Types of Food Reactions

This section will break down the types of food reactions we can have with IBD and which ones you can improve over time. Below this reviews food sensitivity testing and why you can save your money to avoid a print out of your most commonly consumed foods.

While food allergies you may need to avoid long term, many food intolerances can actually improve or resolve completely over time! Quick note on this- this refers to “general food intolerances” not the entire list of non-immune mediated reactions.

Many of our patients report after working with us that many of the foods they thought were symptoms either- 1) actually weren’t the food trigger or 2) they resolve or reduce through working on changing the gut environment!

This isn’t magic or anything crazy- but it does point to the power of supporting the microbiome.

Immune Mediated- Allergies, Celiac, etc. 

1. 1. IgE Mediated-
      • Typically the response is immediate and can be severe
      • Exposure to the food may increase severity of response
      • ex. Food Allergies, Oral allergy syndrome, Acute urticaria
   2. Mixed IgE and non-IgE-
      • ex. Atopic dermatitis 
   3. Non-IgE Mediated-
      • ex. Celiac disease, Food protein induced entercepathy (ongoing inflammation + irritation)
   4. Cell Mediated-
      • ex. Allergic contact dermatitis

2. Non-Immune Mediated – Food intolerances

   1. General Food Intolerances (also referred to as sensitivities)
   2. Metabolic-
      • ex. Lactose intolerance and Fructose Malabsorption
   3. Pharmacologic-
      • ex. Caffeine
   4. Environmental Toxins
   5. Additive Responses-
      • sulfites, nitrates, polysorbate 80
   6. Long term inflammatory dietary pattern 

Immune mediated reactions can be improved by working on the underlying factors:

• Nutrient deficiencies (vitamin D, vitamin A, zinc, etc)
• Increased intestinal permeability
• Stress
• Sleep
• Sufficient but not excessive exercise
• Developing tolerance to a food through introducing small quantities

Non-immune mediated reactions can be improved by working on the underlying factors:

• Microbiome supportive diet patterns
• Increased intestinal permeability
• Poor motility
• Liberating the diet from restrictive eating
  • What is restrictive eating: eating the same meals daily, noticeable decrease from normal intake and frequent fear with food
  • Restrictive eating is quite common in IBD (up to 80% struggle with this) and is different from other eating disorders/disordered eating cases – it typically requires specialized care
  • If you are restricting often, you may need to work with a dietitian (trained in the overlap of IBD & disordered eating) and sometimes a therapist to work through food fears
• Reduced eating in stressed state
• Enzyme supplementation if lacking enzymes

You don’t need to test for food sensitivities

• The term “Food Sensitivities” is not clearly defined in research
• The research is newer in this area and the thought is that symptoms can occur 1-3 days after exposure to an offending food
• Research on food sensitivity tests indicates that it’s a test indicating exposure, not intolerance to a food, making it not valid
  • Testing to Avoid:
    • Mediator Release Tests: Using white blood cells & “mediators”: Early research to show that high levels of white blood cell accumulation may indicate sensitivity. Research doesn’t yet support this as a valid way to test or treat sensitivities.
    • ALCAT Tests: IgG Antibody Tests, IgG Antibodies are protein that attaches to an antigen (food) to alert the immune system to cause inflammation which is a normal occurrence that occurs day to day. Research doesn’t support this as a valid way to test or treat sensitivities
    • Everlywell, Hair Tests etc: Not valid tests to identify anything

Research

https://link.springer.com/article/10.1007/s12016-018-8710-3

https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0285-2