I recently gave a talk on childhood nutrition. My holistic approach is sometimes a bit unconventional, but it’s grounded in science. As a functional medicine physician, I’ve taken a special interest in nutrition. Beyond that, my experiences as a mother have pushed me to learn more. While much of the research presented here is directed toward children, these principles apply to adults as well.
I’m surprised by how much misinformation there is about nutrition, even among physicians and well-educated parents. Hopefully this helps to clear some things up.
In this 4 part series, I’ll address:
This week my focus is on the growing problem of food allergies and sensitivities. When I was in second grade, my teachers doled out salted peanuts as a reward. Can you imagine? Does anyone else from Kyffin Elementary remember this? It’s now the norm that classrooms are strictly nut-free because there’s at least one child who has a dangerous, even life-threatening, reaction. That’s a food allergy. Food sensitivities are also a growing concern.
Food allergies & sensitivities are more common than they used to be.
The incidence of food allergy among children in the United States is becoming more common. According to the CDC, food allergy among children increased by 18% from 1997 to 2007. This is a conservative estimate, based on other reports I have read. More dramatic is the rise in hospitalizations for food allergy related issues. From 2004 to 2006, the CDC reported that food allergy accounted for an average of 9,537 hospital discharges per year. This is an increase of 365% from 1998 to 2000.
Food allergies illicit an abnormal immune response that triggers an immediate or delayed hypersensitivity reaction. Immediate (Type I) hypersensitivity reactions, mediated by IgE, are obvious. Histamine is released, causing varying degrees of symptoms like hives, itching, swelling, trouble breathing, wheezing and anaphylaxis. They are easier to study because of this and most research is centered around these types of reactions.
There are also non-IgE mediated food allergies that are not as obvious or immediate. They are less well understood at this point, although increasing in frequency. They include atopic dermatitis, dermatitis herpetiformis, celiac disease and eosinophilic esophagitis. (source)
Food intolerance or sensitivity, on the other hand, does not involve an abnormal immune response. It is a negative reaction to a certain food, often with a delayed onset. Other than lactose intolerance, food sensitivities are not well understood. They are also becoming more prevalent, perhaps the most well known being non-celiac gluten sensitivity. There is no definitive lab test for gluten sensitivity, but it is nonetheless a real and growing issue. More research is needed to understated the exact mechanisms at play.
Hidden food allergies & sensitivities may be at the root of chronic issues.
Because they are sometimes less obvious and can take 72 hours to develop, food allergies and sensitivities may remain unrecognized in many people. This Dutch study concluded that many parents are not aware that chronic ailments in their child may be caused by food intolerance. In my experience, most parents and many physicians in the United States don’t consider food triggers as a cause of chronic symptoms.
Hidden food allergies and sensitivities are a real problem. Recurrent exposures to unknown food triggers can inflame the gut, activate an immune response and cause chronic underlying inflammation. This can manifest as anything from skin issues, to behavioral problems, to chronic gastrointestinal complaints. Some of the more common issues include:
Our food supply has changed dramatically in the past 15-20 years. Our genes have not. So what gives?
There is not one distinct cause for the rise in food allergies and sensitivities. I think it’s the perfect storm that has disrupted our intestinal barriers and immune function. Contributing factors likely include:
It’s hard to pinpoint, but it’s clear that there have been multiple environmental changes that contribute to this problem.
What can we do?
Traditional allergy testing is helpful for people who have IgE-mediated reactions. For the less obvious reactions, there are blood tests for IgA and IgG antibodies that are more controversial. IgA and IgG tests are not recommended at this point by the American Academy of Allergy, Asthma and Immunology. However, many practitioners and patients find them to be a useful guide. It’s important that you and your provider interpret them with some caution. I, personally, discovered a sensitivity to almonds which was contributing to my headaches. I don’t think I would have found that out without IgG testing.
I also usually recommend an elimination diet, like the Whole30. Elimination diets get rid of entire food groups for a period of time, then slowly reintroduce them one at a time in an effort to identify triggers. If that is too daunting, I recommend at least eliminating gluten and dairy for 6 weeks, since these are the most common food triggers. Note that if gluten intolerance is suspected, I like to test for markers of celiac disease before eliminating gluten. Celiac tests are invalid once gluten has been eliminated, and testing helps differentiate between celiac disease and non-celiac gluten sensitivity (NCGS).
Next week I’ll address dairy, which is one very common cause of both food allergy and sensitivity in children.
If you missed last week’s post on Pesticides, GMOs and Organic Foods, you can read that here.