More on Food Intoleration (September 8, 2015)

You are probably already worrying about the pesticide content, nutritional makeup, genetic origin and calorie content of what you are eating. And I feel for you, I really do. But that might not be enough. As I was saying last week, it may benefit you to consider an aspect of diet that doesn’t get a lot of press since the Feinstein diet for ADHD went out of fashion, and that is food sensitivity or intolerance. Because it's possible for even a healthy food to cause you trouble. 

I should mention here that “food intolerance” is not a made-up alternative medicine concept created by people who are always looking for something else to freak you out about in order to sell books or otherwise part you from some of your cash. It is a legitimate medical issue with all kinds of research substantiating various aspects of it. Here is a very brief synopsis of what the Experts have to say on the subject.

Food intolerance / food sensitivity is not the same thing as food allergy, because immune reaction plays no part in food intolerance. Instead, it derives from difficulty in digesting a particular food. It can be caused by absence of a digestive enzyme (like in lactose intolerance). It can also result from the presence of a naturally-occurring food chemical.

Such food chemicals include caffeine or histamine or salicylates (which can be present in multiple foods), or an artificial food additive (most commonly nitrates, MSG, sulfites and food colorings) that your body simply doesn’t appreciate. Most symptoms are gastrointestinal in nature (especially bloating and gas, diarrhea, stomach ache and irritable bowel) but you can also suffer migraine or other headaches, hives, cough, runny nose, or generally feeling under the weather from a food or food ingredient your body can't deal with properly.

Unlike with food allergy, in food intolerance often small quantities of that food can be eaten by a sensitive person without difficulty. [That means that even if you have to stop eating a food you are sensitive to, you may eventually be able to return it to your diet. It also makes it harder to detect in the first place. As you already know, there are no unmixed blessings.] Additionally, the symptoms take longer to emerge (several hours to up to 48 hours) with food intolerance than they do with a food allergy. So the two are quite different and shouldn't be confused.

Skin prick tests are not reliable in detecting food intolerance (they aren't in food allergy either, actually) and blood tests are useless since the immune system is not involved. The only solution, again, is discovering and eliminating the offending food or food constituent with an elimination diet.

My personal opinion is that the range of possible symptoms is far wider than those listed above. Otherwise, I don't dispute the current state of the evidence. Interestingly, apart from a few general principles there are no guidelines for conducting an elimination diet. So instead I will offer you my opinion and experience regarding same. Without evidence-based guidelines, that is all that anyone can offer you regarding this. 

An elimination diet is just what it sounds like – you eliminate foods that you suspect might be causing you trouble and see if your symptoms lessen or disappear. But to do this properly, you can’t take any chances that the food or foods you DON’T eliminate are the ones causing the Symptom. Because otherwise you may not only suffer dietary boredom to no avail, but you could also miss the boat on ever tracking down and eliminating the source of your Symptom.

So you want to make sure you get it right, and get it right the first time. And if you do what most of the popular wisdom says to do, and simply eliminate one or more classes of foodstuffs and see what happens, you very well may miss the responsible food and thus screw it up. Therefore you should do it my way. That is true of everything in life, of course, but it is much more crucial to your well-being in this case than if, say, you make squash casserole differently than I do.

Here are my rules for doing an elimination diet. You start with a water fast. Yes, you consume nothing but water for a time. (Warning; do NOT do this with tap water. Especially Nashville tap water. Spring water, reverse osmosis, distilled water, whatever. Just not that stuff that comes out of the faucet, unless you thoroughly filter it first. Like so many things these days, water ain't what it used to be.) If you can do this for a week, great. But you should do it for at least three days to give it a fair test.

By the end of that first week the Symptom should be gone. After a week, if the Symptom is still present, you can't blame what you're eating for it. But if it's gone, you need to find out exactly what you were eating that was causing it -- or you may NEVER GET RID OF IT. 

So you now find the Offending Food (or food ingredient) by performing one or more food challenges. There is more than one way to do this, but my preference is that you eat a substantial amount of the food you are testing on a given day and see what happens. If you've got the right food, usually the Symptom will have returned by the next morning. If it has not, you can keep eating that food and test a different food that day. And so on, adding foods one at a time, until you figure out what is to blame.

There’s a caveat here, and that is that it can take two to three days for a symptom to manifest after you consume the responsible food. But seriously, after water fasting for a week, are you going to eat only rice for three days to see what happens? That’s just too cruel. No, just test one food a day. Offending foods usually show themselves by the next morning, anyway. When your Symptom finally shows up, if cutting out the last food you tested from your diet doesn’t eliminate it from your life, cut out the last three foods you tested and wait until the Symptom is gone again. Then you can test the remaining suspects one at a time. 

Here is an example. You think that something you’re eating has been playing a part in your headaches. First you water fast for a week (at which time you have not only lost about ten pounds but have also sworn to kill me on sight). But your headaches are gone – huzzah! Day eight, you decide to eat bananas all day. Day nine, no headaches, you keep eating bananas and also start drinking coffee again. Day ten, bananas and coffee and whatever you've decided to test next. And so on until the headaches start again. But now you know who to blame. 

What I just described sounds fine in theory, but in practical terms, many people simply can't do it, and then they feel inadequate and guilty as well as ill. And that, I say, should not stand. There are things you can do instead that work very nearly as well. So that is something I will discuss when I wrap this up next week. In the meantime, if you're doing the water fast -- I salute you.

--dr. diane holmes
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