What’s on the menu for your dinner party? You’ve invited a few friends over for steaks on the barbecue, a tossed green salad, and maybe some spaghetti squash from the garden. Easy, right?

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Well, what if you’re unsure of the friends of your friends coming along? Do they have dietary restrictions and food allergies? All of a sudden there’s a wrinkle in your meal  plan. You may need to prepare alternatives. But which ones? What’s Plan B for the lactose-intolerant, gluten and soy free eater?

In the last decade or so, food allergies have dominated the health pages and medical websites. Bread and butter at the table is not a foregone conclusion anymore. The number of gluten intolerants grows daily.

Why now? Are food allergies growing? Or are they merely a byproduct of the Internet’s information access by weight loss seekers and celebrity diet plan devotees? When Miley Cyrus lost all that weight after she went gluten-free in 2012,  many of her fans followed suit.

So Are Food Allergies Real or Imagined?

Food allergies are not fads. Real ones are deadly serious. How do you know if you have allergies, intolerances, sensitivities, or mere reactions? It’s important to know the differences.

Allergies

Allergies are not only products but byproducts of the immune system, causing serious reactions, such as rashes, vomiting, swelling, hives, wheezing, stuffy or runny nose, and at its most life-threatening, anaphylaxis, which is characterized by constricted breath, tongue-swelling, and dizziness: food allergies kill 150-200 people each year.

Symptoms occur almost immediately after ingesting the offending food. Certain proteins in food trigger reactions, and once they’re introduced into the body, the immune system releases histamines to ward off what it detects as harmful invaders. In their mad dash to get rid of the poisonous proteins, histamines cause sneezing or other reactions to eject the perceived foreign matter.

Approximately  0.2 to 1% of adults and 2-3% of children under one year suffer allergies, such as  milk allergies, primarily cow’s milk. Though various allergy tests existblood, kinesiological, and other tests50-75% of food allergy blood tests yield false positives so that too many patients restrict their diets unnecessarily.

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The big eight allergens include milk, eggs, peanuts, tree nuts, wheat, soy, fish, and shellfish, which account for 90% of U.S. food allergies. Other common allergy producers are buckwheat, mustard, celery, and sesame. Many of these allergens hide in foods as substitutes or processed foods, triggering allergic reactions (soy lecithin in chocolate, for example). Unlike other countries, the U.S. doesn’t mandate allergen labeling.

Celiac Disease Versus Allergy

If you have celiac disease, your auto immune system causes the body to produce antibodies that attack gluten but also the gut and its ability to absorb nutrients, creating a malnutrition risk. Symptoms include stomach cramps, diarrhea, bloating, anemia, fatigue, and calcium deficiency, which manifest after a couple of days. 1% of the population has this lifelong disease.

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Celiac disease is an immunological disorder, just like allergies. However, antibodies produced by allergies cause immediate allergic reactions, whereas with celiac disease, which is the inability to absorb gluten, symptoms appear gradually. Even more than allergy sufferers, those with Celiac disease are prone to contracting other autoimmune diseases, like thyroid disease.

Food Intolerance or Metabolic Food Disorder

Intolerances are genetic defects, not immunological disorders. Those with metabolic food disorders lack an enzyme needed to digest specific foods. Take lactose intolerance, for instance. Those who suffer from bloating, diarrhea or other digestion problems after ingesting cow’s milk or milk products lack the enzyme to digest lactose or disaccharide, the sugar in milk products. And those with favism, whose reactions include fever, chills, or nausea, are missing an enzyme in the red blood cells to counter the oxidants in fava beans.   

Food intolerance symptoms don’t appear immediately. It may take days or more to experience the bloating, gas, and abdominal pains. The symptoms are not as severe as allergies or celiac disease, and they don’t leave permanent damage. However, over a prolonged period, food intolerances can impair the small intestine’s ability to absorb nutrients.

Dairy (65% suffer genetic lactose intolerance) and gluten intolerances are on the rise; unfortunately, no reliable tests exist to detect intolerances. Diagnosis and treatment still depend largely on anecdotal evidence and self-diagnosis. Immunoglobulin (IgG) blood tests check for antibodies traced to certain foods, but these tests are also imprecise and often fail to locate the cause of food intolerances.

Food Sensitivity

Many people suffer headaches, indigestion, or acid reflux from spicy foods on occasion. These food reactions are common. However, idiosyncratic reactions, which are adverse reactions with unknown causes, are less common. Typically, food additives, artificial colors, and MSG cause a wide variety of symptoms that are hard to pin down to specific causes.

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Sulfite-induced asthma is the exception. A definite cause and effect relationship of sulfites to symptoms define this sensitivity. Sulfites prevent foods from rotting, turning, or oxidizing, and are both naturally occurring (fermented foods with yeast, for example) and processed. Few people are severely allergic to sulfites, but for those who are, it can be lethal. That’s why manufacturers must label sulfites on all ingestibles.

Though dyes and food coloring have been implicated in manifested symptoms, studies have not confirmed them as food sensitivity culprits. For instance, inconclusive evidence correlates yellow food coloring or Tartrazine with hives and asthma.

Fodmaps

Certain sets of sugars (fermentable oligo, di-saccharides, mono-saccharides and polyols), or fodmaps, pool bacteria in the intestines, causing bloating, gas, and diarrhea. Often foods that contain gluten also contain fodmaps, so it’s hard to tell if gluten or fodmaps cause symptoms attributable to gluten intolerance. Wheat has fodmaps too.

Eliminating fodmaps, such as garlic, onions, and mushrooms (and many more foods) could isolate the cause.

Is the “Free” Movement Healthier?

So how many gluten-free eaters ban wheat, barley, and rye from their diets for weight loss or healthier eating? Just know that while you may lose weight by not eating gluten, you may be defeating your purpose by eating starchy substitutes like potatoes and rice, which are calorie-packed.

And eliminating dairy is risky without an adequate calcium source. Dairy products provide 75% of the calcium in U.S. diets and is especially important for the bones of growing children and postmenopausal women, who have a  greater risk for osteoporosis. In other words, you won’t hurt yourself eliminating gluten, but you might do so by eliminating dairy without a suitable replacement and careful planning.

Most other milks (except for soy), like nut milks, lack the protein, Vitamin D, and calcium of cow’s milk, which are all important in preventing diabetes, heart disease, and colorectal cancer.

Eating healthier is admirable. Once you’ve made the decision to do so, be sure you’re smart about it. Eat a variety of foods to ensure you get all the vital nutrients you need for your health. And while the Internet is a great source for dietary information, don’t rely on it to self-diagnose food allergies. Seek professional help before changing your diet drastically.