When pursuing health and wellness, it’s important to tune into how food, exercise, and emotions feel in the body. Food allergies, intolerances, and sensitivities can have a major impact on a person’s quality of life and, in recent years, have increasingly led individuals to exclude more and more foods. The decision to exclude certain foods may be diet culture driven, a medical necessity, or somewhere in between. Are these exclusions always necessary or beneficial? To get to the bottom of this question, it’s imperative to decipher the differences between food allergies, intolerances, and sensitivities. 

Food Allergies

32 million Americans have food allergies. The eight most common food allergens—accounting for 90% of all food allergies—include milk, egg, peanut, tree nut, soy, wheat, fish, and shellfish. In a food allergy reaction, the immune system registers a harmless food as dangerous and begins to attack, leaving the individual with symptoms such as digestive problems, a swollen airway, hives, or possibly even anaphylaxis. A person’s reaction can vary from one exposure to another, so it is best to completely abstain from food allergens. 

When a food allergy is suspected, expect to be referred to an allergist or immunologist for testing. Diagnostic tests may include skin prick tests, oral food challenges, or IgE blood work. Ig stands for immunoglobulins or antibodies, which are found in the body and are markers of an immune response. It’s important to distinguish between IgE and IgG immunoglobulins as outlined in the chart below:

ImmunoglobulinWhat It Tells UsKey Point
IgEAfter blood is drawn, the sample is sent to a lab for testing of various foods with the blood sample to measure IgE levels. An elevated IgE response is indicative of an allergy or allergic response. IgE blood work can serve as part of the diagnostic plan for food allergies.
IgGMost antibodies in the blood are IgG. These antibodies develop after exposure to a food or other foreign body. IgG blood work proves exposure and shows tolerance, not allergy. These tests are not valid or reliable for the diagnosis of a food allergy, intolerance, or sensitivity.

Note: Applied kinesiology, hair analysis testing, and mediator release assay are not evidence-based methods in the diagnosis of food allergies, intolerances, or sensitivity.

Food Intolerances and Sensitivities 

Generally speaking, food intolerances occur when the body isn’t able to process or digest certain foods, often due to factors like the absence of an enzyme needed to fully digest a food, irritable bowel syndrome, sensitivity to food additives, celiac disease, or recurring stress or psychological factors. Though food intolerances are not life threatening like food allergies, symptoms can range from annoying to extremely uncomfortable. 

One example is lactose intolerance, which occurs when the body lacks the enzyme (lactase) to break down milk sugar (lactose), causing cramping, nausea, pain, gas, bloating, and diarrhea. It’s important to note that there is no question of tolerance in a food allergy; the food must be completely avoided. However, with a food intolerance, it’s not a question of avoidance, but rather, “what’s my threshold?” to avoid exclusion in favor of thoughtful inclusion. With some food intolerances, the threshold can change based on variables such as portion size, pairing with other foods, and other factors.

There’s a lot of uncertainty and controversy about what exactly happens in an individuals’ body causing food sensitivity. Every body experiences the disruptive discomfort of a sensitivity in a different way, such as joint pain, stomach pain, fatigue, or rashes. The good news? Food reactions, especially sensitivities, can fade away with time. Our bodies, immune systems, and the gut microbiome are continually changing, and what one may not feel well eating today may feel just fine later on in life. 

Where To Go From Here…

With food allergies, treatment planning is a little more cut and dry. Due to a lack of accurate, reliable, validated tests to identify food intolerances and sensitivities, healthcare providers must encourage patients to rely heavily on their lived experiences and discernment to help guide a treatment plan. From there, it is important to assess whether or not the changes they make to their diet are translating to meaningful outcomes that preserve a peaceful, healthful relationship with food. Questions to consider include: 

  • Are the changes I’m making to my diet making an objective difference in my quality of life? How so?
  • Am I able to nourish my body in a way that feels sustainable throughout my life?
  • Is the exclusion of the specific food(s) worth the psychological impact?

If you or someone you love needs help cutting through the noise of diet culture, emotions, or misinformation to find clarity, Memphis Nutrition Group is here to provide support toward rooting actions in evidence-based science and attunement to the body. Our ultimate hope for our clients is that they will be able to enjoy the least restrictive diet possible…even when navigating food allergies, intolerances, and sensitivities.

Caroline Shermer, MS, RDN, LDN is a nutrition therapist and Registered Dietitian at Memphis Nutrition Group. Memphis Nutrition Group believes in a non-diet approach that promotes overall health and optimal performance without compromising the enjoyment of food. For more information call Memphis Nutrition Group at 901.343.6146 or visit MemphisNutritionGroup.com.