Finding a Diagnosis: Food Sensitivities

Aug 4, 2017 by

You can have me read this article to you instead of reading it yourself…



Or you can read it the old-fashioned way below…



Food sensitivity is different than an allergy.  When an allergic reaction occurs, the body sends in the troops, causing a severe reaction that can go so far as making a person unable to breathe (anaphylaxis).  When a food sensitivity occurs, it causes GI upset, like gas, bloating, constipation, and diarrhea.

These sensitivities to food are more common than we might think.  But they can be hard to recognize.  This is because they are typically due to a certain, very specific ingredient, which might be found in a bunch of foods that don’t seem very similar on the surface.  Understanding how these sensitivities work can be very helpful for managing your symptoms.

Lactose Intolerance

This is a well-known condition that I am only including here to ensure that it is clearly under­stood in comparison to other food sensitivities. Lactose intolerance is actually quite common, impacting as many as 65% of adults to different degrees. It occurs because the body is lacking lactase, the enzyme responsible for digesting lactose, the sugar found in milk products.

When lactase is missing, the bacteria in the gut begin to process the lactose (milk sugars) found in the milk products that you consume (more on gut bacteria here). Unfortunately, these bacteria produce byproducts that can cause bloating, gas, and diarrhea.

Each person experiences these symptoms to a different extent with different items. For instance, some people that can’t tolerate milk can easily tolerate yogurt. Eliminating the dairy products that cause issues is the easiest treatment for this condition, made even easier today with the many alternative milk products that are now available. There is also a unique treatment option – the lactase enzyme is available as a pill (also called Lactaid).  This can be taken when someone plans to eat dairy-heavy products such as ice cream and cheese.

Carbohydrate Sensitivity

Most sugars (carbohydrates) are easily broken down by the GI tract of the typical person. However, some people do not digest these sugars completely.  When this happens, they are broken down by the bacteria in the large intestine instead, leading to the production of extra gas and liquid. This can cause bloating, constipation, and/or diarrhea.

The carbohydrates that have been most commonly associated with this intolerance are the components of a newer and popular acronym: FODMAPs.


These terms probably don’t mean anything to most people (I personally do not typically think of my foods in terms of the type of carbohydrate molecule that composes them!). But they do summarize the specific carbohydrates that can be most likely to cause this form of GI discomfort.

The reason that this acronym has become so popular is because of the diets built around it, often referred to as FODMAP diets.  In these diets, all of these products are cut out completely. This leads to a highly restrictive diet that is often not necessary, can be difficult to maintain, and can lead to nutrient deficiencies due to the extensive restriction.

Narrowing it Down

There are breath tests available that can evaluate if you are sensitive to any specific carbohydrates in the FODMAP family, such as fructose. By having these breath tests conducted, you could identify whether you are truly sensitive to any specific FODMAP ingredients. This would allow you to narrow down your sensitivities so that your dietary restrictions will be easier to maintain and less likely to impact your nutritional status.

If these breath tests do not identify any specific culprits, the FODMAP diet can be trialed. A permanent, strict FODMAP diet is rarely recommended because it is often not needed and can be so damaging to long-term health. This diet change can be tested for as little as a couple of weeks – if no change occurs in this time frame, then the diet does not work for you.

If the diet does improve your symptoms, it is important to add specific sugars back one at a time in order to identify which ingredient is the specific source of your symptoms.

There’s more about that here, as well as a link to a helpful website that can guide you through the diet in a healthy, appropriate way.

Gluten Sensitivity

We discussed Celiac Disease, a condition in which the body attacks itself in response to gluten, here. The only treatment for Celiac Disease is the permanent and total elimination of gluten from the diet due to the severe damage that can develop.

Gluten sensitivity, on the other hand, refers to the apparent existence of a sensitivity to gluten that does not result in damage to the body. This very new concept has only recently emerged and is still poorly understood, although significant research is currently being conducted to improve our understanding.

What is it?

We know so little about gluten sensitivity that it is not even fully accepted as a true disorder within the medical community. There is also no test available to confirm whether it is present. The condition is actually defined as simply “an improvement in symptoms when gluten is removed from the diet and a recurrence of symptoms when it is added back in”.  The symptoms that have been attributed to this sensitivity may be mild or severe and cover a large range, including bloating, gas, diarrhea, constipation, pain, nausea, fatigue, and mental fogginess.

One of the reasons that gluten sensitivity continues to be such a blurry concept is due to the number of people that have chosen to remove gluten from their diets without being tested for any other conditions. In fact, a gluten-free diet could be much more extreme than what is truly needed to improve a person’s symptoms. It may also mask the actual cause of the problem.

Many people that have improved on a gluten-free diet and then had proper testing completed were found to have a wide range of conditions, including fructose intolerance, SIBO, or microscopic colitis (a sub-type of IBD). Some of these conditions should be treated with medications or surgery and not recognizing their presence can lead to complications down the road.

And What is Gluten, Exactly?

It might be helpful to push past the marketing and gain a clearer understanding for what gluten actually is. Gluten is one of the proteins found in wheat. There are proteins that are similar in structure to gluten that can also be found in rye and barley. However, no other naturally occurring substances should contain gluten. Thus, any other base for a product (such as corn, soy, rice, nuts, or dairy) is, by nature, gluten-free. Many companies have hopped into the gluten-free market by simply raising their prices and labeling their products as gluten-free even though they always have been, such as corn chips, peanut butter, and cheese.

Gluten Sensitivity vs. Something Else

If you are concerned that you have an issue with gluten, please note – You must be tested for Celiac prior to removing gluten from your diet.  In order for a Celiac test to read positive, you must have recently eaten gluten products.  So, it is important not to self-treat first if you would like to receive an accurate diagnosis that can guide your health choices.

Similarly, you should be tested for any of the conditions that we have discussed (from IBS to carbohydrate sensitivity) before commencing a gluten-free diet. Proper testing for conditions that can be accurately diagnosed and treated is very important prior to making such a drastic diet change. This approach will ensure that you are evaluating all options and guaranteeing your best health.  Outside of possibly masking a more severe condition, a gluten-free diet carries concerns similar to those with the full FODMAP diet. Excessive restrictions can cause nutritional deficiencies, a well-documented issue with gluten-free diets.

Another concern that is present with the gluten-free diet is that many commercially available gluten-free products are actually higher in sugar and fat than their traditional counterparts. This can make the diet even more difficult to follow if also trying to maintain a healthy and active lifestyle. Just as with the FODMAP diet, the gluten-free diet can be trialed for two weeks, at which point if it is not providing benefit, it should be considered ineffective.



Feeling a little bit overwhelmed about how to start applying any of this to your health?  Or unsure of how to keep it all straight?  No worries.  Take a look at the step-by-step guideline on how to figure out what is causing your symptoms.

Next: The Step-by-Step Guide to Figuring it Out

Or refer back to the Unclear (or No) Diagnosis Section

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