Ask An Adult: What’s The Difference Between An Intolerance And An Allergy And How Do I Know Which Is Which?
The Debrief: Are you giving up foods without needing to?
2016 was undoubtedly the year of eating clean. ‘Free from’ foods became a massive business – sales of gluten-free products, once something you could only get on prescription, are booming and worth an estimated £365m, while almond and oat milk are absolutely everywhere. There’s even been a backlash, with Jennifer Lawrence calling going gluten-free ‘the cool new eating disorder’ and many think-pieces taking wellness bloggers to task. However, this can be frustrating for people with genuine food allergies and intolerances, who find their health problems are being dismissed as being just the next big trend.
Leeds-based Maddie, 22, was diagnosed with lactose intolerance as a child and says it can be frustrating when people think she’s just being fussy or trying to cut out certain foods when she doesn’t need to. ‘There’s definitely a stigma. Sometimes I feel people just think I’m following a special diet when I choose dairy-free options, especially when I pick the vegan option in a restaurant - which I normally do to be completely safe,’ she says. ‘In my job, I often have to take clients out for food. I usually ring the restaurant in advance to see what I can eat, just so I don’t come across as being faddy and can avoid questions.’
When she consumes dairy products, she experiences a range of nasty symptoms, including stomach pains, developing a puffy face, and eczema. ‘At the moment, I’m actually taking antibiotics because I had eczema which got infected. I ate a pizza after a night out, and though I asked for no cheese, the dough must have had dairy in it and caused it to flare up again. It’s actually really awful having a genuine intolerance,’ she adds.
An estimated 22% of adults in the UK say they have a food allergy or intolerance, according to a 2014 survey for the Food and Drink Innovation Network. Twice as many women than men said they had problems, and dairy and gluten were the most likely to be given up by people saying they had an allergy or intolerance. However, the survey did not ask for proof, so it’s possible many of the people who responded haven’t had a diagnosed problem, and could be giving up foods without needing to.
‘The word allergy gets misused a lot and there’s a real lack of understanding about what having an allergy means,’ Lindsey McManus, Deputy CEO of Allergy UK says. ‘A lot of people say they’re allergic to things when they’re not - this can make a mockery of genuine sufferers, as real life allergies can be very serious.’ There are around 21m adults in the UK who suffer from at least one allergy, and every year the number of allergy sufferers increases by 5%.
Allergies and intolerances are often confused with each other, but there’s a big difference in the causes and symptoms. Marlene Hochstrasser, Clinical Director of the Devon Allergy Clinic (www.thedevonallergyclinic.co.uk) says a food allergy is caused by the immune system responding to normally harmless fodder. Cells in your body, known as ‘mast cells’ respond quickly, secreting a chemical called histamine. ‘This causes symptoms such as sneezing, tingling lips, swelling, hives and rashes and breathing problems,’ she says. ‘Allergies can be life-threatening and result in a reaction called anaphylaxis which is a medical emergency and can be fatal.’ Symptoms usually come on within a few minutes of being exposed to an allergen, and sufferers will usually be given anti-histamines and steroids to reduce inflammation. Those with severe allergies who are at risk of anaphylactic shock will have an EpiPen to carry around with them in case they have a severe reaction.
In comparison, intolerances are caused by problems with being able to digest certain foods - so for example somebody with a lactose intolerance will have a lack of the enzyme lactase, which is necessary for digesting lactose. ‘The symptoms will be more gut-based than with allergies, such as nausea, stomach pain, diarrhoea and constipation, and will take a few hours to come on,’ Marlene says. There seems to be a genetic link to allergies, however intolerances can be caused by other factors, such as stress or even eating the same types of food too often.
Dani, 23, says she’d been having stomach issues after eating foods containing gluten and wheat, such as pasta, biscuits and bread, for a long time. ‘My ex-boyfriend had Coeliac disease (an auto-immune, chronic condition where the immune system mistakes substances found inside gluten as a threat to the body and attacks them) and ate a gluten-free diet. I’d always felt generally ‘ugh’ – bloated, with very bad, stabbing stomach pains and I kept losing weight, but once I started eating what he ate these nasty symptoms went away.’ She took a test that showed she had gluten intolerance, so she now avoids it completely where possible.
‘Though intolerances aren’t as serious as allergies in that they aren’t life-threatening, it doesn’t mean they shouldn’t be taken sincerely,’ Lindsey says. ‘Having ongoing stomach problems can make your life miserable and negatively affect you, so you definitely need to get them looked into if you’re suffering.’
So, what can you do if you think you have an allergy or a food intolerance? According to Lindsey, it’s important not to ‘self-diagnose’ and start cutting stuff out unnecessarily. ‘If you notice that soon after eating something you’re having the classic allergy symptoms, like itching, rashes or hives, then seek advice from your GP as soon as you can, as they will be able to send you to a specialist to get to the bottom of it,’ she says. ‘If you’re having breathing problems it’s best to go straight to A&E, as this could be life-threatening.’
If you’re feeling bloated, nauseated, fatigued or having digestive problems, Lindsey recommends making a food and symptoms diary for a couple of weeks. ‘Record everything that passes your lips, so not just food but any drinks - including alcohol - and medication, alongside any symptoms you’re getting,’ she says. This way, it’s highly possible that you’ll soon see a pattern forming. Take anything making you ill out of your diet one at a time, and don’t eat it for 4-5 days, then slowly re-introduce it. If you notice you improve, but then feel bad after bringing it back in your diet again, try and get an appointment with your GP or a dietician. The Allergy UK helpline and website (www.allergyuk.org) can offer more advice.
Marlene says if you are diagnosed with a food allergy or intolerance it’s important to not get despondent. ‘Focus on what you can eat, not what you can’t,’ she says. ‘For a lot of people, their problems can improve over time with the right treatment.’ At her clinic, she’s seen patients with intolerances vastly improve after being put on the right, high-quality probiotics and adopting a healthier diet, and they’ve even been able to eat things that have previously made them feel ill.
The flip side of the clean eating and wellness revolution is that there’s never been so much choice for people with allergies and intolerances too. ‘My ex used to always say it was so hard to find gluten-free products,’ Dani says. ‘Now, you can get them in all major supermarkets, and I feel I can eat out basically anywhere, as most menus indicate which dishes are gluten-free.’
There’s a lot of helpful websites out there too, for example Can I Eat There? (www.canieatthere.co.uk), which is a great resource for people with allergies. You can search by allergy and work out what dishes will be safe for you to eat before you book.
At the end of 2014, labelling regulations were brought in meaning the top 14 food allergens, which include eggs, fish, cereals containing gluten, and peanuts had to be listed in the ingredients of pre-packaged foods. It was a massive step in acknowledging food allergy as a serious medical condition. Allergy UK have also recently launched an allergy-aware scheme to highlight restaurants who understand the needs of people with allergies, and Lindsey says there’s been a lot of interest from businesses who are seeking accreditation.
Still, for people with allergies and intolerances like Maddie the frustrations still remain. ‘I’ve grown to accept my lactose intolerance, but sometimes I wish I was ‘normal’ and could do things like eat the box of Christmas chocolates or the birthday cake that get passed round the office without my face flaring up,’ she says. ‘Alternatives are getting better, but there really isn’t anything that can truly compete with the taste of actual chocolate or cheese.’
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