It’s a modern day mystery – why are so many of us unable to eat common foods such as pasta or milk without negative effects, ranging from the painful to the perilous? It wasn’t always like this. A food allergy used to be an obscure affliction – sufferers had to hunt down out-of-the-way specialist shops and avoid dining out. Today, supermarkets have aisles dedicated to ‘free-from’ foods, and most restaurants flag up potentially dangerous ingredients on their menus.
While true food allergies cause an immune system reaction, food intolerance symptoms are less serious, but far more common – the British Dietetic Association estimates that fewer than 3 per cent of adults have a food allergy, while 45 per cent of the British population believe they have a food intolerance according to Allergy UK, and the same goes for more than 30 million Americans, says the US Institute of National Health.
It’s no different in the UAE, where several specialist food intolerance test labs have sprung up in the past few years, offering to help the growing numbers of those with food sensitivities. “We treat five to ten cases of food intolerance a month, with lactose and gluten being the most common,” says Safeek Ali, dietician at Welcare Hospital in Dubai. The escalating consumer base has encouraged big manufacturers such as General Mills to enter previously niche territory, and invest in foods without ingredients such as gluten, lactose, nuts, egg, soya and additives. In fact, the industry will to be worth $26 billion by 2017, according to Global Industry Analysts.
But with celebrities from Gwyneth Paltrow to Victoria Beckham gushing about the benefits of ‘free-from’ diets, could we be conflating the fussiness of excluding certain food groups from our diets with the glamour of being a demanding A-lister? Or perhaps it has even deeper psychological roots. UK-based doctor and author Max Pemberton suggests that our desire to restrict and control what we consume is part of a primal human urge to enforce order in an otherwise chaotic world. Or, at the very basest level, could it be that having a food intolerance to our names make us feel that little bit more ‘special’?
There’s more to it than that, says Welcare Hospital’s Safeek. The incidence of food intolerance diagnoses has risen in recent years, not only because of increased awareness, but because food intolerance is, to an extent, a product of modern lifestyles. It’s the result of “consuming manufactured foods – which contain additives, flavourings and colourings – an unbalanced diet, and stress,” he says.
According to Wael Samawi, deputy general manager of Star Metropolis Medical Laboratory ME, 85 per cent of patients who are referred to Welcare’s laboratories show significant food intolerance to three or more food types. “Many people are suffering from food intolerances because of regular consumption of incompatible foods, which means the body is always on high alert and fighting against what it perceives as an intruder,” he says. “Continued consumption of such foods stresses the immune system, affects the digestive system and you end up reacting to everything you eat.”
Research also indicates that there is a strong genetic predisposition to specific food intolerances says Dr Ajie George Oomen, a GP paediatrician at Lifeline Medical Day Care and Surgery Centre in Mankhool Dubai. Some ethnicities, such as Asian, African, Mediterranean and Native Americans, are more strongly predisposed to being lactose intolerant because they produce less of the enzyme lactase, making it harder for them to adequately digest lactose. Food intolerance also tends to run in families, and can be passed from mother to unborn baby through the placenta or transferred through breastfeeding. We asked our UAE medical experts for the low down on this modern phenomenon and advice on what to do if you’re a sufferer:
Food intolerance versus food allergy
Although they are often equated, food intolerances and food allergies are very different. Food intolerance, or non-allergic food hypersensitivity, refers to a digestive system response (as opposed to the immune system response of allergies), associated with a particular food or compound found in a range of foods, says Dr Zohreh Safai, a family medicine physician at Dubai Bone and Joint Centre. A food intolerance generally occurs when food irritates the digestive system or when one isn’t able to digest and process some foods properly due to lack of certain enzymes and insufficient friendly gut flora (bacteria and other organisms that live inside the intestines, which help in the digestion of food).
Where an allergic reaction doesn’t depend on the amount of food consumed, a food intolerance worsens as you consume more and more of the offending food.
In an allergy there is rapid onset after ingestion because the immune system immediately generates histamine, a chemical which dilates blood vessels, narrows the airways and causes production of acid in the stomach. Ingestion of a peanut by someone who is allergic causes anaphylaxis and the symptoms can be severe or life-threatening if the treatment, epinephrine, isn’t administered immediately. An intolerance, on the other hand, has a delayed reaction and may occur hours or days after ingesting an allergen.
Symptoms: Food intolerance symptoms vary from skin disorders to digestive problems, says Star Metropolis Medical Laboratory’s Wael. Although food intolerances are not life-threatening like allergies, they can cause discomfort and could result in weight gain, which is linked to diabetes – a major concern in the UAE. Some of the symptoms are bloating, migraines, insomnia, anxiety, palpitations, sinusitis and skin problems like eczema. Other conditions related to food intolerances include autoimmune diseases (where the body attacks its own cells), headaches, fatigue, depression, arthritis and joint pain/stiffness and swelling, chronic respiratory symptoms (wheezing or bronchitis), abdominal pain and bowel problems (irritable bowl syndrome, diarrhoea and constipation). It can also worsen existing conditions such as Crohn’s disease.
Common food intolerances: Studies show that intolerances differ from one person to another. However, Lily Mueller, a nutritionist at Dubai Herbal and Treatment Centre, says the most common ones are lactose (especially in children) and gluten (contained in wheat and other grains) intolerances. Other common ones include dairy products (cheese and cows’ milk), eggs, shellfish, bananas, nuts and soya products.
Tests: One way of diagnosing an intolerance is the trial and error method. This involves recording everything that you eat in a food diary and analysing the symptoms you get after consumption of certain foods, says Welcare Hospital’s Safeek. Another method is the elimination diet. According to Dr Safai, this involves identifying foods that cause adverse effects and avoiding them for several weeks while observing whether you get the symptoms. When the symptoms disappear the foods are reintroduced one by one until you find the culprits.
Food intolerances are also detected by running a blood test known as the ImuPro 300 test, which screens for intolerances to 271 specific foods and additives in the blood. Food components are placed in 271 test tubes and the patient’s blood is added to each test tube. If a food intolerance exists, antibodies develop and bind with the food or additive and the machine records the level of the intolerance on a five-point sliding scale, which ranges from “no intolerance” to “severe intolerance” (a higher concentration of antibodies in the blood would indicate a the higher intolerance level).
Treatment: Treatment for a food intolerance is based on reducing or eliminating the intake of certain problem foods that are causing the digestive system to flair up. Additionally, the specific symptoms that arise can be treated, says Dr Safai.
The most important part of the treatment plan is eliminating the culprit foods. This should be followed by proper eating habits in order to heal the digestive system.
Living with food intolerances: This can be difficult and frustrating, but incorporating Dr Safai’s tips into a daily routine will make managing the condition easier:
When eating at restaurants, always ask the waiter about how the meal will be prepared. Some meals could contain foods that you have an intolerance of, but menus are not always clearly marked, so it may not be evident.
Learn to read food labels properly and always check the ingredients for problem foods. Don’t forget to read the ingredients of condiments and seasonings – they may contain MSG (Monosodium glutamate) or other additives that can trigger an attack.
Common food intolerances to look out for and what you can do about them
You know you’re intolerant to nuts: if they cause vomiting, hives, diahrrea, swelling of the lips and abdominal pain.
You’re intolerant because: your body thinks the protein in peanuts is harmful and generates IgE (Immunoglobulin E), an antibody that fights against an antigen. The IgE in turn trigers the formation of histamine (a compound involved in autoimmune response for the body to protect itself) to fight against the protein.
What can you do: it’s always better to avoid the food completely until the symptoms subside. Try to eat small amounts of other types of nuts like walnuts and almonds.
You know you’re intolerant to milk: if it causes bloating, abdominal pain, flactulance and diarrhoea.
You’re intolerant because: your body doesn’t produce sufficient lactase enzyme, which helps digest lactose, a sugar found in milk and milk products.
What can you do: you can have a little bit of yougurt or milk along with tea. You may also try lactose-free milk subsitutes such as soya milk and rice milk.
You know you’re intolerant to eggs: if they cause skin inflammation/hives, cramps and digestive problems like vomiting and nausea.
You’re intolerant because: you cannot properly digest the protein in the egg and the undigested particles end up in your colon and cause gastrointestinal symptoms like heartburn, constipation, diarrhoea, stomach pain, vomiting and nausea.
What can you do: in severe cases avoid eggs altogether and try other protein sources like lentils, lean chicken and lean meat. In baking, use egg substitutes that are available in powder form, for example custard or cornstarch powder.
You know you’re intolerant to wheat: if it causes diarrhoea, vomiting, itchy skin, skin rash and bloating.
You’re intolerant because: you can’t digest a protein in wheat called gluten due to lack of digestive enzymes in your small intestines.
What can you do: avoid intake of foods that contain gluten for a month. When the symptoms disappear try to reintroduce wheat into your diet in small amounts. If you react again opt for gluten-free cereals like corn and quinoa.
You know you’re intolerant to soya products: if they cause running nose, abdominal pain, tingling sensation in the mouth and redness of the skin.
You’re intolerant because: your body isn’t able to digest the soy protein.
What can you do: opt for other protein-rich foods such as legumes – kidney beans, chickpeas and red beans.
You know you’re intolerant to cheese: if they cause itching, burning sensation in the mouth, throat and tongue.
You’re intolerant because: your body cannot tolerate either the milk protein called casein or tyramine in aged cheese.
What can you do: usually when taken in small amounts cheese can be tolerated because it’s easier to digest, however, if the symptoms are severe avoid it. If you’re intolerant to tyramine you can have milk or yoghurt. If it’s casein you’re not agreeing with go for soya products.