Healthy Living: Allergy or Intolerance
A few years ago, Paul Coniglio, co-owner of Colony Grill, noticed a trend that just didn’t sit right.
The menu at the famous thin-crust pizza joint (which now has locations in Stamford, Fairfield and Milford) features only one main-course option: pizza. When the company opened its Fairfield location in 2012, he says he began to notice that more and more people were coming who didn’t eat wheat.
Coniglio’s staff would try and do what they could to accommodate these guests; allowing them to bring outside food or even their own gluten-free pizza dough. However, often in those cases, one kid would still be sitting at the table eating something different than everybody else. Coniglio was unhappy with that. “We just didn’t like the feeling of seeing one member of a family miss out,” he says.
To rectify the situation, Coniglio and his business partners began offering a gluten-free pizza at all Colony Grill locations. The gluten-free dough is purchased from Still Riding Pizza, a Connecticut-based company that manufactures and supplies gluten-free pizza dough to restaurants.
Like many Connecticut food-based businesses, Colony Grill has adapted to increasing demand for food products that take into consideration diverse dietary restrictions. And Coniglio is not the only person who’s noticed that there are more and more people with dietary restrictions.
The occurrences of food allergies and food intolerance—a separate group of adverse reactions from foods that are often, but incorrectly, referred to as allergies by the general public—seem to be on the rise. Food allergies among children increased approximately 50 percent between 1997 and 2011, according to a 2013 study by the Centers for Disease Control and Prevention (CDC). The website Foodallergy.org points to research showing that roughly 1 in every 13 children in the U.S. has a food allergy of some type. There’s a good chance those numbers also include individuals with food intolerance, as most studies are based upon telephone interviews, and many confuse food intolerance with allergies.
Eight food groups account for 90 percent of serious allergic reactions in the U.S.: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts and tree nuts. Nut allergies, in particular, have captured the public’s attention and with good reason. According to Foodallergy.org, approximately 3 million people in the U.S. report having nut allergies. While some peanut allergies are minor, in other cases it can be so severe minimal exposure (such as eating food made near peanuts) can result in potentially life-threatening anaphylaxis.
In October, the CDC released “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers.” The non-mandatory guidelines outline, among other things, ways schools can ensure the daily management of food allergies in individual children, prepare for food-allergy emergencies, and provide professional development on food allergies for staff members.
“There has definitely been an increase in overall allergies, especially food allergies and intolerance,” says Dr. Prasad Srinivasan, an allergist with Allergy Associates of Hartford. “The awareness is definitely heightened, which is a good thing, but beyond that I’m not sure why we’re seeing more cases, we don’t know the answer to that. Maybe it’s the processed food that we’re eating; there are so many different chemicals in our food. Or maybe it’s the way our animals have been raised, and what they are exposed to and are eating. There are a whole slew of things that have changed between where we are today and the way things were for Grandma Stein. Maybe that’s what’s contributing to these higher incidences, but that’s pure hypothesis.”
As the instances of adverse food reactions have increased, so has the misinformation surrounding the situation. “There is a huge amount of urban mythology about adverse reactions,” says Dr. Bernard Adelsberg, an allergist with the Connecticut Medical Group in Hamden. All negative symptoms that come as a result of eating food are generally referred to as “allergies” in conversations, which is a very common misnomer, explains Adelsberg. “Allergies are something specific, they involve your immune system, and they’re actually not very common. Adverse reactions to food are much more common and don’t involve your immune system; they involve your metabolic system.”
Or as WebMD puts it: “When a food irritates your stomach or your body can’t properly digest it, that’s an intolerance;” on the other hand, a food allergy occurs “when your immune system mistakes something in food as harmful and attacks it. It can affect your whole body, not just your stomach.”
Though justified, all the attention on food allergies can sometimes lead to confusion over what a food allergy is. For instance, many food intolerances such as a lactose intolerance are referred to as allergies. But there’s an important distinction: although intolerances can cause extreme discomfort, they are not life-threatening.
Generally, food allergies come on suddenly, can be triggered by small amounts of food, occur every time a person with the allergy eats the food in question and can be life-threatening. Symptoms can include rash, hives or itchy skin, shortness of breath, chest pain and a sudden drop in blood pressure.
Food intolerances tend to come on gradually, and may only happen when a lot of the particular food is ingested by the person with the intolerance, or if the food is eaten often.
The shared symptoms of both intolerance and allergies include nausea, stomach pain, diarrhea and vomiting.
Properly diagnosing food allergies and intolerance can be difficult. There are few reliable tests for food intolerance and although food allergy tests have more accuracy, they can also be unreliable and can give false-negative or false-positive results. Because of these testing limits, identifying which food group is causing an allergy or intolerance often requires some medical detective work, says Srinivasan. “We have patients keep a strict diet diary, and monitor it very closely. That becomes the way we can test,” he says. “We monitor it over a week, and then monitor it over a two-week period to see what the symptoms are. If every time you have a dairy product then two or three days later you have a headache, we’ll eliminate dairy completely over a two-week period and see if you feel better.”
In attempts to definitively solve the food-reaction cases of his patients, Adelsberg often uses what’s called a food challenge. During a food challenge, patients will be given various food groups in the medical office and their reactions/or lack of reactions will then be observed.
Adelsberg also offers his patients an easier method.
“I tend to be very practical about what people tell me about things they tolerate and they don’t,” he says. “If someone comes in and says, ‘Every time I eat this food, something bad happens to me,’ the very first reaction one ought to have is ‘Well, don’t eat it.’ It doesn’t really matter what kind of physiological process is occurring, if you do something that makes you feel uncomfortable, don’t do it. The problem is people will go ‘But I want to do it.’ That’s when you have to get into finding whether or not it’s actually a problem.”
Mary Beth Green is a registered dietitian (RD) and certified dietitian nutritionist (CDN) who works at Norwich’s Backus Hospital, which is part of Hartford HealthCare. She warns that even if you feel better after dropping out a certain food group such as gluten or dairy, it does not necessarily mean you have an intolerance to that food.
“Sometimes it’s hard to piece together what’s actually going on,” she says. “When you stop eating wheat products, as a result you’re not eating cookies anymore, you’re not eating doughnuts, and people might actually be eating a more healthy diet as a result of that, because they’ve stopped eating those less healthy foods.”
Green cautions that just cutting out food groups doesn’t actually make you healthier. She advises consulting with medical professionals before taking any long-term action. “You don’t want to go willy-nilly dropping whole food groups, that can do more harm than good, you want to get a diagnosis,” she says.
Green adds if you have been diagnosed with an allergy or food intolerance and have been advised to stop eating certain foods, you’ll want to make sure your new diet is well thought-out.
“Seeing a registered dietitian is a really good idea because when you’re cutting out whole groups of food you might be cutting out essential nutrients, things like calcium and fiber,” she says. “It’s a really good idea to see a professional instead of relying on the Internet. There’s a lot of misinformation out there.”