Food Intolerance

What is it?

Food intolerance or food sensitivity is a negative reaction to a food that may or may not be related to the immune system or to food poisoning. Food intolerance is an adverse reaction to some sort of food or ingredient that occurs every time the food is eaten, but particularly if larger quantities are consumed.
This isn't the same as a food allergy, because the immune system isn't activated. It is also not the same as food poisoning, which is caused by toxic substances that would cause symptoms in anyone who ate the food.
Food intolerance doesn't include psychological reactions to food either.

What is the cause?

Food intolerance occurs when the body is unable to deal with a certain type of foodstuff. This is usually because the body doesn't produce enough of the particular chemical or enzyme that's needed for digestion of that food. Both natural and artificial ingredients may cause adverse reactions in sensitive people if consumed in sufficient amount, the degree of sensitivity varying between individuals.

For an example, one of the most common types of intolerance is to cow's milk, which contains a type of sugar called lactose. Many people have a shortage of the enzyme lactase, which is normally made by cells lining the small intestine. Without this enzyme they can't break down milk sugar into simpler forms that can be absorbed into the bloodstream.
Lactose intolerance can cause symptoms very similar to irritable bowel syndrome.
Another common example is a deficiency of an enzyme called alcohol dehydrogenase. Drinking even small amounts of alcohol can make affected people feel unwell. Some people have adverse reactions to chemical preservatives and additives in food and drinks, such as sulphites, benzoates, salicylates, monosodium glutamate, caffeine, aspartame and tartrazine. The lack of a specific enzyme in the body may lead to the build up of toxic byproducts and histamine, which then mimic the symptoms of an allergy. This is called a 'pseudo-allergic' reaction. Reactions to chemical components of the diet are more common than true food allergies. The most widely distributed natural food chemical capable of provoking reactions is salicylate containing foods, cross reactions with tartrazine and benzoic acid are well recognised. However it is not widely recognised that significant amounts of benzoates and salicylates occur naturally in many different foods including fruits, juices, vegetables, spices, herbs, nuts, tea, wines, and coffee.

Chemicals involved in aroma and flavour are often suspect.

Who is affected?

There's a strong genetic pattern to food intolerances. Lactose intolerance is less common among northern and western Europeans (10 to 15 per cent are affected) than in Asian, African, native American and Mediterranean populations (70 to 90 per cent are affected). Babies are usually born with higher levels of lactase, so lactose intolerance usually only begins after the age of about two, as the body begins to produce less of the enzyme. But many people don't experience symptoms until they're much older. A temporary lactase deficiency may follow gastroenteritis, especially in children. Alcohol intolerance is common among Asian people - 50 per cent are affected.

What are the symptoms?

Food intolerances are rarely harmful but may cause unpleasant symptoms, including nausea, bloating, abdominal pain and diarrhoea, which can begin hours or days after eating or drinking the food in question. The severity of symptoms varies depending on the amount of enzyme the person makes and how much of the food has been consumed. In alcohol intolerance, there may be intense flushing of the skin, nausea, palpitations, headache and feeling faint.

How is it diagnosed?

The easiest test for a food intolerance is to remove the food from your diet, see if symptoms improve and then try reintroducing the food. If symptoms return, an intolerance is likely.
It takes around 5 days of total abstinence to unmask a food/chemical, during the first week on an elimination diet, withdrawal symptoms can occur but it takes at least 2 weeks to remove residual traces. If symptoms have not subsided after 6 weeks, food intolerance is unlikely involved and a normal diet should be restarted.

Lactose intolerance can be tested for more thoroughly using a lactose tolerance test, a hydrogen breath test and a stool acidity test. Your doctor can arrange these and other food intolerance tests if necessary.

What is the treatment?

Food intolerance can be managed simply by cutting the food out of your diet. Babies or younger children with a lactose intolerance can be given soya milk or hypoallergenic milk formula instead of cow's milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment to work out what they can eat. Lactase enzyme drops or capsules can be used for lactose intolerance. It's important that if foods are excluded from the diet suitable alternatives are introduced to avoid nutrient deficiencies. Once all food chemicals are identified a dietitian can prescribe an appropriate diet for the individual to avoid foods with those chemicals. Contact your GP to discuss any suspected food intolerances before putting a child on a restricted or elimination diet.