Food intolerance vs Allergies we all have this familiar experience at some point in our life: we eat something new, we experience symptoms like bloating, nausea, itching, sometimes even vomiting up. Then comes the panic—this is a food allergy reaction, it is getting worse, I need medical attention. But then in some cases, it subsides and you are fine again; a visit to the doctor and the episode is termed as a food allergy. These two conditions may feel very similar, but are in fact quite different: while food intolerance at the max causes discomfort, food allergies can result in fatal reactions within minutes. Thus, it is important to understand these conditions so decisions can be taken in a timely manner. So, food intolerance vs food allergy: learn what is affecting your gut.

Firstly, why the confusion between food tolerance versus food allergy?

It is simpler than we thought—many of the symptoms overlap in both cases. For example, both can cause stomach upset, nausea, pains. However, the underlying mechanisms are very different. Adding to the confusion, conditions like the celiac disease do not fit neatly into either category. Celiac disease is an autoimmune disorder triggered by gluten, but it is not the same as a wheat allergy or gluten intolerance. So let us understand these two conditions in detail to understand what is affecting your gut.

Food intolerance

Food intolerance is majorly caused by an inability of the digestive system to process certain types of foods—unlike the food allergy which mainly involves the immune system. This happens mainly due to deficiency in certain digestive enzymes or sensitivities to certain chemicals in the food. Symptoms from this condition are often delayed: can happen after hours or even days, and is dose dependent: if you eat more of it, your symptoms are immediate and worse.

Food intolerance symptoms include

1. Bloating and gassy feeling
2. Stomach cramps and pain
3. Diarrhoea or constipation
4. Headaches
5. Fatigue

Some common examples often heard are:

Lactose intolerance: lack of the lactase enzyme which results in an inability to digest the sugars in milk.

Fructose malabsorption: inability to absorb fruit sugars due to a lack of certain proteins in the body.

Chemical sensitivities like:

Gluten sensitivity (non-immune reaction to gluten in wheat etc),

Food additive sensitivities (intolerance to certain preservatives and taste enhancers such as MSG),

Histamine intolerance: inability to break down histamine found in aged cheese, alcohol, and smoked meats,

Caffeine sensitivity causing rapid heartbeats, anxiety, and restlessness.

These symptoms can often be handled by yourself using OTC painkillers, antacids, antidiarrheals and other home remedies (having jeera water, ajwain water, adding asafoetida in the diet) along with monitoring and avoiding the foods which cause it. Medically, supplementation with enzymes can also help.

Food allergies

Unlike food intolerances, allergies often are severe and always involve the immune system. Your body would misrecognize a harmless food type as a foreign invader and attack it like it would for pathogens such as viruses and bacteria. Most of these food types contain certain molecules known as allergens in them which triggers the reactions. Even microscopic amounts of these food allergens activate an antibody (Immunoglobulin type E) resulting in release of the chemical histamine which affects the skin, heart, and lungs majorly causing reactions such as hives, lung inflammation and breathlessness, throat swelling etc.

Thus, when it is food intolerances vs food allergies, allergies can happen immediately, even with trace amounts of the triggering allergen often resulting in exponentially fatal reaction within minutes.

Symptoms of food allergies are:

1. Hives (itchy and bumpy rashes on skin)
2. Watery eyes
3. Swelling of tongue, lips, throat, and airways resulting in an inability to breathe (anaphylaxis)
4. Rapid heartbeats
5. Nausea and vomiting
6. Bloating and stomach pain
7. Headaches
8. Fatigue and fainting

Most common food allergens include:

• Tree nuts like cashews, walnuts, almonds
• Soy
• Shellfish and certain sea food like prawns
• Wheat
• Milk
• Eggs

Due to its mechanism and severe effects, food allergies often require to be medically diagnosed for the specific allergen. They usually do it with skin prick test, blood test or even eating the trigger food in front of a doctor to identify the allergen. Once this is done, the person would need to strictly eliminate this allergen from the diet usually for a lifetime. The most common treatment for this is injection with a specific chemical called epinephrine which stops the reaction almost immediately.

Here is a small table as a quick reference to help you understand about the differences between food intolerance vs food allergy:

What is affecting your gut ?

Take home points:

It is quite common to get confused between food intolerance vs food allergies: which is affecting your gut, specially when many symptoms overlap between the two. However, by focusing on the most distinguishing symptom—the time between eating the food and beginning of the symptoms, one can easily take proper decisions to avail medical help or not. Remember: immediate symptoms experienced-immediate action required; if breathlessness, bloating, vomiting are immediate, you are most likely experiencing allergy and need medical attention. Symptoms occurring later would most likely be due to intolerances and do not involve breathlessness.

However, all being said and done, only a medically certified gastroenterologist can tell with a cent percent accuracy if food intolerance or food allergy: what is affecting your gut. It is always best to err on the side of caution if you are experiencing any of the symptoms after eating a food type. At Smiles Gastroenterology, Bengaluru, our doctors help you with accuracy with the state-of-the-art knowledge and testing systems in place. No symptom listed above is dismissible when it comes to your health and well-being. Come to us right away and leave with a confident smile.