Most of you will have noticed that organizing a dinner party is more difficult than it used to be. One friend is gluten-free, another is dairy-free, one can’t eat onion, and two more are vegetarian. Is food intolerance on the rise? Or are we just hearing more about it now?
What are food intolerances?
Food intolerances are reactions to eating food, in normal amounts, that does not involve the immune system.
They are very different from food allergy that’s when the body mounts an immune response to a food that is either ingested or even touches the skin. This immune response is very rapid (within 20 minutes to two hours) and releases chemicals that can affect the person’s breathing, gastrointestinal tract, and heart.
Common food allergies include eggs, peanuts, wheat and shellfish. Allergies differ from intolerances in that the most severe allergies cause anaphylaxis: severe allergic reactions that are life-threatening.
The mechanisms behind food intolerances can vary widely. A common mechanism is when people lack enzymes necessary for breaking down nutrients.
With one of the most common food intolerances, lactose intolerance, people lack the enzyme “lactase” used to break down these carbohydrates found naturally in milk and some other dairy products. Lactose is broken down into glucose and galactose in the small intestine and then absorbed.
Without lactase, lactose stays in the gut, where it takes water from the blood supply to dilute the amount of lactose. Initially, this leads to diarrhea, and as the lactose enters the colon, it is fermented by the bacteria in our gut, resulting in gas that causes bloating, pain and discomfort in the abdomen.
Other food intolerances due to the lack of enzymes are intolerances to histamine and caffeine. Some people are unable to break down histamine, which is found in red wine, strong and blue cheeses, tuna, tomatoes and pork products.
This can lead to symptoms such as itching, red flushing on the skin, abdominal pain, nausea, dizziness, headaches and migraines. Likewise, people can also be sensitive to caffeine (found in coffee and cocoa).
Food intolerances also differ from autoimmune reactions, such as in celiac disease. In this case, people develop an autoimmune reaction in the small intestine to a protein in wheat called gluten. The autoimmune response also damages the villi, the tiny finger-like structures that absorb all the nutrients.
Many people who experience gastrointestinal symptoms in response to wheat products assume they have celiac disease. However, they can be sensitive to fructan, a type of carbohydrate in wheat. Fructan is a naturally fermentable carbohydrate and a “FODMAP” – which stands for Fermentable Oligo- Di-Monosaccharides and Polyols, a group of nutrients that can cause sensitivity.
As with lactose (which is also a FODMAP carbohydrate), some people cannot absorb high amounts of fructans (which are also found in onions and garlic). Like lactose, this causes diarrhea, and then the bacteria in the colon ferment the fructan, causing gas, abdominal pain and discomfort.
So are food intolerances on the rise?
While it seems that food intolerances are on the rise, we don’t have good evidence that this is actually the case. Data on actual numbers are lacking, perhaps because food intolerances generally do not lead to the need to take medication or seek emergency medical attention.
A 2009 report suggests about: 20% of the population has one or more food intolerances, with no apparent change since 1994. A more recent survey from 2020 of self-reported intolerances among Internet users reported about 25% of the population.
The observed increase may reflect many other factors. Some people self-diagnose a food intolerance based on well-intentioned but misleading health advice from family and friends.
In addition, people may mistakenly attribute medical symptoms to foods they have eaten. Thanks to Dr Google, we also have a greater ability to self-diagnose. In other cases, dietary requirements may reflect ethical choices about food.
We all know by attending social events with food how often we have to meet our dietary needs. This also contributes to normalizing food intolerances, compared to even ten years ago. Previously, people would have suffered in silence or simply avoided consuming their problematic trigger foods at events.
Another factor could be that there are more people of different ethnicities living in Australia, some of whom are: genetically more likely have an intolerance.
If you suspect you have a food intolerance, it’s best to get a diagnosis from a doctor to make sure you’re not overlooking a potentially worrisome medical problem. You may also be unnecessarily avoiding a particular food group and missing out on essential nutrients needed for optimal health.
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