One area of an anti-inflammatory diet I didn’t delve into in my “On Nutrition” column Sunday was food sensitivities and intolerances. There were a few for this:
  1. Lack of space (if you read it online, you might think there are no space constraints, but my length is dictated by space in the print edition)
  2. The fact that I present information for a general audience in my columns (as opposed to information I would cover when working one-on-one with a patient/client)
  3. The fact that food sensitivities/intolerances are a HUGE topic that could fill a whole other column (see #1)

When I work with patients to implement an anti-inflammatory diet, known or potential food sensitivities always enter the conversation. In fact, any health condition that might affect the intestinal tract enters the picture, because conditions like inflammatory bowel disease (the umbrella term for Crohn’s disease and ulcerative colitis) and celiac disease cause inflammation and damage to the intestinal wall that can in turn contribute to body-wide chronic inflammation.

If a patient has signs or symptoms consistent with some sort of food-related disturbance, I want to make sure that these more serious conditions are ruled out (again, because they cause actual damage) before we turn to the possibilities of less serious intolerances (like lactose intolerance) and sensitivities. I say “less serious” not because while they often cause symptoms that impair quality of life (if you have to run to the bathroom 20 minutes after ingesting dairy, your quality of life is certainly impaired!), they aren’t causing overt damage.

The Perils of Self-Diagnosis

I feel like it’s irresponsible to address a possible food sensitivity when a more serious problem might be lurking. It’s not uncommon for someone with Crohn’s to think they are, say gluten sensitive, give up gluten, feel better for a little while, but then have their symptoms return. By the time they finally get an official diagnosis of Crohn’s, their disease has progressed and more damage has occurred.

Similarly, if someone with undiagnosed celiac disease goes off gluten and feels better, they are not going to want to go back on gluten for a period of weeks in order to be tested for celiac. (If you have celiac disease but are tested while avoiding gluten, you are likely to get a false negative result.) This matters, because the treatment for celiac is 100 percent avoidance of gluten. Gluten sensitivity doesn’t generally require such strictness. If you don’t know for sure that you need to avoid all traces of gluten, how likely are you to maintain that level of compliance with a gluten-free diet?

Why Individualized Treatment Matters

Food sensitivities and intolerances are highly individual, and while many can’t be diagnosed with a simple blood or skin test, a thoughtfully planned elimination and challenge diet can often provide important clues. My goal is to help people enjoy the most varied, healthy diet possible. Frankly, wholesale elimination of certain food groups when there is no evidence that a particular individual has trouble tolerating that food group is unnecessarily restrictive. As I like to say, as a species, human beings are remarkably similar, but as individuals, human beings are remarkably different.

If you’re interested, yesterday I found a somewhat science-y but not TOO science-y explanation of inflammation on the Linus Pauling Institute site.