Food sensitivities and intolerances occur in up to 65% of the US population, with the most common causes being gluten, dairy, and eggs. In contrast to food allergies, many patients will have food sensitivities undiagnosed for years based on nonspecific symptoms and the lack of definitive diagnostic testing.
Dietary changes, which can involve eliminating entire food groups, are crucial to treating food sensitivities. Personalized nutrition strategies are vital to improve symptoms and ensure adequate nutrition for optimal treatment.
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What Are Food Sensitivities?
Food sensitivities and intolerances occur when patients react adversely to certain foods or ingredients. These differ from food allergies, which involve an exaggerated immune response to the food and cause more severe symptoms, like hives, swelling, or anaphylaxis.
Sensitivities and intolerances result from a direct response within the gastrointestinal tract. Possible symptoms include:
- Abdominal pain
- Bloating
- Diarrhea
- Constipation
- Flatulence
- Headache
- Skin rash
- Mood changes
- Fatigue
Causes of food intolerances and sensitivities can include individual health factors, enzyme deficiencies, and inflammation.
How to Diagnose Food Sensitivities
Diagnosing food sensitivities can be difficult, requiring a thorough clinical history and an elimination diet.
Initial Evaluation
The first step is to obtain a detailed history, including the signs and symptoms the patient is experiencing. A food diary can be a helpful tool in identifying possible connections between a particular food and symptom occurrence.
Diagnostic Tests
The gold standard for diagnosing food sensitivities is an elimination diet. Eliminating the food of concern for at least 4 weeks and noting symptom improvement suggests a food intolerance.
Beyond dietary testing, food-specific IgG testing is often used, but its specificity and applicability are widely debated. Other nonspecific, less-validated biomarkers can be used to check for gut inflammation and enzyme deficiencies, yet their reliability is also unknown.
Personalized Nutrition Strategies
Formulating personalized nutrition strategies is critical for the long-term management of food sensitivities.
Elimination and Reintroduction
The first step is eliminating the offending agent for at least 4 weeks. If symptoms resolve with the elimination, consider slowly adding the food back to assess tolerance in small amounts. However, if symptoms recur after reintroducing the food, eliminating it from the diet is the best treatment.
Alternative Nutrient Sources
Patients can focus on alternative food sources to ensure adequate nutrition when food sensitivity requires eliminating gluten, dairy, or eggs.
Gluten-free, nutrient-dense options include quinoa, rice, and gluten-free oats, providing complex carbohydrates, fiber, vitamins, and minerals.
Dairy alternatives like almond, soy, or coconut milk products are substitutes for calcium and vitamin D.
With the elimination of eggs, consider alternative protein sources like lean meats, tofu, or legumes. Also, be sure to include a variety of fruits and veggies to ensure micronutrient adequacy.
Supplementation
Supplementation is warranted if patients cannot obtain all the necessary nutrients from their diet. When excluding dairy, the most common deficiencies are calcium and vitamin D, which are vital for bone health.
With gluten avoidance, patients may have vitamin B12, folate, magnesium, or iron deficiency.
If patients cannot eat eggs, most nutrients, like fats, cholesterol, and fat-soluble vitamins, can be obtained from other animal products.
Creating Balanced Meal Plans
While adhering to long-term dietary modifications that eliminate offending agents, it is essential to maintain a balanced, varied, and nutrient-dense diet. Incorporating different foods and flavors that are well-tolerated can make meals more enjoyable and improve long-term adherence.
Many free resources are available for recipe and meal ideas to avoid certain food groups. Consulting with a nutrition professional can also help jumpstart significant dietary changes.
Patient Education and Support
Adhering to an appropriate diet for food sensitivities and intolerances involves reading food labels and recognizing hidden ingredients. Be sure to look for "dairy-free" or "gluten-free" on the label, as cross-contamination is common.
Dining out can be challenging due to uncertainty about the ingredients used in various dishes. Be sure to notify restaurant staff about your dietary restrictions.
Implementing dietary restrictions can be difficult, as it may involve eliminating favorite foods or isolation in social gatherings that center around food. Ensuring patients have the appropriate knowledge and adequate social support helps facilitate long-term adherence.
Monitoring and Long-Term Management
Follow-up visits with patients should include monitoring symptoms, nutrient intake, and ongoing reevaluation of overall health status.
By noting any changes in symptoms, energy levels, and overall well-being, patients can be empowered to manage their health. Incorporating patient feedback is crucial to effectively managing food sensitivities and restrictive diets.
Serial lab testing is necessary to monitor the development of nutrient deficiencies and ensure prompt correction. Consider monitoring the following labs, plus others as indicated:
- Complete blood count (CBC)
- Comprehensive metabolic panel (CMP)
- Vitamin B12
- Folate
- Magnesium
- Vitamin D
- Iron Panel
- Zinc
Ongoing, regular communication between patients and healthcare professionals helps promote optimal health outcomes.
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Key Takeaways
- Common food sensitivities are prevalent in clinical practice, often causing significant impacts on patients' quality of life.
- Using an elimination diet is the gold standard of diagnosing based on symptom resolution, and avoiding that food group is the necessary long-term treatment.
- However, following a restrictive diet puts patients at risk of nutrient deficiencies and other psychosocial stressors.
- Adopting a personalized nutrition approach with regular follow-up is vital to effectively managing food sensitivities.
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