Many people suffer with diseases and issues related to food, including: food intolerances, food allergies, irritable bowel syndrome (or IBS) and celiac disease. While the symptoms can seem similar, the underlying cause of the reaction and discomfort in the body can be very different. The causes can range from an intolerance to an immune response or even an autoimmune disorder.
Where to begin
If your child is struggling with gastrointestinal discomfort or what you think could be food allergy symptoms, you should begin first with a visit to your health care provider. This is important because your pediatrician can work with you to determine if further testing or evaluation is needed, such as working with a gastrointestinal specialist, allergist, or a registered dietitian. Getting the proper testing done to determine what is going on is essential because otherwise you could be improperly treating the underlying condition.
Understanding the difference
Having a basic grasp of food allergy, food intolerance, IBS and celiac disease can help you understand how the treatment for each is different.
Some 15 million Americans are affected by food allergies, and a food allergy can start in childhood or can begin in adulthood. A food allergy is an immune response or reaction when an otherwise harmless food protein is ingested. Symptoms of a food allergy are a result of the body’s defense and can range from mild to moderate or severe, including: hives, redness of skin, nausea, vomiting, diarrhea, stomach pain, chest pain, trouble swallowing and life-threatening anaphylaxis. There is no cure for food allergies; the only treatment for a food allergy is to not ingest that food.
In contrast, food intolerance does not involve the immune system and may be referred to as non-allergic food sensitivity. An example of food intolerance is lactose intolerance, which is the body’s inability to digest and break down lactose (milk sugar). With food intolerance you may still be able to tolerate small amounts of the food.
Irritable bowel syndrome is a common gastrointestinal disorder with worldwide rates of around 10 percent to 15 percent. IBS is characterized by chronic lower abdominal pain and discomfort, bloating, gas, distension and altered bowel habits (ranging from diarrhea to constipation) but with no abnormal pathology. Treatment of IBS can be different for different people and one approach is a low-FODMAP diet—more to come on this.
Celiac disease is a serious autoimmune disorder that is estimated to affect 1 in 100 people worldwide. With celiac disease the ingestion of gluten triggers an immune response that damages the little finger-
like structures (villi) in the small intestine. The treatment for celiac disease is strict elimination of gluten from the diet. Gluten is a protein found in wheat, barley, farro, rye, triticale, and in many other ingredients and forms (for example, malt and brewer’s yeast).
Steps to take
After you have worked with your health care provider to rule out underlying diseases, you are left to sort out what food intolerances are triggering your symptoms. Two strategies that can be used are an elimination diet or the low-FODMAP diet. When using these strategies, it is helpful to enlist the support of a registered dietitian who can help guide you through the process and work with you to narrow down what the culprit or culprits are.
Before eliminating anything, keep a detailed record of everything that is consumed (meals, snacks and beverages) for a couple of weeks. Along with what is consumed, keep a record of how your child felt, bowel movements and gastrointestinal symptoms (such as bloating or pain). The record of what she is eating paired with the symptoms can help to zero in on what could be causing the distress.
After you have completed the recordkeeping phase, the elimination process can start. There are different routes to take for elimination; one is very restrictive and one is more of a guesswork process.
The restrictive method is to start with a clean slate and only consume foods that are typically well tolerated by most people, such as rice and pears. Then gradually reintroduce foods over several weeks. Throughout the reintroduction, continue recording all foods and beverages consumed along with any symptoms to identify trigger foods that result in discomfort or distress. Something to keep in mind is that intolerances can take a couple of days to show up after eating a food.
The less restrictive route is, after the documentation phase, carefully evaluate the intake record you kept to identify any patterns. Examples of patterns could include: intolerance to high fat foods, dairy, etc. Then the identified foods or groups of foods can be eliminated and you can re-evaluate to see if your kid’s symptoms have been relieved.
With an identified intolerance, it may not mean that your child can never have
the food again—rather that your kid may have to limit the portion or frequency.
An approach that is gaining traction to sorting out what foods are causing IBS symptoms is the low-FODMAP diet. FODMAP is an acronym that refers to groups of carbohydrates researchers have linked to irritation of the GI system: fermentable oligosaccharides, disaccharides, monosaccharides and polyols.
With this approach, you eliminate all FODMAP foods and then slowly reintroduce the foods from each FODMAP group to determine which food or groups of foods could be causing the issue. For example, if foods in the monosaccharide group, like apples, honey and fruit sugar, are causing GI distress, avoiding or limiting these foods should relieve symptoms.
A low-FODMAP approach is not meant to be a diet to follow strictly forever; rather it is intended to help evaluate which foods or groups of foods are not tolerated. Then you can determine how much of the specific food can be tolerated.
Support and resources
Remember to use the support of your health care provider to navigate the process and use reliable resources. (See the suggested resources listed here.) While GI discomfort can be frustrating and uncomfortable, it is worth the effort to determine what foods or underlying factors are causing the symptoms.
Molly Morgan is a registered dietitian and author of three books, including, most recently, Drink Your Way to Gut Health. She lives in the Southern Tier area with her two children and husband. Visit her website at creativenutritionsolutions.com.