Anonymous wrote:
Anonymous wrote:What good tests exist for food sensitivities or allergies? My daughter has developed sensitivities tondairy. I seem to have reaction to palm oil. But are there tests to establish this ?[/quote
There are skin prick and blood tests that can tell you if it's a true allergy. ]
Intolerances are different from allergies, and not well understood IMO. (IANAD, just a celiac parent who has done a lot of reading in this area.)
-Dairy intolerance falls in two main buckets: lactose (milk sugars), and casein (milk proteins). There is a breath test for lactose intolerance. There is no test that I'm aware of for casein intolerance, but you could A/B test by using regular milk for a week, then A2 brand milk for a week. (A2 has a different kind of casein protein from the one found in most US milk.)
Lactose intolerance is nbd; you can just take lactaid and figure out what degree of lactose you can tolerate in foods (butter and kefir have low/zero, yogurt has low/some, milk has lots unless it's lactaid brand.) Note however that lactose intolerance can be a symptom of celiac disease, because the lactase is made at the tips of the villi in the small intestine, which is significantly affected by the autoimmune response in celiac.
- Gluten intolerance is different from wheat allergy, and likewise falls into two categories: celiac disease (not really an intolerance - rather, an autoimmune condition triggered by gluten, affects ~1% of the population), and non-celiac gluten intolerance/non-celiac gluten sensitivity (thought to affect more, but hard to determine because there's no biomarker so it's a diagnosis of exclusion).
Gluten is shorthand for a protein contained in wheat, barley, and rye. (Fun fact: some celiacs react to the protein in oats (avenin), even certified GF oats. GF oats are a thing because regular oats are often grown next to and/or processed/transported with the same equipment as used for wheat, so you have to assume that unlabeled oats are almost certainly cross-contaminated.)
There are biomarkers for CD - several different types of blood test (though a negative blood test doesn't mean you don't have it), a genetic marker for susceptibility (which about 30% of the population has, so it's used more to rule out CD than to confirm it), and biopsy-confirmed damage (biopsies taken through an endoscopy).
Because it's an autoimmune condition, CD is lifelong and people with it can have a flareup triggered by ridiculously small levels of gluten (like, using the same cutting board or tongs) - the limit for "gluten free" is 20 parts per _million_. It's a pain in the neck - most restaurants are clueless, so eating out is risky, and the lifestyle gluten free people make many others skeptical about whether your food really needs to be GF (or are you just a flake). Diagnosis requires you to be on gluten for a while (anywhere from 2 to 12 weeks depending on who you listen to); if you've been GF for a while, it will be hard to go back on, so take care of any screening before going GF. Testing is important because a CD diagnosis means heightened risk for other autoimmune conditions; on the other hand, it also means that schools, workplaces, etc. will listen to you about the GF diet because you'll have a doctor's note in hand.
NCGS/NCGI is less well understood and still debated in some circles; IMO it's real but this is based on anecdata and observation (plus, the study that came out a year or so ago claiming to disprove it was based on a small number of people, and IIRC had some questionable design aspects as well).
For both CD and NCGI/NCGS, symptoms are not confined to GI issues; headaches/migraines, skin reactions, behavioral effects (depression, anxiety, irritability), and something like 300 other symptoms have been associated with celiac, and similar (though maybe not as rigorously) with NCGI/NCGS.
There is no "lactaid" equivalent for gluten; you just have to avoid it, super-strictly if you have celiac. Be ready to be surprised how many random products carry the " ... may contain wheat" disclaimer.
Some believe there to be a link between gluten and other autoimmune conditions (Hashimoto's thyroiditis, MS, etc.), so some authorities recommend that people with those issues go GF. I don't know if there are studies one way or the other.
- FODMAPs, Crohn's, IBS, IBD are other GI issues/conditions that might be affected by gluten, dairy, etc. so don't self-diagnose - get a referral to a GI who is knowledgeable and talk to them. (Celiac bulletin boards have plenty of horror stories about clueless GIs - which is understandable, in that not every GI is up on the latest science on every condition, but nonetheless something to be aware of.)