Are We All Imaginary Patients?

Many people avoid certain foods. Are you really suffering from intolerance or are you hysterical? An attempt at mediation.

Before we listen to our stomachs, let’s start with the figures: 20 to 40 percent of Americans believe they are allergic to food; this is actually diagnosed in only three to four percent of adults. Well, some people may confuse allergies and intolerances – and the latter are actually a bit more common in some cases.

However, the consumption of gluten and lactose-free products has virtually exploded: 54.2 million was spent on gluten-free goods in this country in 2012, a good 14 million more than in 2010, and in the USA 28 percent of adults already eat little or no gluten; but only up to one percent suffer from gluten intolerance (celiac disease). In 2007, 6.5 percent of German households bought lactose-free products, five years later just under 18 percent; in 2012 alone, sales rose by 20 percent; the proportion of the population that cannot digest milk sugar (lactose), on the other hand, has remained constant for centuries.

So are we all hysterical? “All in all, one can say that the subjective assessments that I have intolerances are four times as high as what doctors diagnose,” says nutritional psychologist Christoph Klotter, professor at the University of Applied Sciences in Fulda. When we hear sentences such as “I can’t tolerate XY (anymore)” or “Since I’ve left XY out, I feel much better”, the probability that they have no objective basis is therefore greater than that they are really true. Why is this so? Three answers.

1. There are complaints even without diagnosis

Food can cause many problems: There are allergies, pseudo-allergies, intolerances, autoimmune diseases (see below). The army of potential triggers is even larger: our diet is diverse, new exotic foods are constantly being added, and additives lurk in many industrially processed products.

But a medical test only finds what it is looking for. Some triggers can actually only be identified by lengthy recording of diet and symptoms. Moreover, the symptoms are often diffuse, individually different (skin blemishes, headaches, nausea, fatigue, diarrhea, etc.) or occur with a delay. The diagnosis becomes even more complicated because our current eating habits also have an influence.

Those who already do without gluten may no longer be able to reliably diagnose celiac disease. And those who consume lactose-free products for a long time may even develop an intolerance because the intestinal flora changes. “You should always be careful with the judgment that people imagine intolerance,” says psychologist Klotter. “It is even possible that medical progress will at some point discover other intolerances.”

Research is currently being conducted on FODMAPs, sugar molecules. Obviously, some people with irritable bowel syndrome cannot tolerate these molecules; at least they feel better if they avoid FODMAPs. But there is no test for this yet. And whether there is a so-called gluten sensitivity in addition to the real coeliac condition is currently being discussed in expert circles.

For nutritional therapist Imke Reese, the question of whether there is always a diagnosis for the complaints in black and white is not the most important one. The more important thing is that people feel better. In her Munich practice, she therefore works mainly symptom-oriented. “Often people do not have a disease at all. Their digestion actually works well, or would if they were eating properly,” she says. With diaries Reese often comes typical nourishing errors fast on the trace: Too little fat, too little ballast materials or too much fruit for instance prepare even the most tolerant intestine problems.

However, because many of those affected believe that this is a particularly healthy way of eating, they wrongly attribute their complaints to certain substances in their food. “Self-diagnosis is the attempt to give a name to the existing complaints and to determine a direction in order to be able to do something actively,” explains Reese.

Conclusion: The fact that no diagnosis could be made so far does not mean that there is none. And even without incompatibility, a change in eating habits can be the solution to the problem.

2. Bellyache is abdominal pain

In April 2014, a good 30 high school students were hospitalized in Hamburg with nausea, headaches and dizziness – allegedly older students had mixed alcohol into their drinks during the Abi prank. However, doctors then found nothing at all in the children’s blood, but diagnosed mass hysteria, presumably triggered by the announcement of the school management that alcohol and drugs had been found.

What does that mean? First: The children did not imagine that they were sick, they were sick. Secondly: complaints are contagious. When others feel sick, I become more sensitive, and attention or even fear intensifies my feelings. Such nocebo effects also play a role in eating. Researchers from Italy were able to prove that even dextrose, which test persons thought was milk sugar, can cause flatulence. The symptoms are always real for those affected.

Pain becomes less when we distract ourselves and not by feeling it more and more.

The only thing that is not correct is the diagnosis they give themselves. “The media report so much about complaints, it’s logical that I also feel inside myself at times,” says Reese. Feeling into oneself, attentiveness – that’s what’s called for anyway. Sometimes the opposite is also quite healthy: pain is reduced when we distract ourselves, not by feeling it more and more. The trend towards inwardness is naturally accompanied by the desire to optimize the body. Abdominal pain or flatulence is not something we accept or even indulge in, as in Luther’s time.

Any deviation is registered, pathologized and controlled if possible. That we become softer and softer is therefore only half the truth: softer in our sensitivity, yes, but at the same time harder to tolerate these sensations – that is, against ourselves. And if we then cut something from our diet?

We often feel better because we eat more consciously, healthier and last but not least more moderately. And again, placebo effects support our well-being. In one study, the complaints of people already decreased if they only thought they were eating gluten-free. This gives people the feeling of doing something good for themselves. A life without gluten or lactose is certainly not healthier per se. But since more and more celebrities such as Gwyneth Paltrow or Lady Gaga have been raving about their “life-changing diet”, the expectations for healing have become enormous. If you want to be close to your star, your body is certainly smart enough to deliver the right sensations – “I’ve also been feeling much better since then”.

Conclusion: Nobody imagines complaints. We can only fool ourselves (and others) about their cause. But if someone feels better with it – why not?

The most common nutritional diseases

Allergy

The immune system reacts to an actually harmless allergen such as peanuts – even at the lowest dose and with sometimes severe, possibly even fatal consequences.

Lactose intolerance

Due to a deficiency of the enzyme lactase, milk sugar (lactose) is only partially broken down or not broken down at all, but fermented by bacteria. This leads to abdominal pain, nausea or diarrhoea.

Fructose Malabsorption

Fructose cannot be absorbed from the intestine because it lacks a transport protein. It is then fermented by bacteria; abdominal discomfort develops.

Celiac disease

The immune system reacts to the gluten protein gluten in cereals, the wall of the small intestine becomes inflamed. This mix of allergy and autoimmune processes leads e.g. to diarrhoea. In addition, nutrients are increasingly poorly absorbed due to the increasing destruction of the intestinal epithelium.

Pseudo-Allergy

The symptoms are very similar to those of an allergy, but the immune system is not involved. Triggers are mainly additives and also drugs.

3. I eat, so I am

If you look at the history of mankind as a whole, we live in paradise: We always have enough food in this country. “That’s why, for the first time, we can really pay attention to what exactly we eat,” says Prof. Klotter. “This is when the individual enters the stage.”

We no longer eat to get full – we are anyway – we work on our self-image, we individualize, we stage ourselves. “I’m a vegan, apricots are not good for me, if I eat brown bread after 6 p.m. I can’t sleep – all this is part of presenting my self in public”, says Klotter. Of course, in times of abundance, we define ourselves particularly sharply through renunciation – and as a quasi fateful incompatibility, it carries much more weight than a self-chosen taste preference.

Eating is always about the idea of good and right living.

“Eating morality is the origin of all morals,” says sociologist Eva Barlösius. “Eating is always also about the idea of good and right living.” In this sense, “I don’t eat XY” is never just a personal statement, but always one about those who eat XY. Those who tolerate everything, who thoughtlessly shovel everything into themselves, eating machines. “I myself can’t come up with anything in terms of incompatibility,” says Klotter. “That makes you feel normal in an unusual way. As if one were not only when eating, but altogether completely undifferentiated.

A food intolerance is like a dress that you put on to demonstrate your own sensitivity and distinguish yourself from the insensitive masses. But isn’t it simply narcissistic to be constantly concerned with one’s own eating habits? No, self-centeredness rather stands for a desperate rescue operation. “It is the answer to a confusing world,” says Klotter. “When we stop trying to understand the world, we have to go back to our clearly arranged body. It is the last bastion we hope to control.”

The more difficult it is to differentiate between good and evil, the more comforting it can be to at least clearly separate lactose-containing from lactose-free – provided, of course, that one attaches similar importance to this differentiation. From psychology we know how important the feeling of control is for our well-being. In this respect, people who have found out for themselves what they can and can’t tolerate – regardless of whether this is true in the medical sense – are perhaps even happier in the end than others. And what would be bad about it if they were physically better because it is good to have something under control, regardless of lactose.

Of course, extremes become problematic: when we demand the attention we have for ourselves from others and at the same time become inattentive to others. The cry “You know that I can’t take XY anymore”, which breaks up the common meal, rightly annoys the table neighbors. In addition, the need for control can become a delusion. Those who do not acknowledge that we can never have complete control over our health and our bodies will always see serious illnesses as a personal mistake. But only those who accept them can live well with them. And of course, control can control ourselves. There are people for whom it is a matter of life and death what they eat or not. They have no other choice than to select exactly what comes onto their plate. Of course, in principle, everyone has the right to every personal eating rule. But if we choose to have too much control, we will not necessarily be happier, but above all, we will become unfree.

Conclusion: What we (do not) eat is part of our self-image and our confrontation with the world. However, this does not make our living together any easier. But what’s wrong with a little more tolerance – if not on our own plate, then at least among ourselves?