When good food bites you back - understanding food allergy and intolerance

athlete eating at table
Author:  Carole Richards, Accredited Practising Dietitian
Issue: Volume 27 Number 3

Sometimes healthy foods cause major reactions in sensitive people.  Those who suffer from food allergy or intolerance are often concerned that, despite all preparations, a reaction to a food will prevent them playing to their best.  Self confidence can suffer as well as having feelings of 'letting the team down'.  With knowledge and some planning ahead, there is no reason why those with food issues cannot participate in sports and enjoy the experience.

There are a number of food related conditions:

  • Food allergy, an immune system reaction that occurs in about one in 20 children and one in 100 adults.  The symptoms can be very serious, even life threatening.
  • Food intolerance, a sensitivity to the natural and added chemicals in foods and occurs in up to 10 per cent of the population.
  • Enzyme deficiencies, of which lactase deficiency is the most common.
  • Gluten intolerance (coeliac disease, and non-coeliac).
  • Food aversions.

The term 'allergy' is often misused to describe major as well as relatively minor conditions including headaches, bloating and indigestion.  The public sometimes has the impression that food reactions are trivial.  Unfortunately, severe allergic reactions can occur.  For those of us looking after athletes, it is important to understand the difference between allergy and intolerance and to have an action plan in place should a reaction occur.

Food allergy

Symptoms of food allergy are usually obvious.  Reactions are immediate, often occurring within minutes, of eating a food containing an allergic protein such as cows milk, egg, wheat, nuts, seeds, soy products, fish and seafood.  Sometimes it is the combined effect of exercise and food that brings on a reaction.  It may only take a very small amount of food to cause symptoms, for example preparing a sandwich on the same chopping board where a peanut butter sandwich was prepared earlier may be enough to cause a reaction. While  most allergy reactions are mild or moderate, limited to skin rashes (hives) and swelling, some people have a severe, life threatening reaction called anaphylactic shock that includes breathing difficulties, swelling of the face or throat, vomiting, diarrhoea, dizziness, a drop in blood pressure, and loss of consciousness. 

Up to 20 people die in Australia each year as a result of anaphylaxis.  The most common foods causes are peanuts, other nuts and shellfish.

The only way to prevent food allergy reactions is to completely avoid the problem foods.  No amount of the food is safe.  Players who have an allergy usually wear a medical identification bracelet.  Look out for these and ask questions.  If you have a team member who carries medications for their allergy, such as antihistamines or an Epi Pen syringe (adrenaline) it is worthwhile knowing where they are stored and how to use them. Be prepared and hopefully you will never need to deal with this type of emergency.

Not all reactions to food are due to allergy.  Feeling unwell after a meal does not always mean that the meal is to blame.  Sometimes we overeat, or the food is too fatty for us to easily digest the meal or the reaction is due to food intolerance or other conditions.  The reactions are not as dramatic or as severe as those from food allergy but they can affect sporting performance.  Athletes that feel less than 100 per cent will perform less than 100 per cent.

Food Intolerances

Food Intolerances are reactions due to irritation of the nerve endings in different parts of the body. Symptoms include skin rashes (hives), itchiness, swellings (lips, tongue, throat, eyes), migraines, bloating, painful gut cramps, diarrhoea, blocked noses and mouth ulcers. Reactions are not life threatening unless the mouth, tongue and throat swell and interfere with breathing.

Some people report changes in behaviour as a result of foods eaten.  Reactions can develop from half-an-hour to even up to three days later and occur due to an accumulation in the body of natural and added substances such as:

  • salicylates, aspirin-like substances in tea, peppermint, fruits, vegetables, herbs and spices
  • amines in wine, cheese, bananas, avocados, chocolate, and citrus fruits
  • MSG found naturally in parmesan cheese, tomatoes, and mushrooms
  • MSG added to stock cubes, soups, soy sauce, and flavoured potato chips
  • preservatives and food colours added to improve appeal and shelf life of foods.

Food intolerances are generally misunderstood by the general public because the reaction is to a group of foods that can cause the build up in the body and because foods can sometimes be eaten in small amounts.  It may be alright to eat a certain food once a week, but not two or three days in a row.  There is further confusion because many of the foods are seen as being healthy such as oranges, broccoli, honey, nuts, strawberries and tomatoes and yet can cause a significant reaction in those who are sensitive.  Food intolerance can come and go over a lifetime.  Stress may increase sensitivity.  Female athletes may be more prone to migraines and the effect of foods around the time of menstruation. Encourage your players to inform you of their medical and food requirements.  Be aware that they may be a little shy about discussing gastrointestinal reactions.

Enzyme deficiencies

The most common enzyme deficiency is lactose intolerance. Some people are born without enough lactase enzyme to digest lactose (milk sugar). In others the condition develops over time or is a temporary condition after a gut infection.  Eating dairy products that contain lactose such as milk (major source in the diet), custard, cream, butter, cottage cheese and ice cream will result in bloating, wind, nausea and diarrhoea.  Tolerance varies – for some, a limited amount of lactose is tolerated, while others cannot have any lactose. Yoghurt and matured cheddar cheese can usually be eaten safely. If catering for the team, make sure you have some lactose-reduced or lactose-free milk available.  Both of these are readily available in supermarkets, as UHT long-life milk and sometimes as a fresh version stored in the cold section of the supermarket. The carton will be clearly labelled 'lactose free' or 'lactose reduced'.  Many players will manage their condition on their own, provided lactose-free alternatives are available.

Gluten intolerance

Coeliac disease is an immune system reaction to gluten, a protein found in wheat, rye, barley and oats. Eating gluten damages the lining of the gut and reduces the ability to absorb nutrients from foods.  It may also cause stomach pain, cramps and diarrhoea.

Life long avoidance of all glute-containing foods is the best treatment for coeliac disease. Sometimes people who do not have coeliac disease also have an upset stomach after eating gluten-containing foods. They may be able to eat small amounts of gluten containing food without problems.  It is important to distinguish between the conditions and assist your athletes in selecting foods that are suitable.

Food aversions

Aversions to particular foods are emotional reactions to something that is disliked.  A person may react to the sight or taste of a food and experience very real symptoms which should settle with reassurance and rest.

Planning food for trips away

Be a second set of eyes for your team when eating away from your home ground.
Trips away need special attention to ensure that all foods available are suitable. Plan ahead, discuss meal options before the trip and if necessary take familiar foods (biscuits, cereal bars, breakfast cereal, fruit, even a spare meal) with you.  Try to include planning as normal part of preparing for a trip. Restaurants can be contacted ahead of time and requirements discussed.  The Yellow Pages web directory is a useful resource for trips within Australia, and there are some helpful guides on food for travel available from the Australian Institute of Sport and Sports Dietitians Australia (see References below). Ask questions at takeaway food outlets and restaurants, read ingredient labels on foods purchased and assist your players in ordering safe foods.  Food labels must now declare the presence of ingredients that are likely to cause an allergic reaction no matter how little is contained in the food.

Key points

  • Be aware that your team members may suffer from food reactions.
  • Ask questions to determine if it is allergy, food intolerance or another condition.
  • Include team members in planning meals for trips away from home.
  • Be prepared to assist team members in selecting suitable foods, especially when away from home.
  • Don’t take chances with food allergy.

Some questions to help you understand your player’s condition?

  • What food or foods do you react to? Is your reaction an allergy?
  • Can you tell me what happens when you eat these foods?
  • How severe are your reactions? How quickly do you react?
  • Have you ever needed to go to hospital because of your reaction to a food?
  • What medications do you carry in case you have a reaction? Do you have a treatment plan?
  • Do you carry an Epi Pen? If yes, where do you keep it and how do you want me to assist you when you a have a reaction?
  • Do I need to call an ambulance if you have a reaction?

Common foods that cause allergy

  • Milk
  • Eggs
  • Nuts, including peanuts
  • Seeds, including seasame
  • Soy milk, tofu and other soy products
  • Fish
  • Oysters, scallops, squid, calamari, mussels, lobster, crab and prawns

Common foods that can cause foods intolerance

  • Tomato-based meals and sauces such as pizza, lasagna, spaghetti bolognaise, casseroles
  • Asian meals made with soy sauce, fish sauce, oyster sauce, etc.
  • Curry
  • Coke, cordial, beer, wine and tea
  • Citrus fruits and juices
  • Chocolate and chocolate-flavoured drinks
  • Preservatives (for example, in bread, dried fruits and wine)
  • Colourings in lollies and baked goods

References

To contact a dietitian in your area call 1800 812 942, visit www.daa.asn.au or look under 'Dietitian' in your local Yellow Pages.



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