Food Intolerance vs. Food Sensitivity

By Amy Burkhart MD, RD

Food intolerance, food sensitivity, food allergy; the terms are similar but their explanations and treatment are different. The words are frequently used interchangeably by the general public but the approach to managing them is worlds apart. Blah blah blah

Food intolerance happens when our bodies struggle to process certain foods properly. This happens sometimes because we might not have enough enzymes as in lactose intolerance, sucrose intolerance, or histamine intolerance. that our bodies need to break down these foods. Symptoms of food intolerance are not usually immediate and, often show up hours after eating those foods. These symptoms can be quite varied, like getting rashes, headaches, tummy troubles, joint pains, or problems with the digestive system. Unlike food allergies, food intolerances usually don’t come on very quickly or severely. They are not usually a big danger right away. Treating a food intolerance often means avoiding certain foods and sometimes taking special enzymes to help digest them, like lactase for lactose intolerance.”

Food allergies occur via a different immune process. A severe allergy to food (such as with peanuts) can be life-threatening. Allergic reactions are usually immediate, and symptoms can range from rashes to anaphylaxis. An allergic reaction occurs when the immune system is triggered, releasing substances called IgE antibodies.  Treatment of food allergies is strict avoidance, and if exposed, antihistamines, steroids, and epi-pens may be used. In severe cases, hospital admission and IV medications may be needed.

Food sensitivities are poorly understood. The terms “food intolerance” and “food sensitivity” are often used interchangeably. But, they are different.

In food sensitivities, there appears to be some involvement of the immune system, such as in gluten sensitivity. The exact mechanisms are still not understood.

Symptoms are not life-threatening but can significantly impact someones’ day-to-day life. Symptoms include but are not limited to fatigue, cloudy thinking ( brain fog), headaches, joint pain, digestive problems, and more. Food sensitivities are diagnosed via an elimination diet. Reintroduction of foods is then done, and a food log is used to correlate food intake with symptoms. Treatment is limiting or complete avoidance of the particular food or food groups.

Histamine and mast cells have been identified as main actors in new findings identifying foods as IBS triggers.(source)

Mast cells are an essential part of the immune system. They store and release histamine, a chemical found naturally in the body. The word histamine often evokes thoughts of over-the-counter medications used for hay fever or other allergies. But, histamine is always naturally present in the body. It is released from its storage site in mast cells when there is a need to combat unwanted intruders such as infections, allergens, or in this case, particular foods.

Histamine levels in the body can rise for other reasons such as during exercise and stressful situations, infections* or when eating foods containing histamine. Histamine is a natural component of many foods.

Problems occur when the level of histamine exceeds a person’s tolerance level. When this happens, symptoms begin. Some of those symptoms are related to IBS, such as bloating, cramping, and diarrhea.

Click here for more information on histamine intolerance and the low histamine diet

*Histamine has been implicated in problems seen in long-haul COVID-19 patients. (SOURCE)

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1. Work with a licensed nutritionist or dietitian (as well as your physician) to determine the cause – and best management – of your intestinal symptoms.
2. Keep a food log
3. Show the Nature research paper to your doctor. Nature is a well-respected journal. It will provide validation
4. Work with a dietitian to help navigate your road to health
5. What about food sensitivity testing? Stay tuned!