Food Intolerance

Symptoms

After eating the triggering food, digestive disturbances usually develop within hours. These include:

  • Flatulence, bloating
  • Abdominal pain, abdominal cramps
  • Diarrhea
  • Stomach burns

Depending on the trigger, pseudoallergic reactions such as a hives, rhinitis and respiratory disorders may also occur. According to the literature, up to 20% of the population is affected. The disorders typically occur on a regular basis. They are predictable if the causative foods are known.

Causes

In food intolerance, certain foods are not tolerated, resulting in digestive disorders. Some ingredients, such as carbohydrates, are fermented in the intestines by intestinal bacteria. This leads to increased water concentration in the intestinal lumen, accelerated transit time, thinner stool, and gas formation. Critical foods and ingredients are listed below. Milk, dairy products, foods containing lactose:

  • Milk sugar (lactose) cannot be adequately broken down into its components glucose and galactose in the intestine in lactose intolerance because the enzyme lactase (β-galactosidase) is not present. The lactose is fermented in the intestine by bacteria, which triggers the complaints

Fruits, honey:

Vegetables, seeds:

  • Vegetables such as cabbage, beans, onions, beet, kohlrabi, beans and legumes contain indigestible carbohydrates such as oligosaccharides (raffinose, stachyose, verbascose). They belong to the so-called FODMAP. They are also fermented in the intestine. Fructans can also be responsible. These are polymers of fructose, which are found, for example, in onions, garlic, artichokes and leeks.

Bread, pastries, pasta:

  • Gluten is a complex mixture of water-insoluble proteins found in the endosperm of cereal grains, especially wheat, spelt, rye and barley. Gluten can cause disorders in those with gluten sensitivity. The more severe celiac disease is not considered a food intolerance because it has an immunological cause. Fructans are also present in cereals.

Fermented foods:

  • Fermented foods such as aged cheese, alcoholic beverages such as beer, as well as sausage contain histamine, which can cause pseudoallergic reactions in people with histamine intolerance. Other vasoactive biogenic amines such as tyramine, for example, can cause headaches.

Other incompatible food and stimulants:

Tolerance varies from individual to individual and depends on the dose supplied.

Diagnosis

The diagnosis can be made on the one hand by observation. A diary in which the consumed foods and beverages are recorded is helpful. On the other hand, symptoms can be specifically provoked by ingesting larger amounts of the triggering foods. Various diagnostic methods are available (e.g. H2 breath tests, a blood sample or a gastroscopy). Diseases of the digestive tract must be ruled out. Food allergies, such as peanut allergy, are not considered food intolerances.

Nonpharmacologic treatment

Trigger foods and beverages should be avoided. Usually, small amounts are tolerated. This is with the exception of celiac disease, in which gluten must be completely avoided.

  • Eat slowly.
  • Eat small portions.
  • Watch out for hidden ingredients, for example, sorbitol in medicines.
  • Balanced diet with adequate intake of the necessary nutrients.

Drug treatment

For some food intolerances, specific enzymes are available that break down or isomerize the triggering ingredients in the gut:

  • Lactose intolerance: lactase.
  • Fructose malabsorption: xylose isomerase
  • Vegetable intolerance: alpha-galactosidase
  • Gluten sensitivity: prolyl oligopeptidase
  • Histamine intolerance: diamine oxidase

Acute symptoms can be treated symptomatically, for example, with loperamide for diarrhea, with scopolamine butylbromide for cramps or simeticon for flatulence (see there). Probiotics may have a positive effect. Herbal medicines and bitter remedies can stimulate the secretion of digestive juices and contribute to better digestion.