Predictably, Dr Guido Basilisco’s assertion that the majority of those who think they are suffering from lactose intolerance are actually suffering ‘altered somatization’ (they do have the symptoms but they are not caused by the disease) has spawned the usual rash of the ‘we keep telling you that food intolerance is all in the mind’ articles. (The Daily Mail on May 10th, The Times Weekend on the 14th and no doubt several more.)
Dr Basilisco, a researcher in the gastroenterology unit at IRCCS-Ca Granda, in Milan, evaluated 102 patients, 77 of them female, for lactose intolerance and for anxiety and depression. When given a breath test only 29% and 33% respectively of the patients were identified as lactose intolerant or lactose malabsorbers. However, when he looked at the figures for those patients who were anxious and/or depressed, four times as many of them reported lactose intolerance symptoms than among the non-anxious/depressed group. Dr Basilisco presented his findings at Chicago’s recent Digestive Disease Week.
‘Altered somatization’ is a medically recognised condition: ‘a process by which psychologic distress is ‘converted’ into physical symptoms. Somatization is an unconscious process.’ But while useful in terms of classification of the condition the definition is little help in understanding it.
Conventional medicine excels in specialisation: a neck specialist cannot deal with a shoulder problem, a gastroenterolgist has no expertise in kidney disease; an asthma doctor is no help with an eczematous condition even thought both asthma and eczema may be have been triggered by similar allergic reactions. Yet necks and shoulders, stomach and kidneys, lungs and skin are all served by the same blood supply, the same nerve pathways and are all integrally linked to their owner who may, or may not, be feeling anxious or depressed for any one of a thousand reasons. When so closely linked to each other, how can the health of one not affect the health of the others? And why should not mental or emotional distress not cause physical distress or pain in exactly the same way as an ongoing physical pain can cause mental distress, anxiety and depression?
Food intolerance is a loose term with no exact medical definition. All it suggests is that the ingestion of certain foods can cause some sort of short term or ongoing physical or mental discomfort which sometimes appears to be relieved by removing that food from the diet. What is almost always true, but rarely spelled out, is that the vast majority of people who believe that they have a food intolerance are also eating a diet far too heavily reliant on processed foods with a poor nutritional profile, getting far too little exercise, probably, drinking too much alcohol – and are stressed, anxious, often depressed.
Given that the digestive system is the most closely linked to our mental and emotional systems, it seems reasonable to assume that its efficiency would be the first to be impacted by mental or emotional distress. If its owner were anxious or depressed, it might struggle to perform its basic role of breaking down what we eat, assimilating nutrition from it and then expelling the waste – and that its struggle might be manifested in the digestive symptoms complained of by many who believe that they have a food intolerance.
Removing the food that is proving hard for the digestion to process may relieve the symptoms, and thereby the reduce extra physical and mental stress caused by them, but it will not solve the problem. This will only be solved by addressing the underlying physical and mental health of the person concerned.
We all know that genuine ‘food allergy’ (an immune system reaction to a specific food) is relatively rare – well under 10% of the population depending on whose figures believe, but it is profoundly unhelpful to confuse food allergy with the ill defined and hazy state of being that is general defined as ‘food intolerance’.
However, there are other forces at work here.
The foods most usually accused of causing ‘food intolerance’ and therefore most often excluded from the diet are dairy products and wheat/gluten. And never do you read an article about food intolerance in which the mantras of ‘endangering one’s health by shunning crucial groups of nutrients’ are not trotted out. (See both the Mail and the Times articles mentioned above.) But…
Ostoeporosis – inevitable, we are told, if you do not eat enough dairy products and thereby absorb enough calcium.
But… Osteoporosis is unknown in the animal world where all infants stop drinking milk as soon as they are weaned, and was unknown in the Far East (China, Japan, Singapore etc) until they adopted a Western diet high in dairy products. Green leafy vegetables, fish with bones, nuts, seeds, pulses, eggs, seaweeds all provide excellent sources of calcium all more easily absorbed by the body, because of their calcium to magnesium ratios, than the calcium to be found in dairy products.
But… The dairy industry is massive – and to remain so it needs us to continue to drink milk and eat yogurt, and cheese, and cream, and ice cream – in quantity….
Gluten – a hugely useful ingredient in food manufacture as it, literally, glues ingredients together. So useful that a great deal of effort and research has gone into breeding wheat with higher gluten content which is used very widely in the food industry in both the UK and the US. But glue is glue – and while useful and harmless in relatively small quantities, the very large quantities consumed by someone eating a diet high in wheat-based processed foods can cause serious digestive problems.
(If you want to look at the other side of this particular picture see the article in yesterday’s Independent about Novac Djokovic’s spectacular sporting success and fitness which he attributes at least partially to his gluten-free diet and to an article we ran last year about the Garmin-Transitions pro cycling team.)
Yes, wheat (well, wholewheat at any rate) is a nutritious product containing lots of B vitamins. But so are a whole range of other grain, pulse and nut based flours – which have just as many, often more, nutrients than wheat but far less, if any, less gluten. But just as there are massive vested interests in the dairy industry, so are there in the wheat-growing and baking industries, whose pockets would be hard hit by a wide spread shunning of high-gluten, highly processed wheat based foods.
So, take with a large spoonful of salt those worthy protestations about ‘endangering one’s health by shunning vital food groups’. Of course you must be careful to continue to eat a wide variety of different foods with good nutritional profiles, but if you never ate another slice of wheaten bread and never drank another glass of milk, your health is more likely to benefit than to suffer.