Food Intolerances & Sensitivities

The three-way sort: allergy is immune and IgE-mediated — symptoms within minutes to two hours, potentially anaphylaxis, and strictly clinical territory. Intolerance is enzymatic or dose-based — the lactase story. Sensitivity is the umbrella the internet overuses. Getting the category right determines everything downstream, including whether an epinephrine prescription belongs in the conversation.

Lactose, the classic, honestly: reduced lactase in adulthood is the species norm — roughly two-thirds of the world's adults have it; lactase persistence is the mutation, concentrated in dairy-herding lineages. And the reaction is dose-dependent: aged hard cheeses carry near-zero lactose (the sugar ferments out with age), yogurt's cultures pre-digest much of it, and small servings with food often pass unnoticed — the management ladder runs through portion and form long before it reaches enzyme tablets.

FODMAPs and gluten, without the mythology: FODMAPs are fermentable carbohydrates that draw water and ferment into gas in sensitive guts — the mechanism behind much IBS bloating, and the reason the pipeline page's gas story matters here. The low-FODMAP approach has real trial evidence for IBS — as a structured eliminate-then-reintroduce protocol, ideally dietitian-guided and temporary, identifying personal triggers — never as a permanent lifestyle (the restriction cost is real). Gluten has three distinct stories: celiac (autoimmune, testable, and the test must run before the diet — serology stops working once gluten-free), wheat allergy (rare), and non-celiac gluten sensitivity — where the honest twist is that blinded trials often fail to pin symptoms on gluten itself once FODMAPs (the fructans in wheat) are controlled: the fructan, not the protein, may be the culprit.

The testing and the shelf: histamine intolerance — a real concept, genuinely over-diagnosed online. IgG 'food sensitivity panels' — the mail-order industry's flagship: IgG marks exposure, not intolerance; the higher the number, often the more recently eaten — not evidence, and graded accordingly. What actually works: celiac serology before any diet change, hydrogen breath testing for lactose and fructose (clinical), and the structured elimination-reintroduction — the personal gold standard, done with guidance rather than guesswork.

• Three categories, three different stories: allergy (immune), intolerance (dose), sensitivity (contested).
• Lactose intolerance is the species norm — persistence is the mutation.
• Aged cheese, yogurt, and small portions: the lactose ladder before any supplement.
• FODMAPs: eliminate, then reintroduce — a protocol with dietitian guidance, not a lifestyle.
• Test for celiac before going gluten-free — the serology stops working after the diet.
• IgG panels measure exposure, not intolerance — the flagship myth of the mail-order industry.