by Dr. Josy Hoff

It’s been said that “food is love.”  Over meals we reconnect with old friends and make new ones. Many of us hold on to warm memories of a loved one cooking or baking some special treat. When we find ourselves far from home on a holiday, our memories often drift back to the kitchen and many cherished sights, tastes, and smells of home. The foods and meals we eat aren’t just nutrition—for many, food brings to mind some of the most evocative memories and feelings that we will ever have.  

Of course, most of us also have some memories involving foods that we’d rather forget. The reality is that there are certain foods that pose risks to health and well-being for some people. While there are many foods that aren’t healthy or need to be reserved as a special treat,  others are more urgent, and for some people, cause intolerances and allergies.

Most everyone will experience a reaction to some foods in their lifetime. Not all of these are allergies, however. They may be food intolerances. In fact, doctors believe that the vast majority of food allergies reported by patients are actually food intolerances.   

A food allergy occurs when your body’s immune system launches an immune response against a food, while a food intolerance does not.     

It can be difficult to tell the difference, because many people have similar symptoms with both allergies and intolerances, such as abdominal pain, diarrhea, gas, or nausea.  

If you have a food intolerance, the symptoms may come on gradually after eating the food, or it may only happen some of the time you eat the food, or only if you eat a very large amount of it at one sitting. The classic example of a food intolerance is lactose intolerance with dairy products. People with a lactose intolerance simply lack the enzyme to digest a sugar (lactose) found in milk and can find some relief with medication. Food intolerances are inconvenient and at times very uncomfortable but fortunately are not life threatening.

Food allergy symptoms usually start very suddenly, are very strong, and will happen every time a food is eaten. These can be life threatening situations. Some possible symptoms include hives, rash, or shortness of breath. If you experience these symptoms, you must seek treatment immediately.  A classic example of this that we hear about in the news is life-threatening peanut allergies.

The U.S. Food and Drug Administration lists eight different foods that are responsible for 90 percent of true food allergies: milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. Do you have a reaction to a food not on the list?  It may still be an allergy but is more likely an intolerance.

How can you and your doctor tell the difference between an allergy and an intolerance? Allergy testing can be a possibility, and keeping a written log of the foods that cause your symptoms can be immensely helpful. You can also try to stop eating one possible problem food at a time to find the culprit.

Why is this important? For your own safety, it’s good to know whether you have a true allergy or an intolerance. If you have a true allergy, then it’s critical that you stop eating the food and have access to medications to combat reactions, but with an intolerance there may be a way to still enjoy the food in smaller amounts or by eating it less often.   

Dr. Josy Hoff is a third year family medi- cine resident at the UND Center for Family Medicine.