Food Allergies: Fact or Fiction?

It used to be easy to throw a dinner party for friends — toss a few steaks or a salmon on the grill, accompanied by a watercress salad with raspberry vinaigrette, sauteed fingerling potatoes, and something chocolate for dessert. But unless you’re dining with people whose food habits you know intimately, you risk violating someone’s food restrictions: soy, dairy, gluten, seafood, or even fava beans. That’s on top of the calorie counters and conscience eaters.

What do you cook for the soy-free, lactose and gluten intolerant vegan? Has the world grown more allergic or more susceptible to marketers? Some cynically proclaim the gluten-free “fad” a money-making scheme preying on the misled healthy eater. After all, twenty years ago, no one thought twice about the bread and butter on the dinner table. Wheat and dairy have been dietary staples for millennia.

Are food allergies merely the products of imagination and emulation? In the age of the internet, everyone is more educated than ever about disease, illness, medicine, and diet. When Miley Cyrus revealed she had celiac disease in 2012 (after noticeable weight loss by her fans), many young people went gluten-free too.

Are food allergies real?

Allergies are real — and potentially deadly. But it’s important to distinguish first between food allergies, intolerances, sensitivities, and reactions.

Allergies

These are the real deal. Allergies derive from and affect the immune system, eliciting severe reactions, such as vomiting, rashes, swelling, wheezing, hives, stuffy or runny nose, and at its most severe, anaphylaxis marked by constricted breath, tongue swelling, and dizziness: 150–200 people die each year from allergic reactions to food.

The onset of symptoms occurs almost immediately after ingestion. The allergy is usually a reaction to a protein found in the ingested food. Once the culprit is introduced, the immune system releases chemicals, like histamines, to protect the body from what it detects as harmful invaders.

Only about 0.2 to 1% of the adult population and 2–3% of children under one year suffer allergies, including cow’s milk allergies. Doctors diagnose allergies with various tests: blood, kinesiological, and challenge tests. However, 50–75% of food allergy blood tests yield false positives, which causes unnecessary dietary restrictions in too many patients.

The big eight allergens are peanuts, tree nuts, milk, eggs, wheat, soy, fish, or shellfish, comprising 90% of U.S. food allergies. Many of these are often hidden in foods as substitutes or processed foods, causing allergic reactions (soy lecithin in chocolate, for example). Unlike other countries, the U.S. does not require manufacturers to label these allergens. Other common allergy-causing foods include buckwheat, celery, mustard, and sesame.

Celiac disease

Celiac disease is an autoimmune disease in which the body forms antibodies to attack gluten, but also, unfortunately, the gut, potentially leading to malnutrition. 1% of the population has this life-long hypersensitivity where symptoms, such as bloating, stomach cramps, diarrhea, anemia, calcium deficiency, and fatigue set in after a day or two.

Like allergies, celiac disease is an immunological disorder but not from antibodies. It’s the inability to absorb gluten. But unlike allergies, symptoms don’t appear immediately. Those with Celiac disease are more likely to contact other autoimmune diseases, like thyroid disease, insulin-dependent diabetes, and Down’s Syndrome.

Food intolerance or metabolic food disorder

Intolerances are not immune system disorders but genetic defects. If you have a metabolic food disorder, your body is missing an enzyme needed to digest certain foods. For example, lactose intolerance results from the lack of the enzyme to digest lactose, the sugar (disaccharide) in milk and milk products, and favism afflicts those with the missing enzyme in the red blood cells to counter the oxidants in fava beans. Favism results in nausea, fever, or chills.

Unlike allergies, food intolerance symptoms appear much later, even days later, and are not as severe — bloating, gas, and abdominal pain. They don’t leave permanent damage but over a prolonged period can impair the small intestine’s ability to absorb nutrients.

Dairy (65% suffer genetic lactose intolerance) and gluten intolerances are on the rise, though no reliable tests exist to detect intolerances. Anecdotal evidence or self-diagnosis are the basis for diagnosis and treatment. IgG or immunoglobulin G blood testing checks for antibodies produced by certain foods, but this test too is imprecise at locating the culprit of symptom-causing food intolerance.

Food sensitivity

Food reactions, characterized by headache, indigestion, or acid reflux from spicy foods occur periodically in many people. However, idiosyncratic reactions are less common. They are adverse reactions to foods, the causes of which are unknown, most commonly with food additives, MSG, and artificial colors (tartrazine and sunset yellow). Since no direct cause and effect relationship has been proven, symptoms vary widely.

The exception is sulfite-induced asthma, which does have a verified cause and effect relationship and specific symptoms. Sulfites are both processed (added to keep food from rotting, turning, or oxidizing) and naturally occurring, say, in fermented foods, especially with yeast. Few people have severe sensitivity to sulfites, but for those who do, it can be a lethal food sensitivity. Fortunately, sulfites must be labeled on ingestibles.

Yellow food coloring or Tartrazine has been associated with hives and asthma, but studies are not conclusive to establish the direct cause.

Fodmaps

These are sets of sugars (fermentable oligo, di-saccharides, mono-saccharides and polyols) that pool bacteria in the intestines, causing bloating, gas, and diarrhea. Often gluten-containing foods also contain fodmaps, so it may be unclear if gluten or fodmaps cause these symptoms. Wheat has fodmaps too.

Eliminating fodmaps, like garlic, onions, and mushrooms (and many more foods) could isolate the cause.

Is the “Free” movement healthier?

So how many gluten-free folks are foregoing wheat, barley, and rye for weight loss or health reasons? While you may lose weight by eliminating gluten from your diet, remember that wheat has starch just like potatoes and rice, and starch is calorie rich.

And eliminating dairy as well to eat “healthier” is risky without an adequate calcium source. Dairy products provide 75% of the calcium in U.S. diets; calcium is especially important for the bones of growing children and postmenopausal women, who are at greater risk for osteoporosis. While foregoing gluten is harmless, eliminating dairy takes more conscious effort to do safely.

Substituting with almond milk may not cut it. Out of the plant-based milks, only soy milk has the protein of cow’s milk. Others lack sufficient Vitamin D and calcium, which is important to fend off diabetes, heart disease, and colorectal cancer.

You can’t knock eating healthier. But eating healthy foods starts with being smart. Eat a variety of foods to get the vital nutrients you need for optimal health. And while dietary information abounds, self- or mis-diagnosing lactose or gluten intolerance based on the symptoms you read on the internet may lead to unnecessary and potentially dangerous dietary restrictions. Seek professional advice before making drastic dietary changes.