I suck at food
December 28, 2009 9:43 PM   Subscribe

What type of doctor (or doctors) should I see to help me sort out food intolerances and devise a proper diet?

I am lactose intolerant, and though I'm religious about reading labels and knowing exactly what's in my food, I still have days where I'm too nauseous to eat, and I can't always pin down a culprit. My reaction is pretty minor as these things go - I'm usually just very nauseous for a while but rarely actually get sick - but its enough to prevent me from going out or doing normal activities.

My guess is that I have some other minor food intolerances, but my method of dealing with this thus far has been to eliminate any suspected problem foods entirely, and at this point the list of foods I CAN eat is pretty short. Lately I've just been avoiding food as much as possible, but I've lost a great deal of weight and am not healthy.

I'm realizing that I need some help coming up with a more rational approach to tracking down which foods are a problem, and figuring out what is an actual allergy or intolerance and what is just my stomach processing something unfamiliar. I'm not sure what type of doctor to consult, though - would an allergist be helpful if I just have food intolerances? A gastroenterologist, or is that only for more severe issues? Maybe a nutritionist? Or something else entirely? Ideally, I would want someone to help me with various elimination diets and serve as a voice of reason to tell me when I'm being overly cautious, and to help me figure out a way to eat well in spite of my restrictions.

(Anxiety and stress are a factor too, and I am currently seeing someone to work on that, but I don't think they're the only problem.)
posted by Fifi Firefox to Health & Fitness (11 answers total) 6 users marked this as a favorite
Definitely see an allergist to figure out whether your food intolerances are allergy related. Then you can move on from there once you've pinpointed any allergies (or ruled them out).
posted by amyms at 10:02 PM on December 28, 2009

Its quite possible your problem is not allergy related, especially with the description you are giving. You should probably go visit a GI specialist as well, see if they have any other ideas about what could be causing your nausea.

Your description is a little vague, but I can think of at least 2 things (Celiac sprue, or chronic gastritis) that are more common with similar symptoms and easier to control than some random food allergy.
posted by i less than three nsima at 10:11 PM on December 28, 2009

I was in a similar situation in July - I was nauseated all the time, could not tolerate some foods, had a number of health issues (in particular migraines, contact dermatitis, stomach issues). I went to see a naturopath (ND). I was able to get an appointment with one person that was highly recommended, by early September. We had a long appointment, she went over my health issues and my complaints of nausea, she did a VEGA test for food intolerance and I brought home a list of foods that I should avoid outright for six weeks.

Some thoughts on the matter.

There is a difference between intolerance (which builds up over time) and allergy (which is a much stronger, and faster, reaction). You could see an allergist (traditional medicine) and look for food allergies, but remember to check for intolerances too - and that's a different doctor (naturopath, alternative medicine - which may, or may not, be covered by your extended health insurance).

Cutting out the foods is an important first step. It can be traumatic at first ("oh my goodness, how can I eliminate wheat from my diet - it's everywhere!" was my first question when I received my results). However I found that there are many substitutes to wheat that are tasty and nutritious (I can have oats, barley, millet, buckwheat, teff, quinoa, etc...)

Find a good naturopath, find one that has graduated from a reputable university, and has good reviews. I don't know where you live (texas? colorado? your bio is sparse and your tags are few) but I am fairly certain that you must have a directory for alternative medicine in your city.

Then, read up on books and web sites. This book helped me a lot: Coping with Food Intolerances by Dick Thom (amazon link). It is written very well, is compassionate, and offers insight into why so many of us have food intolerances. Main takeaway - eat a variety of foods, and vary often. Many people eat only 30 different foods in a given month. This is why intolerances develop - through constant repetition.

Another book is also highly recommended - it has excellent recipes and also works with food intolerances: Whole Life Nutrition Cookbook (they have a web site too) (cook book link). This is more about "now that I can't eat x, y, z, how can I prepare my meals?"

So it's the end of December, and my stomach issues have resolved. I have pretty much eliminated the foods that hurt me from my diet. My contact dermatitis is gone. My migraines are infrequent (they used to occur every two weeks) - when they occur, they are congruent with me eating something from the elimination list. I lost a bunch of weight as well, which is a good thing for me.

Now - I am an experiment of one, your mileage will vary.

See your doctor, see an allergist, and look to naturopathy as help to solve your health issues. Read lots. Ask questions. Find out what hurts you. Do a six-week elimination of the foods that ail you. Watch closely how you feel. You may find that you feel much better after a few months of avoiding these foods.
posted by seawallrunner at 10:29 PM on December 28, 2009 [1 favorite]

Any old GP can run the blood test for celiac, but you'll need a gastroenterologist for the more comprehensive workup that confirms it. I'm not a doctor, but chronic nausea even when you're trying to avoid food sounds more like a case for a GI doc than for an allergist.
posted by fairytale of los angeles at 11:19 PM on December 28, 2009

Sounds similar to me before I learned I had fructose malabsorption. Carbohydrates such as those in sugars, fruits, beans, and grains can do tricky things to those of us with touchy stomachs.
posted by chez shoes at 11:29 PM on December 28, 2009

Definitely see a good Naturopath as outlined by seawallrunner.
Mine recommended this book which has a lot of great "hypoallergenic" recipes, as well as some good lists of foods to avoid and why.
posted by smartypantz at 4:48 AM on December 29, 2009

The list of foods to consume / avoid. It's very specific, which I liked when I was having to eliminate foods. It helps to know what foods you CAN have (ie ones that are soothing and least likely to cause reactions).
posted by smartypantz at 4:52 AM on December 29, 2009

I read on here recently that "nutritionist" is not the same thing as "registered dietician." The latter has professional certifications.
posted by cranberrymonger at 7:15 AM on December 29, 2009

What you describe could be a lot of things. My experience with both parasites and pregnancy have been a lot like that. If you can go to a GP and get some general diagnostic things done, rule out some things, bring others into better focus, then the GP could recommend what follow up you need. That's what I'd do (but I'm in the Canadian system, so it might be different for you).
posted by carmen at 7:21 AM on December 29, 2009

You could see an allergist. Google any reviews in your location of allergy clinics and call about testing for allergens and what the process is like. From what I have seen, they try test you with a skin test of various common allergies of food, dust, house hold items, etc. and see what your skin reaction is to them. Then there are follow up treatments based on this. For the lactose intolerance though, I am not sure if an allergist would deal with that situation. Call and ask if they deal with lactose intolerance? Also, you may be having food allergen reactions that you are unaware of. A dietician would probably do a better job at calculating and tabulating your diet and setting up a regimen.
posted by proficiency101 at 8:43 AM on December 29, 2009

If you haven't eliminated wheat, rye, or barley yet*, have your regular doctor order a full celiac sprue blood panel immediately. Don't ask, insist. Up until a couple years ago, doctors were taught it's rarely seen; recent comprehensive new studies by Mayo Clinic and the University of Maryland have proved it's actually very common (~1:100-1:133 people has it) but rarely diagnosed. So doctors aren't necessarily familiar with looking for it, let alone finding it.

Reasons to consider celiac first: there is an unusually high degree of overlap between lactose intolerance and celiac, celiac is a malabsorption disorder (causing weight loss) whereas food allergies are not, the damage caused by celiac makes it difficult for foods to digest generally (so withdrawing categories of foods can feel easier, but misleading you into concluding that all sorts of foods are a problem when actually there's only one underlying problem), and high stress is a trigger for the disease to emerge. Eliminate celiac as a possibility, then yeah do investigate food intolerances.

[*] If you have eliminated or cut back on these, any tests for celiac will give invalid results. You'll need to consult with a celiac-savvy gastroenterologist about doing a gluten challenge first.
posted by nakedcodemonkey at 11:43 AM on December 29, 2009 [1 favorite]

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