This article first appeared in the FoodsMatter blog in response to an article in the Daily Mail. However, the article itself and a response received today (November 2013) suggested that it might be of more general interest.

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.

Michelle Berriedale-Johnson May 2011

From Rudy – 28th November 2013

Interesting article and I have extensive experience with this.

I was diagnosed with bi-polar disorder 9 years ago and took a wild ride on the psychiatric drug roller coaster. Five years ago I decided to ween myself off my medication after being told that I did not produce sufficient testosterone for my age, my levels were that of a man in his 80′s, so I began hormone therapy.

I began feeling better so the decision to leave the so called practice of psychiatry care was a goal I would see through. After coming off the medication I felt great but found myself unable to eat anything. I went on a gluten, soy, dairy and lactose free diet and have been on it for the past almost 5 years.

My Gastrologist told me after extensive testing that my inability to digest food was due to the worst cast of acute anxiety he had ever seen. My anxiety is not noticed in my actions or personality, as I am a very talkative and social person even though I require time to be alone, my anxiety manifests itself in my digestive system.

I cannot eat regularly and struggle to maintain weight. My testosterone therapy keeps me looking athletic. I do take medicine for anxiety, but it does not work for my digestive system unless I were to take anti-depressants (which I refuse to do). I have noticed that certain foods cause emotional strain or fatigue, so I literally live off of four foods everyday with a acidic free smoothie everyday. Does anyone know of a way to relieve this without psychiatric medication?

From Cathy – 8th December 2013

You may remember me. I have followed foodsmatter for many years and am the mother of two boys born with severe food allergy and intolerance and spent a long time in the Royal Free in London. I love your magazine and have read it avidly for so long now. I would like to comment on the article about anxiety and intolerance.

I have always suffered with stomach upsets. Tummy aches were some of my earliest memories along with headaches and eczema. In my late twenties I became weak and the tummy aches increased. At the time the consultant told me it was depression and anxiety and I accepted this as I did feel depressed at the time although I had thought it was because I felt so terrible. In the end I was too weak to work and was suffering terribly from the depression.

Another consultant did a biopsy and found I had coeliac disease. I felt much better on the gluten free diet but still not completely well and eventually realised that dairy was also a problem so cut it out. I then had two children who were born with allergies and food intolerances which were understood, diagnosed and treated by a consultant in a London teaching hospital.

As time went by my stomach problems returned and I became intolerant to more and more foods. If I ate even the smallest amount of an offending food then I would have severe cramps and diarrhoea so was losing loads of weight and feeling rough most of the time. I saw Dr's and consultants as I was fearful that soon I would be unable to tolerate all foods but each time I was told it was anxiety and depression. I admit I did have a stressful life as the children had difficulties and as there seemed to be no other answer I had to believe them. However, this was absolutely no help as I wasn't in control of the factors in my life which were causing the stress.

Eventually I got to see Prof Brostoff who on the first session recognised two possible problems. An infection in the small bowel and a candida problem. He sent me for tests and I tested positive for both. He first put me on specific antibiotics to kill the bacteria and within days I started to feel better. He then tackled the candida and I went on a strict diet along with medication over a period of months to kill off the candida. I lost pounds in weight (even though my clothes size didn't change) and I started to look and feel better than I had in years! As I started to put foods back into my diet the candida returned with a vengeance so it was treated again and now I avoid sugars and yeast. I was (and still am) very restricted in what foods I can eat and need to avoid Gluten, Dairy, Soya, Corn, Sugar, Yeast, all processed food and many individual foods but I felt well again, put weight on and was able to live my life as normal. I thought problems solved as Prof Brostoff had said it may take a long time for my gut to be able to tolerate a full range of foods again and I was happy with that.

A few years later I started to feel weak again and was getting palpitations. I had a couple of 24 hr tapes done and nothing showed up. Guess what? According to the Dr's it was back to the depression and anxiety! I believed them again (I should've known better!) and so went through months of therapy which made absolutely no difference whatsoever and cost me a fortune. My life was stressful as I was now also caring for my husband as he had sustained a head injury so of course the stress diagnosis made absolute sense.

Eventually things got much worse and my heart rate dropped significantly and I even up in A&E. I was referred back into cardiology and after dozens of tests they eventually gave me a pacemaker and diagnosed a low blood pressure problem. I now feel better than I have for years! It turned out that my heart was generally beating too slow for me as well as dipping low enough to cause my brain to be starved of oxygen so I would become dizzy and confused. This year I was 50 and I climbed a mountain with my son leaving many of the teenagers way behind! It's so exciting to feel so well and I now have bags of energy!

I have had time to reflect on the question of stress and illness in my life and have come to the following conclusions. There is no question that there is a link between stress and illness or feeling unwell. We know that if we are very nervous we get butterflies in our tummy or need to run to the loo. Stress may well have been the cause of my problems but there is no way for me or anyone else to know this for sure. Either way, I had genuine illnesses which needed proper diagnosis and treatment.

We live stressful lives and are not always in control of the stressors but we do need to continue to function. To say its caused by stress, anxiety and depression can often add to a persons stress as it is then another problem to deal with and in my case, dealing with the effects of the stress made absolutely no difference whatsoever.

The other interesting realisation I have had is that I have always been a very optimistic person who thrives on being busy. I have had absolutely no depression since my health problems have been solved and I lead a very busy life. Every day I wake up feeling blessed that I feel well and can do all I want to in the day, and I can go and climb a mountain if I want to! I am also very grateful to the consultants who did eventually take me seriously and helped me to be well again.

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