Lactose, gluten: how do you know if you have a food intolerance? – 14.05.2022

While for most people eating is a pleasant feeling, for others, eating certain foods means feeling sick and having various gastrointestinal disturbances, as with some people with intolerances.

“Food intolerance is an adverse reaction that occurs in the body’s major digestive tract, due to difficulty digesting a particular food,” explains Karina Gama, clinical nutritionist at Instituto Dante. pazza Department of Cardiology. According to him, discomfort can be caused by the absence or malfunctioning of enzymes that carry out the “breakdown” of certain components of the food, such as substances that make it difficult to digest.

Among food intolerances, lactose intolerance is the most common and occurs when there is a deficiency of the enzyme lactase, which is responsible for the digestion of lactose, the sugar found in milk, and derivatives such as cheese and yogurt.

But there is also intolerance to gluten (or non-celiac gluten sensitivity), fructose (the sugar found in fruits, some vegetables and grains, and processed products), sucrose (table sugar), and undigested carbohydrates that are then fermented. by gut bacteria (from milk, fruit, grains, legumes, and some sweeteners) also known as fodmap

According to gastroenterologist and pediatric Hélcio Maranhão, anyone can have a food intolerance and the factors that predispose to it depend on the individual’s conditions, such as genetics, health status, immunological status, or the food itself, such as allergenic potential, protection and amount ingested. Nutrologist, professor in the Department of Pediatrics at UFRN (Federal University of Rio Grande do Norte).

In people with intolerance, symptoms may begin immediately or shortly after eating and can last for hours.

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How to determine if you have an intolerance to any food?

Symptoms and signs can vary, but are usually related to the digestive system: cramping or abdominal pain, stomach bloating, bloating, borborygmus (abdominal sounds), nausea, regurgitation, gas, constipation, and even diarrhea. Systemic symptoms such as irritability, fatigue, migraine, hives, and joint pain may also be present, according to Auzelivia Rêgo Falcão, MD, professor of the discipline of diseases of the gastrointestinal and coloproctological systems in the UFRN Department of Integrated Medicine.

Symptoms can begin immediately or some time after eating and can last for hours. Relief usually occurs after complete fermentation of undigested components by intestinal bacteria or excretion of the substance through the feces.

But it is important to make it clear that just feeling bad after eating does not constitute a food intolerance. “This is because there are other digestive diseases that can cause similar symptoms, including food poisoning,” Falcão says.

To suspect the condition, persistence and persistence of symptoms while consuming the food at different times is necessary. “Making a food diary that describes the symptoms and the foods eaten that day can help,” the gastroenterologist adds.

If the person suspects that they have an intolerance, it is recommended to take a break from the food in question. “This measure is expected to promote the reduction and resolution of symptoms. After a few weeks, he may return to eating the food to see if such symptoms come back. If he is, he’s likely to have this condition,” says Maranhao.

If the manifestation of clinical symptoms is persistent, the doctor or nutritionist may conduct a detailed evaluation to confirm the diagnosis. This includes researching health history, medications or supplements used, lifestyle habits, bowel function and dietary habits.

What tests can be done?

Some laboratory tests and specific tests can help with the diagnosis. These include, for example, an oral tolerance test that helps identify lactose intolerance. This test consists of administering the investigated substance to the patient on an empty stomach and taking blood after 30, 60, 90 and 120 minutes and checking whether there is at least 20 mg/dl increase in fasting blood sugar. , as a result of digestion of the studied substance. If the blood sugar level is lower, it is determined that the digestion is incomplete and there is not enough absorption.

The expired hydrogen test uses the same principle as the oral tolerance test, but instead of assessing the change in blood sugar, the patient blows a device that measures the amount of hydrogen delivered in the fasted state after taking the standard solution under investigation. Intervals ranging from 2 to 4 hours.

“In the intolerant patient, the undigested and absorbed substance is fermented by bacteria in the last part of the intestine to form hydrogen. Therefore, the increased hydrogen perception in the breath reflects that the substance cannot be digested and absorbed properly,” explains Karina Gama, a food scientist.

There are other tests that may be used, such as stool acidity testing, intestinal biopsy, and genetic testing, which are usually used in infants or children, and are more often indicated when conventional tests are inconclusive. For non-celiac gluten sensitivity, tests are done to look for celiac disease.

French Roll, Bread, Carbs - iStock - iStock

If in doubt, the ideal thing is to call a doctor or nutritionist and perform tests so that the person does not make unnecessary dietary restrictions.

Image: iStock

Intolerance and allergy are different

Even not to confuse food intolerance with food allergy, which is a different condition, testing to confirm the diagnosis is important.

As explained earlier, food intolerance consists of a deficiency of the enzyme responsible for the digestion of a particular food, causing difficulty in its absorption. It is a condition that produces more local symptoms associated with the gastrointestinal tract.

Allergies, on the other hand, as they are an immunological phenomenon, can have general reactions or endanger different devices such as the skin and respiratory system in addition to the gastrointestinal tract.

How is the treatment?

According to the experts consulted in the report, the treatment of food intolerance should be individualized and based on reducing or excluding the foods that cause the problem.

Some people can tolerate small amounts of the product, but this limit is individual. In lactose intolerant, lactose-free or low-lactose products should be preferred. There is also the option of using the lactase enzyme in tablet or powder form to be diluted in liquids, before or together with lactose-containing foods. This may reduce the occurrence of symptoms, but may not be completely effective.

Nutritionist Gama reinforces that “all intolerance should be properly diagnosed by a healthcare professional so that there are no unnecessary restrictions on food.”

Resources: auzelivia ditch Hawkgastroenterologist, professor of the discipline of gastrointestinal diseases, and coloproctological From the Department of Integrated Medicine at UFRN (Federal University of Rio Grande do Norte), he also works at Onofre Lopes University Hospital (HUOL/UFRN); Helcio Maranhaogastroenterologist and pediatric nutritionist, full professor in the UFRN Department of Pediatrics, secretary of the Department of Nutrology at the Brazilian Society of Pediatrics; Karina GammaClinical nutritionist at Instituto Dante pazza Master of Science in Cardiology and a Master of Science in Food Science from the School of Pharmaceutical Sciences at USP (University of São Paulo).

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