Non-Immunological
Identifying a food related problem can sometimes be quite hard. Irritable bowel syndrome and non-coeliac gluten sensitivity symptoms such as diarrhoea, constipation, wind, bloating, burping, stomach pains, reflux, nausea or mouth ulcers may occur due to intolerances to substances in our food.
Fatigue, brain fog, or symptoms including headaches, migraines, hives, itch or muscle and joint aches and pains may also improve with food management strategies. Read more in headaches, migraines, mood and rashes.
There is no simple test to determine whether or not you are intolerant to a food. It is NOT an allergic reaction, so skin prick tests are not helpful in sorting out this problem. IgG food antibody testing will also not diagnose a food intolerance.
The term Irritable bowel syndrome (IBS) is given to a set of symptoms experienced by a person when no other gut related disease can be diagnosed. Pain or gut discomfort is often experienced once or more in a week, which is relieved by passing a bowel movement. Diarrhoea, constipation or alternating forms of these are often experienced. Wind, bloating, burping, reflux, nausea or vomiting may also be present.
Non-coeliac gluten sensitivity (NCGS) is a condition where the intestinal and extra-intestinal symptoms described above occur when eating wheat or gluten containing foods, but the small bowel damage that classifies coeliac disease and the IgE immune reaction of wheat allergic conditions do not occur. My clinical experience most often shows that wheat/gluten is only one possible food trigger in people who experience these symptoms.
You are advised to see a Gastroenterologist initially to ensure there is no underlying disease that is creating the symptoms experienced. If coeliac disease and other diseases are ruled out, an investigation to find possible dietary triggers is often the next step.
People commonly alter their food intake to try to control symptoms. While some people find dietary triggers, in others, food does not play a role in contributing to symptoms. There are a lot of books on the market trying to address these issues by manipulating foods to decrease symptoms. Each book has its own theory and the foods in their diets are broken into groups based on these theories. Some divide by thiol groups, histamine content, fibre content, wheat, gluten, lactose, food combining, no grains, nothing commercially processed, nothing genetically modified etc, etc. There is no one way to join all the theories together and come up with just one possible diet therapy.
The most common diet regimes, beyond removal of wheat and dairy, used by Health professionals to investigate this are:
Pharmacological triggers (food chemicals)
Fermentable sugar triggers (FODMAPS)
END GOAL OF THE DIET INVESTIGATIONS
The investigative dietary regime chosen generally depends on the symptoms you are experiencing and information you impart to the dietitian (see diagram below in purple heading). Your variety of foods will be reduced during the initial clearing stages and challenge phase of the protocol.
The intended outcome is to find substances within the foods that your body reacts to. For good nutrition it is best to follow through the diet investigative protocols with a dietitian who can advise you on food substitutes, tips and suitable supplements if required.
Total avoidance of these substances is not the desired outcome.
At the end of the food investigation process you are advised to put foods back into the diet which contain substances to which you reacted. Ultimately you will eat LESS of the foods that contain those substances. They are NOT food allergies and they do NOT need to be totally avoided when you start to return food back to the diet. Each person needs to find the amount they can tolerate.
The end goal is to eat foods from the 5 food groups, but your choices within some of those food groups will be reduced. If the end choices are quite limited, then suitable substitutes need to be advised to maintain overall nutrition in your long-term diet.