You probably remember an occasion when you ate something that did not agree with you. But if your stomach issues have become severe and frequent, you might have a food intolerance.
“Food intolerances puzzle many older men, since foods they long enjoyed suddenly give them problems,” says Evagelia Georgakilas, a registered dietitian and nutritionist with Harvard-affiliated Beth Israel Deaconess Medical Center. “They might tough it out and suffer in silence, but by identifying the problem foods, making adjustments in portion sizes, and switching out certain foods as needed, they can avoid painful and recurring digestive issues.”
Allergy or intolerance?
Many people confuse a food intolerance with a food allergy because they often share many symptoms, but the conditions are quite different.
Food allergies involve your immune system. An allergic reaction occurs when the body mistakes a food ingredient, usually a protein, as harmful and defends itself by producing high levels of an antibody called immunoglobulin E.
A food allergy can be life-threatening, requiring immediate medical attention. The most common food allergies are to shellfish, nuts, fish, and eggs. Symptoms can range from mild to severe and include the following:
.rash or hives
.cramping or stomach pain
.shortness of breath.
“Skin or blood tests can confirm an allergy. If you suspect you have a food allergy, see your doctor,” says Georgakilas.
In comparison, food intolerances are only a digestive issue. They can occur more often as you age since your digestion naturally becomes slower and your body produces less of the enzymes needed to break down food. “This allows more time for bacteria to ferment in the gastrointestinal tract and lead to digestive distress,” says Georgakilas.
You also may become more sensitive to a particular chemical or food additive—for instance, sulfites found in wine, dried fruits, and canned goods, or the flavoring monosodium glutamate (MSG), which is sometimes found in Chinese food and snack foods like chips.
Lactose and gluten
The most common food sensitivities, however, are to lactose and gluten. With lactose intolerance, your body can’t break down the sugar lactose in dairy products like milk, yogurt, and ice cream, because your gut does not produce enough of the intestinal enzyme lactase.
People with a gluten sensitivity have trouble digesting gluten, a protein found in wheat, rye, and barley. (Gluten sensitivity is different from celiac disease, an immune disorder in which consuming gluten damages the lining of the small intestine. For that, you need to see your doctor or nutritionist about adopting a gluten-free diet.)
Symptoms of food intolerance sometimes mirror those of food allergy, like nausea, diarrhea, cramps, and stomach pain, but also may include other issues, like vomiting, heartburn, headaches, and irritability or nervousness.
Over all, the reactions from food intolerances are less severe than from a food allergy, and while often uncomfortable and inconvenient, they are usually not considered life-threatening.
Keep a food diary
A food intolerance is sometimes tricky to pinpoint because you may be able to eat small amounts of a problem food without having any trouble. (With a food allergy, even a tiny amount can trigger a reaction.) Instead, symptoms may appear only after you have eaten a large portion or if you consume the food frequently.
The best way to identify problem foods is to keep a detailed food diary. Write down what you eat for every meal—individual foods and portions—and list any symptoms that occur and rate their level of intensity on a 1-to-10 scale, with 1 being no reaction and 10 being the most severe.
Maintain your diary for two to four weeks and then review. “You should be able to find a connection between foods, portions, and common symptoms,” says Georgakilas.
Once you pinpoint one or several foods that coincide with your symptoms, eliminate them from your diet. After a few days, add only one of the foods back into your diet and monitor your reaction. If your symptoms return, you’ve found the offending food.
Eliminating the food entirely is the easiest move, but here are some other strategies to consider:
Make meal adjustments. Your food intolerance may be a cumulative effect. For instance, if pizza causes you problems, it may be the result of certain ingredients or combinations.
“You may be able to tolerate the cheese and tomatoes on their own, but together they create the perfect storm,” says Georgakilas. Try to eliminate one ingredient at a time, and then certain combinations, until you find the right balance.
Adjust serving sizes. Sometimes you can still enjoy your favorite foods by reducing the amount. “For instance, if you have an intolerance of excessive fructose, you may discover that a half-cup of fruit may not cause a problem,” says Georgakilas.
Find a substitution. If the problem food is a source of vital nutrients, make sure you find an adequate replacement for your diet. “Cutting out gluten foods like wheat, barley, and rye can rob your diet of fiber and B vitamins,” says Georgakilas. In this instance, switch to gluten-free bread, or increase your intake of gluten-free grains like rice, quinoa, and buckwheat. If you have a lactose intolerance, drink lactose-free milk, or almond or coconut milk to ensure you get plenty of calcium and protein.
(Harvard Health Publications)