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Food Allergy vs Intolerance vs Sensitivity: What You Need to Know

April 3rd, 2018 | 2 min. read

By Mark Petrizzi, M.D.


Gluten sensitivity, peanut allergies, lactose intolerance—we encounter phrases and buzzwords like these every day, but what do they mean exactly?

It's time to demystify food allergies vs sensitivities vs intolerance.

What is a food allergy?        

An allergy is literally an immune system response to the food. So if you have a food you're allergic to like peanuts, you have a physical, immune response, such as hives, tightening of the throat, or vomiting. That's an allergy.

What is a food sensitivity?

A food sensitivity or food intolerance involves the digestive system, rather than the immune system. For example, in regards to food sensitivity, if someone eats tomatoes and experiences heartburn, that's a food sensitivity, not an allergy.

Food intolerance falls in between the two spectrums.

For example, someone might say they're gluten intolerant, yet they don't have celiac disease. While they do have a biological response to the gluten, it doesn't make them sick in the same way it does with someone who has celiac disease. That's intolerance.

When it comes to lactose intolerance, it's a bit different: you don't have enough of the proper enzyme, lactase, to digest the lactose. Ten percent of the adult population (and it's probably a lot more than that) loses the enzyme to digest milk after infancy. You lose lactase. You can't digest milk, so if you eat lactose, it sits in the gut and ferments. So that's food intolerance due to a biological deficiency of something else that helps digest the food. It's not an allergy. You're missing an enzyme to break it down.

Some foods result in certain "mechanical" reactions that are perfectly normal.

Eating cabbage or beans, for example, will often produce gas. That's not a true sensitivity or an allergy. It's just a mechanical response to the food itself as you digest it.

Testing for food allergies, sensitivities, and intolerances.

If you suspect you have a food allergy, sensitivity, or intolerance, the best thing you can do is talk to your doctor. Allergy tests can help uncover true allergies (and not just to foods, but other things, such as metals, for example).

Elimination diets can help point to food sensitivity or intolerance. At its simplest, if you suspect a certain type of food is causing you discomfort—say you experience heartburn after eating tomatoes—try giving up tomatoes for a month and seeing how you feel.

Keeping a food journal is a good practice if you suspect a certain food or type of food (e.g. highly acidic foods). Then, you can share this info with your doctor as well. When dealing with potential allergies, your primary care physician might refer you to an allergist.

It's important to note that sometimes the reverse happens: a patient might come in with certain symptoms, such as fatigue or bloating. Once we rule out other potential issues, we might discuss food sensitivity and discover that a particular food is the culprit.

Saying goodbye to certain foods.

Giving up a favorite food can be tough, but once you try it for a month or so—and you realize how much better you feel—it becomes a little easier to let go.

Health coaches can be a great resource and support system as well—especially for complicated diagnoses. For example, getting a diagnosis of celiac disease can feel overwhelming at first, but between your physician and a good health coach, you can learn to navigate successfully.

Bottom line: when it comes to anything related to your health, talk to your doctor. That's why we're here.

At PartnerMD, we endeavor to become true partners in your overall wellness. Learn more.

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Mark Petrizzi, M.D.

As a board-certified family medicine physician at PartnerMD in Short Pump, VA, Dr. Mark Petrizzi went into family practice to treat his patients like family. For over 20 years as a board-certified family medicine and concierge doctor, Dr. Petrizzi has focused on providing holistic, preventive care to patients ages six and up. He enjoys being a part of your life and your journey to better health.