Today’s excellent coverage of ‘freefrom food’ – a fab, in depth investigation on Radio 4’s Food Programme (you can ‘listen again’ or download a podcast here) and a short item on BBC 1’s Breakfast this morning – were, on the whole, pretty balanced, but they have caused the usual rumbles of discontent amongst both the food allergic and the food intolerant community. It is a difficult subject and one that does call for more understanding from both sides than is sometimes given.
Very briefly…
A food allergy causes an immune reaction, normally almost immediate and varying in severity from quite mild symptoms (hives, itching,vomiting, diarrhoea etc) to life threatening anaphylaxis. It can be diagnosed relatively reliably via skin prick and blood tests, and reliably through food challenges, and there is an accepted way of treating it – by avoidance and the prescription of life-saving adrenaline (Epipens) in the event of anaphylaxis. Approximately 2% of the population suffer from food allergy.
In food intolerance, one or a number of foods disagree with you but none of them cause an immune reaction. However, ‘disagreeing’ can range from giving you stomach cramp, a headache or making you feel unreasonably tired to making you so ill that you are unable to work and are often forced to restrict your diet dramatically because you feel so unwell when you eat a wide range of ‘normal’ foods.
But while for some people just one or two foods do turn out to have been the triggers for their unwellness, very often a food intolerance is a ‘whole body’ illness in that it is inextricably bound up with the person’s general health and well being. If they are stressed, run down, have suffered from a trauma, viral illness or a serious stomach upset or are in any other way emotionally or physically in poor shape, their digestion will almost inevitably be in poor shape too. This means that the gut wall or lining of their intestine may have become porous allowing partially digested food proteins through unto the bloodstream (where they have no business to be), they will be unable to absorb nutrients from their food, their bowels may have got blocked up so that they cannot dispose of waste which becomes toxic when trapped in the system etc etc etc… Their digestions may simply not be able to cope with an ever increasing number of foods so the only apparent option is to exclude them.
The corollary to this is that if the person’s general health can be improved, especially their digestive health, then they will be to eat, process and digest a much wider range of foods and hopefully, in due course, return to a ‘normal’ healthy diet. And one way to help their digestive health to improve is to restrict their diet, in the short term, to foods that they are able to eat without feeling ill and thereby stressing their system even further. No one is suggesting that a severely limited diet is a good idea in the long term – we are, after all, omnivores – but if, in the short term it reduces the stress on their whole body system, then the benefit outweighs the reduction in nutritional options offered by a wider diet, which will probably not be absorbed anyhow.
The problem is that every body is different, as is every digestive system, so there is no one test which can be given to everyone complaining of a food intolerance. Moreover, because everyone is different, there is no one treatment which will work for everyone either.
Which is why complementary therapists who take a more holistic approach to their patients (looking at not only their whole body but their emotional/psychological health as well) seem able to offer more help to those suffering from food intolerance than allopathic doctors who look for a single or organic disease or cause – and when they cannot find one have little to offer. (Although, as was made clear in both of today’s ‘freefrom’ programmes, the understanding of food intolerance in primary care is, very gradually, beginning to improve.)
But, by definition, a food intolerance is a horribly woolly condition not only leaving more conventional medics struggling but offering endless opportunities to all of those ‘dietary charlatans’ that main-stream medics and dietitians get so exercised about. And, of course, there are charlatans out there and there are people who end up on horribly restricted diets which could further compromise their health, but one charlatan does not a crooked industry make, to coin a phrase, and for every charlatan flogging dodgy tests there are many hundreds of nuritionists, nutrional therapists, naturopaths and other therapists doing a very responsible job in trying to resolve their patients’ dietary issues.
The difficulty here is that dietitians (such those quoted in today’s programmes) tend only to see those very few patients who have gone to extremes in terms of exclusion diets – they do not see the many thousands who have adopted exclusions diets which seemed appropriate for thier particular problem and whose health has, as a result, improved, so they tend to get a slightly unbalanced view of what is going on out there.
And, to wave a few more controversial flags while I am at it……. The vast majority of the foods which are excluded by most ‘food intolerance’ tests are dairy products or gluten-containing products – eg wheat.
But, despite the claims of the Milk Marketing Board, do we really need dairy products in our diet? Far better sources of calcium are to be found in green leaves, nuts, pulses, fish and many other foods. And what animal – apart from the human animal – continues to drink milk after it is weaned and, even more bizarrely, chooses to drink the milk of a quadruped with four stomachs which was designed for young quadrupeds with four stomachs, not for humans with two legs and one stomach?….
As far as wheat is concerned, those dietitians that claim that wheat is a very nutritious grain full of vital B vitamins, are absolutely right, but…. The wheat they are talking about is the stuff that our grandparents used to eat. The wheat used for commercial breads today has been bred to have an extra high gluten content, milled to exclude the nutritious wheat germ and then baked into breads with excess quantities of enzymes and of yeast that has not been allowed (thanks to the Chorley Wood Bread Processing Method) to prove properly so continues to do so in our stomachs.
Does anyone actually need either of them?
It is very understandable that parents who could lose their child any day to a chance encounter with a peanut butter sandwich should feel that those who ‘only’ suffer from a food intolerance which makes them feel rather unwell should not have the same standing in the allergy world – but it is equally understandable that someone whose life has been put on hold by the fact that nearly everything they eat makes them feel so ill that they are unable to function normally, should get enormously frustrated when their condition is not taken seriously.
Both are serious conditions and both deserve the utmost sympathy and understanding from those of us who are lucky enough to be able to eat what we want when we want without fear of ill-health or even worse. And, much more importantly, both deserve respect and what help it is possible to give from the medical professional that they consult.
Well said, Michelle.
The only point I would pick up there is that I disagree with the prevailing mainstream opinion that food intolerance does not involve the immune system. In classical allergy, we look for the IgE antibody. In food intolerance, the foods, as you say, make their way through a porous gut wall, the so-called leaky gut, the body recognises them as foreign bodies and creates antibodies, amongst them IgA, IgM and IgG (even IgD). To create an antibody, there has to have been immune involvement.
From there, we can then get cross-reactive antibodies to similarly structured food and self-antigens to similar-looking body tissues. This is the cause of auto-immune disease. And that’s what makes food intolerance or sensitivity a real health concern, in my view.
Not every food sensitivity reaction causes an antibody type reaction, though, which is why the tests are never going to be 100% accurate; we simply don’t yet know all the mechanisms at play.
For completeness, we also have the enzymatic food sensitivity problems such as histamine, fructose and lactose intolerance, of course.
It’s a minefield. I see it as an allergy illness spectrum, I suppose.
That is one of the most sensible, well-balanced articles I have read on this topic. It is far too easy to allow emotion to get the upper hand when arguing a case, which Michelle avoids beautifully.
Well done Michelle.
Here Here! I couldn’t have put it better myself. A very succint and thorough explanation.. What a can or worms! On the bread front, the modern bread only contains those vitamins and nutrients because they ADD it back in! Sweeping statement I know. Great article though Michelle, and may I say, you were brilliant on the radio. A fantastic spokesperson for the allergic (and intolerant) world..
Gee – that was a speedy response !! Thank you to all.
Micki – I know exactly where you are coming from and I suspect that what you are saying may well prove to be right. I guess I was guilty of using the ‘usual’ classifications because, for now, that is what people understand and can sort of relate to.
In fact, assuming that you are right about the cross-reactive antibodies it will be a serious break through for allopathic medicine as it will bring, effectively, ‘food intolerance’ into the allergy fold. Let us hope that this would result in a better outcome for patients.
I’d love to get stuck into this – and I do agree with a lot – but will restrict myself to a comment on milk….
I do have a bit of an issue with the argument that we shouldn’t be drinking cows milk because we’re not calves because it conveniently ignores the other food that by that argument we shouldn’t be consuming because it contravenes some sort of intent of Mother Nature – such as lentils which are poisonous unless boiled or the flesh of animals we cannot hunt and kill with our bare hands. Like the invention of fire and cooking, the development of dairy farming opened up a wider source of food for humans and strengthened for instance European populations which established it.
I think what I’m saying is I’m not sure this argument is necessarily relevant in the context of food hypersensitivity. Although consuming these proteins clearly broadens the allergens we’re exposed to, some of the most dangerously allergenic foods – nuts, fish – are clearly foods we should, according to nature, be eating. I suspect dairy is more of a problem because we rely on it and consume it so much – not that we eat it in the first place.
Hi Alex – and yes, you are, of course, right that we consume a whole range of foods which need serious input to become edible and many of which present our digestions with sometime insurmountable problems. As you know there are many varieties of diet-related therapists who think that we should not be eating lectins and many other constituents of what many regards as staple foods.
It is also true that dairy products (well, dairy products from organic cows that are healthy and have not been treated with hormones or prophylactic antibiotics and whose milk has not been pasteurised) do provide excellent nutrition in terms vitamins, minerals etc.
However, the fact remains that cow’s milk was designed for cows and not for humans and although we are all mammals, we are very different sorts of mammals. So while I am not getting on any sort of ethical high horse about whether we should or should not be drinking cow’s milk, in terms of digestibility and its allergic potential, I really do not think that we should be surprised if it causes us problems. And of course, the fact that we eat so much of it and that so much of what we eat is poor quality (from intensively reared animals with all the health problems that entails) certainly does not help.