Is It Food Allergies or Just Hype?
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Fitness

Is It Food Allergies or Just Hype?

What to do when good-for-you choices like fruit, seafood, and whole wheat bread are triggers for food allergies? Here's help separating what's healthy from what's hype.

Food Allergies, Intolerance, and Sensitivities

When Gwyneth Paltrow gave up dairy, I rolled my eyes. And when Zooey Deschanel waxes poetic about "g-free" cupcakes, it makes me want to bake some gluten-licious ones stat. In the past few years celebrities have made wheat, dairy, nuts -- you name it -- into public enemies, mostly, it seems, because cutting out these foods helps them fit into their red-carpet dresses.

But I found myself wondering if I'd been too quick to judge when my doctor prescribed an elimination diet after medication failed to get my chronic weekly migraines under control. He told me to give up alcohol, chocolate, and bacon -- in other words, joy -- plus nuts and any foods containing nitrates, sulfites, or MSG for an entire month. I did it and my migraines disappeared. Then I reintroduced these foods one by one. After some trial and error I figured out that red wine, nitrates (in my beloved bacon), and aspartame were my key food triggers.

The experience made me more sympathetic to friends who have suddenly started pestering waiters with questions about whether a sauce contains soy or cream, because they believe a certain food group is at the root of their breakouts, digestive issues, or other health woes. It turns out that food allergies really are on the rise, although experts aren't sure why. As many as one in 20 children and one in 25 adults are now allergic to some type of food. Peanut allergies have tripled in the last decade, and more than two million Americans have celiac disease, an autoimmune disorder in which the body can't process gluten. A growing pile of research suggests that certain foods can also play a role in chronic problems like migraines, irritable bowel syndrome, diabetes, asthma, and more.

At the same time, it's become difficult to determine what's a bona fide food allergy or health condition and what's just hype. Case in point: Sales of gluten-free foods in the United States grew to $4.2 billion in 2012, according to the market research firm Packaged Facts. Yet "probably 60 percent of the people who are on a gluten-free diet today do not need to be on it for medical reasons. They are responding to the hoopla and think going gluten-free is good for them," says Alessio Fasano, MD, the director of the Center for Celiac Research at MassGeneral Hospital for Children in Boston. "They may believe it's a cleaner way to eat or that they'll lose weight, but they're likely to be disappointed because they won't see drastic health changes or weight loss."

Itching for an Answer

Adding to the confusion is the fact that although you might not be allergic to a food, you could be intolerant of or sensitive to it. The following three terms are used interchangeably, but they actually refer to several different conditions.

Food allergies, which usually begin in childhood, are triggered when your immune system overreacts to a particular protein in a food, typically within a few minutes to a few hours of consumption. Common symptoms are hives, itching in the mouth, and labored breathing; some people can go into anaphylactic shock.

Food intolerance often begins in adulthood and occurs when the digestive system can't break down certain foods, frequently because of an inherited enzyme deficiency. Lactose intolerance is one of the most common types. "As many as 60 to 80 percent of Asian, Hispanic, and black populations will have some degree of lactose intolerance by the time they're 50 years old," says Steve Taylor, PhD, the founder and codirector of the Food Allergy Research & Resource Program at the University of Nebraska-Lincoln. "This is probably because these cultures weren't historically dairy dependent." Food intolerance usually results in gas, bloating, and diarrhea.

Food sensitivities are harder to pin down. For instance, a significant number of people test negative for celiac disease but report similar symptoms -- gastrointestinal distress, chronic fatigue, joint pain -- whenever they eat gluten. "We know they're having an immune response," says Dr. Fasano, who estimates that 4 to 6 percent of the population may have gluten sensitivity. "But we don't know what causes it."

Scientists are more skeptical about sensitivities to other foods and chemicals, including red wine, nitrates, and MSG, which so many migraine patients, like me, credit with causing our pain. "How much of a role food plays in migraine activity is controversial, but about a third of patients associate their headache with a particular food," says Dawn Marcus, MD, a neurologist at the University of Pittsburgh Pain Evaluation and Treatment Institute and a coauthor of The Woman's Migraine Toolkit. "The best studies we have suggest that it may matter more that you eat meals on a consistent schedule."

So why did eliminating certain foods help prevent my migraines? A "nocebo" effect may have been behind the apparent miracle cure: Because I believed that giving up Pinot Noir and prosciutto would deliver a significant payoff, it did. Or perhaps I inadvertently reduced another migraine trigger like stress or fatigue. No one can say for sure.

Fix Your Food Allergies

Food Fix

If you've got symptoms that are consistent with a food allergy, intolerance, or sensitivity, the first step is to figure out what's causing them and then avoid that food. But unless you break out in hives every time you eat shrimp, for instance, that's easier said than done. If you can't connect your symptoms to a particular food, see a doc for help rather than trying a DIY elimination diet. "If you stop eating a certain food before you've been tested for it, your body won't produce the necessary biomarkers to test positive," Dr. Fasano explains. "The test will be useless." Choose an allergist if your symptoms are skin or respiratory based (go to aaaai.org and click on "Find an Allergist/Immunologist" for a member of the American Academy of Allergy, Asthma & Immunology). See a gastroenterologist if you have digestive troubles (enter your zip code at patients.gi.org to find a member of the American College of Gastroenterology).

Your doctor will administer the necessary tests -- probably either a blood or skin-prick test -- and also rule out any other potential causes of your symptoms. "Only once we're sure that there's no other possible explanation that requires treatment does it make sense to try an elimination diet," Dr. Fasano says. The physician may suggest a dietitian who will teach you how to read food labels and work with you to develop a plan so you'll know what steps to take if you do become ill. And be patient: "Elimination diets done properly take weeks and aren't much fun," notes Marion Nestle, PhD, a professor of nutrition, food studies, and public health at New York University. From my own months of bacon deprivation I can tell you she is right. But then again, feeling sick isn't much fun either.

The Skinny on Going G-Free

Warning: Giving up gluten can make you pack on pounds if you replace regular cookies, cake, and other treats with gluten-free versions. The reason is that some of these products have extra sugar to make them more satisfying. "It's easy to swap in foods that are higher in calories and less nutritious than what you were eating before," says Ashley Koff, RD, a nutritionist in Los Angeles and a FITNESS advisory board member. To give up gluten and still eat healthily, limit your consumption of processed g-free fare and eat more fruits, vegetables, lean meats, fish, beans, and nuts, as well as naturally g-free whole grains like quinoa and brown rice to get the fiber, selenium, and manganese you need.

Are You Allergic?

These foods and additives are top triggers for adults. Here, how to get relief.

Dairy
If you get gas, cramps, and diarrhea whenever you drink milk or eat ice cream, you may be lactose intolerant.
Feel better fast: Avoid dairy products, especially soft cheeses, ice cream, and other foods high in lactose. (You may be able to tolerate hard cheeses and yogurt because these foods have less.) Or take Lactaid tablets before eating dairy; these over-the-counter pills contain an enzyme that is key to helping you digest lactose.

Raw fruits and vegetables
If you get itching around your mouth whenever you eat certain types of uncooked produce, you may have a mild condition called oral allergy syndrome.
Feel better fast: Eat cooked fruits and vegetables. Heat breaks down the protein that triggers the allergic reaction.

Peanuts and tree nuts
Many people have a serious, lifelong allergy to nuts. Symptoms range from swelling and respiratory problems like labored breathing to anaphylactic shock.
Feel better fast: Avoid not only foods that contain nuts but also those that may have come into contact with nuts during processing.

Fish and shellfish
A seafood allergy commonly starts in adulthood; it can cause itching around the mouth, hives, respiratory problems like labored breathing, and even anaphylactic shock in severe cases.
Feel better fast: No surprise here: Avoid seafood.

Wheat
Up to 0.5 percent of the population is allergic to wheat, experiencing hives, nasal and chest congestion, nausea, and vomiting whenever they eat it. Celiac disease and gluten sensitivity are not considered food allergies; sufferers have abdominal pain, bloating, diarrhea, and fatigue if they eat gluten.
Feel better fast: Avoid anything with wheat in it if you have a wheat allergy. Follow a gluten-free diet if you have celiac disease or a gluten sensitivity.

Chemicals
MSG, aspartame, nitrates, sulfites, and other additives in foods may cause migraines, dizziness, sweating, ringing in the ears, and a feeling of faintness in some people.
Feel better fast: Eat fresh foods when possible. Before you consume anything processed, read the label and skip those with the offending ingredients.

Originally published in FITNESS magazine, May 2013.

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