Allergy, sensitivity, intolerance, or ED?

The relationship between food allergies and eating disorders is certainly a complicated one. Recovery is hard enough as we try to re-integrate feared foods into our diet, but unpleasant, painful, or even life-threatening reactions to foods can sometimes hinder our progress. There is a whole lot of information on the internet about food sensitivities and the symptoms they cause, and some of this information may not be scientifically supported. Let’s look at what the research shows about allergies, intolerances and sensitivities by answering some questions people in recovery often have.

What is the difference between a food allergy, a food intolerance, and a food sensitivity?

A true food allergy occurs when the immune system mounts an inappropriate response to a protein in a certain kind of food (Smolek, 2018). This response could look like hives, or it could occur as a life-threatening reaction like anaphylaxis, which makes it very difficult to breathe. People with life-threatening food allergies often have a lot of anxiety about the chance they will go into anaphylactic shock and sometimes, this anxiety around food can progress into disordered eating (Farrar, 2019). The most common allergens are peanuts, gluten, milk, eggs, soy, and shellfish. A food allergy can only be diagnosed by an allergist or immunologist and usually involves a blood test or skin pricks. People with allergies do have to totally avoid the food they are allergic to, but it is entirely possible to outgrow an allergy (Smolek, 2018).

What is celiac disease?

Celiac disease is actually different from a wheat allergy. It is an autoimmune disease where there is actually physical damage to the intestines, whereas a wheat allergy causes symptoms like the above mentioned ones (anaphylaxis, hives). Celiac disease can cause symptoms like digestive discomfort and fatigue, but it can also cause bone loss, anemia, and even depression (Celiac Disease Foundation, 2020). Sometimes, people with celiac disease might not show any symptoms at all, but their intestines are still experiencing damage. Along with wheat, people with celiac disease have to avoid barley and rye. Celiac disease is diagnosed with an endoscopic biopsy, which will show atrophy in the lining of the small intestine.

What about lactose intolerance?

Food intolerances aren’t as severe as allergies, but anyone diagnosed with lactose intolerance can tell you that they can be pretty uncomfortable. Lactose intolerance is not the same thing as a dairy allergy. People with lactose intolerance have trouble digesting the specific sugar in milk called lactose. Luckily, there is treatment for lactose intolerance. A GI doctor can diagnose the intolerance and will advise taking a lactase enzyme pill before eating meals with dairy, or eating lactose-free foods. Lactose free milk is largely available, as are lactose free ice creams or cheeses, so people with lactose intolerance don’t need any kind of restricted diet.

I don’t have celiac disease, but I’ve been hearing a lot about gluten sensitivity. I have abdominal discomfort, bloating, and fatigue. Could I benefit from a gluten-free diet?

There is actually no way to accurately diagnose gluten sensitivity (Smolek, 2018). It’s possible that some people do experience a range of symptoms like gastrointestinal discomfort or even “brain fog” after eating gluten, but we also can’t blame gluten because we can’t know if that it is causing those symptoms, or if those symptoms are due to something else, like the expected discomfort of the refeeding process. Adopting a gluten free diet when it isn’t medically necessary can be dangerous for someone trying to recover from an eating disorder. It’s a restrictive diet and may deepen someone’s existing anxiety about food.

My nutritionist/dietician/doctor is recommending that I take a food sensitivity test. This test is pretty expensive, but I do want to know if anything I’m eating is causing my bloating and abdominal pain. What should I do?

The science behind food sensitivity tests is far from solid. We know that allergies can be identified by the presence of certain antibodies called IgE antibodies, which indicate an inappropriate immune response to a specific food or substance (Love, 2018). Food sensitivity tests claim to measure IgG antibodies, but there is actually no evidence that suggests that IgG antibodies are connected to food intolerances. If you do pay for one of these tests, you will likely get an overwhelming list of the many foods you are “sensitive” to. It’s not unusual for these tests to show over 20 different food sensitivities! Why would they show so many?

Some researches think that the presence of IgG antibodies only indicates previous exposure to a certain food, not a sensitivity or intolerance. So, if you’ve recently eaten blackberries before you take the test, you might have IgG antibodies for blackberries in your blood, which would show up as a “food sensitivity” when those antibodies are actually a good sign that your body is recognizing and processing those blackberries! Don’t be fooled by the very “scientific” packaging of these sensitivity tests. Just because you send your blood to a lab somewhere doesn’t mean the test is valid or diagnostically useful.

What does all this mean for my recovery? Is there any way I can lessen my painful GI symptoms?

In a nutshell, elimination diets are not your friend unless they are medically necessary, like in the case of a true food allergy or celiac disease. It makes sense that if your eating disorder has restricted you from certain foods, re-introducing those foods is going to be a bit of a shock to your GI system. One route to symptom relief could be working with a dietician and a therapist to reduce your anxiety around food. That is not to say that your symptoms are “all in your head”, though! There is some fascinating research on the gut-brain connection that shows how anxiety can physically alter the digestive process.

When you’re stressed, your brain sends signals through your autonomic nervous symptoms that tell your GI system to slow digestion and even change the gut micro biome (Love, 2018). In other words, getting stressed about getting sick from certain foods may actually be causing you to get sick from those foods! Being aware of this self-fulfilling prophecy and learning effective techniques for reducing anxiety, including exposure to those feared foods, can definitely help you in your recovery.

References:

Celiac Disease Foundation. (2020). Symptoms of celiac disease. https://celiac.org/about-celiac-disease/symptoms-of-celiac-disease/

Farrar, T. (2019). Food allergies and eating disorders. Mirror-Mirror. https://www.mirror-mirror.org/food-allergies-and-eating-disorders.htm

Love, S. (2018). Food intolerance tests are shoddy science and traps for disordered eating. Vice. https://www.vice.com/en_us/article/43778n/food-intolerance-tests-are-shoddy-science-and-traps-for-disordered-eating

Smolek, B. (2018). What you need to know about food allergies and eating disorders. The Feed. https://thefeedblog.com/2018/06/20/what-you-need-to-know-about-food-allergies-and-eating-disorders/