Doctors Dish on Food Intolerance

Between allergies, diseases and intolerances, just the prospect of sitting down for a nice meal can be daunting. Fortunately, two of Atlanta’s Jewish experts on all things intestinal, Dr. Marc Sonenshine and Dr. Brett Mendel of Atlanta Gastroenterology, spoke to the AJT about the misunderstandings that exist surrounding food intolerances.

“A food intolerance is something that you’ll know about when you eat it,” Sonenshine said. “You’ll get some pain, some discomfort, some abdominal bloating, maybe some diarrhea.”

Intolerances are completely different than allergies, and even though they’re often thought of in the same vein, Sonenshine was careful to draw a distinction between the two.

“An allergy is a reaction in the body in which it develops hives, difficulty breathing. Very few people have true food allergies,” he said. “When someone has a reaction, we know, not because they don’t feel well, but because they develop a rash, they have difficulty breathing, and require Benadryl or epinephrine.”

One of the most common food allergies is a reaction to nuts. But the most common intolerance, particularly in the Jewish community, is to lactose or dairy products, Mendel said. And while it may be the most common, there isn’t an effective, concrete way to test for it, unlike most food intolerances.

“There’s a breath test that is very inaccurate and tends to not be used often because it’s not a reliable test,” he said. “The best way to test for it is to eliminate the products and see how the patient feels.”

In terms of diagnosing an intolerance, that can also be a tricky prospect for gastroenterologists as they are most concerned with ruling out a more serious diagnosis, such as celiac disease, Crohn’s or inflammatory bowel disease, Sonenshine said. In comparison, an intolerance hasn’t been found to carry any long-term health effects, he said.

“If they haven’t tried cutting out foods, that’s often one of the first things we do, but if they still have symptoms, that’s when it becomes time to put them through tests,” he said.

Much of the intolerance diagnoses aren’t made at their offices but are discovered either by primary care physicians or by patients themselves.
“A lot of patients will use trial and error,” Mendel said. “Part of it is certainly a mind-body question: is it because they got rid of gluten or because they know they got rid of gluten?”

Mendel explained that another intolerance is to FODMAPs, or “fermentable oligo-, di-, mono-saccharides and polyols,” which requires a very restrictive diet.

“It gets rid of wheat and lactose as well as many fruits and vegetables. As limiting as it is, some people swear by it,” Mendel said.

One of the most commonly referenced intolerances is gluten, not to be confused with celiac disease.

“There is non-celiac gluten sensitivity, which is technically not a medical diagnosis, but there is a contingency of people pushing for it to be one. It is what it sounds like — someone who tests negative for Celiac disease but eats gluten, and that causes any number of symptoms.”

Common signs for food intolerances include gaseousness, bloating, diarrhea and discomfort, Sonenshine said.

“There really aren’t many signs for an intolerance except how you feel,” Sonenshine said. “If you eat something you’re intolerant of, you may rush off to the bathroom and have diarrhea.”

He also said that those same symptoms, coupled with other more serious ones, could be signs of a more significant issue at play.

“Intolerances should not cause symptoms like weight loss, blood in the stool, keep you from sleeping at night,” Sonenshine said. “Your bloodwork should not be abnormal. Those are symptoms of a real disease going on.”

While there have been all kinds of theories that float around the internet about why there is a perceived increase in food sensitivities and intolerances, both doctors agreed they hadn’t yet seen anything leading them to believe there was an uptick.

“I think it’s more that people talk about it and now people have multiple options to eat and are more conscious about their health,” Sonenshine said. “I’m not sure that there’s anything genetically that has changed; I think marketing has changed more than anything else.”

Mendel agreed that increased awareness likely led to more concerned people who otherwise may never have questioned a little bloating or discomfort.

“These sorts of food sensitivities have nothing that would be causative,” he said. “There doesn’t seem to be anything environmental that is contributing to an increase.”

As for what he tells patients dealing with an intolerance, Mendel’s message is quite clear.

“If you want to eat that cheese pizza, then go for it, but do it knowing that you’re going to suffer for it,” he said. “You’ll find yourself on the toilet more than you’d like to be.”