Tired of feeling uncomfortable after you eat? We take a closer look at food sensitivities and what you can do about them. By Rebekah Kendal

You love pizza, but every time you eat it you feel bloated and a little gassy. You begin to suspect you may be intolerant to gluten. Maybe you are allergic to milk. Or both. Perhaps it is time to cut wheat and dairy from your diet. And nuts, and fish, and dried fruit, and eggs. Just to be safe. After all, it worked for your friend, right?

Whoa. Hang on a second. Before you go eliminating half your diet, let’s clear up the basics.

Allergy vs intolerance

Although there can sometimes be an overlap in symptoms, there’s a difference between a food intolerance and an allergy. In the case of an allergy, your immune system reacts to something it perceives as harmful in the food by creating specific antibodies to fight off the allergens. In severe cases, this might even result in lethal anaphylaxis, where the tongue swells, the throat constricts and it becomes very difficult to breathe. In the case of a food intolerance, there’s no immune response and the symptoms are usually restricted to the gut, such as bloating, diarrhoea, constipation and irritable bowel syndrome.

‘An allergy is a reaction to the protein in a food, whereas an intolerance is a reaction to the carbohydrate in a food,’ explains registered dietitian and spokes- person for the Association for Dietetics in South Africa (ADSA), Lila Bruk. ‘For example, a milk allergy is a reaction to the whey or casein protein in milk, but lactose intolerance is a reaction to the lactose carbohydrate in milk.’

‘Depending on the type of allergy or intolerance at hand, both may present gastrointestinal symptoms. However, an allergy may present as eczema, rhinitis or asthma, which an intolerance is unlikely to. An anaphylactic reaction is not seen in the case of intolerances.’

Lila points out that because food allergies can result in an anaphylactic reaction, they tend to be more serious than intolerances. However, in the case of coeliac disease, which is associated with gluten intolerance, the individual can have very severe side effects from eating gluten.

The devil’s in the details

Lila cautions against concluding that you have an allergy or intolerance just because eating one particular type of food makes you feel uncomfortable. ‘Many people just assume they have a food allergy or an intolerance because they feel bloated or uncomfortable after eating certain foods, which is attributed to a food sensitivity too quickly. Very often other factors are involved, such as the form the food is in. For example, refined wheat may cause one to feel bloated, but a more wholegrain version is well tolerated.

‘There may be an improvement in symptoms when wheat is eliminated from the diet, but that is because the refined wheat has been removed from the diet along with the unrefined wheat. Therefore, this same improvement in symptoms could be achieved by just altogether removing the refined wheat foods, and there is actually no wheat intolerance present.’

What can you do about it?

‘The best way of identifying whether you have a food sensitivity, and towards which food you have the sensitivity, is to see a dietitian,’ suggests Lila. ‘The dietitian will be able to send you for blood tests and skin-prick tests, as well as assist you with an elimination diet. ‘In such a diet, you exclude the doubted  food or foods from your diet to discern whether your symptoms improve. You would also be asked to keep a symptom diary where you record what foods you eat, the time you eat, and any reactions you experience.’

If you have a food allergy, you will need to stop eating the offending food altogether. In the case of certain types of intolerances – for example, lactose intolerance – it is possible to manage the intolerance by opting for lactose-free milk or taking an lactase enzyme supplement. Once you know what is causing the sensitivity, it is important to start reading food labels to check ingredients for trigger foods.

‘It is quite possible to develop a food sensitivity later in life,’ explains Lila. ‘It is possible to “outgrow” an allergy after taking it out of your diet for a sufficient time period, but it is more common in children than adults to outgrow food allergies. Intolerances are less likely to be overcome than allergies.’

With distinction

Allergies

• Food allergy symptoms usually come on suddenly

• Trace amounts of the food can cause an allergic reaction

• The allergic reaction seems
to persist

• The reaction can be life-threatening

• Common triggers of allergic reactions include peanuts, tree nuts, fish, shellfish, eggs, soy and wheat.

Intolerances

• Intolerance symptoms usually come on more gradually

• You may have to eat a lot of the food or eat it frequently for the symptoms to appear

• The symptoms are usually related to your gut

• An intolerance can be caused by the absence of an enzyme needed to fully digest the food

• Common intolerances: lactose intolerance, gluten intolerance, or sensitivity to sulphites or other food additives

• Intolerances can also be caused by a reaction to chemicals that are produced naturally in foods, for example, caffeine, salicylates and histamine in foods such as straw-berries, cheese and chocolate.