Intolerating Food (September 1, 2015)
Food is a wondrous thing. I’m reminded of that every time I'm forced to avert my eyes as I walk through the Trader Joe’s dessert section. Some people eat only because they need to (we generally refer to this class of persons as “skinny”) but most of us enjoy the necessity to eat quite a bit, and choosing foods we enjoy over those we don’t is a natural thing to do. In fact, if you don’t have a good reason to avoid a food you like, you aren’t going to do so. These next couple few newsletters are dedicated to giving you more reasons for avoiding foods that you like. Aren’t you glad?
Food sensitivity/food intolerance is a very curious area of knowledge and practice because although its basic principles are agreed upon, no one knows what to really do with them. I am not talking about food allergy here, which is fast and violent immune response to a food. Everyone knows what to do about THAT. (Except for the grandmother of a friend of mine who is allergic to chocolate but winds up in the ER once or twice a year from eating it anyway.) But just because you do not immediately swell up like a toad and collapse, suffocating, to the ground in response to a particular food like Mindy's grandma does, does not mean that you do not have a problem with it.
What kind of a problem? Practically anything you can think of as a symptom. My feeling is that anyone with any chronic or recurring health issue at all should make at least a token attempt to discover any food intolerances they might have. But people with fibromyalgia, GI issues, migraine headaches and/or emotional and mental issues might particularly want to make the effort to look for foods or food ingredients that might be behind their symptoms.
I’m going to give you some examples from my personal experience. A gentleman with whom I am very well acquainted developed a gallbladder inflammation so severe that I was not permitted to tell jokes for weeks because laughing was so painful for him. He identified coffee as provoking the problem and although he used some supplements and a gallstone-dissolving medication (yes, there is such a thing) as well, eliminating coffee fixed the problem -- a problem that was bad enough that any medical doctor would have recommended surgery (and one actually did). I know a lady who discovered that the yeast in beer triggered her migraines and stopped having them – beer and headaches both. Another lady found that bread was causing her diffuse but severe muscle soreness. And the list goes on, people.
My feeling is that there are two reasons that although the existence of food intolerance is a subject that is not in scientific dispute, how to identify them still is. First, there’s really no money to be made in getting people well by getting them to eat differently, so few people are interested in investigating the subject. Secondly, the list of symptoms that can be caused by a food constituent is amazingly long – this makes developing a workable system harder, not easier. And thirdly (ok, three reasons), elimination diets aren’t much fun to do. But they are simple to do and when they work the way they are supposed to, the benefits are incalculable. There are decades of studies that have found foods to influence all aspects of physiology and behavior, and it is on this diverse but very solid foundation that elimination diets are based.
In very brief summary, an elimination diet will remove a food or foods from your diet for at least a couple of weeks. You watch and see if your symptoms lessen or disappear during this time. If they do, you eat the suspect food in large quantity and see if those symptoms return. A very simple experiment anyone can do on his or herself, with results that are inarguable.
Everyone is a little different, and every food in a particular category is different as well – beef is different from lamb although they are both meat. That is why I don’t believe that elimination diets as they are generally done these days are very helpful. These diets (which I would be more inclined to call "exclusion diets") will eliminate one or more categories of food from your diet and see if your symptoms diminish over several weeks. That works fine if your symptom is due to a single basic food or food category, and if that also happens to be the food that you eliminated. But most sensitivities are sneakier than that. Not to mention that you can be sensitive to a "good" food, which you will not discover if you eliminate only "bad" foods from your diet (however otherwise beneficial that might be).
I particularly have a bone to pick with the Whole30 diet, an anti-inflammatory / exclusion diet which in a moment of madness I went on with a friend a while back. This one eliminates several categories of food and is meant to be anti-inflammatory. The problem is that it retains eggs, meat and nuts as allowable foods, all three of which can be quite inflammatory. After three weeks on this poorly thought-out abomination of a diet, I not only developed some tummy issues I hadn’t had in decades, but my friend wound up for the first time ever with gout in BOTH feet. So much for anti-inflammatory.
After some years of experience with these things, both as a doctor and as a patient, I will assert very firmly here that the only real way to do an elimination diet is to eliminate not just a category or two of foods -- you need to start by eliminating ALL of them. Or at least all but a few foods that are rarely found to cause sensitivities. These are called “oligoantigenic” diets in the trade and they are considered to be extreme. Of course the same folks calling these diets extreme don't see anything extreme about stapling people's stomachs or putting preschoolers on Ritalin, so I say, so much for THEM.
"Extreme" they may be, then, but they are the only way you can be SURE that you're finding out whether a food is causing problems or not, and what it is. This was the problem with the Feingold diet for ADHD, which you may have heard of. It assumed that the reason children with ADHD had their symptoms was because of reacting to just a few specific substances. Sometimes the diet worked and sometimes it didn't, and it's pretty much history now because of that.
There are several ways to do an effective elimination / oligoantigenic diet, which I will discuss next time. None of them are a walk in the park. But it is interesting and beneficial to experiment on yourself once in a while, and the benefits to be gained here are usually well worth the temporary discomfort.
--dr. diane holmes
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