By Carin Clegg, Accredited Practising Dietitian
These days it seems common for people to get various symptoms from the foods they eat and to be cutting out foods. However, foods are complex and many contain similar components. It is important to have a diagnosis as dietary management differs. Let’s understand what the most common food–related conditions are.
Coeliac Disease
Coeliac disease is an autoimmune condition, often presenting as gut symptoms such as bloating, diarrhoea or nutrient malabsorption, such as iron deficiency with associated symptoms (poor concentration, fatigue, poor sleep).
Gluten, a protein found in wheat, rye, barley and the protein avenin in oats, causes damage to the small bowel. If coeliac disease is suspected, tests must be done with adequate amounts of gluten in the diet to confirm or rule it out. The management of coeliac disease is a strict gluten–free diet.
More information can be found at www.coeliac.org.au
food allergy
The word ‘allergy’ gets thrown around a lot, usually in substitution for the word ‘reaction.’ However, not all reactions are allergies. A food allergy is usually an immediate reaction to a specific protein in the food where the IgE antibodies in one’s immune system overreact to something that would usually be considered safe. Reactions can range from mild to life–threatening (anaphylaxis requiring adrenalin treatment).
Skin prick tests or RAST blood tests can indicate the likelihood of allergy. An immunologist is usually required to interpret the results with knowledge of a detailed history, then provide a diagnosis and guide dietary management.
For more information see www.allergy.org.au
food intolerance
In the case of food intolerance, food components a person is intolerant to can be consumed without symptoms depending on their tolerance level, how much is eaten and how often it is eaten.
Food chemical intolerance
Usually occurs when there is a delayed reaction to one or more natural or artificial food chemicals or components common to many different foods. Symptoms can change throughout life, and tolerance levels can be affected by stress, hormone changes, infection and inflammation.
Food chemical intolerance can affect more than one body system. Some symptoms of food chemical intolerance include:
- eczema, unexplained rashes, hives, itchiness, skin swellings.
- reflux, IBS, abdominal pain, bloating, excess wind, diarrhoea, constipation.
- non–allergic rhinitis or hayfever symptoms.
- fatigue, muscle aches, sleep disturbance, altered mood, poor concentration, hyperactivity, headaches/migraines, anxiety, and depression.
Foods/food chemicals people react to include wheat, dairy, soy, salicylates, amines, glutamates, and certain additives. The RPAH Elimination Diet with Challenges is the gold standard test to 1) diagnose food intolerance and 2) identify food triggers with challenges. After this process–diet variety is increased to manage symptoms.
See further information: www.slhd.nsw.gov.au/rpa/allergy
Lactose intolerance
Presents as abdominal pain or discomfort and diarrhoea after consuming dairy products containing lactose. Limiting lactose in the diet (including the use of lactose–free dairy products) will stop symptoms from occurring.
People with lactose intolerance can consume dairy foods symptom free by consulting with their dietitian.
Medical tests for diagnosis is not as helpful as dietary testing, which assists people to understand if lactose is their trigger, how much they can consume and how often.
It is important to understand the reason for lactose intolerance, as any damage to the gut will result in lactose intolerance until the gut heals.
FODMAPs incomplete absorption
FODMAPs stands for fermentable –oligo–di–mono–saccharides and polyols. FODMAPs are digested by the microbes in our gut and create gas, which is usually reabsorbed by the gut and breathed out. However, in some individuals, this gas is not reabsorbed from the gut and causes symptoms such as bloating, distention, pain, diarrhoea and constipation.
In everybody’s gut, there is a threshold at which having too many FODMAPs can cause problems. The FODMAPs diet is promoted as assisting with IBS. However, it is often the underlying irritation to the nerves of the gut (visceral hypersensitivity) caused often by food chemical intolerance that contributes to symptoms. Adding gas–producing foods (FODMAPs) tends to further add to the symptoms.
Read more at www.monashfodmap.com/about-fodmap-and-ibs
Whatever the food issue, an experienced Accredited Practising Dietitian (APD) can help in several ways to:
- conduct a nutrition assessment.
- give dietary education on the condition, diet and testing.
- advise on appropriate dietary modification according to medical advice or evidence–based practice.
- assist with identifying food triggers quickly and accurately.
- ensure foods are not avoided unnecessarily, particularly for a long time.
- ensure nutritional adequacy, preventing deficiencies (commonly seen when changing the diet without dietitian support) and chronic disease.
- provide ongoing guidance and support with dietary changes.
If you, or someone you know, feel that food is a problem, please reach out to get the best help you can from your dietitian and get back in control of your symptoms and your life!
Carin Clegg is the Director of Bright Diets, is a Paediatric Dietitian and Fitness Professional with an interest in sustainability. Carin wants everyone to be clever about their eating to feel happy, healthy and vibrant! Reach out at 0413 77 44 11, on our website www.brightdiets.com.au or on the socials.