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Got Stomach Problems? It Could Be Your Diet

March 7, 2018 4:00 PM with Dr. Jeffrey Nathanson

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Do you find yourself getting bloated after enjoying your favorite dairy treat? Do baked goods give you hours of stomach pains? Like 20% of Americans, you may be experiencing food intolerances, which are chronic symptoms triggered by particular foods. These intolerances, such as celiac disease and lactose intolerance, are the result of digestive issues which many may not know they have. Dr. Jeffrey Nathanson, NorthShore Gastroenterologist  will be taking your questions about food intolerances, how they differ from food allergies, how they relate to your digestive health and what you can do about them.

Kathryn (Moderator) - 4:00 PM:
Our chat on food intolerances is now open. You can submit questions at any time during our chat.

Dr. Jeffrey Nathanson (NorthShore) - 4:00 PM:
Hello. I wanted to introduce myself. My name is Jeff Nathanson and I am a Gastroenterologist at NorthShore University HealthSystem, located in Highland Park. Food intolerances are something I hear about from patients very commonly, and today, I'm hoping to address this topic and answer your questions.

  Olivia (Evanston, IL) - 4:01 PM:
I did a test for celiac disease, which came back negative, but the elimination diet found that I have a gluten sensitivity. Does that mean I have to avoid gluten at all times, or can I eat it occasionally?
Dr. Jeffrey Nathanson (NorthShore)

Excellent question, and one that comes up all the time.

If you had a reliable test for celiac (either a blood test or a biopsy of the small intestine at the time of an endoscopy), then you almost certainly don't have celiac. That's good news! You don't need to worry that if you ingest gluten (which by the way is in wheat, rye and barley) your immune system is going to react and that you could potentially develop some more serious issues, i.e. malabsorption of nutrients, or other autoimmune conditions.

However; a lot of people have a hard time digesting gluten. They may get bloating, or discomfort, or bowel changes, but that's it. Nothing worse. You can certainly try to avoid gluten to avoid these symptoms. However; if you do ingest gluten (either accidentally or on purpose because that piece of cake looked really good!), the worst that's going to occur is that you get some GI upset.

  Katherine (Evanston, IL) - 4:08 PM:
Is there a downside to following a gluten-free diet for someone who has a mild sensitivity to gluten?
Dr. Jeffrey Nathanson (NorthShore)
Again, if we are talking about gluten intolerance (rather than celiac disease), there is no downside, other than you not being able to enjoy these foods. However; if avoiding gluten allows you to avoid the GI symptoms that have been so problematic, then it may very well be worth it.

  Elizabeth (Evanston, IL) - 4:12 PM:
My question is how quickly after eating can a food intolerance issue arise? I have a problem in which I eat eggs, and sometimes within a minute or so, I feel like I have to stop or I may vomit. I can tolerate eggs if it's just an ingredient (like in baked goods). It makes me wonder if this is true intolerance, or maybe the whole thing is just in my head.
Dr. Jeffrey Nathanson (NorthShore)
That's interesting. First, to clarify an important point, you don't have a food allergy. Food allergies are adverse reactions to foods due to the immune system reacting to it abnormally. Some food allergies can be very serious, even life-threatening (IgE-mediated food allergies). This is the classic example of someone with a peanut allergy who has trouble breathing with even minimal ingestion. What you have is a type of food intolerance. The fact that you are okay with eggs as an ingredient suggests to me that the eggs alone likely trigger some reflux in your stomach, which can then trigger the vomiting. When ingested with other ingredients though, the stomach response is muted and not an issue.

  Mimi (Gurnee, IL) - 4:18 PM:
Is constant bloating a sign of a serious digestive problem?
Dr. Jeffrey Nathanson (NorthShore)
Good question. Bloating is extremely common. The most common causes are constipation or excessive intake of gas forming foods (i.e. roughage in the diet). There are occasionally other causes which can be rarely serious. If they are any other "red flag" symptoms (i.e. weight loss, vomiting, fevers, significant pain), you should definitely see a doctor. Also, if you are above age 40 and this is new, you should discuss with your doctor. Otherwise, it would be reasonable to back down on the roughage in the diet (raw veggies, fruits with skins) and maybe take a gentle OTC laxative that is safe such as Miralax for a couple of weeks and see if symptoms resolve. If not, then yes, you should discuss with your doctor, but most of the time it is not serious.

  Hyka (Wildwood, IL) - 4:22 PM:
My husband gives me a protein shake every morning and I feel some abdominal discomfort after drinking this breakfast meal. Could this be because of an intolerance? How can I find out?
Dr. Jeffrey Nathanson (NorthShore)
I often hear patients complain that protein shakes cause abdominal discomfort. Sometimes the protein load can be a little hard to digest. Plus often there may be other ingredients that can difficult to digest and can be gas forming due to their fermentability (i.e. green shakes). Also, if its made in a mixer, the air bubbles that you ingest can contribute to bloating discomfort. Furthermore, if you drink it through a straw, that's more air that you are swallowing that can also compound these symptoms. Keep it simple - try a different protein, minimize other ingredients, and don't drink thru a straw. See if that helps.

  Lisa (Evanston IL) - 4:24 PM:
I know that I am sensitive to gluten but do not have Celiac. I choose to eat gluten free. I am at higher risk of developing Celiac later in life? Thanks for your time.
Dr. Jeffrey Nathanson (NorthShore)
If you do not have celiac, and you choose to avoid gluten, that does not increase your risk of celiac disease in the future. There is actually a genetic test that can assess your risk for celiac. The genes for celiac are carried by 1/3 of the population. If you get tested, and you do NOT have this gene, then you have zero risk of celiac now or in the future. If you happen to carry the gene, as 1/3 of the population does, most will never get celiac. But there is a small chance.

  Jennifer (Chicago, IL) - 4:27 PM:
Is there a natural way to treat acid reflux caused by intolerances?
Dr. Jeffrey Nathanson (NorthShore)
Reflux is when stomach juices and/or gas come up from the stomach into the esophagus. Acid is the most caustic of stomach juices. Foods that increased acid reflux include spicy, greasy, chocolate, caffeine, alcohol, peppermint, and citrus. However, I hear people all the time complain that a particular food may cause reflux. Certainly avoiding that food is the first option. Chewing gum Even more important than particular foods, though, overeating and eating close to bed are BIG triggers. Smaller portions, staying upright after eating, not eating within 3 hours of bed, and keeping your head a bit elevated at night can all help.

  K (Evanston, IL) - 4:35 PM:
Almond milk and soy milk give me severe stomach pains. Does this mean I have an intolerance to all kinds of milk? Do I have other options?
Dr. Jeffrey Nathanson (NorthShore)
Are you intolerant to cow's milk too? There is a slight increased risk of soy allergy in patient's with allergy to cow's milk. I'm not aware any overlap with almond milk though. If you have intolerance to dairy, then there is the option of taking lactaid before dairy ingestion- a pill that contains lactase, the enzyme that patients with lactose intolerance are relatively deficient in. However, this is different from your issue.

  Leila (Wilmette, IL) - 4:38 PM:
Is there a way to test for intolerances, kind of like what's done now with allergy tests?
Dr. Jeffrey Nathanson (NorthShore)
Lactose intolerance can be tested for with a breath test. However, sometimes there can be false positives. There's also a genetic test that picks up some, but not all, patients with deficiency of the lactase enzyme. Because both these tests have limitations, we often don't perform them. If the story fits - if you eat above a certain threshold of dairy, you get bloating, crampy, gas, and diarrhea - we say you have lactose intolerance. As for other food intolerances, with the exception nof a few other genetically defined deficiencies (such as G6PD deficiency), there are no tests.

  Jen (Evanston, IL) - 4:41 PM:
What intolerances are most common? I know a lot of people with lactose intolerance, but don't really hear about much else.
Dr. Jeffrey Nathanson (NorthShore)
Carbohydrate intolerance - specifically short chain fermentable carbohydrates - contribute to a lot of GI symptoms, in particular in patients in whom we label as having "irritable bowel syndrome". These foods include wheat, rye, barley, onion, leek, garlic, artichokes, peas, legumes, dairy, apples, pears, cherries, peaches asparagus, honey, high fructose corn syrup, watermelon, mushrooms, and cauliflower. Studies have shown that the FODMAPs diet (acronym for Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols) can help some of these patients. But a warning: it is a very difficult to follow and, in my experience, often only provides partil relief of symptoms

  Shelly (Skokie, IL) - 4:45 PM:
What makes an intolerance different from an allergy? Is how they're treated similar?
Dr. Jeffrey Nathanson (NorthShore)
Food allergies affect approximately 5% of the population, involve the immune system, can be triggered by even tiny amounts of ingested food, and can cause serious, even life threatening reactions. These foods need to be strictly avoided and you need to be under the care of an allergies. Food intolerance affects 20% of the population, do not involve the immune system, and are due to difficulties in digesting and metabolizing food. The amount of food ingested is often directly related to the severity f the symptoms, and symptoms are often (although not always) limited to the GI tract.

  Barb (Highland Park, IL) - 4:50 PM:
I recently was diagnosed with lactose intolerance, and I'm not sure where to start when it comes to diet changes. I feel really overwhelmed. Is there a specialist I can go to for diet guidance?
Dr. Jeffrey Nathanson (NorthShore)
It may be a good idea for you to see a certified dietician to help you adjust. Generally speaking, you should avoid dairy. Often, individuals can eat small amounts and be ok(particularly of yogurt or hard cheese; creams and milk are generally more likely to trigger symptoms at a lower threshold. There is also the option of taking Lactaid which I mentioned early. It is a pill that contains the digestive enzyme lactase which you are deficient in.

  Kelly (IL) - 4:53 PM:
Why is it that celiac disease seems to be so talked about now? Was it just thought to be a stomach problem before?
Dr. Jeffrey Nathanson (NorthShore)
That is an interesting question. Celiac disease was first recognized after World War II. For years, it was thought to be a condition affecting only children and one really only thought about when children had severe issues of malnutrition and poor growth. More recently, it has been recognized that celiac can affect adults of any age too and that is manifestations are extremely varied. A significant number of patients with celiac don't have GI symptoms but rather other issues related to malabsorption such as osteoporosis or anemia. So doctors are thinking about it a lot more in a lot of different situations. In addition, our tests have become a lot better. The newest generation of celiac blood tests pick up >90% of celiac cases. Finally, and I think coincidentally, gluten free diet has become extremely popular. This has had the side benefit of increasing awareness of celiac, although sometimes has led to self-diagnosed celiac, which is an issue.

Kathryn (Moderator) - 5:00 PM:
This will be the end of our chat. Thank you for all of your questions. If you would like to find out more about food intolerances or schedule an appointment with a GI specialist like Dr. Nathanson, contact the Department of Gastroenterology

Jeffrey Nathanson - 5:00 PM:
Thank you for sharing all of your interesting questions. I think food intolerances is a source of confusion for a lot of patients (and even health care practitioners!). I hope my answers helped provide some clarity.

This chat has ended.

Thank you very much for your participation.