Ac­count­ing for food al­lergy

New Haven Register (New Haven, CT) - - NEWS - DR. DAVID KATZ Dr. David L. Katz Au­thor, The Truth about Food

A re­cent pa­per in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion on the preva­lence of food al­ler­gies in the U.S. spawned head­lines in op­pos­ing di­rec­tions.

Some me­dia out­lets em­pha­sized that many fewer peo­ple have food al­ler­gies than be­lieve they do, and thus im­plied that the prob­lem has been ex­ag­ger­ated. Oth­ers noted that the num­bers af­fected — nearly 11 per­cent of the sur­veyed sam­ple of 40,000 adults in­tended to re­flect the gen­eral pop­u­la­tion — were high just the same.

I side with the lat­ter.

An al­ler­gic re­ac­tion to food af­fect­ing more than one in 10 of us is a sub­stan­tial pub­lic health prob­lem, not di­min­ished in my view by the fact that al­most twice as many thought they had food al­ler­gies. And quite frankly, they may be right — be­cause the study was lim­ited to a short, strin­gent set of spe­cific al­ler­gic re­sponses — in­clud­ing such en­tries as hives, tongue swelling, trou­ble breath­ing and vom­it­ing.

Of those re­port­ing food al­ler­gies that did meet the re­searchers’ cri­te­ria, al­most 40 per­cent re­ported at least one emer­gency depart­ment visit as a re­sult. This is an alarm­ingly high num­ber: roughly one in 10 of us re­ports a food al­lergy po­ten­tially se­vere enough to war­rant a trip to an emer­gency depart­ment, and of this group, four in 10 wind up mak­ing such a trip.

I’m im­pressed. If we add in­tol­er­ances to overt al­ler­gies — in­tol­er­ances of lac­tose, lectins, gluten, FODMAPS, etc. — the num­bers af­fected go up sub­stan­tially. If we al­low for the less dis­crete symp­toms some food sen­si­tiv­i­ties in­duce — from bloat­ing to brain fog — the num­bers go up sub­stan­tially. Add them all up, and this is a bona fide cri­sis of pub­lic health nutri­tion and mod­ern epi­demi­ol­ogy. Food is sup­posed to nour­ish and sus­tain us — not trig­ger the im­mune sys­tem like a bee sting or poi­son ivy.

Why is this prob­lem so preva­lent? There is no sin­gle, de­fin­i­tive an­swer — but there are some rather ob­vi­ous and widely ac­knowl­edged ex­pla­na­tions. They come in two ba­sic fla­vors: what we are do­ing to our food and what we are do­ing to our­selves.

Re­gard­ing food, we have al­tered it rad­i­cally and cu­mu­la­tively over re­cent decades. The specifics in­clude the rou­tine sub­sti­tu­tion of for­mula for the first, best, na­tive food for Homo sapiens like other mam­mals: breast milk.

They in­clude food chem­i­cals, such as ar­ti­fi­cial fla­vo­rants, ar­ti­fi­cial col­orants, preser­va­tives, mis­cel­la­neous ad­di­tives (of­ten as tex­tur­iz­ers), sugar sub­sti­tutes and more. They also in­clude trace, or maybe at times not so trace, amounts of her­bi­cides, pes­ti­cides, hor­mones and an­tibi­otics.

They in­clude novel com­bi­na­tions of com­pounds that don’t oc­cur in na­ture; some­times it is com­pounds in com­bi­na­tion rather than in iso­la­tion that trig­ger the im­mune sys­tem to strike back. They in­clude ge­net­i­cally mod­i­fied food prod­ucts

as well. While ge­netic mod­i­fi­ca­tion can be use­ful and safe, it is none­the­less sub­ject to the law of un­in­tended con­se­quences. If novel pro­teins, for in­stance, are in­tro­duced into foods — new al­ler­gies and in­tol­er­ances are likely to re­sult.

Re­gard­ing our­selves, our var­i­ous im­mune re­ac­tions to food re­late to both the health and bal­ance of our im­mune re­sponses in gen­eral, and the in­tegrity of gas­troin­testi­nal lin­ing.

Stress and sleep de­pri­va­tion are gen­er­ally in­flam­ma­tory. Im­por­tantly, mod­ern di­ets tend to be in­flam­ma­tory due to ex­cesses of sat­u­rated fat, re­fined car­bo­hy­drate, added sugar and per­haps to a lesser ex­tent, omega-6 fats, along with rel­a­tive de­fi­cien­cies of omega-3 fats, fiber and di­verse an­tiox­i­dants from plant foods. This cre­ates an ob­vi­ous feed­back loop: in­flam­ma­tory mod­ern di­ets heighten im­mune sys­tem re­sponses, in­clud­ing to com­pounds de­liv­ered by that very diet.

Dis­tur­bances di­rectly af­fect­ing the gas­troin­testi­nal lin­ing may be of even greater con­cern. In­flam­ma­tion of the gas­troin­testi­nal tract re­sult­ing from var­i­ous sen­si­tiv­i­ties can cause so­called “leaky gut” which in­creases the like­li­hood of height­ened im­mune re­sponses to com­pounds in food. Mod­ern liv­ing and the mod­ern diet are known to dam­age the mi­cro­biome, which is a key con­trib­u­tor to our healthy diges­tion.

Gen­er­ally, the only safe ap­proach to an es­tab­lished, se­vere al­lergy is avoid­ance. But view­ing the prob­lem more gen­er­ally and with pre­ven­tion in mind, the trig­ger­ing faults lie within our mod­ern food sup­ply and within our bod­ies. We have means at our dis­posal to ame­lio­rate both be­gin­ning with: eat­ing gen­uinely whole­some foods, in sen­si­ble, bal­anced as­sem­blies. It’s never too late, nor too early, to start.

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