There is growing public awareness of food intolerances, and allergies in general. More and more people are discovering that they are adversely affected by foods of various kinds. Food manufacturers are starting to provide low-allergy foods, and gradually friends and families of those affected are becoming more understanding.
But the scope of symptoms and disorders that can be caused by food intolerances is still largely misunderstood, so many people remain undiagnosed and suffer unnecessarily. This page is intended to give you a overview of some of the new knowledge and to enable you to have a better idea whether you or someone you know might be affected.
There are a number of terms used to describe adverse reactions to foods – allergy, intolerance, addiction (as we are often addicted to foods we react badly to), sensitivity. For the purposes of this article, any of these can be taken as terms to describe anywhere on the whole spectrum of reactions.
Although there are many foods (and other substances) that we can be sensitive too, gluten is possibly the most common and the most under-diagnosed. Many people feel that it is also one possible cause of other sensitivities. So for this article, we’ll be focusing mostly on gluten, though most of what is discussed is applicable to other foods as well.
Covered on this page:
What are the different types of sensitivities?
Why does gluten cause so many problems?
How common is gluten intolerance?
What symptoms indicate gluten intolerance?
How can I get gluten intolerance diagnosed?
What should I do next?
I already know I need to be gluten free – take me straight to the page on how to do it!
WHAT ARE THE DIFFERENT TYPES OF SENSITIVITIES?
There are at least three main types of antibodies associated with food sensitivities – IgE, IgA, IgG. Ig stands for Immunoglobulin, and these are proteins produced by the body to deal with foreign pathogens. They are specific to the pathogen. So what we’re talking about here is when an antibody is produced to something that should be benign, like a food. To make it easier to see which is which at a glance, I’m going to give them “nicknames”.
Associated with the “immediate” allergies, caused by a release of histamine. These aren’t usually life-threatening, but sometimes cause anaphylaxis, which can be fatal if not promptly treated. Some examples of reactions are:
- Hayfever, as a reaction to spring pollen or dust
- Hives, as a reaction to eating tomatoes or other foods
- Eczema and dermatitis, as a food or contact reaction
- Anaphylaxis, as a reaction to peanuts or bee stings
IgE allergies are well covered by traditional allergists, so we won’t go into them in any depth here. Let’s call these ones “Evergreen”, in honour of the green grass of spring, a time when many people get hayfever.
IgA allergies to egg, yeast, soy, milk, or gluten have been identified, though gluten has been the most studied. IgA is associated with the gut, and IgA allergies can cause gut damage. In the case of gluten (and possibly also casein) the IgA causes intestinal permeability. (More on this below.) So we’ll call these ones “Attackers”. IgA allergies don’t seem to “go away” and appear to be genetically linked.
IgA (Attacker) reactions have a high correlation with some specific genes in the HLA range of genes. This is still being studied, but the following possible correlations have been identified so far:
Gene: Associated with: HLA-B8 Celiac disease HLA-DQ1 Gluten sensitivity HLA-DQ2 Celiac disease HLA-DQ3 Gluten sensitivity HLA-DQ5 Gluten sensitivity HLA-DQ6 Gluten sensitivity HLA-DQ7 Celiac disease HLA-DQ8 Celiac disease HLA-DR3 Celiac disease
If you have one of these genes, there is a high likelihood that that gene will have been “expressed”, and you will have functional gluten intolerance.
Foreign proteins that enter the blood elicit an immune response by the IgG system. This is what is most often meant when people talk about “food allergies”. IgG allergies sometimes come and go, and are often associated with your favourite foods, as they are what’s eaten most often. So these ones we’ll call “Greedies”.
If a person has a lot of IgG (Greedies) allergies, chances are they have leaky gut. The good news is that if the leaky gut is healed, the foods can usually be reintroduced after a while.
IgM is a class of antibodies found in circulating body fluids. IgM antibodies are the first antibodies to appear in response to an initial exposure to an antigen. Apparently the IgM’s are sometimes the only place where the gluten reactivity shows up – which may explain why some people test clear for gluten, yet have definite symptoms when they eat it.
It is possible to have both an IgA (Attackers) allergy and an IgG (Greedies) allergy to the same food. People with an IgA (Attackers) allergy to gluten often also have an IgG (Greedies) allergy to it, for example. But IgE (Evergreen) and IgG (Greedies) allergies are incompatible.
So if you have an IgA (Attackers) allergy to gluten, then develop an IgG (Greedies) one as well, you won’t get an IgE (Evergreen) one. This is probably why IgE (Evergreen) allergies to wheat or gluten are comparatively rare.
It seems that “allergy shots” for IgE (Evergreen) allergies (so you don’t react to dog hair, for example) work by causing an IgG (Greedies) allergy. Injecting the protein into the blood causes an IgG (Greedies) allergy, which dampens the IgE (Evergreen) response.
The above reactions can be termed allergies, as they involve the immune system. But there are other reactions that could be termed sensitivities.
- Lactose intolerance, for example, is the result of a deficiency of the enzyme lactase and is not an allergy.
- Toxic reactions may occur in cases of food poisoning or in response to eating a food that is harmful for most people by it’s nature, eg. refined sugar. Or you may be reacting to a non-food item, such as mercury.
- There may be foods that you have no specific allergy to, but don’t enhance your health. Maybe foods that are not appropriate for your metabolic type, or that you just don’t feel specially well on.
WHY DOES GLUTEN CAUSE SO MANY PROBLEMS
Gluten intolerance linked to IgA (Attackers) causes damage to the intestinal lining, allowing partially digested food to pass into the body. This is often known as leaky gut syndrome. There are two different theories about why this happens.
It is most commonly believed that the gluten sticks onto the villi, and the IgA (Attackers) attacks it there. The villi are damaged or destroyed, and the gut becomes permeable. In celiac disease, at least some of the villi are always destroyed.
But Dr Fasano, of the University of Maryland School of Medicine, has another theory. He found that a human protein called zonulin, which regulates the permeability of the intestine, is at increased levels during the acute phase of celiac disease. It seems that gluten (and possibly also casein) trigger a higher than usual level of zonulin, which allows substances to pass through the gut wall. It also increases the permeability of the brain/blood barrier, which may explain how gluten is implicated in mental problems. In this case, reducing the zonulin levels could bring the gut quickly back to it’s normal level of permeability. For more details, see http://www.umm.edu/news/releases/zonulin.html
It’s possible that both theories are right – the first kind of damage is related to celiac disease, and the second to other types of gluten intolerance.
It is commonly believed that “leaky gut” is the cause of IgG (Greedies) food sensitivities, and also is one of the causes of many autoimmune and other diseases. For example, due to the damage to the intestines, nutrients are not properly absorbed, resulting in various kinds of malnutrition, including anaemia. For a full explanation of the damage gluten can cause, a recommended book is Dangerous Grains.
Gluten isn’t the only cause of damage leading to gut permeability though. It can also be caused by other IgA reactions or by overuse of antibiotics, candida overgrowth, parasites, bacterial infection, heavy metal toxicity and other causes.
So it is possible to have sensitivities to other foods without also having a reaction to gluten. But if you have any other sensitivities, look closely at the possibly of gluten intolerance as well.
HOW COMMON IS GLUTEN INTOLERANCE?
James Braly and Ron Hoggan, the authors of Dangerous Grains, estimate the incidence of gluten sensitivity to be around 30% of the population. Dr Fine of Enterolab, based on results of IgA (Attackers) antibody tests and gene tests from his laboratory, estimates 30-40%. However, as some people have no symptoms, so are never tested, some commentators feel that it’s closer to 50%. (That is, in the US. Due to different racial mixes, not all countries will have the same incidence.)
Let’s take a moment here to differentiate between different levels of gluten or wheat sensitivity.
- Coeliac, or celiac, disease – where the intestinal villi are damaged by gluten (or specifically to gliadin, the gluten in wheat). Coeliacs must stay on a 100% gluten free diet for life.
- Gluten intolerance – where the symptoms haven’t yet progressed as far as coeliac, or are manifesting in a different way. There are a variety of different manifestations of this. This isn’t yet widely recognised in the medical profession. As some people use this term interchangeably with Coeliac, a more appropriate term may be Gluten Reactivity.
- Wheat intolerance – the sensitivity isn’t to the gluten, but to other aspects of the wheat. Other gluten grains can often be tolerated.
- No specific allergy, but health is best when grains of any kind are kept to a minimum
- No specific allergy, but health is best when maintaining a lowish level of carbohydrate generally. A certain number of people also seem to be unable to digest and break down starches, most likely because of the gut problems we’ve already mentioned.
Humans have only been eating grains for about 10,000 years. Most of us haven’t fully evolved to digest and assimilate them. In the early days of agriculture, wheat was usually a food for the rich, and most people ate other grains such as oats, rye and millet. It’s important to also note than the older forms of wheat had a lot less gluten in them. The modern forms have been bred to have a huge amount of gluten to make fluffy bread.
So it’s likely that even those people (probably less than 50% of the population) who don’t fall into one of the above categories are not well served by a diet high in grains, especially wheat. This is contrary to what most nutritionists and government agencies are telling you.
Those of you who can eat grains with no problems should always eat them well prepared. That is, soaked or fermented to reduce phytates.
Other common food allergies, apart from wheat or gluten:
- Nuts or peanuts:
Usually an IgE allergy, and can result in anaphylaxis
Even for those who are not allergic to soy, it’s not a recommended food, unless fermented.
Mostly in the US where it’s eaten a lot, and where many things are sweetened with corn based sweeteners. Not as common in NZ.
It is usually the egg white that people are allergic too, so you may still be able to eat egg yolks, if you’re careful to remove all the white.
Note than casein is usually an actual allergy, where lactose intolerance is an enzyme (lactase) deficiency. With lactose intolerance, you can take lactase supplements, or eat dairy products that either don’t contain much lactose (butter, cream, ghee, some cheeses) or have been fermented (yoghurt, kefir). Avoiding casein is more difficult. Some people can tolerate A2 casein, eg from sheep or goats milk, whereas others can tolerate no diary products at all, with the possible exception of properly prepared ghee. For more on dairy allergies, and dairy in general, click here.
You may not be able to eat any fruits
If fruits seem to be the main problem, but doesn’t quite cover it, you may also need to check these out. If this is a problem for you, you will also react badly to aspirin.
- Starches generally:
This is more of an inability to digest them. This may also be associated with a gene in the HLA range – HLA-B27. Recommended reading for more information on the Specific Carbohydrate Diet is Breaking The Vicious Cycle by Elaine Gottschall.
WHAT SYMPTOMS INDICATE GLUTEN INTOLERANCE?
There are a huge range of different symptoms that can be attributed to just gluten intolerance, without even considering other sensitivities. Many people believe the most common symptoms are gastrointestinal, but many people with gluten intolerance (and celiac disease) have extra-intestinal symptoms, or even no symptoms at all. So there is no easy correlation between symptoms and the cause. Below is a list of common symptoms of gluten intolerance, and some disorders that have associated with gluten intolerance. For a more complete list of related disorders, see Dangerous Grains.
- Digestive problems & gastrointestinal distress – eg. gas, bloating, “beer gut”, diarrhea, constipation, vomiting, reflux
- Respiratory problems – eg. asthma
- Hormonal problems – eg. delayed menarche (menstrual cycles), amenorrhea (lack of periods), infertility, PCOS
- Pain – eg. headaches, migraines and bone, joint or muscle pain
- Mental problems – eg. inability to concentrate, ADD
- Emotional problems – eg. moodiness, depression
- Skin problems, including DH or Dermatitis Herpetiformis (a “sister” of celiac disease)
- Obesity, weight loss or gain
- Mouth sores
- Dental enamel hypoplasia & other dental problems
- Tingling numbness in the legs
- Short stature
- Abnormal liver test
- Addison’s disease
- Autism & Aspergers
- Autoimmune hepatitis
- Chronic abdominal pain
- Chronic fatigue
- Crohn’s disease
- Dermatitis Herpetiformis
- Down syndrome
- Family history of celiac disease
- Gall bladder disease
- Hyperthyroidism / hypothyroidism
- Total IgA deficiency
- Insulin-dependent diabetes (type 1)
- Infertility / spontaneous abortions / low birth-weight babies
- Iron deficiency
- IBS (Irritable Bowel Syndrome)
- Multiple sclerosis
- Myasthenia gravis
- Non Hodgkin’s lymphoma
- Osteoporosis, osteopenia, osteomalacia
- Pancreatic disorders
- Pathologic fractures
- Peripheral neuropathy
- Pernicious anemia
- Primary biliary cirrhosis
- Recurrent stomatisits
- Rheumatoid arthritis
- Scherosing cholangitis
- Sjogren syndrome
- Systemic lupus
- Turner syndrome
- Ulcerative colitis
This doesn’t necessarily mean that if you have some of these symptoms, or one of these disorders, that you are gluten intolerant. But given that such a large portion of the population IS gluten intolerant, If you THINK you have it, you probably do.
There are also a lot of gluten intolerant people who don’t have any symptoms. If you are one of them, but members of your family are affected by gluten, it would be wise to be tested.
Also be aware that you can be coeliac without having ANY symptoms. Some people are diagnosed with it after a family has been diagnosed, but have no symptoms of their own. Up to 40% of diagnosed coeliacs may fall into this category.
HOW CAN I GET GLUTEN INTOLERANCE DIAGNOSED?
There are a range of different tests, but none are 100% accurate. Mostly they are only looking for one type of sensitivity, and there is potential for false negatives and false positives. My recommendation is to take any type of testing as an indication of what might be causing problems. Then eliminate the foods in question and see if this helps the problem.
- The official way to diagnose Coeliac disease is by biopsy of the intestinal tract. As damage to the villi occurs at an advanced stage of the disorder, and not all of the intestinal wall may be damaged, there are many false negatives to this test. It is also fairly invasive. This may be done in conjunction with blood tests looking for IgA (Attackers) antibodies and other antibodies specific to celiac.
- IgE (Evergreen) reactions can be diagnosed by either skin scratch tests or RAST serum tests. They each have their pros and cons. Both can have a quantity of false positives for food allergies, but are reasonably accurate for respiratory allergies, and insect venom reactions. For more information see the Allergy NZ allergy website. Another useful page for deciding which test to choose is the Auckland District Health Board site.
- It should be easy to arrange IgE testing through your doctor, but if that is a problem, you can try approaching a lab direct. In the US, Great Plains Lab will arrange your tests. In NZ, FXMed can tell you who your nearest practitioner is.
- IgG (Greedies) reactions are identified through blood tests. But according to the Allergy NZ website: “The relationship of IgG antibodies to food allergy remains to be established. Many asymptomatic individuals generate IgG antibodies to foods and other environmental substances. These IgG antibodies may simply represent exposure to foods in otherwise well individuals and may have no relevance to food allergy.” Or maybe it’s because you have leaky gut, so you’re reacting to whatever you eat most often.
- In NZ, contact FXMed for your nearest practitioner. In Christchurch, contact Dr Rodney Ford . In the US, York Allergy USA can test up to 113 foods.
- IgA (Attackers) antibodies are usually looked for through blood tests. But IgA antibodies are not supposed to be in the blood, so although they sometimes do appear there, a blood test will often show nothing ie. a false negative.
- Stool tests for IgA (Attackers) reactions are much more accurate. However, some people produce low levels of IgA generally, so even with a stool test, low amounts for individual foods may appear as a false negative. False negatives may also occur if you have been avoiding the food for a while. As far as I can tell, stool sample testing is not available in NZ (if this is not the case, please let me know). In the US, Dr. Fine of Enterolab does IgA stool tests for gluten, casein, eggs, and yeast as well as a range of other tests.
- From a correspondent: “I’d like to point out to you a little known blood testing panel for gluten reactivity by Immunosciences Laboratories. It is very detailed and tests for gluteomorphins as well as gliadins, tTG, tTG-AGA and also for foods that may cross react and organs/tissues that may also cross react with these food related antibodies. They also run IgA, IgG and IgM tests on most of the items they check. However at the moment the IgMs are temporarily unavailable. I’m told a patient can ask to have the specimen stored until they become available for an later add-on panel of IgM’s if they are necessary.”
- For a more in depth look at some tests available, see www.glutensensitivity.net/testing.htm – this page is still being compiled but already has a wealth of testing information on it.
- Gene tests are available to check for genes that have a high correlation with either celiac disease or gluten intolerance (IgA – Attackers – reactions). In NZ, try seeing your doctor with a list of genes you want to be checked for. In the US, see Enterolab again.
- An elimination diet involves eliminating potential problem foods to see if symptoms improve. Then reintroduce them one at a time to see if symptoms get worse again. Although this approach is potentially the most accurate, even this has some pitfalls and drawbacks.
- When reintroducing a food that causes a problem, the reaction may not happen straight away. Especially with gluten and dairy, the reaction can take up to 4 days to appear. Or in extreme cases, where the reaction is “silent”, problems may even take months to appear.
- Sometimes a food can cause silent damage, so neither the elimination nor reintroduction may appear to cause any change. This is most common with gluten. So there is still a possibility of a “false negative”.
- Just eliminating a food that is causing damage may not be enough to heal the damage straight away, so you may not get an immediate improvement. There may be other body systems that need extra repair work to come back into balance. Or permanent damage may have been done, that can’t be repaired.
- Muscle testing – This involves challenging a muscle to see if a food weakens the body’s energy system in some way. There is potential for both false positives and false negatives with muscle testing, and a lot depends on the skill of the kinesiologist. A single muscle test for each substance picks up some sensitivities, but not all. It is sometimes necessary to test in different ways to uncover all sensitivities. From my research, it appears that double blind testing does NOT give good results. The results are more accurate when at least one party knows what is being tested. Look for a kinesiologist who is experienced in allergy testing. Ask whether their clients have had good results when eliminating the foods identified from their diet.
- Pulse test – A do-it-yourself test that involves taking your pulse before and after each meal. If your pulse rises by more than 10 beats per minute, there is a possibility that you are reacting to one of the foods just eaten. There are a lot of variables with this kind of test though, so it would be most accurate to keep records over a number of different meals to see what common denominators there are. Don’t discount the possibility that the pulse has been raised purely by the act of eating, or by something that happened during the meal.
WHAT SHOULD I DO NEXT?
The test information given above is to help you decide which type of testing which would be most useful to you. It is recommended that you work with a doctor or natural health care practitioner experienced in working with allergies and who can help you analyse your results, and plan your diet and treatment.
Eliminate potential problem foods
Once potential allergens have been determined, the usual approach is to eliminate the foods from the diet for a period of time. In some cases, celiac disease for example, the foods concerned must be avoided forever. In other cases, they are reintroduced later to see if they can now be tolerated.
If anyone in your household has a sensitivity, I’d recommend considering banning it from the house completely. There are several reasons for this:
- For some gluten intolerant people, even miniscule amounts can cause a reaction. So even having it in the house for others can cause contamination. You may need to replace your toaster, for example, to completely clear the house.
- If one member of the household has an IgA (Attackers) reaction to a food, chances are it will be harmful for others, even if not diagnosed.
- It’s easier to prepare the same meals for everybody, than to have one person on a special diet.
- If the whole family eats the same, the “allergic” person doesn’t have to feel like a freak, or deprived and left out.
Be aware that you may suffer withdrawal symptoms, as we are often addicted to the foods we are allergic to. These can range from fairly mild to severe – flu like feelings, headaches, etc. This should pass within 3-6 days and you should start feeling better.
You may prefer to gradually wean yourself off the suspected foods, to let your body adapt. The withdrawal symptoms will be less severe, but will go on for longer.
It can be hard to keep a balanced diet when your foods are restricted. You may want to work with a nutrition coach to help with meal planning. Look for one who follows whole food principles, and will not restrict your diet incorrectly by telling you to eat low fat and avoid red meat! Some general principles:
- Eat properly prepared, nutrient dense whole foods as much as you can
- If you know your metabolic type, keep to the macronutrient ratios (that is, amounts of protein, fat and carbs) recommended for your type, and eat from the recommended food lists where possible.
- If you don’t know your metabolic type, eat some protein, some fat, and some carbohydrate at each meal
If you look around the internet, you’ll find lots of sites with alternative recipes for people with allergies. Many of these are not compatible with eating a nutrient dense diet, so may not be very satisfactory for you. Check out the Yahoo group http://health.groups.yahoo.com/group/GFCFNN/ for recipes with a native nutrition slant. This is a very supportive group for anyone suffering from food allergies, but especially gluten or casein intolerance. In fact, much of the information in this article came direct from that group, with special thanks going out to Heidi Jean.
There are some gluten free recipes in my cooking course, and there are some sample recipes you can download on that page.
Further tips on changing to a GF diet are in the Resources section of the website.
Once you’ve eliminated gluten or other allergies from your diet, you will need time for your body to heal. Once you’ve adjusted to a new way of eating, your body will start to heal itself. If this doesn’t seem to be happening, you may need to look at other problems such as:
- Further food allergies. if you suspect that gluten is a problem and just eliminated that, you may find that you also need to cut out other foods. Casein intolerance is a common secondary allergy for those with gluten intolerance.
- Impaired digestion – digestive aids may be required for a while
- Gut dysbiosis eg, candida overgrowth or insufficient “good” bacteria
- Nutritional deficiencies – both current and past.
- Hormonal imbalances
- Damage to other body systems
Once again, the GFCFNN Yahoo group is a great place to ask questions about what you’re going through, and what might be your next step.
There are some therapists who have had a lot of success with treating food and environmental sensitivities using energy techniques such as NeuroLink, Kinergetics, EFT (Emotional Freedom Technique) or NAET. These have the potential to reduce the impact of sensitivities much more quickly, either by directly addressing the sensitivity or by improving the function of the digestive system. Some sensitivities can be neutralised quite quickly, and some are very resistant. I believe that IgA (Attackers), and possibly IgE (Evergreen), reactions are innate and cannot be neutralized easily, whereas IgG (Greedies) reactions are acquired and can be healed, as long as the underlying causes (eg. IgA (Attackers) reactions) are removed.
Check any such treatments in the same way as you checked the test results – by using your body as a guide. WARNING – If your reactions are acute and life threatening, by all means have treatments to minimise any reaction to accidental exposure. But in this case, DO NOT test the results!
For further information, do your own searches on gluten sensitivity or reactivity, as new information is being uncovered all the time. One helpful website is GlutenReactivity.com.
If you’re in Wellington, NZ, and think you may have allergies to gluten, casein or other foods, contact me for a free 15 minute consultation to go through your options.
Other pages about gluten: