Milk, gluten, red wine… Every second 60-plusser seems to have an intolerance to one food or another, which can sometimes make meals challenging for families and friends. What are food tolerances all about?
What is a food intolerance?
When you have a food intolerance or sensitivity, your digestive system struggles to digest a certain food – possibly because your body doesn’t make enough of a particular enzyme to break it down. Intolerance is a non-immune related reaction to food or chemical substances in food that usually results in irritation to your digestive system, but may cause other symptoms, says Dr Candice Royal, a paediatrician and allergologist in Cape Town.
How to spot it
Symptoms can start 30 minutes to 24 hours after you consume a food or beverage, and the reactions build and then fade. They can include cramps, bloating, flatulence, heartburn, headache, nausea, upset stomach, irritability, fatigue, ‘brain fog’ (not thinking clearly), and low mood, but they’re not life threatening. A food intolerance is different from a food allergy, where your immune system identifies a food protein as dangerous.
It releases antibodies (proteins) into your blood to fight the threat, causing reactions ranging from a slight rash and swelling of your face, tongue and lips, to vomiting, difficulty swallowing or breathing, and sometimes a sudden drop in blood pressure and anaphylactic shock – which can be fatal. You can get tested for an allergy with a blood test or skin-prick test, says Dr Royal.
What are the three main triggers of food intolerance?
Gluten is a protein found in certain grains, mainly wheat, rye and barley, and sometimes in oats through product contamination. If you have a reaction after eating it, get checked out professionally to rule out coeliac disease (CD) – an autoimmune disease where gluten damages your small intestines, making it hard to absorb vitamins and other nutrients.
It’s usually apparent from babyhood, when you’re first introduced to cereal, but may develop in adulthood, causing weakness, fatigue, fluid retention, easy bruising, mouth ulcers, rashes, cramps, tingling in feet and legs, anaemia, nausea, diarrhoea and poop that’s pale, smelly or that floats. There are tests for CD – and you will need dietary guidance for a gluten-free diet for life, or risk long-term complications such as chronic fatigue, malabsorption, anaemia and cancer.
Lactose is the sugar found in milk and dairy products. This can cause digestive problems if your body doesn’t make enough lactase enzyme to break it down. “Typically, small amounts of processed dairy don’t cause problems, but larger amounts of fresh products may produce bloating, cramps and diarrhoea,” says Dr Royal.
Histamines are chemicals occurring in fermented foods and beverages, such as yoghurt and some cheeses, sauerkraut and beer, as well as in processed or smoked meats, dried fruits, avocados, eggplant, spinach, shellfish, pineapples, strawberries and chocolate. They can be a problem if your body doesn’t make enough diamine oxidase enzyme to break down the histamine
How to diagnose a food intolerance
A hydrogen breath test can pick up lactose intolerance. “This test picks up that sugars, such aslactose, are not being digested properly by the gut,” says Dr Royal. There is no test for gluten or histamine intolerance. Your health provider will usually advise you to keep a food diary tracking everything you eat and any symptoms. You can also remove suspect foods from your diet, one at a time, for two to six weeks – if symptoms stop, but return when you resume eating the food, you could have an intolerance. “This is known as an elimination rechallenge diet,” she says.
How to manage a food intolerance
You may need to cut out, or at least cut back on, problem foods – some people are able to consume small quantities with few symptoms; this is in contrast to a food allergy, where even a trace exposure may cause life-threatening symptoms.
If you are lactose intolerant, you can opt for lactose-free milk and dairy products made from plants, such as nuts or grains. You can also buy lactase enzymes at pharmacies – pills you can take before consuming dairy products, or drops you can add to milk to break down lactose.
If you cut out all milk and dairy products, you may not get enough calcium and vitamin D. Explore other food sources – for calcium, have leafy greens, tinned fish, sesame seeds and calcium-fortified cereals; for vitamin D, spend time in sunlight, and eat fatty fish, mushrooms, egg yolk and fortified food.
If you cut out all gluten, you can become low in vitamins B and D3, calcium, iron, zinc, magnesium and fibre, cautions Dr Royal. “Also, gluten-free foods often have a higher glycaemic index,” she says. However, it’s still possible to eat a nutritionally complete gluten-free diet.
“Focus on fresh foods, vegetables, fruits, protein (some meat, fish and plain dairy), eggs, potatoes, rice, corn, sorghum, quinoa and gluten-free pasta,” says Lucille Cholerton, a Durban nutrition counsellor who runs Gluten Free For Life. “It’s a healthy diet if you add extra fibre with the likes of mixed seeds.”
Before cutting gluten, lactose or any food from your diet, consult a professional dietitian for advice on the optimal diet for your specific requirements, and possible supplementation.
For more information, visit the Allergy Foundation of SA
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