How are those new year's resolutions going? While well meaning, at this time of the year all too many are solely focused on calories and weight loss rather than on the quality of their food. For instance, a bowl of lettuce may have more calories than a diet soda, but the nutritional differences and impact on your body should be obvious. Sometimes even making healthy choices, choices that would be considered optimal for most people, may be a huge issue for you. This can be confusing. You think, “I’m eating right, exercising, and getting rest. Why do I feel off? Why do I have this eczema, rash, fatigue, pain, or depression?” The answer could be a food allergy or sensitivity. We invite you to take a deeper look at your food and customize a dietary plan that’s as individual as you are.
What’s the difference between an allergy and a sensitivity?
A food allergy can be severe and potentially life threatening. Anaphylaxis is the most dangerous scenario and requires immediate medical attention or the use of an epinephrine auto-injector—an epi-pen. Symptoms of anaphylactic shock include a sudden drop in blood pressure and blocked breathing due to swelling of the tongue or throat. Other symptoms can include rapid pulse, skin rash, hives, diarrhea, nausea, and vomiting. Since food allergies occur almost immediately—within seconds and up to 2 hours after you’ve eaten the food—the culprit can often be easier to identify. Strict avoidance of the food should be observed once this happens. Please check all ingredient labels and don’t be shy about asking the chef to make sure you don’t inadvertently ingest a food you know will give you a problem.
A food sensitivity, or intolerance, is generally less serious and can result in such symptoms as digestive distress, headaches, skin rashes, and joint pain. The tricky part is that symptoms can be subtle, systemic, seemingly unrelated to what you’re eating, and can occur on a delay making it even harder to identify the offending food.
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Which Foods are the Top Offenders?
They’re called the “The Big 8:” milk, eggs, fish, crustacean shellfish,* tree nuts,* peanuts, wheat, and soy. These foods account for 90% of all food allergies in the U.S. and for that reason, must be declared on the labels of processed foods. I would add a few qualifications: gluten in general can be problematic, not just wheat, as can all dairy, not just milk. Other common symptom-triggering foods can include corn, tomatoes, citrus fruits and juices, sugar, chocolate, coffee, alcohol, yeast, MSG (which goes by many different names), and artificial sweeteners.
Gluten: It’s Not Just Wheat
Gluten is a general name for proteins (gliadin and glutenin) in wheat, barley, and rye. Gluten gives baked goods their elasticity and chewiness. To make things more confusing, wheat can go by many names such bulgur, matzoh, cous-cous, farro, graham, spelt, kamut, durem, emmer, eikorn, semolina etc. Oats can also contain gluten due to cross-contaminated in factories that process other grains. Just because the label says “wheat-free,” doesn’t mean it’s gluten free.
Gluten-free grains include brown rice, quinoa, buckwheat, millet, and amaranth.
Tip for gluten-free baking: try flours made
from coconut, rice, chickpeas, or almonds.
Cornmeal is another gluten-free substitute.
Celiac vs. Non-Celiac Gluten Sensitivity vs. Wheat Allergy
Celiac is a hereditary, life-long autoimmune disease responsible for 300-some-odd symptoms. These can include digestive distress (often severe), weight changes, fatigue, joint pain, depression/anxiety, and fertility issues. Dermatologically, it can manifest as an itchy skin rash called dermatitis herpetiformis.
After initial blood work is done, a definitive diagnosis is reached by a biopsy of the small intestine (you must be eating gluten at the time of your tests). The biopsy is used to confirm that immune reactions to gluten have eroded the tiny villi lining the small intestine. When these finger-like villi get damaged, the gut becomes more permeable, or "leaky." This means that the gut lining, which once only allowed nutrients through its tight junctions, now allows undigested food molecules and toxins through. Circulating where they should not be, these stray bits are viewed as foreign invaders by the body and it launches an immune attack against them resulting in more inflammation. In this way, multiple reactions to previously innocuous foods can crop up.
For celiacs, maintaining a strict gluten-zero diet is essential. This is the only way to manage the disease and to prevent serious complications from arising. The slightest amount of gluten—even a crumb—causes the body to launch an immune response that can last for months. This can be challenging because gluten is often used as a filler in many products and can hide under many names such as hydrolyzed vegetable protein, modified food starch, artificial coloring, and malt extract, to name a few. It can also show up in beauty products, medications, and vitamins so you have to be really smart about reading labels and checking with manufacturers. There are apps available that can help you decipher what’s safe. Please visit celiac.org for more information.
People with gluten sensitivity share many of the systemic symptoms celiacs have, but they don’t have the villous atrophy—damage to the small intestine—or antibodies.
Like other allergies, a wheat allergy is similar to allergies in general and is tested for in the same way. People with a wheat allergy may be able to tolerate other grains.
Be a Food Detective
Want to know which foods to avoid? At SoCo, we offer comprehensive food allergy and sensitivity testing through KBMO labs. Our simple blood test screens for dozens of antibodies to food allergens, spices, and an array of other ingestants. Find out more about our food sensitivity testing here.
Elimination Diet How-To:
Want to test on your own? It takes a little patience, but if your symptoms clear, you’ll have evidence that confirms your food issue and that can make you more motivated to stick with dietary restrictions, especially long term.
First, choose the suspicious food or foods you want to cut out. Strangely, it’s often the case that it's the food we crave and eat most that’s causing the trouble.
It can be helpful to pick a time of low stress, when you can stay home, or when you won’t be eating out a lot. It’s harder to control your restrictions at restaurants, dinners, parties, or when traveling.
I suggest eliminating the chosen food(s) for 4 full weeks. Eliminating several foods at once can speed the process along. You’ll know what’s what when you add the foods back in one at a time.
Be sure you’ve swept the cupboards reading ingredient labels and removing anything that contains the ingredient(s). It’s important to spot alternate names used for the ingredients you’re trying to avoid. You’ll also want to stock up on foods you can eat.
Keep a food journal recording everything you ingest and write down any symptoms and how you’re feeling. You may feel worse at first as your body adjusts to the change or if your body goes into detox mode. That’s another reason why you should try to pick a low-stress time.
After the full 4 weeks go by, add the food(s) back in one at a time waiting 1 week between each reintroduction. Carefully note how you are feeling. If your symptoms return, cut that food out again. Sometimes, if you give yourself a break, you can eventually eat your trigger food again, but proceed with caution. It’s best to confirm your findings with someone like me, a medical doctor, and get advice on how to maintain a balanced diet.
If this seems too overwhelming, just keep a food diary. When you notice symptoms, check to see what you ate for your last meal. You might be able to make a correlation between your lunch and the rash you have an hour later.
Finding out which foods are right for you takes a little effort, but feeling your best makes it all worthwhile. At SoCo Dermatology, we’re here to help you dine your way to better health and gorgeous skin!
Call us if you have questions or if would like to come in for testing:
*Crustacean shellfish include lobster, crab, crawfish, prawns, and shrimp.
*Tree nuts include almonds, cashews, hazelnuts, litchi, macadamia, pecan, pine, pistachio, walnut, brazil, chestnut, and other exotic nuts.
Please check other sources for comprehensive lists of ingredients and read labels carefully.