Is this a food allergy? If not, what is it?

October 5, 2016 6:58 PM

A few years ago, while I was writing about drinks, I started experiencing some … symptoms within an hour or so of getting home. As a courtesy I will describe them after the jump.

So, I was writing about drinks for a web site, and around the time I got press credentials to cover a big event, I started to have a problem with my drinking. But not, like, a drunkenness problem. My wife and I would be out, we'd have a few drinks (say, up to three, sometimes four over the course of a few hours, but not, say, six or seven or more). We'd get home, we'd go to bed, and very soon I'd jump out of bed and go projectile vomit in the bathroom. This happened several times. Because I planned to cover a booze industry event I got really concerned, so for the last month before the event I quit drinking entirely. Then I went to the event and for five days straight I started drinking by noon and didn't stop until bedtime*, and I had no problems at all.

* Sessions at industry events are accompanied by drinks, there are tastings throughout the day, people have bottles and flasks, etc. It has been acknowledged that this isn't really the healthiest way to run an event, and at things like Tales of the Cocktail they now have events on keeping yourself healthy while working in that environment, but in general you learn when not to finish drinks, you drink a lot of water, and you avoid going out at night after sessions end because that's when the really bad decisions happen. But anyway.

After the event we resumed our regular habits, and soon enough I had another vomiting episode. I realized at that point the difference was that the event was all spirits and cocktails, and at our usual bar we'd often drink like the bartenders did: a shot and a beer. And that seems to be it. If I drink two beers, I'll end up vomiting. If I only drink one, I may make it through the night, but I'll still probably have some pretty bad cramps. No beers, no problem.

Meanwhile, I've also found that a small (but apparently growing) list of foods will result in near-instant gastrointestinal distress of another sort (diarrhea, accompanied by lots of really foul gas). The first problem food I identified was kimchi and I have learned I pretty much can't eat any Korean food. I also figured out that a local ramen shop's "spicy miso ramen" is a no-go, but I don't have any problem at all with other spicy foods (Mexican, bottled hot sauces, etc), and the miso soup you get at sushi joints has never presented an issue either. I can eat the other ramen at the same place, no problem. Last night's dinner was northern Thai, a cuisine I've eaten and loved before, but something clearly didn't agree with me. I suspect the fermented soy beans in one course, but I can't be sure.

I'm at a loss. When it was just beer and kimchi I could avoid those two things easily enough, but if the list is growing I'd like to know what I need to be looking out for. I suspect it has something to do with fermentation (or byproducts of fermentation) but not every fermented food causes a problem (sauerkraut is fine, and I can eat pickles all day long, as long as they're not the pickled vegetables in a Korean restaurant). My symptoms don't really line up with any FODMAP groups either. It's like the worst Silly Sally game ever and I'd like to know how to win it.

To recap: BAD: beer, kimchi, "spicy miso ramen." FINE: wine and spirits, sauerkraut and pickles, spicy foods in general, regular miso soup. Bread and pasta are fine. FODMAP things like broccoli, cauliflower, and Brussels sprouts make me a little more gassy than most people, but don't cause any distress. For extra credit, raw onions are fine but cooked onions may not be (the more cooked, the worse they are).

So, who can I even see about this? I saw an allergist years ago and the standard battery of prick tests didn't identify any food allergies at all. If the side effect is vomiting I certainly don't look forward to a challenge test. I was screened for celiac and lactose intolerance a few years ago and both were negative. I don't know if an allergist or dietician or some other specialist could look at that list of problem foods and identify the common element, but I'd really like to know what to avoid, if such a thing is knowable.

Help?

posted by fedward to Health & Fitness (12 answers total)

I saw an allergist years ago and the standard battery of prick tests didn't identify any food allergies at all.

Did you have these symptoms at the time? You could very well have developed an allergic reaction that you didn't have back then, which means that tests now might give different results.
posted by the agents of KAOS at 7:02 PM on October 5, 2016

Response by poster: I didn't have a problem with beer, but my first exposure to kimchi would have been around the same time as the test, and I've never been able to eat it without symptoms.
posted by fedward at 7:12 PM on October 5, 2016

Tyramine levels in some fermented foods. Dark beers more than light ones, fermented soy beans, miso may be higher in tyramine, than commercial soy sauce. If you take a tricyclic antidepressant you have to avoid some fermented foods, and a whole list of other things until you figure out a tolerance. Migraine sufferers can be affected by this too. On a personal note, some fermentation starters bug me but not others. I can drink red wine if it is put up with champagne yeast, but not typical red wine yeast. I can eat pizza, but not fast rising pizza dough. I have to buy conventional yeast to bake. What you are describing might be a precursor to migraine. I used to have a seafood salad with bleu cheese dressing, a San Miguel Dark beer, and not often enough to attach it to vomiting and then catastrophic migraine. The fifth sit down over ten years, I woke up to the fact the meal I was about to order was going to do me in. I eat a lot of stir fries and use soy sauce, but I avoid miso. People with an intolerance for foods high in tyramine have a high blood pressure episode, that might trigger vomiting, as a part of a reaction. You might have a hiatal hernia, these are common, and bubbly beverages are kind of a difficulty for people with those, and that hernia can crowd the other organs in the chest area. You might want to look into that. It might just be physical, rather than allergy of any kind.
posted by Oyéah at 7:29 PM on October 5, 2016 [9 favorites]

Wait, are you sure that the vomiting is triggered by the beer alone and not by mixing of shots and beer? Because mixing shots and beer make me vomit, too, and I think that's a pretty common reaction. There are even little cutesy rhymes about it.

I'm guessing that the vomiting is unrelated to your diarrhea issue.
posted by PhoBWanKenobi at 8:43 PM on October 5, 2016

My guess if your problems stem *only* from beer combined with shots, and also certain similar Asian foods, you're probably looking at two distinct phenomena.

PhoBWanKenobi is right, combining shots and beer is a bad idea that will make you sick. Frankly, with one or two exceptions I haven't taken shots since college and I find that a completely acceptable way to live. Unless you're writing about new shot concoctions for work, I would just avoid ever taking shots.

My guess for the other thing is that there's a particular ingredient in certain Asian dishes that doesn't agree with you. Since you can eat other ramen dishes from that particular restaurant but not their spicy miso ramen, maybe ask what ingredients are in that specific dish that wouldn't be in other ramen dishes? It's also not lost on me that kimchi and spicy ramen are both spicy, and a lot of Northern Thai cuisine is spicy. Could there be a particular chili pepper preparation that you can't tolerate, or even a commonly used preservative or secondary ingredient in some Asian chili sauces/mixtures?
posted by Sara C. at 10:30 PM on October 5, 2016 [1 favorite]

Tyramine is a problem with MAOI drugs, not tricyclics. TCAs have no specific dietary restrictions. If you were taking an MAOI, your doctor would have been certain you know how serious the interactions are.

Could still be a problem with certain strains of ferment micro-organisms, but unlikely as most beers in this country are pasteurized. Beer and kimchi probably have no ingredients in common. But kimchi and other Korean cuisine are likely to be seasoned with the same type of chili peppers.

The beer could be acid reflux. Do other carbonated drinks cause a problem?

Allergy testing might be helpful, but I wouldn't bet the farm on it. My most dramatic reactions are to things allergists don't, haven't, or can't test me for. Food log and avoidance are probably your best course of action.
posted by monopas at 12:22 AM on October 6, 2016 [1 favorite]

Seconding acid reflux.

I have both food allergies and acid reflux, which can be flared up by food. Here's a breakdown of what I get:

Allergy: Oops - I eat something with strawberries in it, which I am allergic to. I start to wheeze, my face feels hot, I get sniffly, and my tongue swells. My inhaler + Benedryl usually settles it down, but I also carry an Epi-Pen just in case. No vomit, no bloating.

Acid Reflux: Oops - I drink a beer or have something that upsets my stomach, like onions. My stomach will hurt, I'll get bloating, I'll get gas. I will also get asthma, because the stomach acid shoots up the throat, and I breathe in the acid. (Sexy!) Sometimes, I'll cough up a little bile. I sleep on a wedge pillow every night; that keeps the acid reflux partially under control. Pantoprazole helps with the rest of it.

I noticed that you mentioned vomiting as soon as you went to bed; that may be the stomach acid moving past your stomach sphincter when you lie down, and backing up into your throat, causing you to vomit.

All the foods you mentioned are also either carbonated, alcoholic, and/or rich and spicy - all potential acid reflux triggers. I had to give up spicy foods, fatty foods, booze, and coffee to help keep mine under control.
posted by spinifex23 at 12:56 AM on October 6, 2016 [4 favorites]

It does sound, from the particular list of irritants you've mentioned, like it's possible you might be having trouble with foods that contain live yeasts, as mentioned by others above. A family member had similar issues, but found it very difficult to get any kind of clear diagnosis, and just cut them out for a few years.

What kind of beers are we talking about? I've found myself very occasionally sickened by Trappist or other craft beers that rely on in-bottle fermentation, where the yeast levels are particularly high. But if it's something more generic on tap I'd consider that less likely a cause.
posted by distorte at 1:00 AM on October 6, 2016 [1 favorite]

My son went to a standard allergist for food issues that manifested through diarrhea and not wheezing, the allergist said basically prick tests wouldn't tell you anything.

This was after our reg.doc had sent us there so this helpful suggestion of I can't help you cost $ 250....so.

Apparently, intestinal allergies are different. Don't know what you have, but good luck!
posted by aetg at 4:13 AM on October 6, 2016

Many beers will make me throw up (later, not immediately usually). I can drink light beers (like pilsers), but nothing malty. The effect is particularly strong if I eat fried food. Or if I also take a shot of liquor. I don't consider this a food allergy. I think people who can drink a beer and a shot must have iron stomachs.

I also have food allergies. Some foods give me asthma or intense mouth itch, some give me gastro distress.

The solution for both of these is to avoid the offending foods or beverages. This was the advice that I received from an allergist, and it means I can't eat most fresh fruit, for example. So you can certainly see an allergist about this, but I think there is a good chance that they will tell you to simply not do the things that you have already identified as causing you pain and distress.
posted by ewok_academy at 10:01 AM on October 6, 2016

Response by poster: Spiciness in general isn't an issue, it really does just seem to be one or more ingredients in some spicy Asian foods but not other dishes (so, like, Sriracha and Huy Fong's garlic chili paste are both fine, and I've had northern Thai and Lao food on multiple occasions but never had symptoms before). As for acid reflux, I have a genetic predisposition for it, but I take omeprazole or Prilosec daily under the guidance of a gastroenterologist and have for years. With that, heartburn usually isn't a problem for me, and when it is, I usually know what triggered it (likely Coca-Cola or tomato sauce). FWIW the vomiting is less "right after getting in bed" and more "about an hour after drinking the critical beer" (so, I don't have to go to bed for it to happen, I just have to drink beer and wait). Non-beer fizzy drinks are fine, and I drink a lot of ginger ale. I even made some ginger beer last year with Champagne yeast and had no problems with it.

I wish I could say it was only certain beers, or certain types of beer, or only beer + shots. Sadly, it seems to be any beer, especially if I have more than one, regardless of what else I've had. The side effects are unpleasant enough I haven't really done my own challenge test ("this week: lagers! Next week: domestic pale ales!"). I've just switched to highballs if I find myself in a beer bar with friends.

So, yeah, I don't know if the beer and mystery Asian ingredient problems are related or just coincidental, but it seems so far like coincidence may be it.
posted by fedward at 11:29 AM on October 6, 2016

I was just recently in my local Japanese supermarket and saw a product on the shelves called "kimchi base spicy chili sauce". How likely is it that this is the product your local ramen place is using to spice up their spicy miso ramen? It seems likely enough to me that this product, kimchi, and the Northern Thai dish you reacted badly to may have all had this or some ingredient found in this.
posted by Sara C. at 8:44 AM on October 9, 2016