• The Puzzle of Food Intolerance and Its Effects

    by Daljeet Samra M.D.
    on Mar 9th, 2017

The Puzzle of Food intolerance and Its Effects

Patients often present to my clinic with complaints of bloating, abdominal pain, diarrhea and distention.  Although, food allergy can cause these symptoms it is often the case that these symptoms are just as often the result of food intolerance.  While food intolerance is a very complex topic, we are beginning to understand more about the causes behind it and starting to understand why it may be on the rise.


Food intolerance is the inability of our GI Tract to properly process and digest foods and in some cases is the result of direct irritation of the GI tract by foods. Sometimes food intolerance can be related to mechanical and structural defects in the functioning of our GI tract.  Some other factors likely contributing to food intolerance include changes in our food supply, changes in the types of food we are eating, the increasingly processed nature of the food we eat and the increased carbohydrate content of our diet. Food today has a higher number of chemical enhancers, preservatives and texture enhancers than ever before.  Our gut is responsible for the task of digesting and absorbing the increased load of chemical substances in our food.  Some theorize that as genetic engineering of food becomes more commonplace we are creating foods that our body has never been exposed to before, thus from an evolutionary perspective the gut is not well equipped to digest and process these foods.  The gut itself is a very complex organ and much of the processing and possibly even immunological consequences of changes in our food supply chain are yet to be fully understood.


Foods that typically cause intolerance include additives, preservatives, fructose, lactose, wheat and highly processed foods such as processed meats. These same foods have become more prevalent as part of our “normal” diet.


In addition to increased fructose levels in our diet, we have experienced a significant increase in the amount of fermentable oligosaccharides/disaccharides/monosaccharide’s and Polyols (FODMAP’s) in our diet.  For some people these FODMAPS are hard to absorb, when they are incompletely digested they provide fuel for bacteria in our large intestine, bacteria ferment these substances which leads to symptoms of bloating/diarrhea/gas.


Gluten content of food is higher than ever before, gluten is also used in a variety of products as a binding agent, it is also used to improve the texture of various foods.  Gluten can be hard to digest in high quantities and may lead to many of the symptoms noted above.  Thus, as gluten content in foods has increased the gut likely has a harder time processing the increased load this leads to symptoms such as bloating and diarrhea.  Gluten intolerance is very different than Celiac disease which involves damage to the gut caused by the immune system.


Certain patients may have gastrointestinal symptoms related to inability to tolerate foods which contain high histamine levels.  These patient’s GI complaints will include flatulence, colic and diarrhea.  Foods which are rich in histamine include:  cabbage, red wine, tuna, mackerel, sausage and foods which lead to release of increased amount of histamine include citrus fruits, nuts and alcohol.  Histamine intolerance is very rare and studies have shown less than 1% of the population suffers from this, although approximately 80% of the patients suffering from it are women.


Simple measures you can take are to limit foods which typically are associated with intolerance in your diet.  Another important tip is to eat a balanced diet, all of your meals should include equal proportions of carbohydrate and protein rich foods, unlike what we are used to, which is a very high carb diet.  Also I would recommend limiting the proportion of food in your diet which are highly processed and cut back on carbohydrate rich foods.   Often times it is very hard to pinpoint the exact causes of symptoms such as severe abdominal bloating, but with a comprehensive approach including your allergist, gastroenterologist and primary care physician you can gain important insights into the cause of symptoms in your specific case.  

Author Daljeet Samra M.D. I'm a Board Certified Allergist/Immunologist serving the Tri-Valley region including Dublin, Tracy, Pleasanton and Livermore area. I have extensive experience in both clinical and lab research with over 10 years’ of experience in the acute care, critical care and outpatient clinic settings. My main focus and passion is improving patient's health through prevention and treating underlying causes of disease and not just symptoms.

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