Food Intolerance & Expertise SARAH KEOGH CONSULTANT DIETITIAN EATWELL FOOD & NUTRITION

Food Intolerance & Expertise SARAH KEOGH CONSULTANT DIETITIAN EATWELL FOOD & NUTRITION

Food Intolerance & Expertise What is food intolerance? Common food intolerances Why are consumers claiming more food intolerance? Nutrition confusion: the rise of the non-expert expert How can we protect consumers when it comes to nutrition

Food Allergy v Food Intolerance Food Allergy Immune Reaction Usually a response within minutes Even tiny amounts cause a reaction Symptoms every time Easier to diagnose (via history & IgE blood tests)

Food Allergy v Food Intolerance Food Intolerance Non-immune reaction Usually a delayed response Small amounts can sometimes be tolerated May be more difficult to diagnose Testing is by elimination diet & challenge

What Causes Food Intolerance? Lack of an enzyme (e.g. lactose intolerance) Pharmacological (e.g. caffeine, MSG, amines in cheese) Bacterial overgrowth Histamine in foods (fish, shellfish) Genetics

Common Food Intolerances: Lactose Affects 10% of people in Ireland, 34% in Spain, up to 90% outside Europe Due to lack of the enzyme lactase Symptoms: Bloating Diarrhoea Cramps Treated by avoiding milk, some cheese and limiting yoghurt

Common Food Intolerance: Gluten

Gluten & Coeliac Disease Affects 1 in 100 people Sensitivity to gluten Gluten damages the lining of the bowel Short-term: tired, migraine, diarrhoea, cramps, infertility, depression Long-term: osteoporosis, anaemia, bowel cancer.

Gluten & Coeliac Disease Testing: Blood test with GP followed by endoscopy with gastroenterologist Treatment: Need to avoid All gluten ALL the time Referral to qualified dietitian Need advice on calcium, vitamin D, B vitamins & detailed advice on avoiding gluten

Non-Coeliac Gluten Intolerance FODMAPS 2011 Study found gluten caused gut symptoms in non-coeliacs In 2014 the same researchers found that it wasn t gluten that caused the reaction Trigger for the symptoms were FODMAPs Fermentable carbohydrates

FODMAPs & Irritable Bowel Syndrome Affects 12% population men, women children, adults Major contributor to work days missed Seriously affects quality of life for many people No cure Symptoms can be treated, mainly with diet 70-80% of IBS patients improve on a low FODMAP diet

The Rise of the Food Intolerant 13% of Adults claim to have food intolerance 1% of people are coeliac (gluten intolerant) 10% are lactose intolerant 12% of people have Irritable Bowel Syndrome So is 13% an unrealistic figure? But is everyone with a food intolerance aware of it? How many claim food intolerance but don t have it?

The Rise in Food Intolerance Testing Heavily Marketed Treat conditions that medicine struggles with Tests Available: Vega Testing Hair testing Kinesiology IgG

What do the Experts Say? Allergy UK: recommend AGAINST tests such as IgG testing, Vega testing, hair analysis and kinesiology because the results are not relevant or based on sound scientific evidence. NICE Guidelines (UK) Which tests should be avoided? The tests not recommended by NICE are: applied kinesiology (a process based on muscle testing) Vega test (which involves measuring electromagnetic conductivity in the body) hair analysis serum specific IgG tests NICE says that it could not identify any evidence that the tests worked.

Food Intolerance and IgG Testing What is it? IgG Testing tests the amount of IgG the body produces when a food is eaten. Blood sample is taken, but no history Patient given a list of foods to avoid based on results May also be carried out on children Does it work? Current research suggests that a high IgG may actually mean you tolerate the food or that you have eaten it recently

What do the Experts Say? Irish Food Allergy Network There is neither a rational scientific basis nor proven role for hair analysis, isolated IgG testing, Kinesiology, Vega testing or Enzyme Potentiated Desensitization for diagnosing or managing food allergy or intolerance.

So How do we Test for Food Intolerance? Elimination Diet Gold Standard for intolerance testing Works for all intolerance Detailed history Limited elimination of food or foods Nutrient balance Resolution of symptoms Challenge

Does it Matter? Consequences of Food Avoidance Nutrient deficiencies Weight loss Faltering growth in children Long term health implications: Osteoporosis Anaemia Dementia? Sarcopenia? Other medical conditions being missed

Where do Consumers get Food & Nutrition Advice? Media, websites, health professionals Nutrition experts BUT Anyone can all themselves a Nutritionist Anyone can be seen as a nutrition expert even without training or study Many people believe that they are experts on nutrition because they work in health

Dietitian, Nutritionist, Expert: What s the Difference? Nutritionist Can have: A 3 year degree in nutrition or A 2 year part time course (usually 20 weekends) or A 3 week course or No training at all No legal definition or restriction Dietitian 4 year full-time university degree Can have additional masters or PhD. Legally protected title in Ireland, UK & US.

The Dunning Kruger Effect (or: a little learning is a dangerous thing) People with a low level of knowledge or skill overestimate their knowledge or ability They: fail to recognize their own lack of skill fail to recognize the extent of their inadequacy fail to accurately gauge skill in others recognize and acknowledge their own lack of skill only after they are exposed to training for that skill

How do we help Consumers? Educate yourself Make sure to get nutrition information from reliable sources Nutrition Journals Dietitians Reputable nutrition courses Challenge what you read in newspapers; watch on TV; read online; advertisements. Refer appropriately

Thank You