The most common food intolerances, how they are diagnosed and treated
Food is a big part of the culture in the UAE and something that brings people together. Unfortunately for some, eating is a constant battle, with certain foods triggering unpleasant reactions.
According to the Food Allergy Research & Education, a non-profit organisation, in the United States alone, as many as 15 million people suffer food intolerances, and nine million of those are adults.
Food allergies and intolerances are both forms of food sensitivity that can make a person sick. A food allergy involves an immune-system reaction, while an intolerance is an adverse reaction to a particular food.
“Food sensitivities tend to be driven by a change in the gut environment after a bout of food poisoning, antibiotic usage, lowered immunity, habitual use of ibuprofen and other medications,” says Stephanie Karl, a Dubai-based nutritionist at JTS Medical Centre. “Not all food sensitivities are immune responses ... looking for the underlying cause is important.”
There are many factors involved when it comes to food intolerances, adds Katharina Elbracht, a nutritionist at Fitness First Nutrition in Dubai.
“The gold standard for the diagnosis of food intolerances is food exclusion and reintroduction, while keeping a food and symptoms journal,” she says. “This should be professionally supervised by a dietitian or nutritionist, or a doctor with a background in allergology or nutrition.”
Those diagnosed with an intolerance are generally forced to follow a special diet to combat the symptoms, but there are a number of support groups and specialist supermarkets that offer a selection of food options, including Organic Foods and Cafe in Dubai and Abu Dhabi, The Change Initiative in Dubai, Tawa Bakery in Abu Dhabi and the online GlutenFree-Supermarket.ae.
For those with coeliac disease or suffering from a gluten intolerance, the Gluten Free UAE Facebook page has become a valuable resource. “Linda Forster set the page up in 2015 after receiving the diagnosis that her daughter was a coeliac,” says page administrator Wendy Allcorn. “Information and education is key. We are who you want us to be, a support group, an information source, a shoulder to lean on and a restaurant directory.”
According to Elbracht, those suffering intolerances should focus on eating whole, natural foods and avoid processed foods that contain reactive ingredients.
Elbracht and Karl highlight some common food intolerances and how they are diagnosed and treated.
This type of intolerance is caused by a deficiency of the digestive enzyme lactase, which means that the intestine is unable to absorb lactose (milk sugar). It is estimated that 75 per cent of the world’s population has this condition to some extent and it becomes more common as people age. Symptoms include nausea, diarrhoea, bloating and gastrointestinal malabsorption. Lactose intolerance is diagnosed by a hydrogen breath test after drinking a liquid that contains a high amount of lactose. It is treated by cutting lactose out of the diet.
Coeliac disease or non-coeliac gluten-free sensitivity
Coeliac disease is a chronic, autoimmune digestive disorder that appears in genetically predisposed individuals and causes a person to react after ingesting gluten – the protein that is found in wheat, barley and rye. It is said to affect one in 133 people and wreaks havoc with the small intestine, causing it to become inflamed. Symptoms include abdominal bloating, diarrhoea, fatigue, iron-deficiency anaemia, osteoporosis, weight loss and malnutrition. It is diagnosed by way of a small-bowel biopsy and blood tests.
Non-coeliac sensitivity produces symptoms similar to those seen in coeliac disease, but it does not have a genetic component. Common symptoms are mental fatigue, lack of energy or lethargy, gas, bloating and abdominal issues. There is no diagnosis for this, apart from food-exclusion testing.
This is characterised by a deficiency of fructose carriers, which means that fructose (sugars) cannot be absorbed. Fructose malabsorption is said to affect about 30 per cent of people, while fructose intolerance is a rare genetic condition in which a person doesn’t produce the enzyme for breaking down fructose. Symptoms include bloating, diarrhoea, fatigue, low iron levels and sugar cravings. Fructose sensitivity is diagnosed by a hydrogen breath test after drinking a liquid with a high amount of fructose, and is treated by following a strict fructose-free diet.
This is caused by diminished capacity of histamine-degrading enzymes in the body. Histamine is a chemical involved in digestion, regulating the immune system and central nervous system. It is a component of stomach acid and helps break down food in the stomach, and as a neurotransmitter helps relay messages from the body to the brain. When there is an infection, histamine causes blood vessels to dilate, enabling the white blood cells to quickly find and attack the problem. Finally, enzymes break down the histamine so it does not continue to build up. When the histamine response does not dampen, it is referred to as histamine intolerance. Reactions are diverse and often mimic the symptoms of an allergy. The most reliable way of diagnosing it is through an elimination diet, which involves avoiding histamine-rich foods such as eggs, milk, green tea and aged cheeses, and watching the effects. Antihistamic medication can help to ease symptoms.