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Tips for Managing Food Intolerances

Aug 26, 2022

More common than food allergies, food intolerances are a digestive response to a food rather than an immune response. They are thought to be caused by enzyme deficiencies, impaired food absorption, and other gastrointestinal issues.

The four most common food intolerances are:

  1. Celiac disease
  2. Non-celiac gluten sensitivity (NCGS)
  3. FODMAP intolerance
  4. Lactose intolerance

In this post I'll share nutrition tips for managing these food intolerances, along with four steps to help you get closer to a diagnosis. If you'd like more detailed information on each, read my last post on Food Allergies vs Food Intolerances.

Managing celiac disease

A lifelong gluten-free diet is the only known treatment for this condition because as long as gluten is consumed, damage to the digestive system will continue to occur. Gluten is a protein found in wheat, rye, and barley.

For someone with celiac disease, s
erious side effects of consuming gluten can include:

  • Nutrient malabsorption
  • Unexplained iron-deficiency anemia
  • Diarrhea, gas, or abdominal pain
  • Chronic fatigue
  • Brain fog
  • Migraines or seizures
  • Infertility
  • Bone/joint pain
  • Arthritis
  • Osteoporosis or osteopenia (bone loss)
  • Tingling in the hands or feet
  • Depression or anxiety

It’s important to note that many patients with celiac disease have no GI symptoms and may not even know they have it. This “silent” form of the disease is far from harmless and is associated with higher rates of iron-deficiency anemia, osteoporosis, and neurological symptoms.

Managing non-celiac gluten sensitivity (NCGS)

Symptoms of NCGS (also known as gluten sensitivity) often overlap with those of celiac disease and improve when gluten is eliminated from the diet. The difference is, the individual doesn’t test positive for the disease.

Just like celiac disease, the only treatment for NCGS is the complete removal of gluten from the diet.

For more information on celiac disease and NCGS, please visit the Celiac Disease Foundation at:  

Managing FODMAP intolerance

FODMAP stands for: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Along with a low FODMAP diet, addressing intestinal bacterial overgrowth and imbalance is key.

A popular dietary treatment to help heal the gut is the GAPS diet. This plan eliminates difficult-to-digest foods that may damage the gut flora, and replaces them with nutrient-rich, gut-healthy foods.

For more information on FODMAPs, please visit:   


Managing lactose intolerance

Most people with lactose intolerance can handle small amounts of lactose, and may even be able to enjoy yogurt, kefir, butter, and hard cheeses, such as cheddar or Swiss in moderation, without experiencing any symptoms. However, it is probably best to minimize dairy products and consider replacing them with plant-based options like almond milk, coconut yogurt, cashew-based cheese, and coconut butter.


4 Additional steps to managing food intolerances

#1: Start by improving gut health

In many cases, your food intolerance may be due to compromised gut health, a condition caused by improper digestion and/or food molecules making their way past the gut lining—something they should not be able to do.

Here are some suggestions you may wish to consider to help support the health of your gut:

  • Get tested and treated for intestinal pathogens or SIBO (small intestinal bacterial overgrowth). The goal here is to reestablish a healthy gut flora.
  • Eat fermented foods like raw sauerkraut and kombucha—they are wonderful sources of gut-friendly bacteria, called probiotics.
  • Consider taking a probiotic supplement.
  • Enjoy foods rich in fermentable fiber—known as prebiotics. These foods act like fertilizer for healthy bacteria and can be even more effective than probiotics at improving gut health. Prebiotic foods include asparagus, Jerusalem artichokes, onions, garlic, leeks, jicama, seeds, unripe/green bananas, plantains, cooked and cooled parboiled rice, cooked and cooled potatoes, and soaked or sprouted legumes that have been cooked and cooled.
  • Drink bone broth! The gelatin, glycine, and glutamine in bone broth all have beneficial effects for the gut.

#2: Keep a food diary

If you suspect a food allergy or intolerance, keeping a food diary can be an extremely helpful way to map your symptoms and pinpoint any potential culprits. To keep a food diary, open up a fresh notebook and record the following information for one full week:

  • All foods and liquids consumed (include type of food and brand name)
  • Amount of food or liquid consumed
  • Time food or liquid is eaten
  • Time symptoms begin (if applicable)
  • Symptoms and remarks (including symptom description, how long it lasted, and any medications) 

Possible symptoms to look out for are hives, itching, rash, trouble swallowing, nausea, vomiting, diarrhea, stomach pain/cramping, stuffy nose, runny nose, itchy throat, coughing, wheezing, trouble breathing, shortness of breath, chest pain/tightness, irritability, fatigue, faintness, dizziness, headache, anxiety, brain fog, lethargy, seizures. 

#3: Get tested

Although food allergy testing can be beneficial, an allergist or immunologist will likely request that you keep a food diary first (assuming the allergy isn’t life-threatening of course!).

If a problem food is suspected, you may be sent for a formal allergy test to confirm and identify any other allergies. This could be a combination of blood tests and “skin scratch” tests.

It’s important to note that food intolerances will not show up on standard allergy tests, but that doesn’t mean your symptoms aren’t real.

Potential food intolerances can be measured using antibody-based tests called IgA and IgG. There is some controversy surrounding these tests, however, food exclusion diets based on these results have been shown to offer relief from conditions like ulcerative colitis, migraines, and skin disorders.

#4: Try an elimination diet

With detailed food diary in hand, the next step is an elimination diet—the gold standard for identifying a potential food allergy or intolerance. It involves removing foods from your diet that you suspect your body can’t tolerate.

Next comes the “oral challenge.” This is where you eat the eliminated food(s) one by one after a period of avoidance to determine your reaction.

Temporary withdrawal symptoms may occur when you stop eating a problem food. If this is the case, you may have to follow an elimination diet for two weeks or so before the symptoms clear up and you’re ready to start testing foods in an oral challenge.

To reduce the guesswork as to which foods are problematic—and to help guide your elimination diet—some practitioners will test for food intolerances first.

Following an elimination diet requires commitment, careful record-keeping, and paying attention to your body. This is why I recommend enlisting the help of a qualified practitioner. They can also help you navigate confusing food labels and offer reasonable substitutions. 


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