I can’t tell you how often I hear this question. Maybe its because I’m a mom now and I hang out with other moms, or maybe it is because there is so much media attention about food sensitivities – either way, I get this question all the time. And honestly, as it is with most things in the nutritional world, there is a lot of misinformation about it out there. Prepare to be enlightened.
First of all, let’s get our terminology straight. There are differences between food allergies, food sensitivities, and food intolerances and many people get them confused.
A food allergy is the one most people know of. Think of Will Smith in the movie “Hitch” when he ate shrimp and his face blew up. A food allergy doesn’t have blow your face up to be an allergy, but a food allergy will always involves the immune system making specific antibodies (IgE) and is sometimes called a hypersensitivity reaction. These often have a genetic component to them and can be serious as in an anaphylactic reaction or mild as in a tingly feeling in ones tongue after eating a certain food.
A food sensitivity is a little more insidious. These typically also involve the immune system, but in a different, often more subtle way. Instead of making IgE antibodies, food sensitivities can result in the production of different antibodies (eg IgG) as well as a number of different inflammatory immune molecules called cytokines. Food sensitivities can be the culprit for anything from migraines, to eczema, fibromyalgia, GERD (heart burn), and a host of other symptoms and conditions. And in our children, food sensitivities can potently influence . . . get this . . . their behavior, attention span, ability to focus, etc.
Lastly, food intolerances are completely different. Yes there is a response to food, but it is usually at the digestive level and doesn’t impact the immune system. Think lactose intolerance. These individuals lack the enzyme to break down the milk sugar lactase, causing the unfortunate results of gas, bloating and diarrhea.
So to summarize:
Food Allergies – fairly immediate, can be mild to intense, and involves the immune system in the production of IgE antibodies
Food Sensitivities – can be delayed, often subtle, also involves the immune system but in an entirely different way than food allergies
Food Intolerances – a reaction to food, usually at the digestive level and rarely involves the immune system
If you suspect a food allergy in your child, the first thing to do is an elimination diet. Yes it can be a total pain in the asterisk to get your kid – depending on their age and normal eating habits – to avoid certain foods. But despite all the fancy, boutique, and expensive testing for food sensitivities, the elimination diet remains the gold standard in the world of immunology in identifying food sensitivities. (There are some tests you can run, but more on them in a minute.)
The great thing about kids when it comes to an elimination diet is they can get away with doing it only for a little over a week, so it is not quite as daunting. (Adults usually require three weeks.)
Here’s basically how it works:
- Avoid the more common food sensitivities such as gluten/wheat, corn, soy and eggs for about a week. Longer wouldn’t be a bad thing if you and your kid can stick with it. Be sure to keep track of their sleep, behavior, personality, etc. Don’t look for change, but notice them if they are there.
- Then, while staying on the elimination diet, reintroduce one food or food group for one day and watch for any physical or mental changes in your child for the next couple of days. If there was no reaction after a few days, reintroduce another suspect food.
Here’s how it might look:
- You do the elimination diet from Sunday to the following Saturday.
- Sunday – eat some form of dairy at each meal, and watch for symptoms, while otherwise staying on the elimination diet.
- Monday – elimination diet, watching for symptoms
- Tuesday – elimination diet, watching for symptoms
- Wednesday – eat some wheat/gluten at each meal, and watch for symptoms, while otherwise staying on the elimination diet
- Thursday – elimination diet, watching for symptoms
- Friday - elimination diet, watching for symptoms
- Saturday – I think you’re starting get the point
I’ve had patients who reintroduced food for three weeks (!) following the end of the elimination diet. They had egg day, dairy day, wheat/gluten day, tomato day . . . until they ran out of things to reintroduce. On the other hand, I’ve had people that only reintroduced a couple new foods. It’s up to you and how much you want to test.
I cannot tell you the potency of food sensitivities on a kids behavior and in my opinion, as a mom wanting the best life has to offer for my kids, trying out an elimination diet for a couple of weeks is the
A few keys for success:
- Do it when they are not in school. The temptation to eat someone else’s snacks is too great. You need to be in control of their food for a week or so. Obviously, choosing a time away from holidays or birthday parties will make it easier for everyone involved.
- Do it with them! Honestly. Get the whole family involved. For a couple of weeks dedicate your lives and kitchen to eliminating certain foods. What’s the worst thing that can happen? (And by the way if you’re not willing to give up certain foods for a couple of weeks, it is questionable how badly you want to be healthy anyway.)
- Do some research first. Figure out options they can snack on when they are hungry. This isn’t a starvation diet, it is an elimination diet. In fact I tell people on an elimination diet to eat as much as they want of what’s allowed. Eat up. Get full. Just stay away from foods you’re eliminating.
The elimination diet is inexpensive and simple to do. (Yes, I know simple and easy are two different things). But what happens if you don’t get the results you were expecting and want to consider testing. Here are some options:
- Food Allergy Testing – this will be done with a conventionally trained immunologist. The can run things like blood tests, skin prick tests, and more to identify an IgE-mediated food allergy. This will not identify food sensitivities however!
- Food Sensitivity Testing – most of the available tests which include IgG testing (ELISA and RAST), or the ALCAT test, are incredibly expensive and a waste of money in my opinion. They are questionable in their validity, reliability and therefore accuracy and thus, just simply aren’t worth it.
If you’re interested in having your child tested for gluten sensitivity, currently the best test out there today is the Array 3 by Cyrex Laboratories. This test goes well beyond conventional gluten testing in identifying a possible underlying gluten sensitivity. For less money that also doesn’t require a blood draw, they also have an Array 1 which is a little less comprehensive, but is also a non-invasive option for looking for gluten sensitivity.
Lastly, if nothing seems to be working and your mommy intuition is saying your kid has food sensitivities but you can’t quite figure it out, there is the Mediator Release Test (MRT) which is probably the best, most accurate and comprehensive test looking for food sensitivities. It is a little more expensive, but it’s the test we run on patients, and I’d run on our children, if we suspected food sensitivities but weren’t able to identify them. (Note: This test does not look for gluten sensitivity.)
So there you have it, the real scoop on food allergies. It's a serious problem with a pretty simple solution. Please share this with anyone and everyone you know with this question. If you have any more questions on this topic, please fire away.
P.S. It's easier than ever to eat an allergen-free diet. You don't even have to make special health food store trips because most grocery stores are starting to carry gluten and dairy free products. You don't have to spend hours in the kitchen to make this happen. Here's one of my favorite blogs with simple but delicious allergen-free recipe ideas.