general info DO YOU HAVE A FOOD INTOLERANCE?
Do You Have A Food Intolerance?
Updated on 02 January 2020

A food intolerance, or a food sensitivity occurs when a person has difficulty digesting a particular food. This can lead to symptoms such as intestinal gas, abdominal pain or diarrhoea.

Lina Doumani, Clinical Dietitian at Allied Medical Center says, “A food intolerance means either the body cannot properly digest the food that is eaten, or that a particular food might irritate the digestive system. Often it is due to lack of a certain enzyme in the lining of the small intestine or insufficiency of that specific enzyme for that particular food.” Bloating and stomach ache are the common signs of food intolerance, however these are not the sure shot signs. Dr Zahid Saeed, General Practitioner at Dubai London Clinic says, “Difficulty in digestion of certain food and having symptoms like bloating, tummy pain usually after few hours of having food; many people think that they have food intolerance but their symptoms maybe attributed to something else .”

How Is Food Intolerance Different From Food Allergy?

While food intolerance symptoms can go unnoticed and cause some kind of uneasiness with less serious consequences; reactions from food allergies are instant and can do serious damage to the health. The reaction can cause symptoms such as coughing, throat tightness, hoarseness, abdominal pain, vomiting, hives, drop blood pressure, and sometimes swelling.

Dr Sanjeev Kumar Rastogi, Specialist Gastroenterology at Canadian Specialist Hospital says, “ Food allergies are another kind of food hypersensitivity but are dissimilar in terms of their mechanism of action. Food allergies, like other allergies are caused by our immune system due to release of histamine and typically gives a fast and almost immediate reaction. Food intolerance can also go unnoticed by consuming only a small amount and are largely non-lethal, whereas even a small quantity can flare up the allergy which can be lethal if not corrected in time. Dr Basil Khaled Moh’d Nasrallah, Consultant Pediatrician at Emirates Speciality Hospital says, “Food intolerances involve the digestive system. Food allergies involve the immune system that affects numerous organs in the body. With a food allergy, even a microscopic amount of the food has the potential to lead to a serious or life-threatening reaction called anaphylaxis."

Ruba Elhourani, Senior Clinical Dietician at RAK Hospital says, “Food allergy can be potentially life-threatening since it can affect the immune system and consequently numerous body organs. Food intolerance on the other hand is mainly limited to the digestive system, and can be prevented as well if certain foods are eaten in small amounts or avoided. For example, people who suffer from lactose intolerance do have the alternative of drinking lactose-free milk or consuming lactase enzyme pills to help with the digestion.”

What Are The Most Common Examples Of Food Intolerance?

Generally foods that cause intolerance in the body include dairy products, grains that contain gluten and foods that can lead to acidity, such as beans, cabbage and others. In lactose intolerance, the body can't digest lactose (milk sugar) found in milk and milk products.

Dr Sanjeev Kumar Rastogi of Canadian Specialist Hospital sums up the most common food intolerances as follows:
• Dairy - Lactose in dairy products are broken down by the enzyme lactase. Absence of the enzyme causes an inability to digest milk and milk products resulting in diarrhoea, stomach pain, bloating and nausea
• Gluten - Gluten is found in wheat, barley and rye. Gluten intolerance can be due to celiac disease or other factors yet unknown. Celiac disease is an autoimmune disease which can attack the digestive system. However, people who have tested negative for celiac disease have also had a milder version of gluten intolerance called ‘non-celiac gluten sensitivity’.
• Caffeine - Found in our coffee, tea and sodas, caffeine is a chemical that blocks adenosine, a neurotransmitter which regulates the sleep-wake cycle. Most of us can consume a decent amount of caffeine without any side-effects. Those intolerant due to an inability to metabolise or secrete the chemical out of the body can suffer from anxiety, insomnia and rapid heartbeat.
• Salicylates - These compounds are found in a variety of natural (fruit, vegetables, tea, coffee, spice, nuts honey) and man-made products (as preservative, medicines). Salicylate intolerance can cause sinus infection, nasal congestion, asthma, diarrhoea, hives etc.
• Amines - A by product of fermentation and food storage amines are found in dry fruits, cured meats, cheese, vinegar or anything fermented. Histamine is the most common amine and most people can metabolise it, but those who can’t can present with headache, itching, hives, anxiety, cramps, diarrhoea etc.
• Additives - Additives in different foods can cause intolerance in some people. Additives are used to enhance flavours, make foods look more appealing, and to increase their shelf life. Examples of food additives include: antioxidants, artificial colourings, artificial flavourings, emulsifiers, flavour enhancers, preservatives and sweeteners.

Dr Zahid Saeed of Dubai London Clinic lists the name of food products for which people generally develop intolerance:

• Lactose - milk, yoghurt , ice cream
• Wheat - bread , cereal , pasta , cookies, pizza
• Gluten - pasta , bread , crackers
• Caffeine - tea, coffee, chocolate, green tea
• Histamine - present in mushrooms, pickles, and cured food
• Additives - artificial sweeteners, colouring, or other flavourings

What Causes Food Intolerance?

Food intolerance can be caused due to absence of an enzyme, reaction to additives in foods, increased sensitivity of the gut due to Irritable Bowel Syndrome, stress and psychological factors.

Dr Zahid Saeed of Dubai London Clinic says, “Absence of enzymes which digest food for example in people with milk intolerance do not produce enough lactase to digest lactose, hence it stays in the body for long and causes symptoms. Stress can also trigger symptoms. IBS, a chronic condition causes diarrhoea, constipation or cramping in the abdomen.”

“Celiac a chronic digestive condition which is caused by gluten, a protein found in wheat and other grains. The symptoms can include diarrhoea, bloating and unexpected weight loss. It does involve immune system and has some features of true food allergy. But people with celiac are not at risk of anaphylaxis.”

What Are The Early Signs Of Food Intolerance?

The most common early signs are abdominal pain, bloating, gas, however these are not very severe and you don’t need to visit the emergency department and can schedule a regular doctors appointment.

Ruba Elhourani of RAK Hospital says, “The most common food intolerance signs and symptoms include irregular bowel movements, constipation or diarrhoea, and insomnia. At times the symptoms can be similar to food allergy signs, such as itching or tingling in the mouth.”

Dr Sanjeev Kumar Rastogi of Canadian Specialist Hospital says, “Common symptoms of food intolerance are stomach troubles such as abdominal pain, bloating, gas, diarrhoea which can be distinguished from allergy reactions. Since food intolerance is non-lethal there is no need to panic and go to the ER. You can comfortably schedule an appointment with the doctor.”

What Are The Common Tests To Identify Food Intolerance?

Some of the most effective methods include elimination, keeping a diary and specific blood tests. Doctors can recommend any of these tests based on one’s condition.

Dr Sanjeev Kumar Rastogi of Canadian Specialist Hospital says, “Apart from lactose intolerance and celiac disease, there is no accurate, reliable, and validated test to identify food intolerance. The best diagnostic tool is an exclusion diet, also known as an elimination or diagnostic diet.

In a typical exclusion diet, the suspected food is removed from the diet for a set period, usually between 2 weeks and 2 months. If during this period the adverse reactions resolve, it becomes more likely that the culprit has been found. This can be further confirmed if it is then reintroduced and symptoms return.”

Dr Zahid Saeed of Dubai London Clinic says, “There are simple things which people can try, like keeping a food diary and making a note of the food consumed, the kind of symptoms and timing of symptoms in relation to when food 
is consumed.”

Ruba Elhourani of RAK Hospital says, “Food intolerances can be gauged by a blood test which evaluates the response of our immune system to certain foods and measures the levels of allergy-related antibody called immunoglobulin E (IgE). The blood sample is then sent to a laboratory, where different foods can 
be tested.”

Are Food Intolerances Treatable?

The good news is that you're not necessarily destined to have these food sensitivities forever. When the offending foods are removed from the diet and the body is given time to heal, many people no longer react to the same foods. this is known as tolerance, It takes time, diligence, and discipline.

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