Background: Inaccurate food allergy myths blur the understanding of the critical differences between food allergies and intolerances. We review evidence based approaches to diagnosing and managing food allergies/intolerances, and how to best approach an eating disorder patient who reports food aversions or previously diagnosed food allergies that need to be re-explored.
I. RD – Brief ED summary
- How food allergies/intolerances present for each types of ED
i. AN – self elimination of foods, fear food avoidance and severe restriction of energy impact GI functions and create discomfort when eating many different foods, become more restrictive and fearful. Many may have testing, results come back inconclusive or no aversions found.
ii. BN – often tested due to desire to increase food restrictions, will make extreme food changes, but binge on those “allergic” foods and purge
iii. BED – least likely to look for food issues or have testing done
iv. Orthorexia – may have many tests done by multiple health professionals, will pick and choose results to follow
II. Dr. Anand – Initial contact with patients and how assessment is completed and testing is determined
- Summary of the different available assessments/testing
i. Blood tests – IgE and IgG
ii. Skin prick tests (skin and blood tests combined)
iii. Oral Food challenge
iv. Food elimination
v. Delayed sensitivity – swallow issues, eczema, etc.
vi. Adolescent food allergies vs Adult food allergies
- Varying degrees of allergy/intolerance severity
- Research and reliability of testing methods
i. False positives and Clinical judgment
- Interventions and treatment approaches
- Gluten and Celiac’s Disease (RD and Dr. Anand)
III. RD and Dr. Anand – Impacts of ED and treatment approaches specific to ED patients
- Re-introduction of foods
- Honoring food allergies upon admission – progressively challenging fears
- Specific approaches for AN, BN, BED, EDNOS, etc
- Anaphylaxis reactions
There are many myths regarding food allergies and it is important to first understand the differences between food allergies and food intolerances. Food allergies occur when the immune system recognizes and reacts to a food being consumed, and this differs from food intolerance, where a food can trigger an unpleasant symptom(s) independent of the immune system. An example of the latter would be tomato sauce inducing acid reflux symptoms. The immune system, on the other hand, will react to a food in different ways, ranging from potentially life-threatening scenarios involving anaphylaxis; to an immune response to gluten, found in wheat and other grains. Both of which are legitimately concerning reactions to food, with varying degrees of severity and damage being done to the body.
Unfortunately, there is a lot of misleading information about food allergies and food intolerances available to the public, and sometimes even medical professionals may not have a true understanding of how to assess and diagnose food allergies. If a comprehensive approach to the issue is not taken, often times recommendations are made to eliminate foods or groups of foods in order to “see” if that may resolve the issues. Of further concern, is when non-evidence based testing methods are used and patients are given a list of foods of which they now must avoid due to having an “allergy”. These types of diagnoses can be very damaging to patients with eating disorders, causing them to limit their diet even further than they may have been doing previously. It also creates a further food fear that can be very difficult to overcome. We will review the evidence based approaches to diagnosing and managing, or resolving, food allergies or intolerances, along with how to best work with an eating disorder patient who may have food aversions or previously diagnosed food allergies that need to be re-explored.
Megan is the Director of Nutrition and Culinary Services at Rosewood Centers for Eating Disorders and A New Journey. She brings ten years of experience working with wellness programs, eating disorders, and addictions in men, women and adolescents. She is a Certified Eating Disorder Dietitian and an Approved Supervisor through IAEDP, and is passionate about educating dietary professionals to further understand the unique challenges of working with eating disorders. Megan teaches basic nutrition courses along with a graduate course on Eating Disorders and Addictions at Arizona State University, and she has presented at universities, conferences and events across the country.
Dr. Miriam Anand is an Allergy/Immunology Specialist who treats and manages asthma, hives and a range of allergies, rhinitis and sinusitis, along with other disorders/diseases that affect the body’s immune system. She graduated from George Washington University Medical School and is a Diplomate with the American Board of Internal Medicine, and the American Board of Allergy and Immunology. She is a Fellow with American Academy of Allergy, Asthma & Immunology, the American College of Allergy, Asthma, & Immunology, and the American College of Physicians. She has received honors related to her work with patients and authored multiple peer reviewed publications.
