We all could’ve been here at least once in a lifetime: You may have eaten something, and your belly started aching. You’d occasionally feel bloated or experience indigestion. Things couldn’t have been better until opening up the bowls. A food intolerance could be the issue if you’d usually started having abdominal cramps and bloating, right after taking the meal. There are a number of potential conditions responsible for causing food intolerance, such as Irritable Bowel Syndrome, SIBO (Small Intestinal Bacterial Overgrowth), Celiac disease, Gluten Sensitivity and the list continues. However, SIBO is one of the most common reasons responsible for food intolerances, followed by sugars indigestion, i.e. lactose, fructose, and sucrose intolerances. Before diving into the diagnosis and the ways to tackle the condition, we will first look at what the food intolerance actually means, and how the common terms such as food intolerance and food allergy are generally misunderstood.
What Actually Is Food Intolerance?
If you are suffering from food intolerance, this means that the enzymes in your gut responsible for breaking down the food particles are either deficient or there is a defect in their functioning, or the mechanism by which the nutrients are transported across the gut into the bloodstream is malfunctioned, causing maldigestion and malabsorption.
If the gut enzymes are unable to break down lactose into glucose and galactose, or the fructose is partially digested, symptoms will show up. After undigested or malabsorbed sugars get into the large part of your intestine, it gets metabolized by the bacteria in the colon, creating gases in the process of fermentation. This is how a patient starts experiencing cramps, bloating and abdominal pain. Furthermore, the sugars in the colon (large intestine) create an osmolar gradient, which causes the water to flow to the large intestine, causing diarrhea. This further gets aggravated by the increased motility of the gut because of the lactic acid and the acetic acid formed in the fermentation process.
Food Intolerance Or A Food Allergy?
Food intolerances and food allergies are sometimes misunderstood and often the terminologies interchangeably used. However, there is a significant difference amongst the two.
Food allergies are the reaction from your immune system to a protein substance in the food, which is presumed to be a foreign harmful substance by the immune system, ending up with the production of antibodies to fight off the foreign substance. All this ends up with the patient experiencing symptoms, which range from mild rash to even anaphylactic reactions (life-threatening difficulty breathing).
Nevertheless, food intolerance has nothing to do with your immune system. It completely involves the digestive element, with the enzymes not being able to digest or breakdown the food particles properly, resulting in your food being malabsorbed, and eventually maldigestion. As discussed initially, the symptoms are typically abdominal cramps, bloating, and troublesome abdominal pain as well as occasional diarrhea.
So, now people who suffer from indigestion issues tend to ask for an appropriate test to have a provisional diagnosis. For us to understand the testing mechanisms, it is important that we discuss some different kinds of food intolerances and their physiologies so that we should know what kind of testing is appropriate to find out the possible food intolerance.
SIBO & Its Relation To Food Intolerance:
SIBO stands for Small Intestinal Bacterial Overgrowth. It refers to the condition where there is an abnormal increase in the bacterial population of the small intestine. Briefly explaining, after an abdominal surgery such as a peptic ulcer repair or a gut infection, the movement of food particles in the digestive tract slows down which provides optimal conditions for bacteria to overgrow, resulting in food intolerance by a fermentation process which manifest with a range of symptoms, for example, diarrhoea, abdominal bloating, and even may lead to malnutrition. So the patients having SIBO suffer almost the same symptoms as the patients with food intolerance do. So, instead of thinking down deep into diseases such as Celiac Disease or other malabsorption syndromes, mostly, carrying out Hydrogen Breath Test alone reveals SIBO to be the main culprit responsible for food intolerances.
The first evidence in favour of this is that the researchers have founded HBT (Hydrogen Breath Test) to be positive in patients experiencing food intolerance symptoms, possibly pointing out SIBO as the underlying problem.
The second evidence is the effect of specific antibiotics given to food intolerance patients with the suspicion of SIBO being the cause. Interestingly, this has led to a significant decrease in severity of symptoms. As these specific antibiotics are not absorbed in the stomach and only work in the small intestine, thus, adding more to prove that SIBO is the key problem.
Testing And Management:
There are several tests commercially being offered to find out the cause of food intolerance. The Immunoglobulin G (IgG) antibodies are measured by skin prick testing kits. The presence of IgG does not necessarily mean that it is a cause of intolerance. Infact, this antibody has been found to be present in perfectly healthy people because the production of IgG is a normal reaction to the food particles, as clearly explained in Allergy and Clinical Immunology journal, in 2018. This emphasizes that there is already a false trend in place about home-based skin prick testing to look for the food specific IgG, which should not be practiced since there is no evidence that the food specific IgG are of any use to diagnosing any type of food intolerance, and quite worryingly, the results based on this test may lead you to avoiding some foods that your body really needs, or even you may end up eating some unhealthy foods. Therefore, if you have been experiencing the signs and symptoms suggestive of any possible food intolerance, SIBO and sugar indigestions such as lactose intolerance, fructose or sucrose intolerance should first come in your mind to be the causes of food intolerance. This means that Hydrogen Breath Test, as described above for SIBO,, along with the specific malabsorption tests such as Lactose Malabsorption Test, Fructose-Sorbitol Malabsorption Test, Sucrose Malabsorption Test, are the tests one must look for.
Elimination Diet As A Diagnostic Tool
After the diagnosis is confirmed, a detailed diary of the foods usually consumed help in identifying the diets involved in aggravating the symptoms. This is followed by placing patients on a temporary elimination diet, supervised by a dietitian and physician. This definitely helps in identifying the problem causing foods, allowing a patient to identify the specific food to be avoided. It is vital that the elimination dieting trial must be practised for the short time period, as a diagnostic tool, or otherwise, this may put the patients on the verge of being malnutritioned.