Changing Food from Adversary to Ally – Part 2

Earlier this week I started a mini-series on food intolerances and allergies. If you’re just tuning in now, be sure to check out part 1 of this series here – Today I’m going to tackle an approach to managing food intolerances. I will be posting more about food allergies next week!

In the last post I introduced the concept of functional medicine and wrote about how many people experience physical symptoms despite not having a clear-cut diagnosis. This can happen with any body system (think fibromyalgia, chronic pelvic pain, interstitial cystitis, non-epileptic seizures and even migraines). So what does this mean and what can you do to feel well?

As I’ve mentioned before, I believe there are 4 main areas of health – nutritional, physical, emotional/mental health and environmental. I am going to break down approaches to managing food intolerances (and really, any other functional illness) based on these areas.

Nutritional: This is the logical place to start since it includes food! Many people get hung up on this area and don’t think about the others because we’re linear – I eat A and feel B, so I must have C. While that might be true, other factors influence this linear pattern. First, it’s vital to rule out an allergy before moving forward. Be sure you talk with your doctor and get any necessary testing. But in general, if you have an allergy you have clinical inflammation and the reaction is happening from the protein in whatever you’re eating. A great comparison between intolerance and allergy is dairy.

  • Milk allergy – if you consume any milk product, shortly after you will develop hives, itching, a rash or even anaphylaxis (throat closing up). If you can eat a little of something without trouble you do NOT have an allergy.
  • Lactose intolerance – if you consume any lactose-containing product you develop nausea, vomiting, cramping or diarrhea.

Another great example is the ever ongoing debate between gluten intolerance and celiac disease.

So why does this difference matter? If you have an allergy, you could die if you eat something you shouldn’t, so that’s obviously a big deal. But on the flip side, if you have an intolerance you could be overly restricting your diet for no reason. An intolerance is not an allergy so that means that with the right approach it can be managed and you may be able to even eat small amounts of the foods without symptoms.

Enter FODMAP diet.

At first glance, the FODMAP diet is ridiculously restrictive and most people will refuse to even try it. But hear me out! This diet is NOT meant to be a long-term diet. It’s purpose is to reduce gut inflammation and get your GI tract back in alignment. The FODMAP diet is a unique diet that eliminates key items that trigger inflammation and distress in the body. Interestingly, many “healthy” foods are on this diet.

See some specifics of the FODMAP diet here:

The approach to the diet will typically be a four week elimination phase followed by a four week gradual re-introduction phase. Some people may need more or less time, which is why it is important to work with a dietitian or trained doctor as you work through it.  That first month can be challenging and you have a whole new appreciation for those with true food allergies. It’s extremely restrictive and it’s difficult to do anything outside of the home. It’s essential you follow this diet strictly because even one “cheat” day can hijack all the work you have done up to that point. Remember, the goal is to completely eliminate the inflammation caused by foods.

As you begin the diet, I recommend documenting the food that you’re eating. This can be tricky because anyone with a tendency toward disorder eating may become overly obsessive with us. If this might be you it is even more important that you work with a trained provider to ensure the best approach for you to provide any triggers.

There are dozens of food tracker apps to choose from, but I prefer a basic notebook. You will track all the food you eat for the month along with symptoms. It is not important to track any amounts because the amount is really irrelevant. I would recommend drawing a line down the middle of your page. On the left, write times and what you eat. On the right, write times and the symptoms you feel. Logging symptoms will allow you to find correlations, as some will develop immediately and some will be days later. This may also give you insight into cravings that you’re experiencing and what might be setting off those cravings. This is going to help significantly with your intuitive eating and mindful approach to eating as well!

Each week you will review your food and symptom log to see trends. The FODMAP diet is not meant to be a life-long diet. Just one to reset the inflammation so you feel well and then reintroducing foods that you tolerate. After the 4 weeks has passed you can review the trends you noticed in your food log and take a more global approach to how you feel and which foods might be the main triggers. At this point you can decide which foods seem the least bothersome. Typically you should choose 1 food category at a time from the FODMAPs list and reintroduce them. I recommend 1 food every 5 days so you can truly tell if which food might be causing issues if the symptoms return.

As you reintroduce foods you may realize that you can eat small amounts of many foods. This will help you become in-tune with your body and gauge how to tell which foods and how much of a food can be tolerated.

It’s important to remember that these are not true allergies and if. you are able to work with your body, there’s a good chance you’ll be able to eat many foods again.  For example, you may realize you can have a half a cup of ice cream once a month without having any trouble but you didn’t know it before because you were always eating a cup and a half of ice cream in the setting of an already inflamed gut.

I cannot emphasize enough that this diet is very restrictive and it can be really tricky to follow. If you’re going to take the time and effort to follow it you need to do it right the first time. Many people have followed what they thought was a gluten-free diet when in fact they were actually eating gluten the entire time but didn’t realize it. It is also important that you look at your calendar before starting this month-long diet. If you have a wedding coming up that you are going “cheat at” there is really no point in starting this now. Just wait until after when you can be sure to stay on track. We all slip up, but we want to minimize the chance as much as possible.

Stay tuned for part 2 – addressing physical, emotional and environmental approaches to your functional GI condition!

Also, to learn more about the differences between allergies and intolerances, check out @foodallergy or @aafanational

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