WHOLE FOOD SENSITIVITY
Whole foods such as cow's milk, soy, dairy, bread and nuts can trigger symptoms.
Food allergies are reactions to proteins in foods, and the most common allergens in Australia are cow's milk, egg, peanut, tree nuts, soy, wheat, sesame, fish, shellfish and lupins. Together, these allergens account for 90% of the allergic reactions to food! However, it is possible to have an allergic reaction to any food as all foods contain protein. For instance, some people may be allergic to kiwi fruit or strawberries.
Allergy reactions are either IgE mediated meaning that IgE antibodies are raised (which can be tested) or they can be non IgE or cell mediated reactions which means they cannot be tested as there are no raised antibodies but they are still true allergy reactions. This means, if you have tests for allergies, the IgE allergies will show up but not the the cell mediated allergies. The IgE allergies are the potentially more harmful allergies for causing life threatening events such as anaphylaxis so it is useful that they can actually be tested.
This second type of allergies (cell mediated) typically have delayed reactions so seem very similar to food intolerance reactions. In fact there is no way of telling them apart. However, it does not matter as cell mediated reactions are very unlikely to cause anaphylatic reactions and are treated and managed the same way as food intolerances in the elimination diets.
If you think you may have an allergy to whole foods, It is worthwhile getting a referral from your GP for a Medical Immunologist or Allergist Specialist.
A reaction to a whole food such as dairy, soy or wheat may be due to a food intolerance reaction. This may be a reaction to the protein or another component in the food. such as FODMAPS which are a carbohydrate. If you have whole food intolerances then you are more likely to react to dairy foods, soy products and wheat products such as bread, especially if you have gut issues or eczema that is sensitive to food.
ALTERNATIVE ALLERGY TESTS FOR WHOLE FOODS
Other tests such as IgG (immunnoglobulin G- the most common type of antibody found in our blood stream) antibody tests are not validated or recommended by the scientific community. All of us produce IgG when we eat foods and it is not related to food intolerance or any disease. The test results simply reflect what foods you have eaten recently- not necessarily what foods are causing your symptoms (1).
There are so many tests out there that are marketed as being able to be used, often with a hefty cost but they have been shown to produce misleading results and lead to ineffective therapy.
The end result is many people unnecessarily avoiding foods and do not get to the bottom of what is causing their reactions.
Information on these methods is available on the Australasian Society of Clinical Immunology and Allergy (ASCIA) website (2):
Wheat is the the most common grain to trigger reactions. Wheat allergy is rare in adults, but wheat intolerance is more common.
WHEAT INTOLERANCE: Wheat can be eliminated from a diet, often alongside other whole foods and maybe food chemicals depending on your symptoms. The chemical elimination diet can just eliminate wheat, or it can eliminate all the gluten containing grains. Sometimes, gluten free grains such as sorghum or buckwheat can cause reactions.
GLUTEN SENSITIVITY: Some people have a sensitivity to the gluten in grain foods which includes not just wheat but rye and barley as well. This is often called 'non coeliac gluten sensitivity'. Sufferers may benefit from removing major sources of gluten but not the very small or trace amounts. This is a very controversial area with a lack of evidence due to poor methodology.
COELIAC DISEASE: If you have Coeliac Disease, that means you react to gluten in wheat, rye, barley and oats (controversial)- both major and very small sources. This is a very extensive diet and should only be followed after proper diagnosis. Coeliac Disease is common (1 in 70 people in Australia) and 80% of these remain undiagnosed. Read more about Coeliac Disease.
FODMAPs: If you are FODMAP sensitive then your gut is reacting to the carbohydrate in wheat. The low FODMAP diet reduces wheat and so also gluten but does not eliminate wheat or gluten completely.
Many people feel that they are sensitive to dairy. This can occur for different reasons:
LACTOSE INTOLERANCE (milk sugar): Lactose intolerance occurs due to a reduced level of the enzyme lactase which cleaves lactose sugar into its subunits- fructose and glucose.
Lactase sits on the very end of the finger like projections in the inside of the gut (called villi) and if the gut is sufficiently irritated, the lactase enzyme can be lost. Luckily the gut cells continue to make lactase so the lactose intolerance may only occur for a short time. This is very true of babies and children who produce lots of lactase due to milk being very important in their diets (2).
For adults, you can get a decrease in the production of lactase so although lactose intolerance can occur, some lactase is usually being produced. This means that small amounts of lactose can often be tolerated.
Lactose is a FODMAP so lactose free alternatives are recommended as part of the FODMAP elimination diet if it appears that lactose intolerance may be an issue.
PROTEINS IN MILK: Food intolerance or allergy can occur to whey or caesin proteins in cow's milk and other mammalian milks such as sheep and goat's milk and products made from these such as yoghurt, cheese, ice cream, custard, cream and butter. Dairy can also be added as an ingredient in a large variety of foods such as some breads!
Plant milks such as soy, oat, almond and rice milks can be used however check that these are fortified with calcium (120mg per 100ml).
A1 AND A2 PROTEINS IN MILK (in the caesin part of milk): Some people find that they can tolerate A2 milk. This is probably due to the fact that A2 milk contains only A2 protein and no A1 protein. This is in contrast to regular milks in Australia which may naturally contain some A2 protein but more importantly contain significant amounts of A1 protein.
For those sensitive to A1 proteins in milk and milk products, the A2 milks may promote better tolerance.
Egg, Nuts, Soy or Shellfish
Other foods commonly known to cause issues are eggs, nuts, soy, and seafood and shellfish. Some of these reactions may be allergies and some may be food intolerances.
For some people, even minute amounts of eggs, nuts, dairy, soy or shell fish need to be avoided and this is indicative that the person has allergies to these foods.
Babies who have cow's milk intolerance are quite often also intolerant to soy due to the similarity in the proteins.
Whole foods may need to be eliminated alongside other foods
If you are doing the FODMAP elimination or chemical/ food additives elimination then you may also benefit from eliminating some whole foods, depending on your reaction profile and previous sensitivities.
A detailed assessment including your individual reaction profile will help determine the best elimination diet for you especially as these days it is not uncommon to combine both eliminations.
Stapel, S.O., et al., Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy, 2008. 63(7): p. 793-6.
Anderson, J. Food-sensitive babies, dietary investigation for breastfed babies. 2017, Specialist Dietitian and Lactation Services.