The Problem With Self-Diagnosing a Food Intolerance

May 17, 2020

The story usually looks like this: You feel the pressure to get in shape before your upcoming intensive or an important performance. But you know that starting a diet will bring its fair share of critics. Then you see your favorite Instagram star tout the misguided benefits of a #glutenfree lifestyle and voilà! A self-diagnosed gluten intolerance just became your judgment-free ticket to cut carbs.

With an aura of health surrounding diet types like gluten-free, dairy-free and sugar-free “lifestyles,” restrictions have become commonplace—whether one needs them or not. Dr. Alex Schosheim, a pediatric gastroenterologist in Stony Brook, New York, commonly sees patients self-diagnosing intolerances. “There is a lot of misinformation on the internet, and, unfortunately, many patients take to heart what they read,” says Schosheim.

Dancers may be at particular risk. Though dance schools and companies are, more than ever, taking steps to reduce the prevalence of eating disorders among dancers, antiquated body ideals still put pressure on dancers to fit into type-casted roles, pre-fitted costumes and company-wide weight expectations. Dancers may end up blurring the line between social diet norms and disordered eating habits.

They may not even realize that they’re restricting themselves by going, for example, gluten-free. “When looking for quick fixes, one may use impulsive decisions that are not necessarily conscious ones, but, rather, driven by emotion or fear,” says Dr. Rachel Goldman, a New York City–based psychologist. And since talking about diets can be a touchy subject in today’s era of body positivity, masking food restrictions with self-diagnosed intolerances “helps to ease anxiety,” says Goldman.

When do you actually need to restrict what you eat? According to the American Academy of Allergy, Asthma & Immunology, food allergies involve the immune system, while food intolerances or food sensitivities involve the digestive system. If you’re allergic to a food, then it will trigger an allergic reaction (an immune response) as your body releases histamines to fight what it sees as a foreign invader. These histamines are the reason why physical symptoms like rashes, itchy skin and wheezing are common. A food allergy is a serious medical condition that can be life-threatening.

Food intolerances, on the other hand, result if the body has difficulty digesting a certain type of food. For normal digestion to occur, specific enzymes are required to break down food parts. When one or more of these enzymes is MIA, symptoms such as gas, bloating, constipation or diarrhea can arise until the food eventually passes through the gastrointestinal tract.

It’s important to distinguish between true intolerances and culturally influenced food restrictions. If your gluten-free diet looks more like a dodge against bread, then you’ll need to reassess. “If you’re concerned about intolerances, see a gastroenterologist,” says Schosheim.

Self-diagnosing intolerances as a way to avoid certain foods can lead to more severe disordered eating that risks your physical performance and your psychological well-being. You can end up with nutrient deficiencies, be plagued by obsessive thoughts about food and leave yourself unable to partake in social gatherings like cast parties.

Self-prescribing a food restriction can also make it difficult to identify a true intolerance or a more severe medical condition. “Once gluten, as an example, is removed from the diet, then conditions like celiac disease may go unnoticed and therefore cannot be diagnosed,” explains Schosheim. And while it might be tempting to try an at-home food intolerance test, he warns that most are not backed by evidence and may result in false positives.

So what about the bloating you feel after lunch? You can’t always trust your gut on that, either. “Those patients who are self-diagnosing may feel more of a self-imposed placebo effect,” Schosheim says.

And If You Do Need To Restrict:

If you’ve been medically diagnosed with an intolerance or food sensitivity, then you’re likely to be familiar with the unpleasant aftermath. Avoiding the food means that you’re avoiding physical discomfort, which is a plausible reason to say “pass.”

However, this doesn’t have to equate to an overly restricted diet—or lead to disordered eating. Schosheim suggests working with a dietitian who can help construct a balanced meal plan. They can also make sure you’re not using the intolerance as an excuse to cut calories or other foods.

Try Alternatives

Today’s food landscape offers an exceptional supply of alternatives. Dairy-free yogurts and gluten-free breads are widely available. It’s important to remember, however, that unless an intolerance exists, these alternatives are not necessarily healthier than their regular counterparts. Wheat can be a great source of fiber, and dairy supplies bone-building nutrients like calcium and vitamin D. But if your stomach has trouble digesting the real deal, then choosing an alternative is a practical solution to keep your restricted diet inclusive and varied. Digestive-enzyme supplements are another option that can be discussed with your medical provider.

Choose Kinder Thoughts

Avoid an all-or-nothing mindset, which can leave you feeling deprived. “Challenge that thought and change it to something kinder,” says Goldman. Remind yourself why you’re choosing to avoid a certain food. If you experienced discomfort in the past, then Goldman encourages you to swap “I definitely can’t eat X” with “When I eat X, it makes me feel like Y.” This helps to build confidence around your decisions, and build them from a place of self-care.

Find a Tolerable Limit

Unlike people with food allergies, those with medically diagnosed food intolerances can still eat limited quantities of trigger foods. “Even though lactose intolerance is a true intolerance, there is no danger in having lactose,” says Schosheim. “Patients just need to expect some level of bloating, gassiness and/or loose stools when having dairy.” (One important distinction is celiac disease, which is not an intolerance but rather an autoimmune disorder, where you cannot take gluten at all.)

Generally, everyone’s level of intolerance varies, so it’s unreasonable to impose a blanket restriction against any one type of food. “Some people may tolerate pizza, but not a glass of milk, so it’s worth figuring out what is personally tolerable,” says Schosheim. If all your colleagues are enjoying a treat that you like but have a sensitivity to, consider having a taste. Unless you have a food allergy, you can eat it. Perhaps not in large amounts, but just enough that will satisfy your senses