WHEN FOOD GETS COMPLICATED
This is the last article on our series of food as basic need. In the last article, I talked about the societal pressures around food and dieting. To round our discussion out, I wanted to talk about when there is discordance between food and our individual selves. In this article, we will discuss relationship with food on the topics of food sensitivities, intolerances and allergies, emotional eating, binge eating and orthorexia. I will be only briefly naming other eating disorders since I am not a psychologist and have no training or experience here. I will post a trigger warning before this section.
food as foe?
Food we eat is broken into smaller and smaller pieces progressively from our cutting board or plate to our intestines. We cut up food, chew it and start to break it down with saliva. Our stomach mechanically mixes food and chemically breaks it down, then the chemical breakdown continues in the intestines through enzymes and chemicals produced by the pancreas, bile system, and intestines, as well as the normal microbes in our intestines (gut microbiome; flora and fauna). Some people do not have all of these systems because that’s how they were born or they have had surgery, other procedure, or condition. But only when food is broken down to small enough molecules can our small intestine absorb them and transfer them into the blood for our body to use. We have a whole lot of checks and balances to ensure only what our body can handle is absorbed, and the rest is excreted in the faeces. These checks and balances include the barrier of the intestinal epithelium, the transport systems, the local immune system, the normal gut microbe population, and all the complex signalling that goes on between all the parts.
Sometimes the food we eat can cause us problems. We might be showing “gastrointestinal symptoms” like diarrhoea, bloating, gas, nausea, vomiting. And/or we could have a more systemic or whole-body response from inflammation which can cause a wide variety of symptoms including fatigue, brain fog, achy joints, depression. In general, gut-related symptoms and the more vague systemic symptoms are increasing in prevalence in the Western world. There are a variety of different types of gut diseases in this category including “irritable bowel syndrome” (IBS), leaky gut syndrome, inflammatory bowel disease (IBD), chronic enteropathy, or a variety of other terms depending on results of various tests.
The cause for the increase in these types of gut diseases seems to be multifactorial, but immune-dysregulation seems to play a significant part in it. The “hygiene hypothesis” states that since we no longer are ingesting small amounts of dirt in our food which provides us with a wider variety of helpful gut microbes, we clean or disinfect everything, use antibiotics liberally, and no longer have worms and other parasites humans commonly used to have (we are “too hygienic”), that the immune sentinels in our guts are overzealously responding to normal food molecules and our gut microbes are unbalanced. This is coupled with a less tight epithelial barrier which can be triggered by disharmonious microbes, less well-digested food, chronic stress, and gluten. The agrochemical pesticide glyphosate (Roundup) is also likely to contribute, but more research is needed (or to be published). Learn more about glyphosate here.
If our intestinal barrier is less tight than it should be, then some molecules from the gut could enter the blood which are unregulated, triggering inflammation (“leaky gut”). This will then further imbalance the gut microbes and make everything worse. An imbalanced gut microbiome predisposes people to a variety of allergic diseases, immune and metabolic diseases. Not only is the gut a very important part of the body’s immune system, but it also produces many hormones including neurotransmitters such as serotonin and dopamine. The brain is not the only source of these! The theory is that a dysregulated gut produces and/or absorbs fewer neurotransmitters, and this may contribute to depression. Read more here.
Inflamed intestines also will not absorb the normal molecules as well, potentially causing deficiencies or malnutrition. Instead of being absorbed, these normal molecules instead stay within the intestine where some of them can be eaten by the gut microbes, often producing gases or other chemicals which can further cause inflammation and further imbalance the types of microbes (e.g., overgrowth of the “bad bacteria”-dysbiosis) and their signals. Read more here.
sensitivity, intolerance, or allergy?
Clearly the gut is a very complex organ. When we talk about food causing problems, it can be described as sensitivity, intolerance, or allergy – and this likely exists on a spectrum. Food poisoning is something different. Food poisoning is when you have eaten food with an overgrowth of bacteria, their toxins, or other microbes which triggers – rightfully so – an inflammatory response. This is the gut doing its job. Think like “Bali belly”, “Delhi belly” or other types of traveller’s diarrhoea. Many cases of “food poisoning” in the Western world are caused by norovirus which is often transmitted by people who haven’t washed their hands properly after wiping their bottom. Sorry if that’s TMI but wash your hands. More on food poisoning in the US here.
OK, a food sensitivity is where a certain type of food or molecule causes gastrointestinal signs +/- systemic signs (especially over time). Maybe sometimes you can eat it and feel fine, but other times not so much. This could be a certain food, or could be a wider swath of foods. The more different foods you are “sensitive” to, the more likely there is intestinal barrier and/or gut microbe dysfunction. The exact mechanisms of the symptoms are unclear but you need to fix the underlying problem. This can take months to years, by the way. Food sensitivities can be tested by an elimination diet- removing certain types of foods for weeks to months and seeing if you feel better, and also by checking the immune response in the blood. It is good to do both, actually. You may also be able to eat the foods you were “sensitive” to after supporting and bolstering your intestinal health.
A food intolerance is where a certain type of food or molecule pretty consistently causes gastrointestinal signs because of a reduced amount or lack of a certain enzyme or chemical. For example, lactose intolerance is extremely common and is where people do not produce as much of the enzyme lactase, which is needed to break down the sugar lactose into smaller sugars to allow it to be absorbed. So instead of being absorbed, the lactose stays in the gut, gets happily eaten by the gut microbes (sugarrrrrr) who then produce gas. Then, so do you. Most people are born producing lactase because babies need to absorb the sugar from milk. For some people, the body decreases lactase production after the age of 6 when biologically we would no longer need it, and they become lactose intolerant. After all, milk is for babies.
A food allergy is where a certain type of food or molecule causes an immune reaction which can be variably mild to life-threatening. The inflammatory response often causes more systemic effects in the body, not just staying local to the gut. An example is coeliac disease which is an allergy to gluten- a protein found in wheat, barley, and several other grains.
what to do if you have gastrointestinal symptoms or vague systemic signs?
For sure, talk to your general practitioner doctor first and foremost. Get general screening blood tests done, faecal tests including for parasites, maybe get tested for Helicobacter pylori. Then, think about a 30-day elimination diet a ’la The Whole 30 or other. 30 days is not necessarily long enough to see a change, but it’s a good start. See how you feel after removing some of the common types of foods we can be sensitive to. Then, talk to a holistic practitioner or registered dietician to investigate further: your doctor typically won’t have enough time or knowledge to support you through this process. There are a million bajillion diets and plans and books: some of which hinge on the hysteria of weight loss diets. Some more credible and helpful directions to go in include websearching low FODMAPs, The Wahls Protocol, histamine sensitivities. Read more here. Stay open, stay critical, and keep going. Speaking from personal experience, it’s worth it.
food + me = it’s complicated
Our guts can have different reactions to food, but so can our brains. Food is obviously an integral part of life for almost everyone. And for some people, it becomes a focus or source of mental or emotion pain.
Emotional eating is when people use food to help regulate their emotions, as a coping mechanism. This could be “healthy” or “unhealthy” depending on the perception of the person and the impact on their life. The stereotypical sad person eating a tub of icecream is one way it could look. And that’s not a problem, unless they are not also regulating their emotions most of the time in other ways. Some form of support, therapy, counselling or mentoring is very helpful.
Potential trigger warning: Eating disorders
Binge eating is when a person eats a large amount of food in a harmful way toward themselves. This could be a manifestation of emotional eating (as it was for me for coping with stress), or could be part of another emotional or mental dysregulation or eating disorder such as bulimia nervosa. Binge eating certainly needs support by a trained professional since there are underlying issues which need to be identified, supported and guided through.
Orthorexia nervosa is a more recently described mental condition where a person strictly controls the types of foods they eat, typically around eating “healthy” or “clean”. This is the shadow side of eating “healthy” (and the reason I avoid using the terms “healthy” and “clean” to describe food; opting instead for nourishing). By definition, this harmfully impacts the quality of the person’s life. Lee Tilghman (Lee from America) is a blogger who talked about her experience with orthorexia. Read her blog article here.
As discussed in the introduction of this article, I have no personal experience, knowledge, or training with other eating disorders including anorexia nervosa and bulimia nervosa. These are very deadly diseases which need immediate, compassionate professional health and a network of support and care.
In the US, a few starting points for help are:
National Eating Disorders Association https://www.nationaleatingdisorders.org/where-do-i-start-0
National Alliance on Mental Illness https://www.nami.org/Home
wrapping it up like a taco
We take for granted how important food is. It’s more than just the never-ending cycle of “what’s for dinner?”. Most of us in the Western world live in such a different way from our hunter/gatherer nomadic or agrarian ancestors, and so much has changed with the way food is produced, even in the last few decades. I hope through this series that you appreciate some of the complexities of food, and rather than approaching it with fear, this emboldens and empowers you with more knowledge to make the best decisions for your life, and those you love.