Doctors and food intolerance

Doctors are generally reluctant to acknowledge side-effects of drugs (1), and even more unlikely to understand the side-effects of food (2,3).

This is largely because they are not trained in nutrition (4) or food intolerance and so do not ‘believe’ that foods can provide side-effects (3) that are as powerful as those from medical drugs.

With increasing studies world-wide showing that ultra-processed foods are bad for our health (5), experts say that doctors need more training in nutrition (6). And to be able to recognise food intolerance (2,3).

Some ideas to manage the discussion

It is up to you to start the discussion with your doctor and you should expect denial. Keep insisting until you are heard
You may need to hunt around to find a doctor who understands food intolerance
The best way to get a doctor to listen to you is to have a report of your food intolerances from a dietitian, as in this story:

“We have been to a dietitian from your list… It was great advice as it really smooths the way when having to deal with doctors and other govt agencies - they are now very accommodating” - from story [1094]
See our blog on Why see a dietitian

Readers report

Here are some edited reports, most from just the last two years. They come from a recent doctor story collection where you can read the full reports (7 pages)

POSITIVE

“A recent doctor’s visit introduced me to your website. It is wonderful. I finally feel that I am not the only one” - Adelie

“My specialist has recommended your website. It’s a great website with lots of helpful information. I was told to stay away from foods that are high and very high in salicylate” – Anita

“My doctor … has been very interested and supportive of all the food intolerance information. He is quite a convert! As well as asthma, I also had very bad nasal polyps” - Krys

“It was only when my fantastic doctor happened to come across another patient who had the same problems as me that he was pointed in the direction of the allergy clinic at Royal Prince Alfred Hospital ... I can honestly say that this diet saved my life” – Emma

“Immunologist who put me on diet has literally saved my life” - Josephine

NEGATIVE

“I have had my son to the doctors in the past (and just been fobbed off)” – Anna from NZ [1094]

“None of my doctors have ever mentioned that salicylates are in foods. After coming across this information I realised that almost every diet change recommended to me by the doctors has caused my salicylate intake to be astronomical. It's no wonder I've been in and out of emergency rooms” – USA [559]

“Their skin specialist denied that eczema has anything to do with allergies or food intolerances…” - Emma [1454]

“I have to ask what is wrong with our Western medical system when my daughter can make it straight from a GP to a Urologist, who is above considering anything non-drug or surgery-related, without anyone first asking basic questions about what she eats, what her sleep patterns are like etc” – Betty

“I wish that every-one in the medical profession would learn more about Intolerances and be more open minded about how foods affect our children” - Sandra

“I'm done with paediatricians who say there is nothing wrong” - Kelly

“His Eustachian tubes are now clear yet the E.N.T doctors just said he was "in the too hard basket". I believe that food intolerance is responsible for most of my son's problems and that if I had known he would not have wasted four years of his life. It makes me so angry the way we mothers are treated by health professionals” – NZ [075]

“After four months the sleep deprivation really hit home and we began doing the rounds of the doctors in an effort to establish the nature of the problem. We had no answers apart from maybe it's colic, watch your diet, cut out brassicas, fruit juice, yellow stoned fruit, onions and garlic. No one mentioned cutting out dairy, tomatoes or tea! ...The paediatrician was most unsympathetic ..” – Simone [007]

“We have been failsafe for over a year. We did doctors first but got nowhere even with sample testing, hydrogen tests, ultrasound tests, etc” – Donna [1612]

“Countless doctors looked at us puzzled” – Danielle [1607]

“In the UK where doctors are very scathing about these problems, particularly the seizures. I have been ridiculed and shouted at by medical staff and had concussion when I was allowed to fall on the floor” – Sarah from UK [1605]

“The doctor was mystified” - Tom [1600]

“I knew it was food related but struggled to get the doctor to even acknowledge this was possible“ – Beth from UK [1595]

“It’s very frustrating, I went to the doctors for a good 4 years and kept being turned away and told it was IBS in the end I thought I was going insane!” – Jan [1556]

References

(1) Physician response to patient reports of adverse drug effects: implications for patient-targeted adverse effect surveillance https://pubmed.ncbi.nlm.nih.gov/17696579/

This study collected reports from 650 patients who had reported classic side-effects from statin-type cholesterol-lowering medicines. The vast majority of conversations were initiated by patients.
Researchers reported:
•    87% of patients spoke to their physician about the possible connection between statin use and their symptom
•    Patients reported that they and not the doctor most commonly initiated the discussion in 98% of cases (on cognition effects), 96% vs 4% (on neuropathy effects), and 86% (on muscle effects)
•    Physicians were reportedly more likely to deny than affirm the possibility of a connection
•    Rejection of a possible connection was reported to occur even for symptoms with strong literature support for a drug connection, and even in patients for whom the symptom met literature-based criteria for drug-adverse effect causes.

(2) [Food allergy--effect of physician attitude on the diagnosis and reported prevalence] [Article in Hebrew] https://pubmed.ncbi.nlm.nih.gov/16281757/

This study assessed the attitude of 186 allergists, pediatric gastroenterologists, chief pediatricians and physicians working in the community to cross-sensitivity to cow's milk and soybean. Sesame allergy was used to assess the physician's familiarity with food allergy.

•    54% of the allergists estimated that less than 5% of children with cow's milk allergy are allergic to soy, significantly lower than pediatric gastroenterologists and community physicians.
•    On the other hand, only 15% of the pediatric gastroenterologists reported that they encountered patients allergic to sesame, significantly less than allergists (65%) and chief pediatricians (44%).
•    Only half (51%) of the allergists encountered patients allergic to both cow's milk and soy, significantly less than pediatric-gastroenterologists (88%) and chief pediatricians (80%).
•    Although the community physicians felt that the incidence of cross-sensitivity to cow's milk and soy was high, 94% of them were familiar with only a few such patients.

“It seems that the physician's opinion is influenced by "general knowledge" more than by his own experience. We suggest emphasizing through education that there are two distinct entities of cow's milk intolerance: IgE-mediated allergy and non-IgE-mediated.”

(Or, in other words, education about food allergy versus food intolerance)

(3) "As a dietitian who uses the RPAH Allergy Unit Elimination Diet in my everyday practice, I can assure you that it does work brilliantly in the majority of cases ...However, it needs to be done properly .... The diet should be supervised by an Accredited Practising Dietitian with experience in food-chemical intolerances and conducted as a test diet, for a limited period of time - usually only 3-4 weeks in duration... the dietitian ensures that nutrients are adequately compensated for. The challenges are then performed in a timely manner and the diet refined to be liberalised as much as possible, while only avoiding the problem foods long term. I have many, many satisfied clients who were fobbed off by other health professionals in the past, because they didn't 'believe' in food-chemical intolerance" - Joy Anderson, Medical Journal of Australia InSight, June 2013 https://insightplus.mja.com.au/2013/22/salicylate-diet-claims-unconvincing/

(4) How much do doctors actually know about nutrition? Michael Greger M.D. FACLM · August 16, 2021 · Volume 54 https://nutritionfacts.org/video/how-much-do-doctors-actually-know-about-nutrition/

“A poor diet now outranks smoking as the leading cause of death … so if diet is humanity’s number one killer then obviously it’s the number one thing taught in medical school, right?... Sadly, medical students around the world are poorly trained in nutrition”

(5) The rise of ultra-processed foods and why they’re really bad for our health, The Conversation, September 14, 2020 https://theconversation.com/the-rise-of-ultra-processed-foods-and-why-theyre-really-bad-for-our-health-140537

(6) Educating Future Physicians in Nutritional Science and Practice: The Time Is Now https://pubmed.ncbi.nlm.nih.gov/30726681/

The need to educate and train future physicians about nutrition and wellness has become increasingly apparent in the past decade. A rising incidence of chronic health conditions with a nutrition background (e.g., obesity, cardiovascular disease, type 2 diabetes) has led to an even greater need for nutrition educational content in medical school curricula so that physicians may counsel patients regarding their lifestyle factors. This review provides an overview of the successful development and integration of a nutrition thread in a 5-year medical school curriculum. Based on a survey conducted in our medical school program, students beginning medical school are lacking formal nutrition education, as only 8% arrived with some form of exposure. Despite this, nearly 85% of these medical students recognized that nutrition education is necessary in their training, and 70% state that the nutrition education they have received has influenced the way they care for patients. Key teaching points Physicians are faced with rising incidence of chronic health conditions that have a nutritional risk factor Physician self-care including optimal nutrition to support resilience is gaining importance. Nutrition education in medical schools is inadequate to address these rising needs. Implementing a comprehensive nutrition curricula that addresses personal wellness strategies, basic science concepts related to nutrition, and diagnosis and management of diseases that can be modified by or are related to nutrition as a topic thread that is woven throughout all years of the curriculum highlights the importance of nutrition in health and disease.

NOTE. This article about nutrition education for medical students was written by staff from the Cleveland Clinic – a non-profit academic medical centre that integrates clinical and hospital care with research, education and health information. Last year it was rated as the number two hospital in the world for specialised care and number one for cardiac surgery https://newsroom.clevelandclinic.org/2022/03/02/cleveland-clinic-ranked-no-2-hospital-in-the-world-by-newsweek-2/

An email received because of this blog:

I can't express how grateful I am to you for the information on fedup.com.au, I have suffered with several intolerances for about 15 years. I've had no luck or help from multiple GPs...

Gut issues are such a common problem now as is arthritis, and, as a sufferer of both, I greatly appreciate your dedication and commitment.

At 71, looking back, I can see that heredity can play a big part in gut issues. My father had them, resulting in having a part of his bowel removed which then resulted in very painful adhesions. He was told by his doctor that he probably had cancer, which turned out to be incorrect! My daughter also suffers from gut problems.

My son constantly wet the bed, soiled his pants and had serious behavioural issues with dramatic and stressful outcomes. The soiling went on until he was well into his teens. Unfortunately, at that time, there was no internet access, and no information or help available from any of the professionals we talked to. We had no idea it could all be caused by the food he was eating. After years of being in and out of several rehab centres and courts, stints in jail and drug use, he died of a drug overdose at 26. It breaks my heart.

A very heartfelt thankyou for everything you do - Lorna