for other foods including dairy and egg, I utilize food sensitivity testing through another functional medicine lab. It’s important that you and your provider interpret these tests with some caution and understand their limitations. The most common food sensitivities I see are:
- wheat/ gluten
I also recommend doing an elimination diet, like Whole30. Elimination diets get rid of the most common food sensitivities for a period of time, then slowly reintroduce them one by one in an effort to identify reactions. If that is too daunting, I recommend at least eliminating gluten and dairy for 6 weeks, since these are the most common food triggers. Note that if gluten intolerance is suspected, I like to test for markers of Celiac disease before eliminating gluten. Celiac tests are invalid once gluten has been eliminated, and testing helps differentiate between Celiac disease and NCGS.
Resources for Living with Dietary Restrictions
Here’s the good news… Since so many of us have food sensitivities, there is a growing market that caters to this and makes it easier for us to navigate dietary restrictions. I know this all too well. Some of my favorite resources include:
IQYOU – Like 23andMe but more robust. Get to the heart of your food sensitivities.
Paleo On The Go – Heat and serve meals delivered to your door, including Paleo, sugar-detox, and AIP-friendly (Autoimmune Paleo) options.
RealPlans – Meal plans made with dietary restrictions in mind, including AIP and Whole30 options.
Sunbasket – delicious recipes and organic ingredients delivered to your door with everything you need to cook at home. Includes gluten-free, dairy-free, and Paleo options.
Thrive Market – Discounted online organic and non-GMO groceries delivered to your door. You can shop by value, including gluten-free, vegan, and Paleo options.
Please be sure to visit Functional Medicine Physician, Christine Maren D.O. IFMCP.
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