Let’s start by looking at some examples of food intolerance.
There are two very good examples, one of which everyone has heard of, and the other, most are familiar with as well.
Let’s first consider lactose intolerance.
Lactose intolerance is well understood to be a deficiency in the enzyme needed to digest lactose. Lactose is a sugar in milk. If you don’t produce enough of the enzyme, called lactase, then you can’ t digest lactose and you end up with gas, bloating, and abdominal discomfort when you ingest milk products. It’s about as simple as that. You can buy lactose-free milk, and you will be fine. You can also buy the enzyme and take it with your food, and it will help you digest milk products and you’ll be fine.
Note however that lactose intolerance has nothing to do with the immune system. It doesn’t produce inflammation. It doesn’t cause any real damage. It’s definitely not life threatening. It’s just very uncomfortable and perhaps embarrassing.
Now let’s turn to the second example, gluten intolerance. Gluten intolerance does not involve an enzyme deficiency. Gluten intolerance is an immune reaction. And in the case of celiac disease it results in an autoimmune reaction. Antibody production is also involved, but these are not the IgE antibodies we noted when discussing the traditional view of allergy. These are IgA and IgG antibodies.
Gluten intolerance also involves other parts of the immune system beyond these antibodies. As you may already know, gluten intolerance is connected to hundreds of different symptoms. You can have digestive problems, skin problems, neurological problems, psychological problems, weight problems, etc. This list goes on and on.
As you can now can the use of the word ‘intolerance’ in lactose intolerance is something completely different than the use of ‘intolerance’ in gluten intolerance. You have probably already guessed it, but there is no scientific definition for the word intolerance. It means the same thing in this context as it does anywhere else in the English language. It’s just a very broad word that means that things aren’t working out well.
This is a big problem. And I am very sensitive to this. (Or is that intolerant of it?) If the word doesn’t really mean anything, or the medical system uses it in two very different ways, then people will get confused. And that is part of the reason that many people, including many doctors, don’t appreciate the significance of gluten intolerance – because they equate it to lactose intolerance.
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Dr. Wangen is the founder and medical director of the IBS Treatment Center, the award winning author of two books, and a nationally recognized speaker on digestive disorders. He has been on ABC, NBC, and Fox as well as public radio, and was named one of Seattle’s Top Doctors by Seattle Magazine.