By Carin Clegg, Accredited Practising Dietitian
These days it seems very common for people to get various symptoms from the foods they eat and to be cutting out certain food components such as gluten and dairy. However, foods are very complex containing similar food components in many different foods. It is important to have a diagnosis as dietary management differs. So, let’s get a better understanding of what the most common food–related conditions are.
Coeliac Disease
Coeliac Disease is an autoimmune condition that often presents as gut symptoms such as bloating, diarrhoea or nutrient malabsorption such as iron deficiency with associated symptoms (poor concentration, fatigue, poor sleep).
In the case of Coeliac Disease, gluten (a protein found in wheat, rye, barley and oats) causes damage to the small bowel.
It is essential if Coeliac disease is suspected that tests are 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. Information about Coeliac Disease can be found at http://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 over–react 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 Allergy Doctor (e.g. immunologist) is usually required to interpret the results with knowledge of a detailed history, provide a diagnosis and guide dietary management which may be strict avoidance of the allergen.
Information about allergic disease can be found at 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 through different stages of life, and tolerance levels can be affected by stress, hormone changes, infection and inflammation in the body.
Food chemical intolerance can affect more than one body system. Some symptoms of food chemical intolerance include:
- Eczema, unexplained rashes, hives, itchiness, skin swellings
- Gut: 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, depression.
Foods and food chemicals people react to are usually wheat, dairy, soy, salicylates, amines, glutamates, and certain additives. The RPAH Elimination Diet with Challenges is the only best test method to find out what food components are the problem. After the test diet and challenges are complete, the diet variety is increased to manage symptoms.
More information about food intolerance can be found on the Royal Prince Alfred Hospital Allergy Unit’s Website www.sswahs.nsw.gov.au/RPA/Allergy/default.html.
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 still consume dairy foods with no symptoms.
Medical tests for diagnosis can be done but are often not as helpful as dietary testing to assist people in understanding if it is, in fact, lactose that is their trigger and how much and how often they can eat lactose.
It is also important to understand the reason for lactose intolerance, as any damage to the gut will result in lactose intolerance until the gut heals again.
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 an array of lower gut symptoms such as bloating, distention, pain, diarrhoea and constipation.
In everybody’s gut, there is a threshold at which having too many of these FODMAP foods 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, whilst adding gas–producing foods (FODMAPS) tends to further add to the symptoms. More information about the FODMAPS diet can be found at https://www.monashfodmap.com/about-fodmap-and-ibs.
Other Testing
Many unorthodox tests are available to identify food allergies and intolerances, but the results are often misinterpreted, inaccurate and unreliable. For details, see https://www.allergy.org.au/patients/allergy-testing/allergy-testing.
Whether it is a confirmed case or in the process of diagnosis of Coeliac Disease, food allergy or food intolerance, 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
- to assist with identifying food triggers quickly and accurately
- ensure foods are not avoided unnecessarily, particularly for a long time
- ensure nutritional adequacy, preventing deficiencies and chronic disease
- provide ongoing guidance and support with dietary changes.
Unfortunately, due to so much information at our fingertips these days most people who have decided to change their diet before seeing a Dietitian develop nutritional inadequacies or deficiencies.
So, if you or someone you know feel 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 an Accredited Practising Dietitian, (BSc Nutrition, Hons) and a Personal Trainer (Cert III, IV in Fitness) who is the Director of Bright Diets. Carin loves helping people be clever about their eating so they can feel happy, healthy and vibrant, living life to the fullest. Carin specialises in paediatric nutrition, food allergies and intolerances and intellectual disability (ASD, ADHD). You can contact Carin on Ph: 0407 492 278, via her website: www.brightdiets.com.au or on the Bright Diets Facebook page.